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  Library - Magazine Archive

IONS Review - Return to Issue 14 - Table of Contents


NOETIC SCIENCES REVIEW # 14, PAGE 04
SPRING 1990


Art by Calvin Yau Ching
Energy Medicine
In China:

Defining a Research Strategy Which Embraces the Criticism of Skeptical Colleagues

From a talk by David Eisenberg, MD

I wish to being with two quotations which highlight the challenge to our scientific understanding of energy medicine.

Vine Deloria, writing about the evolution of medical systems prior to the one currently in use, made the following observation:

For primitive people the presence of energy and power is the starting point of their analysis and understanding of the natural world…primitive people felt power but did not measure it. Today we measure power but are not able to feel it.

René Dubos, commenting on modern scientific principles, has reminded us that:

Sometimes the more measurable drives out the most important.

Researchers of so-called energy medicine are a curious lot. We unearth ancient practices, dust them off, clean them with modern solvents and study them under the lens of high technology. All the while, we seek to distill simple truths about health and illness.

Traditional Chinese Medicine

China is a nation of 1.1 billion people where more than 800 million people reside in rural areas. These individuals lead a lifestyle not altogether different from the lifestyles of their parent, grandparents and distant ancestors.

It is said of rural China that the three greatest changes in the past century are the introduction of the bicycle, of the thermo bottle and, most recently, the absence of war for more than a quarter century. Chinese customs have changed relatively little. Children, in the eyes of the Chinese people, remain the most precious gift of nature and the source of hope for future generations. But a Chinese child growing up in the latter portion of the twentieth century will surely face tumultuous change. By law, a Chinese family can have only one child. As such, an entire generation of Chinese children will grow up without an understanding of what it means to have brothers and sisters. Moreover, Chinese children will witness a rapidly changing economy and a volatile political atmosphere—one which is struggling to embrace democracy and Western attitudes without destroying its own cultural heritage.

Furthermore, Chinese children growing up in the 1990s will live in a country where there are two distinct systems of medical care. One system, traditional Chinese medicine, is likely favored by the children's grandparents and rural neighbors. The other system, which we refer to as "modern Western medicine", is likely preferred by the parents, educated relatives and urban neighbors.

Traditional Chinese medicine evolved over two thousand years under the influence of Buddhist and Taoist priests. This medical system emerged in isolation from Western sciences as we know it. Not until the middle of the nineteenth century were principles of the scientific method introduced to China. This occurred as a result of education offered by medical missionaries from Europe and the United States.

By the turn of the century American and European missionaries had established medical clinics, hospitals, and several medical schools on the Chinese mainland. Prominent professors fro universities such as Harvard, Yale, and Johns Hopkins lectured at the newly created Chinese medical schools.

Western medicine became extremely popular with China's intellectuals and with it governmental leaders. In an effort to promote Western medicine the Nationalist Government in the 1920s went so far as to outlaw traditional Chinese medicine on the grounds that it was "backwards and superstitious". This effort failed, as the Chinese people perceived Western medicine to be alien, crude, and highly unnatural.

In 1950, following the establishment of the People's Republic of China, Chairman Mao Tse-tung was faced with a political dilemma: There were approximately 500 million people in China but only 38,000 Western-style medical doctors. At the same time, however, there were approximately 500,000 traditionally trained Chinese doctors. Understandable, Chairman Mao launched a political campaign to "unite medical workers young and old of the traditional and Western schools to organize a solid front". For the past four decades this call for unity and integration has persisted in the People's Republic of China.

However, if one reviews statistics from the Chinese Ministry of Health regarding medical manpower throughout the People's Republic of China today, it is clear that over the past three decades the pendulum has shifted from traditional medicine to modern Western medicine. Today Western-style physicians outnumber traditionally trained medical doctors six to one and Western-style hospital beds outnumber those in traditional Chinese hospitals by thirteen to one. This trend toward a dominance of modern Western medicine will continue for the foreseeable future.

And Its Introduction to the West

What about the introduction of traditional Chinese medicine to the West? In the United States the turning point, I believe, was a single newspaper article written by a prominent journalist from The New York Times, James Reston.

In 1971, while accompanying the Nixon-Kissinger entourage, James Reston wrote an article entitled "Now Let Me Tell You About My Appendectomy in Peking". Reston developed acute appendicitis while visiting Bejing and was operated on using Western anesthesia. The surgery was uneventful; however, he suffered profound postoperative pain in the area of his incision. The Chinese medical authorities summoned two prominent acupuncturists to treat these symptoms. Their treatment consisted of inserting several needles. So prompt and complete was Reston's pain relief, that he could barely contain himself from describing this curious technique in detail. This description introduced the West to a therapy which the Chinese referred to as "acupuncture anesthesia".

James Reston's article triggered an enormous surge of interest in this therapy. Medical teams composed of experts traveled to China to witness surgical procedures involving it. Many of these experts returned to the United States utterly convinced that acupuncture anesthesia was a real phenomenon, not merely hypnosis or sham.

I was a college freshman at that time and elected to do an independent study project regarding acupuncture anesthesia. Little did I know that none of the 100 libraries at Harvard University contained a single page describing it.

Acupuncture had been used to treat common illnesses for more than 2,000 years; however, its application as a surgical anesthetic was new. This had to do with the fact that there was no major surgery in traditional Chinese medicine. Major surgery was considered to be a mutilation of the body and the body was considered to be the ultimate gift of one's parents. Filial piety dictated that one never deface the ultimate gift of one's ancestors. Therefore, there was no major surgery in China—only the sewing up of superficial wounds and stabilization of bone fractures.

Acupuncture was not applied to the surgical amphitheater until the late 1950s, as a direct consequence of Chairman Mao's political directive that physicians from Chinese and Western backgrounds work together to "form a united front".

In 1972, when I became interested in acupuncture, there were no English translations of Chinese experimental texts dealing with acupuncture as an anesthetic. Instead, I stumbled on English translations of famous reference texts of traditional Chinese medicine. Chief among them was a book entitled The Yellow Emperor's Canon of Internal Medicine (see quote, right). It is still used today as the primary reference for traditional Chinese medicine.

This ancient text helped me understand the basic theoretical differences which distinguished Chinese (that is, Oriental) medical systems from those used today in the West. Specifically, traditional Chinese medicine emphasized prevention including diet, exercise, thoughts, and emotions, plays a critical role in the natural course of illness and one's ability to maintain health.

Without prospective randomized trials producing convincing data, so-called energy medicine will not be accepted by mainstream health-care providers.

I was intrigued by the basic principles of Chinese medicine and set out to learn the Chinese language in the hope that some day I could study both traditional Chinese and modern Western medicine.

In 1979, when I was a fourth-year medical student at Harvard Medical School, the United States normalized relations with the People's Republic of China. The National Academy of Sciences selected me to serve as the first US medical exchange student to China. In 1979 and 1980, I studied Chinese medicine at the Beijing College of Traditional Chinese Medicine.

I was not prepared for the education I received in Beijing. Without realizing it at the time, I was receiving my initial formal education in "energy medicine".

I was fascinated by the principal methods of physical diagnosis: tongue and pulse examination. It was hard to imagine that each radial artery could be successfully palpated in six separate locations (three superficial and three deep) and that a masterful clinician could differentiate among 40 different pulse variations at each of the twelve pulse points. More spectacular still was the claim that these subtle pulse variations enabled the clinician to know with accuracy the etiology and extent of the patient's pathology within specific internal organs. Such correlations were unknown to me.

More peculiar still was the Chinese diagnostic approach using the tongue. Students of traditional Chinese medicine were required to master several hundred tongue variations. The size, color, coating, tooth indentation, etc., of each tongue type was said to enable the clinician to make a specific diagnosis in terms of location and etiology of pathology. Again this claim seemed utterly fantastic and new to me.

Not only were the diagnostic approaches to the physical examination alien, so were the specific therapeutic interventions within traditional Chinese medical hospitals. Each, I came to learn, was based on an "energy" system.

Treatment

Acupuncture
For example, acupuncture, known in the West primarily in regard to surgical analgesia, was used daily in the treatment of almost every medical, surgical and psychiatric illness known. Its application as a means of "restoring energy balance" was yet another new observation for me. Clinicians spoke of "putting energy through the needles" and "taking energy out of the body" in a language which was alien to me.

…Acupressure Massage
Acupressure massage, based on a system of points and meridians identical to acupuncture, was yet another unexplored modality. Again, claims of energy transfer were used by my mentors in describing what they were doing in diagnosing and treating patients on the massage table. I was impressed clinically by the extent to which patients with acute musculoskeletal pain and/or pain in association with chronic neurologic or musculoskeletal problems found relief from massage therapy. More importantly, in many instances patients' relief was not short-lived but, rather, lasted for days, weeks or months in a fashion which I could not explain. These were among my most humbling observations.

…Herbal Medicine
The principal mode of Chinese intervention is not acupuncture or acupressure but herbal medicine. Over the past two millennia the Chinese have developed a vast pharmacopoeia of plant, animal and mineral substances based on empirical observation and clinical experience.

Herbal therapy is unquestionably the most respected and difficult of all Chinese interventions because it requires the study of hundreds of herbal preparations used in complicated combinations specifically for the purpose of rebalancing bodily excess, deficiency or stagnation. Without a mastery of classical Chinese, pulse and tongue diagnosis and insight into Chinese pathophysiology, herbal therapy is a foreboding if not impossible discipline.

…and "Energy": Qi Gong
The other Chinese medical therapy which is most closely related to the notion of Western "energy healing" is that of "Qi Gong" (pronounced "che gong").

Qi Gong is a martial art, arguably the oldest and most important martial art, from which other forms of martial arts have evolved. The physical movements of Qui Gong, which are circular, symmetrical, and slow, are similar to those movements used in other martial arts (such as Tai Chi Chuan and Jung Fu). However, in addition to the physical movements, the Qi Gong practitioner is instructed in the art of centering, or achieving a particular state of physical balance, and, simultaneously, to meditate.

The practice of Qi Gong involves some of the key elements found in Western relaxation training. These include paying attention to one's breathing, establishing a passive disregard toward one's thoughts, and—unique to Qi Gong—instructions in techniques to sense the source of one's Qi (vital energy) at a point below the navel and to learn to move it through one's body. I will return to this unusual aspect of Qi Gong.

It is said that anyone can learn Qi Gong exercises and that it takes approximately three to six months before one can "feel one's Qi" (in the form of heat or fullness) and begin to move it at will.

The practice of Qi Gong, when analyzed from a Western perspective, may be thought of as a combination of behavioral techniques. These are typically performed for 30 to 60 minutes every day of the year. The behavioral components of Qi Gong include the elicitation of the relaxation response and/or other aspects of relaxation training, aerobic exercise , progressive muscular relaxation guided imagery, and elements of the placebo effect. In China, where an estimated 50 million persons practice Qi Gong every day, there is an unprecedented opportunity to investigate the impact of behavioral (that is, non-pharmacologic, cognitive) therapies as they relate to a multitude of illnesses.

The Concept of Qi

There is a single fundamental concept of traditional Chinese medicine which helps clarify the seemingly disparate diagnostic and therapeutic techniques I have summarized. This concept is called "Qi" (vital energy).

"Qi" is said to be that which differentiates animate from inanimate. The body is viewed as a complicated series of conduits through which Qi flows. These conduits are the acupuncture meridians referred to in Chinese diagrams depicting human anatomy. Pathogenesis relates to the excess of deficiency inextricably linked to the force of Yin ("female", "cold", "hollow", etc.) and its opposing force, Yang ("male", "hot", "solid", etc.)

The Chinese clinician's task is to identify where the Qi exists in excess or is deficient. This is done chiefly by means of taking a history, observing and using pulse and tongue diagnosis. The diagnostic label used by the Chinese clinician refers to the specific imbalance which has been noted on physical examination. Each therapy, whether it includes needles, herbs, changes in diet or meditation, is aimed at reestablishing the balance of Qi.

There is one more piece of traditional Chinese terminology which is worth mentioning. "Internal Qi Gong" or "Soft Qi Gong" refers to an individual's ability to sense and move his/her own Qi within his/her own body. "External Qi Gong" or "Hard Qi Gong" refers to the (alleged) ability of some Qi Gong practitioners to emit their Qi externally so as to influence other animate or inanimate structures.

The notion of emitting energy from the human body is yet another example of how traditional Chinese medical thought diverges radically from that of conventional Western medicine. Traditional Chinese medicine asserts that Qi Gong masters can emit Qi at will and use this energy a s treatment for common illness.

The notion of "Qi" is not unique to China. It is found within the medical systems of Tibet, India, ancient Greece, branches of the Catholic Church, and also has similarities to more recent theories such as that of "animal magnetism" proposed by Mesmer in the eighteenth century.

In the last 1970s and early 1980s the masters of Qi Gong reemerged and began to perform publicly throughout China. They had all "gone underground" during the 1960s and '70s as a result of the cultural revolution's ban on Qi Gong (which was labeled "superstition" by China's political authorities). These individuals claimed to have practice Qi Gong from early childhood and proudly displayed their seemingly supernatural skills to audiences as large as 50,000 persons. Qi Gong masters split stones with their hands and their foreheads, had trucks drive over them, had massive stone slabs lowered on their bodies by cranes, claimed to be able to see within human bodies and to move inanimate objects at will. The claims seemed carnival-like and appeared to be well-rehearsed circus acts.

Researching Qi Gong

My personal interest in Qi Gong was sparked as a result of a television broadcast in 1980 which suggested that scientific laboratories in Beijing and Shanghai were applying rigorous methods of investigation to the physiologic changes produced by Qi Gong masters. First among these observations were reports of thermal change in surface skin measurements of Qi Gong masters who were "emitting Qi". Thermally sensitive films suggested that when Qi Gong masters emitted energy, the energy tracked down lines in the forearms and legs which were similar to classical acupuncture meridians.

A second series of publications in the area of microbiology were more fantastic still. Professor Feng Li Da of Beijing published as article pertaining to the predictable change of bacterial cell growth in response to external Qi emission by Qi Gong masters. Her paper reported on the ability of several Qi Gong masters to increase or decrease bacterial cell growth in a variety of common bacteria. Dr. Feng claimed to have replicated these experiments on numerous occasions in multiple laboratory settings and seemed confident of her results.

A more recent series of assertions has to do with the claim that certain Qi Gong masters can modulate AC electrical current from any common wall socket and act as a "human rheostat".

After attending a conference in Beijing in October 1988 I was asked by a Qi Gong master if he could demonstrate his skill to me on a visit to my hotel room. He came equipped with an electrical volt meter and a simple wiring device. The device was no more that a plug attached to two wires with live ends. He put the plug in the wall and demonstrated its current by lighting lightbulbs and then tested the current on his hand-carried volt meter. He then licked his thumb and forefinger of both hands and grasped the two live wires. I was horrified and worried he would quickly be electrocuted before me. He was not. Moreover, he convinced me that he could light a lightbulb by touching it with other fingers from both hands. More curious still was his ability to regulate voltage across his two hands, at will, simply by touching the volt meter with the ground in one hand, the meter device in the other. On several attempts he regulated the voltage from 0 to 220 volts, or held the voltage constant, at will, upon my request.

Because I have grown increasingly skeptical of such provocative claims, I asked him how I could be certain he was in fact conducting electricity and not simply fooling me by means of some extraordinary high technology tick. He offered to touch me with his hand while he was connected to the wall socket. I declined, but a colleague with me at the time volunteered. When touched on the shoulder by the Qi Gong master, my colleague's trapezius and biceps muscles went into spasm. Moreover, the Qi Gong master could control the electrical current so as to induce the spasm or not. I allowed the Qi Gong master to touch me a for a split second, long enough to feel the live current emanating from his forefinger. He was "live" all right.

In a final demonstration the Qi Gong master took two metal skewers along with a one-pound pork steak which he ad brought with him. He put the two skewers through the steak then grabbed the skewers, one in the left hand and one in the right so as to complete an electrical circuit. Having grasped the wires along with the two skewers the circuit was engaged and the pork chop began to smoke and flame. Within minutes there was a medium-well-done pork chop which my Qi Gong friend sliced and offered to serve! I was astounded by this demonstration and have no explanation for why the Qi Gong master did not injure his skin, or cause a serious heart irregularity, seizure or other damage to his own person.

Such feats are no more than a tantalizing introduction to the many provocative clinical applications of so-called External Qi therapy. For example, Lin Ho Sheng, a Qi Gong master in Shanghai, claims to have emitted Qi directly to the acupuncture points used for acupuncture anesthesia. As reported, this type of Qi Gong anesthesia was successfully used in several dozen operations involving the thyroid gland or abdomen. There is no explanation for this kind of claim. Hypnosis has been flatly denied by the Chinese. I am unaware of any replication of this kind of analgesic technique outside of Shanghai.

Qi Gong masters throughout traditional Chinese medical colleges in the People's Republic of China are using External Qi Gong as a treatment for a wide variety of illnesses. They typically treated patients with chronic neurologic and musculoskeletal disease, including multiple sclerosis.

More spectacular still is the observation that large numbers of patients said to have biopsy-proven, non-malignant cancer are being treated with a combination of Internal and External Qi Gong therapy. Hundreds of purported cancer patients meet at dawn each morning for the purpose of practicing Internal Qi Gong and receiving External Qi Gong therapy from a Qi Gong master. Moreover, the Chinese lay press frequently displays headlines such as: "Qi Gong Defeats Breast Cancer". These articles tend to summarize anecdotal case histories and are rarely if ever substantiated in medical journals.

I wish to point out that recent estimates suggest that 50-60 million Chinese practice Qi Gong at dawn each day for the purpose of disease prevention or in an attempt to alter the natural course of serious or lethal illness.

A Proposed Research Strategy

I would like to offer a strategy for experimental validation of assertions regarding Chinese energy medicine (see box on page 8).

  • My opinion is that we should emphasize basic science experiments before attempting to design and implement clinical trials involving human subjects. My rationale for this is based, in part, on the fact that clinical subjects committees in hospital and academic institutions are unlikely to approve human subjects experiments if they have insufficient basic science data to support their objectives.
  • A specific list of basic science experiments pertaining to energy medicine should include demonstrations of the effects of Qi on a variety of electromagnetic fields, bacterial growth patterns, cell and tissue culture models, and plant and animal physiology. Without measurable, predictable and reproducible evidence in these areas, clinical research will be difficult if not impossible to promote.
  • With regard to clinical investigations, the first category is that of diagnosis. An effort should be made to assess, in a critical fashion, the diagnostic acumen of "gifted healers". They should be tested in comparison to the diagnostic acumen of modern technology. Moreover, there should be an attempt to describe inter-rater reliability as well as test-retest reliability among so-called "Energy Diagnosticians".
  • The same general philosophy should ideally be applied to devices and machines which claim to be based on "subtle energy" mechanisms. These should all be subject to controlled study in a rigorous fashion.
  • A separate set of experiments should ideally assess the ability of healers and/or energy devices to induce acute physiologic change in human subjects. For instance, can healers or "energy devices" predictably alter organ function (for example, renal flow or cardiac output) in a fashion which is safe and reliable?

Once demonstrations of acute physiologic change are completed, experiments should be designed to document sustained physiologic change. Claims of altering the natural course of illness will likely only be accepted if and when evidence of sustained physiologic change can be supplied.

  • If clinical therapeutic trails are to be implemented, they will need to meet rigorous clinical epidemiologic criteria in order to demonstrate efficacy and effectiveness. Ideally, such studies should avoid anecdotes and case studies in favor of randomized controlled trials. Designing such trials will be challenging in that they will need to include non-biased patient populations, controls for confounding variables (such as co-intervention, contamination, experimental bias, etc.). The confounder which is most apt to cause methodological difficulty is that of expectancy of relief (for example, placebo effect). Without careful assessment of expectancy factors prior to, during and post intervention, these studies will likely be subject to savage criticism. Statistical methods will need to include meticulous sample-size calculations and attention to both statistical and clinical significance.
  • If and when clinical trials involving therapeutic modalities such as acupuncture, herbal medicine, energy emission devices and/or Qi Gong are implemented, these trials will likely need to involve multiple centers, hundreds of patients followed over months or years and strict outcome parameters which include objective variables such as health costs, days or work lost and overall medical expense. Such studies may require the professional involvement of dozens of skilled researchers and will likely cost hundreds of thousands or millions of dollars to complete. Without prospective randomized trials producing convincing clinical data collected under rigorously controlled conditions, so-called energy medicine will not likely be accepted or promoted by mainstream health care providers and third-party insurers.

Utilizing Constructive Criticism

I have a number of suggestions whereby energy medicine researchers can work together to build credibility by inviting constructive criticism from qualified skeptical colleagues.

The first priority might be to create professional forums wherein debate pertaining to energy medicine basic science and clinical investigations can take place. Such debates may take the form of prioritizing research projects the utilization of financial resources, popularization of ongoing research and a more meticulous review of work in progress.

We should consider identifying and electing appropriate experts to serve as mentors and scientific advisers with regard to energy medicine research. Such individuals might offer constructive criticism to protocols prior to their implementation. Once successfully implemented, this mentor (or scientific advisory) group could assist in refining data analyses and perhaps attempt to implement a replication of successful experiments in the laboratories of qualified skeptical colleagues.

Ideally, if experiments can be critiqued and replicated in the laboratories if critical colleagues, they would stand a far greater chance of being accepted in peer-reviewed journals. Moreover, having engaged qualified skeptical scientists prior to publication, professional criticism post-publication is apt to be predictable and more easily handled. This group might also consider a formal pledge to avoid public disclosure of critical experiments and/or manuscripts prior to acceptance for publication in peer-reviewed journals.

Last, scientists investigating energy medicine-related phenomena should be encouraged to share and publish experiments which have resulted in negative findings as well as those with positive results. Only in this way will the field gain credibility and will researchers be properly informed so as to avoid nonproductive methods of inquiry.

I conclude my remarks with a Chinese proverb: "Real gold does not fear the heat of even the hottest fire." Qi and Qi-related phenomena, if real, are life precious gold. Undoubtedly, once subjected to the heat of criticism, they will be reshaped, recast, but not destroyed. This process of enrichment will enable investigators to demonstrate more clearly the value of "energy"-related biological phenomena.

"Real gold does not fear the hate of even the hottest fire." - Chinese proverb

A summary of the major assertions regarding Chinese Energy medicine (Qi Gong"):

  • "Qi" (vital energy) exists as a physical entity. The Chinese claim the Qi can be measured, controlled and has biological and clinical significance.
  • "Qi meridians" ("energy fields") exist as physical entities. The Chinese claim that meridians are measurable, and necessary for pulse, tongue and energy diagnosis. Furthermore, Chinese theory suggests that meridians can be predictably influenced by acupuncture stimulation, herbal therapies, massage, Qi Gong or other cognitive interventions.
  • Tongue, pulse and energy diagnoses are reliable and may help to elucidate important physiologic relationships. The Chinese claim that subtle variations noted on the radial artery, the tongue and along acupuncture meridians can elucidate the location and severity of internal organ pathology.
  • Internal and/or external manipulation of "Qi" can alter the natural course of illness. The Chinese specifically assert that Qi Gong therapy can alter illness patterns in malignant cancers, chronic diseases (for example, renal failure, chronic obstructive pulmonary disease, arthritis, etc.), psychiatric disorders (such as anxiety, depression and schizophrenia) and immunodeficiency (for example, AIDS).
  • Paranormal (that is, psychic) abilities are "Qi related" phenomena. There is a long-held Chinese claim that individuals who practice and become masterful at manipulating internal or external Qi are capable of unique paranormal skill.

"To administer medicine to diseases which have already developed and thereby suppress bodily chaos which has already occurred is comparable to the behavior of those who would begin to dig a well after they have grown thirsty, or those who would begin to cast weapons after they have engaged in battle. Would these actions not be too late?

"…I have heard that in early times the people lived to be over 100 years old. But these days people reach only half that age and must curtail their activities. Does the world change from generation to generation or does man become negligent of the laws of nature?

"…Today people do not know how to find contentment within. They are not skilled in the control of their spirits. For these reasons they reach only half of their 100 years and then they degenerate."

The Yellow Emperor's Canon of Internal Medicine, c. 400 BCE


Presented at The John E. Fetzer Foundation Conference: "Energy Fields, Meridians, Chi and Device Technology" May 11-14, 1989

David Eisenberg, MD, is Instructor of Medicine, Harvard Medical School, Associate in Medicine, Beth Israel Hospital, Boston, and is author of Encounters With Qi: Exploring Chinese Medicine (see page 45 for ordering information). Dr. Eisenberg was one of the first American medical scholars to be invited by the People's Republic of China to study medicine in that country.


 

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