Just prior to the earthquake, I completed a month internship at Chengdu University of Traditional Chinese Medicine’s (TCM) teaching hospital. There I spent time in the departments of oncology, pediatrics, and respiratory, as well as both oncology and acupuncture in-patient wards. This was an invaluable experience, where I was able to see Chinese medicine practiced in the land of it’s genesis. It was truly remarkable to see an entire hospital dedicated to the practices of acupuncture, herbs, tui na massage, and other modalities of Chinese medicine. What follows is an account of my time in the acupuncture clinic, presented in part as an attempt to get our lives back to normal. We have less than a month left here. Our time in China is rapidly coming to an end.
I had the great fortune to observe Dr. Hu Ling Xiang practice acupuncture at the Chengdu Hospital of Traditional Chinese Medicine (TCM) for several days in April and May. Acupuncture is practiced differently in China than in the US, and I got a close up look at how it’s done.
Dr. Hu in her clinic in Chengdu, China.
In the US, acupuncture is generally practiced in private. One pays a handsome fee for an hour’s time with a Chinese medicine practitioner. After an initial discussion and examination of your tongue and pulse, you get on a table, and the acupuncturist puts in needles, then leaves you alone in a room for twenty to forty minutes. Usually the session costs between $60 and over $100, a cost which often makes frequent treatments prohibitive. Once a week is considered “frequent.” The cost also means that many people simply cannot afford acupuncture, making acupuncture only available to the relatively well-off financially. Acupuncture is nothing like this in China.
In China, acupuncture is practiced more in line with what is called in the US the “Community Acupuncture model.” Community Acupuncture seeks to make acupuncture available to everyone by making it affordable and less of an isolating experience. Instead of being the only person in a room, people who go to a Community Acupuncture practice are treated in a group, sitting in comfortable chairs. Instead of only treating one or two people per hour, this model allows the acupuncturist to treat from four to six people per hour. This in turn allows for the price to come down to $15 – 40 per treatment. And having the price on this kind of sliding scale also allows people to come back more frequently for treatment, which is key to the success of acupuncture.
This is how acupuncture is practiced in China. At the hospital, people pay an initial consultation fee, a registration fee, and a treatment fee. These are all fairly affordable. The registration fee is only 5 Yuan, less than one dollar. The initial consultation fee is usually 7 Yuan, or about a dollar. For the services of senior doctors, such as Dr. Hu, one can pay up to 50 Yuan, or $7.15. Dr. Hu charges 30 Yuan, or $4.25. The cost of each treatment is 36 Yuan, or $5.15.
The initial consultation fee is for time with a doctor to describe your condition, and for them to ask you questions, and take your pulse and look at your tongue. Based on the information they gather during the consultation, they will make a “differentiation” or TCM diagnosis, and chart out a treatment strategy. They will then recommend both the number and the frequency of treatments. Usually doctors will recommend an initial series of five treatments. The severity of the condition will determine how often someone should come in. For severe cases, such as the woman with Parkinson’s disease we saw in the clinic, treatment every day is recommended. For less severe conditions, usually every other day, until there is improvement, then once or twice a week. One pays the initial consultation fee only before the first treatment, then again after the first course of treatment is complete, to check on one’s progress.
After an initial consultation, people come in and sit in wicker chairs, or lay on tables. If all the wicker chairs are filled, people grab a stool to sit on, have their needles inserted, then go sit in the hall. The treatment room is filled with patients, doctors, plus sometimes members of the patient’s family and, since this is a teaching hospital, students and interns. In the mornings, it’s a frenetic mess of a place, like a New York subway, people squeezed in the corners, standing in the way, people pushed aside by interns eager to treat their next patient, every chair filled, people milling about waiting their turn. Like I said, it’s nothing like the way acupuncture is generally practiced in the States.
Dr. Hu is a TCM practitioner. While some who utilize this theoretical framework can be almost dogmatic, she thinks and acts outside the box. The two most obvious innovative tools she uses are her reliance on what are called Ghost Points, and her use of Hua Tuo’s Jia Ji points, both of which I will describe below.
One of the first things one notices about Chinese acupuncture is the use of 3 inch, heavy gauge needles. In the US, thinner needles are favored, and practitioners often use “guide tubes” when inserting needles. Dr. Hu keeps a bunch of needles tucked between her pinky and ring finger on her left hand. She “free hands” the needles in, instead of using a guide tube, seemingly effortlessly. Many of the patients know what points they are getting, and can guide students in their own treatment.
Dr. Hu places a strong consideration upon the emotional and intellectual aspect of pain and other physical discomfort. For her, the person’s mind is as important to address in treatment as their physical state. She relies on what are called Ghost Points, which she uses to calm the mind, so that the person’s worry about their condition doesn’t come in the way of their recovery. Ghost Points come from the more esoteric aspect of Chinese medicine, at a time when emotional disturbances and mental disorders were thought to be caused by “ghosts.” Today, these points are used to treat conditions like anxiety, fear, depression, or mania which may accompany physical pain. They can also be used for more extreme mental states such as schizophrenia and psychosis.
Dr. Hu also uses Hua Tuo’s Jia Ji points in place of the back Shu points. The back Shu points are used to access the Qi of the internal organs. Based in the belief that sufferers of chronic conditions develop both Blood Stagnation and Kidney Deficiency, Dr. Hu believes that using Hua Tuo’s Jia Ji at the same level as the Shu points is both more effective in tonifying specific organs and safer, due to the possibility of pneumothorax associated with the back Shu points. To maintain one’s optimum health, one’s Qi and Blood should flow freely. Stagnation of either can result in pain. The bodies’ Essence, or the essential energy that we are born with, is said to be stored in the Kidneys. Any trauma, or chronic health condition, takes a toll on this energy. Hence her reliance on tonifying the Kidneys and moving Blood. For all chronic cases, she utilizes the Jia Ji points for Heart, Diaphragm, Liver, and Kidney.
This is consistent with Hua Tuo’s original use of these points, which he preferred to the back Shu points. Dr. Hu has the patient turn around, and pull up their shirt. She then does quick in-and-out stimulation of the Jia Ji points. Then the patient leans back in the wicker chair and gets the rest of their points.
Dr. Hu needling the Jia Ji points along the spine. Notice the bunch of needles in her left hand.
Like many acupuncture clinics in the US, the primary type of cases seen in this walk-in clinic is pain, or what’s called “Bi Syndrome” in TCM parlance. Bi translates as blockage. Qi and Blood blockage cause pain and discomfort. There are several types of Bi Syndrome, including those caused by such things as Wind, Cold, Damp and Heat. Like Portland, Chengdu is very damp and cold in the winter, so one sees a lot of Damp-Cold Bi here. No matter what the differentiation, Dr. Hu has a set of principles for addressing Bi Syndrome.
The first is always use Ah Shi points, or places on the body that are tender or painful to the touch. One should find as many Ah Shi points as possible in the affected area, and needle them. One can use three needles in a triangle, four in a cross, or five or more in a circle. She recommends locating the border of the painful area, and surrounding it with needles pointed towards the center.
She’s also big on moxa. Moxa is the herb mugwort, processed and used in many different forms. It can look like a cigar, and waved like a wand to heat a local area, or be loose, and tightly compacted with one’s fingers and put on the ends of needles, then lit. Dr. Hu uses moxa, whether the differentiation is Cold Bi or Heat Bi. If it’s Cold Bi, moxa will warm the area, and if it’s Heat Bi, the principle of Heat against Heat is employed, using heat to drive the Heat away.
Dr. Hu spends a good deal of time reading the classic texts of Chinese medicine. One she is particularly found of is the Nan Jing, or The Classic of Difficulties. Based in this text, she developed her treatment of Bi Syndrome.
Dr. Hu is also an advocate of assisting the “Po,” or the spirit of the Lung. She believes that normalizing the Lung function and waking the Lung “spirit” is essential to healing. She believes that if the Po is weak, the patient will not have much tolerance of pain.
Finally, one should then employ various points for both the location of the pain, and based upon one’s differentiation.
This patient suffers from “Tennis Elbow.”
This patient has facial paralysis. In China, they are not afraid of using many needles.
I learned some other tricks in the clinic. For instance, for pain all over the body, one can use sliding cupping all over the back. Before the cups are applied, a liniment to ease the movement of the cups is spread over the back. Cups are applied to the back, with a flame creating the vacuum needed to attach the cup. The cup then sucks the flesh of the back upward into the cup. This helps the muscles “breath” better, drawing stagnant blood up to the surface of the skin where it can be cleared by the bodies’ circulation. This also stimulates all the back Shu points, is believed to increase the Yang energy of the body, and opens the body to release pathogens. One should work the back until it is red or purple. It’s important then to turn the patient over on their back, and to do some tonification points. Another form of cupping used is “flash cupping,” in which the cup is put on the skin and taken off very quickly, which is said to increase Yang energy, and move Qi and Blood.
A patient is cupped for back pain
This clinic uses gua sha pretty regularly, even doing the Conception Vessel, beginning at the mouth, and down the throat and chest. In a way similiar to cupping, gua sha scraps the skin, bringing stagnant blood to the surface, providing freer circulation. It looks bad, but feels very good. They also employ a mystery paste, said to move Blood and Qi, applied to problem areas. And they use electro-stim machines fairly regularly, to stimulate needles.
Gua Sha, or scraping, is used here for back pain.
The “mystery paste,” said to move Qi and Blood, as applied on a patient’s face. Fascial paralysis is very common in Sichuan province.
My time in Dr. Hu’s clinic inspired me both in terms of providing ideas about treating various conditions, and in terms of how a community-based clinic can be set up. Acupuncture doesn’t have to be prohibitively expensive and done in private. It can serve people currently underserved by the existing health care system in the US. By making it affordable, people can get the type of regular treatment that will really improve their health.
Seeing acupuncture practiced here really demystifies it. It seems very practical, not at all esoteric. People readily stick out their tongues, offer their wrists for pulse diagnosis, and answer questions about the quality of their stool and their sleep. They approach having needles inserted, or their backs cupped or scrapped, in a matter-of-fact fashion which points to the medicine’s directness, and simplicity. It is a practice for relieving suffering, for making people better. And it works.
Setting up a clinic like this is one of my goals. I envision a clinic which would serve the local community, a place people could come to in order to resolve any physical or emotional issues they confront. It will be a welcoming place which plays a constructive role in the life of the community. I will always think about Dr. Hu’s clinic as I make this a reality.
If you’re interested in a more technical version of this report, one which includes specific points used and protocols for various conditions, see my Chinese medicine website blog here.