May 2008


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
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.

The Room
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.
Cooking

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.

Needling the Back
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.

Tenis Elbow
This patient suffers from “Tennis Elbow.”

Fascial Paralysis
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.

Cupping II
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
Gua Sha, or scraping, is used here for back pain.
Mystery Paste
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.

Dr. Hu II

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.

It’s been over two weeks since what is now classified as an 8.0 earthquake struck 55 miles north of here. Every day we still experience aftershocks, although the number per day is slowly decreasing. In the last two weeks, there have been over 7,000 of them. Of those, 182 have been a 4.0 or more in magnitude. Five have been of a magnitude of 6.0 or greater.

The death toll is over 68,000, with 21,000 still missing and over 5 million homeless. The threat of dams collapsing, and lakes and rivers overflowing is quite high. Because of the debris from the earthquake, rivers are backing up, flooding villages, and threatening to spill out and cause further devastation. With the rainy season on the horizon, this is the new danger.

Over 10,000 students have been killed, with the vast majority being from poor areas. In the same towns, students who attended more wealthy schools survived because those schools did not collapse. Class politics is playing itself out here, as parents from poorer areas are asking why their schools were so shoddy that they collapsed, while those from more wealthy schools just down the street survived. After days of protests, a group of parents planned a march to Chengdu to demand answers. At first, a local Communist Party official pled with them, from his knees no less, not to march to the capital. They also offered the parents $4,500 per child if they would just keep quiet. Finally, they corralled the protesting parents onto a bus and drove them to a meeting with local Party officials, hoping to avoid the embarrassment of going over local officials’ heads. The initiative of the parents could lead to a wider evaluation of the role of money in deciding who lives and dies, but that’s only if they are successful in their efforts. As of yet the Chinese media is ignoring this dimension of the story. All of China is so head-over-heels in love with the soldiers and the government’s response to the destruction that bringing to light the class dimension of this tragedy is about as likely as China granting independence to Tibet.

On Monday I was at the Traditional Chinese Medicine (TCM) school, and I met a group of students and faculty who had just returned from doing volunteer work at the epicenter. They had brewed up huge vats of Chinese herbs for victims of the quake. Some of our students have also gone to volunteer. We have heard they are getting so many volunteers, they are turning people away, and only accepting Communist Party members.

Many people have fled Chengdu. One estimate is that a third of this city of 11 million have left. A good deal of them have chosen to sleep in their cars outside the city. Of those who remain, a significant percentage are sleeping in the streets. People have constructed makeshift tents in any space available: parks, along riverbanks, besides roads, in parking lots and empty fields. They use tarps and canopies, big pieces of plastic, grass mats, and string to construct their new homes.

Shelters

Tree & Shelter

Side of the rode

Although the original earthquake did not cause any buildings to collapse here, people see what happened a forty minutes’ drive northwest, and they’re scared. They don’t want to end up under twelve stories of rubble. They are being Better Safe Than Sorry.

A week ago, after 11 at night, Mr. Yang, our boss, knocked on our door and told us the radio was reporting that an aftershock of between 6 and 7 was expected that night, or the next day, and that we should therefore not stay in our apartment, but rather sleep in the hotel next door. It was only safe to sleep on the first floor – our apartment is on the third – but no rooms were available, so we’d have to sleep in the lobby. We spent the night with several other foreign teachers, blankets and pillows spread out on the floor, and with hotel workers milling about late into the night, and early the next morning, talking, watching television, listening to the radio, pacing about. You could say people are rather high strung these days. Each aftershock reminds people of the earthquake, which reminds people of the images of the devastation in Wenchuan, Dujiangyan, and elsewhere, which is broadcast on every TV station here 24/7.

We’re caught between our understanding of science and our opinions, and the views of the people around us. The next day’s New York Times had an article on-line which said the rumor of the impending aftershock was unsubstantiated. It wasn’t. It was put out by a group of Chinese seismologists. The problem was, they issued it for the area around the epicenter, not for Chengdu. This was later clarified on the local radio, but by that time, anyone who hadn’t already been sleeping outside was, including most of our campus. And, of course, it’s been raining.

Despite the clarification that the warning of an aftershock did not apply to Chengdu, Mr. Yang insisted that we spend a second night in the hotel, this time separately, with several men in one room, and several women in the other. We didn’t want Mr. Yang to “lose face” over this, but we can’t sleep very well next door, and chose instead to stay in our apartment. At four in the morning that night, an aftershock hit, loud enough to wake people up, make people scream, and cause dogs to bark, but not to do any damage.

This has been our life the last two weeks. A kind of hysteria has taken hold of people here, and every time there’s the rumble of an aftershock, people scream and run outside. With hundreds and hundreds of aftershocks, this can become exhausting. In my mind, the 8.0 earthquake that struck two weeks ago did not topple any buildings in Chengdu so, unless the building you are in was seriously compromised by the initial quake, you do not have much to worry about when there is a short aftershock of considerably less intensity.

Of course going through a trauma like this is not an entirely rational or logical process. A deeper, darker part of one’s mind lurks in the background, challenging the rational, and sometimes overtaking it. During the last couple of weeks I have occasionally been haunted by images in my mind of our building collapsing when it begins shaking. I know that our building will not collapse from a minor aftershock, but sitting on the couch as the building starts to tremble, occasionally images of the floor giving way or the ceiling falling in emerge in my consciousness. It’s this fear that competes with my rational mind. And of course part of me feels it would be ridiculous to stubbornly insist on staying in our apartment, only to die when the whole building collapsed. Partly for this reason, usually when our hosts feel there is a threat that requires us to relocate, we do, even though our own assessment of the situation is different.

For a while over the last two weeks I have had an internal struggle between my rational mind, and my irrational fears. Those haunting images of being buried beneath collapsing buildings competed with my logical assessment of the likelihood of this occurring. In talking this through with Lara, I realized that I was displacing this irrational fear onto the people camping outside. Look at how ridiculous they I are, I thought. Living outside, under a plastic tarp, for days on end, for no logical reason. These people became the embodiment of my own irrational fears, and I, with my reason, was above that. Silly fools. Once I brought this inner conflict to consciousness, I felt less antagonistic to the people sleeping outside.

On Sunday I was giving final exams, sitting with four students having a conversation in English. Suddenly the whole classroom building began shaking. I felt impervious, jaded, and confident. The three students who were not speaking got nervous, but the student speaking seemed unaware and kept on going, and I let her, even as I could hear students in the hall screaming and running out of the building. This was no garden variety aftershock. It was serious enough that I felt it was right on the verge of requiring getting out of the building. In the first few days, a couple of the aftershocks got me up and out the door. But after several a day, sometimes several an hour, over the course of two weeks, you grow accustomed to them. You learn that nothing happens except that the building shakes for a little while. After less than a minute, it stops. And this is what happened this time. The building shook a little, then it stopped. That’s it. Over and over, and over. The important thing is that nothing major happens here.

I found out later that this was one of the bigger aftershocks, collapsing 70,000 buildings at the epicenter, injuring about 500 people, and killing eight. But this is the important thing which most of Chengdu seems to be missing. The damage, death, and destruction is not happening here. It did not when the 8.0 quake hit, and it has not in any of the hundreds of aftershocks since. It would be a better use of resources to send Chengdu’s tents, and tarps, canopies and rope, north, to the people that can really use them, and for us to all get on with our lives, and helping the people that really need it.

There have been at least 1,000 aftershocks since Monday afternoon’s earthquake. These aftershocks alone are the equivalent in strength of the only two other earthquakes I’ve experienced, both of which were in Portland, Oregon. When they occur, the whole apartment building shakes and sways slightly. Sometimes a glass will need to be grabbed to prevent it from toppling, sometimes the windows rattle, sometimes they are strong enough to get us up and out the front door to escape the building. Mostly though, they are a kind of background noise, a natural hiccup you grow accustomed to. They pale in comparison to the real thing. Monday’s 7.9 magnitude quake, the epicenter of which was only 55 miles north of here, shook all of China and down to Thailand and Vietnam.

When the earthquake struck, I was in the middle of a martial arts class, practicing Xing Yi Quan (Mind Intent Boxing) at the Qingyang Daoist Temple near the Traditional Chinese Medicine (TCM) school. My teacher, Yang, and friend, fellow student, and translator Zhang Hui, were in the middle of working on the finer points of the various Five Element Fists of Xing Yi. Teacher Yang was instructing me to better coordinate my arms and legs as I move forward, to keep my weight predominantly in my back leg, and to remain relaxed until the last instant, when I should “release (my) power,” or Jing.

There I was, practicing the punch/block combination associated with the Earth Element, when suddenly something changed. At first I thought a jet was flying overhead. Both Teacher Yang and Zhang Hui had puzzled and concerned looks on their faces, and I noticed plaster falling down upon us. We practice in one of the temples, and all at once all three of us beat a hasty path out from under the roof of the temple into the courtyard. There we joined a couple of Chinese and foreign tourists who had a strange combination of happy and perplexed looks on their faces.

We quickly realized we were experiencing an earthquake, as the ground shook back and forth and the temples trembled and swayed. The earth, which we take for granted as being stable and solid, suddenly felt elastic and loose, almost liquid. This was like no other earthquake I’ve ever experienced. It went on for four or five minutes. I thought it was pretty cool, exhilarating really, but also felt right on the line of it becoming less playful and more dangerous. It felt right on the verge of getting really serious, wherein the earth might open up, or the temples might start crashing down upon themselves. We all kind of stood there, riding it out, not sure how it was going to turn out. Cautiously enjoying it. Then, it was over.

Yang is in charge of part of the temple, so he had to go off and check about damages. Zhang Hui and I went and sat down. I sent a text message to Lara to make sure she was alright. Sometimes the magnitude of what you experience is not immediately clear, as Zhang Hui and I sat and waited to see if we would continue class. Soon enough, Yang told us we would continue next time, and we headed out of the temple. I went and retrieved my bike.

Riding home through the streets of Chengdu, the first thing I came across was the hospital across the street, which had been evacuated, and thousands of people were in the parking lot, including patients holding their own IVs. The next major intersection I came to was filled with hundreds of people, simply standing around, having escaped from the surrounding buildings, and wanting to stand far enough away from them in case they collapsed. I rode by the TCM school, and it looked like everything there was alright, with the exception of a lot of people walking around in various states of shock, confusion, and glee.

I rode down one of the tourist streets, which features high priced souvenirs, jewelry, and art works in newly built, old fashioned Chinese buildings. Several had some minor damage, with one in particular having dumped most of its tiled roof onto the street below.

Rubble
A building damaged on Qintai Street.

As I rode home, the cities streets were filled with people. Everyone had scrambled outside, and now were standing in the streets and parks, staring back at the buildings they had just fled, in a kind of anticipation and disbelief. All the major intersections were filled with thousands of people.

People in the streets
People in the streets of Chengdu, half an hour after the quake.

When I arrived at the gates of our compound at Sichuan Normal University, I ran into some friends, and we traded stories of where we were when the quake hit. One friend, a Peace Corp volunteer who teaches English, was on his way into Wanda Plaza, site of our gym. He said he was on his way in, when hundreds of people came running out, screaming.

I soon received a call from Lara. She told me she was with her students out on the sports field which, following the lead of our Chinese students, we refer to as “the playground.” I rode my bike through the throngs of students milling about campus, arriving at the playground to see thousands of people there. Lara was right at the gate, a welcome sight. We went and joined her students on the field. Lara was giving a Pragmatics lecture when the earthquake hit, on the fourth floor of a rickety old classroom building. They fled out the door as the ceiling began to crumble and fall to the floor and the walls began to crack.

The students on the field were a little spooked, but overall in good spirits. People were sitting in little groups talking, or playing cards. Occasionally an aftershock would rattle the bleacher seats where some students were sitting, and they would run down to the field screaming. Chinese students are prone to screaming.

After spending an hour or so with the students, we decided to venture back to our apartment, get some work, books, and a change of clothes, and to assess the damage. On our way in, Mr. Yang, our boss, warned us to go in and come out very quickly, that it wasn’t safe to be indoors. We took his advice and headed in. Our kitchen was trashed, with broken spice bottles, a smashed press pot, and utensils all over the floor. The ten gallon water dispenser had shifted over two feet on the counter and was on the verge of tipping over. The cabinet was jostled forward, and all the cooking bottles on the fridge had shifted forward a couple of feet. In the living room the book shelf had come about two feet away from the wall, and the pictures and Tibetan artifacts that were on top of it were on the floor. The cabinets in the bedroom had also shifted several feet. All-in-all, not bad. We lost a press pot and a new lamp, but otherwise everything was alright.

We rejoined the people out on the playground, saying hello and checking in with our students and relaxing. I had a Cubs game on my computer I watched, and Lara helped a student who had some questions about her class. We eventually got word that the students were being asked not to return to their dorm rooms, and to sleep on the sports field. Students began walking by with grass mats and blankets.

Upon returning to our apartment, we were told we had a first floor room in the hotel across from our apartment that we should stay in. It was felt this was a safer place for the night than our third floor apartment. We shared the room with our Peace Corp teacher friend and his Chinese girlfriend. We set about sending emails letting people know we were ok. We didn’t get much sleep that night.

It had begun raining around four in the morning. Students scrambled back to the shelter of their dorms, only to turn around and head back to the field when the next aftershock struck. A friend of ours described the waves of students going back and forth between the playground and the dorms, trapped between the rattling of the aftershocks and the downpour of the rain.

Playing Field Camp II

Playing Field Camp
The day after the earthquake, students camped out on the “Playground.”

The next morning we went back to our apartment and cleaned up. The aftershocks continued throughout the day. Students were being asked to remain outside. We walked around campus, and saw people camped out everywhere: little parks, the playing field, classroom building lobbies, under ping pong tables.

Forest Camp

Ping Pong Shelter
Students camped out under ping pong tables.

Our building shook pretty fiercely during the quake, but as far as we could tell was not structurally compromised. The outside of the building, the hallway, and our apartment had no apparent cracks. Lara had an over-the-phone job interview to prepare for. I started packing. We are leaving Chengdu in less than a month, and I thought it’d be therapeutic to prepare to leave. That night we slept at home. The aftershocks continued, and for the second night in a row, we didn’t sleep very well.

In the days that followed, the devastation of the earthquake became clear. We now know at least 19,500 have been killed, a number that will surely rise, with 26,000 people still buried and another 14,000 missing. Hundreds of thousands are homeless. Some 400 dams in the region may have been damaged, and could collapse in the coming weeks. In the cities of Guangyuan and Mianyang, located close to the epicenter which was in Wenchuan County, plants which produce nuclear weapons and process plutonium for weapons may have been damaged.

Today for the first time we are starting to feel normal again, less strung out and edgy. We slept twelve hours last night. Three days after the quake I’m still awoken by aftershocks. But as this day has progressed the frequency of the rumblings has decreased. Tonight we are bringing spare blankets, clothes, and non-perishable food to a local establishment which will deliver supplies to the most affected area. It seems the worst is behind us now.

Zhou Hong is an Oncologist at the Chengdu University of Traditional Chinese Medicine (TCM) Hospital. I spent several days a week with her during April, seeing both walk-in patients and in-patients. We saw people with esophageal cancer, lung cancer, brain cancer, and a variety of tumors, both benign and malignant. It was difficult seeing so many people with cancer. One begins to suspect it’s an inevitable condition. Despite the dire circumstances, Dr. Zhou was very matter-of-fact and relaxed. She went about her business with a high degree of competence, dispensing herbal formulas with ease, and explaining to us interns her diagnosis and treatment strategies.

Zhou Hong
Dr. Zhou at work.

Some people had discovered their cancer early, had undergone either chemotherapy or surgery, and now were on herbs to deal with the after-effects of the whole experience. Others were in the midst of Western treatments for their condition, and were seeking herbs to complement this. Still others were so far down the road, had had cancer so long, that they were foregoing chemo or radiation therapy altogether, and instead had sought out TCM to help prolong their lives.

Some had tumors so big the doctors didn’t want to operate. It became medically impossible to remove some of the growths. This was especially true in cases were the cancer had metastasized, having spread to the liver, or lungs, or brain. Some of the people in these states had proven the pessimistic prognosis of the Western doctors wrong by turning to Chinese medicine. In one case, a women who had been given six months to live chose herbal medicine, and had now lived another six years. Dr. Zhou explained that in these latter cases, the strategy was to improve both the quality and the duration of life.

Some herbs are thought to be anti-carcinogenic. In particular a combination of Huang Qi (Astragulus), Ren Shen (Ginseng) and Ku Shen is administered intravenously to cancer in-patients. This combination is marketed as a patent formula called Kangai. I’m not sure if any clinical trials have been conducted to test the effectiveness of this combination, but almost every cancer in-patient was getting it.

In various herbal formulas, different herbs are included which are said to be specifically anti-carcinogenic for particular conditions. For instance, if a patient has esophageal cancer, Dr. Zhou will include Sha Ren and Dan Shen, among other herbs. Fu Shen is believed to be a general anti-tumor herb, which kills cancer cells and stops cancer cell division.

In was very exciting to be in a place which combines the best of two medical worlds to confront one of the most deadly conditions facing us. In many cases, Western and Chinese medicine work together very well. A patient may be getting radiation treatment, while at the same time taking an herbal formula which addresses the nausea and fatigue associated with this treatment. This formula may also have anti-carcinogenic herbs, and herbs which address the underlying condition which gave rise to the development of cancer in the first place. Another patient may lack an appetite from her chemo treatment, and will get a formula both to stimulate her appetite and boost her immune system. In the West, we refer to this as complementary medicine.

Many of the patients Dr. Zhou treated were returning patients, so she only had to make minor adjustments to their formulas based upon how they were doing. She would always take the patient’s pulse, look at their tongue, and ask them a series of questions.

Zhou Hong Pulse Taking
Dr. Zhou taking a pulse.

Pulse diagnosis allows the practitioner of Chinese medicine to determine the condition of the internal organs and the overall health of the body. There are three positions on each hand, on the radial, or thumb side of the wrist. For instance, on the right hand one has the Lung pulse, then the Spleen/Stomach pulse in the middle, and finally the Kidney Yang pulse furthest from the hand. There are 28 possible pulse qualities, for example Deep, Wiry, or Slippery. The quality of the pulse is an important part of Chinese medicine diagnosis.

Looking at the tongue coat can tell one about the condition of the digestive track, or middle jiao. The heart is represented on the tip of the tongue. One also looks at the color of the tongue. For instance, a pale tongue body means a general deficiency, whereas a purple tongue represents stagnation.

In addition to taking the pulse and looking at the tongue, Chinese doctors will ask the patient a series of questions, called the Ten Questions, although there are usually more than ten. These concern the quality of the stool and urine, the length and quality of sleep, the presence of phlegm and its quality, how strong the appetite is, the presence of bloating or gas, etc. If the patient is suffering from pain, the doctor will want to know the nature of the pain, for instance whether it is a dull ache or a sharp pain. This set of questions requires the patient to really pay attention to their body. My friend Nir joked that the average Chinese five year old could tell you every detail about the quality of their stool, whereas the average Westerner has no idea.

One thing that I found problematic was one case in which a patient who was in the late stages of abdominal cancer was told that she was lucky and they caught it early. She was told her surgery was successful and she was now cancer free. In fact, the doctors went in and the cancer was so big, and had spread so much, that they couldn’t operate. The Doctor thought that telling the patient this would dampen her spirits. Thinking she was free of cancer gave her a great attitude, which the doctor thought important to her quality of life. This is true, but I found it unethical to lie to a patient like that. They rationalized it by saying that “common people” don’t have the education to understand the complexities of medicine. Each patient we saw that morning after this, we couldn’t help but joke, Is that true what the doctor said about her condition, or is she just telling him that? This was the one incongruous aspect of my experience with Dr. Zhou. I can’t comment on whether this is a general practice of Chinese doctors, or even of Dr. Zhou. It may have been isolated to this one instance. It didn’t invalidate her overall approach in my eyes. In this one case I think she was wrong. Overall though, my experience in the oncology department was a positive one.

In addition to working in oncology with Dr. Zhou, we also spent time the last month working in pediatrics, respiratory, acupuncture in-patients, and acupuncture walk-ins. My favorite was the acupuncture walk-in clinic, as I have the most affinity for acupuncture and feel the most comfortable with this dimension of Chinese medicine. A future blog with photos will be devoted to my experience there.

The Pulse

Bicycles have been the dominant form of transportation in China since the 1950s. When people think of China, one of the images to come to mind is of hundreds of bicyclists in the streets. After the 1949 Revolution, and in Mao’s heyday, owning a bicycle was seen as a status symbol, something to aspire towards having. Bicycling was promoted by the new Communist government, in part through subsidies for both producing and buying bikes. The term “Critical Mass,” now used by bicycle advocates in the West, originated in China as a way to describe the number of bicyclists needed to move across an intersection as a group.

Bicycles are an ideal form of transportation, providing a convenient, economical, and ecologically friendly way to get around. Bicycles are a key to the way out of the contemporary crises of climate change and, in the US, increasing obesity and other health problems.

Unfortunately, bicycles in China are being eclipsed by the car, an invention which is making a significant contribution to humanity’s demise as a viable species. US automakers, in a clear case of putting profit ahead of human health, are moving in on the China market. Millions of cars are being sold in China, with the total number sold increasing by one million per year. Cars are overflowing into the bicycle lanes here, and Chinese cities are now experiencing all the joys of rush hour traffic, pollution, and other benchmarks of the Western standard of living.

People in the US, particularly in places like Portland, Or, Chicago, and San Francisco, are increasingly riding bicycles, and devoting more money to developing an efficient bicycle infrastructure. Lately I’ve been photographing the bicycles of China, in part to inspire people to put bicycles to creative uses elsewhere. It’ll be interesting to see how this whole climate change scenario plays itself out over the coming years. I believe bicycles are part of the solution.

Man With Greens
A new page has been added in the column on the right, called Bicycles of China. There I’ll be posting photos of various bikes, and trikes, from around the streets of Chengdu and other parts of China. When I have enough, I’ll be submitting a photo essay to a Portland bike blog called bikeportland.org. Tell me which ones you like best, and check back periodically as I update the page.