Chinese Medicine


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.

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

On Thursday, April 3rd, between eight and fifteen more Tibetan monks and lay people were shot and killed by Chinese para-military police forces in Sichuan Province. They were marching on a police station where two monks were being held for possessing pictures of the Dalai Lama, a crime in China.

The incident began when monks at a monastery in the town of Donggu, refused to allow a military force of over a thousand troops into their monastery. The troops forced their way in, ransacked the place, and found the pictures. They arrested two monks. All 370 monks from the monastery, joined by some 400 or so others, marched to demand the monks’ release. Once again, the Chinese police opened fire on unarmed demonstrators, killing several and wounding many.

China acts surprised and outraged that the Olympic Torch relay has been disrupted by demonstrations in Greece, London, Paris, and San Francisco. Anyone who is paying attention to what China is doing should not be surprised by the anger and determination of the protestors. Outside China, the Communist Party can’t control public opinion. For this, they are looking to hire a public relations firm.

Despite all the international frenzy over China, Tibet, and the Olympic Torch protests, life here in Chengdu, Sichuan, goes on as normal. Simply walking around the streets here, one wouldn’t even know that China was in the middle of an international firestorm.

For me, normal life has included a renewed study of Chinese medicine and martial arts. Last week I started interning in the teaching hospital associated with Chengdu University of Traditional Chinese Medicine (TCM). I spent the week in the oncology ward, working with cancer patients. I also began training in a martial art called Xing Yi Quan at a Taoist Temple. Doing these kinds of things are the reason I came to China.

I ride my bike along the river, which runs through the center of Chengdu, to the hospital, a trip which, depending on traffic, takes about forty minutes. Before eight in the morning is rush hour, when one has to compete with scooters, electric bikes, other bicyclists, cars and buses. Two-wheeled vehicles have their own lane. These bike lanes are protected from internal combustion vehicles by concrete medians filled with bushes and trees or bright blue metal gates. In the mornings the bike lanes move faster than the cars, which suffer from roads not designed for the number of vehicles now appearing on China’s streets.

At the hospital I’m paired up with a couple of friends and a very good translator. We spend every morning with a doctor, either seeing patients who come in for herbal formulas, or doing rounds in the in-patient ward. Those coming in to see the doctor in most cases recently had surgery, chemotherapy, or radiation therapy and are seeking herbs to aid in their recovery. The doctor prescribes herbs to help with the side effects of Western therapies and to treat the root causes of individuals’ problems.

For example, we saw a 66 year old women who was recovering from cancer of the bile duct. She had an operation one year ago, and had parts of her bile duct and stomach removed. Previously she had had three gallstone operations. She now suffers from stomach ache, distension after meals and heart burn.

After asking her a number of questions, taking her pulse and looking at her tongue, the doctor determined she was suffering from Liver Heat Attacking the Stomach, a TCM diagnosis. The lack of a coat on her tongue indicates she has Stomach Yin deficiency, caused by Heat. She was given a formula to deal with the excessive stomach acid by generating stomach mucous to protect the stomach and to ameliorate the acid regurgitation, which in TCM parlance are signs of Heat. Included in the formula where herbs to nurture her stomach Yin. Hopefully by resolving the Stomach Heat, one can help avoid another appearance of cancer which may result from the chronic irritation she is experiencing.

Another day we visited three in-patients, all getting a combination of chemo and herbal formulas. Most of these patients were pretty far along in the development of cancer, and the intention of the doctor is to lessen the pain and increase both the quality and the duration of their lives. I’ll be spending every morning at the hospital, except Thursdays, when I teach, and plan to move around to various departments and see as much as I can over the next month or so.

Ten minutes away from Chengdu University is the Qing Yang Taoist Temple, one of my favorite places in Chengdu. There I’m doing Xing Yi Quan, or Mind Intent Boxing. It’s what’s referred to as an “internal” martial art, which means that one of its primary objectives is the cultivation of internal power, or Qi. It is a sister art of Tai Ji Quan. I’m getting private lessons with a man who has been practicing this form for over 25 years. I go there with a friend, Zhang Hui, who acts as translator and thus gets free lessons out of the deal. That, plus I help him with his English.

In Xing Yi there are five “fists,” or punch/block combinations, associated with the Five Elements (Earth, Metal, Water, Wood, and Fire). Over the next two months my instructor plans to teach me all five, and a “linking form” which includes them all.

Being in the hospital and doing martial arts reminds me of the positive side of China, the ancient culture that paid attention to the body and mind and cultivated techniques and practices aimed at improving both. Doing these things reminds me that the people of China are not the government, a distinction people from other countries are kind enough to grant Americans.

The following is a talk I gave at the US Consulate General in Chengdu, China on December 12th, 2007. Despite the hassle of getting through security, about sixty English speaking Chinese students and one old man who comes every week to get out of the cold attended. They were a bright group that asked very interesting questions after the talk. The two most interesting concerned the differences between Western and Chinese medicine, and the relation of traditional Chinese culture to Chinese medicine. I may write about these in the future.

I am a Chinese doctor. Or at least I practice Chinese medicine. I went to school in the Pacific Northwest of the United States, graduating in 2004 from the Oregon College of Oriental Medicine in Portland. The weather in Oregon is quite similar to Chengdu’s. It’s often cloudy, and sometime you don’t see the sun for weeks at a time, although I never thought I’d live somewhere where one sees the sun less often than in Oregon. But here we are. Chengdu is also similar to Portland in the way people rely on bicycles as a form of transportation. In Portland we ride bikes, and rarely drive.

I went into Chinese medicine because I’ve always been attracted to Chinese philosophy and culture. I’m drawn to Taoism and Buddhism, martial arts, and Qi Gong. In High School I first started using the I-Ching, or The Book of Changes. I wanted to learn a craft which I wouldn’t get bored with. I felt that Chinese medicine was something which would keep my interest the rest of my life. Because it’s so vast and varied, I thought that there would always be something new to learn. I wanted that kind of life-long engagement with my work.

The fundamental orientation of Chinese medicine is towards Qi, or vital life force. We all have Qi. It’s what makes us go. According to Chinese medicine, when Qi gets stuck, or doesn’t flow, we experience discomfort and pain. Other times, we may not have enough Qi, and we feel tired. Sometimes we have other internal imbalances, and we can’t sleep, or we develop allergies, or have digestive distress. For all these situations, through the use of needles and herbs, a Chinese doctor can get one’s Qi moving again, or through herbs can give you more Qi to overcome fatigue, or help restore imbalances so you can sleep.

There are twelve major meridians, or pathways for Qi, which correspond to twelve internal organs, which each has its own functions. For instance the Spleen, among other things, is responsible for transforming food into Qi. It’s meridian starts just off the nail of the big toe, travels up the inside of the leg, and ends up in about the middle of the rib cage, on the side of the chest. The Lung does many things, but one of its main functions is to transform the air we breathe into Qi. It’s meridian pathway starts in the pectoral muscle on the upper chest, and travels down the arm out to the thumb.

The basic idea is that the human body, when working correctly, is healthy and disease free. Chinese doctors tune the body so that it works well, thus eliminating problems. In addition to acupuncture and herbs, Chinese medicine also includes things like cupping, moxabustion, gua shua, and electro-stimulation.

Chinese Immigration
Although various forms of Chinese medicine have been used in China for thousands of years, it is very recent that these practices have come to the US. It is most likely that Chinese medicine first came to America with the Chinese immigrants of the mid-1800s.

Many of the first wave of immigrants from China were skilled artisans, hotel and restaurant owners, fishermen, and merchants. This was followed by thousands of unskilled workers. At that time some 25,000 Chinese immigrants were working in California, mostly as part of the “Gold Rush.” Another 10,000 worked on building the Central Pacific Railroad.

In 1882 the US Congress passed the Chinese Exclusion Act, the first in American history to place broad controls on immigration. The Act suspended Chinese immigration, and required all Chinese people to carry documents identifying themselves and their line of work. It was not repealed until 1943.

Many Chinese came to the US to support their families back home. They would work for less pay than non-Chinese workers, and this caused tensions. Chinese and non-Chinese laborers were pitted against each other. This resulted in anti-Chinese discrimination and violence. For instance, in 1887, in the Snake River Massacre, 30 Chinese miners were murdered near the Oregon-Idaho border.

It was around this time that a young man named Ing Hay moved to John Day, in Eastern Oregon. Ing Hay was born in China and came from a family of herbalists. Know as Ing ‘Doc’ Hay, or the China Doctor, Ing Hay is probably the most famous early practitioner of Chinese medicine in the US. He and his friend Lung On opened a store called Kam Wah Chung along The Dalles Military Road. They supplied canned foods, tobacco, and bulk goods from China. Kam Wah Chung also functioned as a social center and hiring hall. This is where Doc Hay established his medicine practice. He treated not only other Chinese immigrants, but also local cowboys and miners. Doc Hay had a reputation for curing blood poisoning, a common problem for Oregon ranch hands.

Doc Hay was primarily an herbalist. He practiced in John Day from 1888 until 1948, and died at the age of 89 in 1952 in Portland, Oregon. When the Kam Wah Chung building was reopened in the 1960s, over 500 Chinese herbs were discovered, some of which have yet to be identified.

Doc Hay relied primarily on pulse taking for diagnosis. In Chinese medicine there are three pulses on each wrist at the radial artery, and each of the three corresponds to different internal organs, and in turn has three levels. For instance at the top, near the wrist crease on the left is the Heart, below this is the Liver, and at the bottom is the Kidney Yin. On the right at the top is the Lung, under that is the Spleen, and finally the Kidney Yang. This is one of several schemes. A well-versed pulse reader can diagnosis a great deal about the state of a person’s health simply by reading pulses. Although Doc Hay is the most well-known, there must have been other doctors amongst the wave of Chinese immigrants to the US in the 1800s, although their stories are yet to be told.

Chinese medicine first came to the attention of the Eastern Establishment when acupuncture was mentioned in the medical literature in 1822, and was endorsed by Sir William Osier for the management of lumbago, or low back pain, in his text. The Principles and Practice of Medicine, published in 1892. Unlike France, however, where acupuncture was incorporated into mainstream medical practice in the 19th Century, Chinese medicine didn’t make it into the mainstream in the US until the 1970s.

I think there are three main events which propelled acupuncture and Chinese medicine into the mainstream in the US.

Acupuncture in the Headlines
Acupuncture was first brought to the attention of large numbers of Americans by a New York Times reporter named James Reston in 1971. Reston was in China covering the opening up of relations between the US and China, when he suffered an attack of appendicitis, and had to have an operation. In the Chinese hospital he was administered acupuncture to treat his post-operative pain. He was amazed and intrigued by the effectiveness of this approach, and wrote an article on it for the Times. This caused a stir in the US, generating a great deal of interest. For the first time millions of Americans heard about using needles for health.

Miriam Lee’s Civil Disobedience
At the same time, a Chinese immigrant named Miriam Lee was living in San Francisco, working in factories. She was a trained acupuncturist. Although acupuncture was not at that time a recognized form of medicine in the US, she was convinced to use her knowledge to address a friend’s illness. Her treatment was so effective that her friend told her friends about it, and before she knew it she was treating lots of people. She found a sympathetic MD, and set up her practice in her office, and soon lines were forming around the block. Ms. Lee was subsequently arrested for practicing medicine without a license. But she did not desist from helping people. Through a kind of one-women campaign of civil disobedience, in which she’d break a law she felt was unjust, the state of California eventually relinquished its punishment, and instead recognized acupuncture as a legitimate form of medicine. This was only thirty years ago, in 1976.

Lincoln Hospital and Acupuncture Detox
On the East Coast in 1970, in New York City, a group called The Young Lords Party was agitating about the terrible conditions at Lincoln Hospital in the Bronx. The Young Lords were a group of Puerto Rican activists that came together to work for the rights of Puerto Ricans specifically and poor people generally in New York and Chicago. A coalition emerged, including the Young Lords, the Black Panthers, hospital workers, and community people to bring about improvements in conditions.

Despite recording hundreds of grievances, the hospital administration refused to acknowledge problems and talk to the activists. Lincoln Hospital was in a building that had been condemned and was both understaffed and under-financed. After mass demonstrations were also ignored, the Young Lords occupied the hospital in the middle of the night. The next morning the media publicized the occupation and the issues that led to it.

During the occupation, a preventive medicine community clinic was set up. One result of the occupation was that an historic acupuncture-detoxification program was established, with licensed doctors, acupuncturists, and staff members hired from the community including members of the Young Lords Party and Black Panther Party. Ahead of its time, for years the Lincoln Hospital Detox Program served as an international model of treating heroin and alcohol addiction with acupuncture instead of methadone, before it was eventually closed down by Mayor Koch later in the ’70s. None-the-less, it became the model for acupuncture detox programs around the country.

At Lincoln Hospital a Five Needle Protocol, or 5NP, employing five acupuncture points on the ear was developed to treat addiction and is now the cornerstone of detox programs around the US. Out of the experience at Lincoln Hospital, an organization called NADA (National Association for Acupuncture Detox) developed to promote education and training of chemical dependency clinicians in 5 NP. NADA has trained 10,000 people.

As a student intern, I worked at the Portland Alternative Health Center, or PAHC. PAHC combines acupuncture, herbs, Western medicine, counseling, housing, and other modalities, while serving a homeless addict population. They were successful in 89% of their efforts at getting people off heroine after six months. It was great to be able to work at PAHC. People would come in and sit in chairs. We’d talk to them about what else was bothering them, in addition to battling withdrawal symptoms. We put five needles in each ear, then a few more for various ailments, such as knee pain, or neck problems. The people who came to PAHC were very thankful for this service.

As a result of the efforts around the Lincoln Hospital takeover, NADA, and institutions like PAHC, acupuncture has had a positive effect on thousands of members of an otherwise underserved population. Acupuncture has become a very effective and widespread component of community detox programs around the country.

TCM Schools and Varieties of Chinese Medicine
In the late 1970s and 1980s, people began establishing Chinese Medicine schools. One of the first to be established was the New England School of Acupuncture in 1979. My school, OCOM, was established in 1983. It was one of the first Chinese medicine schools to offer a Master’s Degree, and in 2005 began offering a PhD, or Doctoral Degree.

Most schools in the US teach Traditional Chinese Medicine, or TCM. TCM is a system of Chinese medicine put together under Mao, following the Revolution. This is the style of medicine practiced here in China, and is the standard for the national certification exam in the US.

Other forms of Chinese Medicine popular in the US include Five Element and Dr. Richard Tan’s system. Five Element was primarily developed in England, and is more psychological and esoteric in its approach. The people who developed it claim it’s more based in the way Chinese medicine used to be practiced, long before the development of TCM. The five elements – Earth, Metal, Water, Wood, and Fire – each have different characteristics and personalities. For Five Element practitioners, each person has a basic type, either you are Earth, or you are Water, or you are Wood, and so on. Once your type is determined, you can be treated by points related to this element, as each element has two organs associated with it, which in turn has meridian pathways and points. The points can then be needled to bring about a change in consciousness or a physical condition. For instance if you are an Earth element, you would primarily be treated on the Spleen and Stomach meridians.

The third major type of Chinese Medicine practiced in the US is that developed by Dr. Richard Tan. Dr. Tan has developed an interesting system in which the body mirrors itself. For example, if someone is suffering knee pain, Dr. Tan suggests treating their opposite elbow. For hip pain one would treat the opposite shoulder, or vice-a-versa. And this works! Basically one is looking at which meridian is affected, then looking at the paired meridian on the opposite side of the body. This style of acupuncture is very effective for pain management, and is used frequently in walk-ins clinics and in detox centers because people are sitting in chairs and are clothed. Therefore a doctor will want to choose distal points that can be accessed easily, usually from the knees down, or the elbow to the hand. This is the primary system we used at PAHC.

Some acupuncturists choose to specialize. Some of the most popular specializations include gynecology, fertility, allergies; and musculo-skeletal pain. Most of my patients tend toward this last group, perhaps because I am also a massage therapist.

Increased Acceptance and Insurance Coverage
In 1996 acupuncture needles were designated an “accepted medical instrument” which both recognized acupuncture as a form of medicine, and laid the basis for insurance companies to start covering acupuncture treatments. In the last several years that’s just what is happening, as an increasing number of insurance companies are paying for acupuncture.

The medical community in the US is also becoming increasingly open to acupuncture. Doctors can do a several week training to learn the basics of acupuncture to incorporate it into their practice. This is good and bad. On the one hand it’s good MDs are learning about the Chinese system of health. On the other, they are learning it at a very basic level. Basically, if the patient has knee pain, use these points. They thus avoid learning all the complex theory which would lead one to choose those points. It is still a positive development to have doctors incorporate acupuncture into their practices.

In addition, hospitals sometimes now have acupuncturists on staff to treat patients. As an intern I worked at a hospital alongside MDs. We were very busy, treating patients that the Doctors believed that Western medicine was inadequate for, mostly patients with chronic pain. It was a great experience, in which doctors actually deferred to me, an acupuncturist, in diagnosing and treating patients. We had a great deal of success working in this hospital, and hopefully there will be more of this in the future.

Community Based Acupuncture
An exciting recent development in the US is something called Community Based Acupuncture. The motivation behind Community Based Acupuncture is to make acupuncture accessible to more people. From this perspective, acupuncture in the US is too exclusive because it costs so much. A typical acupuncture session in the US runs between $60 – $100 dollars. Many people can’t afford that, and the price also makes it difficult to get the type of regular treatment that acupuncture requires. Here in China one typically goes for acupuncture every day, or every other day until the problem begins to resolve, then you can start going less frequently. In the US, frequent treatment is more often once a week, sometimes twice. The price makes getting treatment more often prohibitive. In community based clinics, the cost is usually $15 to $45 per treatment, sliding scale.

There is also a critique of the isolation of the treatment process in the US, in which patients are brought into a room by themselves. In contrast to this, people who come to a community based clinic are treated in one large room, together, the way acupuncture is practiced here. The idea is to create an environment in which people will feel comfortable, and which they can afford. Having the cost cheaper both allows more people without a lot of extra money to come in for treatment, and to come in more often.

There are now several community based acupuncture institutions in Portland and about fifty around the country. There is also an organization of clinics and practitioners called the Community Acupuncture Network.

This development is very important, as a significant percentage of the population in the United States lacks health insurance, and therefore has little to no access to health care, or if they do, the bills haunt them for decades afterwards. By setting up Community Based Acupuncture clinics, affordable health care is being made available, and acupuncture can fill an important need for potentially millions of people. When I return to the US, I plan to work with a Community Based Acupuncture clinic, and eventually open my own clinic.

The emergence of Community Based Acupuncture is very exciting as it points acupuncture in the US in a direction more in line with the way it’s practiced here in China, and also in a way that will make it available as a form of health care to larger numbers of people.

Dr. Zhang II

I’m finishing up a week-and-a-half seminar with Dr. Zhang Zhiwen, an expert in what’s referred to in Chinese medicine as Warm Disease (Wen 1 Bing 4). It’s sponsored by the Chengdu University of Traditional Chinese Medicine, and is part of a program for Czech, French, and German students, plus three from Singapore. Myself and one other American, a woman from Brooklyn, NY, managed to squeeze in as well.

Dr. Zhang speaks in Chinese, which is then translated into English, then into German. The delay is helpful, allowing copious note taking. The whole thing takes place in a TCM Hotel. It’s a hotel, which also houses a first floor treatment area, where massage, acupuncture, and things like cupping, are available, as well as a travel agency and restaurant. On the eight floors above is a strange combination of conference rooms, lecture rooms, and hotel rooms.

The temperature recently has dropped dramatically to the upper 50s, lower 60s. There’s no heat in China, so the classroom is cold. Ironically, on the second day of lectures, many students were sneezing, and blowing their noses, leading to a good amount of suppressed laughter.

In the classroom each chair is accompanied by a white cup with a lid, filled with loose jasmine tea. Just before class begins, a women comes in with a large thermos of hot water, filling our tea cups. She reappears throughout the afternoon, helping keep everyone both a little warmer and more awake.

The German group leader and translator, who has been coming to Chengdu for twenty years, has a good sense of humor. He had a hard time keeping a straight face when Dr. Zhang was using the metaphor of irrigating a swamp in his advise to use herbs that promote urination to address a condition known as internal dampness, or when he went into great detail describing the nature of a hypothetical patient’s hypothetical stool (chocolate color, and as though mixed up with green beans).

The lectures go for three hours a day. It’s all fairly basic Traditional Chinese Medicine (TCM) theory, with a considerable amount of attention put on treatment strategies and the specifics of various herbal formulas and their various modifications. It’s a good review for me, and a chance to learn directly from a master in the field.

Traditional Chinese Medicine has an elaborate system of metaphors for making sense of our relationship with the physical world. Viruses are one way of thinking about the common cold, and this approach is not in any way discarded by TCM practitioners. But the conceptual landscape of TCM is quite different from Western models.

At the same time, TCM developed through application of the scientific method. Ideas were developed, then tested in the real world. Those that proved to work were kept in the corpus, and those that did not were discarded.

Traditional Chinese Medicine posits things such as External Pathogenic Influences (EPI). Phenomenon such as Wind, Heat, Cold, and Damp are all environmental factors which greatly influence human health and therefore play prominent roles in TCM thinking. Parallels with Western thinking here include the notion of “catching a draft,” and not going outside if it’s cold and windy without a hat and scarf. In TCM Colds are caused by either Wind-Cold or Wind-Heat. Two ways to distinguish between these two causes are the existence of a sore throat and the condition of the coating on the tongue. The presence of a sore throat indicates a Wind-Heat Invasion (looking at the effect to find the cause). Once the person has been ill for a while, or in a chronic condition, Heat will manifest as a yellow tongue coating.

According to the school of thought around Warm Diseases, if a Heat Invasion is not caught at an early stage, it will continue to penetrate to deeper levels. Also included are epidemic diseases and conditions which do not originate as the common cold.

There are four levels to Warm Disease, starting at the surface level (Wei) moving to the Qi level, then to the Nutritive Level (Ying) and finally to the Blood Level (Xue). Heat in the Blood level, features such symptoms as hemorrhaging, bleeding from orifices, convulsions, mania, and delirium. Thus the theory of Warm Disease covers everything from the common cold to conditions resembling those suffered in 28 Days Later.

Dr. Zhang discussed the whole Odyssey of the Wind-Heat Invasion, following it from sore throats through high fevers, to heat in the intestines, thick yellow greasy tongue coating, tongues with no coat, deep red or purple in color, convulsions, mania, and delirium and a whole variety of herbal formulas to cover almost every contingency.

The body is protected by something called Wei Qi. This is our first line of defense against Evil Wind. One of the early signs of a Wind Invasion is aversion to wind, which represents the weakening of the Wei Qi. Without that external defense, we feel vulnerable. When the External Pathogenic Influence gets tangled up with the Wei Qi, a battle ensues. This back and forth is what causes chills.

A classic Chinese formula for the common cold fairly well known and widely available in the West is Yin 2 Qiao 2. Be careful though. Only take Yin Qiao if you have a sore throat. If you’re suffering from a Wind-Cold Invasion and take it, it could become worse. For the early stages of a Wind-Heat Invasion, Yin Qiao is very effective.

Last week I was asked to help edit a translation of a proposal for a Garden of Chinese Herbs at the new campus of Chengdu University of Traditional Chinese Medicine. This is the University where I will be interning and studying, so of course I was glad to help out.

On Friday Lara and I took the bus to their campus. I was told the work would take about two hours, then we would all have dinner together. When we arrived our contact, Angel, said there was a driver who would be taking us and her associate, Tracy, to their new campus where I would do the editing. The drive was to take about fifty minutes.

Angel and Tracy of course are not their actual names. English speaking Chinese here often take American names, perhaps thinking we couldn’t possibly pronounce their real names.

The new campus is huge, with a tremendous archway entrance featuring a colossal Yin Yang symbol, and Ginkgo leave cutouts along the outer fence surrounding the campus. It is very modern and well layed out. The campus dorms probably house thousands of students.

Upon our arrival we were escorted into a TV studio and I was asked to read the English translation so they could record it. They said the English translation would be used for fundraising for the garden. The translation however was very poor, and much of it did not make sense: “Herbs aroma emitting in woods: Gazed into the distance, the spiral trail winds through the chain of hills and woods where aroma of the flourishing herbs flying over.”

I told them I would need a couple of days to work with the translation to rewrite it and get it to be clear and understandable. That in order to make recording me reading it a worthwhile project, the English would need to be improved. After lots of conversations involving half a dozen people, and a phone call, I was told the University President was expecting the recording the next morning and there was no time to further clarify the translation. It was to be used as a voiceover on a video. It had to be done now.

Fortunately Lara was with me, so we started working on making it more intelligible. After a little while I started reading the 18 page proposal, while Lara edited the pages just ahead of me. It all worked out well, but some of what I had to read was very comical. For instance, the conclusion: “World rise and fall, everyone has a share of responsibility! Inheriting Tradition, advocating innovation, stressing on the characteristics, strengthening superiority, serving society are the beliefs of CDUTCM people; Persisting in scientifically developing, constructing harmonious society are our responsibility; let us join hands to make our contributions and achievements for the realization of the Four Leap Cross of Sichuan Province!” Only once did we have to stop because I started cracking up. Some of the things I read were so ridiculous.

The garden project itself is really incredible. They basically want to have an herbal farm, where they can cultivate and distribute Chinese herbs on a large scale. It’s a worthy project, I just don’t know how much the English version of the fundraising proposal is going to help. This is what I tried to explain to them. They may want me to work on the translation and re-record it. We shall see.

Tomorrow Lara and I meet our new Tai Ji Chuan instructor at Chengdu University.