Roots and Needles, Healing in China Today
by Christopher Trahan, O.M.D., L.A.c.
In the summer of 1987 I traveled to the Peoples Republic of China, to study Traditional Chinese Medicine (TCM) at Chengdu College of Chinese Medicine. Chengdu is the capital of Sichuan Province, in south-central china; it is the hometown of the Chinese doctor Michael Zeng, who is the director of the International Institute of Chinese Medicine, where I formerly taught, in Santa Fe, New Mexico. Michael took nine of us to Chengdu, where for many years he practiced and taught Western medicine as well as TCM, to do an advanced clinical internship. In addition to giving an account of my experiences in Chengdu, I will discuss TCM and how modern-day China integrates its native healing system with Western medicine.
To give you an idea of my background: I work with acupuncture and herbal medicine, many with Chinese herbs though I also use American herbs (the latter according with Western and Chinese concepts of herbal medicine). I treat many kinds of ailments ranging from orthopedics to internal medicine and gynecology. I generally treat specific health problems, though people also seek my services to maintain their health, with acupuncture “tune-ups” and herbal medicine, homeopathy, and nutrition.
Chinese medicine has developed through a continuous tradition of several thousand years. Its medical principles and philosophy are based in ancient classics such as the Huang di Nei Jing, The Yellow Emperor’s Canon of Internal Medicine, compiled from 500 to 300 BC. While different theories and interpretations have predominated at different times, a consensus of medical concepts pertaining to herbal medicine and acupuncture has endured through history to the present time.
Chinese medicine has endured several distinct phases in the 20th century November 9, 2009 cal and economic strife, which included interference from Western nations, and the Western support of Chiang Kai Shek. Western medical science produced impressive new life-saving drugs (such as antibiotics) and gained popularity, while TCM fell out of official favor. Though Chinese medicine continued to be widely used, TCM was actually declared illegal during Chiang Kai Shek’s rule. Apparently this was not taken very seriously, but formal medical education became modeled on the West. Western influence continues in term of medicine and cultural values: The most popular elective surgery in Beijing in 1987 was the “Westernizing” of Chinese eyes.
TCM began a resurgence with the communist victory of 1949. In the 1950’s Mao proclaimed Chinese medicine to be “a great treasure house of knowledge.” I have heard conflicting stories on how his stance related to ethno-medical insight, or political necessity, or opportunism. Mao’s national health-care program was based on the training of “barefoot doctors,” who used TCM as well as basic Western medicine treatments such as antibiotic drugs and minor surgeries.
In 1956, four TCM colleges were formed, in Beijing, Shanghai, Chengdu, and Guangzou (formerly known as Canton). In 1987 China had 28 TCM colleges, 324.000 TCM professionals, and 1179 TCM hospitals above the country level. As the indigenous medicine of one fifth of the world’s population, 80% of which is rural, TCM offers a very effective and economical health-care system.
In Chengdu I studied some acupuncture, but was primarily in the department of herbal medicine, officially titled Internal Medicine; the Chinese term denotes its emphasis on metabolic and organic diseases. Whereas most Americans are familiar with acupuncture, particularly its spectacular achievements as an anesthetic, herbal medicine is by far the most popular and respected healing modality in China. Herbal medicine demands a higher level of diagnostic abilities, which in turn apply and refine those of the acupuncturist.
Typically two American students were assigned to a doctor, plus an interpreter. In the morning we worked in the outpatient clinic, seeing about fifteen patients per day. Doctors’ caseloads were reduced to allow for our participation; from 8:30 to noon a doctor would see as much as 40 patients – an average of about one every five minutes.
In the afternoon we had occasional lectures, but usually visited inpatient wards; here we would see two patients per day, which allowed us to get a more through case-history and left ample time for discussion. The resulting detail and depth of understanding well complemented our breadth of exposure to the many different cases viewed in the outpatient clinic.
We participated in the four classical modes of diagnosis: Listening, Asking, Looking, and Feeling. The doctor or an assistant took the case history, which was translated for us. We would all perform pulse and tongue diagnosis: The doctor would give his or her findings, sometimes asking ours. Then the doctor would give the final diagnosis, according to TCM physio-pathology syndromes, for example “Deficiency of Qi with depressed liver Qi”; state the treatment principle, “Tonify Qi and move Liver stagnation”, and give a prescription of about twelve herbs, usually a modification of a classical formula – many of which originated in ancient times.
We were able to question the doctor and patients for additional information, for instance details of the medical history, or clarification of the diagnosis or prescription. We had some access to previous herbal treatment, and especially in those patients whom we saw several times it was fascinating to follow the doctors adjusting the prescriptions as the patients condition changed.
As time allowed, we were able to ask about the patient’s progress – sometimes over a period of years of continuous or intermittent treatment. Often the patient had been treated by Western and Chinese medicine, though usually not concurrently. Modern technology such as blood tests, X-rays, and sonograms were sometimes used to monitor the effects of herbal treatment. Sonograms, for example, gave concrete validation that herbs were successful in “ Dispersing damp and moving Liver Qi,” and so dissolving gallstones.
I also had the opportunity to observe patients in the gynecology department, where I viewed cases of amenorrhea, infertility, habitual miscarriage, uterine fibroids, endometriosis, and functional uterine hemorrhage. It was obvious that TCM has much to offer for these problems as compared with Western medicine treatments.
My personal experiences as a patient of herbal medicine while in Chengdu were very gratifying. I received effective treatment for diarrhea, a canker (mouth ulcer) sore – on the eve of going to hot, dry Tibet, which I knew would aggravate my Stomach Fire – and a cold with a sore throat. My sore throat was treated with a formula which included dried silkworms as part of the tea. This raises the point that while Internal Medicine relies primarily on plants, it also makes use of minerals, fossilized bones, and animal remedies such as deer antler, anteater scales, centipedes, and scorpions.
Chengdu was definitely an interesting place to study herbal medicine. As one of 28 provinces, Sichuan is home to one sixth of mainland Chinas population. Its lush climate makes it the agricultural center of China. It grows two thirds of the varieties of herbs used in Chinese medicine, and produces ten percent of the nation’s total volume of herbs . One gets the idea that all the tea in China is a much more extensive and imposing universe than one had imagined.
In the acupuncture department we observed and performed acupuncture for the treatment of muscular atrophy, facial palsy, pain syndromes such as arthritis, headaches and neuralgia, deafness and rehabilitation following stroke or injury.
In a sense, the modernization of TCM has brought a more physicalist view of acupuncture, and so underestimates it, relegating it to the role of physiotherapy and musculo-skeletal and neurological problems. Historically acupuncture has been used to treat any disease, since it balances and enhances the body’s energy in a general way while dealing with specific symptoms. While herbs or Western drugs are the primary therapy for organic diseases, acupuncture can complement them.
We witnessed two surgeries: The correction of a trauma-induced glaucoma, and a partial thyroidectomy. General acupuncture is combined with drugs to induce anesthesia, as the synergistic effects of the two allow for much lower drug dosage than would otherwise be needed, and thus a higher level of psychological functioning by the patient during surgery can be maintained. This promotes a more rapid recovery following surgery, and decreases the risks associated with drug-induced anesthesia.
TCM also includes Tui Na, a system of massage and orthopedic manipulations reminiscent of Western osteopathy and chiropractic; TCM hospitals have Tui Na departments, which form an important part of their treatment of orthopedic problems. Chinese medicine successfully treats some spinal disc problems with Tui Na, as well as acupuncture, in cases were Western medicine would typically resort to surgery.
In a broader sense, TCM also includes meditative practices such as Tai Qi Quan and the Taoist Yoga knows as Qi Gong. Tai Qi thrives as daily practice for many Chinese, especially the elderly. Qi Gong is experiencing a renaissance: Its traditional spiritual metaphors are now supported by modern physiological concepts of relaxation-response and visualization. Qi Gong is gaining wide acceptance as treatment for cancer and many chronic diseases; we might view it as a combination of yogic breathing and techniques similar to those of biofeedback. Recently TCM medical colleges have begun to implement formal Qi Gong departments.
China has separate institutions for Western and Chinese medicine; TCM doctors are well trained in Western medicine, and Western medicine doctors are exposed to TCM. There seems to be a good level of cooperation: TCM doctors refer patients to Western medicine hospitals for appropriate medical treatment and some surgeries, and make use of western medicine’s technological diagnosis.
Chinese people typically go to local doctors, of Chinese or Western medicine, and herbal pharmacies for most of their health care. For serious diseases they turn to major hospitals. Many go to TCM hospitals, and many end up at, and often receive more effective treatment from TCM after trying Western medicine. Some Chinese perceive western medicine a more scientific, while others prefer TCM and stay within that system unless they are referred out by a TCM doctor.
China is committed to a synthesis of Traditional and modern medicine, and offers practitioners like myself a view of the of two possible worlds. China will continue to benefit from modern medical practices, as well as research which validates TCM, as in the pharmacological study of herbs and the technological measurement of physiological improvements due to TCM therapies. The fact that TCM can comfortably assimilate modern science points to its durability and profound insights. The adaptability of Chinese medicine in dealing with disease is mirrored in its confident acceptance of cross-cultural examination. We may wonder if our Western science and culture can do the same: can our biochemists live with themselves if they believe in the 5 elements and Ying and Yang?
As Westerners whose patients’ ills often include important psychological aspects, we were very interested in how TCM deals with mental and emotional disorders. There is no specific field of “psychology” in Chinese medicine, as the body and mind are not conceived as separate entities; all diseases involve psyche and soma.
While TCM is used to treat serious disorders such as schizophrenia, I did not witness such cases. And there was little explicit reference to the correspondences, postulated by the Five Elements Theory, between internal organs and specific emotions; excessive anger, for example, is one sign among the constellation of otherwise mainly physical indicators associated with a liver imbalance.
Although some degree of psychological counseling is a part of the Chinese healing tradition, TCM is today primarily concerned with physical medicine. There is due mainly to the fact that there is such a great need to provide for the treatment of physical diseases. Communism’s materialistic overtones and Western medicine’s bio-chemical approach also contribute to this trend.
It is not a very satisfying or inspiring to hear a doctor tell a patient to “change her emotions.” And yet another doctor carefully explained to his patient that she should not worry so much, that dwelling on her problems would pose an obstacle to improvement. “Worry” relates specifically to the Spleen energy, which was deficient in this woman, and by overly dwelling on her problems she would stagnate the circulation of Qi, exacerbating her situation. While the doctor spoke in the context of TCM, it also seemed he was offering common sense – and it seemed like good practical advice.
TCM does not offer startling psychotherapeutic techniques, but its notion of health as the smooth, balanced, unobstructed flow of Qi (bio-energy), and its treatments to facilitate this, can contribute to emotional health in ways which can benefit us in the West.
Traditional Chinese Medicine is an impressive healing system, and is challenging to study. As a body of knowledge it has less voluminous information than Western medicine, but it is a difficult art to master. While it is filled with naturalistic metaphors and may seem based in a mystical biology, it is actually very concrete and practical to work with, once one learns the basic concepts and vocabulary.
Difficulties arise because TCM is truly an accumulation of empirical knowledge; while it is systematized and categorized, in clinical practice one finds endless shadings, subtleties, and exceptions. This is why it is said, “If you can find a rule, it is not Chinese medicine.” The doctors with whom we studied where almost always correcting and refining our diagnosis, and every herbal prescription seemed to reveal a new wrinkle.
And yet Chinese medicine feels coherent and even elegant in its ways. This is partly due to the inherent ambiguity of human health and disease; TCM fluidity is well suited to encounter such slippery phenomena. Chinese medicine is holistic in treating the entire energetic physiology, or at least an expansive cross section of it. Its diagnostic tools and constant permutations of herbal formula also make it an amazingly precise medical practice. And it is grounded in thousands of years of experience with specific healing substances and acupuncture points.
Chinese medicine works not with microcosms of microbes and macrophages, but with man as the offspring of Nature’s processes. China’s medicine today looks at molecules and compounds, but its gift to the world is the astute appraisal of symptoms and signs which can be interpreted through skillful physical diagnosis, inductive reasoning and intuition.
The doctors we met were very proud of Westerners interest in TCM; they were also secure in its future, in its developing alongside Western medicine, and its continuing to provide a source of medical knowledge which will be increasingly appreciated and utilized throughout the world.