Chinese Medicine Today
By Ken Rose, Co-author: Who Can Ride The Dragon?
One of the first cases I ever treated, when I began my clinical apprenticeships in the teaching hospital attached to the University of Traditional Chinese Medicine in Chengdu, was a man in his mid-sixties who had retired from a career as a music teacher in Tibet. He had been sent to the remote countryside in the 1960s as part of the general pattern of the Cultural Revolution to relocate urban dwellers to rural locations for "reeducation." Unlike many of his fellow Han Chinese who thus found themselves in far flung regions of the country, this man had chosen to stay in the strange and wondrous land of the high plains of the Tibetan plateaus.
"It is so quiet," he once told me, "that when I lay down in the grass, I could hear the insects crawling on the leaves and stems. The blue sky stretches overhead, so beautiful."
I was moved by the vivid images that came to life when he spoke from his hospital bed. He had entered the hospital seeking relief from crippling arthritis. The pain, he explained, was not the worst of it. It was the disability. He was in the final stages of composing a symphony based upon the folk songs of the Tibetan people with whom he had lived for twenty-nine years before returning to his homeland in Sichuan province. His disease had finally forbade him from working at the piano.
"Now, I don't know whether or not I will ever complete my life's dream," he said one morning when we made our rounds with Dr. Li.
Dr. Li was a woman in her late forties. Although I never heard her Cultural Revolution story, she had one. No one in her generation, or that of her older patient, escaped those ten years without an unbelievable story that many are still reluctant to tell. She leaned over and took up the retired music teacher's twisted hands and patted them firmly.
"You will get better. Old Grandpa. Don't you worry."
The old man's eyes lit, but only briefly. His despair, like the knots in his fingers, was deep.
"His condition is characterized by dampness and heat," explained Dr. Li. "Damage to the digestive system from all those years eating dried meat."
"They have no vegetables," said the old man to me by way of explanation of what he now understood to be the most painful lesson of his reeducation.
We discussed the point prescription in some detail and then Dr. Li stood by and watched while I inserted the needles, correcting me, as always on my lack of resolve.
"You foreign students are all so tentative. Never hesitate when inserting the needle. That will only make the patient feel uncomfortable needlessly." She took up a needle and deftly inserted it into the next point just below the old man's knee. "Like this."
The old man's bed was in a room occupied by three other patients. The air was thick with the smoke of burning mugwort, which is used commonly in the clinic. One of the things I noticed in the acupuncture and moxibustion clinics in both the inpatient and outpatient wards was the fact they were definitely both acupuncture and moxibustion. Moxa (the Chinese herb, ai, artemesia vulgaris) is relatively speaking unused by practitioners of acupuncture in the States. It was this awareness that led me to question many aspects of how Chinese medicine has been imported into the United States up until today.
In fact, the whole identification of acupuncture as the discipline that is recognized and licensed by various state governments today reflects a profound misunderstanding about Chinese medicine. In the teaching hospital in Chengdu, between three and five thousand outpatients are seen every day. Of these, no more than ten percent receive acupuncture and moxibustion. The great majority of patients is seen in the Internal Medicine departments and is treated with herbal medicine. Moreover, a high percentage of patients who do receive acupuncture and moxibustion are concurrently being treated with herbal medicines.
The preponderance of herbal medicine as the therapy of choice is evident when you first enter the hospital. The front doors open into the herbal pharmacy waiting area, where hundreds of patients congregate to wait for their prescriptions to be filled throughout the day. Dozens of white-coated pharmacists toil endlessly, weighing out portions of Dang Quai, Fang Feng, Chuan Bei Mu, and a hundred other herbal ingredients and mixing them into the endless stream of formulas that appear as bundles of herbs tied up in paper wrappings and passed in plastic shopping bags across the counter into the waiting hands of the patients who impatiently jostle one another at the pharmacy windows.
The herbal formulas for patients in the inpatient wards are prepared by the nursing staff and delivered in bottles to the bedside so that patients can take them at the prescribed times. Generally there are three dosages administered each day. Some herbal formulas have been extracted and otherwise refined for hypodermic administration. And there are a wide variety of prepared formulas in use as powders, pills and liquids. Most of the large and many of the smaller hospitals of traditional medicine operate their own research labs and pharmaceutical factories. The factory attached to the teaching hospital in Chengdu became a joint venture operation with one of Sichuan's leading private pharmaceutical firms several years ago and continues to supply the hospital and the general public with formulas that are developed by the clinical and research staff of the hospital.
At the university in recent years, a number of formulas for treating coronary artery disease have been under intense development. To treat the rheumatoid arthritis of the old music teacher, however, Dr. Li was having to rely upon ancient, tried and true formulas. She reviewed each patient's condition daily and adjusted their formulas accordingly. When the morning medications appeared, brought in by a young nurse-in-training, Dr. Li opened the bottle and sniffed the mixture it contained. Nodding approvingly, Dr. Li handed the bottle back to the young nurse who set it down on the nightstand beside the old man's bed and proceeded to pour its contents into an enamel coated metal drinking cup that was kept there for this purpose.
"You drink up," said Dr. Li cheerfully to the old man as we prepared to leave his bed and proceed to the next patient. "And don't worry, everything will be alright."
As I turned to follow Dr. Li, I felt the old man's fingers on my left arm. His grip was surprisingly strong for someone in such pain. I turned to see what he wanted. He smiled at me and said, "Thank you for your help my young foreign friend. I want to play my music for you when I get out of here. I want you to hear the haunting melodies that I recorded in here for all those years." He tapped his temple with his bent finger and sighed.
The smoke swirled around his bed. It seemed that I could almost see the vision that must have danced in his head of the distant Himalayan peaks washed in a different mist. And he began to hum a tune in the back of his throat as he lay back in his bed to rest.
"C'mon," said Dr. Li, there's lots of patients still to see."