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Photos from China

September 2018

I recently visited China to study Traditional Chinese Medicine as part of my Doctorate of Acupuncture and Oriental Medicine program.

10 days Following Acupuncture Doctors in China.

William Leigh

Day 1:First thing is the morning we met at our hotel by Mrs Chinn. Mrs Chinn was extremely polite, happy and definitely all business. She led us briskly to the classroom near the hospital together. It was approximately 7:50 in the morning and the Hangzhou was still waking up. We passed a large police station, with lines of police being inspected by their Sergeant and elementary school without children on the way. Breakfast of humbow’s and other traditional foods was offered from the windows of restaurants. The coffee and tea shops were not quite open yet, because coffee and tea from a shop was recreational food.

Our classroom was located in an older, yet modern seven story business building on a street with many modern 3-7 story buildings, all in slight disrepair. Our school rented one wing of the 5thfloor. All of the furnishings were very practical and seemed a bit old. The classroom had individual desks like you would find in high school pushed together into tight rows. Our classroom had a large air-conditioner unit by the window. We began with a group orientation discussing our schedule for the next two weeks including following doctors and classroom study. We were given white doctor coats and lockers and were divided into three groups. There was also a group of three acupuncture practitioners from Scotland who were primary interested in studying TuiNa.

Our orientation lasted a bit more than an hour. Then we went back outside and walked to the hospital on the next block and were led to link up with our doctors. Our school leader led us up to the 11thfloor of the hospital and were introduced to Dr. Zhou Haijiang. Dr Zhou was a young doctor approximately in his early thirties; he spoke English well and explained many treatments. But he was also moving very fast, we saw over 20 patients in 1 hour. The largest portion of the patients were

suffering from facial paralysis. The second largest group was recovering from a stroke and trying to regain mobility of an individual limb or whole side of their body. Then there were many other complaints including broken bones, dysphagia, GI difficulties and an assortment of other chronic problems.

The hospital was similar to American hospitals in general architecture, but had more patients in every hospital room, 3-4, with beds pushed up against the walls to make more space. Also the Chinese hospitals are not as clean, it was easy to see water damage, excess buildup of dust on ventilators and generally looking like everything could use a new coat of paint. The interaction between patient and doctor was overheard by the other patients in the room and everyone had family members helping.

Dr Zhou began our education with facial paralysis. He told us that patients that were accepted into the hospital usually have recently acquired facial paralysis and received acupuncture treatment every day for up to two weeks. After they were discharged the patients would return to the clinic for acupuncture 2-3 times a day for many weeks. If progress became slow, the patient would receive acupuncture only once a week. He stated that treatment would continue as long as there was some progress, regardless of how slow, sometimes for over a year. He stated that acupuncture was the best form of treatment for facial paralysis and that all doctors in the hospital would refer any patient with facial paralysis to acupuncture treatment.

Often facial paralysis is one sided, but he did not differentiate treatment based on Bellspalsy,virus or unknown etiology of treatment. He only differentiated on TCM signs and symptoms including pulse and tongue. He stated there were two stages of treatment, within the first two weeks and after the first two weeks. Acupuncture needles were not inserted into the effected side of the face during the first two weeks of acquiring the disease.Yetneedles were inserted into the unaffected sideinstead.

The doctor also applied distal acupuncture needles into the limbs following Traditional Chinese Medicine protocols and sometimes needles were inserted into the abdomen for qi deficient patients. We later had classes on three methods of abdominal needle placement.

Treatment for stroke followed similar protocols, but there were not two phases of treatment, and needles were often inserted into the effected limbs. Scalp acupuncture was also used for stroke patients but not as aggressively as I see in the US. Also moxa could not be used in the inpatient setting because they were trying to keep the hospital free of smoke.

Dr, Zhou had two assistants who followed closely listening to every case, they would attach electrodes when directed and removed needles 30-40 minutes after insertion. This was standard procedure for all of the acupuncture doctors and gave Dr, Zhou the ability to see many patients in an hour.

1stday afternoon withDr.Mo.The Traditional Chinese Medicine out-patient clinic was on the second floor of the Hospital, easy to find from the main entrance. This clinic is in a room about the same size as a elementary school classroom, loosly divided into two sides. The six doctors desks and took up half of the clinic. This is where patients first met their doctors and discussed their complaints. Every doctor had a computer and kept notes for every patient. The second half of the clinic was the treatment room. There were approximately ten small rooms separated with partial walls and dividers oh the outside of the room. Each of these small rooms had two massage table size acupuncture beds shoved up against the walls. Therefore there were about twenty acupuncture beds squeezed into the room. In the center were 8 wooden chairs that appeared at least fifty years old in two rows back to back. These chairs werer for patients that could be treated while sitting. Each of the wooden chairs had a small heater attached that again looked like it was fifty years old that was rarely used and mostly seemedbroken.

The most noticeable feature of the room was the smoke from moxa. The room was thick with moxa smoke, obviously many times more noxious than a Grateful Dead concert. The Hospital used a lot of low quality moxa, huge pressed balls on the ends of needles. My fellow American students had watery eyes, were often coughing and sometimes had to step out of the room. This seemed just like another day for the Chinese practitioners and they really didn’t even notice our difficulty.

There were about 6 Acupuncture doctors using the room, each had two assistants. A patient would come into the room and either choose an available doctor or let their previous doctor know they were their for treatment. Sometines the assistants facilitated this communication. Then the patient would wait at the doctors desk, or nearby until the doctor asked them forward. The doctor would sit at his desk and discuss the patients complaints, take their pulse and look at their tongue. Then the patient would be directed to a table or chair in the treatment room. After the doctor did an intake for all of the patients that were waiting, then he would move into the treatment room and treat the patients. Inserting needles and giving instructions to his assistants. The doctor spent less than 15 minutes with each patient then the assistants applied electrical stimulation, moxa with protective cardboard, cupping and infraredlamps.

Dr Mo was a female practitioner who spoke excellent English. She was extremely knowledgeable and helpful. This afternoon,Dr.Mo only had a few patients and we were able to discuss her practice with a broaderview.Weoften would return to asking her questions even when we were following other doctors.Dr,Mo stated that all of the doctors were paid a basesalary,but were also paid per patient. She explained that because they were paid for each patient, this would help the doctors strive to become better doctors. She further said that because she was a female practitioner, that her practice was mostly female patients. Female patients would seek her out to help relieve their difficulties.

A woman in her early twenties came in for treatment. She was inherently shy and waited patiently to speak with Dr, Mo although there were other Doctors available. She was suffering from Amenorrhea for many weeks after many months of prolonged menstrual cycles. She sat with Dr. Mo at her desk and discussed her difficulties then was escorted to a treatment bed by an assistant. Dr. Mo arrived, inserted distal needles for treating Amenorrhea, needles into her lower abdomen and gave instructions to her assistants. Her assistants placed a large moxa box on her lower abdomen. This patient returned many times while I was at the hospital and Dr. Mo said that her condition was

improving. It was easy to see her emotional affect was brighter and happier and she seemed to be making friends with the female assistants in the office.

The most striking part of her and all of the other doctors in the hospital therapeutic practice was that it was simply a Traditional Chinese Medicine acupuncture practice. Exactly the medicine that I learned at Bastyr University. Traditional points and techniques were used for traditional diagnosis.

Even more striking was how clearly the Chinese patients clearly demonstrated TCM syndromes. We clearly saw a mirrored tongue and a heavy fur tongue. It was easy to see a dark kidney deficient complexion vs a yellowish spleen yin deficiency complexion.

On the second morningwe followed Dr. Bi ying. Dr. Bi Ying could not speak english well and he was busy seeing many patients in the morning. We say patients for facial paralysis, digestive disorders, headaches, and many other ailments. It was a busy day and the office was full of moxa.

On the second afternoonwe had a class on Jin’s 3 needle technique. The idea is to memorizee a fast three needle only prescriptin for many common ailments. For example, Knee: Xian, St 36, SP10.

Upper Jiao: Li 4, Li 11, SJ5. Rhinitis: Li 20, Bitong, Yintang. Shoulder: Li 15, SJ14, JianQian and many others. I recognized that these were standard points for treating the designated ailment and thought this was an overly simplistic method of treatment.

On the third morningwe had a similar experience as the 2ndmorning. We worked with Dr. Li and he began to discuss treating Facial Paralysis patients. He discussed that there are primarily three stages for facial paralysis. 1stis Acute stage and lasts for approximately two weeks. In this stage the facial paralysis gradually gets worse. Needles are not inserted into the affected side of the face and only placed distally or in the contra-lateral side of the face. He used GB 21 and Cervical HTJJ points to nourish the nerve. He asked the patients to return at least three times per week. The second stage was

the Sub-Acute stage. Here you needle directly into the affected side of the face and use light stimulation of moxa and/or electro. You also ask the patient to return at least three times per week. In the third chronic stage after 4-6 weeks, you continue treatment similar to the Sub-Acute stage, yet you can increase stimulation. He stated that you continue treatment as long as the patient feels there is progress. You ask the patient to return at least once per week. Dr. Li stated that there is a low recovery rate for facial paralysis in China and it is standard procedure in the hospital to refer patients to the acupuncture clinic.

Weran into the group of practitioners form Scotland and they invited me into the TuiNa clinic where I spent a few hours.Twoof the Scotish practitioners were applying TuiNa to patients. I really enjoy practicing TuiNa and they saw the salivating dog expression on my face and invited me to join. After quickly diagnosing my patient I found a deep Trigger point and I began to apply TuiNa. As I began to work deeper, she was experiencing some discomfort, complained in Chinese and everyone laughed. Then she turned to look at me in a crossed look of surprise and respect. Then she put her headbackdownandenduredthetreatmentuntiltheTuiNadoctorsteppedintoreplaceme.TheTuiNa doctor doctor discussed using needles with TuiNa and stated you direct needles into the muscle cramp pointing at the cramp. He stated that TuiNa increased the flow of blood and qi and increased the patients response toneedles.

Third afternoon:We had a class for abdominal acupuncture taught by the director of the hospital acupuncture program. We discussed the Turtle microsystem, BuaGua system and time clock system. The systems were very similar, The ambilicus was the center for all of these system and as you insert needles away from the ambilicus, you are moving distally throught the body. Generally, this style of microsystem treatment does not make much sense to me. What I gathered is that using abdominal needles for deficient patients is helpful. But the ideas of first choosing exactly which system matches

the patient, then which needle placement treats their condition seemed a little too esoteric for my style of practice.

Fourth Morning:Dr.Xu Fu ran a facial paralysis clininc. This clinic was next to the general clinic and was used only for facial paralysis patients. There were 10 beds and 4 assistants with one excellent interpreter.Dr.Xu Fu was an experienced and highly respected acupuncturist. Patients would travelfor many miles to receive treatment from him for facial paralysis. He treated many patients during theday,but also answered a few of our questions. He confirmed much of whatDr.Li stated the previousday.Dr Li would intake approximately 10 patients at his desk and the assistants would lead them to and acupuncture bed. ThenDr.Li would begin at bed number 1 and treat each patient while giving his assistants instructions. When he was done with the first group, about 90 minuteslater,he would go back to his desk and would intake another 10 patients and repeat the process. He saw over forty patients thismorning.

Fourth afternoonwith Dr Hong Shou Hai. This was slow afternoon at the clinic and many tretment beds wereempty.The assistants were hanging around with their phones.Wewere able to see the practice of leaving a cat gut thread in a patient have constant stimulation of the spleen meridian with an effort to reduceobesity.Wealso began to meet the assistants. Bo was a batchelor student from Malaysia learning Acupuncture in Hangzhou. He spoke excellent english and told us how there are many levels of assistants. There were students at the masters level, doctors level and post doctors level. Most of the assistants were masters students and were working toward their practicing degree. He stated that he would need further education in order to gain a license to practice.Wealso had a question and answer session withDr,Mo.Wediscusses Motor point and trigger pointacupuncture.

After teaching her the fundamentals, we gave her a demonstration. I was the patient. Sung found a

trigger point on GB 21 through palpation, inserted and manipulated the needle while the muscle was reacting. Then removed the muscle. Afterward, the Trigger point was reduced.

Fifth Morningat the Inpatient hospital withDr.Li Jinjin.Wesaw many patients with Dr Li and also had a small class. He began at the highest floor of the hospital and moved down through the floor treating many patients in many rooms. His two assistants were responsible for removing needles and applying electro and cupping. He stated that facial paralysis patients that stay in the hospital stay for up to three weeks and receive acupuncture everyday.They have to come to the hospital while in the acute stage of the disease. He gave us his personal therory on treatment which contradicts the other doctors. He stated that he inserts needles into the affected side of the face during the acute stage ofthe disease. He explained that during the acute stage, the disease is increasing and the patient will not see any improvement. His opinion was that most doctors did not want to insert needles into the affected side because they did not want to be seen by the patient as being a poor doctor and not helping them. He explained that needles increase the local micro stimulation and will have a beneficial effect on the nerves of the effected side even though the disease is gettingworse.

Fifth afternoon in the outpatient clinic: Similar to other afternoons and a slow day. One patient had a clear to see mirrored tongue, another showed a yellow pale complexion of spleen deficiency. I began to recognize that Chinese patients displayed TCM symptoms more clearly than American caucasian patients.

Sixth Daywas similar to the first day. We followed Dr Dr Zhou treating patients admitted into the hospital. We saw over 30 patients. Mostly elderly suffering from stroke or other debilitating disease. In the afternoon we had a slow day with only a few patients.

Seventh Daywe began back in the facial paralysis clinic. The doctor saw many patients but we did not see anything that we had not seen previously. We discussed among ourselves how all doctors inserted their needles without Guide tubes. In the afternoon we had a lecture about acupuncture Analgesia and Discussed western pain medicine.

Eighth Day:The clinic was very busy and e were following a very busy doctor who did not have time for us and could not speak English. We had to make the day morning work for ourselves. In the afternoon we continued the lecture of the abdominal microsystems.

Ninth Day: By this time the fatigue and monotony was getting to the group. Although we have learned a lot, we saw many similar treatments and had many similar days.Wewere back in the Facial Paralysis clinic withDr.Xu Fu. He clearly stated that if you want to be a good practitioner of Traditional Chinese Medicne, you should learn to read and speak Chinese. In the afternoon we stayed withDr,Mo instead of our assigned doctor and enjoyed her company and insight.

TenthDay: In the morning we were introduced to Famous Doctors clinic. This is a special clinic on the side of the hospital which is entered by its own entrance. Here are most famous and experienced doctors in the Hospital. This is one of the most astonishing differences between China and America in terms of Health care. Reputable doctors are sought out by the population and some doctors rise to high levels of fame and fortune just seeing patients with average complaints. In America, doctors rise in wealth by choosing high paying specialties, but not by patients seeking them out and paying them more because they have proven to beexceptional.

Our small group and an interpreter squeezed into the Famous Doctors office. It was a small room with a full size office desk in the middle. Behind the desk was the doctor and his Number 1 assistant interacting with the patient. This assistant was a post doctorate level student. Then there was

another student interacting with the computer following the interaction with the patient. Then there was one or more students just following the doctor standing behind the other three. We squeezed in front of the desk and our interpreter efficiently described the interaction. Our interpreter was a masters level student herself and clearly understood Chinese medicine. On the short side of the desk was the patient and her family. Sometimes the patient answered the question and sometimes the family answered for her. It was a very dynamic interview and often another patient tried to get in the door.

There were about 12 people in the small office and simply not enough room for anyone else. Thorugh out all of this, the Doctor stayed composed, moved forward with the interview, and gave a Chinese herbal prescription. A new patient with family quickly filled the previous chair and surrounding space and the system repeated itself. We saw about 16 patients in a couple of hours. The Doctor was a specialist in Gastrointestinal conditions and most patients complained of digestive trouble.

In the afternoonwe got a tour of the Herbal dispensary and really enjoyed seeing how they measure and package the herbs. The room was huge with hundreds of full size drawers of herbs. There were two tables for measuring and packaging of herbs. What was disturbing was the amount of herbs that have gone rotten and were no longer usable and the build up of dust. You could see a thick coating on the ventilation system vents and high surfaces of the room.

After the tour we graduated from the program.Wewere given 100 hour certificates of completion.Wetook pictures and said good bye to our hosts at the school. This was an extremely informative and important part of my education. Most importantly, I got to see that Traditional Chinese Medicine is practiced in China. Also, through following many different doctors, I received an advanced course on treating Facial Paralysis. I also got to visit the TuiNa clinic and receive a TuiNa treatment from a TuiNadoctor.I hope to return and spend more time in the TuiNadepartment.

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