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FORUMChina Journey Finds Integration of Eastern, Western Medical Practice and Education
By Catherine Chu You should not play Xiangqi [Chinese chess] in the evening. The evening is a time of yin and chess requires much yang energy. As a medical student, you should know this. Understanding the nature of yin and yang is fundamental for the practice of good medicine." Dr. Wu looked at me expectantly from across the table, waiting for an educated response to rescue my pride. "Zhen de ma [really]?" was all I could muster. I was an American medical student in China, sharing dinner with a Chinese medical doctor; this was not the first time my basic medical knowledge had been tested. Fueled over the summer by a traveling scholarship from my undergraduate university, I saw seven Chinese provinces with my eye focused mainly on medicine. I found it easy to gain access to Chinese physicians in any small village or large city I visited. But even though I've invested six-plus years of academic life in studying the West's basic concepts of nature (i.e., physics, chemistry, and biology), in China I was far afield from understanding anything basic at all. "Place your hand under the table and close your eyes," Dr. Wu instructed me. I did so and momentarily felt a swelling of pressure in the center of my palm, which quickly spread out to my fingertips. As I waited a few more seconds, heat seemed to enter my hand and radiate in the same pattern. Dr. Wu knew from my puzzled expression that I had "caught it." "This is the power of qi gong," he explained. "I use this power to heal my patient's illnesses. I would show you more, but I'm on vacation now, like you. So, let's eat!" Dr. Wu leaned back and released a big belly laugh. Which Doctors are Real?Determining who is a "real" doctor in China can be difficult. Although there are several famous Chinese medical schools in the larger cities that are organized in a manner similar to their Western counterparts, the side streets of every small town are peppered with herbalists and masseuses who claim to be able to read the status of your kidney and spleen using the triple finger pulse check and examining your tongue. These "doctors" will set up shop anywhere, spreading their goods before them on a blanket, offering free check-ups to whomever passes by. To an untrained eye, the medicines found at such traveling pharmacies are surprisingly reminiscent of the remedies one can purchase from the larger, hospital-affiliated pharmacies. But then, maybe all sea horses and deer antlers are not the same?"Legitimate" Chinese medical doctors receive their license after attending an accredited Chinese-medicine university for five years, prior to residency-like training in the hospitals that lasts several more years. Like American medical students, Chinese students are required to pass a series of examinations on fundamental knowledge and critical skills along the way. There is a parallel system of Western medical training in China in which the students complete five years of university training in a Western-medicine university prior to their residency in the Western-medicine wards of the hospitals. Western-medicine doctors trained in the West have more total years of university training before becoming a licensed physician than their Chinese-trained counterparts because they typically graduate first from an undergraduate university before matriculating into medical school. Both Chinese-medicine and Western-medicine Chinese medical students enter medical school straight after high school. Though they sacrifice the liberal arts training that most American pre-med students receive in their undergraduate years, these students cover the same medical science material as American medical students do before they graduate. The Chinese system of medical education has some advantages. For example, the system is better at integrating Chinese and Western medicine than systems in the West. Although in China, a doctor trained in Western medicine will not be licensed to prescribe complex Chinese herbal formulas or perform acupuncture, and a doctor trained in Chinese medicine will not be able to prescribe Western drugs or perform surgery, both types of physician understand the basics of each other's professions. The students from Shanghai [Western] Medical University with whom I spent a day doing rotations, for example, were able to explain to me the diagnostic techniques used in tongue examinations and the medicinal uses of several herbal formulas I asked them about. This integrative approach to medical training may be due to necessity. Most of the people I met in China use both Western and Eastern medicines, depending on the type and severity of their problem. Most of the hospitals that I visited in China likewise had both Chinese and Western medicine departments, leaving it up to the patient to decide which ward to visit. Medical students in the U.S. do not receive this type of integrative training. But, as more and more American patients demand access to forms of complementary therapy, I suspect we Americans will have much to learn from the Chinese. The Chinese locals that I asked told me that both Chinese and Western medicine each have advantages. The standard belief in China is that Western medicine is best used to treat acute illnesses that require immediate relief (like appendicitis, infection, and heart attack), and Chinese medicine is best used to treat chronic illnesses that require long-term success (such as asthma, back pain, and allergies). But these generalizations are not always followed to the letter. Chinese PracticeIn Beijing, for example, I spent a day at Beijing University's #3 Chinese Medical Hospital shadowing Dr. Huo in the acute care clinic. There I observed patients presenting with symptoms ranging from facial paralysis to migraines to weakness of the leg being treated with various styles of acupuncture, moxibustion, massage, and blood-letting. The head doctor of this clinic said that most of the treatments he uses have been proven efficacious in lab experiments on rats, although human trials have not yet been conducted. He also explained that though the nature of acupuncture is often difficult for a Western mind to understand, the mechanisms are sometimes consistent with familiar neuroanatomy.Without the training to understand Eastern concepts of health and sickness, much of Chinese medicine still seems to be a lot of hocus-pocus to me. Yet this does not take away from the fascination. After just six weeks of travel, my backpack was crowded with strange herbal potions, medicinal teas, mushrooms, and small dried animals purchased from pharmacies and mountain men or prescribed by doctors I had met. I even had the opportunity to receive a treatment from Dr. He, a Naxi physician from the village of Baisha, whom even Westerner's who have not traveled to the East may have heard of. Dr. He reached international fame after surviving labor camps during the Cultural Revolution and then returning to his small village to study botany and resume his calling as a physician. Regarded as the wisest herbalist in Yunnan province, Dr. He has been written about in more than 500 articles and more than 40 different languages. He was pleased to show me his clipping from the Boston Herald. Though I was impressed by his familiarity with the many books and herbs that were stacked high in his office, the lines of travelers waiting to meet him, and his ability to communicate in the language of each of his international visitors, the real beauty of Dr. He lay in simple actions. For example, he chose to interrupt his appointment with me to first solve the matter troubling a young Naxi woman, who was crying on the steps outside. Although Dr. He, over 70 years old, probably receives a hundred visitors a day, he still moves unflustered and with becoming grace. All in all, two months in China observing the country's rich medical culture left me awed. Already intrigued by my grandparents', friends', and some academic advisers' interests in Chinese medicine, I came to China to uncover a deeper meaning of what it is all about. In a paradoxical way, I have been relieved to learn that the teachings of Chinese medicine go deeper than one summer's wanderings can reveal. One physician I shadowed in Shanghai told me, "In two months, you can only be like a dragonfly skimming the surface of the water. To truly understand, you must return for a longer time, to be as a fish swimming in the depths." As a dragonfly this summer, I may not have learned very much, but I know one thing: I do tend to lose at chess when I play in the evening. —Catherine Chu, a second-year student at HMS |
