Most of my time here in Hangzhou has been spent in the Zhejiang Provincial Hospital of Traditional Chinese Medicine (TCM), so I thought it worth a post of its own.
I do two 4 hour sessions a day. Mostly in the acupuncture outpatient department and specialty herbal departments, but also the Tuina (Chinese massage) department and in the inpatient wards (doing rounds in different parts of the hospital).
Acupuncture
In the acupuncture clinic there are 19 cubicle beds and 10 chairs. They are often mostly, if not completely, full for the better part of each 4 hour shift. 3-4 acupuncturists work at a time with student assistants. There are very few records kept (as far as I can tell), pretty much just the patient cards in which dates of treatment are recorded.
Tools:
-they use only free hand, disposable needles. Needles are sometimes disposed of in plastic disposal containers; just as often in trash cans or trash bags; and there a many needles scattered about the floor.
They use moxa rolls extensivly. the place is well ventilated when it's warm, far less so when it's cold and the windows have to be closed; in which case it is quite smoky. (I have heard that some of the former doctors here have died of lung disease--a testament to how toxic moxa smoke is.) For the moxa rolls they have this cool 8 pronged pitch fork to light and hold the rolls.
-they also have this nifty device to press out moxa cones that they then put on an herbal cake (of Bi syndrome herbs) to put on the skin.
-all of the Electro Acupuncture machines are without clips; just loose wire endings.
-they use a 'thick needle' of 80-120mm that they use to thread down the spine, often for neurological and dermatological conditions. I had it done on me just to see what it was like. I am usually not sensitive to needles, but I became faint and a little nauseous with this one.
Injections:
they do a lot of injections here.
-B12: often at ST36 to build immunity or sometimes SJ17 (in the hole behind your ear--ouch!) for paralysis, tinnitus, deafness. I even saw them do it on ST3 (on the face) for paralysis.
-Dan Shen/Salvia: locally for pain
-one's own blood: drawn from the cubital crease and injected at e.g. ST36, also for immunity and allergic diseases. I'm told it's an antiquated technique from Western Medicine.
-and others.
Techniques:
-Needle insertion: they insert very quickly free-hand, often many points in quick succession--abdomen and face especially, but you see very few winces here.
-Needling: They are also more aggressive than we tend to be--to confirm what we had always heard. I've seen them needle very deeply, lifting/thrusting GV15 (back of neck), CV23 (front of throat), and BL40 (behind the knee). Saw jinjin and yuye (under the tongue) pricked on a guy with aphasia, every GV (spinal) point needled with EA on almost every point, a 2 year needled as his father restrained him while he was crying in an opisthotonic spasm, and a lumbar puncture (by a Western doctor) that would dispel any acupuncture student's fear of needling a point on the GV meridian.
-Abdominal/turtle Acupuncture: they do a lot of abdominal acupuncture. somewhat new a style, it is a microsystem on the abdomen in the shape of a turtle. Many of them swear by it and patients often say they get better immediatly.
-Moxa- not as much direct moxa as i expected, although I've seen it done for plantar warts a few times--in which the patient comes in a just does it themselves. But they do a hell of a lot of the rolled moxa--great, but very smokey.
-Gua Sha- I have not seen it done once.
-Cupping- done a lot. Washing them is done like an afterthought--not much.
-Blood letting- haven't seen it done.
-Catgut implantations- where they insert an acupuncture needle through a hypodermic needle to implant a small piece of catgut (what is used for internal sutures) under the skin in order to stimulate a point for 4-6 days (they say). Only saw it done on the abdomen for weight loss, but could be used for anything really.
Prices: $1=7.5RMB
-needles- 20RMB
-cupping- 3RMB
-EA- 3RMB/pair
-moxa: 5RMB....etc
-total would come to about US$5
----strange scheme if you ask me. But it is pretty damn cheap. The government pays for much of the hospital expenses; for, with prices like that, more money has got to come from somewhere.
Dr. Xuan, the head of the acupuncture department, sees the most people. I have followed her as she saw about 25 people in less than 40 minutes for the first round, 15 on the second, maybe 10 scattered patients after that in a 4 hour shift. She just walks around the room, somehow knowing who is where, walks up to a patient, somehow remembers what's going on with them--for she sometimes barely says a word to them, and starts inserting needles--quickly. That she often does this very popular abdominal acupuncture helps her move so quickly. She often sees people 3times/week, so there need not be much discussion beyond the repetition of the treatment.
Dr. Xuan is what they call a national level doctor. The top level (above the provincial doctor and what more i don't know), she is paid more than other doctors but I'm not quite sure how they attain such status. She taught us a class on abdominal acupuncture, I think I might use some of it myself, in combination with what I already knew.
The acupuncture clinic is mayhem by US standards. There are up to 40-50 people in there at one time. Most people are getting treated, then there are those accompanying, the doctors and the students/assistants. A big open room with many dividers (just low enough for me to peak over) and chairs, it is like a community acupuncture sorta setting.
People come, hang about, get treated, talk with those around them, read the paper...Acupuncture, It's no big deal here.
(hard to see, but she's fanning the moxa smoke)
In general, the doctors here, like a teacher of mine in Boston, BJ Wang, prescribe at least 12 to 15 herbs at a time, more often 15 to 20+. The vast majority is raw herbs, some patents, very little powder, and also Western Medicine. The two forms of medicine are idealy integrated in these clinics. The doctors order and assess lab work and medical images, ask questions of both forms of medicine and prescribe either as they see fit.
Injections:
they do a lot of injections here.
-B12: often at ST36 to build immunity or sometimes SJ17 (in the hole behind your ear--ouch!) for paralysis, tinnitus, deafness. I even saw them do it on ST3 (on the face) for paralysis.
-Dan Shen/Salvia: locally for pain
-one's own blood: drawn from the cubital crease and injected at e.g. ST36, also for immunity and allergic diseases. I'm told it's an antiquated technique from Western Medicine.
-and others.
Techniques:
-Needle insertion: they insert very quickly free-hand, often many points in quick succession--abdomen and face especially, but you see very few winces here.
-Needling: They are also more aggressive than we tend to be--to confirm what we had always heard. I've seen them needle very deeply, lifting/thrusting GV15 (back of neck), CV23 (front of throat), and BL40 (behind the knee). Saw jinjin and yuye (under the tongue) pricked on a guy with aphasia, every GV (spinal) point needled with EA on almost every point, a 2 year needled as his father restrained him while he was crying in an opisthotonic spasm, and a lumbar puncture (by a Western doctor) that would dispel any acupuncture student's fear of needling a point on the GV meridian.
-Abdominal/turtle Acupuncture: they do a lot of abdominal acupuncture. somewhat new a style, it is a microsystem on the abdomen in the shape of a turtle. Many of them swear by it and patients often say they get better immediatly.
-Moxa- not as much direct moxa as i expected, although I've seen it done for plantar warts a few times--in which the patient comes in a just does it themselves. But they do a hell of a lot of the rolled moxa--great, but very smokey.
-Gua Sha- I have not seen it done once.
-Cupping- done a lot. Washing them is done like an afterthought--not much.
-Blood letting- haven't seen it done.
-Catgut implantations- where they insert an acupuncture needle through a hypodermic needle to implant a small piece of catgut (what is used for internal sutures) under the skin in order to stimulate a point for 4-6 days (they say). Only saw it done on the abdomen for weight loss, but could be used for anything really.
Prices: $1=7.5RMB
-needles- 20RMB
-cupping- 3RMB
-EA- 3RMB/pair
-moxa: 5RMB....etc
-total would come to about US$5
----strange scheme if you ask me. But it is pretty damn cheap. The government pays for much of the hospital expenses; for, with prices like that, more money has got to come from somewhere.
Dr. Xuan, the head of the acupuncture department, sees the most people. I have followed her as she saw about 25 people in less than 40 minutes for the first round, 15 on the second, maybe 10 scattered patients after that in a 4 hour shift. She just walks around the room, somehow knowing who is where, walks up to a patient, somehow remembers what's going on with them--for she sometimes barely says a word to them, and starts inserting needles--quickly. That she often does this very popular abdominal acupuncture helps her move so quickly. She often sees people 3times/week, so there need not be much discussion beyond the repetition of the treatment.
Dr. Xuan is what they call a national level doctor. The top level (above the provincial doctor and what more i don't know), she is paid more than other doctors but I'm not quite sure how they attain such status. She taught us a class on abdominal acupuncture, I think I might use some of it myself, in combination with what I already knew.
The acupuncture clinic is mayhem by US standards. There are up to 40-50 people in there at one time. Most people are getting treated, then there are those accompanying, the doctors and the students/assistants. A big open room with many dividers (just low enough for me to peak over) and chairs, it is like a community acupuncture sorta setting.
People come, hang about, get treated, talk with those around them, read the paper...Acupuncture, It's no big deal here.
(hard to see, but she's fanning the moxa smoke)
Herbal Medicine
The specialty clinics (internal medicine, endocrinology, rheumatology, etc) in which doctors use mostly herbal medicine (it's a TCM hospital), but also some Western medicine, are fantastic places to gain clinical experience as a student. The conditions here in which students observe doctors is extremely educational. There are many many patients presenting different variations of conditions, the doctors often stop to explain or point out something or give their diagnosis, and the students get to see what the doctor prescribes/recommends. Far better than what we have, it does not compare. Of course we have no such hospital nor do we study Western medicine as extensivly as they do; much of their time is spent figuring out the Western diagnosis--looking at lab results, medical imaging, or doing a pelvic exam, for example.
The students here seem to be very well educated--in both Chinese and Western medicine. The english vocabulary, for instance, coming out of their mouths often startled me--thymectomy, gastroptosis, lassitude....it's just their grammer and pronunciation that can sometimes leave you stumped.
I spent a lot of time with Dr. Lu, another national level doctor, seeing patients with rheumatic conditions, which he would diagnose within seconds. I learned a lot shadowing him.
In general, the doctors here, like a teacher of mine in Boston, BJ Wang, prescribe at least 12 to 15 herbs at a time, more often 15 to 20+. The vast majority is raw herbs, some patents, very little powder, and also Western Medicine. The two forms of medicine are idealy integrated in these clinics. The doctors order and assess lab work and medical images, ask questions of both forms of medicine and prescribe either as they see fit.
By the way, it was amazing how often patients would leave the doctors office with a referrel for some blood work, CT, X-ray, whatever and return within the hour for the doctor to look at it and then prescribe something. I have not done it myself, but I think such things would take days, if not weeks, to do in the US. And there are no appointments here: they just show up and get in line. How it so cheap, though, I can't figure out. An ultrasound, for example, was about US$10, a Dr. told us.
And the bike parking lot in the basement was quite a sight. I thought there were a lot of bikes in Holland!
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