If you've always wanted to know a little bit more about how Chinese medicine came about, I invite you to watch this video of a talk that I recently gave to members of  the University of Third Age in Crouch End (north London). The challenge was how to condense 3,000 years into a 50-minute talk!

The talk covers how the ancient Chinese viewed health and disease, starting with China's mythological beginnings and then on to the most important developments throughout various dynasties. Why did the ancient Chinese place such importance on living in harmony with nature? How did the concept of Qi (pronounced "chee") or vital energy come about?  We end with the spread of Chinese medicine around the world in the 20th century.

My classmates and I have spent almost two weeks now in Dr Bi's clinic, so we have come to know his patients well. They come everyday for problems with the neck (cervical spondylosis) and lumbar pain. Daily treatment is the norm for musculoskeletal problems in China, which is much more effective -- quite a big difference from how patients come once (maybe twice) a week in our clinic in London. Acupuncture is expensive in the UK, and more often than not patients are paying out of pocket, so daily treatment is not often viable.

It has been such a learning experience to see Dr Bi's needling and massage techniques, choice of points, and how he manipulates necks and backs. But the lasting impression that I have of this bustling clinic is its beautiful communal atmosphere. Photos cannot capture this special quality.

For starters, the patients come everyday so they get to know each other and the doctors and students well. They spend a lot of time getting treated with acupuncture, massage, cupping, guasha (scraping the skin, especially of the back), and electro therapy, usually staying there 2-3 hours at a time. So there is a lot of time to talk, and talk they do!

They talk about how they are feeling and how their treatments are going. They inquire about each other's family, especially their children. When there is a new patient, they are listening to what's going on (because the consultation with the doctor is happening in front of everyone). And they  probably talk about us, the foreign students who are here to absorb as much of Dr Bi's Chinese medicine knowledge as possible in the time that we have.

This morning was particularly beautiful. Dr Bi was alone in the clinic with about six patients. For some reason his students and junior doctors were late to come in, so he had to look after patients by himself. I noticed that the son of a woman patient (he accompanies his mum every day) was helping hook up one lovely older lady to an electro therapy machine -- I guess because he is in the clinic with his mum so often, he knows from observing what to do! 

It is such a stark contrast to how acupuncture is administered in the UK, where you normally treat one patient at a time in individual treatment rooms. I will really miss the happy and healing atmosphere in the outpatient clinics here in Heilongjiang University of Chinese Medicine. Maybe I can recreate this by working in a multi-bed clinic back home?

This week, my classmates and I have been following Dr Bi Xu-wei of a strangely named department called Health Care. I thought at first this would be similar to a General Practitioner (GP) surgery (or primary care in the UK), but it turns out to be a cross between rehabilitation and Chinese massage (tuina).

The majority of Dr Bi's patients have cervical spondylosis (compression of the neck vertebrae) and lumbar disc hernia (or slipped/prolapsed disc). The armoury of Chinese medicine here includes tuina, acupuncture, moxibustion (the burning of rolled up mugwort herb to warm up an area to promote Qi and Blood circulation), cupping, and electrotherapy. Dr Bi is a great doctor to follow because he specialises in conditions that I will see a lot of when I am in practice. He is also very kind and generous with his knowledge.

Yesterday a patient came to see him with a frozen shoulder -- he immediately stuck a needle in her lower leg (Tiakou ST38), quite deep, at least 3 cun (6cm). This was obviously painful for the patient, but at the same time she gained instant relief from the pain -- you could see this in her face. It took me a few seconds to figure out what was happening. I have read about ST38 being used with dramatic results, but this is my first time to witness it for myself.

I often suffer from frozen shoulder, usually when it's cold and I'm too busy and have no time to exercise and stretch. I have a vested interest in frozen shoulders! Today I asked Dr Bi to look at my right shoulder, which has been aching for the past six months. He said it's not frozen but I might have cervical spondylosis. 

Dr Bi then needled two points on my hand (Sanjian LI3 and Hegu LI4), again going in very deeply. The sensation was electric, and like yesterday's patient, I got instant relief from the ache. He massaged my upper back, neck and shoulders and mobilised my shoulder, and now I am walking around like a new woman, a complete fan of this great doctor.

Later on he told me and my classmates -- after he had shown us a secret point near the thumb for headaches -- that he doesn't mind sharing his secrets with us because we are from the UK. I gather that he doesn't share so readily with people from Harbin because competition in the hospital is quite fierce! 


 

This week my classmates and I found outselves in gynaecology. Yesterday we were with Dr Han Feng-juan, a lovely woman who is clearly a leader in her field but has a warmth that is just what you want in your gynaecologist. I also found out that she is the director of the 4th floor gynaecology ward, where we were this morning (although we followed a different doctor).

Dr. Han is well-known for treating polycystic ovarian syndrome (PCOS), dysfunctional uterine bleeding, irregular menstruation, for giving pre-natal care (especially for those with a gynaecological condition) and for "holding" the baby to avoid miscarriage.

She had a very busy clinic yesterday morning. She was quick and efficient, but clearly gave her patients a lot of attention and care. We saw many many cases of Kidney Deficiency, especially in problems of irregular menstruation or amenorrhoea.

But what struck us the most is the lack of privacy, especially for a place as intimate as a gynaecology clinic. At the back of Dr Han's office is an examination table with stirrups (very old fashioned!), separated from the main area with a pink room divider. Every so often, Dr Han got up to examine a patient, who had been prepped by a student and had undressed and climbed on to the table. Bearing in mind that the clinic is heaving with patients and relatives, it soon became apparent that it's considered normal for other patients to look at what's going on behind the screen. I know that the Chinese have a different concept of privacy, so I tried not to feel too sorry for the patients. At least men were not allowed in the room!

This morning we did the round of the 4th floor gynae ward with Dr Zhang and two of her students. I think we saw a total of 20 patients. There were a few cases of surgery (an 82-year-old woman with vaginal tumours, and a woman in her 30s who had a hysterectomy) -- but the vast majority of patients were there because they were in the early stage of pregnancy and had threatened abortion (in danger of miscarriage). The standard treatment seemed to be lots of rest (with an average stay of one month in the hospital), injections of progesterone, and Chinese herbs. 

Clearly there are big cultural differences between China and the UK for this sort of problem. My classmate Sharmin said that in the UK, women with this condition would simply be told to go home and rest. And then there is the argument that if your foetus is not strong enough to survive the first trimester, a miscarriage is (probably) nature's way of "healthy-baby selection".

Our translator said that in China, the pressure to have a baby is so strong, it (probably) overrides this ethical dilemma. There is clearly a strong demand for this service, such that someone like Dr Han has made a reputation for being able to "hold the baby".

And then there are other issues like artificial progesterone being injected into women's bodies. What implications does this have for the baby and the woman's health later on? I would love to see research into this.

Finally, I took a photo of a woman in the ward who was being fed a mountain of baozi (stuffed buns) and noodles by her mother (or maybe a mother-in-law?). I asked her permission for me to take this picture. I found her so beautiful, especially as she tucked into her lunch. Ethical dilemma aside, I hope she holds her baby to full term.

P.S. My classmate Kat later passed on a research paper from mainland China that looked into the effects of the use of progesterone in cases of threatened abortion. It found no difference in terms of birth weight of babies between those who were given progesterone treatment and with a control group. Interesting.

One of the great things about my placement at this hospital in Harbin is the opportunity to observe the rehabilitation of post-stroke patients. I observed in the clinic of Dr Cheng Wei Ping for two weeks and marveled at his skill in scalp acupuncture, helping people move and speak again after a stroke. But the doctor and his students are often too busy to explain the points used on the head, and my limited language skills don't help.

So it was a wonderful opportunity to hear Professor Lu Jin Rong (second from the right in the photo) talk about the basics of scalp acupuncture last week. Compared with classical acupuncture, which has been around for at least 2,000 years, scalp acupuncture is a new development, having been developed in China only over the past 40 years. It is a combination of acupuncture needling techniques and modern knowledge of the brain and its functions.

As a student, I learned the 360 classical acupuncture points -- although only about 100 are commonly used in clinic. However, scalp acupuncture does not use acupuncture points per se, but rather areas on the head that are related to different functions. Professor Lu taught us how to find the motor zone (used for paralysis of the body and face, including speech problems), sensory zone (for numbness like in neuropathy), tremor zone (to reduce symptoms of Parkinson's), and visual and balance zone on the scalp. Professor Lu showed us the techniques for needling and manipulation. It was an amazing afternoon, and was exactly one of the reasons I came to China.

This is not to say that we can be experts with stroke and facial paralysis anytime soon, but it gives us a good grounding to be able to go away and do our own research and try these techniques in clinic when we go home.

Has it really been two weeks since we started observing in Dr Cheng's clinic at the First Affiliated Hospital of Heilongjiang University of Chinese Medicine? Granted, three of those mornings were spent going to police stations and registering ourselves. (That is for another blog perhaps.) And two mornings involved following Dr Cheng while doing his ward rounds at the hospital. But it has given us a few clear mornings to observe how the doctor runs his clinic, with the help of his students.

On any given day, current patients will start coming in at 7.30 in the morning and go into the treatment room, which has about 14 beds. When the doctor arrives -- sometimes with bags of fruit or some delicacy that he shares with others -- the students are ready to hand him needles, which he deftly sticks into each waiting patient, no notes needed, he knows all their conditions. 

The doctor always inserts needles into patients' scalps, and might insert needles into body points. Often he will give instructions to the student on which points to use, then go on to the next patient. Always he has a few words with each patient, always smiling, always encouraging. He touches each one of them on the shoulder, his bedside manners honed by 35-40 years of practice. 

Then he starts seeing new patients (or perhaps ones he has seen before but are coming for another consultation). His consultation room is usually heaving with people -- patients and their relatives, lots of students who are either helping or observing (if they are helping, they are taking notes on the computer or taking down herbal prescriptions on the patients' little clinic notebook, acting as receptionist, or creating official order forms), and hospital staff who might want a word with him. 

Dr Cheng is the top chap for strokes and facial paralysis in this part of northeastern China, but he is more like a GP (general practitioner) in the range of conditions he sees, anything from insomnia and back pain, to tinnitus and hyperactivity (ADHD). One boy who looked about 10 years old came in with his mother. He came three years ago for ADHD and was given herbs. I could not see signs of hyperactivity in this boy, he looked healthy and his eyes full of spirit. I was told the herbs have helped enormously -- I certainly agreed with that. Back home he would have been given Ritalin, like thousands of other boys.

Next week our motley crew will move on to a dermatological clinic, where herbs are used (not so much acupuncture). But first, there is the weekend to enjoy.

On Heping Road in the Xiangfang District of Harbin stands a wonderful new hospital complex devoted to Chinese medicine. Or more accurately, the integration of traditional Chinese medicine and Western medicine. This is my home for the next three months.

My first few weeks will be spent observing Dr Cheng Wei Ping, a famous specialist in neurological conditions such as stroke and facial paralysis, so common in this northeastern corner of China. Dr Cheng holds consultation every morning and might see 30-40 outpatients a morning, aided by about a dozen student assistants. Twice a week he makes the round of wards in the hospital to check on patients with the most serious and acute conditions.

While strokes require immediate life-saving treatment by western medicine, the chronic long-term effects such as loss of speech or movement are not dealt with as well by western medicine. However, scalp acupuncture has been developed over the past 40 years in China, marrying Chinese needling techniques with Western medical knowledge of the cerebral cortex. Many studies show positive results in treating disorders of the nervous system.

Last week my classmates and I observed inpatients and outpatients receiving acupuncture or herbs, more often in combination. Most of the scalp points were unfamiliar -- we were certainly not taught those points at London South Bank! After some reading we realised that these were not actually acupuncture points but were actually areas of the scalp, and mapped directly over parts of the brain controlling areas like speech, motor, sensory, vertigo and hearing, or tremor control. So needles were inserted into patients' scalps depending on what part of the brain needs to be stimulated. Post-stroke patients who have paralysis or weakness of legs will have their foot motor areas needled and stimulated vigorously. 

Lots of research to do this weekend then, so I can understand more of what I will see in Dr Cheng's clinic next week.

Raining in Beijing today -- that can only mean one thing, you have to head into a museum. So my friend and classmate Teresa and I made our way to the very grand National Museum of China, across the street from Tiananmen Square.

Many many objects of art stood out, but the highlight was definitely this bronze figure model for acupuncture and moxibustion. Marked with meridians and acupuncture points, these figures were used in imperial medical academy exams. They were coated in beeswax and filled with water, so students can identify the right points. 

This model was cast in 1443 during the Ming Dynasty. Teresa and I had great fun identifying the points, giggling a lot when we got something right. And probably because those days of acupuncture point identification exams are firmly behind us.