Practicing Medicine
Oct 12th, 2006 by Michael Max
We use the phrase “turn a corner”, but more often than not, it is more like following a road with a long wide curve. Gradually, gradually, without any particular notice, it dawns like a Fall morning of slanting yellow light..
…..it’s different now.
I remember being amazed that acupuncture works.
Now, I’m surprised when it doesn’t.
Is it the voice of experience, or that my worldview has become river rock smooth from years of constant water? There are changes so imperceptible so as to be forgotten, unnoticed as our very breath.
Life only feels fast and headlong in retrospect.
I’m now wishing I’d tarried longer in Yangshuo. I enjoyed the quiet, the conversations, the enjoyment of sitting quietly at the crossroads, the way days melt one into another like a lotus dream.
I enjoyed being doctor to locals and travelers alike. It’s a vast privilege to meet the depth of others.
I’ve had requests from doctor friends. Details please, on the interesting cases. Us Chinese doctors, this is how we advance our craft, through stories and experience. Learning medicine is like polishing diamonds. It takes time and skill to bring light out of all the facets.
Those not so interested in medical details can skip this rest of this post. But, if you are interested in how the mind of a Chinese doctor works, then read on.
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Chinese medicine is a vast treasure trove for women. Not a Chinese medicine school in the West doesn’t have a number of required classes for women’s health. The good that Chinese medicine brings to relieve menstrual pain, or the pain of infertility have been long and documented.
Miss L comes from the southern part of China, I can not quite place her accent which seems to resonate out of her upper palate and nose, then realize, “oh, this is how my Thai friends that speak Chinese sound”. She is 22, and like many young college students has opted for a few months in Yangshuo to work on her English.
She often has pain with her periods, cramping in the lower abdomen with a slightly uncomfortable lower back, no changes in digestion. No headaches. There are other details I usually ask, but with a young Chinese woman I don’t know so well. I just inquire of her pulse and tongue. And palpate her abdomen.
Her tongue is pale pink and a bit dark, with a thin/medium white coat.
Pulse is tight.
Palpation shows a tightness to the left of the umbilicus, and a deficient softness below
Diagnosis: internal cold stagnating the blood and qi.
Treatment: Needles at hegu-LI4, taichong-LV3, sanyinjiao-SP6. Moxa, two cones each at zhongzhu KI15.
Result: post treatment the cramping pain was reduced by 80-90%, within a couple hours there was no pain, and rest of period was smooth and without pain.
Miss K is the owner of a restaurant, a few months ago she caught her right thumb and twisted it badly. Most any movement, while not particularly painful, does produce a sense of discomfort and tightness, especially in the proximal and medial joint. She has used a number of salves and compresses, which irritated the skin, but did not improve the feeling in her thumb.
Tongue is slightly red pale with no coat, pulse a bit thin and weak.
Diagnosis: local qi and blood stagnation, with underlying blood deficiency due to working long hours and lack of rest.
Palpation: palpation of the lung channel on the same side as the injured thumb showed some gummy areas between kongzui-LU6 and chizi-LU5. Palpation of the liver and spleen channels on the opposite foot showed found tender areas with nodules. When these were palpated with force, the patient reported a dull pain, but when the thumb was moved, the usual discomfort was greatly reduced.
Treatment 1: taichong-LV3 (left), yuji-LU10 (right), gummy area between kongzui-LU6 and chizi-LU5 (right)
Result: discomfort with movement reduced in several directions, but there remained discomfort when the wrist and not the thumb joint was moved. This pain was mostly felt between the middle joint and the end of the thumb.
Treatment 2: taichong-LV3 taibai-SP3 (left), shaoshang-LU11 hegu-LI4 yangxi-LI5 (right), yanglingquan-GB34 (right), yuji-LU11 (left).
Result: no pain with movement of thumb joint, but still discomfort in the thumb when the wrist is moved.
I find joint problems to be one of the bigger challenges. These kinds of issues often turn better and then turn worse.
Because people usually wait for a long time after a sprain or injury before seeking treatment, these kinds of problems have an opportunity to root like a difficult weed. Best to seek treatment as soon as the injury occurs!
We all know an once of prevention is worth a pound of cure. And Chinese medicine offers some excellent methods that help to prevent long term discomfort.
It is always music to my ears when I do have the chance to treat someone just after a sprain, and have them later tell me “I guess I did not really need to see you after all, I was completely fine after just a day or two after I saw you”. Now THAT is preventive medicine! Miss K will need a few more treatments before this problem is cleared up completely.
While women’s health is well represented in Chinese medicine in both China and the West, men’s health in the West as been sadly lacking. Blame it perhaps on that men generally don’t come seeking treatment until conditions are more than unbearable. Blame it perhaps on that we are taught to tough things out. Blame it perhaps on there is a better market for treating women.
It’s not like there is not a market to treat men. Most of us will come to have some kind of serious disagreements with our prostate at some point in our life.
Ever since I met Dr Fang last year in Chengdu, I’ve wanted to return and learn more of his methods. While he is the classic kind of excellent Chinese doctor that can treat a wide variety of illness, he also has a special focus on treating prostate and urinary problems.
Last year I sat a couple weeks in his busy as a bus station clinic. Teasing out interesting formulas from the riot of patients, and striving to translate the singsong of Sichuan dialect, into a Chinese I could understand. This year I decided to forgo sifting through hours of crowded clinic to pan for those precious nuggets of gold, and have arranged to spend a few focused afternoons getting the basics of men’s health.
Mr. C is a foreigner like me, we are not that far apart in age, or interest. We both enjoy science, western for him, eastern for me.
“When are leaving”, he inquires over breakfast?
“Soon, I’m sad to say. I’ve some time arranged with a doctor in Chengdu to study men’s health. It’s a terrific opportunity, I can’t not go.”
“Seriously? Do you know something about this already by any chance?”
Mr C has been thinking he needs a trip to the hospital. Last night he awoke every hour, for a worthless trip to the bathroom.
He’s up for a go with some herbs.
Issue: inflamed and enlarged prostate, precipitating poor urinary flow. For years has had urination issues, and occasional flare up’s like the one he’s experiencing now, which results in inability to urinate, along with heat and discomfort.
Pulse: fast, slippery
Tongue: pink, slightly dusky, with a thin yellow coat
Diagnosis: heat and damp in the lower burner. I’m encouraged that the tongue is not red, and the coat is not very thick.
Formula: huang bo 12, zhi zi 9, fu ling 12, zhu ling 10, sheng di 12, ze xie 9, hu zhang 12, huang qin 9, bai/chi shao 8 each, hua shi 20, che qian zi 9, gan cao 6
3 bags for 3 days
In Yangshuo the herbs are easy to come by, but it is too small a town to find a big enough pharmacy that will cook and bag them into handy plastic bags. Luckily, there is help at the language school where I rent a room, and they cook up the bitter brew.
Like many westerners, and Chinese for that matter, the bitter taste is like a guardian at the gate. When I see Mr. C the next day, I find he has only taken half the amount prescribed.
“How did you sleep last night?” I’m curious to know if there has been any progress in his condition.
“Last night? Oddly enough, I slept a straight 6.5 hours”
“When was the last time you did that?”
“It’s been months, it only happens when the stars are right it seems”
“And your urination? More comfortable now?”
“Much better yes, must have been your advice to lay off the alcohol, and I was drinking more water too”.
“Still thinking about going to the hospital?”
“No, not now”
Medicine is an odd thing. What works, or doesn’t, and why.
Why?
Yes, always the question of “why”. This perhaps is one of the big differences between Chinese and Western medicine. Western medicine is practiced in the clinic, but proven in the laboratory.
Chinese medicine? The clinic is the laboratory.
