I’ve been living in Shanghai for 3 ½ years now and I’ve interned in two of Shanghai’s main hospitals: Shuguang Hospital and Yueyang Hospital. I’ve been asked to share some thoughts on the similarities between TCM as it is currently practiced in China and Community Acupuncture.
Acupuncture in China
I conducted my acupuncture internship at Yueyang Hospital. Inpatients often receive acupuncture every day, while outpatients normally receive acupuncture 3 times a week. At the outpatient acupuncture department, patients start lining up as early as 6 in the morning for treatment. The department doesn’t open until 8 a.m., but there are no appointments – treatment is given on a first-come, first-served basis.
If you’re a new patient, the doctor will do a brief intake in her office. The office functions as the intake area as well as the place where the doctor and interns wash their hands, rinse out bloody cups, give injections into acupuncture points, insert ear seeds, check patients’ blood pressure, and even treat patients if the rest of the treatment area is full. It is a hive of activity, and by no means private.
The doctor will review the patient’s chart, ask questions, and check the tongue and pulse. Then the patient goes to the treatment area. The doctor with whom I studied, Dr. Zong, supervises an area of 8 tables and 3 chairs. The main area (pictured below) contains 4 tables and 3 chairs. There are curtains which can be used to provide privacy, but these are rarely used.
Each doctor is followed by a troupe of 2 to 4 clinical interns. Dr. Zong is in charge of the study-abroad program for international students, so there is also a group of 4 to 5 foreign students following her as well. As you can imagine, the treatment room is anything but quiet. Patients are chatting with other patients; interns are running around cupping, applying moxa, and removing needles; and Dr. Zong is calmly and methodically moving from patient to patient. As soon as one patient leaves, another takes his place. There is no time to change the sheets or even pause for a breath.
If you’re a returning patient, as soon as it’s your turn, you go right to your chair or table. Dr. Zong will come to you and do the intake right in the treatment room. There is no whispering here, no hushed voices. It would be hard to hear a whisper over the din. One of the first words you learn upon arriving in China is renao (热闹), which literally means “hot and noisy.” Renao has a very positive connotation. A place that is not renao feels empty and sad. Chinese clinics are very renao.
Patients receive a lot of treatment here. Twenty-plus needles, with either electro or moxa and followed by cupping of the entire back is not uncommon. I was told that this is a vestige of the earlier times of Communism – if my neighbor gets something, I am entitled to get the exact same thing. In a community clinic like this, if one patient gets 20 needles plus moxa and cupping, the other patient wants the same treatment. It is hard to explain to the second patient that maybe his condition doesn’t warrant that many needles, or that much cupping.
Of course, with so many interns, it’s easy to provide this much treatment. Dr. Zong does most of the needling, while the interns perform the moxa, electro, cupping and needle removal. Interns also get a chance to needle some patients. Needles are used once, and then sterilized and reused. The standard needle is 32 gauge, 1 ½ inch. Shorter needles are only used for UB 1 or other delicate points. Dr. Zong carries around a metal box containing the sterilized needles. An intern will grab a bunch of needles and hold them between the pinky and fourth finger of his left hand, only returning for more once his supply has been used up.
Point prescriptions are drawn straight from TCM theory, but that doesn’t mean that Dr. Zong mechanically applies Chinese Acupuncture & Moxibustion point prescriptions. She often uses five element theory and the clinical applications of the five shu points to inform her prescriptions. She uses scalp and ear needling frequently. Often, when I asked her why she chose a particular point, she would quote from the Ling Shu. In addition to having this depth of knowledge, she is also an expert technician. She taught me that not only do you need to insert the needle to the right depth and in the right direction, but you also need to direct the qi to the correct place: When needling GB 20, you direct the qi to the eye for eye pain, to the top of the head for headaches, and to the neck for neck pain, although the needle direction remains the same. When needling LI 4 for toothache, if the patient doesn’t feel the qi moving to their tooth, you haven’t needled it correctly.
In the midst of the noise and through the haze of the moxa smoke, healing is taking place here. One of my favorite patients was being treated for schizophrenia, and she said that the treatment had allowed her to feel stable enough to return to work. Another patient with partial paralysis was able to get down from the treatment table by herself. This is truly a people’s medicine clinic, and the medicine works. Patients typically come at the same times each week and get to know each other. Husbands and wives come together, mothers bring their sons. There is a wonderful sense of camaraderie in the treatment room. They share the road to health together.
While those of us in the West may prefer a quieter room with some relaxing music in the background, Chinese acupuncture clinics and Community Acupuncture clinics are essentially the same: no fuss, no bother, a focus on the treatment itself and not on the interaction with the doctor, and high quality acupuncture at a low cost. Chinese acupuncture is Community Acupuncture.
Herbology in China
Herbs are much more popular than acupuncture in China. A TCM hospital will have a number of specialized herbology departments, including Cardiology, Nephrology, Gynecology, and so on, whereas the acupuncture departments are generally either inpatient (and therefore integrated into the rest of the patients’ care) or outpatient. TCM doctors specialize in either acupuncture or herbology, not both. The herbologists who work in Chinese hospitals do not practice acupuncture. The acupuncturists who work in the outpatient departments may occasionally recommend an herbal formula, but this is not common.
I interned in a few of Shuguang Hospital’s herbology departments. Each was incredibly busy, usually with a line of patients out the door. The doctor typically only spends a few minutes with each patient. She writes a prescription and gives it to the patient to be filled in the dispensary. Most of the time, raw herbs are prescribed, although patent medicines are also used. The doctor will prescribe a week’s worth of herbs at a time.
The doctors in the herbology departments are amazing. They are primary care providers who seamlessly integrate Western medicine and TCM. When a patient arrives, they review the signs, symptoms, tongue, and pulse. If blood work, labs, CT scans or MRIs are required, they will immediately send the patient to get them. The hospitals that I observed are very efficient, and usually the patient can take these tests and receive the results within an hour or two. The patient returns with the results and then the doctor prescribes Western medicine, Chinese herbs, or both. This truly is the cutting edge of complementary medicine.
Chinese herbology departments exemplify the pinnacle of complementary medicine, and Chinese acupuncture departments demonstrate the simplicity and effectiveness of this ancient medicine.