Observations in the Gynecology Dept.

[Guest guest]

More musings from my former student in China:

 

Dear Friends,

 

My classmates at Chengdu University of TCM and I are observing in the

gynecology department.  Basically that entails sitting on a very, very

hard wooden stool in the corner of a very, very small room with many,

many Chinese women of all ages.  However, I am really happy in those

rooms with the doctor, the patients, and the translator because we have

case study after case study to see how patients report, how they are

diagnosed, and how they are treated. 

 

It would be nearly impossible, however, to reproduce the same situation

in the States for various reasons.  Patients, for starters, report

their symptoms in the exact same way they are described in the books: 

" I have a bitter taste in the mouth and am thirsty. "   " I experience

breast distention prior to menstruation. "   " My menses are bright red, "

" dark red, " or " pale-red. "   As you know, Western patients do not either

know how to make such observations or are simply not clued into such

observations about those aspects of their health.  Obviously they can

be educated to do so, but that takes time. I am thinking that it would

be a good idea to write a book about the way Western women report

symptoms and how those symptoms correspond to TCM pattern diagnoses.

 

Another thing that is impossible to reproduce is the ease with which

docs can send out for tests and also prescribe antibiotics, antivirals,

pain medicine, etc.  Some docs are more prone to use biomedical

diagnostics and treatments than other.  But there clearly has been a

great effort put forth to merge these two medicines.  And not only is

there a degree of cohesion that has taken place in the last sixty

years, but there is also a very clear awareness where Chinese medicine

will not succeed and where Western medicine will.  We had a case this

morning where a patient came in with a cervical polyp that was creating

some bleeding.  She wanted an herbal formula to stop the bleeding.  The

doctor did, in fact, give her a formula that both drained damp and

cleared heat, but she also insisted that she needed an operation. 

That's pretty cool.  The doctor knew where Chinese herbs would fail to

achieve her patient¡¯s desired state of health. This is something I

hope to get more of, TCM¡¯s strengths and limitations.

 

And then there are those obvious things that would preclude such an

experience from being reproduced in the West.  Herbal medicine is so

easily accessible, here.  The hospital has a dispensary, the size of

which was beyond my imagination.  Tons and tons of those herbs are

pushed out the door every day.  And ontop of that, if the patient does

not want to cook the herbs, she can have them decocted for an added

fee.  And if that doesn't work, they can be purchased in granules.  And

on almost every block, there is a Chinse herbal pharmacy, both modern

patents and raw herbs in stock. And because there are a lot of them,

there is competition, and competition mean price wars, making the

medicine affordable. I am not saying that it is impossible to have easy

access to herbs.  It can be done, but not with such ease, efficiency,

and at such an effective cost. 

 

In spite of the fact that some of the things can't be reproduced, I am

hoping to develop the knowledge and experience of those that can.  I

certainly think that by observing case after case, which we do, that

certain things can be gained, things that simply can't be imparted in a

textbook or in a classroom.  In general, I seem to be excited by the

patterns that keep reproducing themselves.  In many ways, I feel like a

researcher, wading through a littany of data, trying to cull the random

bits of information into something cohesive.  For example, I keep

noticing similar formulas coming up, or herbs that doctors continue to

use for certain diseases, or diagnoses.  This requires patience, since

the doctors do not speak English; so, we can't really ask the questions

that are coming up.

 

           The doctor clearly needs the situation to run as quickly and

efficiently as possible, and we are hinderances in their furious race

to serve all the women who have come for treatment. The process

basically goes like this. In the room are many women waiting to be

seen. The doctor sits behind a big desk. She sees one patient after the

other in five minute increments. Each patient sits infront of the doc,

reporting symptoms. The doc will ask a few questions, have the patient

present both wrists onto a pulse pillow and display her

tongue. Unfortunately, we have only been able to have pulse diagnoses

confirmed once. Tongue diagnoses, however, are more readily available,

since they don¡¯t require each individual to take the time to

observe. It takes just a moment. After the interview, the doc quickly

jots down symptoms, diagnosis, treatment plan, and formula. There are

no moments for her to sit and reflect, certainly not to discuss with

us. Once the formula is complete, she passes it off to one of her two

assistants sitting on her left side. They quicklly jot down the

formula¡¯s script, and then pass the script, the intake, and the

diagnosis to us, who are located in a corner on the other side of the

patient. The translator quickly reads the information to us and passes

the script to the patient, who is trying to hurry herself out the door

to purchase her formula and get back to work or home. Clearly we are

blocking the efficiency. In fact, when we walked into the room where

the doctor was already treating this morning, she rolled her

eyes. Clearly, she wasn¡¯t happy for us to be there. 

 

           It is becoming more obvious to me that in many ways we are

obstructed from learning the intricacies of the medicine by the mere

fact that we don¡¯t speak the language. I can see how different the

experience would be if we didn¡¯t have to learn the information

filtered through other people. There is clearly quite a lot that cannot

be expressed through an intermediary. I never really got this when I

was in school, but I can see that this second-hand information

prohibits the absorption of the subtle. And while it is very possible

to practice the medicine without these subtle things, it is also clear

that they are not insignificant. That doesn¡¯t mean that I am dying to

go out and learn Chinese. It is not an easy undertaking, at all. I do

know, however, that it would benefit my understanding in many ways. For

the moment, however, it seems o.k. to keep trying to eak out those

little patterns I am seeing in the jumble of data, to make my own

conclusions, and see if I can emerge from this experience with a deeper

understanding than when I came. Let¡¯s see.

 

 

 

Chinese Herbs

 

 

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