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Internship in Tuina at the hospital of Traditional Chinese Medecine of Chendgu

After a week spent learning all sorts of new Chinese skills, I headed to the Sichuan Province with the idea of meeting the Father of my Chinese Tibetan teacher. However, it soon became apparent that Shanna had forgotten an important detail: my Chinese is very poor and her Father only speaks Mandarin, Tibetan and the local Sichuanese dialect.
Sure I could stay with him, she said, and learn from him, but the language barrier might impair this somewhat. Don’t get me wrong, I love a challenge and I am loving having to mime everything, but living with a ninety year-old you cannot even make chit-chat with might become slightly frustrating.

So I decided to make my first stop the Traditional Chinese Medecine (TCM) hospital in Chengdu, the capital city of the province of Sichuan. After a good twenty minutes of getting lost on the student campus, I gave up and walked out… only to finally find the foreign student department. I met “Ricky” who is in charge of the foreigners who wish to study TCM. He offered me a cup of tea before starting a formal interview, asking about my qualifications, my work experience, my hobbies and even my background in Chinese culture and my reasons for wanting to study in the hospital.
I must have made a good impression, as the head of the department suggested an internship within the Tuina department. Mornings would be taken up doind rounds with a senior doctor and a translator and in the afternoons I would get to enjoy some theoritical lectures in Chinese translated into English by his good self. I could even start the following morning.

On my way back, I bought a book about Tuina, as I had not heard the term before. It turns out Tuina is as close to osteopathy as one can get, besides the fact it is mainly based on the meridian system (as is acupuncture and all of Oriental Medicine)

The basic principles of Tuina

– To establish a working diagnosis using TCM principles,
– To treat the cause as well as the effects or symptoms,
– To relieve obstructions ad stagnation of Chi and blood, i.e. to restore smooth circulation, and  
– To restore function of body’s self-regulation of Chi and blood, to restore resistance agains pathogenic factors
– To restore movement throughout the body system and getting rid of stagnation, by:

— relaxing muscles, relocating joints,  manipulating tendons and flicking nerves,
— lengthening and stretching spasmodic or shortened muscles,
— increasing the range of motion of joints through passive movements and mobilisation,
— increasing the pain threshold and breaking down the pain-spasm-pain cycle after injury (this vicious cycle is a concept of Western medicine used in modern TCM textbook. It occurs after a painful injury: the muscles surrounding the affected area go into spasm, therefore compromising the blood supply and drainage of the area. As the metabolic wastes are not cleared away, this generates even more pain, which in turn stimulates the muscles to go into more spasm, and so on),
— enhancing local circulation of blood.

The theory behind Tuina
1. Balancing Yin and Yang
In order to achieve optimal health, the opposing forces of Yin and Yang must be in balance (this is also true of all phenomena in the world and the universe) – check out this previous blog entry for background information on this.
The aims are to restore the relative dynamic equilibrium and remove pathogenic factors by dredging the meridians (=making the lines that channel energy deeper and wider) therefore promoting the circulation of Chi (=Qi) and blood.

2. Regulating Zang and Fu Organs
In Chinese medicine, the organs are divided into three categories:
– Zang organs, which do not come in contact with foodstuff and produce and store Chi (heart, lung, spleen, liver and kidney)
– Fu organs, which receive, digest, transport and transform foodstuff (small and large intestine, stomach, gall bladder, bladder)
– Extraordinary Fu organs, which are a mix of Fu and Zang (brain, marrow, bones, vessels and uterus)  
The aim is to regulate all organs, therefore inhibiting hyperactivity and stimulating underactive organs (called tonifying).

3. Encourage flow within Meridians and Collaterals
Meridians are the channel through which the vital energy, of Chi travels.
The aim is to circulate Chi and blood, therefore nourish the body and stimulate the immune system, to increase protection against pathogens.

As a part of Traditional Chinese Medicine, it considers the body as a whole, and may be used in combination with acupuncture, herbal treatment, cupping, dietary advice, lifestyle advice, etc


During my mornings at the hospital, I visit both the in-patients and out-patient departments. The hospital -as everything in China- is gigantic, and I am told 4000 out-patients  get treated here everyday. Inside, it is completely chaotic. Seriously: Doctors, nurses, pharmacists rushing around the patients, their family and pets. Plus the random soy-milk vendor, a musician and a couple of chickens.
I am taken to a small consultation room, furnished with hard wooden plinths, several small stools and a very old X-ray reading lamp in a corner. The walls are dirty, mould is creeping in the cracks of the ceiling, the windows are open and a cold, chilling wind penetrates the damp room. Bars block the windows, and a neon light flickers intermittently.
The translator and a string of Chinese medical students string in after me. Enter three old ladies, speaking animatedly, followed by their husbands and family friend. One of the ladies sits down in a corner and starts knitting, whilst another takes her jumper off and lies on the plinth.
The female students all hush up when the impressive famous doctors walk in. Their loud voices can barely be heard above the cacophony of the patients, who seem to have come to consultation more for a good gossiping session than a treatment.
But somehow, things start getting organised. The doctors ask questions, palpate, and feel pulses. The translator struggle to keep up with the stream of information. Very quickly, needles fly everywhere and into the patients’ backs, arms, necks and legs.

Hygiene is a very touchy subject, and I only dare to bring it up after a couple of days. For example, the doorless squat toilets that both patients and staff use have no sink. The consultation rooms don’t have access to soap and water or even disinfectant hand wash. Some alcohol spray is sometimes used on the skin before insertion of the needles, but this is not systematic.
And for the more outrageous part: the needles used for acupuncture are indeed re-used many times, apparently after sterilization. In reality, doctors don’t pay a lot of attention to it and I see used needles being put back into a box of fresh ones.
I don’t know what the chances are of contamination, as these extraordinary needles penetrate the body but rarely draw blood. But I know that I personally would not run that risk!

And then the Tuina begins on a 40 year-old woman, complaining of progressive onset tinnitus in one ear. How funny that the first patient I see receiving treatment here suffers from the symptom I studied for my dissertation!
The examination reveals a thready, wiry weak pulse, a yellow-coated tongue, a dry mouth with bitter taste and stiffness if the neck.
The translator lets me know that the symptoms are typical of excessive dampness and heat in the live and gall bladder, caused by a weakness of the kidney.
The diagnoses here are divided in two parts: the branch of the disease (the symptoms) and the root of the disease (the cause or aetiolgy). It is important to relieve the branch of the disease, and clear the root or cause. Of course, the excess “Yang” typical of this woman’s symptoms are not familiar to us Westerners, but I am finding it fascinating to learn about this 7000-year-old medicine, which has proven its clinical efficacy both in Western research journals and empirically over the last few millenia.
The treatment is today focused on tonifying the kidney, by working on remote accupressure points around the ear and head. Some of the techniques used are familiar, other are very different to what I know.
But what is striking is that despite the flowery diagnosis, the practitioner works in exactly the same areas I would have worked on, had this been my patient.
He works on the neck, mainly increasing the mobility segmentally, loosening the muscles and flickign certain tendons. He also works on the scalp and around the ear. Many techniques focus on the face, throat and upper chest.
I get a wonderful realization: despite coming from completely different philosophies, both this practitioner and myself are working on this patient to attempt to relieve them and improve their health, and regardless of where we come from or how we explain things, the human body works the same way everywhere.
So over the next few days, I focus on the specific new techniques and the areas worked on the relieve pain. I believe that with observation and my own experimentation, I can integrate some of the oriental way of thinking into my own practice, and hopefully get even better results for my patients.

The following day, I am directed to the in-patient building. And this is quite something. It is a beautiful modern hospital, with clean airy corridors and rooms, no hussble-bussle and even flatscreen televisions in the three-bed rooms with en-suite bathroom.
I am introduced to the “famous” doctor, a tall guy with soft facial features and an easy-going smile. We follow him around, and he tries to impress me with sme joint clicking: manipulations of the lumbar spine. After the treatment, he asks me whether I have any questions. I smile and tell the translator that I am interested in which vectors he used for his technique, as I use a different one. His face lights up, and he asks me to demonstrate it. A Chinese student volunteers and lies on his side on a plinth in one of the hospital bedroom.
I start setting up, whilst the Doctor, his assistant, four medical students (who, it seems, have materialized out of thin air) and the three patients whose room it is stare at me. No pressure!
When the patient is ready, I look around, make a slightly theatrical gesture and thrust down. A beautiful, clear “pop” emerges from my cobaye’s back, and all the spectators mouthe their appreciation. The student gets up, and someone else lies in their place, wanting to be manipulated by the giant white woman.
Here starts the beginning of a manipulation frenzy, where the doctor and his assistant showed me a new manipulation technique for each one I showed them. Everything got a whack: neck, back, pelvis, shoulders, elbows, wrists, hips, knees, ankles and feet. And in every axis known, in many directions. We enjoyed some banter, approved the techniques we all knew and learnt the ones we had not seen before.
I learnt some incredible shoulder manipulations, as well as hip and knee ones. They learnt a great elbow technique and the amazing CT prone, which are some of my personal favourites.

Over a short period of time, I learnt many new techniques (of both joint manipulation and general soft-tissue mobilisation), new treatment plans (where to treat certain diseases) and a whole new method of approching the body (in the afternoon lectures, which are fascinating)

This weekend, I had great plans as I don’t have class… visiting, sight-seeing, etc, but I am physically and mentally exhausted after all that intensive learning. Instead, I have enjoyed a lie-in, a lazy breakfast and now going to stroll in the People’s Park to enjoy the sun and a cup of herbal tea with the locals.

This week I am continuing my learning in the hospital, and taking some Tai Chi lessons with a great Toaist master, who lives in the mountains outside Chengdu.
My reward is approaching: next weekend I am meeting my sister, who is on a business trip, in Shanghai. I have not seen her in over six months!



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Training with Tibetans in Lijiang, Yunnan

After training in Tai Chi in Yangshuo, I took a couple of days to rest from my intensive training in Kunming, also known as the city of Eternal Spring. The weather was beautiful, and it was dry, which was a beautiful change from Yangshuo.

I moved on to Dali, a pretty old town, loaded with tourists. I was expecting to only stay a night or two, enough time to see the historic temples and the wonderful mountain scenery… except I got bad food poisoning and stayed in bed for four days. The manager of the hostel was great: I was upgraded to a great room with a TV! I guess he felt bad that I got ill from the food from his kitchen… I caught up on world news thanks to BBC world, and am now up to scratch with so-called “new” American foreign policy and floods in Indonesia.

Once I got better, I traveled to Lijiang, in province of Yunnan, despite what other had told me about the over-touristification. Indeed, the historical old town has been taken over by tourist stalls and swarms of Chinese “foreigners” invade the city every morning. I did get up early for my morning jog and Tai Chi, and loved the cobbled stones, the crazy streams that run throughout the town, and the maze of streets. I found the park, and pretended to be a local so as not to pay the 80RMB fee (about 8 Euros). Unfortunately, there were no old ladies practicing Tai Chi, so had to find a deserted back alley to go through the moves without herds of photographers crowding me.

In China, people love to stare, especially at white people. I regularly get photographed or filmed when I am walking about town and doing random things, such as eating or doing Tai Chi.
It took me an hour to find my way back from the park to the guesthouse.

Later that day, I visited the “blue papaya”, a restaurant in the Old town, which advertises its links to the so-called “Lijiang Cultural Exchange Centre” boasting courses in Chinese medical massage, Tai Chi and calligraphy. But as I tried to mime to the waitresses about this, they tried to kick me out. I persisted and it paid, as a phone was handed to me, and a very kind English speaker explained that indeed there was such a place, and if I wanted, I could be escorted to the premises immediately.
And so I was. The puzzled waitress asked me to follow her, and took me through the cobbled labyrinth of the old town. I tried to memorise the way, but lost count after we turned a dozen time. We walked into a shop, and she invited me to sit down. The television was showing a soap opera no-one was watching, the radio screaming a random Chinese pop tune, and the kettle was boiling. My attention turned to a man standing up, biting on a paintbrush.

When one travels, one is bewildered at the amount of utter random events that may occur. This man was completely armless! He was writing some Chinese characters, and he did so by holding the brush with his teeth, moving his whole body the way a martial artist would, to paint beautiful ideograms. I got lost in his ability to move to quickly for such a podgy short man, until a handsome Chinese man tapped on my shoulder, and motioned me to follow him. The waitress, my first guide, nodded in approval and promptly left. I followed the man, who addressed me in Chinese. I apologized in English for my lack of Chinese, and it seemed he apologized in Chinese for his lack of English. We walked quickly out of the old town, and into a residential area on a nearby hill. The altitude here is around 2500m, and this fit young guy was basically running up! I struggled to keep with the pace. He later told me (via an interpretor) that it was him who was struggling, and he was just following my lead.

Shanna welcomed me into her home and school of martial arts, amongst other things. We immediately clicked, and spent the whole afternoon talking about Chinese Medicine, martial arts and Chinese culture. Fascinating.
She is Tibetan, daughter of a wealthy Doctor of Chinese Medicine, escaped Tibet and the Chinese repression. She owns the restaurant in town, and is a confirmed internal martial artist and Chinese massage therapist. She knows many doctors around the province of Yunnan, Sichuan and Tibet.

She invites me to stay in the school, and Adu helps to get my luggage. Adu is training in Chen-style Tai Chi in the school, he also helps running errands. We mime random things, laugh a lot and decide to become each other’s teachers. He teaches me the word for dog (go), small dog (sho-go) and big dog (da-go). There are many dogs in China, and they bark constantly. I am now used to this constant background sound, which has become the soundtrack to my life here!

Over the next few days, I spend hours discussing with Shanna and her boyfriend about the very subjects I have come to China to learn about: Tai Chi, Traditional Medicine and Xi Gong. We get on, and we exchange massages. The food here is delicious, the bed is comfortable (there is no heating, so it’s only about 10 degrees in my room, but I am starting to get used to it, and the duvet is from Tibet, so it is geared up for that kind of weather!) and I am learning lots.

My days here are divided up by practising Tai Chi, giving or receiving treatment, walking around the countryside, learning about the theory behind traditional medicine and eating delicious food! I am very much enjoying my time here. I am also learning Chinese language and calligraphy. Starting with my new Chinese name: ma-yu-lan, and going onto everyday words.

This afternoon, I am going to meet a 90-year old doctor, who is willing to treat my shoulder and teach me a thing or two about manual therapy. He is a friend of Shanna’s father, and despite being retired, is happy to give me some of his time.
Shanna also suggested I go to Chengdu’s hospital, where friends of her father work, and I could follow some classes there. She has also invited me to meet her Father and Daoist practitioners, who live in the mountains of Sichuan. I am not sure whether I will have time for this though, as I am meeting my sister in a few weeks in Shanghai, and going to these remote places would take me a lot of time.

I have published more photos, check them out on facebook (you can access them even if you are not a member by following this link) http://www.facebook.com/album.php?aid=106946&id=671740139&l=cd5e2d9790

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Preparing to leave Australia

Today, Friday 13th 2009, has been a particularly productive day, starting around midnight, as I was giving Qantas a call (really badly managed call centre, basically impossible to get through during the day, but 24/7 service so I call them at night). I have decided to forget all the negatives from this call and retain only the most important: I now have a ticket from Sydney to Singapour, at the end of February, in exactly two weeks.
After a short week-end stopover, I will be heading to Guangzhou, China. This morning, I went to the Chinese consulate to get my visa!! It is so beautiful! It is as if I have passed some kind of exam, and I am now allowed to enter Chinese territory (thank you Mastercard, for paying for it!)

Landing in Guangzhou, formally known as Canton, on March 2nd. It is in the South East of China, a stone’s throw away from Hong-Kong. The sub-tropical climates are not dissimilar to Thailand, and the north of Australia.

Guangzhou, Province of Guangdong

Guangzhou, Province of Guangdong

From there, I will travel to Yang Shuo, in the Guangxi Province, to get to a school of Chinese martial arts. Google tells me it is just over 500 km North West, on what seems like a very windy road indeed. LongTouShan Martial Arts School was recommended to me by a fellow Thai massage therapist I met on a course in Chiang Mai. The school is set up in a small town (rare occurence in China, where any town is a super metropolis) in the middle of the countryside: lush forests, beautiful mountain ranges and lots of outdoor activities available. “Spring in Yangshuo is a good time of the year to visit. Spring last from March to May. In March the day temperature can be chilly but as soon as April comes, the temperature goes up to a pleasant 20°C (70°F). Typically it is dry and although there’s occasionally a shower, this is the time of the year when Yangshuo’s limestone mountains show some of it’s real beauty. Clear skies and sunshine, now the mountains look like paradise.” Yanghsuo travel guide.
There is unfortunately/fortunately a heavily developed expat community and many travelers come through here on the Li River. This is good, as it is easier to get around (the locals are used to the White Giants who can’t speak the language) and many courses (martial arts, massage, cooking…) and activities (hiking, rafting, rock climbing, kayaking…) are available, but not so good as it is not so authentic. (Check out this expat website for more local info)

All in all, it will be a great place to start my Chinese adventures. I will start with Tai Chi and Chinese massage, and see how I get on from there. Depending on how I like the place, the people I meet and the teachers, I will decide how long I stay. The great news is that at the end of April, my sister is coming over to visit and I am delighted to start planning our trip!

This should be my Tai Chi instructor!

I have been reading about Chinese Medicine, and Oriental philosophy; as well as current affairs on China. Another wordpress blogger says that most blogging websites are not available from China, so if I am to continue blogging, I will need to email my stories to someone outside of China, and they can publish them online.
The Chinese Government has put into place what has become known as “The Great Firewall of China” and stops the Chinese people from accessing certain websites. I understand that the Firewall is constantly changing, so during the campaigning for the Olympics for example, there was a certain laxity, but all websites concerning the Tienanmen massacre of 1989, democracy and freedom of speech in general, or anything relating to Tibet are completely banned(and now that I have mentioned these, my blog is definitely banned in China). Other websites are partially banned, as I read on someone’s blog: they could access the sports and entertainement pages on the BBC website, but not the news part.
Certain foreign companies, such as Google decided to create government friendly search engines and programmes, to avoid being completely banned. This has created major protests in the West, as it is seen as a form of encouragement and therefore collaboration. There was an interesting article published in the New-York Times a couple of years ago, for those who have time (it’s 10 pages long) and want more background information.

I am looking forward to China immensely, to see for myself the effect of such a violent, so-called communist dictatorship and the contrast with the peaceful, awe-inspiring four-thousand year-old medicine.

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