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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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