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November 17, 2009

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Expat TCM docs take your pulse

AS Anna Xu waits to see a traditional Chinese medicine doctor, she is extremely surprised when a Westerner enters the consulting room, applies three fingers to her pulse and asks about her discomfort.

It's just the way TCM is supposed to work, except the doctor is foreign and he speaks Mandarin Chinese.

Her doctor is an American, Greg A. Livingston, 41, from San Francisco.

Legend has it that the principles of TCM were identified more than 4,000 years ago by the Yellow Emperor, Huangdi, said to be the ancestor of all Han Chinese.

But TCM today has adherents all over the world, and many come to China to study and practice the ancient healing arts.

Some are beginners, with no TCM background, while others have studied TCM in their own countries and seek further training in TCM academies. Some attach themselves as apprentices to TCM masters.

In Shanghai there are around 1,000 overseas students in short-term study and 700 others in long-term study in Shanghai University of TCM. About 100 expats enroll each year.

The city's three major TCM hospitals - Shuguang, Yueyang and Longhua - each accepts 100-200 oversea interns each year.

It's not known how many foreigners are practicing TCM in Shanghai.

Learning Chinese, including classical Chinese, is essential in the study of TCM as there are few good translations of TCM classics. Some students already know Chinese, for others the difficulties of language and culture force them to drop out in their first year.

Most graduates aim to start TCM clinics abroad, a few stay in local private hospitals and even fewer get the equivalent of a PhD and work in local public hospitals.

One of the successful graduates is Livingston, who has 15 years' experience in TCM. He earned a master's degree and then a PhD in TCM from Zhejiang Chinese Medicine University this year. He works as a TCM physician in the internal medicine department of Shanghai East International Medical Center.

Livingston was attracted by TCM's understanding of human beings and their relationship to the universe.

He graduated from university with a bachelor's degree in biology in his early 20s. Then he decided to pursue TCM and studied in the United States before coming to China.

Both Western and Chinese medicine are exploring the mysteries of the human body but in completely different ways, says Livingston.

"I like to use the analogy of the body as a forest. Western medicine is down in the forest examining each tree, each leaf and each cell, while Chinese medicine stands up on a mountain nearby, overlooking the whole forest," he says.

TCM is more interested in the relationship between each part and how they cooperate while Western medicine is more engaged in exploring the micro world and seeing how each cell comprises the world, he says.

Some people consider TCM unscientific because much of it is impossible to explain through "science," but Livingston says these skeptics are incorrectly trying to explain TCM through Western medicine rather than broader science.

The fact that qi (life force) and jing luo (qi channel) - the major TCM principles - are invisible leads many people to question or deny the validity of TCM.

Livingston acknowledges that nobody can actually find qi, but he maintains that it does exist - but not in the way most people would think.

"Of course you cannot find it, because qi is not a thing," says Livingston. "It is just a word to explain certain phenomena, both in the general natural world and in medicine."

The fact that there is no single word in English to describe these phenomena does not mean that using qi to identify the phenomena is unscientific.

There's no definite path for qi flow, either, in Livingston's opinion. Jing luo is just a word to explain very complicated physiological phenomena when stimulation is applied to a certain point on the skin. It may involve the reactions of blood vessels, nerves, immune system and other systems. Though nobody so far can explain how it exactly works, the phenomena exist and do help to treat ailments.

"TCM is a science based on thousands of years of observation of the world and human beings themselves," says Livingston. And TCM achievements by far predate Western medicine though its practitioners knew nothing about the microscopic and cellular world inside the human body.

Livingston observes: "'Huangdi Neijing' ('Medical Classic of the Yellow Emperor') says that the food we eat travels through the stomach and reaches the intestines, the ying qi (nutrient qi) is absorbed in the intestines and enters blood vessels to travel together with blood; the blood then travels through the heart and enters the lungs; qing qi (clear qi) is absorbed in the lungs and completes the blood; the blood then enters the heart again and then travels to all the other organs.

"Sound familiar? It is the blood circulation including systemic circulation and pulmonary circulation that everybody knows today, except for the different wording," says Livingston. Ying qi is actually nutrition while qing qi refers to oxygen.

This description was completed in Chinese around 2,000 years ago, he says, while it was not until 1616 that William Harvey discovered and scientifically proved blood circulation.

South Korean take

Though Western medicine and TCM observe the world in completely different ways and use different words to describe it, 40-year-old Hong Wonsook from South Korea is very optimistic about combining the two in both diagnosis and treatment.

"Both traditional Korean medicine rooted in TCM and modern Western medicine are widely accepted in my country, yet they are completely separated from each other," according to Hong.

"A traditional Korean medicine doctor never uses Western methods to diagnose or treat patients, while a Western medicine doctor never applies traditional Korean medicine in any cases, either," she says.

Witnessing her father's suffering from chemotherapy for his stomach cancer, Hong decided to search for another way to help people. Without any medical background, she began her TCM study in Shanghai in 1993 as the second group of foreign TCM students in the Shanghai University of TCM.

Here, she found extensive combination of Western and TCM diagnosis and treatments used in modern Chinese medicine.

Both a Western diagnosis and a TCM diagnosis are written on medical cards in TCM hospitals. TCM treatments are widely used to assist in recovering from serious diseases, together with Western medicine.

Hong earned her PhD in 2007 and became a TCM physician of Shanghai Shuguang Hospital affiliated to Shanghai University of TCM after graduation.

Both Western medicine and traditional Chinese medicine have their strengths and shortcomings, according to Hong.

Modern lab tests and X-rays in Western medicine can effectively discover conditions and diseases like inflammation or tumors, but they are less helpful in what TCM calls "sub-healthy" cases.

The traditional diagnostic methods - wang, wen, wen, qie (observation, auscultation (listening)/olfaction, questioning and pulse taking) - are good at identifying chronic ailments and conditions, and even wei bing (likely future diseases/conditions). But they cannot make a definitive diagnose of an organic problem, such as a tumor and organ/blood vessel hardening.

It is also the case with treatments. Western treatments take effects fast but with great side-effects while TCM treatments protects the healthy qi but takes long to expel the pathogenic qi completely.

"You cannot expect to eliminate a tumor by drinking herbal soup," says Hong, "but surgically removing a tumor from part of an organ and chemotherapy will inevitably damage the immune system and health."

In such cases, the most widely used method in modern Chinese medicine is to surgically remove a tumor and help patients recover through acupuncture and drinking herbal soup.

"If we can help patients recover sooner while suffering less, I see no reason to oppose the complementary use of Western medicine and TCM," says Hong.

Dr Greg Livingston

Tel: 5879-9999


Dr Hong Wonsook

Tel: 5132-8888 ext 8520

E-mail: hongyuanshu


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