7 features of your Great Chinese Medicine physician
<—— Hua Tou. Now he was a GREAT physician.
– Now that I’ve discussed how to find a legitimate (read: non-lethal) Chinese medicine physician - I’d like to get to my passion, what sets apart the merely legitimate physicians from the ones who are truly great or, if they are new to the profession, on their way to greatness. The following characteristics embodied in a doctor represent the template of the highest that Chinese medicine - and perhaps medicine in general - has to offer.
1. She has an unflinching dedication to lifelong scholarship. This is absolutely, positively ESSENTIAL. A good doctor is a good student (the reverse is not always true). Several thousand years of the practice of Chinese medicine have resulted in an avalanche of information available and one could spend a lifetime investigating only a tiny portion of that information. Add to that the fact that for CM doctors the true teachers are human beings and the rest of nature (both endlessly transforming) and you have a recipe for a life filled with study. Knowing more doesn’t guarantee they will be able to treat more effectively, but it lays the foundation.
2. She has excellent clinical abilities. This starts with the first handshake in your first meeting with her. Every moment of the patient-doctor relationship has the potential to be therapeutic and a great physician knows this. This also includes her ability to diagnose, treat and follow up. Combine this with #1 above and you should also have a doctor who is constantly at work improving their clinical prowess. How will you know if your doctor possesses this trait? Well, partly by word of mouth. But, you can also look into the depth of the clinical portion of their education. Failing that, just see how she interacts with you when you first meet. Does she handle herself well? Does she seem to be observing you in a diagnostic manner? Do you feel comfortable with her? Remember - she is probably going to be sticking needles into you - so you should be pretty comfy with her.
3. He is familiar with other systems, particularly Western medicine. I don’t think a great doctor of any tradition can be a jack-of-all-trades. What I mean is that every medical tradition (particularly Chinese medicine) is so deep and broad that a lifetime cannot exhaust its secrets. But at the same time, a basic familiarity with other systems - particularly Western medicine in all its youthful exuberance - shows a willingness to understand the body from many angles. It also makes it more likely that they will have built up a referral network that can be helpful if you use your CM physician as your primary care physician. Though CM doctors are not licensed to be primary care physicians in most states, many people use them that way. If you plan to, or even if you don’t, knowing that your doctor probably knows an oncologist or dermatologists can be a great comfort. To find this out, ask the doctor directly. Ask him if he is familiar with Western medicine (or whatever system you are interested in) and to what extent he is familiar with it. If you’re not comfortable with that direct approach, try again checking the website of the school he went to and investigate.
4. He will understand the Classical basis of the medicine. Chinese medicine is a tradition based on… well, tradition. In a youth and future obsessed culture this can seem a little quaint. But Chinese medicine functions best when it takes seriously the proposition that the past holds vast wisdom. Being well acquainted with the foundational texts of Chinese medicine, being engaged in the process of understanding what they mean and being capable in the classical diagnostic procedures and treatment principles is utterly essential to utilizing the true power of Chinese medicine. Any attempt to avoid this is dishonest at best and dangerous at worst.
5. She will have an impeccable personal character. I do not believe you can separate the medicine from the (wo)man. This is not an entirely popular opinion. I’m not saying that you couldn’t get a decent treatment from a doctor who, say, lies to her wife and cheats her business partners. But we’re talking about greatness, here, and Chinese medicine is deeply rooted in ethical bases of behavior - particularly those elements of CM that come from Confucian traditions. A good CM physician will be honest, forthright, ultimately gentle and in every way the picture of ethical behavior. At the least, they will be striving in this direction. Think: do you really want to be treated by someone who is anything else? There is of course, no obvious way to determine your doctor’s “score” in this department. But watch for the same cues you would watch for in anyone, and pay attention to word-of-mouth reports. Most of all, trust your gut.
6. She will have a reasonable pricing structure and be reasonably skilled in basic business. I feel that developing a pricing structure that is both fair and yet allows the physician to make a living shows that the doctor cares about the medicine. No one is served by either astronomical prices on the one hand or (much more common among CM physicians) disturbingly low prices on the other. Doctors on the latter side of the equation are often overworked and sometimes fail to thrive in business, ultimately robbing patients of their skills and expertise.
7. He will have an approachable manner and willingness to answer questions and concerns. One of the things I always found frustrating about my Western primary care physician was his unwillingness to discuss with me the questions and concerns I had. Often, I would be brushed off with a casual explanation of a problem, even when I demonstrated that I knew a fair bit about the subject and simply needed clarification or a slightly more advanced understanding. I understand that often this attitude is due to the high time pressure so many PCPs are under, but I also think it is a flaw in the Western medical system and the education M.D.s receive. I feel it is even more vital in Chinese medicine that doctors are willing to discuss questions the patient has because there is no latent knowledge about the system in Western culture. Patients may have questions about the theory behind a treatment or diagnostic procedure, they may have concerns about herb-drug interactions, they may want to discuss lifestyle options that would assist or hinder their treatment… all of these questions should be addressed in a compassionate manner.
—
Although some of these qualities are going to be a little difficult for a patient to assess without some time to get to know the doctor, they can still act as guidelines as your relationship with your CM physician progresses. I also believe this list can serve as a skeleton for students seeking to learn Chinese medicine. We have to learn the points, the herbs, the theory and diagnostic skills - all of those are vital. But it’s traits like those listed above that separate an OK doctor from an excellent one. Let’s all strive to be the latter.
e
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Tags: CharacterRelated posts
Should Chinese medicine be modernized?
You probably already know my answer to this question. Reading through my Chinese Medicine news feed, I came across this article - China to further modernize Traditional Chinese Medicine. Here’s their description of what modernizing means for the medicine.
“In modernizing TCM, efforts will be made to improve standards, study new applications and standardize planting, production and processing of medicinal herbs, according to the report of the center, which is under the Ministry of Science and Technology.”
This doesn’t sound too bad, actually. I can understand the wisdom in standardizing planting, production and processing of herbs. Unfortunately, standardization too often means bringing everything down to the standard of the least excellent instead of bringing everything up to the standard of the most excellent! If they are going to standardize the herb industry they need to take care to:
- Make sure the integrity of biological systems is maintained, or where already damaged, improved. The energetic quality of the herb is certainly impacted by its environment. In ancient times, these herbs grew wild - in harmony with their surroundings. The best quality of many herbs is still found in their wild counterparts! In standardized cultivation, one should do the best they can to replicate that environment - even if it harms yields.
- Follow traditional guidelines in harvest and processing of herbs. If in the Materia Medica an herbs is meant to be mix-fried until yellow, don’t char it. If it is meant to be processed in salt water, process it in salt water. Perhaps contemporary research methods don’t pick up the difference between one processing method and another - but don’t kid yourself into thinking that the sages that developed this medicine were stupid. Their guidelines were precise and developed over centuries of testing. Respect that.
- Use the implementation of standards to ensure the elimination of heavy metals, pesticides and non-edible products from the herbs.
Unfortunately, this isn’t all “modernization” has in store for Chinese medicine in China. If prior activity is any measure, it will almost certainly entail the purging of important information from the official canon and redoubled efforts to justify Chinese medicine from a Western scientific standpoint. Further, practitioners with diverse (yet vital and functional) theoretical standpoints, diagnostic methods and treatment principles may be forced to embrace the standard despite the fact that it is not clinically more effective. This, so the line goes, is the only way that Chinese medicine will be accepted into the mainstream.
If that’s what it takes to be accepted into the mainstream - I’ll take the tributaries.
Eric
Tags: activity, china, clinic, Cultivation, environment, herbs, news, Science, standardization, study, tea, Technology, traditional-chinese-medicineRelated posts
Why it is vital to study the Classical Texts of Chinese medicine
National College of Natural Medicine, where I go to school, is outstanding on a number of fronts. It’s the longest running college of naturopathic medicine in the country. It’s in the city that is widely recognized as being at the forefront of the natural medicine revolution - PORTLAND, OR. But most important for me, it’s the home of the Classical Chinese Medicine (CCM) program begun by Dr. Heiner Fruehauf and others - one of the only programs of CCM in the world and I believe the most potent and viable. I love my school, I love my program.
Our training is rigorous. In some ways, it’s like three programs in one. First, we learn Western medicine in a manner similar to M.D. students. Second, we learn Traditional Chinese Medicine (TCM) in a manner similar to other Chinese medicine and acupuncture students in the US and abroad. Third, and most important, we learn Classical Chinese Medicine. This has resulted in some amount of mental anguish for some students - it’s hard to keep everything straight in one’s mind - but as time goes on we can all see the wisdom in the way the program is put together.
There are several aspects to our classical training:
- Chinese language: No one is required to learn Chinese in order to graduate. However, it is widely recognized to be the easiest way to take one’s education to the next level. Many of the most pivotal medical texts are translated into English, but some gaps remain. Further, most of the commentary and almost all of the contemporary TCM research is published in Chinese. Being able to access this information is vital to rise to the next level of competency. Further, because Chinese is such a baldly symbolic language, understanding its intricacies helps one “think Chinese” which I think is ultimately helpful.
- Medical classics: There is a program-long series of courses specifically devoted to translating and beginning to understand the Chinese medical classics such as the Huang Di Nei Jing and Shang Han Lun. Most of these courses are taught by professors that urge us to come into relationship with the material, creating our own translations of the texts. These texts are also referred to quite frequently in courses that are not specifically devoted to their study. I feel this latter aspect encourages students to read and study the texts on their own even if they don’t take the Classical Texts series.
- Other Chinese classics, culture: There are frequent discussions concerning ancient Chinese history and aspects of both ancient and contemporary Chinese culture. In fact, our entire first year is basically devoted to getting ourselves to think in an ancient Chinese context. The thought is that we are going to be more capable of truly understanding vital CM concepts if we are able to step out of our thoroughly Westernized mindset. To this end, we have studied the Dao De Jing and various Confucian classics as part of several classes. This is another aspect of study that many students take into their free time.
- Classical diagnostics: Many of our professors have made it their lifework to go deeper into the diagnostic process, including pulse, tongue and palpation. Thus in courses and in our clinical experience, we have the unique opportunity to study with people who are putting Classical principles into practice. I feel that the expansion of palpation skills is an important part of this process - we have learned to palpate channels and points in a way that takes us beyond seeing an acupuncture point in the static way they are presented in most textbooks. In the realm of pulse and tongue, widely accepted by the Chinese medicine mainstream, we learn to apply classical principles to our use of these skills. It results in a more nuanced understanding of the human body, one that increases the likelihood of an excellent diagnosis, and thus, excellent treatment.
- Classical treatment: Following from the training in classical diagnosis, we learn classical treatment principles. We follow closely the protocols listed in the medical classics, only expanding on them in ways that are fully congruent with a deep understanding of theory. For instance, we learn Shang Han Lun herbal treatment principles, primarily from the incredible Arnaud Versluys. Packaged along with this, we learn the unbelievably complex understanding of physiology and pathology developed by Shang Han Lun author, Zhang Zhong Jing. This is not something most Chinese medicine students learn. It’s also difficult to learn, and some of us gnash our teeth a bit because of it. But ultimately, we are being trained to treat people based on theory and using methods that were created through countless years of clinical practice by individuals who are probably, to this day, unsurpassed in their understanding of the human being.
Why does this matter? Why should we spend so much time studying works that are thousands of years old - based on theories that are even older? In our modernity obsessed culture, in a time when TOMORROW seems most promising and old things are spurned unless they are likely to make someone a bucketload of money… why bother?
Well, first, as I’ve said before - it is clinically superior. People who have been through the Western medical system with no relief, then through the “alternative” medical system without relief who happen upon a Classical Chinese medicine physician often find relief. My understanding is not yet deep enough to know why this is the case. But medicine is meant to heal, and if it heals, I’m behind it.
Further, consider this - within Western medicine to become a great doctor one has to keep up with current research, one has to constantly refine one’s own skills to keep up with one’s peers and changing technology. A M.D. who treats every cold and flu today with antibiotics is behind even in her own profession - Western medicine has come to understand the folly of treating every illness with a single medication.
Classical Chinese medicine does not share a scientific basis with Western medicine - it has its own foundations, its own systems and its own conclusions. The obsession with “proving” Chinese medicine concepts with Western methods is misguided at best. As a profession, Chinese medicine is deeply different. The classical texts urge Chinese medicine physicians to be devoted to their own cultivation, to the rigorous study of the medical classics and to the full understanding of nature. In a way, then, “keeping up with our profession” means a very different set of things. We must still constantly seek to improve our diagnostic skills, must constantly seek to deepen our understanding of the principles of our medicine - but instead of using the future as our standard, we must use the past and - most importantly - the present. The present state of our own personal growth and the present state of the improvement of our patients and our ability to care for them.
Tags: AcupunctureRelated posts
10 Things you should expect from your first acupuncture appointment
Every CM doctor is different just as every patient is different. The interaction between doctor and patient has a lot to do with the way the appointment proceeds and whether it turns out to be a mutually agreeable experience or not. However, there are some basic elements that will be present in every appointment. In this article, I’d like to detail the most important of these. I hope that it will help set your mind at ease prior to your first appointment, or if this isn’t your first appointment, help you to be an advocate for your own excellent care!
Prior to arrival
1. A pleasant experience in setting up your appointment and getting your questions answered.
It has been my experience that otherwise great Chinese medicine physicians don’t have a lot of basic business skills. This can result in frustrating experiences for patients. This is not always the case, however. You should be able to expect an effortless appointment set-up process, possibly the mailing of pre-appointment paperwork and related informational materials and a kind reception with plenty of willingness to answer questions. You may even be referred to a website for more information and for downloading paperwork - that’s a sign of someone who’s been doing their business homework! ;)
After arrival
2. A lengthly interview process including questions that you may have never been asked before!
Although every doctor has a slightly different interviewing process based on their training and personality, there are standard questions that most every doctor will ask. She will begin with learning more about your chief complaint and possibly more detail about your health history. If you are on medication or under the supervision of other physicians, she will likely ask you questions about this. Then she may begin to ask you questions that may appear to be irrelevant to your chief complaint.
Questions about your sleeping patterns, digestive and urinary function, sexual function, emotional quality and basic level of stress are typical. Be prepared to disclose the frequency and quality of your urine, feces, and if you are a woman, your menstrual period. Rest assured that these questions are not meant to make you feel uncomfortable. Many conditions that manifest in a non-digestive/urinary/menstrual way (such as skin conditions) may have a basis in your basic digestive function or other apparently unrelated system. Answering these questions completely honestly will increase the accuracy of diagnosis and help your doctor to craft an excellent treatment. Believe me, it won’t be anything your doctor hasn’t heard. She is used to it.
3. Insightful questioning and the sense that the doctor is already hot on the trail of a spot-on diagnosis.
You will probably notice that the doctor will ask you questions that you had not anticipated. Often, however, when you answer them you will see that there was an unusual finding that you hadn’t thought about. For example, the doctor may ask you about your sleep though you came in for shoulder pain. Though you weren’t prepared to talk about your sleep and perhaps hadn’t thought about it, upon considering the question you may find that your sleep has been restless and interrupted recently.
This, along with other cues, will probably give you the sense that the doctor has a real idea of what is going on with your body. This should set you at ease, although some people experience it as being a little disconcerting! We’re not used to doctors with answers!
4. Taking of the pulse and observing the tongue.
The cornerstone of any Chinese medicine diagnosis is the pulse. While patients descriptions are certainly important, it is the more objective information available to the skilled practitioner that really cements the diagnosis. They will have you relax your arms and will feel your radial pulse for a minute or more on each side. Sometimes they will return to a pulse they have already felt. Every doctor has a slightly different technique, and some doctors are more skilled in pulse taking than others. This art has been practiced in some form in Chinese medicine for thousands of years. It gives the practitioner information about your entire body and everything in it.
Another very important diagnostic technique is the observation of the tongue. In CM, the tongue is thought to be a “microcosm” of the entire body. This means that the entire body is reflected onto the tongue in such a way that observing the quality of the tongue in particular areas tells the practitioner something about the corresponding area of the body. They will look at the color of the tongue body, the quality and color of the “fur” on the tongue as well as the general shape and any deviations in form. It can be a little embarrassing to show your tongue to someone you don’t know - but it is important and the doctor will appreciate your cooperation.
As a quick note - it is important not to scrape or brush your tongue on the day of your treatment. Additionally, eating highly colored foods or drinking highly colored drinks (like orange soft drinks or coffee) will impede diagnosis.
5. Treatment
Treatment will consist of the use of needles or pressure (with hand or other implement) to access the Qi of the channels, usually at specific points along the body. It may also involve the use of moxibustion (the burning of a medicinal herb either directly on the body or indirectly from an inch or so away), cupping (glass cups placed on the skin with a negative pressure, producing suction) or other techniques specific to the doctor’s training.
You may feel discomfort during the insertion of the needles - this is normal. For a quick discussion on this issue from my perspective, please see my previous article “Should Acupuncture Hurt?”
6. A variety of reactions during treatment
People have a variety of reactions to acupuncture treatment. Particularly in the first treatment, or after a particularly stressful or otherwise difficult time in your life - the emotional reaction can be very intense. You may feel like crying, laughing hysterically or expressing yourself in another way. So long as you stay as still as possible (so as not to bend the needles - this can be uncomfortable) please feel free to let your emotions flow out of you. This is part of the treatment. You may also have strange or uncomfortable thoughts, see shapes/colors as if in a semi-dreaming state, or go into a true dreaming state by falling asleep!
All of these reactions are just fine and you shouldn’t stop them unless they cause you an unreasonable amount of discomfort. Your doctor may help you through these reactions, but most often they will simply leave you to process what is coming up. If you feel that you need help - just ask your doctor. He will be happy to help you.
7. Possible restimulation of the needles and eventual removal of the needles (if used).
Sometimes the doctor will come back to restimulate the needle, producing more sensation and more Qi movement. They may use specialized techniques during this time to further encourage your body’s Qi to help in your healing process. The final removal of the needles is usually painless.
8. Discussion of the treatment, delivery of herbal formula or other recommended supplements.
After your treatment, the doctor will probably discuss your future treatment options with you as well as providing you with any recommended supplements or herbal formulas. It is very important that you understand what your doctor is explaining to you - if you have ANY questions at all, inform her immediately. This is particularly the case if you are being asked to use bulk/crude herbs, boiled at home and drunk over a period of time. There are many important things you should pay attention to, such as: how to boil the herbs (with how much water, in what kind of container), how to drink the herbs (when? what temperature? with food or without?) and how to store the herbs (at room temperature or in the refrigerator?).
Your supplements and herbal formula are an extremely important part of your treatment and they MUST NOT be neglected. If you find the herbs too distasteful, contact your doctor and ask him about other possibilities. But remember, though the herbs may not always taste the best they are very powerful and will help you immensely in your healing journey.
9. Scheduling of follow-up, possible contact mid-stream if the appointment is far away.
If your doctor does not talk to you about your treatment plan, solicit the information. Find out when you should come back and if there is anything you should do in the meantime. In some areas, “group acupuncture” may be available. This is a form of acupuncture where you will be treated - usually fully clothed - in a room with several others. It is typically very affordable and some doctors recommend it to their patients in between “regular” appointments. It will keep your Qi moving and continue the treatment you are receiving. Your doctor may also want to see you briefly if your next appointment is several weeks away in order to take your pulse and observe your tounge and possibly make modifications to your herbal formula.
10. After the treatment.
Tags: AcupuncturePeople sometimes report feeling a bit spacey after an acupuncture treatment, and for this reason you should give yourself time to relax before driving or jumping straight into work or other duties. The work of acupuncture and related treatment usually continues for several days after the treatment as your body realigns around this “new information.” If you are concerned about your reactions, feel absolutely free to contact your doctor. In the unlikely situation that the reaction is unanticipated by your doctor or causing you much distress your doctor may ask you to come back to the office so she can rectify the situation.
This actually did happen to me once. I received a particularly intense treatment that was meant to “shake up” my body’s energy in the hopes that some long standing negative patterns would release. I was fully informed of the purpose of the treatment and its possible uncomfortable aftereffects. I consented, but found that the resulting emotional and physical sensations were too intense. I called my doctor and she was more than happy to see me briefly - take my pulse and tongue readings - and retreat me. I felt much better afterwards and actually the original intent of the treatment did occur - freeing me to begin some very important work that has had lasting effects to this day.
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Should acupuncture hurt?
Should acupuncture hurt? When you ask people whether acupuncture hurts, most of them will say some variation of, “No.” I’m going to add the opposite opinion, with a few caveats.
Pain is relative. It’s relative within your own experience - that time you got beaned with a softball hurt way more than burning your hand with coffee. It’s relative depending on the part of the body being impacted - a hit to the head is going to hurt worse than a hit to the thigh, if all other variables are held constant. It’s relative between people - your girlfriend can take way more pain than you can, buddy. I’m serious.
There are different kinds of pain. Stubbing your toe feels different than burning your toe. A grazing blow to the leg feels different than a direct kick to the leg. Most importantly for this discussion, we all know what “good pain” feels like. That burn after a good workout, for instance.
You don’t need to be afraid of sensation! Even those powerful sensations that we call “painful.” Acupuncture hurts a bit - at least when it’s doing its job. But that pain is entirely different than anything you’ve ever experienced. So different, in fact, that you could call it something other than pain. In a treatment with a licensed practitioner, the sensation does not come from the insertion of the needle. It’s also not life threatening in the slightest. So don’t be afraid!
Some people describe the acupuncture sensation as “pulling” or “electrifying” or “dense” or “indescribable!” It’s a feeling like something MOVING - and at first, or when a particularly strong point is being needled, you may experience it as pain. This sensation is produced by the Qi of the body “grabbing” the needle. It is a good sign. It means that the treatment is beginning. Let me repeat: If the acupuncturist is skilled you will FEEL something. Rest assured that this sensation will pass and that you will come to understand it as a “good pain,” perhaps right away. The sensation is a signal from your body that says, roughly,
“Whoa!”
It is the sensation of good things to come. Very good things.
It is, of course, possible that the pain you are feeling is NOT a good pain. This happens occasionally when a point is misneedled, but your doctor will be aware of that and will most likely remove the needle and reinsert. More experienced doctors do this rarely, students do it… more often. Fortunately, we’re mostly just needling eachother and once we get into the student clinic we’re mostly past that phase. :)
So, the next time somebody tells you that acupuncture doesn’t hurt - ask them what they mean. If they insist that they felt nothing during the treatment, you might recommend that they find another practitioner.
Tags: Acupuncture
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