A day in the gynae department

As gyneacological conditions constitute most of the patients I see in the UK, I was looking forward to the gynaecology department. It turned out that we would observe three different doctors two of whom are the children of Han Ling Bai 韩百灵 (1909-2010) who, according to our interpreter, ‘ was a real celebrity’. From the beginning it was quite clear that there was indeed something very celebrity like about Han Yan Hua 韩延华 (1952-), the oldest  of the two siblings. To begin with the number of patients waiting was the greatest I had seen up to that point; everything was prepared to the fine details by her students for the doctor’s arrival, one of whom patiently waited for her at the hospital entrance to carry any bags. The doctor’s jacket was then swiftly put into a protective bag hanging on the wall and swapped for the white coat followed by the removal of two mobile phones from her handbag. The whole process was a smooth and effortless dance which only took a couple of minutes.

In finding out that I was from Italy Han Yan Hua vivaciously enumerated various Italian cities she recently visited and boldly added how the food and  ‘Italian noodles’ in particular were terrible and the wine just ok. I nodded and gave a big apologetic smile for my country not living up to her expectations although at that right moment I would have happily swapped the worse Italian meal for my canteen dinner which I am sure was the cause of msg related insomnia more than once. Smile and just go with the flow is my latest survival technique while I feel the cultural divide opening up like a gigantic crack under my feet.

The clinic set up itself was also like a perfectly oiled machine. Some of the basic information already gathered by the sternest looking student, Han Yan Hua swiftly proceeded to the five minutes long consultations. Most physical examinations were carried out at the same time behind a flimsy pink screen on a table that pointed in the direction of a window with open curtains which gave onto a busy road. Brisk, unapologetic but efficient to the receiving end.

While at the current dermatology department I have mastered the art of floating between patients and literally almost hugging the person who computerises all information in order to take a snapshot, keeping track of what was happening at the gynae clinic was much harder because of the combination of a more crowded space and somewhat more hierarchical set up.    

Luckily I discovered most prescriptions were a variation of eight major formulae written by her father which we finally managed to get hold of. That paired with starting reading one of Han Bai Ling’s books and a couple of his daughter’s articles allowed for placing some of the puzzle pieces together in a setting where there was not little time for any discussions.

A large number of patients sought treatment for pcos and were often diabetic, a reflection of the doctor’s main area of specialization. Han Yan Hua treatment approach to pcos is fairly straightforward; the physician is of the opinion that most cases involve a pathology of spleen and kidneys, where kidney deficiency is the root and phlegm and damp the branch.

Han Yan Hua strongly believes in the use of western medicine in low dosages and for short period of time to begin with. She often suggested a course of treatment of metmorfin for three months together with a modification of her own formula called yi shen hua shi tang 益肾化湿汤.

 If after taking those herbs the patient developed a slippery and rapid pulse, swollen abdomen and breast distention which signified the imminent arrival of menstruation she would prescribe yi shen hua shi tang plus herbs like chuan xiong, tao ren, dan shen, hong hua, yi mu cao to invigorate blood and regulate the menses.

Han Yan Hua more than once pointed out her belief in having a few formulae as a basis to be modified appropriately according to diagnosis. Despite perhaps not being the most exciting way of practicing to observe, it did seem to serve its purpose as a few patients reported of successful stories and certainly contributed to such an efficient running of the clinical day. Will I be back for more…I still haven’t decided.

 Yi shen hua shi tang益肾化湿汤: tu si zi, ba ji tian, shan zhu yu, gou qi zi, huai niu xi, xiang fu, bai shao, dan nan xing, cang zhu, chen pi

The Escape

Last weekend was Qingming festival 清明节, a day to remember the ancestors where tomb sweeping and spring outings are the most popular activities.

One of the Chinese language teachers once told me about the custom of putting miniature objects on the ledge of the tombs in order for the passed away to have a more comfortable after life. Those included things like little cars, fridges and tellies; keeping my face straight at the thought of the after life being exactly like the present one, i.e totally obsessed with material acquisition, was a real struggle. So last week I asked our interpreter (a lovely guy who is currently experiencing all sort of blushing as the only man in the gynae department) about this custom. He looked at me in disbelief and mumbled ‘I don’t think so’. I wasn’t surprised. I made a bleak attempt at asking where the nearest cemetery was but the alarmed look I received made me realize that finding out for myself about the mini fridges and tellies was not worth the hassle.

I remember having dinner with the only other language student left at the end of January and him venting his frustration at not being able to get the same answer from the three language teachers who all seemed to have different opinions on everything. It gave my fellow student searching for ‘best way’ a lot of grief; that same grief I have experienced when trying to look for definitive answers in Chinese medicine. China and anything Chinese related does test my patience on a daily basis.

The Foreign Students Group (us) took advantage of this holiday to flee…not only the Enclosure but Harbin! Trepidation was in the air; we were about to leave what someone defined as the ‘armpit of China’.

The quick stop in Shenyang was packed with a visit to two lovely friends (thank you for the unexpected lush continental breakie!) and a couple of the major touristy things which were worth a visit  (the Imperial Palace and Beiling Park). For the rest, Shenyang seemed like an incredibly heavily industrialized city constellated with monstrous construction sites. I am glad it wasn’t our last stop.

Instead, our real destination was Dalian; because of the holiday period we had to compromise on the train time and go for a 2am night sleeper which meant a few hours to kill after dinner. What followed a rather lovely meal at the oldest dumpling place in the city was the encounter with two local institutions, the bai jiu 白酒 (literally translated ‘white wine’ but truth is that my uncle could make something that tastes better at the back of his garage) and the KTV (karaoke tv). Now, the combination is lethal and not one I want to repeat any time soon especially when followed by a night train with people I have only known for a month. But trust the Brits to get their best side out with a little alcoholic help.  So in a sparkly world of mirrors, lights and various props which resembled nothing of the dodgy karaoke cubicles in London Soho, we wailed away for hours and the following morning, getting off the train, we felt a bit more friendly to each other despite the pounding headaches and radioactive breaths.

A grey, cold and windy Dalian greeted us despite the Qingming festival usually marking a rise in temperature. For a place called the Chinese Riviera I was expecting blue water and idyllic settings. Instead we were never too far from some sort of ugly building being built and the omnipresent sound of human phlegm being powerfully dislodged.  It nevertheless provided respite from the urban setting of the previous months and we indeed managed to find some quiet spots. Cycling along the sea on tandem was fun especially when charging groups of Chinese strolling around, revenge time.

After a shaky start which involved almost walking into the typical tourist scam of being taken to the wrong place for a ridiculous price things started looking up. Until we chose the wrong place for dinner; unknowingly we must have walked into Gangster Land. I had heard about the feistiness of the north easterners before but I wasn’t quite ready for this type of fighting at the dinner table. Full teapots smashed on each other heads, plates and glasses flying and waitresses hiding behind us Westerners. It ended with a pool of blood on the floor and one person being driven to hospital with half an ear hanging off his head. The resigned look on the waiters’ face mopping up the battlefield hinted that he had seen it all before.

Nasty and needless to say it left a bitter taste in our mouth and no desire for food any more. And for an Italian, that is not a good way to end the day.

So…I cannot really bring myself to say that leaving the Enclosure was a pretty experience but it was certainly an eventful one. And that is China for you. Or at least for me so far. 






If you are planning a visit to Dalian,  the best time is probably around May, when the weather is milder and the city is not yet inundated with people on holiday. Dalian is a young city and has very little history so it wouldn't be my first choice where to be based. But if that is not important, it indeed seemed like a rather pleasant and clean place and certainly to be taken into consideration if you want to learn Chinese as the language I heard in the street was close enough to standard Mandarin.

Good accommodation in Dalian: Yijia Express Apartments 

The life of a Chinese student (part 1)

Sucks. I initially thought.
Being based on the university campus has the disadvantage of leading a somewhat artificial life within the Enclosure; everything to meet basic needs is within short walking distance so going behind the gates (and encountering manic traffic) always feels a bit of an effort. We (the foreigners) are in a different derelict building and thank god for that. Living in a squalid, tiny room with other five students and sharing a bathroom with many more is not appealing.
However being on campus has many ups, such as cheap meals and quite a few free classes. But so far the real privilege has been being able to observe the daily life of a Chinese student. Their chores seem to be never ending; I see students up and about from 6am, we leave them behind at the hospital when it is lunch time and in the evening quite a few are still in the classrooms studying when I am more than ready to chill out.
I recently sat in a couple of lectures on the Shang Han Lun. Perhaps breaking into is more of an appropriate term as those classes were not part of the scholarship deal. But learning justifies it all (and having italian blood helps too). On top of that I do need to get some adrenaline rush from somewhere since my coffee making attempts  without a gas hob have been so far pathetic to say the least. 
It all began with a nerve wracking interrogation from the lecturer who would call out random names. The selected victims were expected to recite out loud verses from the original text; the tension was so palpable that from my hiding place I started worrying I would hear my name.  After the torture was over, a few students at the back collapsed one by one and literally went to sleep and I started sweating as they were my shield. The studious ones at the front continued frantically taking notes while I kept trying to deal with a language that was beyond my capabilities and all my gadgets at once (camera to take pics of slides, recorder and dictionary) without being seen. A painful but interesting experience. 
Students got fed information, more than the average Western student will ever dream of, like a mass production of foie gras. No space for discussion nor questions, unless they came from the teacher.
That same subdued atmosphere applies to the hospital settings; students don't say a word unless requested but follow the doctors/teachers around. While I appreciate the value of being quiet and learning from observation, I also often witnessed the shortcomings of relying on memorisation alone as the main studying method.  
I was expecting this sort of set up but I nevertheless found myself more than once wanting to shake the sharp looking ones in an attempt to bring them back to life. But then I had to remind myself that Chinese medicine is no novelty here and they are just (very young) students and as such probably only trying to go through hoops in the least painful way.

So, up to a certain point, I thought looking at those overworked and lifeless Chinese students living in s*** holes…your life sucks…
Until I went to the ‘ Crazy English Club’.
To be continued… 

A bloody encounter

All Harbin is known for is the Ice Festival and being asked about it was one of the ice breakers when I first got here. One month later, I started receiving surprised looks that I still had not gone but I had the perfect excuse, I was waiting for my partner to arrive and with the entrance ticket going for £ 30, I was certainly not going twice. Truth is that I also was not in a hurry…the only person in China I confided that was my Chinese teacher who smiled and told me ‘ah, don’t worry…it is just for the tourists…we don’t go there’.  When I finally came around to go, I enjoyed it a lot for all the wrong reasons.  It was like looking at something that it is so tacky that one cannot help but staring in awe. Surely there is something a bit perverse about going up and down ice slides at -25 degrees with “Gangnam style’  music pumping out loud surrounded by millions of bright lights while I was silently praying the epileptic seizures would not make a come back? I much preferred the ice statues and decorations scattered around the city, so much so that when two weeks ago I finally managed to leave what I call ‘The Enclosure’ (the university campus) I felt post concert like sadness to see that they were all gone due to the rise in temperature.

However at that same ice festival I had my first encounter with a lovely fruit used in Chinese medicine. As soon as I passed the entrance gates, I immediately immersed myself in the touristy mood and decided to buy an overpriced tanghulu (糖葫芦)/ fruit skewer which are very popular in the north east of China. Nothing healthy there as the fruit is covered with sugar syrup. As I started munching away my lips must have become numb by the fruit and the temperature because the deadly frozen syrup made his way into my lip without me feeling any pain. So for a while I leisurely strolled with blood pouring out until Kerry turned around to find that Dracula has taken my place. So my most vivid memory of the wonderful Ice Festival was trying to stop the bleeding while admiring the psychedelic activities all around me. 

My favourite fruit of the piercing skewer was 山楂 shan zha/ Chinese hawthorn. Once I started paying attention, I realised that it is everywhere. In drinks, snacks and jellies …I still have to come across the fresh fruit. It usually comes in a very sugary form (no surprise there) but I prefer it in dried form which is quite sour. It brings back childhood memories of stealing the lemon slices from the adults’ drinks. As there is nothing like experiential learning and because I find memorising single herbs much harder than formulae I decided to read up more about this lovely fruit.

I am trying to avoid Chinese medicine literature in English so I went to a shop to choose a book about herbs (and also to feed my books buying addiction). As usual, I got there without my Pleco ( The Dictionary/ my best friend here) so I had to use one of my random ways of picking a title with very limited Chinese/ knowledge of who is who apart from the very obvious ones. I chose a book on the use of herbs by 孟景春 Meng Jing Chun  because the cover had his mug shot and he looked suitably old. In addition he had other two books published (which, thinking about it, doesn’t mean anything but at the time I found reassuring) and, by quickly flicking through it, I recognised another doctor's name who I was told was good by someone who knows much much more than I do. So after such an informed choice and with my wallet only £ 2 lighter, off I went to read about shan zha whilst chewing on some. 

This book includes from some general info about shan zha taken mostly from Zhang Xi Chun, brief explanations on the author's personal take on the usage of this fruit for certain conditions and two case studies. In one of them, 孟景春 uses shan zha on its own and in high dosage as translated below.

Mou, female, 65 yrs old. First visit on 04/08/1983. Had been suffering with chyluria for 19 years. Patient tried Chinese and western medicine but to no avail. In the previous month the condition had worsened. Every time she urinated there would be a great quantity of chyle which was turbid and murky like starch, worse early in the morning, but no difficulty urinating nor pain. When eating oily and greasy food she would suffer from bloating of the stomach and abdomen with a sense of oppression, sloppy stool and the urine turbidity would get worse. The face and the eyes presented with deficiency puffiness, the four limbs were limp and painful. Pale tongue, white greasy coating; pulse thin and relaxed/moderate (缓). 
Diagnosis: spleen and stomach qi stagnation, spleen not transforming essences with fat flowing downward. Treatment consisted in strengthening the spleen, move and disperse stagnation.
The prescription consisted only of shan zha ground into a powder and made into pills with honey. 90 grams/day divided into 3 doses. After half a month the chyluria was completely resolved and digestion was better as well. (Patient stopped taking the prescription). A follow up visit two years later revealed that there had been no more relapses.

Commentary: shan zha is able to dissipate stagnation of oily and greasy substances. It enters the spleen  channel. It strengthens and moves spleen qi; it opens up the middle jiao. The spleen distributes the essence into the lung which supplies it to the one hundred vessels. The lung also unblocks and regulates the water pathways. By strengthening and moving the spleen, there is any more food accumulation and stagnation and therefore the water pathways are open and the source of the downward flow of fat is cut off.

After one week at the hospital...

It has been just over a week in the department of acupuncture under Dr Zhao. She is one flamboyant character whose personality easily fills up the room; her vast array of facial expressions transfixed me for the first couple of days.

I heard quite a few stories about how different clinical practice is in China  compared to the West and this setting is no exception. If anything it is probably more run down than others because the whole hospital will be soon transferred to a brand new building and the Chinese are not very good at looking after their buildings…what gets old, gets destroyed seems to be the motto and in the meantime things fall apart (like most stuff in my room).

Patients never come on their own, in fact they have at least one family member but most often two or three which makes the room easily crowded. Like other things in China, there doesn’t seem to be many rules. Consultations are easily interrupted by other patients making sure that Dr Zhao knows they are there, people walking in bringing gifts or with business proposals or Dr Zhao herself answering private calls. Patients’ complaints and stories are shared with at least thirty people in the room and they often continue on the treatment table or after being dismissed by Dr Zhao.

I am making the most of this formality free environment and so for example it felt perfectly normal this morning to literally stick  my head and rummage into one patient’s bag of herbs to check out what he had been prescribed (in fact the patient helped me to do that). I must remember that next time I give grief to someone at the supermarket for having sneaked upon me and checked the content of my basket (yes it happens often!).

Most patients come for conditions such as cerebral palsy, stroke, insomnia, numbness, depression/anxiety, tinnitus and certain types of pain. The needles used are indeed thicker and longer but I haven’t seen anything too extravagant; in fact stimulation is down to a bare minimum but I must say the number of scalp points used is quite extraordinary. 

The other day one of the Chinese students’ head was used as a pin cushion to demonstrate our needling techniques; I cannot see that happening any time soon at the University of Westminster where I trained. The chosen one was a particularly timid student, as loudly pointed out by dr Zhao, in the hope he would overcome his shyness.. She certainly got some reaction from the guy, although maybe not the desired one.

If in Chinese medicine we usually say that there four methods of diagnosis, for Dr Zhao there is a fifth; one that comes before anything else which is the MRI. Nobody walks in without one; we were told she is the expert at reading them. I believe that; she looks at the MRI before doing anything else quickly followed by neurological tests… it is such a routine that even the other foreign students who don’t speak Chinese have started chanting to themselves with the same lament like tone ‘扎这儿疼？ ‘扎这儿疼？ 一样吗？’(does touching/pricking here hurt? And here? Is it the same?).

Dr Zhao is often delighted to inform her patients about diseases we don’t see in our clinics and usually proceeds to give us a quick lecture which consists of reaching for her book and reading out some paragraph of explanations constellated with Western medical terms that sends our poor translator into a panic. At this point I can perceive the boredom spreading among my fellow students and my only consolation is to concentrate on the language aspect of things. Today she gave what seemed like the first real explanation of some patient’s condition from a Chinese medicine point of view; the sense of relief was palpable.

Although not having had any epiphany of the sort, I am learning something everyday and admittedly the placement being through scholarship and therefore free, it takes some of the pressure off; certainly that is the reason why I think most of my colleagues are putting up with translation which is rather poor and often a collective effort. Everybody who is assigned the job gets a scolding from dr Zhao for not being a good enough translator (which is true but then again the poor victim is a ‘volunteer’ student because we are scholarship students so there is no funding for a professional one). I sometimes feel like telling her that we are the ones visiting but for obvious reasons I shut up (well I don’t want to eat my dinner on my own, right?). Don’t get me wrong, my Chinese is super basic but paired with the shaky translation I feel like I have less gaps in the bigger picture. Well after all, I have put myself through a few weeks of isolation at -25 degrees and it seems to have paid off.