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

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.