One challenge out of the way...

After quite a bit of review, I'm at the point where I can recognize ~90% of the prescriptions that Dr. Peng writes down. I carry a thick bundle of annotated prescription print-outs with me most of the time (easy in this big-coat-weather), and make sure I review the whole set every day.

I went through a similar process of learning how to read handwritten notes when I was doing my internship in the Neurological department ICU. I was responsible for intake of new patients that were going to receive acupuncture treatments (as well as doing the treatment). When writing the consultation reports for each patient, it was essential that I was able to read everything in the patients medical record, and in our hospital most records were handwritten.

As I slowly progressed from needing fellow interns to read out entire passages to me, to only needing help on the occasional term or character, I realized there were two aspects to learning to read messy handwriting: first, it involved becoming familiar with 'cursive' Chinese, and with the writing styles of the doctors in that department; secondly, it involved simply becoming more familiar with the relevant material - in that case, common neurological examinations, the anatomy of the brain, common conditions, etcetera (subjects which were covered only briefly in the basic Western medicine classes I took).

The same is true for what I'm doing now. By reviewing so many of Dr. Peng's prescriptions every day, I'm becoming familiar both with his handwriting and with the basic and adjusted formulas that he prescribes most often. Two birds with one stone! Or, as is more commonly said in Chinese, two eagles with one arrow! (一箭双雕)

The challenges of an internship in China

Five days a week I spend half a day observing Dr. Peng Jian treat patients in a variety of different situations. On Tuesdays, he sees patients the 1st Affiliated Hospital of the Hunan University of TCM. As the hospital has a computerized prescription system, he has taught himself to use the patient management software and types all prescriptions directly into the computer. This is great for me as an observer, as it is a piece of cake to read the names of the herbs he is prescribing. Like in printed material, computers use very standard and clear fonts for Chinese characters. On the other days of the week, however, it is a different situation altogether.

At the Bai Cao Tang clinic where he sees most of his patients, there is nothing on the desk but a lamp and a small cushion used for taking the pulse. The absence of a computer screen and keyboard changes the interaction slightly, in my observation: patients at the hospital always seem a bit anxious as he hesitantly taps away at the keyboard, and they often express concern about leaving the room empty-handed (the prescription is automatically entered into the computer system). In the Bai Cao Tang clinic, however, as soon as he puts pen to paper the patient and those accompanying them settle into a half-trance, only broken by his further questioning as he makes adjustments to their formula.

From my point of view, there is a huge difference between having a digital prescription vs a hand-written one in terms of my access to information: I can hardly read his handwriting!

Generally speaking, it is more difficult to read hand-written characters than it is printed characters. Additionally, it is a standard stereotype that doctor's handwriting is quite difficult to read . . . but Dr. Peng really hits it out of the ball park when he writes formulas!

Using the app 'Turboscan' on my iPhone, I spent one week making PDFs of every single prescription that Dr. Peng wrote (over 200 pages!). I printed them out, and with the help of his other students, who carefully record the details of each patient visit, I am now going through each printout and am writing the characters for each herb next to his 'too beautiful'* version.

FYI, the herbs in the image are: 生地30克 地骨皮30克 赤芍10克 丹皮10克 水牛角30克 桃仁10克 白鲜皮30克 首乌30克 荆芥10克 防风10克 白蒺藜30克

* This is a common way to joke about somebody's messy handwriting - to say that it is 'too beautiful' to read.

Tcm as a field of study is the same as a language. Something to be used.

Something to be understood? Do you understand a language? Or do you use a language?

学院派的骨骼-

学院派中医的骨骼是西医。

中医和西医在病名方面不是纲目关系，但是学院派中医的教材基本上是以西医的病名为纲，以中医的症型为目。

其实西医的病名和中医对疾病的认识（较西医复杂，包括病和证）应该是错杂关系。

我好想没看过这样的书。。。但应该有。我该去找一下！

In certain circumstances,

why does the water boil fiercely after I turn down the heat?

Orchestra equals Hospital?

Two recent phenomena:

1. The creation of Traditional Chinese Instrument Orchestras.

2. The integration of Traditional Chinese Medicine into modern (i.e. Western) hospital systems.

Explore:

Orchestra=Hospital, Soloist=Personal Clinic

When did (1, 2) occur?

What was the largest music ensemble before Western-style orchestras were introduced to China? What instruments were used? Was there a conductor? Was the music notated? Memorized? Was there improvisation? 'Jamming'? How did the musicians indicate the music was finished? Was there applause?

(inspired by this article: "Chinese instruments and the creation of a national music")

TCM is simply another school of thought in Chinese Medicine.

It no more represents the entire field than the "spleen-stomach" school or SHL does.

It has many weaknesses and many strengths, and defining these will become my life's work. (eh? What was that last thing?)

Which dict?

When your understanding is being filtered through a dictionary, the choice of dictionary becomes very important.

I've wondered in the past if I had gotten the Wiseman/Feng PD when I first started studying CM (rather than non-specialized dictionaries) would my current understanding of the field be much different. I think it would.

I'm starting a translation project of 《西国记法》written in 1595, and I'm going to be careful in my selection of dictionaries. I'm going to stick with only Chinese-Chinese dictionaries, starting with a modern one - 《现代汉语规范词典》on Pleco.

I was reading the intro to Pi Wei Lun, and thought it interesting that he used all sorts of quotes from Nei Jing to support his argument that the spleen and stomach were all-important.

It started me thinking that no text (that I can remember) has mentioned that if you stop breathing you will die . . .

Perhaps because issues dealing with breathing were considered the realm of qi gong practitioners, and not herbal physicians?

[UPDATE] A recent discussion with my taiji Shifu confirmed a hunch - the medicine I'm studying is more about treating disease (治病) than 'nourishing life' (养生). The latter is more a part of the daoist tradition.

Were there periods in Chinese history when the visual was not emphasized?

It is certainly a characteristic of modern medicine (a product of current society) that what is visible is real. Visualizing the disease is incredibly important in making a WM diagnosis.

In CM "the inside is known by observing the outside", and observing includes palpation, smelling, and asking in addition to visually observing - in other words, the visible aspect of disease is not emphasized.

So is this a product of Chinese culture?

(racing along here, do modern Chinese CM physicians emphasize the visible more than those in the past? Also, given that our reconstruction of practices of the past is done mainly from textual evidence, and is presented in reference to modern practices . . . how accurate can it be? Bleah...is it even worth thinking about, given that we can only imagine what it was like in the past? What is the value in trying to recreate past practices? . . . )