Recently retired rheumatoid arthritis sufferer Ts'ao Lin would pay regular visits to hospital while at the same time obtaining Chinese herbal remedies and acupuncture treatment from a Chinese medicine clinic. This duplicate method of treatment had been going on for years, but he never dared let on for fear of what the doctors' reaction might be.

Last October a friend introduced him to the Clinic for East-West Medicine's "all-round health project", where at his first physical examination, once the routine X-rays, blood pressure and biochemical tests were over, a herbal medicine doctor also felt his pulse and enquired about his symptoms. A week later the family doctor in charge of his case arranged a Chinese-cum-Western medicine consultation for him.

Ts'ao Lin hadn't expected this family doctor with his Western medical background to recommend him a herbal cure, and was delighted to be relieved of worry over side effects from taking a double course of drugs, because his prescription had been made out after consultation between two experts in Chinese and Western medicine. Today he still pays regular visits to the clinic for acupuncture treatment.

This case is typical of the Clinic for East-West Medicine, set up only last August.

The clinic is headed by Dr. Julia J. Tsuei, director of the Center forEast-West Medicine at the University of Hawaii at Manoa, who has invited around a dozen specialists in herbal medicine, Western medicine and dentistry to join her staff, for unlike a large general hospital this clinic combines all three departments in one.

"The three clinics are independent but mutually supportive, patients choose where to register and can consult doctors from all three if necessary. It saves the cost of building a general hospital while making the most of the streamlined and versatile service we can provide at grassroots level." Dr. Liu Chia-liang, who has returned from the States to run the dental clinic, points out that this type of clinic, although an innovation in Taiwan, is quite common in America.

But why choose Chinese herbal medicine to complement Western medicine, specifically?

"Some of Taiwan's larger hospitals, such as the Veterans General Hospital and Taipei Municipal Ho Ping Hospital, have started introducing herbal medicine outpatient departments, but these are run separately, which reduces opportunities for joint consultation; and there's even less chance in the smaller hospitals." Clinic coordinator Dr. Julia Tsuei observes that separate registration is troublesome and time-consuming, while if herbal and Western medicine doctors fail to communicate they may not only waste resources but, far worse, accidentally produce nasty side effects from harmful combinations of drugs.

"Here we discuss cases together as necessary and have devised a physical examination system which brings both types of medicine into play." Dr. Wen Yang Fan, head of the department of family medicine, points out that this is the first time Chinese medicine's diagnostic approach has been combined with the Western physical examination in a family health plan.

"We hope to make the most of herbal medicine's advantages and promote it as a means of preventive medicine." Dr. Tsuei believes, "Western medicine is effective at curing illness, especially acute symptoms. We've only recently taken up the idea that 'prevention is better than cure,' but our ancestors thousands of years ago used to say "the best doctor works his cure before the patient falls ill," which refers to the excellent preventative effects offered by herbal tonics."

For all her training in Western medicine, Dr. Tsuei thinks it places too much emphasis on physiological research at the expense of emotional or psychological factors, while modern specialization encourages a blinkered approach in which doctors only look at a single aspect of the patient's health. Western doctors have become more aware of this failing of late, with the result that broadly trained family doctors have become responsible for monitoring their patients' overall physical and psychological health.

"Chinese herbal medicine has long taken account of both these aspects," explains Dr. Tsuei. The Chinese medical theory of channels and conduits is very much concerned with interactions throughout the body, and illness is seen to have links with the seven emotions of joy, anger, sadness, pleasure, grief, timidity and fright. "After all, surely Ch'in K'o-ch'ing in the Story of the Stone is a perfect case of just such a psychosomatic illness."

But herbal medicine has its failings too.

"Relying on the doctor's physical diagnosis alone doesn't seem accurate enough to most people," says Dr. Tsuei. So as well as using an electric pulsometer to produce a visible read-out, her clinic also allows herbal and Western medicine doctors to join forces in tackling a case.

"We are not simply catering to the Chinese taste for consulting herbal and Western medicine doctors simultaneously, our aim is to create opportunities for mutual observation and communication between these two totally different systems." As Dr. Tsuei points out, the all-round health project provides for integrated linkage between the approaches of herbal and Western medicine towards diagnosing individual cases.

This totally innovative project can be traced back to Dr. Tsuei's efforts over the past 20 years to further East-West medical exchange.

Faced with the problem of rapid population growth due to the post-war baby boom, the World Health Organization assembled a team of population control and family planning experts in the 1960's and sent them to third world countries in Asia and Africa to promote maternity and child hygiene and family planning. As an obstetrician by training and a Philadelphia University medical school major in reproductive physiology and population control, Dr. Tsuei naturally found herself involved.

Arriving in what were then poor, backward countries such as Nigeria, the Philippines and Indonesia with her Western training and modern medical equipment, she found to her surprise that "age-old local traditional medicine provided the most economical and practical means of care for most people." And this sparked her interest in studying traditional medicines round the world.

"As I practiced across Asia I also found that traditional treatments such as acupuncture, herbal remedies and tonic foods usually stemmed from Chinese herbal medicine, and so I thought of researching into Chineseme dicine." In 1967 in New York Dr. Tsuei happened to meet the eminent herbal doctor Cheng Man-ch'ing, and began studying the Chinese medical work known as the Internal Classic with him.

"The more I read the more fascinated I grew, and I found many principles that could be explained in terms of Western medicine or from a scientific angle." By way of example, Dr. Tsuei cites the Chinese use of a hot compress to relieve swelling, in which the action of heat transforms sodium ions within the body into potassium ions, a process which releases water and so brings down the swelling.

In 1970 she came to Taiwan as director of the women's and children's center at Veterans General Hospital. There she was treated by the hospital's resident acupuncturist Huang Min-te for a bad shoulder that had troubled her for years, an experience which encouraged her to take up research into acupuncture.

Twenty years ago the principles of acupuncture were not scientifically proven, and yet she had clearly found the treatment effective. Dr. Tsuei describes her reaction as being "faced with an intellectual challenge."

Once having become a skilled acupuncturist herself, she allied it to her own field of obstetrics and became the first person to conduct research into acupuncture-induced labor. In 1974 and 1976 she gave two papers on the subject before the American Society of Obstetricians which are still widely referred to today. As an experienced acupuncturist at the University of Hawaii School of Medicine she even found herself approached by male patients seeking acupuncture treatment.

By then interest was growing internationally in the secrets of Chinese traditional medicine and much exploratory work began to be done. Clinical acupuncture analgesia has now progressed from control of chronic pain to use as an operative anesthetic, and its pain-killing effect has been scientifically explained by the discovery that acupuncture stimulates the body to produce cerebral morphine.

The phenomenon of ch'i that is central to Chinese medicine's theory of bodily channels and conduits has been explained in terms of physics as "bioenergy." A German doctor has invented an electrical instrument for measuring changes in the body's bioenergy which correspond precisely to the Chinese concept.

"In clinical practice, Chinese medicine places great importance on the differentiation of symptom complexes. First of all the patient's symptoms and physical condition are diagnosed by means of observation, auscultation and olfaction, interrogation, and pulse feeling and palpitation. This diagnosis forms the basis for determining treatment, but without standardized models of treatment there is an over-reliance on the doctor's experience, so the same illness can be prescribed for in a totally different way by doctors whose diagnoses happen to differ." Dr. Tsuei maintains there are too many variables to allow of scientific proof.

"To make Chinese herbal medicine scientific you have to identify the variables and eliminate them, then make the phenomenon recur under controlled conditions. Only then can you identify standard categories and establish effective courses of treatment along the lines of Western medicine, and go on to compare the relative strengths and weaknesses of the two," she says.

The first major difficulty in this line of research is to collect sufficient case histories. The second is to overcome the barriers to communication set up by the fact that Chinese and Western medicine spring from utterly different cultural backgrounds.

The all-round health project is designed to tackle these very problems. "Our aim is to collect 3,000 cases of East-West medical consultations within three years. The clinic's doctors will be responsible for follow-up records on these cases, while a team of experienced researchers will help the doctors carry out surveys and analysis on cases. Then a team of some twenty research advisors on the physical, electro-mechanical, statistical and public health aspects will hopefully summarize the various correspondences and similarities between the two systems of medicine," Dr. Tsuei explains.

Chieh-fu Chen, director of the National Research Institute of Chinese Medicine is not only delighted with the project from a research viewpoint but also admires Dr. Tsuei's courage. "Quite apart from all the instruments and equipment needed for clinical research, there's also the problem of funding a large body of researchers and maintaining her clinic's running expenses," he notes.

Sadly enough, Chieh-fu Chen has hit the nail right on the head.

"The institute's expenses are met by the Foundation for East-West Medicine, whose funding comes from contributions by individuals and businesses throughout Taiwan. Our initial contributions will be exhausted by the end of the first year, and we need NT$60 million for the next two years," admits a worried Dr. Tsuei. Drumming up financial support is undoubtedly a major concern, and she can only hope that the clinic's operations will soon be on track.

In order to encourage more people to become foundation participants by contributing at least NT$30,000 each, the clinic provides two physical examinations a year free of charge and has spruced itself up with a face lift. It looks reminiscent of a greenhouse with plants and greenery every where, and the nursing staff wear colorful patterned uniforms rather than white.

"I believe this clinic, which unites the best of Chinese and Western medicine, will be popular with the Taiwan public," foundation chairman Chiang Yen-shih, secretary-general of the Presidential Office, asserts with confidence. He plans to establish branch clinics in Tainan, Kaohsiung and elsewhere so that everyone can enjoy the fruits of East-West medical collaboration.

"At present I'm just looking forward to achieving some concrete results as soon as possible so that people will accept this approach to medicine and come forward in greater numbers to offer financial support." Dr.Tsuei adds: "In the end, the purpose of marrying the medicines of East and West is ultimately to provide people with a better medical service."

[Picture Caption]

The clinic's director Dr. Julia Tsuei has worked for decades to further cross-fertilization between Chinese and Western medicine.

With a tradition stretching back thousands of years Chinese herbal medicine still has a major role to play in modern medicine.

At the Clinic for East-West medicine family doctors occupy a front-line position and will arrange joint consultations between herbal and Western medicine doctors as needed.

The clinic's herbal and Western medicine doctors gather together every Saturday to discuss cases.

The clinic's central courtyard is planted with an array of individually labeled medicinal plants for instruction and delight.

The herbal and Western medicine clinics are right next door to each other, ready to act as "good neighbors" at any time.

The clinic's director Dr. Julia Tsuei has worked for decades to further cross-fertilization between Chinese and Western medicine.

With a tradition stretching back thousands of years Chinese herbal medicine still has a major role to play in modern medicine.

At the Clinic for East-West medicine family doctors occupy a front-line position and will arrange joint consultations between herbal and Western medicine doctors as needed.

The clinic's herbal and Western medicine doctors gather together every Saturday to discuss cases.

The clinic's central courtyard is planted with an array of individually labeled medicinal plants for instruction and delight.

The herbal and Western medicine clinics are right next door to each other, ready to act as "good neighbors" at any time.