Ni hao,

Again, apologies for my long silence. Lately, I've been travelling and the chinese censors don't seem to like blogs much, so I've been unable to access it...right now I'm in a cafe in Kunming having hit upon the idea of writing it in my email and then pasting it in when I get back to my secure connection in beijing. Hope it works..

So...as I'm not allowed to read my own blog, I can't remember exactly when I left you, but i believe it may have been sometime around the end of November. Then followed a fairly unexciting period of finishing essays and taking exams which is far too dull to write about; finished the acupuncture placement and then had four more weeks in the Xiyuan hospital of gynaecology (lots of interesting things on infertility), dermatology (a bit dull), paediatrics (very cute chinese kids) and surgery (not actually surgery!). And before we knew it, it was all over. However in the meantime there was of course a Chinese Christmas to be had - actually I was surprised by how much Beijing had latched onto the idea (in the commercial sense at least) of the holiday- all the supermarkets had decorations and bad songs - not so different from the uk really! My Christmas was spent in style with lunch at a sumptuous buffet at the Raffles hotel, followed by rather a lot of bad chinese wine for the afternoon, eventually falling asleep during charades..true festive style..All in all it was a surprisingly lovely day.

Then on Dec 30th, nursing a hangover from the 'punk band' night at the local rock club, I found myself sitting in a cafe in Wudaokou waiting for - a wandering sister by the name of Faith Arabella Elliott who had by chance happened to board a plane for beijing and find me there. We had of course about six months of talking to catch up on whilst running around searching for warm clothes in the sub-zero beijing temperatures- I had a narrow escape from one paticular silk market vendor, whose coat I rejected after bargaining her down from 3500 yuan to 200 (I decided I didn't actually like it..) - I managed to get away at last with just a few scratch marks on my wrist and insults ringing in my ears...phew. New years eve was spent playing pictionary in a friend's cosy flat and the next week with me rushing around organising, her exploring the city, a weekend of cycling around the hutong districts and mountain walking with the hiking group, strange evenings involving mongolian throat singing and reggae, several farewell meals...and before we knew it we were on a train headed south.

Well it could have been that simple but, alas, nothing ever is in China...the taxi driver misunderstood that we wanted to go to the west railway station and on realising his mistake promptly dumped us by the side of the road...we shouted abuse at each other for a while as we refused to pay him, until with the help of some friendly chinese bystanders we manged to get another driver to take us down the excruciatingly slow 2nd ring road to the station, making it just in time to buy some unappetising food supplies and jump on the 4.50pm to Kunming (Yunnan province, SW China) This is a journey of around 3000km, 37 hours to be precise, and it passed in the usual manner of such journeys, sleeping, eating, reading, staring out of the window at the mistily indistinguishable scenery and so on. It was much like a russian train except more cramped - I'm not sure whether because the tracks are narrower or people are just smaller..we found a restaurant car where you could stretch out a little but they seemed fairly unwilling to let us stay for long or serve anything at all except sweet milky coffee, and every now and again had a visitor to our carriage in the form of a jolly luggage handler who was very keen to practise his english and tell us many enlightening things such as the current state of relationships in the british royal family and the fact that both beethoven and mozart were from manchester! (we didn't have the heart to disillusion him..)

Stumbled out at kunming at 7am, already too hot from the themals we were still wearing, fought off the barrage of cries of 'dali, dali' (a popular tourist town which everybody will oh so kindly get you a ticket for for just a little wad of cash) to the bus station and got our tickets for the 12 bus to Lijiang. I can't tell you much about Kunming apart from the street food is very spicy and tasty - 8 hours of staring through bus windows at green hills later, and we pretty much fell into the starry night of lijiang and into a hostel where we met a comic korean who mimed his adventures in the snow mountain. Lijiang is a strangely wonderful place- it's so incredibly touristy I didn't see how it could be any more so if it tried...(luckily in winter you can avoid most of the hordes..best time to travel in my opinion!)- but at the same time, extraordinarily picturesque and with a relaxed charm coming not just from the cobbled streets, well kept wooden houses, criss-crossing rivers and canals and compulsory ethnic dress, but also from the waterside cafes where teenagers gathered to play folk songs on the guitar and the old Naxi women chatting in doorways. Lijiang is the centre of the Naxi people, a 'minority group' (there are around 26 of these in Yunnan altogether!) who are descended from ethnically Tibetan Qiang tribes, famous for their matriachal culture and the hieroglyphic language (apparently the only one in the world still in use.) I like the description of how the addition of gender alters nouns- for example, stone + female = boulder, whilst stone + male = pebble! Anyway, the striking black and pink dress is worn by every shopkeeper and waitress, whether they be naxi, han chinese or whatever...very bizarre!

The next day, jan 12th, was faith's birthday which we celebrated with breakfast in the sunshine and then hiring bikes to explore the area a little. En route to the village of baisha, we found ourselves drawn into a weird historical village which had made the transformation from place to theme park so successfully that it was like finding yourself in disneyland in the middle of the Yunnan countryside. I don't think there was one building that didn't sell 'authentic' trinkets. However, chinese tourists appear to love such places, especially with loudspeakers. The more loudpeakers the better. the phenomenen of these in china is still a mystery to me.. it's as if too much peace and quiet would be simply damaging.

Luckily we escaped and found the real village we were looking for, a pretty place in the beautiful green Yunnan countryside, and home to some eccentric characters, including 'Mr. Yang' who served us naxi bread and pickled wild pears, and persuaded us to buy a 'happy birthday' in hieroglyphs he'd painted himself...and Dr. Ho. He was an odd example of soembody who is famous for being famous- he literally leapt out on us in the road and called us inside his clinic - the entire of which was a shrine to himself, it seemed- newspaper clippings, letters of recomendation, even a video documentary and that all-important note from Michael Palin, who had written that 'I will suggest to the other Pythons that they come to you for treatment'! He certainly looked the epitomy of the wise Taoist physician - wispy beard, traditional robes, and he had a room filled with herbs he had collected himself from the mountains - but he seemed reluctant to answer my questions, preferring to talk about his own fane instead. It made an interesting contrast to the generally pretty humble hospital doctors I'd spent time with in beijing - just shows that having a beard isn't everything! If you look up 'the most admired man dr.ho' on google, he told us, you'll find him. It's true...

We rounded off the day with a visit to the traditional Naxi orchestra, during which faith nodded in a scholarly manner over various old chinese instruments, but we eventually had to flee due to the extreme cold (they just don't have heating in the south- I've never sat through a concert in my down jacket, hat. scarf and gloves before!) and the conductor who joked interminably in chinese, into a roadside cafe where we huddled by the fire and made friends with the owner, a regal old naxi woman, and a jolly young han chinese on his holidays, culminating in us all singing each other songs..

The next day we were up in the dark to catch the bus to Qiaotou, the start of Tiger Leaping Gorge. After sitting blearily eating noodles for a while waiting for the bus to leave, we were dropped off a few hours later in a little town where we wandered around a while trying to find the start of the trail. Tiger Leaping Gorge is so called due to a legend with has something to with a, er, leaping tiger, is one of the world's deepest gorges but could disappear if controversial plans to build a series of 8 dams in the upeer reaches of the Yangzi river go ahead. This will force around 100, 00 people to move and wash away much unique local wildlife and history. It will also put huge numbers of people at risk should it burst like the hannan dam in the 80's.

However, for now it's a beautiful, serene area and every bit as dramatic as it's reputation - hiking the high trail takes you right up via the exhausting series of '24 bends' above the foaming water below, and despite the bewildering number of signs directing to the guesthouses that are rapidly springing up along the way to cash in on the popularity of the trek, was in winter peaceful and deserted except a few goat herders and a lone woman sitting at the top selling honey tea, snicker bars and tangerines and ambitiously trying to sell space on the 'lookout rock' (really, they'll try anything in china..). We spent the night at the 'tea horse guest house', drinking beer and looking at the stars with the dutch and english couples also walking, whilst simultaneously trying to hide in a misanthopically british manner from a noisy bunch of americans who arrived later. The next day we carried on walking past more wondrous scenery along with our new friends, reaching 'sean's' guesthouse for lunch before deciding, in the spirit of adventure, to set off with tim and ali (the brits) all the way up, up, up to the icy cold of Shangri-la.

Shangri-la was opportunistically so-named by officials due to being 'proved' to be the location of James Hilton's 'The lost horizon' - originally known as Zhongdian, it was a fairly successful strategy to coax the tourists up to this primarily Tibetan town on the edge of the Himalayas. Most of the time was spent trying to wear as many layers of clothes as possible (especially in the unheated dorm room - although we did get electric blankets!), enjoying the winter light in the pretty old town, watching everybody come out to dance in the squsre at night, and visiting a fine and well kept large monastery - the Ganden Sumtesling Gompa. Interestingly there seems to be more religious freedom here than inside Tibet itself where it is so closely monitored.

We spent just a day in its friendly vicinity before clambering onto another early morning bus back to Lijiang, bidding farewell to tim and ali who were going to take the hard, cold route back to Leshan where they were teaching via local buses and the mountians of western Sichuan. The prospect of another 24hours of bus travel not really striking joy into our hearts, faith and I purchased tickets for that evening's flight to jinghong, 800km to the south, which as the first air travel of my entire trip seemed shamefully easy.

Jinghong is the capital of Xishuangbanna region of yunnan, which borders Vietnam, Laos and Burma and is home to many different peoples- with its 20 degree days and tropical flowers it could hardly have been further removed from the northern winter we'd left behind. A little enquiring in the friendly backpacker cafes soon found us a jungle trek and a guide to take us there, and the next day, feeling slightly the worse for wear after an evening's drinking with our new german friends (Jinghong being the kind of place that it's actually quite difficult not to know everybody within a couple of days), we boarded a bus for a small town whose name i forget, not far from the burmese border for the start of our walk. Over the next four days we walked nearly 90km along little paths through terrain varying from forested mountain ridges, to hot, dry sugar cane plantations, thundering waterfalls and luscious deep old-growth rainforested valleys, passing bulang, dai and akr villages and golden hinayana buddhist temples. We stayed in Bulang villages along the way; idyllically beautiful places, if you don't have to do any work, full of marauding black pigs and muddy children, in wooden, bamboo and sometimes, now, stone houses on stilts, sleeping around the edges of a the large dark central room which revolved around the fireplaces, used for cooking, boiling water for tea and warming yourself and chatting by at night. The people we stayed with were kind and shy and cooked delicious meals of home grown rice and vegetables. They were very neighbourly places with a strong sense of community - people will take it it turns to work on each others land, to help build each others houses. There is no word in the Bulang language for 'hello' - if you meet someone along the way, you ask questions - 'what are you doing? where are you going? how is the way ahead? do you know so and so who's cutting that tree down?' and so on.

We were lucky to have a brilliant guide, Anipa, who had grown up in one of the Bulang villages with ambitions; he spoke pretty good english and took his tour guiding very seriously (seeing himself destined for bigger and better) a veritable mine of information about everything from the plants and wildlife to culture and religion, social tradition and politics, and having been walking these paths since childhood, knew every bend and every tree. As he was the same age as us and had quite a silly sense of humour, the three of us made good walking companions and spent a large chunk of time discussing his relationship dilemmas- he had a chinese girlfriend in Kunming who texted him constantly, to his annoyance, whilst just about everywhere he went there would be some female relative or family friend who would nag him to settle down and marry a nice bulang girl until he looked quite harrassed. It's traditional in Bulang culture for unmarried young men to go out in the evening to visit 'pretty girls' who are supposed to sit at home waiting for them to arrive! So one evening Anipa announced we would all go out visiting to see one such girl- however, much to our surprise, there was another visitor already present- a young monk! Apparently in Bulang, culture, the fact that 'monks can fall in love' (if they decide to leave the monastery) is one of the eighteen Bulang 'strange things' that include 'a bus is faster than a train' and 'a horse is faster than a car' (there are historical reasons behind these..!)

Buddhism is a central part of this world- each village has its one temple, and on the second day we visited Anipa's village, and were lucky enough to see a ceremony of tying white string which had something to do with good fortune..The elders of the village then proceeded to get rather drunk on baijiu, and treated us to some Bulang singing - traditionally this is a competiton in which the men and the women sing against each other - we sang them a song in return and felt a bit like celebrities as Anipa translated one old woman's song, which was something about that she couldn't speak out language in order to welcome us but she hoped we would understand through her singing that she was glad were had come.

At the same time all this was happenin, outside sat a travelling silversmith furnishing bracelets from lumps of solid silver with his blackened anvil, furnace of earth and ashes and old fashioned bellows. We asked him to make one for us and sat there in the dirt watching him wring miracles from metal - looking at the silver bracelet on my wrist now it all seems like something of a dream. Altogether we had a very special experience in that village and it was hard to walk away - luckily we didn't have too far to walk that day as the further away village we'd planned to walk to had had an outbreak of fighting amongst the young men...something about arguments over a girl and a tractor....Anyway apparently it had got quite seriously resulting in several people being hopitalised and the army being called in! Everybody seemed to think this was highly unusual - nobody could remember this ever happening before- but rather amusing at the same time! We met one of those involved that same night around a fire at a different village and he told s that it was all the other group's fault..well...obviously..

On the third day we reached the final chinese checkpoint before Burma, which they reluctantly let us through (and we later surreptiously photographed (- and visted an Akr village where we drank tea with somebody who just so turned out to be Anipa's father's friend and whose son was his schoolmate..who told us stories of serving in the chinese army and showed us his collection of hunting equipment. Akr houses are quite different from the roomy Bulang ones- they are on the ground, not stilts, and are dark and cramped by comparison, with separate rooms for men and women to sleep and live. It's interesting how two neighbouring peoples came to live in such different ways..

On the fourth day we walked a hefty 32km including a long climb up out of a deep jungly valley with giant fig trees and vibrant flowers, to triumphantly arrive at the end of a long hot dusty path in a town just 2km from Burma, caught a bus that bumped and jolted us all the way home in time for tea.

Our final two days were spent mostly wandering around jinghong trying to find bike equipment and information for faith to embark on her Laos adventure (they know her well in the jinghong bikeshop now!) and getting distracted by talking to people in cafes. One particularly surreal moment was trying to perusade a chinese postman to sell her his china post bike panniers, but he wasn't having any of it. We eventually found the only non-postal ones to be had in the town, and seized them with relief. The night before last we went with Anipa, his girlfriend (who had turned up unexpctedly from Kunming, much to our amusement, and turned out to be great and not at all the nagging harpie he'd painted her as..), and their respective cousins, to a nearby hot springs and then for - karaoke! where faith as i suspected embraced her inner mariah carey and we all enjoyed some 'disco'..The final night we sat talking to a born again christian ex yorkshire bus driver about living in jeruselam before being waved goodbye by faith, the girl who worked in the cafe and a small child, to get the night bus to kunming. Where I am now. And she is...I know not...i left her with her brand new bike and a pile of little useful things to be packed into panniers to cycle off to the border. She plans to make it across laos to thailand...the route is changing daily as everybody has a different opinion...but wish her luck!!

And me? i'm reluctantly getting on a plane to beijing in a few hours. Where i will pack up all my enormously heavy books and drag them back all those nearly 7 weeks of travel back, not to mention the nearly 7 months i've been away, in a mere matter of 3 hours, according to relative time differences, on sunday. Have to be in clinic 10am on monday morning for a meeting about my dissertation.

Guess that's that then.

POSTSCRIPT

Back in beijing, horrible plane flight, cramped, delays, fat chinese men taking up all the room...gnnn give me a train any day! Have message from faith: she is halfway to laos border with bike. Go faith!

I feel there should be some philosophical reflection in true 'returned traveller stroking beard style' so perhaps another post will follow.

Hello to you, wherever you may be. It's a cold and windy tuesday evening in Beijing, and I've just had the strangest day ever. Seriously. I'll tell you all about it in a minute.

First, a bit of a 'hospital news' catch up. The last 3 weeks have been spent in the acupuncture department at the Zhongri (China-Japan friendship) hospital, which has been, well, really special actually. We seemed to evolve a really nice relationship with the doctors and the students who were translating for us. Not to brag or anything, but they kept telling us that of all the foreign groups (there were various other nationalities also doing a placement there), they liked us the best. (Bet they told all the groups that!) And when they like you, then they start to tell a few secrets... Here is a typical day:

7.30 - set out on the long cold cycle ride (ok so sometimes there may have been a taxi), arrive all glowy and red faced and numb-toed, get ready for day. 8.30- Dr. Yang - straight into it with the hard questions. 'So what is the difference in the functions of Fengchi, Fengfu, Fengshi, and Fengmen? (These by the way, are the names of acupuncture points - we tend to learn them by name rather than number which in my opinion is sooo much better as the names give you a lot of information - as well as being rather poetic. For example Feng means wind - wind gate, wind pool and so on, so all of these points are used to treat wind-based problems) We all look at our feet, mumble rubbish answers and are told off and enlightened. Next one...different types of facial paralysis? Nope, didn't know that either. Differences and similarities between Zusanli and Shousanli? Phew, between us we managed to cobble together a half-decent answer and managed to save ourselves from total stupidity! In the mean time we are seeing all sorts of different patients, and points used that we've never really thought about before.

11.20- lunchtime, and a whole two hour break, woo-hoo! So we go to the university restaurant with our student translator friends, Wangzhen and Bin (or 'teddy bear' as Thuy likes to call him') and after the usual meat vs. vegetables and tofu ratio debate (guess which side i'm on?) eat a sumptuous meal including mine and Thuy's favourite dish, fried potatoe shreds with a vinegary dressing. It's almost chips! I'm telling you, not having 2 hours lunch breaks is going to be a serious shock....

1.30 - back to hospital. Dr. Zhang is there, and as he does not have many patients, he takes us through needling technique practice. He also demonstrates some cool stuff - why did putting one needle in a patient's neiguan (on her inside forearm) and asking her to move her knee around make the knee pain immediately disappear? Why why why? you have to work it out for yourself, he says. aaarrrghh. I ask him to demonstrate his technique on me and he puts a needle in my waiguan (opposite side of forearm. Then I have to sit quietly for 15 minutes and see where there the sensation ends up. It goes to my opposite foot. Why is that?? I think of an answer. He nods, cryptically. There are probably many. He also talks a little about philosophy. To be an Chinese doctor, he says, you have to stop worrying about the surface things in life, and be content with simplicity (this is quite literal as doctor's wages are very low here). So many people in China now are obsessed with appearance, especially girls, he said. You must go beyond that. More about that in a minute.

On the last day, we saw Dr. Bai in action. She is one scary woman. From Korea, she is a fire needling specialist. This is exactly as it sounds - you get a massive needle, dip it in a flame and then plunge it into wherever your victim is suffering most. In Dr. Bai's case, this was mostly neck and spine problems, and whilst holding the sizzling needle still, she would make vicious adjustments by yanking at the vertebrae. Afterwards these poor people often had Gua Sha (scraping therapy) until not only were they scarred and burnt, but also bleeding and bruised. It looked like a torture chamber in there. But we met an Australian girl,another student, who had suffered from scoliosis (abnormal lateral curvature of the spine) since she was young, causing a lot of muscular pain and her wearing a back brace for several years. After 4 treatments, this 'incurable' problem ahd significantly decreased. Incredible....Dr. Bai also had her own special treatment for stroke and facial paralysis (which, incidentally, she is in the process of patenting!) This basically involves about a hundred needles in the head and neck, according to a complex theory or meridians, nerve pathways and so on. You think I'm exaagerating? I'm not! But again,as she claimed, she could treat people on whom everything else had failed...

Now we're back in the Xiyuan hospital, in the acupuncture department there, which si crazy in a different kind of way. the doctor we were with yesterday treated about 70 patients in a morning. Poor man, he barely had time to speak as he ran between beds! We're allowed to take out the needles at least - sometimes you just want to actually have something to do other than observe!

So today, i skived hospital. This is unusual for me. Usually I am a right keen bean, but this morning i woke up feeling that my feet were itching. i wanted to do something different for a day, to explore the city I'm living in a bit more. So I made the big trip into the centre, and found myself at the poetically entitled 'White Cloud Temple'. This is a large Taoist temple complex, complete with Taoist monks wearing their distinctive black robes with white legwarmers (that's what they look like), and top-knotted hair. It was mercifully tourist free, and I spent a peaceful, contemplative time nosying around the many temples with their golden gods and ornamental roofs, with the familiar smell of incense drifting through the air. Taoism can be described as China's only home grown religion, as Buddhism came from India, and Confucianism is more of a philosophy. It has become divided into two branches, the philosphical and religious, and its ideas of acceptance, non-action, non-resistance and essential formless simplicity have long attracted me, in what sometimes seems to be a confusing and multiplicous mish mash of gods, demons, and religions that are all around. The oft-repeated phrase 'The Tao that can be told is not the eternal Tao' is certainly applicable to studying here, as Taoist ideas can be said to underpin much of Chinese medical thought...worth bearing in mind when you're going mad trying to figure out what the right answer actually is!!

The interplay between Confucianism, which although originally a radical philosophy, is now seen to be a more systematic, rigid, practical set of ideas, with its emphasis on rules, social order and family ties (and let's not forget the more or less disregard of women) with the spontaneous, flowing, some might say metaphysical ideology of Taoism, do, to my mind at least, help to explain some of the contradictions that are always apparent here.

However, I suspect the practice of these two religions/ philosophies, together with Buddhism are nor so different in practice - religious Taoism evidently still involves plenty of god/ ancestor worship, as shown by the chatting chinese who wandered around absently rubbing bits of statues and lighting things at the appropriate moments. Much as I think it must be lovely to have these comforting and symbolic rituals to turn to - one of my nicest memories ever is waking up in the early morning in small villages in Ladakh to the smell of burning incense being carried through the rooms and the sound of soft chanting - I sometimes wonder if these really mean anything to the participants, or whether they are little more than a habit that doesn't require much thought or reflection, or at worst even prevents it. Call me a cynical existentialist but...

But back to my day. I chatted briefly to a monk who expressed much approval at my studies (that's about as far as my chinese conversation goes..), and gave me a sweet. I think it might be magic...After this I decided to tackle Tiannamen square, but first went to Wangfujing (the Beijing equivalent of Oxford street), to have just a little look at the TCM books in the gigantic bookshop..as I was walking along I was approached by two Chinese girls who told me they were on holiday from the northeast, and invited me for a cup of tea. We went to a posh teahouse and were served in an elaborate ritual, involving much swirling of tea leaves into tiny cups. They spoke perfect english and we chatted for a little while about this and that.

Chinese girls have started to be divided in my head into 'silly' and 'not silly', the silly ones being the irritatingly giggly girly ones who are preoccupied with boyfriends and appearances, whilst the others have something interesting and often very thoughtful to say. Hey, it's not that i have anything against giggling - some might say i'm guilty of it myself (-; , but from what i've seen, thought china might have quite a forward thinking attitude when it comes to professional equality, in personal relationships they're still pretty backwards. If I had a penny for every time I've heard a Chinese girl saying 'my boyfriend tells me not to eat or I'll get fat' or something similar...The emphasis on skinniness here is alarming, to the point where very thin girls will only pick at meals, and their boyfriends have no problem telling them how fat they are whilst wolfing down several bowls of rice. I've seen a lot of patients having acupuncture for weight loss here, it's a very popular therapy. Ok, so it might not be quite foot-binding, but I find the excessive emphasis on a certain kind of girly, delicate femininity pretty irritating. But is it so much different from the west? Maybe just in a different way. It's interesting, that post cultural revolution, with tis demands for homogeneity, masculine clothes and short hair, that this is so obvious. As we say in TCM, an excess of one aspect always turns eventually into the other, yang turns to yin, and so on.

So, back to these girls...they were of the 'silly' type, and sure they were a bit annoying but it's always nice to chat to someone from somewhere else, and they also both had a certain sort of sharp intelligence and ambition- one worked for an international company and the other was a language student. After the tea-drinking had finished, we asked for the bill and prepared to go our separate ways. It's worth mentioning here that when a Chinese person invites you for something it is always expected that they will pay- this can lead lead to some difficult situations, like when eating out with chinese studnets who insist on attempting to pay for their 5 western guests, it takes a lot to persuade them out of it! So, i hadn't looked to hard when they'd ordered a pot of tea and a few snacks, and when they announced that we would split it I was a little surprised, but how bad could it be?

Turns out they'd ordered what must have been the most expensive tea in the place, and the total bill was 1500 yuan. Which meant that my portion was 500Y. Which, in case you're not familiar with yuan, is about £35. Thirty five pounds. Thirty five pounds!! however many times i repeat that it doesn't become any less painful and shocking. That is a lot of money in england. In China, it's a fortune. It's 20 meals out, 100 dinners of street food, 200 breakfast pancakes. And to them it was obviously nothing. It struck me at last who i had encoutered; they were the rich kids, the equivalent of the spoilt LA blond using daddy's credit card. And they blithely assumed that it would be no problem for me either. What could I do? I was so angry I was actually shaking, but also so much in shock I just handed over the money and left. In retrospect I wonder if i should have just made a run for it. But in their defence, i genuinely didn't think it occurred to them that it would be a problem. I'm a westerner, right, and money grows on trees here after all.

You hear all the time in the British press about the growing gap between rich and poor, but I never before had it illustrated so vividly as today. The man who stands in the cold all day looking after the bikes at the hospital charges 2 mao (0.2 yuan) per bike. On a sunny day, there might be 40 bikes. You do the sums...The women outside my flat who search the dustbins all day for recyclable goods must earn a tiny, tiny revenue. And the countryside is a whole other story. even China's own researchers agree with this. I'm going to paste in a couple of articles.

This is from the New Economist

China's growing gap between rich and poor

Writing from Guangzhou, Reuters' John Ruwitch reports that China's wealth gap is reaching critical level:

Fancy imported cars, five star hotels and slick malls dot Guangzhou, the hub of a region that has blossomed into one of China's - and the world's - main economic engines.

...Persistent poverty in China's countryside, against the backdrop of fast growing cities, has sparked social unrest in some spots and elicited sympathy from the wider populace.

The public was outraged in 2003 when a driver in northeastern China ran over and killed a peasant with her BMW, but was given a light sentence.

The leadership in Beijing is deeply concerned there could be a wider backlash, threatening a decade of strong economic growth and the Communist Party's grip on power, says Wenran Jiang, a China expert at the University of Alberta.

"They have come to the conclusion that ... the regime will not survive if they don't address the growing wealth gap, and more importantly, the perception that the government only cares about economic growth and the urban rich," he said.

Deng Xiaoping espoused a trickle-down approach, saying: "Let some people get rich first".

Some have become gloriously rich. Next week, the Hurun Report, which tracks China's wealthy, will issue its 7th annual China Rich List on which the average wealth for the richest top 400 is about $200 million. Seven are billionaires.

To be sure, tens of millions of people have been lifted out of abject poverty since the Party came to power 56 years ago. But the wealthiest 10 percent of China's urban households now own 45 percent of the urban wealth while the poorest 10 percent have less than 1.4 percent, Chinese statistics show.

That has left Deng's successors, President Hu Jintao and Premier Wen Jiabao, grappling with a wealth differential that economists say is wider than when the Communist Party came to power in a 1949 revolution. Average urban incomes last year were 9,400 yuan ($1,164) while rural income was 3,000 yuan ($372).

The Reuters story then cites the recent Central Party School newspaper report, warning that "social contradictions" are on the rise (see my previous post China wants less inequality, more 'social fairness and democracy' for more details). How has Beijing responded?

Beijing has taken steps to try to buoy rural incomes, allowing grain prices to rise and starting direct farm subsidies. It has also scrapped the agriculture tax, a centuries-old Chinese institution, and tried to abolish an array of crippling local fees.

But some of the measures, while lightening the burden on farmers, have bankrupted local governments, which are forced to raise cash elsewhere. The once robust Communist social safety net has vanished, and rural dwellers now pay for things like education and health care.

"In poor areas, there are a lot of conflicts between the government and the farmers," said Li Fan, director of the World and China Institute, a private thinktank in Beijing.

China's "Gini coefficient", a measure of inequality used by economists that runs on a scale from zero to one, is believed to be above 0.45, among the highest in the world. The closer to one, the greater the inequality, and the prospect for unrest. "That means it's already a critical time," said Li.

To escape poverty, country dwellers keep pouring off trains in cities like Guangzhou and the nearby border boomtown of Shenzhen:

...Liu Zhengde begs for change outside a candy store in a lively shopping district. Originally from the Henan province in China's heartland, Liu has drifted for much of his life. He has never married, and his last job was selling fruit in the central city of Wuhan.

That venture failed a few months ago, leaving the equivalent of less than 6 U.S. cents in the pocket of the weathered man with a wiry beard and wide eyes who, asked his age, says: "over 80".

"I couldn't even afford a steamed bun. Those cost five mao. All I had was four," he said. "Everybody said go to Guangdong."

The economic boom has made Guangdong one of the wealthiest places in China. But opportunity has been elusive for Liu who sleeps under bridges. "All I want is enough money to buy a train ticket back home."

And from the Washington Post

China Warns Gap Between Rich, Poor Is Feeding Unrest

By Edward Cody
Washington Post Foreign Service
Thursday, September 22, 2005; Page A16

BEIJING, Sept. 21 -- China's official media warned Wednesday that the gap between rich and poor has become alarmingly wide during two decades of economic liberalization, contributing to spreading unrest in towns and villages across the country.

While the income disparity, particularly between farmers and city dwellers, has been widely discussed and reported, simultaneous and extensive reports by the New China News Agency and the Communist Party's main organ, the People's Daily, suggested that officials wanted to call particular attention to the problem.

iots and other violent protests, which the government acknowledges are increasing dramatically, have become a major issue for President Hu Jintao's government. Hu and Premier Wen Jiabao have made calls for "harmonious society" and "social stability" watchwords of their speeches over the last year.

The reports on income inequality seemed to attribute violence to economic rather than political causes and warned that more unrest could be coming. Following this reasoning, the Standing Committee of the People's Political Consultative Conference, one of China's two legislative bodies, declared in July that the widening income gap "is the root cause of disharmony."

Some senior officials in Hu's government think that the economic reforms begun in the 1980s have gone too fast and that more attention should be paid to the people left behind, according to Chinese academics with ties to the government. Yang Zhaohui, a political specialist at Peking University, said the focus on income disparity shows that the government and Communist Party take the issue seriously.

"I think the purpose of these signals is to give the society a warning," Yang said. "The government might bring out some policies to mitigate the problem."

Since taking over 2 1/2 years ago, Hu and Wen repeatedly have emphasized concern for the poor, but without repudiating the movement toward a market economy. They have, however, sharply curtailed the sale of state-owned enterprises. Shutting down money-losing government factories may make sense economically but often results in large-scale layoffs. Those layoffs frequently generate protests by workers suddenly deprived of the health care, lodging and other benefits they were accustomed to under the socialist system.

The reports on Wednesday gave added weight to the subject by citing the Study Times, official organ of the Communist Party's prestigious Central Party School for training young officials. In an article last week, Study Times suggested that a major reason for the unequal distribution of wealth and opportunity was the alliance between party officials and private businessmen that has grown since the party abandoned doctrinaire socialism and made swift economic growth its main mission.

"There are many people, especially upstarts, who gained wealth through collusion with officials in power-for-money deals," said the writer, Che Haigang.

Chinese often complain about such corruption and about alliances between politicians and private businessmen who have stakes in joint economic development projects. This concern is frequently mentioned by rioters and demonstrators.

The Party School paper based its comments on a Labor and Social Security Ministry study published last month that said China's income gap could cause "destabilizing social phenomena."

According to U.N. statistics, the poorest 20 percent of China's 1.3 billion citizens account for only 4.7 percent of total income, while the richest 20 percent account for more than half. Moreover, that gap has been widening steadily over the last three years. It was cited as China's most serious social problem in a survey conducted by the Central Party School last year.'

So, back to today. It was truly a weird experience. But enlightening. Sometimes you feel like Beijing is one big shiny surface (at least it will be once they wipe all the construction dust off) without the structures underneath to hold it up, one massive advertisment to the world to come and spend. It's like, have you ever seen Beijing opera (don't), or traditional Chinese dance? They wear these fixed smiles, whatever may happen. Mostly the cheeriness is lovely - but - I never thought I's say this - I'm also almost craving some Russian rudeness. At least, if they're nice, you know it's real! Keeping 'face' is very important here.

After my disturbing experience, I made my way to Tiannamen square, and contemplated its bloody history over the last century. From the May 4th movement of 1919, that ended in the birth of the Communist party, to the mass protest after the death of Zho Enlai in 1976, to the infamous student protests of 1989 and the more recent 2001 attempts at self-immolation by 7 people who may of may not have been members of Falun Gong. The 1989 'incident' is the one that immediately springs to mind, I'm sure you know about it but here is what good old 'banned in China' Wikipedia has to say on the subject.

'Since 1978, Deng Xiaoping had led a series of economic and political reforms which had led to the gradual implementation of a market economy and some political liberalization that relaxed the system set up by Mao Zedong. By early 1989, these economic and political reforms had led two groups of people to become dissatisfied with the government.

The first group included students and intellectuals, who believed that the reforms had not gone far enough and that China needed to reform its political systems, since the economic reforms had only affected farmers and factory workers; the incomes of intellectuals lagged far behind those who had benefited from reform policies. They were concerned about the social and political controls that the Communist Party of China still had. In addition, this group saw the political liberalization that had been undertaken in the name of glasnost by Mikhail Gorbachev.

The second group were those, including urban industrial workers,[citation needed] who believed that the social and political reforms had gone too far. The loosening of economic control had begun to cause inflation and unemployment, which threatened their livelihood.

On May 4, approximately 100,000 students and workers marched in Beijing making demands for free media reform and a formal dialogue between the authorities and student-elected representatives. The government rejected the proposed dialogue, only agreeing to talk to members of appointed student organizations. On May 13, two days prior to the highly-publicized state visit by the reform-minded Soviet leader Mikhail Gorbachev, huge groups of students occupied Tiananmen Square and started a hunger strike, insisting the government withdraw the accusation made in the People's Daily editorial and begin talks with the designated student representatives. Hundreds of students went on hunger strikes and were supported by hundreds of thousands of protesting students and part of the population of Beijing, for one week.

At the beginning of the movement, the Chinese news media had a rare opportunity to broadcast the news freely and truly. Most of the news media were free to write and report however they wanted to due to lack of control from the central and local governments. The news was spread quickly across the land. According to Chinese news media's report, students and workers in over 400 cities, including cities in Inner Mongolia, also organized and started to protest.[6] People also traveled to the capital to join the protest in the Square.

Although the government declared martial law on May 20, the military's entry into Beijing was blocked by throngs of protesters, and the army was eventually ordered to withdraw. Meanwhile, the demonstrations continued. The hunger strike was approaching the end of the third week, and the government resolved to end the matter before deaths occurred. After deliberation among Communist party leaders, the use of military force to resolve the crisis was ordered, and a deep divide in the politburo resulted. General Secretary Zhao Ziyang was ousted from political leadership as a result of his support for the student demonstrators. The military also lacked unity on the issue, and purportedly did not indicate immediate support for a crackdown, leaving the central leadership scrambling to search for individual divisions willing to comply with their orders.[citation needed]Soldiers and tanks from the 27th and 28th Armies of the People's Liberation Army were sent to take control of the city.

Within the Square itself, there was a debate between those who wished to withdraw peacefully, including Han Dongfang, and those who wished to stand within the square, such as Chai Ling. The assault on the square began at 10:30 p.m. on June 3, as armored personnel carriers (APCs) and armed troops with fixed bayonets approached from various positions. These APCs rolled on up the roads, firing ahead and off to the sides, perhaps killing or wounding their own soldiers in the process. BBC reporter Kate Adie spoke of "indiscriminate fire" within the square. Students who sought refuge in buses were pulled out by groups of soldiers and beaten with heavy sticks. Even students attempting to leave the square were beset by soldiers and beaten. Leaders of the protest inside the square, where some had attempted to erect flimsy barricades ahead of the APCs, were said to have "implored" the students not to use weapons (such as Molotov cocktails) against the oncoming soldiers. Meanwhile, many students apparently were shouting, "Why are you killing us?" By 5:40 a.m. the following morning, the Square had been "cleared".'

Of course, this is an abbreviated version, and the whole story is much more complicated. I'm not a historian, nor do I have a good grasp of politics.

'Scholars have pointed out that while many in Europe and America saw the events through their own cultural perspectives, the movement was not alienated from the Chinese culture that it arose from. It was not an expression of bourgeois liberalism promoting western-style democracy.[18] As one historian notes "Students elevated the principle of unity above that of majority rule, while their conception of democracy (minzhu) did not allow for a free competition of divergent ideas and was itself tinged with elitism. In many ways students in 1989, like the traditional Confucian scholar class, continued to assume that the leading role in society would be played by a virtuous and educated elite.'

But sitting in that enormous square with its portrait of Mao looming through the dusk, full of throngs of smiling tourists, and children playing, teenagers hanging and vendors selling, it seemed to me the saddest thing in the world to imagine those students, my age, being gunned down. And for what?

'Unlike the Cultural Revolution which people can still easily find information through government approved books, Internet sites, etc, this topic completely disappeared from any media (including books, magazines, newspapers and internet web sites) inside mainland China. It is a forbidden topic by the Chinese government.

The official media in mainland China views the crackdown as a necessary reaction to ensure stability. It is common for Chinese youth to be entirely unaware of the Tiananmen protests.[20] Every year there is a large rally in Victoria Park, Causeway Bay, Hong Kong, where people remember the victims and demand that the CPC's official view be changed.

Currently, due to the strong Chinese government censorship including the Internet censorship, the news media is forbidden to report anything related to this subject. That part of history disappeared in most of the Chinese media including the Internet. No one is allowed to make any web sites related to this.[citation needed] A search on the Internet in Mainland China largely returns no result, apart from the government-mandated version of the events and the official view, which are mostly found on Websites of People's Daily and other heavily-controlled media.

In January 2006, Google agreed to censor their mainland China site, Google.cn, to remove information about the 1989 Tiananmen Square massacre,[23] as well as other topics such as Tibetan independence, the banned spiritual movement Falun Gong and the political status of Taiwan. When people search for those censored topics, it will list the following at the bottom of the page in Chinese, "According to the local laws, regulations and policies, part of the searching result is not shown." The uncensored Wikipedia articles on the 1989 protests, both in English and Chinese Wikipedia, have been attributed as a cause of the blocking of Wikipedia by the government in mainland China.'

How's that for self referencing? (-: Anyway, whilst we're on the cheery subject of the Cultural Revolution, here's another strange experience I had lately! I've told you already about my friendly landlord Jin. Well a couple of weeks ago he invited Lorena and myself for dinner with his family (it was just me in the end), the whole lot as before, this time plus his wife's parents, who were quite elderly. But not just any restaurant. Oh no. This was a theme restaurant..the theme being, you got it, the CR itself! I'm not just talking hundreds of people, waiters dressed as Red Guards, portraits of Mao and newspapers on the ceiling. I'm talking live performance of old communist songs, dances and little skits in the most earsplitting chinese i've ever heard. And everyone singing along heartily, waving their little red flags. Including my landlord. And his wife's parents, who, by the way, were persecuted due to being 'intellectuals'. I asked Jin whether it bothered them, but 'oh no' he said happily, 'it was such a long time ago'. (On the way out there were some old photographs on the wall. One of them showed a man on his knees holding up some kind of placard, obviously as punishment. The old man looked at it and chuckled. 'That happened to him' said Jin, merrily). How could they do this? I don't think there is any way that I could possibly understand. I honestly could not decide whether the whole thing was meant to be really ironic tongue-in-cheek like the Producers 'aren't the Nazis silly'-esque, or really a veiled mass exercise in nostalgia. You tell me.

On a lighter note, I did karaoke! (it is tantamount to a religion here). And it was so much fun I'm ashamed to confess to it, can't remember when I last laughed quite so much you get your own private room and full icence to be as truly awful We took two chinese students along and they sang so beautifully it was embarrassing!

Oh yeah, and finally, do you remember my obsession with the Russian religious orthodox sect, the 'Old Believers'. Well, i just heard that a load of them have locked themselves in a church somewhere in south Russia, awaiting the End of the World (which is apparently sometime soon) and certain demise. That's the spirit! That's dedication for you! There's the Russian soul! (-;

Ok, so farewell for now!!

Ni Hao,

Again, apologies for my long silence. Lots to tell...

I'm sitting at my computer on a friday evening, drinking tea, eating toast from the stall outside, and listening to late junction (I love online radio!). It's getting quite cold now; this morning I left the flat at 7.30 and the world outside was bathed in clean, clear sharp sunlight; the trees are starting to lose their leaves and were covered in a thin layer of frost, and there was something magical about the light reflecting off the hordes of cyclists meandering down Xueyuan Lu. I stopped to buy a pancake for breakfast on the way, and ate it sitting by the canal, watching a group of elderly men and women taking part in a morning fan dance, complete with a portable tape player. Often, in the morning, there are groups practising Tai Chi, dancing, drumming, and singing, which is really lovely to see - old age here is a whole nother kettle of fish. We started at a new hospital this week, the China-Japan Friendship Hospital (Zhong Ri Yiyuan), which is bigger and grander, and a whole 45 minutes cycle ride away- great on a day like today, but when the famous Beijing dusty winds kick in, time to dive for a taxi! Outside the flat right now are lots of little glowing stalls with people huddled round for warmth, serving everything from spicy tofu to grilled aubergine to freshly made popcorn - you can have your food grilled, barbecued or boiled in a big hotpot as you wish, and come home with a meal for 5 quai (35p). Needless to say, I'm becoming addicted to this way of eating - it's also a fun way to interact with the community and the popcorn man never fails to chuckle when he sees us coming! I'm slowly beginning realise that you could quite happily live without ever actually leaving the complex- i keep discovering new things, like hidden enormous vegetable shops. This is what I like best about Beijing - not the largeness but the smallness, the way it is like a set of Russian dolls and everything has something else hidden inside, if you will only have a look.

I guess this way of living stems from the time that everybody lived in the old hutongs, and it was necessary to live very much together. There are, well, really a lot of people in China... I can never get used to the sheer volume of humanity in Beijing, and the way of living is naturally far more collective than the West. One of the doctors, Dr. Zhang, was talking to us about the difference in western and eastern sensibilities the other day. He said, in Europe you each have your own plate of food, whilst in china we all eat from the same one. There are advantages and disadvantages to both. He was using this to explain the method of studying TCM, but it applies to a lot of what we see. The patients, for example, are completely uninhibited about seeing a doctor with students and multiple onlookers present, and appear, on the whole, pretty uncomplaining. I've never seen ill people smile so much! And if you catch their eye, they will always grin back, or crack a joke. People here seem far less wrapped up in their own personal absorptions and problems.

Otherwise, life is going on as usual..I joined the Beijing Hikers club, who go for hikes in the mountains outside Beijing every weekend, which is wonderful to be able to get out of the city for a day. It's difficult to walk on your own here, as detailed maps are banned, reserved for use by military only (yes, they're paranoid..), and most easy-to get to places are filled with throngs of chinese tourists. The group, organised by an energetic Beijing girl named Huijie, takes groups along wild paths they've found themselves. I've been on 3 walks so far, two of which were along pretty hillside paths, valleys, through villages complete with farmers and goats, and stunning views of autumnal coloured trees. Then last Saturday, I, accompanied by Matt who stayed with us for a few days en route to New Zealand overland (oh yes, he so beats me!), decided to tackle the 15km Great Wall walk. Now, this may not sound like much, but when it's 7 hours of walking up steps..and down steps..and up..and really far up...and all the way down, we were completely jelly legged by the end! But it lived up to all expectations- it truly is extraordinary, a long line of grey stoned towers reaching into the morning mist in a distinctly lord of the rings - esque fashion (helped by matt's excellent gandalf impressions..). I just started reading a fascinating book entitled 'The Great Wall: China against the world' which I really ought to stop watching Desperate Housewives (to which Lorena and I are completely addicted..) and get into, so next time maybe I'll be able to tell you lots of fascinating historical snippets..At one point, we had to cut across the mountains with the help of a local farmer due to a heavily armed military post. There certainly appears to be a strong military presence aroung beijing, but I have no idea how this compares to England, for example. It's also noticeable dry - water shortage is a big problem, and the desert is getting closer every day - there's something really sad about seeing villages built around dried-out rivers. Just an hour or two from Beijing, the contrast in lifestyles couldn't be bigger.

We're 8 weeks into the placement now..so far it's been 2 weeks in..the 'foreign' department, 2 weeks in Neurology (I already told you about these), then 1 week in Respiratory (of which, unfortunately, I only experienced 1 day due to catching all the patients' diseases on the first day and then spending the rest of the week in bed!), then 2 weeks in Cardiology and Gerontology (old people), and now, one week in Acupuncture.

Generally, it's all going along very nicely. The patients continue to be varied and interesting - with all sorts of conditions and methods of treatment. Each doctor has their own remedies and methods, and of course each patient is considered individually. I think that it could be easy to look critically at the diagnostic methods and say that they are not in-depth enough, but that would, in my view, be a very foolish assumption that disregards the vast experience of the hospital doctors. Also, the combination with Western medical methods, paticularly imaging (MRI, CT, Xray etc) and the knowledge of conventional drug therapy when necessary, makes the treatment highly effective. I found a quote the other day, from a book on blood stasis, which sums up the philosophy for me, and kind of what I believe myself:

'Integrated medicine (Zhong Xi Yi He Jie) objectively applies methods from both disciplines [conventional Western medicine and traditional Chinese medicine] to find the ideal treatment for the particular type of disease. It is truly a 'holistic' medicine, because it does not reject any therapies, and chooses the most pragmatic way without following any dogma.'

(Gunter R. Neeb)

The doctors have been as kind and patient as ever; as well as the ones I've already mentioned, Dr. Cheng Wei Wei from Gerontology was very lovely, and never failed to make jokes and try hard to explain things to us. She must have been in her late 50's but had an incredible youthfulness and energy- after she'd finished treating patients for the day, she'd go off to Tsinghua university for her English lessons, staying until late in the evening, explaining that what she liked to do best was to study. The doctors work so hard here - and still manage to maintain good humour and patience. If you show you are enthusiastic, they will go out of their way to be helpful. On our last day in Gerontology, we asked Dr. Cheng to show us the pharmacy- she not only did this, complete with giant vats of boiling herbs a la Hogwarts, but whisked us around half thewhospital, introducing us to loads of doctors, nurses, and research students, all of who seemed to be her best friend, and wanted their pictures taken with us..She even took us inside the research labs, where people with wild hair (well, one at least) worked away on giant computers and murmered darkly about genetics...

Some of the acupuncture doctors we have met in the Zhongri this week have been brilliant as well: there was the afternoon session with Dr. Xu Rong-dong who taught us about Chinese needle technique (none of this guide tube nonsense here - it's all about finger strength!) and discussed the concept of Shen in needling and the necessity of cultivating one's own harmonious internal state. There was Dr. Zhang, who explained why it's so hard for us to grasp the Chinese way of learning - first you learn and remember, then understand (oh yes, I've heard that before [sigh]) - also that you cannot expect to get all your questions answered. The best away is to think about it yourself. This can potentially be frustrating. For example, this afternoon when there were hardly any patients, Dr. Zhang treated Marga, a group member, for neck pain. He inserted a needle either side of her knuckle, which immediately relieved it. He had invented this technique himself, which he discovered by chance one day by pressing points on a friend's hand after she had hurt herself. But why it worked? Well that was something we had to figure out for ourselves. Chinese medicine thinking is all about flexibility, about thinking in different ways in different directions, of finding contradictions and not being worried by them, of accepting that there is no set answer and no linear logic. Which basically means that everybody will give you a different answer! Most of the time is leaves you feeling pretty stupid, and feeling that you know nothing but I guess that's all part of the process. Everyone has something to teach you, if you are only willing, at least that's my opinion...

I have so much admiration and respect for the doctors here, they're the kind of people I've wanted to meet for a long time, and their knowledge and gentleness is truly inspiring. The students too- the amount of work they put it puts us to shame, although granted, it's an entirely different lifestyle - you live at the university, eat in the canteen, and spend the rest of the time in class or under supervision - so unlike the often difficult balance of study, work, social life, looking after oneself etc etc that being a student in britain seems to entail. But, when you throw into the balance a whole load of westerners who act in a way which is basically, to my mind, totally disrespectful - not bothering to turn up, not being interested but instead choosing to be critical - it certainly makes you feel embarrassed to be European. Which brings me to the issue which has slightly been dominating life lately. It's an interesting ethical dilemma.

Basically, it goes something like this- members of my group, being generally pretty enthusiastic had, including myself, been growing steadily more annoyed with the tendancy of a certain proportion of the class not turning up regularly (technically, in order to get our degree from BUCM - Beijing University of Chinese Medicine, we have to attend 100% of the placement) and being really negative about it all, not to mention going to all sorts of pathetically sneaky measures to make it appear that they had actually attended. So a decision was reached to contact our head of course in the UK and explain what was going on, as, ethically, this did not seem to be acceptable. Due to all sorts of reasons that i don't want to go into now, i found myself incredibly torn on this issue, which although i totally agreed with in principle, after several days of agonizing, decided I could not be part of p- despite my personal opinion, I could see a lot of different points of view and implications and people more involved than myeself being affected, which is maybe a bit wishy-washy sitting on the fence but there you go. But it went ahead anyway, and now, unsurprisingly, WWIII is now truly underway within the class and i'm counting the days until I'm rid of all their pettiness for ever. Did that sound bitter? It wasn't meant to be, but there's nothing like a small dispute to bring out the worst in people. I'm totally happy with my little group and have a few other good friends, including my lovely flatmate of course, but, as I said, in comparison to the kind of people we're surrounded by, embarassing embarassing embarassing. But then, i really don't want to be self righteous as this is not the right motivation at all, and is every bit as arrogant. However, it's all a big learning experience in itself...

But enough of that, and back to the present. I'm liking beijing better and better as it gets colder - the smog has disappeared mostly to be replaced with lovely clear autumn days, and things become gradually more familiar. China, like Chinese medicine, is to me one big mass of contradictions. People are so friendly and helpful- and yet I have been told that this doesn't last, that is hard to get beneath the surface and nothing comes for free. Whether this is true, i don't know. You can get anything, anywhere- and yet the workmanship is so shoddy that it quickly falls apart. The recycling system is wonderful, but the amount of over-packaging and plastic bags used for absolutely everything is crazy. Food is revered, but is full of chemicals - our teacher even warned us not to eat unpeeled vegetables due to the high pesticide content. There is enormous wisdom, but surprising blinkered-ness the few times I've managed to bring up politics, I'm shocked at how indoctrinated people seem to be - one of the doctors the other day said that government is like cooking a small pancake - you don't want to turn it too often or it will break. A fair enough point- but in defence of a repressive one-party state with an appalling human rights method? We were talking to an expat Chinese man visiting from the US, and I noticed that when he said words like 'democracy' he noticeably hushed his voice. In a hospital room, in English. Says it all really. We have no idea of what's really going on beneath the surface. The government is apparently committed to 'cleaning up' the environment, especially beijing in preparation for the Olympics - and yet pollution is worse than ever. China's speedy development combined with the recent awareness of global environmental issues has created an unprecedented problem, and tehre are no easy answers. A recent NY times article comments thus:

'But just as the speed and scale of China’s rise as an economic power have no clear parallel in history, so its pollution problem has shattered all precedents. Environmental degradation is now so severe, with such stark domestic and international repercussions, that pollution poses not only a major long-term burden on the Chinese public but also an acute political challenge to the ruling Communist Party.

Public health is reeling. Pollution has made cancer China’s leading cause of death, the Ministry of Health says. Ambient air pollution alone is blamed for hundreds of thousands of deaths each year. Nearly 500 million people lack access to safe drinking water.

Chinese cities often seem wrapped in a toxic gray shroud. Only 1 percent of the country’s 560 million city dwellers breathe air considered safe by the European Union.
Environmental woes that might be considered catastrophic in some countries can seem commonplace in China: industrial cities where people rarely see the sun; children killed or sickened by lead poisoning or other types of local pollution; a coastline so swamped by algal red tides that large sections of the ocean no longer sustain marine life.

China is choking on its own success. The economy is on a historic run, posting a succession of double-digit growth rates. But the growth derives, now more than at any time in the recent past, from a staggering expansion of heavy industry and urbanization that requires colossal inputs of energy, almost all from coal, the most readily available, and dirtiest, source.

“It is a very awkward situation for the country because our greatest achievement is also our biggest burden,” says Wang Jinnan, one of China’s leading environmental researchers. “There is pressure for change, but many people refuse to accept that we need a new approach so soon.”

Indeed, Britain, the United States and Japan polluted their way to prosperity and worried about environmental damage only after their economies matured and their urban middle classes demanded blue skies and safe drinking water.

But China is more like a teenage smoker with emphysema. The costs of pollution have mounted well before it is ready to curtail economic development. But the price of business as usual — including the predicted effects of global warming on China itself — strikes many of its own experts and some senior officials as intolerably high.

“Typically, industrial countries deal with green problems when they are rich,” said Ren Yong, a climate expert at the Center for Environment and Economy in Beijing. “We have to deal with them while we are still poor. There is no model for us to follow.”

http://www.nytimes.com/2007/08/26/world/asia/26china.html?_r=2&oref=slogin&oref=slogin

So...I'll leave you there, as my eyes are closing and my bed is calling...oh yeah, you can see I'm living it up over here! After all these confusing conundrums, here is a little Taoism to help us along:

'Let us not be confused
With kaleidoscopic reality
Using wisdom and courage to act
Let us not add to the confusion'

And

'At first, form is needed
Then doubt and inhibition must be dispelled
Eventually, form is celebrated with joy
And expression becomes formless'

Oh yes, it's all about yin and yang, baby...

Back soon, i hope with more meanderings...so..goodnight!

Hello,

Before you go any further, be warnedthat this is entirely about the chinese healthcare system, and I haven't written any of it myself. So, unless you have a specific interest..then..have a quick skim! It's more for my own interest than anything else.

It's a week later, i've not got much to report as I've been spending way too much time in my week off glued to this screen trying to finish off a case study essay (oh yes, no peace for..you know..we have exams too!). But, as is the way of procrastinating essay-writers, I've come across some interesting articles on the health system in China. I wrote a little last time about how what i have observed so far is far more efficient than, well, specifically the NHS..but I'm aware that this is only a small part of the picture - this is a top TCM hospital in an affluent urban area. so, as I have no desire to start writing another essay, and hey, nobody's marking this one, let's use a bit of cut and paste.

The articles I'm using are from the

(1)New England journal of medicine - Privatization and Its Discontents — The Evolving Chinese Health Care System by David Blumenthal, M.D., M.P.P., and William Hsiao, Ph.D. http://content.nejm.org/cgi/content/full/353/11/1165

(2)British Medical Journal - Health in China: Traditional Chinese medicine: one country, two systems - Therese Hesketh, research fellow,a Wei Xing Zhu, programme manager, East Asia b
http://www.bmj.com/cgi/content/full/315/7100/115

(3)Reflections on the Situation of Medicine in the People's Republic of China, 1987
From American Journal of Acupuncture, 1990, 18. 4: 325-343. http://ccat.sas.upenn.edu/~nsivin/medrefl.html

(4) University of Louisville/ centre for Asian democracy - “Intercultural Incommensurability and the Globalization of Chinese Medicine: The Case of Acupuncture,” by Robert St. Clair, Walter E. Rodriguez, Andrew M. Roberts, and Irving G. Joshua http://louisville.edu/asiandemocracy/home_files/papers.htm

Oh, and before I continue, some comments of my own on medical education here - although you see it often written that 'training in TCM is not as extensive and thorough as in western medicine - I can tell you, that of the recent graduates i've met, their knowledge is impressive - 40% of it is in Western medicine, allowing them to practice both systems simulataneously - they are the assigned to a specific department for 2 years after graduation, where they will work alongside and act as assistants to more senior doctors. If only we had a system like this...!

First, let's look at the impact of the Cultural Revolution on healthcare, and try and clear up that old question - so what is TCM (traditional chinese medicine), exactly? And we'll start with good old Wikpedia:

'Classical Chinese Medicine (CCM) is notably different from Traditional Chinese Medicine (TCM). The Nationalist government elected to abandon and outlaw the practice of CCM as it did not want China to be left behind by scientific progress. For 30 years, CCM was forbidden in China and several people were prosecuted by the government for engaging in CCM. In the 1960's, Mao Zedong finally decided that the government could not continue to outlaw the use of CCM. He commissioned the top 10 doctors (M.D.'s) to take a survey of CCM and create a standardized format for its application. This standardized form is now known as TCM.

TCM formed part of the barefoot doctor program in the People's Republic of China, which extended public health into rural areas. It is also cheaper to the PRC government, because the cost of training a TCM practitioner and staffing a TCM hospital is considerably less than that of a practitioner of Western medicine; hence TCM has been seen as an integral part of extending health services in China.'

and

(2) 'In the early 1950s it was feared that traditional Chinese medicine would be superseded by the "more modern" Western medicine. To counter this, a systematic assessment of the effectiveness of the traditional treatments was thought necessary. So thousands of experiments and clinical studies were carried out during the 1950s. Most were case series of patients with a specific Western disease who were then treated with traditional techniques—for example, a series of 112 cases treated for angina pectoris and another of 121 cases of bronchial asthma treated with subcutaneous acupuncture. The result of all this research activity was that in 1958 it was declared that traditional Chinese medicine and Western medicine should be given equal respect and place in the healthcare system. 1 Since then there has been a consistent policy of support for the traditional system.'

It does seem, that, despite the horrific genocide, human rights abuses, persecution, mad political decisions, crazy personality cults and cultural destruction of the Cultural Revolution, it did in fact have a positive effect on the preservation of TCM. After an initial crackdown, it was decided to develop a standardised system that underlies modern textbooks today. Some would argue that this has lost the original meaning and is only a modern version. I would admit some truth in this, but argue that everything is referred back to the classical texts, which is more than you can say for some schools today..

So, how is the situation now?

(3)'The institutions that gave the rural majority inexpensive access to medical treatment during the Cultural Revolution have largely disappeared. The system of Barefoot Doctors in the countryside and Red Medical Workers and others in the cities, peasants and workers with a minimum of training who provided low-level medical care part time, has been quickly disappearing. The new emphasis on individual enterprise has made farming lucrative, doing away with the incentives that attracted farmers to doctoring. At the same time former Barefoot Doctors were being encouraged in 1987 to seek further medical education and even to take up private practice in what used to be collectively owned clinics. At the same time, the system of cooperative medical insurance in rural work units that protected the poorest against medical catastrophes has largely ended as official approval has moved from everyone sharing poverty to individuals getting rich. Those who are not getting rich, for instance those farming poor land, are no longer insulated from medical costs that, although very low compared to those in the United States, are high in proportion to their income. A number of experiments to finance rural health care are under way, but in the present climate they disproportionately benefit wealthy parts of the country. Most city-dwellers work in government enterprises and their medical expenses remain covered by the state.'

(1)'After Mao Tse-tung and the Chinese Communist Party took control of China in 1949, they created a health care system that was typical of 20th-century communist societies that are now largely extinct. However, China added some unique features to meet the needs of its huge peasant population and to take advantage of ancient, indigenous medical practices.

The government owned, funded, and ran all hospitals, from large, specialized facilities (often serving communist cadres) in urban areas to small township clinics in the countryside. The private practice of medicine and private ownership of health facilities disappeared. Physicians were employees of the state. In rural areas, the cornerstone of the health care system was the commune, which was the critical institution in rural life. Communes owned the land, organized its cultivation, distributed its harvest, and supplied social services, including health care, which was provided through the Cooperative Medical System. The Cooperative Medical System operated village and township health centers that were staffed mostly by practitioners who had only basic health care training — the so-called barefoot doctors, who received much publicity in the West for their supposed effectiveness in meeting the needs of rural populations.5 Barefoot doctors provided both Western and traditional Chinese medical care and also many public health services.

From 1952 to 1982, the Chinese health care system achieved enormous improvements in health and health care.5 Infant mortality fell from 200 to 34 per 1000 live births, and life expectancy increased from about 35 to 68 years. These improvements also reflected major investments in public health through a highly centralized governmental agency modeled on the Soviet Union's system of the early 1950s.6 This public health apparatus achieved major gains in controlling infectious diseases through immunization and other classic public health measures, such as improved sanitation and the control of disease vectors, including mosquitoes for malaria and snails for schistosomiasis.5,7 By the beginning of the 1980s, China was undergoing the epidemiologic transition seen in Western countries: infectious diseases were giving way to chronic diseases (e.g., heart disease, cancer, and stroke) as leading causes of illness and death.

Then, in the early 1980s, China virtually dismantled its apparently successful health care and public health system overnight, putting nothing in its place. In retrospect, this startling and almost inexplicable event seems to have been collateral damage from a much more carefully planned and successful policy strike: the privatization of China's economy and a general effort to reduce the role of Beijing's central government in China's regional and local affairs. Only recently have Chinese authorities recognized the pain and the massive disruption in health care that they have caused.

Several specific decisions in the early 1980s created China's current health care turmoil. First, China dramatically changed the way it financed health care. It reduced the central government's investment in health care services, as well as in many other public services.
Second, the government imposed a system of price regulation that had dramatic, unintended effects. To ensure access to basic care, the government continued tight controls over the amount that publicly owned hospitals and clinics could charge for routine visits and services such as surgeries, standard diagnostic tests, and routine pharmaceuticals. But it permitted facilities to earn profits from new drugs, new tests, and technology, with profit margins of 15 percent or more. Those revenues depend heavily on sales of profitable new drugs and technologies. The result was an explosion in sales of expensive pharmaceuticals and high-tech services, such as imaging, and rapid overall increases in health care prices and spending.10 While health services became unaffordable for most Chinese citizens, a growing class of newly rich Chinese sought and received Western style, high-tech care.

Third, the government suddenly and completely dismantled communes to privatize the agricultural economy. A side effect was to rip apart the health care safety net for most of rural China. Without the Cooperative Medical System, Chinese peasants had no way to pool risks for health care expenses, and 900 million rural, mostly poor citizens became, in effect, uninsured overnight. In the meantime, the vaunted barefoot doctors became unemployed and were forced to become private health care practitioners. Virtually unregulated, they abandoned their previous emphasis on public health services, which were no longer funded and for which they were no longer compensated, and switched to providing more lucrative technical services for which they were untrained. As a result, their quality as clinicians is highly questionable.12 The former barefoot doctors quickly found that selling drugs was one of the best ways to stay afloat economically, and drug prices and sales exploded in rural areas as well. Fourth, China decentralized its public health system, as it had its health care financing and delivery system, and reduced central governmental funding for local public health efforts.9 Aside from adding to the disparities between rural and urban health care, this move resulted in reduced funding for public health programs in many locales.

In the meantime, the efficiency of the Chinese health care system has declined precipitously. With the growth of the private health care sector, the number of Chinese health care facilities and personnel have increased dramatically since 1980, but because of barriers to access, the use and thus productivity of the health care sector have declined.16 To many in the United States, this portrait of pockets of medical affluence in the midst of declining financial access and exploding costs and inefficiency will sound depressingly familiar.

Aware that their health care is poorer in quality, rural residents with serious illnesses frequently bypass local practitioners and facilities to seek care in the outpatient units of urban hospitals, leading to underuse of the former, overuse of the latter, and increased fiscal burdens on peasants who seek out more expensive, hospital-based services. Health expenses are a leading cause of poverty in rural areas and a major reason that peasants migrate to cities seeking proximity to better health care facilities and higher wages to pay for care.19 Differences in wealth also profoundly affect public health expenditures, which are more than seven times higher in Shanghai than in the poorest rural areas.

To its credit, the Chinese government has recognized and begun to address the huge health care problems that it created. It has done so with remarkable pragmatism, uninhibited by ideology and often importing (after careful examination) solutions pioneered in other countries. China also benefits at this time from a rare financial opportunity. Because of the rapid growth in its economy, national and local governments have sufficient tax revenues to make substantial health care investments without reducing spending for competing social services, such as housing and education, or for defense, which is now a priority for Chinese leaders.20

Since China now seems to consist of two societies, urban and rural, the government has launched different strategies for ameliorating problems in these two locales. It has tried to recreate an urban health care safety net through a system that knits together a variety of devices that will be familiar to U.S. health care policymakers. The first is mandated employer insurance.

The system is far from perfect. Some employers have refused to comply with state mandates, claiming they cannot afford the contributions. Many urban dwellers do not work for organized employers. Companies form and disband rapidly to avoid paying benefits to workers. Dependents of workers may not be covered. An indigenous Chinese private health insurance industry has arisen to sell health insurance to a wealthy minority that can afford it, and China is considering permitting foreign insurance companies to sell health care coverage as well. Whether the Chinese government will be able to cover the 51 percent of urban residents who still lack protection against the cost of illness, and how it would do so, is far from clear at this point.

The central government was slower and more reluctant to address health care problems in rural areas, but it was forced to act because of evidence that health care expenses were undermining other government efforts to alleviate poverty among the peasantry. In 2002, officials launched experiments to create a very rudimentary financial safety net for health care. Under these schemes, the government provides the equivalent of $2.50 a year to help cover a basic insurance plan for peasants, who must match this with an annual $1.25 of their own. Because of their modest funding, these plans cover only inpatient care (with a very high deductible) and leave peasants without adequate primary care services and drugs.

The Chinese example further reveals that government involvement may be essential to ensure an effective health care safety net and that, regardless of their language, history, or culture, providers will confer the services they are rewarded for offering. When Chinese doctors and hospitals were rewarded for providing high-tech services, they did exactly what U.S. doctors and hospitals have been doing for decades, with the same effects on use and costs. In fact, an overriding lesson of the Chinese experience is a warning to the rest of the world: if leaders anywhere care to, they can mimic and even exceed the inequities and inefficiencies that the U.S. health care system has exemplified for so long.

At the same time, optimists can find reason for hope as China struggles with its self-inflicted health care wounds. China's leaders have begun purposefully and soberly to tackle the enormous social engineering challenge of repairing past damage and shaping a new health care system that fits their unique social system and culture. It is hard to say precisely what that system will look like, but it will undoubtedly combine private and public provision of both insurance and services, and it will look very different in rural and urban areas. A major unaddressed challenge for China (and for the United States) is how to reform an inefficient, poorly organized health care delivery system that is bloated in urban areas and threadbare in rural sectors. A further challenge facing China will be instilling in health care professionals, and especially physicians, an ethic of professionalism that is essential to ensure that private health care systems protect the interests of patients and provide care of reasonable quality. For several generations of Chinese physicians, loyalty to the state and communist ideology replaced professionalism as an ethical framework.12 Another challenge will be China's sheer size and diversity.'

Phew..now..let's consider what role TCM has to play in this.

(2) 'China is the only country in the world where Western medicine and the traditional medicine work alongside each other at every level of the healthcare system. Traditional Chinese medicine has its own department at the Ministry of Public Health and at provincial and county Bureaus of Public Health. It has its own medical schools, hospitals, and research institutes.

Overall, it is estimated that 40% of health care in China is based on traditional Chinese medicine, with a higher proportion in rural areas.2 This figure does not include the massive amount of self medication with traditional drugs, which are used not only to treat illness but also as health promoting drugs, ranging from nutritional supplements and tonics to aphrodisiacs.

Every city has a hospital practising traditional Chinese medicine, and there is a plan for every county to have one. In 95% of the hospitals practising Western medicine there are departments of traditional Chinese medicine, most with inpatient beds; when patients arrive at the outpatient department they can opt for Chinese or Western treatment. In Jiangsu province, one of the richer, more sophisticated eastern provinces, one quarter of all outpatients in one year (10 million) had opted for traditional treatment.

The collaboration between the two systems is well illustrated by the fact that in Western medicine hospitals around 40% of the medicines prescribed are traditional. Similarly, in the traditional hospitals 40% of all prescribed drugs are Western medicine. At township and village levels, doctors often prescribe both types of treatment simultaneously, without apparent contradiction. A survey carried out in two village health clinics in Zhejiang province showed that children with upper respiratory tract infections were being prescribed an average of four separate drugs, always a combination of Western and Chinese.

Training in traditional Chinese medicine varies from family apprenticeships to three to five year university training at a college of traditional Chinese medicine, though the educational standard of these undergraduates is generally lower than their counterparts at the Western medical schools. All Western medical schools devote around 10-15% of curriculum time to traditional Chinese medicine, so all doctors have some traditional training. Nurses too are trained in both and many perform acupuncture and acupressure independently.

Central government continues to have a policy for expansion of traditional Chinese medicine. An increase in the number of traditional doctors is one of the priorities for manpower development; their number continues to increase and is now over 300 000. In addition, 20% of the planned increase in hospital beds is to be for traditional Chinese medicine6; since 1985 there has been an annual increase of 8% in inpatient beds.3

But the wisdom of this planned expansion is being questioned, especially with the pressures of the healthcare market. Many traditional hospitals operate at a deficit. The better equipped Western hospitals, with their better qualified staff, attract more patients. In addition, traditional Chinese medicine is largely an outpatient, low technology specialty, so most of the income of traditional hospitals comes from the sale of drugs. Even with the 25% markup allowed, it is hard to cover operational costs. Government subsidies currently ensure survival, but there is no surplus for improving services.

Traditional Chinese medicine has become a source of great interest to the international research community. It is acknowledged that many of the treatments have enormous potential and could be utilised more widely. With this in view, research is essential in a number of areas. Firstly, randomised controlled trials are needed to establish the effectiveness and safety of treatments. There is still a real shortage of controlled trials of the effectiveness of traditional Chinese medicine and there are almost no double blind, placebo controlled trials. In China such trials are considered unethical because it is wrong to withhold potentially beneficial treatment.1 But the need for such trials is being increasingly recognised, and several are underway in China and other countries. The herb trichosanthin is undergoing trials by the Food and Drug Authority for use in treating AIDS.

Secondly, from a Western standpoint, there is a need to identify the biochemical composition of the active agents in many of the herbal preparations. This approach has been successful in research into the antimalarial drug qing hao su. This herb has been used in China for treating fever for over 2000 years. In 1971 it was found to have specific antimalarial activity and the active compound artemesin was isolated. In clinical trials, parasite clearance times were shorter than with chloroquine, symptoms responded more rapidly, and there was no serious toxicity.7 Qing hao su has now become a first line drug for malaria in many parts of Asia.

Thirdly, research is needed to determine which illnesses are best treated through one approach rather than the other. In China, Western medicine is often regarded as more effective in acute situations or where the aetiology is known, while traditional Chinese medicine is more effective for immune conditions, chronic illness, or where the aetiology is unknown.1 But in practice simultaneous use of both types of treatment is so commonplace that the individual contributions are hard to assess. If the two systems are to be truly complementary more research in this area is essential to facilitate a more rational approach.

As China has opened up more to the West there have been concerns that traditional Chinese medicine would be superseded by Western medicine. This has happened for many types of acute illness, but the opposite has also happened: medicine in the West has become greatly influenced by traditional Chinese medicine. As more studies show the clinical effectiveness of traditional Chinese medicine, an integrated approach to disease using a combination of both forms of treatment becomes a possibility. This may transform the practice of medicine in the new millennium.'

And finally...so how can these different schools be effectively integrated? Some interesting thoughts from, er, someone who isn't me... on the theories of Thomas Kuhn. He put forward a theory of scientific revolutions that went something like this:

(4)

The Structure of Scientific Change
1)Normal Science - The golden age Old journals reject papers that do not confirm normal science views
2)Period of Crisis - Loss of belief in the old paradigm. Journals accept a wide range of articles that attempt to repair and revise the normal science model
3)Revolutionary Science - Community of scientists shift to the new emerging paradigm.
New journals reflect the revolutionary changes in science. Eventually older journals are taken over by the leaders of the new paradigm

What is Kuhn’s theory of scientific revolutions and why is it so
important? Kuhn noted that there are cycles of change within the sciences
and that these cycles are structured and they repeat themselves at regular
intervals with the passage of time. In physics, for example, the revolutions
came every three hundred years. Now that more and more scientists are
working on the same ideas, these revolutions are beginning to appear
more frequently. The first period in the history of scientific change is
known as normal science. Kuhn depicts this as the golden age of a science.
It is a time when one takes pride in the great achievements of the past.
Scientists argue that they have just about solved all of the problems in
their research and that they will soon nothing left to discover. Kuhn noted
that there are several characteristics that mark this period. One of them
has to do with publications. It turns out that new ideas are rejected during
such times of intellectual contentment. Grants during such a period of
normality obviously attempt to reiterate common knowledge. Anyone
who proposes anything new or different will have his funding rejected.
The golden age of science, as Kuhn explained, cannot last forever.
With the passage of time, the practitioners in the field will note more and
more anomalies. Definitions will fail to adequately describe events. There
will be inconsistencies within the various parts of a theoretical model.
Experiments will fail from time to time. In such instances, the theories are
never questioned, only the methodology of the laboratory workers. As
these anomalies mount, the scientific community will become more and
more restless and at some point scholars will begin to talk about them
openly at national conferences, in graduate seminars, and in their
publications. When this shift takes place, the next level in the structure of
scientific progress takes place. This new stage is called the period of crisis.
Kuhn referred to “crisis” in the singular, but such is not the case. More
than one crisis occurs. Many different attempts to solve the conflict may
occur during this time. In linguistics, for example, there were nearly a
dozen such conflicting models of neo-structuralism during this period of
crises. There are certain characteristics which define this period or stage
of development in the progress of a discipline. At such a time, new ideas
are openly accepted and entertained. It is a time for exploratory
discussions about what is wrong with the old model and what possible
changes could or should take place. Editors openly look for new ideas and
suggestions for their journals. Granting agencies entertain new models of
research for funding. It is a time when people within the scientific
community have open attitudes towards problem solving. It is important
to note that what makes the natural sciences different from what has been
called the human sciences (i.e., the humanities) is this attitude of problem
solving. Scientists never complain about what is wrong with a theory,
they keep their controversial ideas in abeyance. It is only when they think
that they have a solution that they openly point out the anomalies in the
older model and propose new solutions to old problems. Kuhn argues that
science is all about problem solving. The search for solutions provides the
driving force behind scientific research and theory building.

The next stage in the development of scientific progress comes about
when one of the competing models from the period of crises is hailed for
its success in problem solving. When this event occurs, the scientific
community encounters a period of scientific revolution. Such a model or
theory is accepted by the scientific community because it is successful in
solving the very problems that plagued other scientists.

A mature science, according to Kuhn (1970), experiences alternating
phases of normal science and revolutions. These alternating phases are
paradigms and Kuhn argues that it is the most misunderstood aspect of his
book (Kuhn, 1962). Scientific paradigms have the consensus of a
disciplinary matrix that function as exemplars. Immature sciences lack
this consensus and consequently there is little opportunity for progress. In
mature sciences a great amount of intellectual energy is invested in
arguing over fundamentals. Once these fundamentals are accepted, further
scientific progress is made. This success is due to the fact that energy is
no longer spent arguing with competing models over fundamentals.
Scientific paradigms are about solving problems and this is once of the
characteristics of a mature science. It is also able to envision new
problems, suggest approaches to those problems, and provide a standard
by which such puzzles can be articulated and tested. The scientific method
used within a paradigm encapsulates the rules of scientific rationality.

Anyway..what has this to do with TCM, you may well ask?

Let's see..

(4)Paradigmatic Incommensurability:

How does one reconcile the germ theory of medicine with its causal
complexes with the Five Element Theory of Chinese medicine? From the
perspective of western medicine, the Chinese philosophy of science is
based on a system of homeostasis, a balancing of yin and yang, (passive
and aggressive; inside and outside; dark and light; feminine and
masculine; blood and energy; anatomy and physiology). These terms are
used metaphorically. As the sun moves over a hill, it produces two
simultaneous conditions. The sunny side of the hill is called yang and the
shady side is called yin. Life cannot be sustained by only living in the
light or in darkness; it requires a balance between them.
One of the areas of incommensurability between these two systems
exists in the contrast of scientific reductionism and the holistic approach
in alternative medical practice. Western science functions in a context of
reductionism, linearity, and causality. Individual events are isolated from
their larger and more holistic complex of interactions and subjected to the
scientific method. Hypotheses are posed regarding these isolated events
and experiments are designed to either prove or disprove these hypotheses.
From this practice, laws or principles are established and theories are
formulated that verify and predict those very principles. It is a quantitative
science. Chinese science, on the other hand, is a qualitative science. It is
holistic in that it is derived from a context of inclusion, concurrence, and
induction. Events are seen as initially interconnected; they influence each
other. These events are studied in context with it interrelationships and
counter influences. Upon observing the phenomena, laws are established
based on how these events are experienced. Are these two systems
incommensurate? They both make conclusions about the same
phenomena. However, western medicine the approach to theory building
espoused by traditional Chinese medicine because it is non-technical and
qualitative. They cannot understand why the Chinese felt no compunction
to quantify phenomena. They cannot relate to the qualitative measures
used by the Chinese philosophers (Yin, Yang, wuxing, and baqua). They
are not comfortable with the metaphor of the path or the way and prefer to
seek causal relationships of a different nature.

When Thomas Kuhn (1970) claimed that some scientific paradigms my
be incommensurable with each other, he had in mind the fact that they
may differ in their lexicon as evidenced in the models being discussed. He
noted that these paradigms could also be embedded in different research
traditions as also evidenced in the models being discussed. However, the
most threatening of all forms of incommensurability occurred
ontologically. This occurs when two conflicting paradigms have disparate
beliefs about reality and because they have different beliefs, they also
develop different epistemologies. Is this the case with modern medical
science and classical Chinese medicine? There are many who would argue
that such models are not really incommensurable if they are investigated
from the perspective of electrophysiology.

The most promising bridge between these two paradigms can be
found in the field of bioelectromagnetism (BEM) which is the study of the
subtle electromagnetic fields that underlie life processes. BEM is a viable
research paradigm in Europe and it is not widely investigated within the
United States (Selden and Becker, 1987) where medical treatments are
largely based on drug therapies and surgical interventions. Lakhovsky
(1992) investigated the interrelationships between high-frequency
electromagnetic fields and living things. In this book, he asked the
question: “What is life?” His response is that life is the harmony of
multiple radiations which react upon one another. He then went on to ask:
“What is disease?” His answer was that disease was the oscillatory
disequilibrium of cells and that this disequilibrium originated from
external causes. Lakhovsky explained that living things receive and emit
electromagnetic radiations. It is the exchange of these energies between
life forms constitutes electromagnetic communication. Pressman (1970), a
Russian scientist, argued that it is electromagnetic radiation that enables
living things to sense information about the environment, facilitate and
control within the organism, and communicate between living things.
Popp and Becker (1988) referred to this energy forms as biohotons and
explained how they regulate many physiological functions such as growth,
maturation, cell differentiation, enzymatic activity, and immune system
functions. This electromagnetic fields within the human body is seen as a
model of resonance in which particles move harmoniously through an
electromagnetic field This research is reminiscent of quantum physics
which is based on the principle that all parts of the universe are connected
to each other and are in communication with all of its parts. The ancient
Chinese description of Qi and its pathways and accumulations in the body
closely correlate with research in BEM. The acupuncture system with its
meridians is largely based on such electromagnetic energies.
Scholars working in BEM research have noted that some points on the
body were more conductive than others to a 12-volt current that was applied
to the skin. These low-resistance spots are good electro-permeable points.
These acupoints are 50% more conductive and function as capacitors in that
they hold and store electrical energy within the body. This research notes
that the potential between these points are concomitant with the concept of
meridians in the human body as described by classical Chinese medicine.
Scientists have used the “beaver dam” metaphor to explain how these
electrical currents function in the body by holding energies back and
releasing them to create surges of electrical force. Bjorn Nordenstrom
(1989), a Swedish radiologist, has successfully used the BEM model of
energy medicine to treat cancer. He considers the meridian system to be a
vascular-interstitial closed circum that is powered by imbalances of positive
and negative ionic charges over long distances within the body. Cancer
cells , he noted, are more sensitive to electrical energy than healthy ones
and they are more sensitive to the use of externally applied currents.
Nordenstrom placed the positive pole of the galvanic stimulator on the
tumor and the negative one some distance away. This causes the tumor to
become dehydrated though electro-osmosis
Semi-conduction and Piezo-electricity are two electrical qualities of
crystalline substances that occur in the human body. Both are highly
relevant to the understanding of the electrical qualities that occur within
the meridian system. Szent-Gyorgyi (Selden and Becker, 1987) was the
first to point out that the molecular structures of the human body are
organized to support semi-conduction by passing information along
chains of protein molecules.

Traditional Chinese Medicine and modern medical science are not
incommensurable if one views current germ theory from the perspective
of BEM research. The secret to avoiding incommensurability within the
historiography of medical science is through the adjustment of
epistemological views so that they will be more consistent with
ontological ones.

The globalization of medicine has taken an interesting turn. Classical
Chinese medicine has made its journey outside of the Middle Kingdom
and into the medical practice of the western nations. One of the major
problems with this transition had to do with paradigmatic
incommensurability. Even though the languages involved were different
and even though the medical practices differed substantially, the two
models were found to be commensurable because of scholars who
understood the significance of the Chinese tradition and its implications
for BEM research. One is reminded that when paradigms overlap, they
become partially compatible and their findings can be made more
commensurable with each other. Such commensurability, however, would
not have occurred if such peripheral practices were not tolerated by the
core medical sciences. Tolerance has its virtues.'

If you made it to this point, you get one big giant gold and purple star!

Ni hao!

and a very happy moon festival to you. i have eaten way too many mooncakes as is the custom at this time of year, and am feeling a little sick..

So, I've been in China for..well, over a month now i suppose, it feels like no time at all but also forever, as these things tend to. Apologies for my silence so far..there is indeed a lot to tell but it has taken a while for all of it to begin to settle inside me in any coherent way..

I live in the area of Wudaokou, which is in the NW of Beijing between the 4th and 5th ringroads. Beijing is really very big..and although its not that far out, it's still a very long way to the centre! I haven't strayed much out of this area yet, as I've been more focused on settling in/ being lazy than sightseeing, and of course now the hospital (in which i've just finished week 4), which can wait until it's not so hot and less full of hot and bothered tourists. You england-dwellers may be thinking enviously of sunny days, but until now it's not a been a very nice sort of heat - sticky and muggy, not to mention Beijing's legendary pollution, which got really bad last week, like moving through a grey soup, until a few days of merciful rain culminating in a fantastic thunderstorm cleared the area, and the last two days have been beautifully clear, blue and sunny..a sign of things to come i hope! (Autumn is supposed to be the nicest season here).

This is the student area, a network of picturesque university campuses and a fair number of other laowai - foreigners - so we don't s