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An Eastern alternative is making its way into the country’s health system for the first time in history. From Respekt.by Hana Capova 17 April 2014
This winter, Chinese medicine will be available at a Czech hospital for the first time, and the hospital director says nearly 300 people are already on a waiting list to try it.
While in the United States and parts of Europe the co-existence of Western and Eastern health systems is not unusual, in the Czech Republic it remains a novelty, with strong backers and vocal critics.
An official with the Czech Medical Chamber calls it “a Pandora’s box” that could create a field day for charlatans.
But Roman Prymula, director of a university hospital in the central town of Hradec Kralove that will host a Chinese medicine clinic, says patients’ treatment will be enriched by adding to Western medicine thousands of years of Eastern knowledge. He has a strong ally in the current health minister, who says if this pilot study goes well, it could be rolled out in other hospitals.
It started last August with high politics. President Milos Zeman and then-Prime Minister Jiri Rusnok’s interim government sought closer ties to China, and health care was seen as an uncontroversial area of cooperation. A 15-member delegation took off for the East that included the health minister at the time, Martin Holcat; Prymula; Svatopluk Nemecek, who would replace Holcat earlier this year; other hospital administrators; and representatives from medical device companies.
While touring Chinese hospitals, the members of the delegation became interested in traditional Chinese medicine. “When we were flying there, no one thought that something would come of this field,” Prymula said. Then, however, he saw how top Western medicine cooperates with traditional Chinese medicine, using whichever approach is suitable, and an idea was born. The Hradec Kralove hospital concluded a deal to cooperate with a university of traditional Chinese medicine in the province of Hunan.
Eager to export their culture, Chinese officials supported the exchange. Holcat, the former health minister, was ecstatic. He remembered how in the 1980s acupuncture helped cure his hay fever when he was recovering from jaundice at some hot springs. After a long while he allowed a senior consultant to “stick needles in him.” “It was quite a miracle,” he said. “My allergies have been much less severe since then.”
As minister he looked for ways to support the entry of Chinese medicine on the market, including having it taught in medical schools or making it easier for Chinese doctors to work in the Czech Republic.
Czech law allows only those educated in classical medicine to practice here, and Chinese doctors are trained in both Western and their own traditional methods. But it remains to be seen if the Czech officials will acknowledge the Chinese classical medicine diploma.
Holcat is now an executive with a hospital in Prague, and of the range of Chinese treatments (characterized by a complex view of the patient, with diagnoses based on taking the pulse or looking at the tongue, and prescribing herbal mixes apart from acupuncture) he wants only acupuncture in his institution.
“We must be very careful,” Holcat said, anticipating the resistance of many Czech doctors. “Acupuncture won’t offend anyone; herbal remedies – that’s different. It's not possible for a doctor to prescribe something that isn’t certified and is mixed differently for each patient.”
Prymula has fewer reservations. He has set aside an area in the Hradec Kralove hospital for traditional Chinese medicine, which he expects will see about 3,000 patients a month (about 50,000 patients go through the hospital in a month).
He said the initial focus will be on pain relief, particularly on acupuncture for cancer patients, who rely on opiates in the final stages of the disease.
Acupuncture could also help with back and joint pain and headaches. In addition, some minor procedures, especially to the face and neck, could be done on patients “numbed” by needles instead of drugs, he said.
But it’s not just acupuncture, which is not new to the Czech Republic, that Prymula’s hospital intends to offer.
“Some of my colleagues consider traditional Chinese medicine as something completely obscurantist,” he said. “However, it was around long before Western medicine. It’s not so easily evaluated, but it does stand on an enormous weight of experience, has strict rules, and takes eight years of study” before practicing.
Most Czech physicians look askance at Chinese concepts such as yin-yang, inner wind, or empty heat, and traditional Chinese medicine in a university hospital is a novelty. But in some clinics Czechs have been encountering it since the 1990s. Three years ago, the Chamber of Traditional Chinese Medicine was created to oversee the professionalism and expertise of its members.
“A thousand people take advantage of Chinese medicine [in the Czech Republic]. Not all, however, practice it responsibly and well,” said chamber president Jiri Bilek. Physicians account for only half of those practicing Chinese medicine in the Czech Republic, but Bilek said a diploma is less important in the field. The chamber, however, urges its members to spend time getting to know Western medicine, if for no other reason than to prove themselves as partners to their physician colleagues.
HAND IN HAND
Internist Michal Strnad, who will lead the Hradec Kralove hospital’s “Chinese section,” has managed to link both approaches. His consulting room on the first floor of the polyclinic at the edge of the city already has one peculiarity. Some patients come here twice: once for a vascular physician and then again for a practitioner of traditional Chinese medicine. In his role as a Western physician Strnad checks blood pressure, administers medicine, and if necessary, sends the patient to another practitioner.
But as a specialist in traditional Eastern medicine, the pulse and tongue interest him. Chinese physicians read much more from a pulse than we are used to, and they learn how to do it over years. For them, the science of diagnosis is connected to the tongue, its color, cover, or scoring on the top. A thick textbook full of photographs of various tongues lies on Strnad's table and on his own computer are stored about 18,000 tongue photographs. Step by step he notes how a patient’s tongue changes to see if a treatment is working or if it should be changed.
Strnad got involved with Chinese medicine as a medical student in the 1980s.
“I found out that places exist that respond to specific acupuncture points,” he said. He became more interested in acupuncture and taught himself from local experts. “However, that which was practiced here was a sort of Western concept of acupuncture,” Strnad said. “The effects were explained by the neurological connections in the skin and external tissues to the central nervous system. But the effect cannot be fully explained just by that.”
Strnad first traveled to China in the early 1990s and from the “little needles” he got into traditional Chinese medicine. “It's not just acupuncture but also herbal mixtures, diets, psychotherapy, massages, or heating of particular points,” he said. “I still use the 'little needles' but I evaluate the state of the patient differently.”
In Western medicine, he said, a patient with a variety of complaints will run a gauntlet of specialists, getting pills and advice from each.
The Chinese practitioner, on the other hand, tries to find the imbalance causing the problems. The prescription could be acupuncture and an herbal tincture.
The different approaches – Eastern and Western – are suited to different ailments, he said.
“If someone has strange pains in their stomach, it is vital to immediately discern whether or not this is an acute appendicitis, intestinal obstruction, or a punctured intestine. It’s definitely not appropriate to try to cure it with needles,” Strnad said.
“For more than 30 years I’ve been poking people with needles, but I don’t accept patients with tumors. I didn’t go through that in school or practice it, and I never tried it – it’s a very complicated thing,” he said.
But even those treated via Western methods can benefit from Chinese potions, which can mitigate the side effects of cancer therapy, for instance, Strnad said.
“Sometimes the body is so fatigued, that it doesn’t even react to the [acupuncture] needles,” he said, as it loses its ability to excrete chemicals that suppress pain.
Strnad expects to see people with joint, head, or back pain pass through his department along with people who have been in accidents, cannot sleep, or suffer from allergies.
NO PLACE IN A HOSPITAL
The new model being created in the Hradec Kralove hospital has many Czech doctors up in arms.
“This is blurs the line between medicine and healing,” said Zdenek Mrozek, an official with the Czech Medical Chamber. “I don't have anything against those methods, but they should be practiced as a different form of healing, and not in the framework of a hospital. To put Chinese medicine next to surgery – that really doesn’t sit well with me.”
Neurologist Milan Novak in Zdravi (Health) magazine was even more blunt, likening traditional Chinese medicine to amateur bloodletting.
Top surgeon Pavel Pafko, who opposes the pilot project, predicted that the medical staff at Hradec Kralove would not stand for its introduction there.
“Modern medicine is a medicine of proof. If there is no proof – this is what alternative medicine is for. That, however, should not operate in university hospitals,” he said.
Mrozek said the Hradec Kralove hospital could be in for trouble if it accepts the credentials of Chinese doctors or gives patients herbal mixes instead of clinically tested Western prescriptions.
For his part, Prymula has anticipated those problems.
“We don't need the state to recognize Chinese doctors' education,” he said. “They’ll only be here temporarily, advising our doctors, and they don’t need a recognized title for that. And as for the herbal mixes, we don’t need them to be recognized as medicine. They can be categorized as dietary supplements, without a problem.”
But the program will have to prove itself to Nemecek, the health minister.
“I would certainly not call it charlatanism. They are two different worlds and each has its own place,” he said.
The minister said he will wait to see how the experiment plays out in Hradec Kralove and then decide in a year or two whether to expand it to other hospitals.