Taiwan Today

Going to the doctor in Taiwan has long meant choosing between two very different ex­periences. Patients can make an appointment at one of the island’s large, modern hospitals, where the equip­ment and the training of physicians are largely the same as in the West. Or they can visit the office of the neighborhood Chinese doctor, typically a one-room shop crowded with an acupuncture bed and jars of herbal ingredients for medi­cines. During diagnosis, the doctor’s main tools are a pen and his or her skills in ob­servation and analysis.

For the past two decades, modern medicine has grown steadily in Taiwan. The number of hospitals and clinics has grown from about 12,000 in 1986 to more than 15,700 today. But while modern medi­cine has become more prevalent, traditional Chinese medicine has not lost its allure among much of the population. During the past nine years, the number of licensed Chi­nese medicine doctors has increased from about 2,000 to more than 2,800.

The two medical systems have long co-existed, but not without a degree of friction. Physicians of modern medi­cine tend to consider traditional Chinese medicine old-fashioned and unscientific, while Chinese medicine practition­ers argue that modern medi­cine ignores a valuable treatment method with a five-thousand-year track record.

Today, however, the two medical cir­cles are finding areas in which they can cooperate. A growing number of physi­cians are reporting positive results in combining acupuncture and Chinese herbal medicines with modern medical techniques for the treatment of certain diseases and health problems. Many expect that this synthesis, or “third medicine,” will become increasingly common. Al­ready, several hospitals offer their pa­tients examinations by both practitioners of modern and Chinese medicine, who then prescribe treatment based on both systems.

While such combinations may be new for many members of the Western­ trained medical community, patients have for generations used a mix of traditional and modern medicines. Many people ad­here to a long-standing belief that Chinese treatments are more effective than mod­ern medicine in treating certain diseases and disorders, including asthma and hepa­titis, and also produce fewer side effects. Thus, it is common for patients to sup­plement hospital prescriptions with traditional herbal remedies prescribed by a neighborhood Chinese medicine practitioner.

Such habits worry many physicians and Chinese doctors because patients are combining treatments without professional supervision. “More than half of my asthma patients are secretly taking tradi­tional Chinese medicine in addition to modern medicine,” says Hsieh Kue­-hsiung (謝貴雄), a professor of pediatrics at National Taiwan University College of Medicine in Taipei. “This probably produces side effects and influences the effectiveness of treatment.”

But a growing number of medical professionals believe that, when super­vised by professionals, patients can ben­efit from a combination of the two medical systems. “Like many doctors, I feel frustrated that there are some diseases I can’t cure,” says Julia Tsuei (崔玖), a senior gynecologist and secretary-gen­eral of the Foundation for East-West Medicine in Taipei. Tsuei views third medicine as another weapon she can employ in fighting difficult dis­eases or when working with hard-to-cure patients. “By combining modern and traditional medical examination methods,” she says, “we can get better result.”

In 1989, Tsuei and a group of doctors and government officials established the Foundation for East-West Medicine to re­search third medicine. One year later, the group founded a sister organization called the Clinic for East-West Medicine, which became the first and only clinic providing a mix of modern and traditional medical services. Doctors use both systems to analyze the patient and to determine a method of treatment. For example, a pa­tient suffering from diabetes might begin the visit with biochemical analyses such as urine and blood tests, then receive a tra­ditional examination based on a Chinese medicine doctor’s four steps of observa­tion and questioning. Next, the patient might receive an analysis wherein a computerized “electrodermal screening de­vice” is pressed against a fingertip to meas­ure body temperature, pulse, blood pressure, and other qualities to help deter­mine physiological and psychological ab­normalities. The patient’s prescription might include anti-diabetic drugs plus a special restrictive diet supplemented by Chinese herbs.

A growing number of hospitals are also integrating modern and traditional medical practices. In 1985, the China Medical College Hospital in Taichung, west-central Taiwan, became the first to offer a department combining modern and Chinese medicine. It treats high blood pressure, infertility, asthma, aller­gic rhinitis (inflammation of the nasal mucous membranes), diabetes, hepatitis, hyperthyroidism, nephritis (chronic in­flammation of the kidneys), rheumatism, and tumors. Patients first choose a doctor specializing in either modern or Chinese medicine. After the initial diagnosis, if necessary, a modern medicine practi­tioner may refer the patient to a Chinese medicine doctor, or vice versa. Chang Hen-hong (張恆鴻), director of the hospital’s Depart­ment of Internal Chinese Medicine and a rheu­matism specialist, says the department is now the hospital’s most popular.

Chang says third medicine has been effective in treating patients with special needs. In a cooperative agreement with Changhua Christian Hospital in west-cen­tral Taiwan, patients who are allergic to modern medicines for rheumatism are referred to Chang. They receive either a com­bination modern-and-Chinese treatment or straight herbal remedies. Chang estimates that the program attracts sixty patients a day, and he says the treatments have been more effective and have shown fewer side effects than modem treatments.

Taipei Municipal Ho-Ping Hospital began offering combined modern-and­-Chinese medical treatments for hepatitis in 1992. “To date, no effective single medicine for hepatitis and its complica­tions has been found even though chronic liver disease is among the leading causes of death in Taiwan,” says Ren Pei-lung (任珮鸞), a gastroenterologist at the hospital’s Department of Internal Medicine. For this reason, Ren says many hepatitis patients combine Chinese and modern medicine, but without medical supervision.

Under the Ho-Ping Hospital program, Ren gives patients an initial examination using modern medical techniques. Next, the program’s Chinese medicine expert, Cheng Chen-hung (鄭振鴻), director of the hospital’s Depart­ment of Internal Chinese Medicine, pre­scribes a traditional treatment. The patient’s progress is then monitored using modern methods. Patients who show no improve­ment under the herbal treatments are imme­diately switched to modem medicines. In this way, the doctors believe they offer the best of both medical systems. The depart­ment treats roughly six hundred hepatitis patients per month, and offers third medi­cine services for the treatment of infertility, allergic rhinitis, asthma, and thyroid disor­ders.

Even the top-rated medical facility on the island, National Taiwan University Hospital in Taipei, is showing interest in third medicine. In 1991, pediatrician Hsieh Kue-hsiung gathered a group of physicians, doctors of Chinese medicine, and scholars to launch a large-scale integrated program for asthma. Eight hospitals in Taipei, Taichung, Tainan, and Kaohsiung are now participating in the program. Asthma treatment begins with a diagnosis using both modern and traditional meth­ods. Doctors of Chinese medicine then draw up a prescription. “Dur­ing three years of research, five kinds of Chinese medicines have been evaluated,” says Hsieh. “We have found that Chinese medicine is really effective in treating asthma.” As a next step, researchers plan to purify the ingredi­ents used in the most effective herbal treat­ments to create a new asthma drug.

Today, a total of eighteen hospitals is­landwide offer combined modern-Chinese departments. In addition, Veterans General Hospital in Taipei and Taipei Municipal Chunghsiao Hospital have begun offering acupuncture services. Veterans General has offered an acupuncture training class to doctors since 1977, attracting about fifty physicians per year. Chung Yung-tai (鍾雍泰), an anesthesiologist at Provin­cial Taipei Hospital who took the class, now offers acupuncture services for pa­tients suffering from chronic and acute pain. “It’s especially helpful with sprains,” he says. “Acupuncture can relax a patient’s muscles and relieve pain.” He says nearly half the patients at the pain clinic opt to receive acupuncture as part of their treatment.

Not all physicians are enthusiastic about the rise of third medicine. Many believe that Chinese medicine is primitive and imprecise, even though it has begun to incorporate the use of some modern equipment such as the sphygmograph, for taking a patient’s pulse. “Chinese medi­cine is like a bow and arrow, but modern medicine is like a missile,” says Shen Fu­ hsiung (沈富雄), a legislator and nephrologist at Taiwan Adventist Hospital in Taipei. “There are great differences in logic and diagnosis between the two types of medicine.” Andrew Huang (黃達夫), an oncologist at Sun Yat-sen Hospital in Tai­pei, believes combining the two medical systems can be harmful to patients. “I never consider integrating modern and Chinese medicines because Chinese medicine is out-of-date and unscientific,” he says. “Some of my cancer patients who secretly take Chinese medicine suffer from side effects and become worse. I don’t believe Chinese medicine can cure diseases because its effectiveness cannot be evaluated. A large number of people go to Chinese medicine doctors, but that does not mean they are effective.”

And even when doctors of the two types of medicine agree to work together, problems can arise because the systems are so dif­ferent. One hard­ship is that Chinese medical practitioners tend to depend on a less rigid, more subjective system of diagnosis, leading doctors of modern medicine to complain of a lack of precision and methodology and of a gen­eral lack of research data on traditional treatments. Another is that doctors of Chi­nese medicine use a vastly different pro­fessional vocabulary than do modern medicine professionals.

But pediatrician Hsieh Kue-hsiung believes this problem can be overcome through improved communication. “Phy­sicians should not think traditional medi­cine is wrong because they don’t understand it,” he says. Such a viewpoint is echoed by doctors of Chinese medicine. “Traditional Chinese medicine is a five-thousand-year­ old treasure and it’s hard for modern people to understand,” says Chang Tzen-kwan (張正廣), an associate professor of neurology at China Medical College. “But people can’t ignore the value of Chi­nese medicine for that reason.” Chang oversees a third medicine clinic for epilepsy at China Medical College Hospital.

Many medical professionals also charge that Chinese medicine practitioners do not receive adequate education or prac­tical training. By law, candidates for a li­cense in Chinese medicine must pass a written exam, followed by eight months of training in basic medical sciences and ten months of clinical practice. The eighteen­-month training requirement is a small frac­tion of the seven years of university study and the examination required to receive a license to practice modern medicine.

There is one avenue by which stu­dents can receive an undergraduate de­gree in Chinese medicine. Among Taiwan’s ten medical colleges, only the China Medical College offers a depart­ment of Chinese medicine. Under this program, begun in 1966, students study both traditional and modern medicine, taking a total of 359 credits—97 more than are required for a standard medical degree. (The college also offers a 45­-credit course for practicing physicians in­terested in getting a license in traditional medicine.) Graduates of the program then take a licensing examination in modern or traditional medicine, or both, but by law they can choose to practice only one.

Very few graduates from the China Medical College program opt for tradi­tional medicine. “The environment for Chi­nese medicine doctors is not good,” explains Chang Hen-hong of China Medi­cal College Hospital. He says Chinese medicine doctors have a lower social status than physicians of modern medicine. In addition, the Na­tional Health In­surance system pays lower pre­miums for tradi­tional medical care than for modern medicine. Another problem is that few hospitals offer practical training for graduates in Chinese medicine—a part of a medical student’s education that Chang be­lieves is even more important than class­room study. As a result, many Chinese medicine graduates switch to practicing modern medicine. According to the De­partment of Health of the Executive Yuan, there are some 24,500 practicing physicians, or nearly nine times the number of Chinese medicine doctors.

In order to attract more students, in 1984 the China Medical College began of­fering a channel for graduates in nursing or pharmaceutical studies to seek a post-bac­calaureate degree in Chinese medicine. The five-year program includes 182 credits, and graduates are restricted to practicing tradi­tional medicine upon graduation. In 1991, National Yang Ming University also estab­lished a graduate program in traditional medicine. A total of sixty students gradu­ated from the two programs in June.

Professors of medicine believe greater interest in such programs exists, but that the opportunities are too limited. Most colleges offer one or two courses in Chinese medicine. For instance, National Taiwan University offers just one three-hour course on the topic. “If the education authorities will not establish more Chinese medicine departments, at least they should increase the number of Chinese medicine courses,” says Professor Hsieh Kue-hsiung.

Many Chinese medicine practitioners are also frus­trated by legal barriers that hinder full integration of the two medical systems. Under ROC law, even doctors licensed in both modern and traditional medicine must choose to prac­tice one or the other, but not a combination. Earlier this year, the 400-member Society for the Integration of Chinese and Western Medicine, formed in 1993, lobbied the De­partment of Health to allow doctors li­censed in both modern and traditional medicine to establish clinics offering com­bined methods. But the request was denied because the law forbids use of “traditional and modern medicine” as a medical cat­egory. Even at the Clinic for East-West Medicine, Dr. Julia Tsuei explains that the modern and traditional departments within the clinic are required to use separate en­trances and reception counters.

“It’s illogical,” says Professor Chang Tzen-kwan. “It seems the government doesn’t encourage the integration of mod­ern and traditional medicine.”

But the government may face in­creasing pressure to liberalize health care regulations as more physicians and patients find benefits in combining the two types of medicine. Says Cheng Chen­ hung of Taipei Municipal Ho-Ping Hospi­tal, “The integration of modern and Chinese medicine is a feasible method of treatment. Although the methods of treatment differ, the purpose of both medi­cines is the same.”