Feeling the pulse of traditional Chinese medicine

Letter from Beijing: Recently, when I visited Tibet with a group of Chinese tourists, I joined them on a trip to a traditional medicine clinic. The party I was with was made up of people who were either well-educated technocrats or hard-headed, successful business people - not, in other words, a naturally gullible group.

We were shown into a room with rows of seats and given tea. A pretty young woman in traditional costume then entered and gave us a long lecture, complete with diagrams on the flow of chi, the life-force, through the body. This was a build-up to the entrance of the head of the clinic, a celebrated practitioner of traditional medicine, who took the podium to emphasise the ancient system of diagnosis and healing.

After he left, a string of doctors entered the room one by one and members of the group volunteered to go with one or other of them in groups of two or three.

It all seemed pretty like a hard-sell exercise to me, and I had no intention of buying. But I was emphatically alone. Out of curiosity, I went along with one of the tourists, a man in his late 40s. We were led to a cubicle with a curtain across the front and a plain desk for the doctor.

The patient, as he now was, sat in front of the doctor and obeyed his instructions to put out his left hand. The doctor looked at the lines on his palm for about a minute, then felt his pulse. He did the same with the other hand. Then he asked the man to stick out his tongue, which he looked at for about 20 seconds. And that was it.

The doctor immediately began to scribble a prescription. He explained to the patient that he was suffering from an internal blockage of his chi which would probably kill him if it were not treated. The patient nodded gravely and said the doctor must be right because the same complaint had killed his father. (I asked him about this afterwards and discovered that his father was over 80 when he died.)

The doctor told him he would have to go easy on sex and red meat and try not to get angry. And of course, use the traditional concoction of herbs, which was now going to be prepared for him. The first six months supply would cost €150, and after that he could send a cheque for more.

At this point, the Chinese haggling instinct outweighed even the fear of death, and the patient bargained the doctor down to €90 a pop for the medicine - still a substantial sum by Chinese standards. A white-coated assistant arrived remarkably quickly with the herbs already packaged and the patient paid his money and left.

To me, the doctor's verdict seemed like a parody of the mediaeval European medicine that killed so many hapless patients - a diagnosis of "excess of choleric humour" based on minimal examination of the patient - and it seemed equally obvious that all the people entering the clinic, however healthy they looked and felt, were certain to be diagnosed with something deadly and expensive. But to the Chinese tourist, the doctor's judgment had immense authority.

This little episode was typical of traditional Chinese medicine only in that the exercise was highly organised and that the cures were so expensive. Most sick people, especially in rural China, are still diagnosed by a healer who feels their pulse and looks at their tongue.

And most are still treated, not with western-style patent medicines, but with herbs and minerals from the traditional Chinese pharmacopoeia. Annual demand for traditional medicines is now 600,000 tonnes - four times what it was a decade ago - and supply (limited by environmental damage and booming foreign markets) can't keep up with demand. The industry, which is increasingly commercialised, was worth about €10 billion last year.

The boom has many sources. For many in the countryside, western medicine was discredited by the "barefoot doctor" scheme of the 1960s and 1970s, in which hundreds of thousands of untrained paramedics practised a medicine they barely understood.

Now, well-qualified doctors tend to be drawn towards the big cities. Economic reform has created a medical marketplace, in which the poor have little access to expensive hospitals and drugs. In this context, a traditional system where written records go back 3,000 years retains immense prestige.

It also works - sometimes. There's no doubt that Chinese traditional medicine has accumulated and systematised an immense amount of practical knowledge of the medicinal properties of herbs, flowers and roots. Western scientific medicine has only recently discovered the properties of ephedrine plants, used by the Chinese to treat asthmatic conditions since the time of Christ. The date kernels used by the Chinese to "calm the heart" do in fact counteract cardiac arrhythmia. Equally, though, many traditional medical substances are in fact highly toxic. What's needed, obviously, is the application of scientific and technical rigour to the vast body of traditional medical knowledge. The Chinese government recently announced an ambitious plan to co-operate with pharmaceutical companies to do just that. The question, though, is whether ordinary Chinese people will then be able to afford the products that emerge from their traditions.