JournalTOCs School of Mathematical and Computer Sciences Heriot-Watt University Edinburgh, EH14 4AS, UK Email: journaltocs@hw.ac.uk Tel: +00 44 (0)131 4513762  Your IP address: 34.239.148.127 |
JournalTOCs School of Mathematical and Computer Sciences Heriot-Watt University Edinburgh, EH14 4AS, UK Email: journaltocs@hw.ac.uk Tel: +00 44 (0)131 4513762 Your IP address: 34.239.148.127 |
Open Access journal
This paper focuses on Chinese sources suggested for a narrative medicine (NM) program, called AfterWards. Dr Lauren Small established AfterWards in 2014 and has been coordinating it since out of the Pediatrics Department at Johns Hopkins Medicine. In early 2019, she started giving a series of lectures and workshops about AfterWards to Chinese medical educators and clinicians in Beijing and Shanghai. She created an AfterWards Facilitator’s Guide based on Western-language sources for workshop participants. She also started to organize with Jiang Yuhong (Peking Union Medical College) a workshop for Chinese colleagues to be held at Johns Hopkins Medicine in October 2019. They invited the author to participate. The idea was hatched then to develop Chinese source materials following the AfterWards structure for an updated Facilitator’s Guide that Dr Small had initially written. A typical one-hour AfterWards session consists of a specific five-part structure: a literary text or artwork, an associated theme, discussion topics, a writing exercise, and shared reflection. While the content of the program always changes from session to session, the basic structure remains the same. This paper summarizes the types of Chinese sources and their related narrative-medicine themes that were originally selected for inclusion in the updated AfterWards Facilitator’s Guide intended for Chinese colleagues. These sources about coping with sick family members, aging, and illness ranged from the textual (classical Chinese poems on aging and diagnostic forms for training students) and visual (premodern Chinese paintings and murals of medical encounters) to the fictive (novels) and performative (contemporary Asian-American film in English and Chinese-language film and documentaries).
This essay will review the earliest case that documents a patient’s experience of qi, one found on a bamboo text buried with the patient who died in the 318 BCE. Details of the healing encounter and of concepts of illness show how non-transmitted documents hidden from later editors in tombs preserve an older layer of medical understanding than that in transmitted canons, such as the Huang Di Nei Jing (Inner Canon of the Yellow Emperor). The 4th-century BCE case record described below is the longest early medical record concerning the treatment of a specific individual. It is also an account of failure formally recorded for the sake of the survivors and buried with the dead to be transmitted to the world of the spirits. The essay begins with a reevaluation of ancient concept of qi and then moves on to the individual case record.
When narrative medicine (NM) was introduced into China, traditional Chinese medicine scholars found that the core concepts advocated by NM are manifested in Chinese yi’an. But why NM echoes with ancient Chinese yi’an' How can we better integrate NM into Chinese medical practices' To answer those questions, this article first investigates how NM establishes itself as a remedy to biomedicine by taking traditional healing models including TCM as its ideal Other. Then, the narrative traditions of both case histories and yi’an are examined respectively. This article argues that NM is searching for a lost tradition of narrative case histories, but yi’an functions as a living tradition of TCM. The Parallel Chart in NM, designed as a complement to the dehumanized hospital chart, is still based on a dichotomy of science and art and a conflictual doctor-patient model. But yi’an exemplifies the holistic and humane healthcare that NM hopes to achieve. A comparison of both genres also inspired us to rethink the genre of yi’an in NM. Thus, it is concluded that yi’an should be viewed as an epistemic genre integrating individualization and generalization, a bridge linking medicine and literature. And narrative yi’an can well serve as a tool for NM in China. It is also proposed that a thick description of yi’an be encouraged to further promote a pluralistic NM in China.
This paper is an exploration into the practice of narrative medicine in the clinical setting guided by the theory and approaches of traditional Chinese medicine (TCM). By adopting the theory of TCM, the author attempted to provide the patients with systematic treatment from the perspective of society-psychology-biology under the guidance of both the unity of Heaven and Man, and the unity of Xing (Body) and Shen (Mind/Spirit) through his clinical practice. Guided by yin-yang and Wu Xing (Five Elements) theory and focusing on the social relations of the patients for any possible relationships between patients’ social, psychological and biological state, the author took the patients’ emotion management as a point of departure and helped the patients recover both physically and psychologically by promoting positive transformation in patients’ social, psychological, and biological state. A clinical case was provided at the end of this paper to demonstrate how the above theory was put into practice. Narrative medicine under the guidance of TCM theory can supplement modern medical humanity practices as well as extend the scope of modern medical treatment from the perspective of the unity of Heaven and Man, by enriching the content of narrative medicine, and promoting the medical model from biological medical model toward social-psychological-biological model.
Starting from the inheritance and promotion of Chinese life philosophy and traditional Chinese medicine wisdom by Chinese narrative medicine practice, this paper discusses the inheritance and echo relationship between the “close textual reading ability” in Chinese narrative medicine practice and the “four diagnoses” in traditional Chinese medicine wisdom, narrative mediation and the “mind-body holistic philosophy” in traditional Chinese medicine, and narrative wisdom and Dao Sheng in Chinese life philosophy. Meanwhile, by analyzing the stories of contemporary doctors’ practice of narrative intelligence, this paper expounds that Chinese narrative medicine is a new model of medical education and clinical practice based on the absorption of Chinese traditional life wisdom and the essence of traditional Chinese medicine culture, and the integration of western narrative medicine concepts. It also advocates Chinese scholars to actively build the discipline of “narrative traditional Chinese medicine,” constantly translate the academic achievements to foreign countries, and create a good narrative ecology of traditional Chinese medicine.
Auspicious pulse diagnosis/ pregnancy diagnosis in traditional Chinese medicine involves such issues as medical skills, narrative skills, family decency, and ethics. It is an excellent case for the exploration of ethical dilemmas in traditional Chinese medical practice. The early classical medical texts such as Su Wen (Basic Questions) and Ling Shu Jing (Spiritual Pivot Canon) provide a principle-based ethical guide for doctor-patient communication, while popular fiction such as Hong Lou Meng (A Dream of Red Mansions), Yu Mu Xing Xin Bian (Stories: Entertain to Enlighten), and Feng Yue Meng (Courtesans and Opium) in the Ming and Qing dynasties present literary examples for solving ethical dilemmas. This article will analyze these texts from three perspectives. First, the doctors in the text were subject to gender order and other delicate etiquette and customs, therefore were unable to make the diagnosis without embarrassing the patients and jeopardizing family decency. Second, the narrator tends to attribute pregnancy misdiagnosis to three reasons: incomplete patient information, doctors’ poor narrative competence, and doctors’ corrupted medical ethics. Finally, the Ming-Qing fiction proposes three methods to solve this moral dilemma: clear pulse reading, tactful speech, and taboo challenging. This discussion of moral dilemmas in pregnancy diagnosis in traditional Chinese medical practice can be used as a reference for the localization of narrative medicine.
Recorded stories of the clinical encounter stretch back to ancient times. Throughout their history, these narratives have been called by different names, reflecting changes in format, function, and audience. This paper examines and explains the differences in two related forms of clinical writing as practiced by East Asian Medicine clinicians in the United States today—the case study and the case report. Each has its strengths and weaknesses; each is suited to different roles. The case study is ideal for education and the practice of narrative medicine, whereas the case report has played a vital role in propelling East Asian Medicine into the arena of modern scientific research.
This paper sketches the history and the author’s involvement in the development of narrative medicine in China. It also describes “narrative medicine with Chinese characteristics,” explaining why narrative medicine is regarded as a tool to materialize the medical humanities in clinical practice, and detailing the features of narrative medicine in China. The features include the wide acceptance of the “22334 model” of narrative medicine, and borrowing theories and practice from Traditional Chinese Medicine. Finally, the author argues that the medical humanities should be given a “Class-A discipline” status, and narrative medicine should be a class-B discipline under the medical humanities.
Narrative medicine is a multidisciplinary field of inquiry and practice based on the premise that medical care takes place in the context of stories. Research on narrative medicine training suggests that it conveys benefits such as improved communication skills and personal and professional growth to physicians, medical students, and other health care providers. Narrative medicine can promote empathy and trust between patients and physicians and foster self-care. In 2014, the author and a colleague started an ongoing inter-disciplinary narrative medicine program in the Children’s Center of the Johns Hopkins Hospital called AfterWards. The program, which meets monthly, is open to all on a volunteer basis. Through literature, art, and writing, AfterWards nurtures empathy, encourages reflective practice, and builds community among a diverse group of health care providers. Through a series of lectures and workshops at Johns Hopkins Medicine, Peking Union Medical College, and Fudan Hospital in Shanghai, the author has introduced AfterWards to Chinese medical educators and clinicians. Working with Dr. Marta Hanson, she created an AfterWards Facilitator’s Guide for the use of Chinese practitioners. A recent White Paper on Chinese health care indicates that an infusion of humanities-based education, of which narrative medicine forms a part, can help rebuild patient-physician trust. Recently, there has been an increase in interest in narrative medicine in the United States and China. However, more research is needed to demonstrate the impact of programs like AfterWards. Challenges to the implementation of narrative medicine programs remain, most significantly in terms of expertise, resources, and time.
