ICU and You · Nǐ hǎo Chinatown 你好 · Number 1
The marks that look like one thing and are usually another — and the better question to ask
欢迎 — welcome. This column is new, and it is here because a great many of the people who read this site, work in our unit and teach our registrars are Chinese or of Chinese heritage, and because medicine looks different depending on where you learned to practise it. It is not a column about China written from Australia. It is meant to be a column that Chinese readers would recognise, and I am going to need help keeping it that way. There is a request at the bottom.
A three-year-old comes in with fever, and there are rows of red-purple streaks across her back. You have just read a mind map telling you that bruising in a small child needs a reason. You now have about four seconds to decide what kind of conversation this is.
The reason is very likely guā shā 刮痧 — literally scraping sha. A lubricant is applied to the skin, and a smooth-edged tool, classically a ceramic soup spoon, a coin, a piece of jade or buffalo horn, is drawn firmly along the back in repeated strokes in one direction until small red points appear. Those points are the shā 痧 itself, and raising them is the purpose rather than a side effect. It is done for fever, for colds, for aches, for the feeling of being blocked or overheated, and it is done to children by people who love them.
Recognising them is a skill, not a courtesy. The pattern is orderly: parallel linear streaks running along the paraspinal muscles or following the line of the ribs, often strikingly symmetrical, sharply confined to the treated area with normal skin either side. There is no impact point, no shape of an implement, no cluster in the soft protected sites where inflicted bruises collect. The child is usually otherwise well cared for, and the family will tell you exactly what was done, in detail, if you ask in a way that suggests you already know what you are looking at.
刮痧
guā shā — parallel linear streaks, paraspinal or along the ribs
拔罐
bá guàn, cupping — discrete circular ecchymoses, evenly spaced
艾灸
ài jiǔ, moxibustion — small round burns, often over acupuncture points
Knowing what gua sha looks like is not permission to stop thinking. A family that practises gua sha can also be a family in which a child is being hurt, and the two are not mutually exclusive. What the knowledge buys you is a better question — you can ask what was done, and why, and who did it, without an accusation sitting under the sentence. Ask that badly and the family stops talking, which helps nobody, least of all the child.
And it runs the other way too. A clinician who has never heard of it may report a family for treating a fever. A clinician who has heard of it may wave through a genuine injury because somebody said the words. Both errors come from the same place, which is using the label instead of looking.
A patient or family who tells you in English that the child has inflammation, or is heaty, may be translating shànghuǒ 上火 — literally rising fire. It is a description of a state of imbalance, associated with sore throat, mouth ulcers, constipation, irritability and poor sleep. It is not the pathological process you mean by inflammation, and it is not a claim about white cells.
Take it as what it is: a real and specific description of how the child seems, offered in the nearest English word available. It tells you something. It just does not tell you what you first assumed.
Zhōngyī 中医 is Chinese medicine, and xīyī 西医 is Western medicine — the one you practise, named by where it came from rather than by what it claims. In much of China the two run alongside each other in the same hospital, and a family using both is doing something ordinary rather than something contradictory.
Dàifu 大夫 and yīshēng 医生 both mean doctor. The first is older, warmer, more northern, and began life as the title of a court official. Which one a family reaches for tells you a little about where they are from, in the same way that registrar and resident do.
To our Chinese and Chinese-heritage readers: what do you wish your colleagues here understood — and what should this column cover next?
This first piece is written from the outside looking in, which is exactly the limitation the column exists to fix. If something above is wrong, clumsy, or a generation out of date, I would rather hear it from you than keep publishing it. And if there is something you have watched colleagues get wrong about Chinese patients, Chinese families, or Chinese-trained doctors, that is the column I want to write next.
Everyone else is welcome to answer the first half too: what have you met at the bedside that you did not understand at the time?
The button opens a reply straight to me. If your device blocks it, write to icuandyou@icloud.com instead.