by Eric Brand

Chinese medicine is intricately connected to Chinese culture. As Westerners, when we study Chinese medicine it is essential that we understand Chinese culture well enough to make meaningful relationships with our teachers. Despite the fact that Chinese medical education has largely moved from a lineage-based system to a university system, many Chinese teachers still keep their best information close to their chest and only share it with the students that they have formed close relationships with. Regardless of whether one is simply trying to learn good clinical techniques or whether one is seeking an international lifestyle that is deeply integrated with Chinese society, it is essential to understand the communication style and subtle cues that allow one to form good relationships with Chinese contacts.

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I initially studied Chinese language in college and I studied abroad in Taiwan before I began studying TCM. Consequently, I had a language base and a bit of an understanding for Chinese culture by the time I started studying Chinese medicine in California. However, my understanding of Chinese culture really grew by leaps and bounds when I started doing an apprenticeship with an old Chinese pharmacist in San Diego, Guo Nan-Yu. I’d fill formulas and help out in the shop, and over time we became very close.

Guo is like a grandfather to me, and a decade later we continue to have a profound relationship. He eventually decided to pass on all his family recipes to me (he relies heavily on hundreds of prescriptions that have been passed down from teacher to student for over 150 years in his family), and I invariably bring him back ginseng and Chuan Bei Mu from China. It has been fun to see the relationship grow and it always brings a smile to my face when I can get better ginseng than he can, or when he asks me a question like “you can differentiate good Chuan Bei Mu?” As my knowledge and connections have matured, our relationship has deepened into new dimensions. During the time that I worked in his shop, I learned how to read hand-written Chinese prescriptions, and I learned a lot about quality differentiation, pao zhi, dosage, tui na, and dui yao. But most importantly, I learned how to form relationships with a good Chinese teacher, and I learned how to eat.

In the years since those early days, I’ve gone on to make many great contacts with inspirational teachers throughout Taiwan, Hong Kong, and mainland China. My teachers Nigel Wiseman and Feng Ye basically adopted me when I moved to Taiwan, and I really learned a tremendous amount from Feng Ye and Nigel over several years of studying with them. Feng Ye had introduced me to the head of Chang Gung Memorial Hospital and all the other TCM doctors there, and I learned a lot about making relationships with progressively more formal contacts. Eventually, I started going to lots of conferences and meetings in mainland China because I got involved in academic and political stuff over there (I’m the co-chair of international affairs for the AAAOM and I am also on various Chinese committees). This allowed me to get a lot of insight into the manners of formal Chinese society, and over time I’ve made lots of meaningful relationships with teachers, universities, and business contacts.

The importance of building relationships with Chinese contacts cannot be overstated. There is a saying in Chinese that goes: “you guanxi, mei you guanxi, mei you guanxi, you guanxi,” which basically translates as “if you have connections, you have no problems; if you have no connections, you’ll have problems.” Making relationships with Chinese teachers allows one to gain access to much more information and allows one’s career to blossom from unforeseen opportunities. This art is arguably the single most important factor in professional and clinical success for many people in our field.

Chinese medicine used to be exclusively taught from master to student. The old system had the advantage in that students proved themselves and they were dedicated, and their close relationship with their teacher allowed them to learn all the secrets that their teacher had slowly accumulated. However, the old system also had the limitation that the students inherited their teacher’s weaknesses as well as their strengths, and they didn’t have exposure to multiple perspectives in the same way as the university system provides. The university setting gives students exposure to experts in many different disciplines, but ultimately the best knowledge is still passed down only to select students. Thus, the best of both worlds is to have broad exposure to different teachers while still taking the time to form deep, long-term relationships with those special few.

How to Behave

Don’t expect to demand the goods just because you paid tuition. In the Chinese world, getting into a good school is tough and the people that made it to the top of their field worked hard to get there. Most good teachers have little patience for students who are lazy or have a sense of urgency or entitlement; expect to be diligent and take the time to settle in long-term. Show up on time and never miss a class or an obligation. Bring small gifts periodically and never hesitate to do anything that your teacher needs. Be prepared to eat new things and be ready to work for long hours without pay if it will help to advance your connections.

When talking to someone in an important position, don’t call them by their first name. Address them by their title, Doctor, Professor, Vice Superintendent, Dean, whatever their highest title is, use it. Expect to receive lots of compliments but deflect them; do not ever accept a compliment head-on because it is perceived as arrogant. Praise others but be modest about accepting praise yourself. Learning to speak Chinese will go a long way, but no matter how awesome your Chinese is, never accept a direct compliment about it (anyone that speaks Chinese well knows this already).

“Face” is the single most important thing in Chinese society. You want to make people gain face and never want them to lose face, ever. Don’t put someone on the spot, don’t confront them directly, and don’t ever, ever embarrass them. Give compliments and gifts, structure your whole life so that you are bringing honor to the teachers that have helped you. Promote your teacher’s work and help them accomplish their objectives; always make it about them instead of making it about you. Don’t try to be a hotshot, be a humble student that is always ready to learn. Pay attention to boundaries and don’t ever cross the line; the light humor, sarcasm, mellow and playful attitude that you have with your Western teachers will rarely go far with your Chinese teachers, though you may get to have a hint of these things once you have a good relationship established.

If the setting is formal, wear a full suit. I don’t care if you are the biggest hipster in NY and the traditional tie is passé, if you are at a meeting with Chinese bosses and people are in suits and ties, suck it up and put on a suit and tie. It’s not a fashion contest; when in Rome, pay attention to the Romans. Conform and get over yourself.

Eating

Eating is the centerpiece of all social interaction in Chinese society. The more variety you can handle the more face you gain. If you have a lot of restrictions in your diet, try to get over it. Even if you don’t like something, suck it up and be an adult about it; any personal discomfort you get from eating a plate of pig’s feet is trivial compared to the value of the relationship with your teacher.

At a formal Chinese banquet, the rice or starch (noodles, dumplings, etc) will always come last. Pace yourself and favor the dishes that you enjoy, but try to sample everything. Be prepared to eat every major category of land and sea creature in any given meal, plus all manners of vegetable products in a stunning array of sauces and styles. Don’t be picky, be curious. If you like this kind of thing, the prognosis is good; if you can’t hang with pushing your comfort zone, maybe you should think about just staying home. If you need to go out of your own comfort zone to give your host face, don’t hesitate to do so. Being a selfish picky American should be avoided, sneak off to the bathroom and throw up or secretly drop a slab of duck skin into your lap if you need to, but don’t kill the vibe.

In the West, a fork brings stuff into your mouth but it doesn’t take stuff out of your mouth. Chopsticks, by contrast, are a two-way street. Beasts come chopped in chunks that maximize skin and bones, and the chopsticks are used to take the part that you don’t eat out of your mouth (bones can go on the table or plate in most circumstances). Don’t point with your chopsticks and don’t ever, ever put your chopsticks vertically in a bowl of rice (this is only done at funerals so it is a death omen).

Drinking

Depending on your teachers or professional contacts, drinking may come up. Of course, tea is always present, try to pour tea for others and tap your first two fingers on the table to silently say thanks when someone pours you tea. This looks like the sign for “hit me” in blackjack but here it means thanks for the tea. It has an interesting cultural story behind it, coming from a tale when the Emperor went out in society disguised as a common person and someone tapped their fingers to symbolically prostrate themselves to acknowledge the Emperor without blowing his cover.

Alcohol customs depend on the region in China that you are in. Drinking culture is more relaxed in the South, and they tend to drink less. Drinking in the North is more important, especially for people from the Northeast or regions such as Shandong. If you can’t drink, there is no obligation to do so. But either be prepared to drink with everyone else or don’t drink at all. (It is fine to refuse cigarettes if you don’t smoke, but they will often be offered if others smoke.)

If you do decide to drink, pay attention to how others drink. In Northern China especially, there is a lot of ritual around drinking. Don’t just hit your glass when no one is toasting, people will think that you have no self-control. Only drink during toasts, which will often be constantly coming up. The beer in China is weak and the liquor is strong, so feign a history of liver disease if you need to stick to the beer and don’t want to be pressured to drink liquor.

When you sit down at a table, try to sit with your back to the door. This is an inferior seat so it is more modest to try to take it. You don’t want to sit facing the door unless others insist and you are truly an honored guest. The person that sits facing the door at the center of the table will usually order and pay. Try to fight over the bill but don’t expect to win unless you are the host. If drinking and toasting happens, let the host toast first. Then the hierarchy of people will toast each other, going from the most important to the least important. Keep your mouth shut unless you are really important, and only start raising toasts to others after all the important toasts have calmed down. It is polite to go around toasting everyone at the table, especially the most important people. At a banquet, go around late in the toasting sequence to toast the most important people at other tables.

When toasting, hold your glass with both hands and look someone in the eyes. When you touch glasses, try to come underneath the glass of the other person. This is a sign of modesty, never casually approach from above because this means that you think you are superior (though if you are a gringo you will get away with it because you are just a gringo). The most important person will generally come out with the glass on top, but always try to come from below the other’s glass. They may sip or they may shoot it, but you should do what they do or skip the drinking altogether. If people are shooting it, turn your drained glass towards the other person to show that it is empty and bow slightly.

Drinking can get a bit complex, and one can even form “teams.” For example, if there are several people in your party and you are in a formal meeting with several people from the other party, you all need to work together. The people with the most capacity can do the heavy lifting (drinking), and they can represent for your side. Don’t get your own boss trashed, work together to keep up with the people on the other side.

In expensive settings, the liquor will tend to be very pure and doesn’t give much hangover. However, in some situations it is inevitable that you will either skip drinking or get drunk. If you can’t handle getting drunk, don’t drink at all, not even a drop. Unless you are a politician or a businessman, you won’t be in such situations more than a few times a year, so it may be worth a bit of harm to your liver if the sacrifice will solidify a profound professional relationship with an important connection. Drinking is unnecessary if the other party isn’t into drinking, and fortunately in medicine there are lots of people that don’t drink and not drinking is perfectly acceptable. But the decision to drink or not is always a personal choice that one may eventually have to face.

Singing

Singing karaoke is huge in Asia. You have to do it if that is what is going on. You can skip out if you are stubborn, but it is a loss of face and should generally be avoided. Man up and pick up the microphone, sacrifice your personal discomfort so that your host gains face. In the picture in this blog, I’m being forced to sing Hotel California in front of some of the heads of the Chinese State Administration of TCM, and I still run into people at conferences years later that remember me singing that song.

Useful tip: Doctors from Hong Kong often love the Beatles, and Beatles songs are generally available on Chinese KTV menus.

Business Cards

Always bring business cards. One side should be Chinese and the other side should be English. The Chinese side is like a mini-resume, it should have all your titles and appointments on it. Always exchange business cards (and other valuable pieces of paper) with two hands. Receive someone’s card with two hands, look at it, and then place it somewhere important, such as your chest pocket. Don’t just casually take the card with one hand and shove it into your back pocket without a glance.

Most of this stuff is common sense, and all cultures in the world have a concept that is parallel to the Chinese concept of face. Nonetheless, face is hugely important in Chinese society and it should always be maximized. You never know what opportunities will arise because of one good connection, so always strive to be sensitive to the people around you and try to get a feel for the culture. Chinese people really like it when you understand their culture, and the elite world of Chinese medicine is like a large family. Once you are part of the club and you have the right introductions, you can make progressively better contacts. Being respectful to your teachers will allow you to really learn their secrets and it will set you apart from the other students. The more we can understand and harmoniously interact with people from other cultures, the smaller the world becomes.