After 1848, a large number of Chinese workers came to the United States during the California Gold Rush. Some of them became Chinese medicine doctors to treat a variety of illnesses, pains, and wounds of Chinese workers, and also treat patients from other ethnic groups with intractable conditions. The earliest Chinese medicine doctor in the US might be Dr. Li Putai (1817–1893). From as early as April of 1854, Dr. Li Putai published an advertisement for his Chinese Medicine Practice in San Francisco, in The Golden Hills’ News. Dr. Ing Hay, a.k.a. “Doc Hay” (伍于念 which Pin Yin spells as Wu Yu Nian, 1862-1952) [Figures 1 and 2], came to the US in 1883 and settled down in John Day, a small town in eastern Oregon, in 1887. At that time, John Day was the third largest Chinatown in the US.” In 1888, he and his friend Lung On (梁光荣, Liang Guang Rong) registered Kam Wah Chung (金华昌 Golden Flower Blooms) & Company; this began his medical career in the US, where he was known as a “China Doctor.” His patients mainly came from several states around the west coast, although some of them even traveled from as far as the eastern US and Alaska. Doc Hay was best known for his pulse diagnosis; in order to maintain the sensitivity of his fingers, he wore a glove on his right hand year round. To commemorate the most famous Chinese doctor in early US history his biography entitled “China Doctor in John Day” was published by historians. And his former clinic and residence was converted into the Kam Wah Chung Museum [Figures 3-6], a “State Heritage Site” issued by Oregon as well as an American National Historic Landmark issued by the US National Park Services. From a professional perspective, it is the world's first Chinese medicine doctor's memorial built on the original site of his practice.
To date, there is one book and several papers that documented Doc Hay's personal background, practice experience, and analyzed effects of herbs stored in the clinic's pharmacy. There is no current study published on analyzing his detailed day-to-day practice or academic contributions based on his prescriptions or case records. Our lead author (Dr. Arthur Fan) made an academic travel to Kam Wah Chung museum on August 5, 2018 and checked the books and hand-written prescriptions by Doc Hay, which were not exhibited to the public at that time. This paper aims to analyze and interpret one of the intriguing herbal prescriptions that Doc Hay had hand-written.
MATERIALS AND METHODS
Prescription piece chosen
There were over 30 pictures taken for recording Doc Hay's hand-written prescriptions on August 5, 2018; one picture for one prescription. Prescriptions were hand-written by Doc Hay using traditional Chinese brush pens with black ink, mainly on paper 2 feet width by one & half feet length. The traditional Chinese writing style was adopted: the column (actually in Chinese old style used by Doc Hay was “line”) is from the upper to lower (1 to 5) and the line (on Chinese old style was “column”) is from right to left (far-right is the first, and the far-left is the last); the original herb name was written vertically. Patients’ medical histories were not found in the Kam Wah Chung museum. Majority of the prescriptions have more than 50 herb names. One prescription was chosen for analysis due to Doc Hay's ability to effectively treat infectious diseases. In particular, he was famous because he had treated thousands of patients from 1918 to 1920, during the “Spanish Flu” pandemic and no patient of his died. That prescription has some herbs commonly used in anti-infection herbal medications. It should be noted that although the prescription was dated as January 23, 1907 that a small light-green paper attached, at the top-middle, to the prescription sheet by the Museum mistakenly marked the prescription date as December 10, 1906). His ability to effectively treat patients during the 1918 pandemic with a Chinese herbal formula is significant in that the US and the rest of the world are currently under a similar pandemic. It would be worthwhile to study the ability of this herbal prescription to effectively treat those infected with COVID-19 [Figure 7].
- Step 1: Transform Doc Hay's hand-written prescription (with original herb names) to standard herb names in Chinese.
- Three of the current authors (Fan, Huang and Jin) checked the hand-written prescription in Chinese, transformed the “wrong herb names” (while the sound was correct or similar to the standard herb names) or herbs’ nicknames Doc Hay's had used into standard herb names in Chinese. Converting the lunar calendar date to the solar calendar date, and the old weight unit Qian (coin) to grams (g) that is in use currently. One Qian is equal to 3.125 g. This was then discussed with other authors to make sure this translation was appropriate.
- Step 2: Induct and rearrange the herb name into groups based on herb property characteristics and then translate them into both PinYin names and English names. Analyzation of the prescription may include in what classic formula (s) routinely introduced in Chinese medicine textbooks.
- Step 3: Analyze the herbal action for each group and potential symptoms or conditions the patient may have had. An analysis of classic formula (s) used in the prescription may represent what clinical condition was being treated at that time.
- Step 4: Summarize the analysis to give a comprehensive picture of the patient.
Transformation of Doc Hay's hand-written prescription to standard words is shown in Table 1. The prescription consisted of a total of 67 herbs including Hua Shi (Talc/Talcum), Po Xiao (Mirabilite/Natrii Sulfas), and a weight of 934.6 g. Hua Shi (Talc/Talcum) and Po Xiao (Mirabilite/Natrii Sulfas) did not have their dosage indicated.
Herb names categorized into groups based on herb property characteristics are shown in Table 2. Potential classic formula (s) included and their major actions are shown in Table 3.
Analyze each group's herbal actions and use for potential symptoms or conditions, and analyze classic formula (s) used in the prescription, as this may represent what clinical condition was being treated. The gender or age of the patient could not be determined, but the possibility of male is higher (due to the patient who might have “nocturnal emission,” see below).
Main symptoms and signs (tongue and pulse reading)
The prominent symptoms were: sore throat (maybe with swelling), strong coughing and with difficult breathing; sputum difficult to expectorate (may be thick). Bad coughing that caused pain in chest, side of rib cage, abdomen, and even lower abdomen area. It also caused blood in the sputum; sputum color may be yellow. The patient had obvious chills, fever, pain in limbs (may have had joint swelling as well), indigestion, bloating, and constipation. The patient might also have nocturnal emission and also had obvious anxiety. Patient's tongue would be red, coating might be yellow, greasy, and dry. The pulse might be large and floating, and weak when pressing slightly hard.
Course of illness
Patient's disease or condition might already have persisted for a while and the body had weakness due to persistent illness.
Speculation based on the prescription
It indicated that the patient had obvious pulmonary infection accompanied by severe cough, and probably had prolonged pulmonary tuberculosis (TB) also with acute respiratory infection caused by other bacteria or viruses. The typical herbs used for TB are Chang Shan, Bai Bu, and Po Xiao.
Doc Hay did not leave medical history notes for this patient. Therefore, we only can interpret based on the herbs that he used in this prescription. He was famous for treating various infectious and epidemic diseases, as well as other intractable diseases. Some examples are wound infections, flu, Rocky Mountain spotted fever, typhoid fever, polio, meningitis, mumps, venereal disease, frostbite, gangrene, appendicitis, and even sepsis (at that time, “blood poisoning” would have been the name used) caused by many diseases. It is worth noting that none of his patients died during the 1918–1920 “Spanish Flu” pandemic in John Day under Doc Hay's herbal tea treatment. At that time, there were pretty large numbers of people who lived in John Day, local population was about 2,000 people plus additional many workers (whose number was unknown) for building-up the highway; while there were 3,500 patients who died throughout Oregon State during the same time. Doc Hay's herbal tea was his “name-card.” The prescription discussed herewith is clearly one for an intractable or severe pulmonary infection, with either bacteria or viral origin, although it probably might be mixed with prolonged pulmonary TB. The typical symptoms were severe cough and high fever with body pain. The prescription or formulas inside this prescription, such as Yin Qiao San, Sang Ju Yin, and Zhi Sou San can be used for the treatment of epidemic diseases. In fact, the majority of herbs used in the above-mentioned formula are commonly included in the herbal medicines in China used to effectively fight severe acute respiratory syndrome, H1N1 and currently COVID-19, such as Lian Hua Qing Wen Capsule; and supported by pharmacological studies.
There is currently a world-wide COVID-19 pandemic, pretty similar to the 1918 “Spanish Flu”, which caused a high rate of death and public panic. As of July 28, 2020, there are 16,883,769 COVID-19 cases globally, the pandemic has taken 662,480 lives. while the number in the US is 4,498,323 and 152,319, respectively. This has already caused heavy losses in both people's life and in the economy, especially in America and European countries. During a moment like this, Doc Hay is missed deeply and it is hoped that Chinese herbal remedies can be used in western countries for fighting COVID-19. The authors note that the adoption of Chinese herbal formulas, like the one prescribed by Doc Hay, could effectively fight the current pandemic. They encourage the use of herbal prescriptions for patients with COVID-19. However, at this time, there are many legal barriers within the US that make it difficult for Chinese medicine practitioners to treat pandemic patients, at both the state and federal level. If more research, like that found in this article, can be made public, legal barriers to using Chinese herbs may be removed.
One of the unique characteristics of Doc Hay's prescription is that his formula composition is extremely broad, typically consisting of 50–80 herbs. It is very rare to see a Chinese medicine doctor using such a large formula, which included 67 herbs and weighed approximately 934.6 g, discussed herewith. In general, Chinese medicine doctors’ prescription includes an average of 10–15 herbs, and the herbs in each prescription weigh 100–150 g. The herbal weight of Doc Hay's prescription is about 5–10 times more to other Chinese medicine doctors. Doc Hay did not mention how many days the herbs in this big prescription (934.6 g/dose) can be used for. In common sense, it cannot be used for 1 day only. The current authors speculate that it is for a 5–7-day dosage, because when the patient saw Doc Hay, it was in the winter. Boiling one dose of 67 herbs with clean water with a big pot (Doc Hay did not mention how much water should be used, and how much decoction should get after the cooking), the decoction might be stored and used for 1 week without going rancid. In fact, doc Hay and Lung On let patients store the herbal tea in used glass beer bottles (about 350ml/bottle), and used beer bottles for measurement. It looks like let patients drink one bottle a time, several times a day. A bigger prescription (with the number of herbs much more than the routine number) has more active components and may be more fit for a patient with complicated disease, with multiple conditions or symptoms, although whether it is absolutely better than a smaller prescription is difficult to judge.
At the end of the prescription, Doc Hay mentioned that he will let patient go back to his hometown called Heng Shi (恒市 Heng city); the current authors speculate that this hometown is Bethlehem, Pennsylvania, but are not positive. The prescription was written on lunar calendar December 10, 1906 (丙午年十二月初十日), while a light green note attached to the prescription sheet only marked “December 10, 1906” as former researcher's translation may cause confusion, as actually it should be marked as “January 23, 1907” because currently the solar calendar has been adopted.
All photos are provided by Dr. Arthur Yin Fan. Due to the limitation of the authors' personal backgrounds, experiences, and perspectives, this article may have some omissions, limitations and errors; comments or corrections are welcomed and appreciated.
Financial support and sponsorship
Conflict of interest
There are no conflicts of interest.