[Repost] I'm preparing to take the military civilian job exam and will no longer practice traditional Chinese medicine

[doggie]

This article was transcribed by SimpRead. Original URL: mp.weixin.qq.com

This was a WeChat message sent to me by a friend. When I first read it, I paused on my end—silent for a moment.

I understood, yet felt helpless. I knew exactly why and where he was coming from.

Suddenly, memories flooded back—seven or eight years ago during university, studying Traditional Chinese Medicine (TCM), debating medical theories late into the night. He used to talk so fluently about a wide range of topics. And there was that incredibly capable senior from the neighboring dorm—a total all-rounder who was both handsome and skilled. (Now pursuing his PhD in Beijing, thriving as ever.)

Back then, we lived in Building 10 at Hanpu Campus of Hunan University of Chinese Medicine, facing the Nursing School. Our biggest daily concern was what to eat. The cafeteria food? Boring. Only after graduation did I realize how good we actually had it—the cafeteria staff were kind; if you arrived late, they’d still generously pile your plate high with dishes.

R, the classmate I mentioned, was tall, handsome, and excelled in nearly every way compared to me. I remember when we took the bus together from Hanpu to Congfutang to learn how to identify Chinese herbs. We clumsily practiced wrapping herbal packets—I was terrible at it, messy and uneven—while R wrapped his neatly and precisely, each package looking professional.

He was meticulous and diligent in his studies, far more disciplined than us. He dabbled in everything—from fate calculation to divination. Whenever I was confused, I’d go to him to have my bazi (Eight Characters) analyzed. We’d chat for hours. I’ve always wanted to learn bazi myself, but whenever I showed my chart to “masters,” they’d shake their heads. I realized then that mastering it would require overcoming not just laziness, but deeper personal barriers.

Unlike me, R is a true all-rounder—high emotional intelligence, sharp insight. After graduation, he remained deeply committed to TCM, mostly working outside the formal medical system. Yet even he has started to feel burnt out. So how long can I possibly hold on?

The traditional TCM narrative goes like this: a passionate young graduate dedicates themselves to classical texts, starts from scratch seeing zero patients, and gradually builds up to treating hundreds daily.

But what do most of us actually face after graduation? The following reflects personal observations with regional bias—specifically about Hunan.

First off, Hunan simply lacks fertile ground for TCM. Everyone knows this, but the reality hits harder when it’s your career on the line.

I remember our academic advisor, also surnamed Zhou, once told us bluntly: “Very few graduates end up practicing pure TCM—it’s extremely difficult. Most go work in hospitals. You should focus on learning Western medicine.”

He wasn’t wrong. In our cohort—seven classes, over 60 students per class—fewer than ten ended up practicing pure TCM after graduation.

Back then, I majored in TCM. I memorized the Shanghan Lun, recited classics constantly—especially since formula-based medicine (Jingfang) was highly valued. My copy of Professor Wu’s revised Shanghan Lun was worn to tatters from constant use.

So naturally, I pursued a master’s degree in TCM Internal Medicine, always aiming to follow a formula-based clinical path. I even started receiving patient appreciation banners as early as sophomore year—though now I just see them as clutter taking up space.

We were so naive back then. To us, being a TCM practitioner meant writing prescriptions—classical pulse diagnosis followed by herbal formulas. That’s what “authentic TCM” looked like.

But—but reality hit hard after graduation. The actual environment was nothing like we imagined. I visited several clinics asking for opportunities, only to be told: “We already have senior doctors handling prescriptions—we don’t need another prescriber.”

They added, “It’d be better if you could bring your own patients.”
I thought: If I could bring my own patients, why would I need a clinic? I could just treat them online.

Some clinics are quite harsh toward young practitioners. Businesspeople and scholars operate with fundamentally different mindsets.

I’m willing to treat patients for free—I just want the best outcome for them. But clinic owners immediately ask, “How will you generate revenue?” That mindset? I really can’t adapt. Maybe I’m too idealistic.

Later, I tried Tongrentang. Their manager was relatively open-minded. Despite my youthful appearance, he didn’t reject me outright—said I could give it a try.

They had another young doctor who started during the pandemic. His prescriptions were effective, and he quickly built a patient base. The manager even showed me one of his formulas.

Simple, elegant—beautiful. I fell in love instantly. One patient was prescribed only two herbs: Guizhi (Cinnamon Twig) and Baishao (White Peony Root). I was stunned. Skill recognized. Have you ever seen someone’s prescription and just knew—this person gets it?

Dr. L seized the moment during the post-pandemic opening, when people couldn’t access Western medicine and reluctantly turned to TCM. With one prescription, he brought down fevers. His outpatient volume quickly picked up.

According to other regions’ narratives, that’s where the story ends: sudden fame, success.
But no. What happened next? Dr. L got a job at a public TCM hospital. Tongrentang’s outpatient service gradually quieted down again.

At first, I didn’t understand why pure TCM practice is so hard here in Hunan. Then, during a conversation with classmates from northern China, it clicked.

Northern regions have unique conditions—rhinitis. Yes, because of dry air and pollution, seasonal allergies explode. A teacher there prescribes Xiao Qing Long Tang Jia Fu Zi (Minor Green Dragon Decoction with Aconite), seeing 70–80 patients a day—too many to handle.

Look at high-volume TCM clinics—they usually specialize in fast-acting treatments: pediatrics, acute conditions, etc.

Ah, now I get it. Mastering the sphenopalatine ganglion technique must be essential for breaking through in the North.

Here in Hunan? Rhinitis exists, but it’s less severe—no extreme cold and dryness. Of course, rhinitis is still miserable—I’ve experienced how it affects memory and focus.

As for Guangdong? Hmm. I didn’t know before, but after attending Ganlu Sister’s beauty training there, I sensed a different atmosphere—people carried the smile and confidence of an economy on the rise.

Talking to them, I realized something: even simple, low-margin acupuncture techniques worked well. Digging deeper into case discussions, I found the reason.

In Guangdong, people prefer TCM from the start. They often present with relatively mild, easier-to-treat conditions.

But in Hunan? Let’s be blunt: the patients who seek us out have usually been everywhere else. No results. Or they have complex, stubborn diseases.

Treating these cases is genuinely tough. I’ve seen many such desperate patients—like chronic hiccups. In Hunan, nobody thinks, “Oh, I’ve had hiccups for days—time to see a TCM doctor.”

They just endure it. Or if it gets unbearable, they go to a clinic for an injection. I once treated a hiccup patient—tried everything, nothing worked.

The diseases we face are completely different.

And we can’t ignore one critical factor: medical insurance.

If you work in a city or clinic with good insurance coverage, by year-end you can shift prescriptions and bill through pooled insurance funds—you won’t worry about food or rent.

But—but in most prefecture-level cities in Hunan, clinics and pharmacies don’t have employee pooled insurance benefits. Without pooled insurance? Even if you’re socially skilled and chat warmly with elderly patients all day, you can’t solve basic survival issues.

In Hunan, my employee medical insurance gives me around 120 yuan monthly—my card balance. It vanishes after buying cold medicine.

Compare that to Beijing, Shanghai, Guangzhou—where insurance benefits are far superior, and wealthier populations live.

Faced with this, we’re left with no choice. We become increasingly versatile, but inner anxiety remains unchanged.

So here I am—a graduate in TCM Internal Medicine—who now also does soft tissue mobilization, postpartum rehabilitation, and confidently performs acupuncture (“kuku zha”).

Now I’m realizing acupuncture alone isn’t stable enough—I’m thinking of advancing into rehabilitation training, adding exercise therapy to my skillset.

All because the environment isn’t ideal.

Another issue: the growth cycle. Honestly, becoming a competent TCM practitioner takes years. While peers in other fields discuss buying houses and cars, I’m still wondering:

How can I stabilize my patient flow? How do I build patient loyalty? My communication skills aren’t great—low EQ. And I refuse to use recharge cards that exploit people’s impulsive decisions.

Sometimes it’s frustrating. I originally chose medicine because I didn’t want to deal with people—thought I could rely on technical skill alone.

Then I started working—and realized: Wait, something’s wrong. Some practitioners are clinically average, but their communication warmth? Off the charts.

Patients voluntarily post about them on social media, spreading the word like wildfire. These people are the true TCM prodigies—the sales champions, wherever they go.

Not me. I’m just a blunt, clueless kid. Only recently, listening to some young girl’s gossip, did I realize how deep modern manipulation tactics run.

I’ve never asked: “Treat you for free—just help me by posting online.” People always say no.

Practicing TCM can be emotionally exhausting. This feeling intensifies when comparing life stages. Last Saturday, while proctoring CET exams, I overheard colleagues chatting—already talking about marriage, home purchases, which neighborhood to buy in.

Suddenly, post-graduation life felt like it was on fast-forward. Compared to other industries, TCM’s “the older, the more valuable” trajectory is hard to accept.

A computer science grad might already earn 400,000–500,000 annually. Me? Today I prescribed over 31 doses—too expensive. Why are there so many difficult cases?

How should I communicate with patients? Are clinic owners even human? These are the harsh realities we face head-on.

Honestly, at our age, society doesn’t call us “young TCM doctors”—we’re more like “infant TCM practitioners,” the rookie form of Agumon. If you’ve ever seen middle-aged aunties sizing you up with skeptical eyes, you know what I mean: “Are you even qualified?”

There is another path—everyone knows it: self-media (social media). But honestly, self-media isn’t friendly to TCM.

First, licensing. Posting medical content easily triggers restrictions, violations, or reports. Maybe later I’ll try recording some techniques—see how it goes.

But doctors in big public hospitals—even if their skills are mediocre—have platforms. With professional operations, they gain hundreds of thousands of followers on Douyin (TikTok) effortlessly, smoothly redirecting traffic.

Our room for maneuver? Extremely limited.

I know many senior TCM teachers in Hunan’s top-tier hospitals hire dedicated teams to manage their online presence. But we? We don’t understand any of this. I personally know nothing about internet strategies. Just look at my profile picture—you wouldn’t even guess this person is a doctor.

I don’t know what the future holds. We’re becoming more versatile, but human complexity makes the road tough. I chose TCM thinking I wouldn’t have to deal with people—only to find out I now have to learn everything: medicine, communication, marketing, psychology.

I just want a stable, decent-paying job and lie flat. So if you’re considering medicine but find clinical work too draining, consider alternatives early: prison doctor, military civilian position, or school physician in a major city.

And if you truly want to grow in TCM—go to a big city.

Forget about places like Hunan.

Yes, the state promotes TCM development. Policies support it. But those reaping the benefits are mostly within the formal system.

Still, as long as I don’t abandon the craft, I can keep practicing. When simple cases come, I can still treat them myself.

Recently, I’ve been in a rough mental state. Just venting randomly. Sharing some thoughts—take it as one person’s perspective.