Eight years after graduating with a bachelor's degree in traditional Chinese medicine (TCM) in London, 39-year-old Italian Giuseppe Demartis feels lucky that his dream of working with TCM has partially come true. A small hiccup is that instead of treating human beings, his "patients" are pets.

Italian law regulates that only doctors with a Western medical degree can become licensed to do acupuncture as long as they finish a part-time TCM course, over two or three years. Giuseppe, despite a full-time degree in TCM from Middlesex University, is not allowed to practice legally. "It's a big problem, as in most of these cases, the true essence of TCM is lost during these short courses," he explained.

Tough reality check

Giuseppe has tried several ways over the years to pursue TCM. He briefly taught TCM basics at the Oriental Medicine Center in Milan and treated certain psychiatric patients in rehab centers before opening a vet clinic together with his business partner - a veterinarian called Fabrizio Panzarella - in the heart of Rome.

Giuseppe says that, after several years of practice, his blend of Western medicine and TCM has proved to be very effective and has secured him a customer base from across Italy. However, the favorite memory of his TCM healing career remains when he helped a patient, who was a relative of Fabrizio, who had suffered a stroke. This had left him with a severe speech impediment and paralysis of the right side of his body.

"His condition was almost the same after spending six months in a top center and Fabrizio asked me if 'my' medicine could help," Giuseppe remembered. He began a daily course of specific acupuncture treatments for a month, after which the patient began to speak, walk and even play the piano again. The success on this case finally made Fabrizio, who was Giuseppe's friend at that time and "completely skeptical of the true potential of TCM and acupuncture," believe in TCM.

"We then decided to apply TCM and acupuncture on pets. We wanted to prove to the public and scientific community that animals do not have a placebo effect as they don't know the difference between acupuncture or an injection of antibiotics," he explained.

There is no sign of a foreseeable change in Italy's legislation to allow people like Giuseppe to legally treat patients with TCM. However, he feels he was luckier than his classmates as he was able to stay within the industry while most have given up. Chinese TCM educators say similar reality checks are common across the board for foreigners studying TCM. "In terms of their professional pursuits, it's usually not a smooth ride," Chen Feng, vice dean of the International School of the Beijing University of Chinese Medicine (BUCM), told the Global Times.

Established in 1956, the Beijing University of Chinese Medicine started to recruit overseas students for TCM studies one year later. Tens of thousands of overseas graduates have passed through the school's gates, with 1,700 alone in 2008. But Chen says most of them were unable to practice TCM, even after five years of study. "Most of them ended up working in completely different fields, some moved into herbal therapy and some are providing services for religious entities," Chen added.

Compared with European countries like Italy where TCM regulation remains unchanged, Chen said the wholesale boycott of TCM in South Korea since 2010 has seriously dampened local people's enthusiasm for this healing method.

"We have seen a big drop in South Korean students over the past two years due to the bleak employment outlook created by the current South Korean policy. It dictates that TCM majors are not allowed to sit the exam for the license to practice," Chen said. As a result, several large-scale protests have taken place over the past two years led by those who see TCM as their major and career pursuit.

But in the US, Canada and Scandinavia among others, TCM, as an alternative approach for medical treatment, is accepted on the condition that the practitioner passes a national test to have the right to practice. But in markets where Chinese practitioners coexist with their local counterparts, insiders say local practitioners are always at a disadvantage.

"There are few TCM clinics here in Ottawa that are run by non-Chinese people. Many patients are not satisfied with the performance of local acupuncturists, especially as many have only had 200 hours of training before setting up shop," said Cai Songyin, the Chairman of the Ottawa Branch of Chinese Medicine and Acupuncture Association of Canada, in an interview with the Global Times.

Getting real practice

But for Elke Johnson, a 51-year-old TCM practitioner in Berlin, Germany, this is not necessarily true. Elke insists that the majority of TCM or acupuncture practitioners in Germany are local.

As a German native, Elke earned a degree in TCM in Beijing after seven years of study. Thanks to Germany's reasonably open medical system, Elke opened her own TCM clinic in 2002, covering internal medicine, herbal medicine and acupuncture.

"There is a special license for so-called natural healing practitioners. As long as you take the national test that happens every half year, which is mainly about the basics of Western medicine and the law, you can practice," Elke explained to the Global Times over the phone. Besides TCM, Indian Ayurvedic medicine is also permissible. However, none of these practices, including TCM, have specific national standards.

Many older Chinese TCM practitioners have been unable to pass this national test, due to lacking the necessary language skills. But Elke feels the situation will be different for the new generation of Chinese people coming to Germany. Nevertheless, Elke doesn't feel that Chinese practitioners are superior to non-Chinese, saying "it's a challenge for everybody."

If Elke was the only Westerner in her class back in 1994, with the rest of the overseas students all coming from South Korea, Mame Awa Ly Fall, as the first TCM-major from Senegal, is very optimistic about her future as a TCM practitioner back home.

Having received a full government scholarship, Awa started to learn TCM in 2008 at the BUCM following her one-year language studies in Jilin Province. Awa had once planned to study conventional medicine in China. "But later I changed my mind. As long as I am in China, I should learn traditional medicine here, I believe it's a destiny," Awa told the Global Times at a café in Beijing.

Unlike a former French classmate of hers, who returned to China to work in the TCM field after failing to do so back home, Awa is determined to open her own TCM clinic in Senegal in Africa.

Similarly to Elke, all she needs is a license that can be easily obtained by passing an exam on the basics of Western medicine. Given the relative prevalence of traditional African healing back home, Awa is even more confident about seeing TCM accepted there.

"TCM is based on systematic theories that date back to thousands of years ago, and it's really effective in many cases," said Awa. During the past summer holiday, Awa went home with a full set of acupuncture needles. "I performed acupuncture on my mother and other relatives. They all felt it worked very well and helped soothe general aches and pains or solve problems like insomnia," said Awa proudly.

Ever and present challenges

Thanks to the widening global recognition of TCM, Chen says his school has seen a big increase of self-sponsored foreign students especially since the end of the 1990s. Before that, overseas places in TCM majors were mainly restricted to exchange students sponsored by governments.

In Germany, for example, publications or pamphlets introducing qigong or tai chi are readily available in pharmacies throughout the country. "In general, people are more aware of TCM nowadays, it's much more mainstream now," said Elke.

But challenges remain. One of them, in Elke's eyes, is the wildly inaccurate expectations some people have of TCM. "They simply believe TCM is a wonder drug or a miracle. You just can't expect an overnight solution to problems you've had for 30 years," Elke added. She emphasized that, combined with treatment, a changing of life habits is equally important for a good outcome. "In this regard, Chinese people have a better judgment and understanding of TCM," Elke added.

Her view is echoed by her Italian counterpart. "TCM therapies take a longer time to kick in, but people here have little patience and want to be cured in the shortest time possible," Giuseppe said.

While many African countries have incorporated TCM into the national healthcare system, Western countries like Italy and Germany do not usually have TCM covered as part of most people's health insurance. The prices for acupuncture or herbal treatment are also high. "The biggest challenge is to make people understand that TCM is not only for the elite and rich," said Giuseppe.

At the start of her TCM studies, Awa's international class used to have 10 students, but only four remain today. "It's a tough major for everyone, but it is exceptionally tough for foreigners as it demands a good understanding of ancient Chinese language," Chen commented.

With graduation just half a year away, Awa says she now wants to pursue a master's degree. "I want to enhance my knowledge of Western medicine. Then, when I struggle to explain concepts like qi, yin and yang to my patients, I can at least be more accurate by combining TCM and Western medicine in my diagnosis," she explained.

Back in Rome, Giuseppe is trying every means possible to advocate the integrated approach of TCM through his practice on pets and to get a TCM voice heard in the veterinarian world. "I would love to run a clinic for people too. But for now, I just want to make more people understand that Western medicine can be used along with TCM, a medicine that works on understanding the root cause of the disease, for a better result," Giuseppe said.

Jiang Zhuqing in Ottawa contributed to this story