His Spartan clinic located in Hangzhou 's He Fang Road, in Shangcheng District, has no computer or other modern gizmos. Instead, there are pens and paper and a Chinese book, entitled Shijinmo Pair Herbs.

Greg Livingston attends to a young patient in his clinic in Hangzhou of Zhejiang Province. He is the first Westerner to be granted a license to work as a TCM physician in the city.

The man at the center of all this is a TCM doctor. But what makes him stand out is that Greg Livingston, 38, is an American. He is the first Westerner to be granted a license to work as a TCM physician in Hangzhou, Zhejiang Province.

Livingston not only dispenses traditional medicines, but is also working towards a PhD in TCM at Zhejiang Chinese Medicine University, pouring over texts full of archaic Chinese.

"The reason I'm in China is for the culture," says Livingston. "I appreciate traditional cultures around the world. They have much more meaning than most modern cultures."

Childhood interest

But the road to learning has not been easy and it has taken Livingston more than 12 years of hard work to reach here.

TCM has long been the number one passion in his life.

Unsurprisingly, he grew up in New China Town, San Francisco. He had many Chinese friends as a child and consequently developed an interest in Chinese culture food and philosophy at first and later, traditional medicine.

After earning a Bachelor's degree in Biology in 1990, he began to study for his Master's in Chinese Medicine at a US university in 1994.

However, Livingston soon realized how futile it was to study TCM in English.

"Over 99 percent of TCM literature is in Chinese," he says. "There is a growing number of books in English, but far from the best material."

"Traditional Chinese Medicine is so deep and complicated that any serious study of it has to include Chinese. You cannot be a great doctor if you do not know Chinese. It's that simple."

Livingston sees his four-year Master's program as the beginning of his quest. He followed it by studying Chinese language and TCM in China for two years, between 1998 and 1999.

Livingston moved to Hangzhou in 2004 accompanied by his Chinese wife, who graduated from the Peking Traditional Chinese Medicine University, and found employment at the Hangzhou North American International Hospital.

Building trust

Most of Livingston's clients are expatriates. For those interested in TCM but with limited Chinese vocabulary, Livingston helps bridge the gap.

"Most foreigners know nothing about TCM," he says. "They demand explanations for their symptoms, as do many Chinese people."

"What I noticed in China is that people are used to being given little explanation, often as little as 10 minutes, by doctors who have to see a large number of patients everyday and don't have the time to go into details.

"However, I think communication is extremely important when you are dealing with medical problems. I therefore try to spend a substantial amount of time explaining their condition to my patients.

"This is something I want to do, and have to do," he adds.

Livingston says he spends about one hour with his patients on their first visit to his clinic, so as to understand them better.

Once he has identified the patient's condition, and understood the history of their illness, he presents the results of his diagnosis to his patient, along with possible treatments. "But," he says, "I let the patient decide."

He admits that the reason he does not have many Chinese patients is partly because he is not as old as some experienced TCM doctors, whom the public greatly trust, and partly because he is a foreigner.

"I do know my level is still far below those elderly TCM doctors, but I am not that bad," he says, smiling. "I have had more than 10 years clinical experience in TCM."

Livingston's physical examination follows much the same routine as experienced TCM doctors, and his excellent Mandarin enables him to understand every word spoken by his patients.

However, body language is still required in some cases, he says.

For instance, when he asked a Chinese patient whether she always dreamed about being chased by a tiger , he pretended to be the wild animal, flaying his arms around to help her understand his question.

When asked the difference between TCM and Western medicine he says: "There are many, but most importantly, TCM views the body as an organic whole, and considers the entire body in diagnosis and treatment, whereas Western medicine lacks a complete holistic understanding and thus tends to focus only on the 'diseased' part of the body.

"Also TCM is an empirical science, the product of several thousand years of clinical experience, whereas in the West scientific research generally comes first and in turn guides clinical practice."

He gave an example of how to find the best watermelon in a field. Western medicine would take all the watermelons to a lab for analysis at a microbiological level, and then produce the conclusion. The one with the highest index, however, might not have the best taste. However, TCM is more like a farmer that, from experience, can immediately point out which watermelon is best.

"TCM uses its own understanding of physiology and pathology to treat many problems that Western medicine cannot figure out. TCM is somewhat abstract, while WM is more linear and concerned with scientific evidence," he added.

Besides working in his clinic, Livingston spends three days every week studying for his PhD.

One of his biggest obstacles is coping with the ancient TCM texts.

"If you want to understand TCM on a deeper level, you have to study the ancient medical texts, which are very meaningful," he says.

"Yet the problem is that these texts are difficult, even for Chinese. For a foreigner, the challenge is even greater."

Livingston usually rises at 6 am, and after morning exercise, settles down to his PhD studies. A big healthy Chinese breakfast such as steamed bun, congee and soya milk later, he is ready for work.

When he returns home, he likes to spend time playing with his son. Then, he either works on his online blog (http://www.myspace.com/doclivy), or details the basics of TCM in his monthly columns in a local English magazine called More.

One of his hobbies is to play the guqin , a zither-like seven-stringed instrument.

"The process of learning to play guqin is like studying TCM," he explains. "At first it may be difficult to appreciate. However, after you put in a lot effort, you begin to realize just how amazing it is. You sense the philosophy, and you play for yourself."