Traditional Chinese Medicine and Its Use in the United States

Excerpted from Asian American Food Culture

Fundamentals of Traditional Chinese Medicine and Its Use in the United States

For the Chinese, how and what one eats are inextricably linked to health and longevity. As far back as the fifth century B.C., the medical team that provided care for Chinese royalty included a dietary physician who took responsibility for ensuring that the King ate a balanced and salubrious diet. The foundational text of Chinese medicine, which was codified during the 2nd century B.C., lays out fundamental theories of nutrition and diet therapy. Known as The Yellow Emperor’s Classic of Internal Medicine, the book famously declares medicine and food to be of the same origin, a tenet that played an integral role in the development of Chinese cuisine. The Yellow Emperor’s Classic still serves as the philosophical foundation of traditional medicine as practiced in contemporary China as well as throughout the West.

Having already been practiced in China for millennia, traditional Chinese medicine, or TCM, arrived in the United States along with the first wave of Chinese immigrants to California and Hawaii. By the 1850s, herbal shops had begun to open in order to serve the growing number of Chinese immigrants who deployed herbal medicines as the first line of defense against serious illness. For the vast majority of immigrants, in fact, traditional Chinese medicine was the only recourse for treating disease and injury, as Asians were typically barred from Western hospitals. Where Chinese patients were not banned outright, they were often sent to hospitals that housed individuals with highly infectious diseases or to poorly staffed segregated facilities that catered specifically to Chinese peoples. Despite the fact that Western medical practitioners often refused to treat lower class Chinese immigrants, Western doctors did treat select wealthy Chinese, many of whom had heard of the marvels of Western surgical procedures before leaving their homeland; when Jesuit missionaries first introduced China to Western surgery in the early 1800s, Chinese practitioners were so impressed that they worked to establish their nation’s first Western medical school in 1866. As a result, well-heeled Chinese immigrants sometimes sought Western treatment for cases that required surgery, although they likewise utilized traditional Chinese medicine.

During the late nineteenth and early twentieth centuries, well-trained Western medical doctors were a rarity in the American West, as they had long been throughout rural America. Because trained physicians were hard to find, not to mention prohibitively expensive for lower and lower-middle class households, American housewives had long been accustomed to prescribing herbal home remedies. In fact, up through the late nineteenth century, cookbooks typically contained a compendium of recipes for occasions ranging from treating snake bites to preventing scarlet fever.

The shortage of Western doctors coupled with the tradition of herbal medicine in America, begun by Native Americans and continued in a rudimentary form by rural housewives up through the late 1800s, many whites in the American West were predisposed toward Chinese herbal medicine by the time of its arrival in the mid-nineteenth century. As a result, scores of Chinese herbalists found themselves treating a greater number of white patients than they did Asian. The most successful of these pioneers suffered repeated legal and political attacks aimed at undermining the reputability of traditional Chinese medicine and at driving its practitioners out of business. Despite these racist obstacles, Chinese herbalists continued to thrive in the United States until 1949. That year the Chinese Communist Party rose to power, and the U.S. government banned Chinese imports, effectively stymying the medicinal supply for Chinese American herbalists.

After the embargo was set in place, another twenty-one years would pass before President Richard Nixon would lift the trade ban in 1971. The next year, Nixon made his historic eight-day trip to China, which was beamed via television into homes throughout the United States. Primed by a cultural shift in interest toward the East as well as by Nixon’s highly publicized visit to China, Americans were eager to embrace Chinese cuisine and traditional Chinese medicine alike. This embrace of Eastern culture and cultural values initiated a trend that eventually became mainstream, so much so that close to half the practitioners of traditional Chinese medicine in the United States are not ethnic Chinese. In particular, Americans are drawn to Chinese medicine in response to the environmental and biological stresses that characterize post-industrial living, and Western physicians have become increasingly open to the use of traditional treatments such as herbal formulas and acupuncture. As a result, scientists have begun to study many of the herbs used in traditional Asian medicine, and Western physicians have begun to incorporate herbal formulas into modern treatment regimens.

The philosophical crux of Chinese traditional medicine eddies around the notion that good health derives, in large part, from living in harmony with the natural environment and from maintaining a healthy balance between mind and body, which is regulated through the heart. The human body is understood to be a microcosm of the universe, as opposed to the Western conception of the human body as like a machine. Because traditional Chinese medicine conceptualizes the human body as a miniature version of the universe at large, much medical philosophy is gathered from observing patterns in the natural world, which are, in turn, mapped onto the ecosystem of the individual body.

If an imbalance occurs between an individual and the environment, within the mind or the body, or between the psyche and soma, diet will be adjusted to help correct the instability. In general, the daily diet should include health-promoting foods as well as those that prevent sickness by shoring up the immune system. Food intake should likewise be varied, as striking the right balance of flavors, textures, and ingredients is one of the fundamental ways of maintaining physical and emotional equilibrium. Because our physical status, emotional (psychological) state, and environment are in a constant state of flux, our dietary needs must follow suit. How and what we eat are not only essential to maintaining health and preventing illness but also play an integral role in the treatment of disease and injury. Once an imbalance is detected, the diet should be regulated to include foods to control disease and to correct its early symptoms. For more serious illnesses, foods may be prescribed to combat the side effects of strong herbal and dietary remedies. Yet another set of dietary prescriptions may be recommended to help restore strength and vitality during recovery as well as to repair any lingering damage wrought by an illness.

Traditional Chinese medicine not only focuses on the nutritional contents of foods ingested but also on their energetic properties, which are loosely categorized as cold, cool, neutral, warm, and hot. Chinese cooking works to provide energy, or qi. This energy is provided by the elemental forces of yin (cooling) and yang (heating). All matter is made up of yin and yang, and the two are co-dependent. The amount of yin or yang an entity contains, however, varies along a scale. Entities that fall in the middle section of the scale are deemed neutral, as they contain close to balanced proportions of yin and yang energies. Many grains, such as rice, fall in the neutral category. As a result, they may be consumed in large amounts. Yin is linked with moist, soft, interior, and dark conditions, so many foods that contain layers of loose, watery leaves, such as lettuces and leafy greens, tend to be cooling. Yang is linked to dry, hard, exterior, and sunny conditions, so many hard spices such as pepper, nutmeg, and clove are considered warming. In general, yin is equated with feminine and yang with masculine qi (energy) and characteristics.

For the body to function properly, yin and yang must be held in balance, and diet helps to attain this equilibrium as well as to correct imbalances. In general, heating foods are more caloric than cooling foods. As a result, the way a food is prepared and cooked impacts its categorization. For example fried foods and alcohol are considered extremely yang (heating) and, thus, are only recommended for healthy individuals. Barely cooked or uncooked foods tend more toward yin (cooling), and heavily cooked or salted foods tend more toward yang (heating). Cool-colored, watery, and soothing foods tend to be yin, while hot-colored, dry, spicy foods tend to be yang. Yin foods include water chestnuts, cucumber, coconut, and watermelon are classified as yin. Foods classified as yang include onion, Sichuan peppercorn, coffee beans, ginger, and chili pepper Most staple foods are neutral.

Although an overall consistency runs throughout much of the classification system that determines whether a food is hot or cold, the system is likewise somewhat dynamic, as a food’s classification will depend on such factors as the season in which it is consumed as well as the age, or life stage, of the person consuming it. Some nutrient-dense foods, such as bone broth soups, are classified as strengthening (pu or bo). Most strengthening foods fall somewhere along the yang end of the scale and are prescribed for weakened conditions. Many prescriptions involve sympathy healing, or “like cures like.” For example, a prescription for a poorly functioning liver might entail incorporating liver into the diet, or a broken bone might be treated with bone broth.