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Issue 5, November 2002
Merging Chinese Traditional Medicine into the American Health System
Charles Feng
Human Biology, Stanford University
feng@jyi.org
My
grandmother, a frail 78-year-old woman who has spent her whole life
in China and Taiwan, recently came to stay with my family in the
San Francisco Bay area. At her age, health is of great concern -
she takes four pills every morning for various ailments (such as
chronic bronchitis and osteoporosis), and often spends a large portion
of her days sleeping. All of her pills were prescribed by her doctors
in Taiwan. To supplement her medications, she drinks various concoctions
made from Chinese herbs and animal parts, also brought over from
Taiwan. She doesn't have any desire to see a Western doctor, and
even left the United States so she could go back for a physical
check-up in Taiwan.
On the other hand, my mother - my grandmother's daughter - has been
in the United States for more than 25 years. There is not a trace
of an accent in her English, and she goes to American doctors for
all her sicknesses. On occasion, she also visits a Chinese-trained
doctor for a massage or herbal medicines. Indeed, she actively uses
both Western and Chinese traditional medicine. In contrast, I was
born a few years after my mother immigrated to the United States,
and the only medicines I have ever taken have been prescribed by
American-trained doctors. However, just as my grandmother is skeptical
of Western medicine, I in turn doubt many aspects of Chinese medicine.
In the
United States, both Chinese and Chinese-Americans are forced to confront
a world in which they have medical options from two very different
cultures; their decisions in response to these contrasting systems
have serious consequences on the outcome of their health. Under the
American health care system, diseases that are more prevalent within
the Asian-American community, such as Hepatitis B, are often overlooked
when Asians are getting check-ups, largely because those diseases
have a low prevalence in communities of other cultures. Likewise,
sometimes American doctors are not as familiar with Chinese culture,
either - such as the taboo on HIV and AIDS; the Chinese condemn the
virus and its resulting illness as a disgrace to the family of the
afflicted individual. On the other hand, traditional Chinese medicine
is more subjective, and is often based more on notions of spirituality
than on proven scientific rigor. My grandmother, for example, went
to two different Chinese doctors for the same ailment, and received
two completely different treatments.
Should Chinese and Chinese-Americans choose either Chinese or Western
medicine, or should they try to combine the two? Perhaps they can
learn to adapt to a new medicinal culture, or maybe it is best to
stay within the cultural contexts that are the most familiar.
A Burgeoning Chinese Population in the United States
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"Just as my grandmother is skeptical of Western medicine,
I in turn doubt many aspects of Chinese medicine."
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The first
modern wave of Chinese immigrants resulted from the passage of the
Immigration Act of 1965, which allowed 20,000 Chinese per year to
emigrate to the United States. Consequently, the Chinese population
(both Chinese-Americans and Chinese citizens residing in the United
States) has increased from 117,140 in 1950 to more than 1.5 million
in 1990. Most have come from Taiwan and Hong Kong (when Hong Kong
was still under British rule, before 1997). In the last 20 years,
some have migrated from China, as well as relocated from Caribbean
and Latin American countries. In the last 50 years, the demographic
traits of the immigrants could be characterized as young, educated,
and entrepreneurial. Many Chinese, says author Wenxian Huang, in The
Elites of Overseas Chinese, have thus formed an "elite class,
and are actively participating in the development of politics, culture,
education, science technology, medicine, and business in the United
States," according to Wenxian Huang in .
Immediately following the first modern wave of immigration, Chinese
often lived in Chinatowns, and were especially concentrated in San
Francisco, Los Angeles, and New York City. Although the largest Chinese
populations can still be found in the urban areas of California and
New York, the Chinese community has since spread into Illinois, Massachusetts,
and Texas, as well as more suburban areas. With the size of Chinese
populations increasing rapidly throughout the country, it is imperative
that these Chinese-Americans receive adequate health care.
Health Care for Chinese in the United States
The Chinese face
a series of barriers in fully utilizing the American health care
system. As a result, it is natural for many to turn to traditional
Chinese medicine for their ailments. From their perspective, it
is easier to access and more readily comprehensible. However, by
underutilizing the health care system, Chinese give the impression
that there are fewer health problems facing Asian-Americans relative
to other minority groups. In fact, the opposite is true; according
to health specialist Grace Ma of Temple University, Chinese people
face a host of illnesses that are especially prevalent among Asian
communities, including urinary tract infections, tuberculosis, and
hepatitis. While these diseases are all recognized in the United
States, they are not given special attention when Chinese patients
are being treated.
Chinese immigrants report that language and communication difficulties
are the main reasons they choose not to see American doctors. According
to the 1990 census, 2.4 million Asian people reported deficiencies
in English proficiency. Moreover, 48% of the elderly, the population
with the most extensive health care needs, reported they could not
speak English at all. Ma asserts many feel frustrated and embarrassed
that they cannot fully communicate their problems to their physicians
- and then stop seeking health care altogether. In areas with large
Chinese populations, many hospitals do not have qualified, full-time
interpreters to help patients and health care providers communicate.
Instead, hospital staffs often rely on family members, who may not
be able to understand the medical terminology being used.
Chinese immigrants report that language and communication
difficulties are the main reasons they choose not to see American
doctors.
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The discrepancies
between Chinese and Western cultures also result in many hurdles.
Many American physicians are not culturally competent, in that they
don't fully understand the cultural beliefs and practices that are
associated with the Chinese populace. Moreover, the American health
care system focuses on individual ailments, rather than taking the
holistic approach that characterizes Chinese traditional medicine.
Chinese patients, on the other hand, are often skeptical of Western
medicine, and only use it as a last resort when their herbal remedies
aren't working. Indeed, some Chinese believe Western drugs or prescriptions
are only appropriate for Caucasians. Ultimately, many Chinese are
forced to switch between traditional medicine and Western medicine.
But the result is that the patient could be adversely affected by
the unpredictable and dangerous consequences of using both Western
and traditional remedies simultaneously.
According to Asian-American health expert Zibin Guo of the University
of Tennessee, many Chinese face socioeconomic barriers in their attempts
to access health care. In fact, Chinese are among the populations
least likely to have adequate health insurance coverage, since many
work for small businesses that do not have the economic means of purchasing
coverage. Studies show that as much as 40% of the Chinese populace
does not have adequate insurance coverage. Even with health insurance,
Chinese are still hesitant to see physicians - they feel the costs
associated with Western health care services are just too high.
The Elderly Chinese - A Case Study
In
1999, Guo performed an in-depth study in King City, New York, a
few miles northeast of New York City. It is a prosperous suburban
community, with large numbers of Chinese who immigrated to the country
in the 1970s. Of the 50,000 Chinese living in the area, an estimated
5,000 were elderly. When asked about the American health care system,
the elderly Chinese expressed fear and doubt, due to language barriers,
high costs, and differences between expectations and actual outcomes.
Moreover, the elderly Chinese were discouraged by the necessity
of making appointments weeks in advance, as well as the long waiting
periods incurred once they arrived at the health care centers. After
several decades in China or Taiwan, the elderly Chinese felt that
traditional Chinese-trained doctors were more competent than Western-trained
physicians, since Western physicians tended to rely too much on
high-tech machinery. In some cases, Western doctors were viewed
as medication dispensers, instead of as active healers. While the
elderly Chinese are a subgroup of the larger Chinese population,
their specific views can be extrapolated and taken as representative
of the Chinese population's general perception of the American health
care system.
Concepts in Chinese Traditional Medicine
Chinese
traditional medicine, influenced by the philosophy of Confucianism,
Taoism, and Buddhism, has thousands of years of history behind it.
Thus, according to Zhenguo Wang and his colleagues, authors of History
and Development of Traditional Chinese Medicine, traditional
medicine, with its emphasis on the mind and social interactions,
can be seen as a reflection of Chinese society. The concept of yin-yang,
a balance of hot and cold elements, can be seen as a compromise
of the five fundamental elements: metal, wood, fire, water, and
earth. The human body is divided into yin and yang regions: The
external organs, including the small intestine and stomach, are
considered to be yang, while yin consists of internal organs such
as the lungs and spleen.
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Critics claim that the effects of Chinese
therapy are due to the placebo effect.
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The Chinese
diet is based on the yin-yang balance, since all foods and herbs are
naturally embedded with some of the five fundamental elements. By
eating the right combinations of foods, the correct balance can be
maintained, or if need be, restored. Thus, yang (hot) foods, including
meats, seafood, tonics, and fried food, are eaten with yin (cold)
foods, such as vegetables and fresh fruits. Excesses of yin or yang
foods could result in various illnesses; yin excess results in fever
and dehydration, while gastric orders - amongst other ailments - can
be attributed to an excess of yang. Moreover, foods and herbs have
also been utilized in medicinal remedies. Chinese adjust their food
choices according to climates and seasonality, as well as to the physical
condition of each individual. Consequently, an ailment such as a blood
deficiency has been designated a yin condition, and requires special
yang foods, such as ginger with brown sugar, and soups containing
pork liver. Moreover, high blood pressure, resulting from an excess
of yang, can be combated with garlic porridge or celery porridge.
Qi is another idea intrinsic to Chinese culture. Translated
into English, qi means "vital energy." One gets qi from three
sources: parental heritage, food intake, and the air. As with yin-yang,
qi is concerned with the balance of this vital energy in the body;
the absence of qi results in death. More specifically, qi promotes
the function of the heart and lungs, in that it is the very essence
of the blood vessels. As one grows older, the flow of qi through the
blood is interrupted by an imbalance, either through neglect or a
natural loss. In order to combat qi imbalance, Chinese have developed
the practice of tai chi, a slow form of exercise that promotes
qi balance, as well as yin-yang equilibrium. Many Chinese, especially
the elderly, believe that this martial art nourishes all body parts,
and promotes an increased blood flow rate.
Acupuncture, the practice of inserting fine needles the skin in order
to promote health, is also based upon the principles of yin-yang and
qi. Acupuncture needles, which vary in length and diameter, can be
inserted at different angles into the skin surface, depending on the
specific treatment. Moxibustion, a related practice in which heat
is applied to acupuncture points, is used to treat ailments such as
arthritis, asthma, and bronchitis. Furthermore, modern-day acupuncture
incorporates lasers and mild electrical shock. According to Michel
Strickmann of the University of California at Berkeley, one theory
for the efficacy of acupuncture states that acupuncture increases
endorphin release. Another theory says that acupuncture increases
the levels of seratonin, a neurotransmitter found in the brain. From
a scientific viewpoint, not much is understood about acupuncture -
or many other aspects of Chinese medicine.
Integration of Chinese and Western Medicine - Chinese Perspective
In
1955, Chairman Mao Zedong, the first Communist leader of China,
proposed that Chinese and Western medicine be combined to boost
the health care of the Chinese populace. That same year, the Ministry
of Public Health, staffed by both Chinese and Western-trained physicians,
was established. Over the next 40 years, China integrated practices
from both cultures through a bottom-up approach. Medical students
now have to take courses in both Western and traditional medicine,
and actively implement their cross-cultural knowledge in hospitals
and teaching clinics. Results from this integration are published
in Chinese journals, which then factor in policy determination by
the central government. Moreover, the Chinese believe that in some
respects, Western medicine is just as effective as traditional medicine.
The result is that Chinese physicians are now familiar with the
strong and weak points of both medical traditions, and can choose
the right combination to maximize the positive effects.
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| Laminaria
(kun bu in Chinese), thought in Chinese medicine to alleviate
ailments relating to the liver and kidneys. (Courtesy of www.chineseherbs.com) |
In China,
successful integration has resulted from the fact that medicinal herbs
are synthesized using Western techniques. Moreover, Western doctors
in China tend to prescribe Western medicines. Undoubtedly, the Chinese
are firm believers in the efficacy of traditional medicine, and believe
that certain aspects can still be further developed. However, asserts
that the Chinese also believe Western medicine offers alternative
approaches and methods, some of which are more effective than their
traditional counterparts.
Recent medical literature from China generally supports the combination
of Western and Eastern techniques. Acupuncture has been used to successfully
treat heart disease, gallstones, respiratory diseases in infants,
and cataracts. In many respects, the combined Chinese and Western
treatment "is much better than that of either system applied alone,"
states Pei Wang, author of Traditional Medicine and Health Care
Coverage. Research at Chinese universities has also shown that
Chinese herbs, when combined with radiation therapy, more effectively
inhibit the number of developing tumors in cancer patients, as well
as boosted their immune responses.
Integration of Chinese and Western Medicine - Western Perspective
On
the other side of the Pacific Ocean, American physicians are now
pursuing the same ideas that the Chinese have implemented. It is
more difficult for Americans to accept Chinese treatments as scientifically
valid because Western medicine and culture are more dominant in
China than Chinese medicine and culture are in the United States.
Besides anecdotal evidence, Western medicine has few cases of unequivocal
proof that traditional medicine is an effective treatment (many
Chinese medical journals aren't translated and aren't highly regarded
by the Western establishment), nor are their potential side effects
known. As a result, Chinese medicine must undergo the rigors of
scientific and clinical research in order to be fully accepted by
the Western medical establishment.
Research has already shown that acupuncture affects the central
nervous system through endorphins - pleasure hormones that are secreted
from the brain - as well as other endocrine pathways. Through the
effects of these divergent pathways, acupuncture could conceivably
promote the health of many organ systems. Moreover, studies from
the National Institutes of Health show that qi gong - the
belief that the human psyche can influence the health of the rest
of the body-can increase the number of immune system defense cells,
such as the virus-killing Tc cells. Less is known about
herbal remedies, whose pharmacological properties could result in
new medicines and a better understanding of human physiology. In
a larger context, there are many hurdles that research faces while
attempting to decipher traditional Chinese medicine. Many forms
of measurement, such as pain, are difficult to quantitatively define,
since there may not be physiological responses that can be quantified.
Moreover, critics claim that the effects of Chinese therapy are
due to the placebo effect.
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The American public demands that the health
care system has the best technology available to treat various
illnesses, regardless of costs, while the technology would be
less necessary if people exercised and ate properly to prevent
illness."
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Ultimately,
the merging of Chinese and Western medicine will be dependent upon
the successful integration of two schools of philosophy. According
to David Eisenberg, author of Encounters with Qi, the West
emphasizes intervention over prevention. Oftentimes, the American
public demands that the health care system has the best technology
available to treat various illnesses, regardless of costs, while the
technology would be less necessary if people exercised and ate properly
to prevent illness. In such a context, health is often defined as
the absence of disease. For the Chinese, health is much more of a
lifestyle, integrating psychology, activity, and diet. The Chinese
physician's responsibilities, aside from treating ailments, include
prevention, recommendations about lifestyle, and emotional support.
Thus, in addition to pharmacological and physical treatments, the
West can also learn a different philosophical approach toward medicine
from their Eastern counterparts-a more holistic, far-reaching approach.
General Chinese Perceptions and Practices
Although
Chinese favor a combination of Western and Chinese traditional medicine,
those in the United States believe Western medicine is more effective
in combating chronic diseases like cancer and heart disease. However,
the Chinese also believe Western medicine results in more negative
side effects. In a survey of China- and Taiwan-born Chinese residents
of Houston, Texas, Ma of Temple University showed that nearly all
had some form of experience with traditional Chinese medicine, while
75% still drank herbal tea on a daily basis. Thirty-one percent
of the informants traveled to their home country to receive medical
care, claiming that Western treatment was not effective in alleviating
their ailments. Often, these same patients brought back large quantities
of the Asian drugs for themselves and family members.
Conclusion
It
is important to remember that the American health care system serves
not only the Caucasian community, but the communities of many minorities
as well. Chinese immigrate to the United States with a different
set of values and ways of thinking, which often sets them at odds
with the labyrinth of American health care. By incorporating aspects
of traditional Chinese medicine into the Western health care system,
as well as improving the Chinese understanding of Western medicine,
both cultures can improve their arsenal of medicinal and physical
treatments. In the process, this merging of East and West can foster
cross-cultural understanding, so that Western physicians can accurately
serve in their Chinese patients' best interests, and Chinese patients
will have complete confidence in their Western providers.
Suggested Reading
Further
Reading
Eisenberg, David. 1985. Encounters with Qi: Exploring Chinese Medicine.
New York: W.W. Norton & Company, Inc.
Guo, Zibin. 1999. "The Dilemma in searching for heath care: The scenario
of Chinese American Elderly Immigrants." Asian Voices. Ed. Lin Zhan.
Sudbury, MA: Jones and Bartlett Publishers, Inc.: 117-145.
Guo, Zibin. 2000. Ginseng and aspirin: Health care alternatives for
aging Chinese in New York. Ithaca: Cornell University Press.
Hsu, Elisabeth. 2001. "Pulse diagnostics in Western Han: how mai and
qi determine bi." Innovation in Chinese Medicine. Ed. Elisabeth Hsu.
Cambridge: Cambridge University Press: 52-92.
Huang, Wenxian. 1989. The Elites of Overseas Chinese. Hong Kong: Wen
Wei Publishing.
Inouye, Jillian. 1999. "The Invisible Disease: HIV/AIDS in Asian Americans."
Asian Voices. Ed. Lin Zhan. Sudbury, MA: Jones and Bartlett Publishers,
Inc.: 82-105.
Ma, Grace Xueqin. 1999. The Culture of Health: Asian Communities in
the United States. Westport, CT: Bergin & Garvey.
Strickmann, Michel. 2002. Chinese Magical Medicine. Stanford: Stanford
University Press.
Wang, Pei. 1983. "Traditional Chinese Medicine." Traditional Medicine
and Health Care Coverage, ed. World Health Organization. Geneva: World
Health Organization.
Wang, Zhenguo, Chen Ping, Xie Peiping. 1999. History and Development
of Traditional Chinese Medicine. Beijing: Printing House of the Chinese
Academy of Sciences.
Web
sites related to this topic
Acupuncture
and Qi Gong
UC
Berkeley study, Chinese medicine helps fight hepatitis B
History
of Chinese Medicine
UCLA
Center for East-West Medicine
University of East-West Medicine
Journal of Young
Investigators. 2002. Volume Six.
Copyright © 2002 by Charles Feng and JYI. All rights reserved.
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