This newsletter introduces our community of readers to some of the basic concepts behind the traditional medicines and healing practices of Asian cultures. People belonging to these Asian cultures are accustomed to relying on distinct health practices and beliefs that are significantly different from those of native born Americans and other immigrants. As patients’ health beliefs can have a profound impact on clinical care, it is important for American medical professionals to be familiar with the concepts introduced here.
This topic is expansive, so links for further study are embedded throughout the article. We will be focusing on the health beliefs and practices of people from Southeastern Asia (i.e. Vietnam, Thailand, Cambodia, Laos, Burma as well as East Asian countries (i.e. China, Japan, and Korea. A brief explanation of the interrelatedness of the primary traditional medicine practices if followed by a brief description of each.
East Meets West
In the 17th century, traditional Vietnamese and Chinese practitioners began identifying their medicine as Dong Y to distinguish their medicine from the Western colonial medicine. Similarly, people in the West began to use the term “Oriental medicine” to differentiate Eastern medical practices from Western ones. Today, the terms Eastern medicine and Asian medicine are more commonly used in this country, and perhaps they are the better terms. The use of oriental has shifted to refer to home furnishings, carpets especially, and certainly in the field of cross-cultural communications, the word oriental is never used as a category of culture.
Many Americans quickly associate Chinese herbal remedies and acupuncture with Eastern “alternative” medicine, but are largely unfamiliar with other common practices from across Asia. The philosophies of health and illness causation at the root of Eastern medicines are even less understood and just as important. Traditional Chinese medicine, or TCM, is the best known Asian medicine practiced in the U. S., but it is not the only traditional medicine worthy of our attention. Traditional Vietnamese medicine (TVM) actually evolved together with traditional Chinese medicine and arguably the development of the two are so-intertwined that it is impossible to separate them. However, there are differences. Closely related to both are Japanese and Korean traditional medicines. Historically speaking, many societies in Eastern and Southeastern Asia have been part of the Chinese cultural sphere due to trade, migration, and occupation. Thus it is safe to say that the healing traditions of most Asian cultures are intertwined to some extent, much as their religious philosophies are.
Health Beliefs and Clinical Care
The greatest challenge for Western healthcare professionals once they’ve grasped the basics of different cultural remedies and treatments is to understand the beliefs and attitudes about sickness that drive these ancient practices. Health beliefs can have a profound impact on the clinical care of Asian patients in the United States, affecting the accuracy of health histories and compliance with treatment recommendations from Western providers. Because the principles behind the Western medical model are so different from those of Eastern medicine, it is difficult for American providers to shift gears when talking to Asian patients and consider a mind-set where health is seen as a state of balance between the physical, social, and super-natural environment. Western medicine tends to approach disease by assuming that it is due to an external force, such as a virus or bacteria, or a slow degeneration of the functional ability of the body. Disease is either physical or mental. The Eastern approach assumes that the body is whole, and each part of it is intimately connected. Each organ has a mental as well as a physical function. Perhaps a melding of the two belief systems would be ideal, but it isn’t easy in hectic settings or crisis situations to bring such divergent belief systems together during medical consultation and care.
Beliefs and Practices Briefly Described
Traditional Chinese Medicine
TCM is inextricably linked to Chinese Cosmology, as system of beliefs that can be summed up as follows: all of creation is born from the marriage of two polar principles, Yin and Yang. Examples are earth and heaven, winter and summer, night and day, cold and hot, wet and dry, inner and outer, body and mind. These pairs of opposites are connected via a circular harmony. The yin and yang symbol is helpful in representing this concept. Harmony means health, good weather, and good fortune, while disharmony leads to disease, disaster, and bad luck. The strategy of Chinese medicine is to restore harmony. Each human is seen as a world in miniature, and every person has a unique terrain to be mapped, a resilient yet sensitive ecology to be maintained. Like a gardener uses irrigation and compost to grow robust plants, the doctor uses acupuncture, herbs and food to recover and sustain health.
Chinese Herbal Medicine
Herbal medicine is an important part of Traditional Chinese Medicine (TCM). Herbs are prescribed holistically according to the patient’s individual condition (not only on the basis of current symptoms). Herbal medicines are used to regulate the natural balance of the body and restore health. They come in the form of pills, powders, tinctures and raw herbs taken internally or as balms for external use. Chinese herbal medicine has been used for centuries to treat most health conditions and as a preventative dietary supplement. They can also be used safely in conjunction with many western therapies. Diagnosis is made by talking to the patient, looking at physical characteristics and employing the ancient arts of tongue and pulse diagnosis.
Japanese Herbal Medicine
Kampo is Japanese herbal medicine, which has a long history of clinical application. Kampo uses precisely measured herbs to treat illness, based on the skillful use of well-known formulas, valued for their impact on clear as well as vague conditions. (Kampo does not use rare or endangered plant or animal products). The distinguishing feature of Kampo is it’s method of diagnosis through abdominal palpation. Kampo medicine is based on the theory that diseases arise because of a disharmony in the flow of Qi (Chi). By stressing prevention, Kampo helps the patient to maintain good health according to natural principles.
It is known as gSo-ba Rigpa in Tibetan, meaning ‘the science of healing’. The basic principle is to balance the three principal energies of the body. The practitioner employs the ancient tools of pulse diagnosis and urine analysis, to find the root causes of disease. Treatment is carried out through diet, lifestyle adjustments and herbal medicines grown naturally in Tibet and the Himalayas. Tibetan Medicine is based on Buddhist principles and the close relationship between mind and body.
Traditional Vietnamese Medicine
The distinguishing feature of TVM is the emphasis on nourishing the blood and vital energy, rather than concentrating on specific symptoms. TVM views building up the blood and energy as the key to good health. The main treatments employed by TVM are herbal medicine, acupuncture, and moxibustion.The cornerstone of its theories is based on the observed effects of Qi (energy) in the body. Qi can be inherited from one’s parents or it can be extracted from food. It is also blood and “fuel” gathered and stored by the body.
Acupuncturists insert tiny needles into specific points on the energy channels of the body, to promote healing and stimulate the free flow of energy in the body and mind. It is used to treat many conditions including muscular pain, headaches, asthma, gynecological problems, digestive complaints, as well as anxiety and depression. Acupuncture is also useful for preventative health care.
Moxibustion, Coin Rubbing & Cupping
Moxibustion is a therapy utilizing moxa, or mugwort herb. It plays an important role in the traditional medical systems of China, Japan, Korea, Vietnam, Tibet, and Mongolia. Suppliers usually age the mugwort and grind it up to a fluff; practitioners burn the fluff or process it further into a stick that resembles a (non-smokable) cigar. They can use it indirectly, with acupuncture needles, or sometimes burn it on a patient’s skin.
Coin Rubbing in Chinese is called Gua Sha, or literally “to scrape away fever.” It is an ancient technique used to scrape away disease by allowing the disease to escape as sandy-looking objects through the skin.” The Vietnamese term for this practice is cạo gió (pronounced “cow zaw”), meaning roughly to “scrape wind.” It is also used in Indonesia.
Cupping Fire, or simply cupping, is a form of traditional medicine found in several cultures. It involves placing glass, plastic, or bamboo cups on the skin. This technique, in varying forms, has been found in the folk medicine of China, Vietnam, the Balkans, Iran, Mexico, Russia and Poland. In traditional Chinese medicine (TCM), cupping is a method of applying acupressure by creating a vacuum next to the patient’s skin. The therapy is used to relieve what is called “stagnation” in TCM terms, and is used in the treatment of respiratory diseases such as the common cold, pneumonia, and bronchitis. Cupping is also used to treat back, neck, shoulder, and other musculoskeletal pain.
This brief introduction to traditional medicines of Asian cultures no doubt leaves many questions unanswered and so it seems appropriate to invoke Ben Franklin’s caution, “a little learning is a dangerous thing.” This article is meant to assist clinicians by providing a general framework, a baseline for learning. No hard and fast rules about interacting with Asian patients and families are being offered. Becoming fully familiar with the normative cultural values affecting interactions with patients from different cultures is a process that takes time and experience. Using the links provided for further study, consulting colleagues from other ethnic groups, and speaking to interpreters and community members are all ways to learn more about the practices and health beliefs one encounters that are different from one’s own. It is also important to learn to ask patients questions in a culturally sensitive way, understanding that fear of making mistakes in communicating with them blocks the exchange of vital information. There have been instances where practices such as coining and cupping have been misinterpreted by conscientious healthcare workers and reports of child abuse made in error. Thorough efforts at communication might have prevented these erroneous reports which traumatized families.
A cross-cultural mindset requires understanding one’s own health beliefs and behaviors first and then applying that baseline of understanding as a means of making effective comparisons across cultures. Clinicians should keep in mind that individuals subscribe to group norms to varying degrees. Factors such as socio-economics, education, degree of acculturation and English proficiency have an enormous impact on an individual’s health beliefs and practices. Searching out and really trying to understanding the individual patient is crucial.
The following websites were referenced for several definitions of beliefs and practices: