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.
The yin-yang symbol
(Courtesy of www.newton.mec.edu)
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.
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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.
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.
