Dietary Therapy – The Practical Chinese Way
In China, food is not just seen as a collection of nutritional components such as proteins, carbohydrates, mineral etc. Foodstuffs are understood to have an energetic nature. Foods are appreciated by the effect they have on the body. For example they may have a cooling, warming, drying or moistening effect. In Chinese dietary therapy, foods are chosen according to the type of internal imbalance. For example, if the body is running too hot, cooling foods are used, if the body has too much moisture e.g. in water retention drying foods are used. This is an oversimplification for the purpose of illustration. Inevitably, a blend of foods is used to assist the healing process.
This is a very intuitive and experiential way of appreciating diet: how do you actually feel after eating a chilli pepper or some cow’s milk? Our bodies are able to feel what the food is doing to us. If we feel our bodies are too dry then we should choose food that moistens. This takes good diet out of the realms of the academic into the area of experience. We can then tailor our diet according to personal characteristics, balancing out the effect that changes in the season has on our bodies, using food to rectify a temporary imbalance in our health or just simply choosing a diet that feels appropriate for us personally.
When you consult our clinicians, you will be asked about your diet as another way in which we can help you feel better and heal more quickly.
The Process of Digestion
For those seeking a deeper insight into diet and how the digestive process works in Chinese medicine we recommend reading:
The Tao of Healthy Eating: Dietary Wisdom According to Traditional Chinese Medicine, 2nd edition, Bob Flaws, Blue Poppy Press, ISBN: 0936185929
The following extract is from Bob Flaws’ book ‘The Tao of Healthy Eating: Dietary Wisdom According to Traditional Chinese Medicine, 1st edition’. Newer editions are available that include additional material and rewrites. If you find it interesting please buy his book.
“The Process of Digestion
In Chinese, the digestive system is called the xiao hua xi tong. The words xi tong simply mean system but the words xiao and hua are more pregnant with meaning. Xiao means to disperse and hua means to transform. In Chinese medicine, digestion equals the dispersion of pure substances to be retained and impure substances to be excreted after these have undergone transformation. Therefore, the digestive tract is called the xiao hua dao or pathway of dispersion and transformation. In TCM we mostly describe the process of digestion in terms of the functions of the Chinese stomach and spleen. Once one understands the functions of the stomach-spleen according to TCM theory, Chinese dietary theory becomes very clear and logical.
The stomach and spleen are a yin yang pair. The stomach is one of the six hollow bowels and is relatively yang. The spleen is one of the five solid organs and is relatively yin. The stomach’s function is to receive food and liquids and to ”rotten and ripen” these. In Chinese medicine, the stomach is likened to a pot on a fire. As mentioned in the previous chapter, all physiological transformations in Chinese medicine are warm transformations. The body is seen as three alchemical retorts. These are called jiao or burners. There is an upper burner containing the heart and lungs, a middle burner containing the stomach and spleen, and a lower burner containing the kidneys, intestines, liver, and reproductive organs.
The Stomach as a Pot
The stomach is the pot of the middle burner and the spleen is both the fire under this pot and the distillation mechanism to which this pot is attached. Just as a mash rottens and ripens in a pot, so foods and liquids rotten and ripen within the stomach. In Chinese medical terms, this means that, as foods and liquids rotten and ripen, the pure and impure parts of these foods and liquids are separated or come apart. It is then the spleen’s function to distill or drive off upwards the purest parts of foods and liquids, sending the pure part of foods up to the lungs and the pure part of liquids up to the heart. The pure part of foods or the five flavors become the basis for the creation of qi or vital energy within the lungs. The pure part of liquids becomes the basis for the creation of blood within the heart. The sending up of the pure part of the foods and liquids by the spleen is called ascension of the clear.
The stomach then sends down the impure part of foods to be further transformed by the large intestine and the impure parts of liquids to be further transformed by the small intestine. In Chinese medicine, the large intestine’s function is to reabsorb the pure part of the impure foods or solids. This becomes the postnatal or latter heaven fuel for kidney yang or the life fire. The small intestine’s function is to reabsorb the pure part of the impure parts of liquids. This is transformed into the body’s thick liquids, such as cerebrospinal and intra-articular fluids, and nourishes postnatally kidney yin. The large intestine conducts the impure of the impure solids down and out of the body as feces. The small intestine conducts the impure of the impure liquids to the bladder from whence they are excreted as urine. This sending down of the impure part of foods and liquids initiated by the stomach is called the descention of the turbid.
Therefore, in Chinese medicine, digestion is spoken of as the separation of the clear (qing) and turbid (zhuo) This separation is dependent upon the qi hua or energy transformation of the middle burner or stomach/spleen and upon the spleen qi’s ability to transport or yun foods and fluids. Hence, Chinese spleen function is summed up in the two words yun (transportation) and hua (transformation). Yun hua is the older, more traditional form of the modern term xiao hua.
The analogy of the cooking pot is very important. It is said in Chinese that the stomach fears or has an aversion to dryness. In other words, stomach function is dependent upon the creating of a mash or soup in its cauldron or pot. It is also said in Chinese that the spleen fears dampness. Since spleen function is likened to a fire under a pot distilling the essence from the mash held in the stomach, it is easy to understand that too much water or dampness can douse or injure that fire.
Using this analogy, it is simple and crucial to understand that the digestive process, according to Chinese medicine, consists of first creating a 100°F soup in the stomach, remembering that body temperature is 98.6°F. Whatever facilitates the creation of such a 100° soup in the stomach benefits digestion and whatever impedes or impairs the creation of a 100° soup in the stomach impedes or impairs digestion. This is basically true even from a Western medical perspective. Most of the insights and principles of Chinese dietary theory and therapy are logical extensions of this commonsense and irrefutable truth.
The Implications of this Process
Cooked vs. Raw Foods
First of all, TCM suggests that most people, most of the time, should eat mostly cooked food. Cooking is predigestion on the outside of the body to make food more easily digestible on the inside. By cooking foods in a pot on the outside of the body, one can initiate and facilitate the stomach’s rottening and ripening in its pot on the inside of the body. Cold and raw foods require that much more energy to transform them into warm soup within the pot of the stomach. Since it takes energy or qi to create this warmth and transformation, the net profit from this transformation is less. Whereas, if one eats cooked foods at room temperature at least or warm at best, less spleen qi is spent in the process of digestion. This means that the net profit of digestion, i.e., qi or energy, is greater.
The idea that eating cooked food is more nutritious than raw food flies in the face of much modern Western nutritional belief. Because enzymes and vitamins are destroyed by cooking, many people think it is healthier to eat mostly raw, uncooked foods. This makes seeming sense only as long as one confuses gross income with net profit. When laboratory scientists measure the relative amounts of cooked and raw foods, they are not taking into account these nutrients’ post-digestive absorption.
Let’s say that a raw carrot has 100 units of a certain vitamin or nutrient and that a cooked carrot of the same size has only 80 units of that same nutrient. At first glance, it appears that eating the raw carrot is healthier since one would, theoretically, get more of that nutrient that way. However, no one absorbs 100% of any available nutrient in a given food. Because the vitamins and enzymes of a carrot are largely locked in hard to digest cellulose packets, when one eats this raw carrot, they may actually only absorb 50% of the available nutrient. The rest is excreted in the feces. But when one eats the cooked carrot, because the cooking has already begun the breakdown of the cellulose walls, one may absorb 65% of the available nutrient. In this case, even though the cooked carrot had less of this nutrient to begin with, net absorption is greater. The body’s economy runs on net, not gross. It is as simple as that. Of course, we are talking about light cooking, and not reducing everything to an overcooked, lifeless mush.
This is why soups and stews are so nourishing. These are the foods we feed infants and those who are recuperating from illness. The more a food is like 100° soup, the easier it is for the body to digest and absorb its nutrients. The stomach-spleen expend less qi and, therefore, the net gain in qi is greater. This is also why chewing food thoroughly before swallowing is so important. The more one chews, the more the food is macerated and mixed with liquids, in other words, the more it begins to look like soup or a stew.
Cold Food & Liquids
As a corollary of this, if we drink or eat chilled, cold, or frozen foods or drink iced liquids with our meals, we are only impeding the warm transformation of digestion. Cold obviously negates heat. And water puts out fire. This does not mean that such food and liquids are never digested, but it does mean that often they are not digested well. In Chinese medicine, if the stomach-spleen fail to adequately transport and transform foods and liquids, a sludge tends to accumulate just as it might in an incompletely combusting automobile engine. This sludge is called stagnant food and dampness in Chinese medicine.
Dampness & Phlegm
If the solid portions of food are jam-packed into the stomach or their digestion is impaired by cold and chilled foods and liquids or if too many hard to digest foods are eaten, stagnant food may accumulate in the stomach. The stomach tries all the harder to burn these off and becomes like a car stuck in overdrive. It becomes hotter in an attempt to burn off the accumulation. This often results in the stomach becoming chronically overheated. This, in turn, causes the stomach to register hunger which, in Chinese medicine, is a sensation of the stomach’s heat. This hunger then results in eating more and more and a vicious loop is created. Overeating begets stagnant food which begets stomach heat which reinforces overeating. Further, persistent stomach heat may eventually waste stomach yin or fluids causing a chronic thirst and preference for cold drinks and chilled foods.
If the liquid portions of food and drink jam the transporting and transforming functions of the spleen, what is called the qi ji or qi mechanism in Chinese, these may accumulate as dampness. This plethora of water inhibits the spleen qi’s warm transforming function in the same way that water inhibits or douses fire. Over time, this accumulated dampness may mix with stagnant food and congeal into phlegm which further gunks up the entire system and retards the flow of qi and blood throughout the body.
Different people’s digestion burns hotter than others’ Those with a robust constitution and strong ming men or fire of life tend to have a strong digestion. These people can often eat more in general and more chilled, frozen, hard to digest foods without seeming problems. Likewise, everyone’s metabolism runs at different temperatures throughout the year. During the summer when it is hot outside, we generally can eat cooler foods and should drink more liquids.
However, even then, we should remember that everything that goes down our gullet must be turned into 100° soup before it can be digested and assimilated.
In Chinese medicine, there is an important distinction made between the cold physical temperature of a food or drink and a food or drink’s post-digestive temperature. Post-digestive temperature refers to a particular food or drink’s net effect on the body’s thermostat. Some foods, even when cooked, are physiologically cool and tend to lower the body’s temperature either systemically or in a certain organ or part. In Chinese medicine, every food is categorized as either cold, cool, level (i.e., balanced or neutral), warm, or hot. Most foods are cool, level, or warm and, in general, we should mostly eat level and warm foods since our body itself is warm. Life is warm. During the winter or in colder climes, it is important to eat warmer foods, but during the summer we can and should eat cooler foods. However, this mostly refers to the post-digestive temperature of a food.
If one eats ice cream in the summer, the body at first is cooled by the ingestion of such a frozen food. However, its response is to increase the heat of digestion in order to deal with this cold insult. Inversely, it is a common custom in tropical countries to eat hot foods since the body is provoked then to sweat as an attempt to cool itself down. In China, mung bean soup and tofu are eaten in the summer because both these foods tend to cool a person down post-digestively. If we are going to eat cold and frozen foods and drink iced, chilled liquids, it is best that these be taken between meals when they will not impede and retard the digestion of other foods.
Many Westerners are shocked to think that cold and frozen foods are inherently unhealthy since they have become such an ubiquitous part of our contemporary diet. However, chilled, cold, and frozen foods and liquids are a relatively recent phenomenon. They are dependent upon refrigeration in the marketplace, refrigeration during transportation, and refrigeration in the home. Such mass access to refrigeration is largely a post World War II occurrence. That means that, in temperate zones, people have only had widespread access to such foods and drinks for less than 50 years. 50 years is not even a blink on the human evolutionary scale.
Not only do foods have an inherent post-digestive temperature but different foods also tend to generate more or less body fluids. Therefore, in Chinese medicine, all foods can be described according to how damp they are, meaning dampening to the human system. Because the human body is damp, most foods are somewhat damp. We need a certain amount of dampness to stay alive. Dampness in food is yin in that dampness nourishes substance which is mostly wet and gushy. However, some foods are excessively dampening, and, since it is the spleen which avers dampness, excessively damp foods tend to interfere with digestion.
According to Chinese five phase theory, dampness is associated with earth. Fertile earth is damp. The flavor of earth according to Chinese five phase correspondence theory is sweet. The sweet flavor is inherently damp and also is nutritive. In Chinese medical terms, the sweet flavor supplements the qi and blood. Qi is energy or vital force and blood in this case stands for all body fluids. Therefore, the sweeter a food or liquid is, the more damp it tends to be.
When one looks at a Chinese medical description of various foods, one is struck by the fact that almost all foods are somewhat sweet and also supplement qi and blood. On reflection, this is obvious. We eat to replenish our qi and blood. Therefore it is no wonder most foods are somewhat sweet. All grains, most vegetables, and most meats eaten by humans are sweet no matter what other of the five flavors they may also be. This sweetness in the overwhelming majority of foods humans regularly eat becomes evident the more one chews a food.
A modicum of sweetness supplements the body’s qi and blood. It is this flavor which gathers in the spleen and provides the spleen with its qi. However, excessive sweetness has just the opposite effect on the spleen. Instead of energizing the spleen, it overwhelms and weakens it. This is based on the Chinese idea that yang when extreme transforms into yin and vice versa. When the spleen becomes weak, it craves sweetness since that is the flavor which strengthens it when consumed in moderate amounts. However, if this craving is indulged in with concentrated sweets, such as sugar, this only further weakens the spleen and harms digestion. Thus, another pathological loop is forged in many people.
Going back to dampness, the sweet flavor engenders dampness and the sweeter a food is the more dampening it is. According to Chinese medicine, this tendency is worsened when the sweet flavor is combined with sour. Therefore, Chinese medicine identifies a number of especially dampening foods. These include such sweet and sour foods as citrus fruits and juices and tomatoes, such concentrated sweets as sugar, molasses, and honey, and such highly nutritious foods as wheat, dairy products, nuts, oils, and fats. Highly nutritious foods are those which have more wei than qi. All foods are a combination of qi and wei. In this context, qi means the light, airy, aromatic and yang part of a food. Whereas, wei, literally meaning taste, refers to a food’s heavier, more substantial, more nourishing, yin aspects.
Highly nutritious foods, such a dairy products, meats, nuts, eggs, oils, and fats are strongly capable of supplementing the body’s yin fluids and substances. However, in excess, they generate a superabundance of body fluids which become pathologic dampness. Although to some this may appear a paradox, it has to do with healthy yin in excess becoming evil or pathological yin or dampness, phlegm, and turbidity.
It is also easy to see that certain combinations are even worse than their individual constituents. Ice cream is a dietary disaster. It is too sweet, too creamy, and too cold. Ice cream is a very, very dampening food. Pizza is a combination of tomato sauce, cheese, and wheat. All of these foods tend to be dampening and this effect is made even worse if greasy additions, such as pepperoni and sausage, are added. Tomato sauce bears a few more words. It is the condensed nutritive substances of a number of tomatoes. Therefore it can be especially dampening.
In the same way, drinking fruit juices can be very dampening. Fruit and vegetable juices are another relatively modern addition to the human diet. Prior to the advent of refrigeration as discussed above, juices would turn into wine or vinegar within days. Therefore, when they were available in traditional societies, they were an infrequent treat. Now we have access to tropical fruits and juices thanks to refrigeration and interstate and intercontinental transportation. However, we should bear in mind that we would not eat 4-6 oranges in a single sitting nor every day. When we drink a glass of orange juice, tomato juice, apple juice, or carrot juice, that is exactly what we are doing. We are drinking the nutritive essence of not one but a number of fruits or vegetables. This over-nutrition typically results in the formation of pathogenic dampness and phlegm.
Meats, because they are so nutritious, or supplement qi and blood so much, also tend to be damp in the same way. The fatter and richer a meat is, the more it tends to generate dampness within the body. Amongst the common domestic mammalian meats, pork is the dampest with beef coming in second. Therefore, it is important not to eat too much meat and especially not greasy, fatty meats. Most people do fine on two ounces of meat 3-4 times per week.
On the other hand, eating only poultry and fish is not such a good idea either. Everything in this world has its good and bad points. Poultry and fish tend to be less dampening and phlegmatic, it is true, but chicken, turkey, and shellfish tend to be hot. If one eats only these meats, they run the risk of becoming overheated. I have seen this happen in clinical practice. From a Western scientific point of view, we can also say that eating too much fish may result in mercury accumulation and toxicity and overeating commercial chicken may result in too much estrogen and exposure to salmonella food-poisoning. Chinese medicine sees human beings as omnivores and suggests that a person should eat widely and diversely on the food chain.
The Basic Healthy Diet
Therefore, to sum up the traditional wisdom of Chinese dietary theory, humans should mostly eat vegetables and grains with small amounts of everything else. We should mostly eat cooked and warm food which is not too sweet, not too greasy or oily, and not too damp. In addition, we should eat moderately and chew well. It is healthful to drink a teacup of warm water or a warm beverage with meals. This facilitates the formation of that 100° soup. But it is unhealthy to drink or eat chilled, cold, and frozen drinks and foods with meals.
In general, I would emphasize that most Americans do not eat enough vegetables. It is easy to load up on breads, grains, and cereals but not as easy to eat plenty of freshly cooked vegetables. Grains, like meat and dairy products, are highly nutritious but heavy and relatively more difficult to digest. If overeaten they can cause accumulation of dampness and phlegm. In Asia, Daoists and Buddhists interested in longevity emphasized vegetables over grains and even modern Chinese books on geriatrics counsel that more vegetables should be eaten.
Amongst the grains, rice holds an especially healthy place. Because it promotes diuresis, it tends to leech off excessive dampness. Other grains, in comparison, tend to produce dampness as a by-product of their being so nutritious. This ability of rice to help eliminate dampness through diuresis becomes more important the more other dampening foods one eats.
Flavors & Spices
As said at the beginning of this chapter, the purest part of foods are the five flavors. These are sweet, salty, bitter, pungent, and sour. Chinese medicine also recognizes a sixth flavor called bland. Each of the five flavors corresponds to one of the five phases and, therefore, tends to accumulate and have an inordinate effect on one of the five major organs of Chinese medicine. Just as overeating sweet injures the spleen, overeating salt injures the kidney, overeating sour injures the liver, and overeating spicy foods injures the lungs. I know of no one who overeats bitter food. A little bitter flavor is good for the heart and stomach. In general, although most food is sweet, one should eat a modicum of all the other flavors. Overeating any one flavor will tend to cause an imbalance in the organs and tissues associated with that flavor according to five phase correspondence.
Most spices are pungent or acrid and warm to hot. These spices aid digestion when eaten in moderate amounts. As discussed above, the digestive process is like an alchemical distillation. The middle burner fire of the stomach-spleen cooks and distills foods and liquids driving off their purest parts. To have good digestion means to have a healthy digestive fire. Moderate use of acrid, warm spices aids digestion by strengthening the middle burner fire.
That is why traditional cultures found the use of pepper, cardamom, cinnamon, ginger, nutmeg, mace, and cloves so salutary. These spices contain a high proportion of qi to wei and so help yang qi transform and distill yin substance, dampness, and fluids. On the other hand, when eaten to excess, such spices can cause overheating of the stomach and drying out of stomach fluids, and remember, the stomach does not like to be dry. Therefore, a moderate use of such spices is good for the spleen but their overuse is bad for the stomach and lungs.
A Return to a More Traditional Diet
What this all adds up to is a diet very similar to the Pritikin diet or Macrobiotics. Both these dietary regimes suggest that the bulk of one’s diet be composed of complex carbohydrates and vegetables and that one get plenty of fiber and less animal proteins, refined sugars, oils, and fats. This is very much the traditional diet of all people living in temperate climates the world round. This is also very much like what our great grandparents ate.
One hundred years ago, most people only ate meat once or twice a week. Mostly they ate grains and vegetables. Because they did not have refrigeration, they ate mostly what was in season and what could be stored in root cellars and through pickling, salting, and drying. One hundred years ago, sugar was too expensive for most people to afford more than a tiny bit per year. Likewise, oils and fats were relatively precious commodities and were not eaten in large quantities. Those oils which were available were pressed from flax, hemp, sesame seeds, or were derived from fish oil, lard, and butter. They were not the heavily hydrogenated tropical oils which are so frequently used in commercial food preparation today.
It was also a well-known fact of life 100 years ago that rich people who ate too well and exercised too little were more prone to chronic health problems than those who lived a more spartan and rigorous life. If one looks at the cartoons of the 18th and 19th centuries, one frequently sees the overweight nobleman with the enlarged and gouty toe. Likewise, the Chinese medical classics contain numerous stories of doctors treating rich patients by getting them to do some physical work and to eat simpler, less rich food. Gerontologists today have noted the fact that those ethnic groups who tend to produce a large proportion of centenarians, such as the Georgians, the Hunzakuts, and certain peoples in the Peruvian Andes, all eat a low animal protein, low fat, high fiber diet.
The Modern Western Diet
The modern Western diet which we take so much for granted is mostly a product of post World War II advances in technology and transportation. Until after World War II, mass refrigeration and interstate transportation did not allow for everyone to buy a half gallon of fresh orange juice anytime of the year at an affordable price nor to keep a half gallon of ice cream (or now frozen yogurt) in their home freezer. In addition, special interest advertising has fostered erroneous ideas about the healthfulness of many of these ”new” foods. We have been so bombarded by tv commercials extolling the healthful benefits of orange juice that we seldom remember that these are partisan propaganda bought and paid for by commercial growers who depend upon the sale of their product to turn a profit.
The modern Western diet is a relatively recent aberration in the history of human diet. It is an experiment which has largely run its course as more and more people as well as governmental agencies come to the conclusion that so much of what we take for granted these days as a normal diet is really not healthy. Just as we are now realizing as a society that smoking is bad for the health, likewise we are also now coming to realize that too much sugar, fats, oils, and animal protein are also not good for the health nor conducive to longevity.
Pesticides, Preservatives, & Chemicals
Traditional Chinese Medicine has, in the past, not said anything about pesticides, preservatives, and chemical additives because these things were not known until relatively recently. However, poisoning is a TCM cause of disease listed in the bu nei bu wai yin category of neither internal nor external etiologies. All the evidence suggests that eating food which is contaminated by pesticides, preservatives, and chemical dyes and additives is also not good for long term health and well being. Therefore, it is advisable to eat food which is as free from these as possible. That means organic produce and grains and organically grown meat. These are becoming increasingly more common and available.
Since Chinese medicine says that the qi comes from the purest of the pure part of foods, the xiang or flavor/aroma, Chinese dietary theory also suggests that food should be freshly made and eaten within 24 hours. As food becomes stale, it loses its aroma and its ability to supplement qi is directly proportional to this aroma. Food which is stale is called wrecked food in Chinese. The implication is that, although the substance is still there, the xiang, aroma, or qi is gone.
Such wrecked foods tend to be more dampening and phlegmatic.
If one follows the above Chinese dietary guidelines, one will eat nutritiously and well. One will be supplemented by their food and not unduly harmed by it. Such a moderate, commonsense diet is one of the four foundations of good health. This diet is more or less appropriate to everyone living in a temperate climate. Patients suffering from specific diseases may require various individualized modifications of the above outlined regime. However, because whether in sickness or health the process of digestion is essentially the same, this is the healthy diet for the majority of people. In the following chapter, we will discuss specific modifications for the most common groups of imbalance described by TCM. Yet even these modifications are based on this same commonsense approach to food and eating.
Treatment should primarily be based on pattern discrimination*”
*Patterns of disharmony (also called pattern diagnosis and pattern discrimination) are the diagnosis that traditional Chinese medicine practitioners give the disharmonies that lead to disease; it is these patterns that are treated to return your body and mind to a proper and healthy balance. After your initial consultation and throughout your treatments your practitioner will discuss with you your particular pattern diagnoses, bear in mind that these patterns can change as your condition changes or if you contract new conditions, such as a common cold or constipation. There are dozens of pattern disharmonies and some more common examples are Spleen Qi Deficiency, Liver Qi Stagnation, Dampness, Heat, Coldness, Liver Blood Deficiency, Kidney Yang Deficiency, Kidney Yin Deficiency and Lung Qi Deficiency.”
The Sean Barkes Clinic does not claim to cure any conventional medical disease states. Traditional Chinese Medicine seeks to re-establish and maintain the harmonious function of the human body-mind using tried and tested principles that have been discovered and matured over millennia. A Western medical diagnosis provides very little by way of insight in informing a Chinese Medical diagnosis. Patients usually recognise their own condition in terms of the medical disease category that they have been given by their GP or other conventional medical practitioner. The research presented here is merely an indication of the potential to draw parallels between Traditional Chinese Medicine and Modern Western Medicine.