Legacy of China – Nutrition Past – Nutrition Today: Prescientific Origins of Nutrition and Dietetics, part 3
Louis E. Grivetti
Nature has four seasons and five elements [earth, fire, metal, water, and wood]; to grant a long life the four seasons and the five elements store up the power of creation within [attributes of] cold, heat, dryness, moisture, and wind. Man has five viscera [liver, heart, stomach, lungs, and kidneys] in which these five climates are transformed to create joy, anger, sympathy, grief, and fear. Nei Ching, 1966, p.117
Chinese and eastern philosophy possesses a wonderful logic and structure. Yet Chinese medicine and dietetics remain a puzzle to most Western practitioners. Many Westerners who have attempted to fathom the complexities of Chinese traditional medicine remain skeptical, they notice inconsistencies, they debate efficacy of different techniques, unknown and for the most part ‘untested’ by the western scientific community. Beyond the Yang and the Yin, however, lies a wonderful history of dietetic and nutritional understanding extending well into the 6th century B.C. when China was young [!] and the great philosopher, K’ung Fu-Tzu (Confucius), wrote eloquently on proper diet and said:
Do not … eat [your] fill of polished rice, nor finely minced meat; eat not rice that has gone sour, or fish and meat that has spoiled …. [Do not] eat except at proper times … never drink [wine] to the point of becoming confused … [never] consume wine or dried meat brought from a shop (The Analects. 10:8).
Chinese medicine, nutrition and dietetics owe their origin, development and present status to three great religious faiths: Confucianism, Taoism and Buddhism. The great K’ung Fu-Tzu proposed the Five Virtues of kindness, justice, proper behavior, sound judgment and personal integrity. He held that health was guaranteed if a moral life was led. Lao-Tzu, the founder of Taoism and contemporary of K’ung Fu-Tzu, argued that health was guaranteed if natural law was followed. Lao-Tzu proposed the Three Jewels of compassion, humility and moderation and taught that human contentment and health were gained through unassertive action, and by simplicity in human behavior and actions. Buddhism would enter China and influence its medical-dietary system during the 1st century A.D.
The earlier religions-philosophies of Confucianism and Taoism supported a medical-dietary system based upon five elements and four Yang-Yin principles. The religious, philosophical, medical and dietary puzzle that captivated many early Chinese practitioners was how to align five elements with four principles, a problem all the more complex because in the cosmic beginning, all things began with the number three.
In Chinese world view, three universal elements were created from chaos or the great void: force, form and substance. These universal elements initially were united and invisible but upon successive cosmic evolution they separated. After separation two spheres of heaven and earth became visible and revealed at this time were the complementary principles of Yang-I (male, light) and Yin-i (female, dark). From these principles were generated the Four Figures called Hsiang: Great Yang or T’ai-Yang, Lesser Yang or Shao-Yang, Lesser Yin or Shao-Yin and Great Yin or T’ai-Yin. Further creation produced the five essential elements: earth, fire, metal, water and wood, each with creative-generative and destructive-subjugative attributes (Fig. 1).
ALIGNMENT OF ELEMENTS AND YANG-YIN
Yang and Yin principles are the center post of the Chinese allopathic medicine and diet. They are expressed as in Indian and Mediterranean patterns by paired opposite terms. Four term sets define the primary attributes of Yang and Yin: gender (Yang: male-Yin: female), presence or absence of light (Yang: light-Yin: dark), moisture (Yang: dry-Yin: wet) and temperature (Yang: hot-Yin: cold). These attribute sets, now numbering 50, are assigned to diseases and to foods.
The Chinese list of disease-food attributes is more sophisticated and complicated than either Indian or Mediterranean medical-dietary systems. Only six terms, however, are common to Chinese, Indian and Mediterranean allopathy: gender (male-female), presence or absence of light (light-dark), moisture (dry-wet), moral value (good-evil), power (strong-weak) and temperature (hot-cold). Chinese and Indian allopathic medicine have parallel terms in common for size, texture and weight not expressed in Mediterranean medicine and dietetics, while Chinese and Mediterranean allopathy have common attributes for color, direction and location missing from the Indian descriptive medical system.
The alignment between Yang, Neutrality and Yin and the five elements is central to Chinese medical and dietary treatment. In the Chinese system all diseases are designated Yang or Yin; all foods are classified Yang, Neutral or Yin. Respective disease categories shift according to internal or external forces upon the body; food classifications shift depending upon season, geographical location and method of cooking. Health is represented by balance; disease by imbalance. Disease states are influenced by a specific element, planet, season, climate, direction and number; food attributes and properties are defined by a specific color, flavor/taste and smell; specific animals and plants also are aligned. Parts of the body, whether hollow or solid organs, sense organs, tissues or body orifices, are identified with strong or weak Yang, neutrality or strong or weak Yin. In addition, body secretions, human attributes and emotions are aligned.
CHINESE MEDICINE AND DIETETICS
The first Chinese medical-dietary text to discuss alignment, disease, food attributes and use in therapeutics is entitled the Nei Ching. It has been argued, uncritically, that the Nei Ching is the oldest medical book in the world, with estimates of its origin ranging from B.C. 2697 to the 1st century A.D. In any case, the Nei Ching is considerably younger than the Caraka-Samhita medical document of ancient India or the many Mediterranean medical-dietary accounts.
Regardless of its age the Nei Ching is among the most important and interesting medical-dietary texts to survive from antiquity. It is organized as a dialogue between two persons, who explore disease topics and appropriate therapy. Their dialogue examines medical and dietary questions of balance and imbalance; it identifies the universal and essential elements, classifies body organs and discusses nutritional needs, as well as dietetics and use of food in disease prevention.
Body organs are classified by function: those that collect and store products and those that excrete fluids. Nine are considered important to the body. Heart is deemed the home of wisdom and insight, it governs human activities during the summer, but can be damaged by excessive heat. Lung is the home for breath, it directs correct human conduct, governs activities during autumn, but can be damaged by excessive cold. Liver initiates human strategic behavior, is the power source that propels human activities, governs spring season, but can be damaged by wind exposure. Gallbladder is the center for human decisions; spleen rules the transition period between summer and fall. Both spleen and stomach protect food storage inside the body. Small intestine and large intestine rule the body’s storage chambers, but can be damaged by excessive humidity. Kidneys rule winter, store life essence and regulate human efficiency, but can be damaged by excessive dryness (Wallnofer and von Rottauscher, 1965).
Five of these nine organs have well defined relationships: heart, kidney, liver, lung and spleen. Each is characterized by nine specific actions or functions that: 1) produce a secretion, 2) crave a flavor, 3) control a mental attribute, 4) nourish a body component, 5) strengthen one of the other organs, 6) dominate one of the other organs, 7) is injured by an environmental component, 8) is dominated by a body component-tissue and 9) is strengthened by a body component-tissue.
Each action of the five dominant organs may be defined and diagrammed (Fig. 2).
In addition, each organ has a characteristic odor, taste, color and emotion. Each produces a product, then shapes and controls another organ. Each presents a conduit or opening to another organ, converts or transforms its fluid into another, supplies a body action or attribute and nourishes a body component. Each of these functional characteristics and assigned attributes may be defined.
DISEASE: ORIGINS AND DIAGNOSIS
In the Chinese medical-dietary system disease occurs when the body becomes imbalanced and energy cannot circulate. Diseases are classified by external or internal source with the former subdivided into two categories, those induced from outside the body and diseases dependent upon time, the latter being caused by emotion.
LOCATION AND SEASONALITY
Chinese doctors identified differences in weather and climate, soil fertility and terrain and noted that such geographical considerations affected health and disease. Generalized geographical conditions and basic health complaints for each of the five regions of China were recognized perhaps as early as the 2nd century B.C.: People of the east … live near the ocean and eat much fish and salt; fish and seafood are thought to cause internal burning, salt to injure the blood; these factors cause a propensity towards ulcers; People of the south … live in regions which are fertile through an abundance of sun and dew; they live on sour food and curd and they suffer from contracted muscles and numbness; People of the center … live on level, fertile ground, and obtain a varied diet without great exertion; they are attacked by disease, mainly by complete paralysis, chills, and fevers; People of the west . . live in dwellings of stone, their fields are fertile, and their food good and varied; their bodies are robust and healthy and impervious to external diseases; People of the north … live in mountainous regions; their food consists mainly of milk products; they are exposed to cold winds and frost and hence suffer from [a wide number of] diseases (Nei Ching, 1966).
THE FIVE EVILS
According to the Nan-Ching, a medical text by Pien-ch’ueh (2nd century B.C., or later) external diseases are caused by the five evils’ defined as: 1) wind, 2) heat, 3) cold, 4) humidity and 5) drinking and eating without restraint. All diseases, in turn, are classed as primary or secondary and diagnosed by characteristic aromas, colors, excretions, sounds or tastes. Wind diseases, for example, primarily affect the liver and produce color signs manifest in the patient’s complexion. Heat diseases, in turn, appear mainly in the heart and produce characteristic body odors. Cold diseases are manifest mainly in the lung and diagnosed by sound, after giving careful listening to the patient’s voice. Illnesses caused by humidity appear in the kidneys and are diagnosed by observing the patient’s perspiration, saliva and tears. Diseases caused by improper diet, or those that result because of exhaustion, appear initially in the spleen and are diagnosed by characteristic dietary cravings for specific flavors (Nan-Ching, 1986).
The ancient Chinese diagnostic system that defined the five organs and the five evils allowed a wide range of symptoms to be observed: If the patient has been ‘hit’ by wind, the patient’s complexion will become red because liver has sent its influence to the heart; this produces a hot body with fullness and pain below the ribs. if, however, the heart is ‘hit’ by heat, then the patient will exhibit a burnt aroma or odor; the body will be hot and the patient feel uneasy. Should the heart be ‘hit’ by cold, then the patient will talk incoherently, exhibit a hot body, but will shiver and express a dislike for cold that also will lead to cough. If, however, the heart has been ‘hit’ by excessive humidity, then the patient exhibits the tendency to sweat without end, reveals a hot body, and suffers pain in the lower abdomen while their feet and shinbones feel cold. If, instead, the heart was hit” by over-drinking and eating without restraint, then the patient will exhibit cravings for foods with bitter taste; such a patient presents a hot-feverish body, will perceive their body to be heavy, and will exhibit a desire to lie down but will be unable to contract easily their limbs (Nan-Ching, 1986).
Winds from specific directions are said to injure certain body organs or locations. Winds from the east, for example, injure the liver, neck and throat; winds from the south injure the chest, heart and ribs; winds from the west injure the back, lungs and shoulders; while winds from the north injure the hips and kidneys. People are advised to take precautions and avoid being -hit’ by cold wind blowing from any direction, since cold wind closes skin pores. As a result, body heat rises and fever results. It is generally held that cold winds produce pain, tumors and weakness (Wallnofer and von Rottauscher, 1965).
IMPORTANCE OF DIET
The prominent Chinese physician, Hua Shou, commented on the NanChing text in A.D. 1361 and considered how improper diet led to disease. As a result of his studies he coined three medical-dietary axioms: 1) if the body is cold and one drinks cold beverages, [this] harms the lung, 2) anger, drinking, eating, exertion, grief, movement, rage and human thought [taken to excess] cause harm, and 3) eating and drinking without restraint… harms the spleen (cited in the Nan-Ching, 1986).
IMPACT OF BUDDHISM ON MEDICAL DIAGNOSIS
Buddhism entered China in the 1st century A.D. and influenced disease concepts and medical diagnosis. The structure and organization of Buddhism contrasted sharply with Confucianism and Taoism. The Buddha (Gautama Sakyamuni) had been dead for nearly 500 years when the Buddhist missionaries crossed the Himalayas and entered the Middle Kingdom. Buddhism held that humans were measured by their actions and deeds (karma) and that the purpose of life was to suffer endless cycles of birth-death-rebirth and ultimately reach salvation (nirvana). The Buddha taught that the endless cycles could be halted if the Eightfold Path was followed: 1) correct attitudes, 2) correct behaviors, 3) correct concentration, 4) correct efforts, 5) correct intentions, 6) correct living, 7) correct speech and 8) correct views. Buddhist views and philosophies contrasted sharply with existing Chinese medical traditions. The Buddhists proposed a system of four elements compared to the Chinese five), and argued that each element, if imbalanced, could produce 101 diseases, for a total of 404 specific illnesses not based upon Yang-Yin considerations.
Ten factors that caused human disease are identified in the Chinese Buddhist document known as the San Tsang or Taisho Tripitaka (Three Treasuries); 1) sitting too long without eating, 2) immoderate eating, 3) worry and fright, 4) excessive exertion, 5) immoderate sexual cravings, 6) anger and vexation, 7) suppression of bowel movements 8) intentional retention of urine, 9; suppression of rising wind within the body and 10) suppression of descending wind inside the body (Unschuld, 1985).
Another passage from the San Tsang, attributed to the Buddha, identified nine causes for premature, or unexpected death: 1) eating what should not be eaten, 2) immoderate eating, 3) eating contrary to custom, 4) failure to discharge the old before the arrival of the new, 5) intentional retention of digested foods, 6) disregard for the principles of proper conduct, 7) cultivation of bad acquaintances, 8) untimely appearance and unseemly behavior in the streets and 9) failure to avoid that which should be avoided (Unschuld, 1985).
Specific commentary on the nine causes of untimely death provided guidelines for attaining good health and presumed longevity. Specifically, consumers were instructed to reject all foods that were:
Repugnant to the senses not in accord with the four seasons starting to eat again immediately after the conclusion of a meal; not eat in excess of one’s needs …. [not] eat at unusual hours …. if forced to eat unfamiliar foods sample [only] a small quantity…. not eat [so long as] the previous meal remains undigested (Unschuld, 1985).
Buddhist monks were required to follow strict dietary codes limiting their time of eating to morning hours. Forbidden foods included sour or fermented items, milk, cream, fish and meat. Monks were required not to speak with rice in their month, make noise while eating and not feel envy or anger if another priest had more or better food (Beal, 1970).
Buddhism classified three types of people each with characteristic attitudes towards food:
Greed-type … likes foods [that are] fatty and sweet … he eats slowly and pays attention to the taste of the food, and is glad when he finds anything nice in his bowl.
Hate-type … likes foods [that are] rough and sour … he eats hastily, stuffing his mouth full, and pays no attention to the taste of the food… [he is annoyed] if he finds anything unpleasant in his bowl.
Delusion-type … has no clear preference for any kind of food . . . his mind is easily distracted (Conze, 1959).
By the 6th century A.D. Chinese Buddhist medicine held that there were six causes of disease: 1) imbalance of the four elements, 2) imbalance of nutrition, 3) excessive meditation, 4) demons, 5) evil gods and 6) improper conduct during previous lifetimes. Each category of illness was treated using different therapeutic approaches. Imbalances caused by elements and improper foods were treated using diet and drugs. Other avenues of therapeutics included extensive patient counseling, breathing regulation, exercises, use of amulets, personal introspection, confession and acts of contrition (Unshuld, 1985).
DIAGNOSIS: FROM ANTIQUITY TO THE 20TH CENTURY
Chinese medicine has been influenced for more than two thousand years by the Nei Ching and NanChing documents and by the subsequent blending of Buddhist medical-dietary texts such as the San Tsang. From antiquity to today, Chinese physicians have diagnosed illness by observation, listening to the patient speak, questioning the patient and palpitating the wrist pulse. Modern Chinese physicians continue this system and observe the patient’s skin color and texture, various conditions exhibited by the the patient’s eyes, nose, mouth, teeth and tongue. The patient’s hands and nails are felt, breathing monitored and manner of speaking and type of cough (if present) are evaluated. The patient is questioned as to daily activities, type and quantity of exercise and diet. After evaluation a diagnosis is made, YangYin and organ associations determined, then treatment prescribed based upon allopathic principles. Each disease, whether Yang or Yin in origin, is classified hot or cold, sometimes also wet or dry; the patient is prescribed foods and drugs with opposite attributes or characteristics (Lock, 1980).
DISEASE AND DIETETIC MANAGEMENT
Ancient and modern Chinese dietary management and medical treatment links specific flavors with one of the five major body organs. Once the specific body organ and disease are identified, correct food choices are recommended. Many food-organ-disease associations are ancient and were recorded in the Nei Ching. Liver-related diseases, for example, commonly are treated using sweet foods specifically identified as beef, dates, mallows and nonglutinous rice. Heart-related illnesses are countered using sour foods such as dog meat, leeks, small peas and plums. Lung-related problems are cured by eating bitter foods among them almonds, apricots, mutton, scallions and wheat. Spleen-related diseases are eased by consuming salty foods such as large beans, chestnuts, coarse greens and pork. Kidney-related disorders are cured using pungent foods, among them chicken, glutinous yellow millet, onions and peaches (Nei Ching, 1966).
Ancient physicians identified four broad food categories, each with five foods, that they deemed especially nourishing to the body and useful when treating disease: GRAINS: beans (large varieties), millet (yellow glutinous), peas (small varieties), rice (nonglutinous) and wheat;
FRUITS: almonds/apricots, chestnuts, dates, peaches and plums;
VEGETABLES: greens (coarse varieties), leeks, mallows, onions and scallions; and
DOMESTICATED ANIMALS: chicken, dog, lamb, pig and ox.
When these 20 foods are prepared in different combinations, their numerous blends of flavor, smell and taste provide the physician with a wide range of options used to reinforce ch’i or life essence (Nei Ching, 1966).
By the Chou Dynasty (at least 255 B.C.) dietitians were identified as a medical specialty. They developed therapeutic meals using combinations of the so-called six nourishing foods (not defined) and six nourishing beverages (not defined), and used them to prepare six standard meals, 100 sauces and eight delicacies, to achieve correct balance of taste for healing purposes. There is the suggestion at this time that sour foods dominated therapeutic diets during spring, bitter foods in summer, pungent items in autumn, while salty foods were characteristic of winter (Wong and Lien-Teh, 1936).
Physicians, nutritionists, dietitians and anthropologists have examined the Yang-Yin, hot-cold medical-dietary system of China for decades. Several attempted to create a master list of foods with their respective Yang (hot), Neutral, or Yin (cold) attributes. It was thought that such master lists would facilitate medical and nutritional counseling. Food lists published during the past 20 years, however, exhibit considerable category inconsistency. Physicians, nutritionists and dietitians trained in Western medicine and scientific thought sometimes became frustrated by the category inconsistency, abandoned attempts to understand the Yang-Yin system and tended to conduct dietary counseling sessions using Western, scientific information on calories and nutritional content of various foods. Physicians and dietitians, not infrequently, recommended that their Chinese clients (especially those who were pregnant) take advantage of vitamin and mineral supplementation. Not infrequently, dietetic exchange lists provided to Chinese clients had little in common with the clients’ actual food intake patterns.
The reluctance of many Western, scientific physicians, nutritionists and dietitians to consider the cultural needs of their Chinese clients, their reluctance to consider the order and structure to the Yang-Yin system and their continued insistence that nutrition information be couched in Western dietetic terms produced little Chinese-American confidence in American health personnel. This curious cross-cultural medical-dietary problem attracted several prominent American anthropologists during the 1970s who investigated the foundation and structure of Yang-Yin food classifications.
The Chinese concept of food patterns and diet and the process of food code assignments has persisted throughout the centuries with foods recent to China still receiving Yang-neutral-Yin assignments. Anderson (1988) has argued that health professionals should not be concerned with the assignment or misassignment of any specific food, but that dietitians should seek general patterns of food alignment. His work, frequently overlooked by health professionals working with Chinese and other Asiatic populations, revealed broad logic for food category assignments. Most ‘hot’ or ‘heating’ foods were alcoholic beverages, fats and oils, meats, and strong spices, while most ‘cold’ or ‘cooling’ foods were green plants and vegetables and fruits, especially those eaten raw or grown in moist, ecological zones. He concluded that most heating’ and -hot- foods had common characteristics: 1) they produced mouth irritation or specific digestive tract irritation (chiles, ginger, pepper and many spices) or caused indigestion alcohol and fats), 2) they produced a scratchy sensation inside the mouth or caused mouth or throat soreness (coffee and curry powder), and 3) they exhibited brilliant colors, usually red or orange (cherry, orange, persimmon, tangerine). Anderson suggested that cold’ or cooling’ foods usually were the opposite, that they: 1) produced no mouth or digestive tract irrigation, 2) exhibited high moisture content and low caloric value and were smooth textured inside the mouth, and 3) usually were ‘cool’ colors (green, grey, white). In addition, he noted that many cold’ or cooling’ foods were sour. Neutral foods, those not designated ‘hot’ or cold,” included many starchy staples that were neither spicy or sour, red or green (Anderson, 1980, 1984).
Yang (hot), Neutral, and Yin (cold) category assignments for 186 foods are available in research articles published since 1975. Examples are presented in Table 1. Of the 186 foods, 78% exhibited category consistency: 74 foods always were classified Yang/hot, 12 always Neutral, and 60 always Yin/cold. Only 22% were classified inconsistently into more than one category. Foods classified as Yang and Neutral, or Yin and Neutral in reality, however, do not present problems to dietitians and nutrition counselors. Most interesting, however, are the 13 ‘problem’ foods classified by respondents as both Yang and Yin: duck, bean sprouts, wheat, cabbage (American), cauliflower, onion (green), mango, orange (American), persimmon, pineapple, honey, parsley and tea. Three foods, pork, banana and white sugar, are designated as Yin, Yang, and Neutral. The opportunity to question clients as to their specific beliefs helps to avoid misinterpretation.
Despite some category inconsistency, the generalizations identified by Anderson hold. Most Yang foods are meats, while seafood and fish, because of their aqueous environment, tend to be classified Yin. Legumes with high caloric density and vegetable protein, are spread between Yang and Yin; legumes from trees tend to be classified Yang, whereas green legumes are classified Yin. Soybean is an example of changes in classification depending on manner of preparation: the basic soybean is Yin, fresh soybean curd is Neutral, while dried soybean curd generally is classified Yang. Cereals also are variable; rice is either Neutral or Yin depending upon the manner of cooking, while wheat and wheat noodles change from Neutral to Yang also in accord with the type of preparation. Most tubers and vegetables are Yin as are most fruits. There is, however, a wide range of Yang fruits: cherry, dates, mango and tangerine (all red or yellow), and vegetables such as chives, leeks and onions, while green are classified Yang. Spices and flavorings are mainly Yang; salt and soy sauce are notable exceptions. Beverages are variable; alcoholic drinks (except beer) generally are classified Yang, while fruit juices, milk, tea and unboiled water are Yin. Among the more interesting items are ice (Yang), candy (Neutral), and Jello (Yin).
PREGNANCY AND LACTATION
A wide range of ancient Chinese medical and dietary texts offer nutritional advice during pregnancy and lactation. Several Chinese physicians wrote books on proper diet and identified foods that should be encouraged or prohibited during pregnancy and lactation including: Chang Chi of the Han Dynasty; Sun Ssu-Mo of the Tang dynasty; and Yeh T’ien-Sih of the Ching Dynasty.
In addition to accounts by ancient Chinese physicians are the important contributions to medicine, nutrition and diet made by Chinese herbalists. The herbal component of Chinese medicine and diet is ancient and dates to circa B.C. 400. The accepted founder of Chinese herbal medicine, Shen Nung, wrote on the properties of 365 herbs. This text was copied and annotated circa A.D. 500, and in A.D. 659 the herbalist Su Ching wrote what may be the earliest official pharmacological text known. A Tang dynasty physician compiled a text on herbal medicine in A.D. 739. During the Sung dynasty a herbalist revised earlier texts and republished them in A.D. 973. A subsequent Sung herbal physician discusses the origins and therapeutic attributes of more than 1,000 herbs. Another Sung dynasty physician included references to more than 1,700 herbs. In A.D. 1590 a Ming dynasty physician expanded the official Chinese herbal list further. By 1978 herbalists in the Peoples Republic of China had identified more than 5,700 medicinal products; of these, approximately 500 remain commonly prescribed today, many during pregnancy and lactation (Hsu et al., 1986, Sivin, 1987).
ENCOURAGED FOODS AND MEDICAL PRODUCTS
Cultural rules determine dietary intakes during pregnancy and lactation in all societies. Ancient, medieval and contemporary Chinese texts identify many foods and products especially prescribed during pregnancy and post partum periods (Table 2). Prescribed foods must be in accord with Yang-Yin principles. Nonpregnant women are Yin, but when they become pregnant, they then are considered strongest Yang. This shift in classification is mirrored in a dramatic change in diet. During the hottest Yang of pregnancy the mother is cautioned to eat Yin foods. Yin foods generally are low in calories and protein and have high water content. Strict adherence to Yin diet can produce a low birth-weight baby. Cultural encouragement of Yin foods at this time is associated with fewer delivery complications due to small body frame and pelvic disconformity, easier delivery and less pain during labor. It is easy to see, too, the potential for miscommunication during the prenatal period between traditional Chinese women and Western-trained health professionals who would encourage substantial weight gain and regularly prescribe high protein foods and possibly vitamin and mineral supplements.
Examination of recommended foods, however, reveals that during pregnancy women are not limited to Yin foods low in energy or protein. Many foods high in calories and protein are prescribed: fish during the 4th month; beef and lamb during the 5th month; wild game during the 6th month. Chicken and chicken-tea infusions are regularly prescribed to reduce `spotting’ or vaginal bleeding, while oysters are recommended for fetal stability.” High calorie foods include: lotus seeds, pine nuts, sesame oil, rice and wheat dishes. While fruits are not specifically recommended, it should not be difficult to prescribe a range of vegetable items that meet vitamin and mineral requirements at this time. Spices such as cardamon and dried ginger are recommended to reduce fetal restlessness.’ Even the moderate use of sweet wine is encouraged to relax the mother during the latter stages of her 9th month of pregnancy. A wide range of herbs and other medicinal products are prescribed to counter conditions such as edema, kidney pain, toxemia and uterine hemorrhage.
During long, protracted delivery the mother may be served a wide range of foods and medicinal products to ease labor, facilitate placenta and uterine blood expulsion, reduce hemorrhage, provide strength or lessen pain. A dried seahorse sometimes is placed in the mother’s hand as a charm to protect against difficult, painful labor. During labor the mother may be fed small quantities of chicken brain, pork heart and kidney, perhaps venison, or may be offered easily digested preparations from sweet basil, honey or saffron.
The month immediately after delivery is considered a time of great danger, of illness and potential death to both mother and neonate. Traditional Chinese women follow a program that consists of 15 well-defined cultural practices designed to reduce this danger. The anthropologist Barbara Pillsbury (1978) described these practices in a classic paper. Women who follow the traditions are said to be Doing the Month’ (Tso yueh-Tzu) and the 15 requirements are the mother should 1) not wash her body or hair, 2) not go outside the home, 3) not eat raw or cold foods, 4) eat chicken daily, 5) not sit in a draft or otherwise in the wind, 6) not move about the house needlessly, 7) not visit another’s home, 8) practice positive behaviors to avoid becoming ill, 9) not read or cry, 10) abstain from sexual intercourse, 11) not eat with other family members, 12) not burn incense, 13) avoid any potentially disease-causing object, 14) avoid offending the gods or contaminating family members with any fetal blood residues and 15) consume hot foods.
During the post partum period the mother’s physiological classification changes, as does her diet. This is a period of strongest Yin; accordingly, her diet should be based upon Yang foods. Since Yang foods typically are those high in energy and protein, this shift in dietary pattern is a cultural way to provide biologically for increased milk production requirements. Several foods are encouraged in the belief that their consumption will increase the mother’s breast milk production. Such foods, called galactagogues, include chicken plus squid, clams (small varieties), dog (especially meat from the dog’s feet), fish (especially carp), millet, mutton, pork, rice wine, sea slug, shrimp in red wine, soybean milk mixed with powdered walnuts, squid, wheat cakes, wheat noodles with egg, wild boar lard and various insects (cicada and june beetle grubs).
Other foods encouraged during the post partum period are said to provide strength to the mother so she recovers quickly from the exertion of labor. Strength-providing foods and medicinal products identified include: ashed deer bone, chicken, frog, ginsing (Panax ginseng), ginger, licorice extract and razor clam. Other foods, specifically pheasant, are prescribed if the mother exhibits dysentery, while sheep’s blood is prescribed to improve the mother’s general well-being and blood circulation.
Newly delivered mothers are encouraged to eat a range of foods that have perceived positive effects upon their lactating infants. Sow’s milk, for example, is drunk as a preventative for neonatal epilepsy. Ashed buffalo horn applied to the mother’s nipples is said to improve infant sucking, while ashed horse bone applied to the nipples reportedly keeps infants from crying during nighttime feeding. Other foods and medicinal products given directly to the neonate are prescribed to ease nausea and reduce vomiting. These include boiled extract of mulberry tree grubs (13 different genera identified) or rush grubs (members of the Pyralidae family, possibly Scirpophaga family).
Women Doing the Month’ are encouraged to eat chicken cooked with sesame oil each day, beginning at the 3rd day post partum. Meat from black-boned chickens is most esteemed. Other encouraged foods at this time include brown sugar, chicken soup, eggs, fish especially bream), liver, kidney, noodles cooked in brown sugar broth, pig liver cooked with black dates in ginseng broth or sesame oil, pig’s feet, rice wine and infusions of rice wine with ginger (Pillsbury, 1978).
PROHIBITED FOODS AND MEDICAL PRODUCTS
Most societies also have culturally incorrect or proscribed foods to be avoided during pregnancy and lactation. Examples of these numerous dietary prohibitions in the Chinese tradition are shown in Table 2. Foods forbidden generally fit two categories: those thought to produce adverse effects on the mother, especially life-threatening problems and others that might inhibit a full-term pregnancy, and foods thought harmful to the developing fetus.
Prohibitions of the first category are numerous and include foods thought to produce spontaneous abortion or miscarriage; almond, amaranth leaf, banana, beans (in general), barley, beer, eggs seasoned with salt, pineapple, seaweed, soybean and watermelon. Foods rejected in the belief that they lead to overterm pregnancy, painful delivery and thereby threaten the life of the mother include: meats from donkey, horse and mule and shellfish in general. Other foods said to produce breech, reverse or transverse presentation and threaten the mother’s life include: crab, domestic and wild duck, duck combined with mulberry, mulberry mixed with duck egg and pheasant.
Prohibited foods and products thought to produce adverse effects on the neonate represent the second category of dietary restrictions during pregnancy. Beef and sparrow meat mixed with soybean paste are avoided lest the child have blemished, dark or pockmarked skin; bullfrog, chicken, dog, eel, goat, rabbit and turtle are rejected in the belief that the child might be born mute; dried carp mixed with egg or carp roe is said to produce infants with skin lesions; dog meat and rabbit are avoided at this time to prevent hare lip or cleft palate. Elk meat and any dish that contains deer fat and plum are rejected in the belief that the child will be born blind or exhibit serious eye disease. Traditional mothers also reject eating eggs and carp at the same meal in the belief that their neonates will be covered with boils or sores. Pregnant women who consume fresh ginger are said to risk bearing children with extra digits on the hands and feet. Eating mutton during pregnancy is proscribed in the belief this food causes neonatal epilepsy.
Some Chinese dietary prohibitions are unique in their linkage of food intake during pregnancy and negative effects much later in time. Some foods are forbidden in the belief that consumption will produce a deleterious effect during childhood, even many years later as an adult. Should a pregnant woman eat frog it is said that her baby will suffer needless death during later childhood. Should a mother eat sparrow cooked in alcohol or wine, it is said that her child upon maturity will exhibit lewd, licentious behavior directly traced to the mother’s dietary mismanagement- during pregnancy. Chicken mixed with glutinous or sweet rice is rejected in the belief that the combination causes parasitic infections later in life, while goat meat consumed by the mother at this time is said to produce needless illness during childhood.
Dietary prohibitions also are extended to lactating women, although these are less numerous than the taboos during pregnancy. It is widely held that lactating women should avoid cold and raw foods, especially, bamboo shoots, Chinese cabbage, duck, fish, most varieties of fruits, turnips and green-leafy vegetables. Lactating women are cautioned to avoid drinking ice-cold water and leftover foods. Alcoholic beverages are proscribed at this time because they may cause the new mother to bleed or faint. Salt as a condiment and salty foods in general are to be rejected, too, in the belief that use reduces breast milk production (Pillsbury, 1978).
EFFECTIVE DIETARY COUNSELING
Members of all ethnic groups in America today fit one of three categories: 1) they follow exclusively their traditional diet and medical practices, 2) they follow exclusively an Americanized’ diet and Western medical practices, or 3) they follow an eclectic blend of traditional and “Americanized/western” practices. Most registered dietitians are trained in science and are not exposed to nonscientific, traditional allopathic medical-nutritional systems. Those professionals who take time to work carefully with their clients, to determine awareness and practice of Yang-Yin food associations, will be rewarded; other professionals who dismiss the ancient Chinese system as inconsistent, who stress only scientific nutrition, will continue to be frustrated in their work. The best social scientists who worked on Chinese Yang-Yin traditions saw beyond food category inconsistencies and sought broad meaning in the rich Asian heritage that the Chinese shared with the world.
A historical-cultural review of Chinese dietary practices reveals ‘three indisputables.’ First-the Chinese medical-dietary system is ancient and has been maintained and sustained for more than 2500 years. With such a heritage there is presumed merit that can be examined scientifically. Second-the Chinese medical-dietary system is inconsistent. This property of inconsistency underlies the rejection of Chinese medicine-nutrition by many Western-trained, scientific physicians, nutritionists and dietitians. From the perspective of science, inconsistency is anathema; prediction and precision are the only worthy icons. Third-inconsistency should pose a challenge to scientists, not frustration.
Consider the foods encouraged and those forbidden during pregnancy. A careful reading reveals that eight foods appear on both lists: beef, carp, chicken, duck, eel, barley, ginger and wine, each with well-defined reasons for their recommendation, conversely for their prohibition! Western scientists might observe and say: How can this be? Inconsistency is illogical. Chinese and other Eastern doctors do not see duality as inconsistent and would argue correctly-has not Western science, too, changed through the years? Have not Western views of correct dietary-nutritional management changed-even during the past several decades?
A Chinese Buddhist text entitled the Four Truths presents a fitting way to end Part Three of this series on the nonscientific origins of nutrition and dietetics. While the work is ancient and set in China, its message is universal and cuts across time and geographical space. The passage reflects the contemplative nature of Chinese thought, whereby a lesson may be presented for several levels of analysis:
To roads extend across the Chinese landscape and meet at a crossroad. A merchant sits nearby on a dusty mat. Beside him there is a large pot filled with food of the most beautiful color, enticing smell, wonderful taste, and healthful properties. In the distance a poor, hungry, thirsty traveller approaches the crossroad. The merchant looks up, observes and smiles. The traveler reaches the intersection, sees the merchant seated next to the pot of wonderful food and speaks: What is it you have? I am so hungry and so thirsty. – The merchant smiles and replies: I see that you have traveled long and I expect that you have far still to go. My pot holds the best food in all the world. It is obvious that you are hungry, thirsty, and have suffered all your life. Fate has not brought you to my crossroad; each person on their life’s journey passes by me. My food is for the asking. Should you wish to eat, your life will be changed forever. Never again will you hunger, thirst or suffer.’ The traveler listened and looked intently into the pot of wonderful food, he saw its beauty, its color, and he sampled its aroma. The merchant smiled, then spoke again: But there is one caution, traveller, something that you must know. Upon eating my food a limit will be placed upon your lifespan. By eating my food, you will end your suffering, you will prosper and live long, but you will sacrifice your immortality.
The hungry, thirsty traveller stared into the pot of food. Oh, how I have endured hunger, thirst and suffering all my life, and still I have an eternity to travel. What shall I do? Should I accept the merchant’s food, eat, find earthly contentment, then after a long life enter the great void never to re-emerge? Or should I, instead, refuse his food, then hunger and thirst as before, and share only the companionship of other sufferers throughout eternity? The merchant spoke: It is time to choose. The hungry, thirsty traveller made his choice.
The merchant smiled and spoke: You have chosen wisely. You will not regret your decision. And as one traveller left the crossroad and vanished, in the distance another approached.
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