Cultural Integration of Chinese Medical Theory in Taiwan

Taiwan is an excellent place to discover the complexity of Chinese medicine within its homeland. Taiwan is a densely populated island that is a major center of Chinese culture. Its political isolation from the PRC has allowed it to enthusiatically assimilate global ideas, while maintaining the continuity of its traditional culture. A Westerner is instantly overwhelmed by the depth and complexity of options through which to witness the practice of Chinese medicine. Streets are lined with herbal pharmacies, clinics and integrated hospitals abound, and products sold everywhere from 7-11 to the busy nightmarkets demonstrate the influence of traditional medical theory upon the culture.

The rooted value of traditional medicine in Chinese culture makes the Western practitioner realize that TCM is anything but a new and stylish trend. Modern Taiwanese perspectives differ greatly from one person to the next, and for every enthusiast of TCM there is a strictly scientific neighbor next door who reaches for antibiotics with every sniffle. However, when the average university graduate gets a common cold, they are far more likely to blame the changing weather than their hand-washing diligence. Taiwanese people of all ages are likely to speak of “fire damage” in common conversation. The topic of qi is never discussed as though it were a new age concept or a leap of faith. It is simply a normal word that has long been integrated into their language and thought.
The environment of TCM study in Taiwan is on an entirely different scale than in the West. For example, Chang Gung University is a large medical university outside the capital of Taipei. It has an enormous campus with thousands of students of both medical systems, and is affiliated with three large hospitals. Every subject and department in Chinese medicine is available in their curriculum, and the faculty is culled from the top four mainland Chinese universities.

Students of TCM have a command of double the number of single medicinals and formulas than are covered by the US national exam. The Taiwanese licensing exam for TCM involves not just the memorization of these agents and formulas, but also the rote memorization of classics, both medical texts such as wenbing and shanghanlun as well as cultural classics such as Laozi and Confucius. A well-known doctor such as Feng Ye (co-author of the Practical Dictionary of CM and Paradigm’s Shanghanlun) sees over 3000 patients a month in clinical practice, which gives his student interns the chance to see great diversity of patient presentations. Thus, the sheer volume of textbook study and patient visits typically gives the Taiwanese student wider exposure than their counterpart in the West obtains.

Physical modalities such as acupuncture and tuina abound. Tuina doctors study tuina specifically for seven years, while the acupuncture department is full of specialists who have dozens of beds filled with all manners of punctured patients. The average acupuncture treatment allows the doctor about three minutes to determine the diagnosis and administer the treatment before a timer is set for the nurse who removes the needles. Doctors usually manipulate the needles with great skill, invariably obtaining a very stong qi sensation that brings out a yelp but sends you floating in some distant mental state for the next 30 minutes. Tuina sessions typically last about 10 minutes and can be quite agonizing (or masochistically pleasurable), complete with bone manipulations and herbal plasters. Both departments like to use heat lamps, and sometimes one sees the use of steam dispensing machines. The steam dispensers are little glass devices that plug into the wall and have herbal decoctions cooking within. The stream is concentrated to be shot out of a tube which blasts the steam on the offending joint for impediment cases, usually done on joints with a couple needles already inside. Taiwanese doctors are often amazed to hear that needles are still re-used in mainland China, and the relative abundance of resources generally allows for much more sanitary hospital conditions.

Enthusiasts about food are in heaven in Taipei. All the hours of textbook study jump to life when common medicinals are spotted all over town integrated into tasty treats. Delicious snacks made from maltose and black sesame seeds (heizhima) are always a treat that is never far away- variations include black sesame mixed with peanuts or mung beans, and black sesame paste has also been known to find its way into succulent little pastries served hot right on the street. Some shops specialize in supplementing foods, and have a variety of chilled or warm soups made with red beans, lotus seeds, lily bulb, mung beans, tremella fungus or wild yam (shan yao). Street vendors sell pancakes made from wild yam for a healthy snack, or you can opt for pork ribs cooked in shiquandabutang if you are craving a warm and savory vibe. Nowhere in China are supplementing foods so popular as in Taiwan; and locating a spot for dang gui duck is seldom difficult (it is usually cooked in a modified si wu tang). Spotting some gou qi zi floating in your soup is a common occurrence even in restaurants where “nourishing life” is far from a theme. Taiwanese food is generally fantastic, and the medicinal cuisine is an excellent complement to the ordinary dishes.

The herbal beverages available in Taiwan feature an astounding array of options for whatever ails you. Every 7-11 (and Taiwan has a lot of them) stocks all manners of drinks that are popularly consumed as healthy refreshments. Winter melon (dong gua) is among the most common in vending machines, but a convenience store has drinks made from everything ranging from mei gui hua, ju hua, lavender flower, or xia ku cao to the ever-present gou qi zi with long yan rou and hong zao. If you feel under the weather, 7-11 has a beverage similar to yin qiao san for you, or if you are simply run down and overworked you can try supplementing drinks made with Tibetan hong jing tian and a blend of other tonics. They can usually be found next to the red bull if you are in a 7-11.

The array of products offered clearly reveals some cultural biases customized to the local climate. For example, in nearby Hong Kong, the Cantonese are obsessed with the idea of heat damage. Here you will find an abundance of cooling teas, usually complex blends simply called liang cha (cooling tea) or the simpler wu hua cha (five flower, which invariably has jin yin hua and ju hua in the mix). Hong Kong’s convenience store beverages of choice seem to feature American ginseng, but you also can spot xia ku cao, ji gu cao, luo han guo and wild date drinks. Gui ling gao is a famous product of Hong Kong; it is a jelly made from tu fu ling, gui ban, and bie jia, and is a nice way to minimize the effects of the damp-heat that seeps into your body the second you leave the air-conditioned indoors.

Other popular Cantonese products include warm soup made from ground black sesame or the other usual suspects, mung beans, white tremella fungus, lotus seeds, and lily bulb; the “zhi ma hu” made from black sesame is clearly my humble favorite, but I must say it is quite ineffective at treating baldness. Maybe I should be more consistent with my intake of fresh mulberry juice, which is a tasty treat currently in season. Speaking of hair supplements, he shou wu (ye jiao teng) vines can sometimes be spotted in a pile on the street, usually sold by a little old lady with thickly accented Mandarin.

Taiwan contains the entire spectrum of Chinese medicinal use, from folk medicine to the rigorous evaluation of herbal drugs by medical schools and pharmaceutical factories. All clinics tend to use granule extracts since they are covered by national health insurance, but herbalists will often write raw prescriptions with no consultation fee for their good customers. The worldwide interest in holistic and healthy lifestyles has reached Taiwan, and there are many common products accepted into local folk medicine.

Tea is perhaps the most abundant herbal product in Taiwan. A famous area for producing quality oolong tea is right outside of the capital, and tea is a component in the cooking of a number of specialty dishes. Tiny plantations where special tea is grown dot the hillsides and provide a perfect spot to sit and talk while overlooking the city. Tea is mostly known medicinally in the West for its polyphenol consituents, which are potent antioxidants; it also contains xanthine chemicals, primarily caffeine, which ranges from about 2–4% of its dry weight. In traditional theory, tea is thought to be an agent that is bitter, sweet, and cool; its channel entry is ascribed to the heart, lung, and stomach. Its primary actions are to clear the heart and eyes, eliminate vexation-thirst, transform phlegm, disperse food, disinhibit urination, and resolve toxin. It is used for headache and clouded vision, which perhaps explains the folk use of strong tea as a cure for hangover. It also treats a tendency to sleep, heart vexation and thirst, food accumulations and phlegm stagnation, malaria, and dystentery. It may be brewed and taken as a beverage or made into pills and powders; the dosage range is 3-10g.

Tea is not the only herbal drug widely consumed in Taiwan for recreational or medicinal purposes. Betel nut is the world’s fourth most-commonly consumed drug, falling behind only tobacco, alcohol, and caffeine sources in its total number of users. TCM practioners largely know bing lang to be an agent useful for killing parasites and promoting peristalsis, but there is a folk belief that its strongly warming energy can prevent external contraction of cold evils as well. It is frequently consumed by bus drivers or truck drivers for its stimulating effects; it is habit forming and is linked to oral cancer. The nut of Areca catechu is usually wrapped in the leaf of a plant called Piper betel, and a type of limestone mixture is added- this is said to be the component primarily responsible for the damage to the teeth and gums that marks chronic users. A constituent of betel nut, arecoline, has been reported to be a cognitive enhancing agent as an isolated drug. Apparently, it improves serial memory and learning, but it is not typically recognized for this property in Taiwan. The “buzz” of betel nut is mild and short-lived, somewhat akin to tobacco; proponents claim that the different preparations and types of nuts provide slightly different effects. It appears that the chewing of betel nuts is a practice that never caught on in mainland China and likely originated from India. Betel nut stands are found on nearly every street corner in urban areas. Rural betel nut stands often employ young women in bikinis to entice customers, but don’t let the window display and pink lights fool you- betel nut is the only thing that is offered for sale.

Taiwan is a perfect place to illustate the options that exist for students of Chinese medicine and language. While much of the discussion on the CHA often revolves around the importance of language to reference medical literature, a benefit of language study that is equally significant is the degree to which it makes the world of Chinese culture accessible. The spirit of our medicine can be seen in all aspects of life in Taiwan, and there are far more things to see than one column could ever introduce.