By Eric Brand

I recently moved back to my hometown of Boulder after spending the past ten years or so living in Taiwan and California. In each place, it seems that the local culture has a strong influence on people’s perception of health and medicine. In particular, I find it fascinating to observe differences between places like Taipei and Boulder, which are night and day in terms of their attitudes and surrounding environments.

Allow me to give a little background on the things I notice about these places and the attitudes that seem prevalent to me. Boulder is a pristine land of sunshine and clean mountain air, and the locals tend to favor things like dietary restrictions, fasting, and cleansing. The environment is quite clean and pure, and there is a cultural bias towards separating things like foods into categories of “pure vs. impure” or “good vs. bad” based on a variety of ecological/moral/medical parameters. In Boulder, people do yoga and shop at Whole Foods to stock up on the stunning selection of vegetarian, dairy-free, organic, gluten-free items that are available to satisfy the local palate.

By contrast, Taipei is a dense city with plenty of pollution and no concept of food allergies. When it comes to food, variety, freshness, and flavor are the things that people prize and most locals tend to eat absolutely everything as long as it is fresh and tasty. While people like natural organic food from deep in the pristine mountains, people that eat organic food exclusively are few and far between compared to Boulder. Taiwan does have a significant number of vegetarians, but most are vegetarian for religious reasons (they also avoid eggs, garlic, chives, onions, scallions, etc) and other dietary restrictions are rare. In Taiwan, the majority of people eat all manners of creatures from land and sea, and a formal banquet could easily have a dozen beasts served in a single meal. They don’t overdo any one thing but they eat absolutely everything, and this diversity is emphasized in their cuisine.

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I remember getting ready to go to Taiwan for the first time. I was going to the University of Colorado at Boulder and I had been a strict vegetarian for several years. Before starting my study abroad, I remember thinking that I might need to toughen up my system to handle eating meat again, since I didn’t know what I’d be served and I didn’t want to offend anyone by not eating what they gave me. So I shaved my hippie beard and started introducing meats, starting slowly with fish, then small amounts of organic chicken, venison, etc. I remember it was difficult to introduce animal products back into my diet because my system felt so delicate and sensitive to the slightest perceived impurities.

Many years later, I don’t even bat an eye when served a dozen different creatures in the same meal. Things like pollution and strange foods don’t faze me much at all, and the days when I had a delicate constitution seem far, far away. What has changed? Was I weak and I got tougher? Or was I more clean and pure and now I’m more polluted and thus less sensitive? Sometimes I wonder if both are true.

Culture and medicine are very closely connected. This is particularly evident when it comes to things like food. Americans are not very focused on food compared to many Old World places like France or China. Americans fit food into their schedule, whereas Chinese people schedule their day around meals. In Chinese society, one never sees a friend, family member, or business colleague without having food together. Food is so important there that a problem with eating would be a major issue- it would be a subtle loss of face if your diet was so restrictive that eating out became difficult, and the concept of a telling your teacher that you can’t eat because you are on a fast would be unthinkable.

The Chinese cultural values around food have influenced Chinese medicine. Chinese medicine has the concept that food should be transformed and should not be stuck as a stagnant mess in the intestines, but Chinese medicine never had a strong emphasis on cleansing, fasting, or dividing foods into categories of good and bad. All foods have certain properties, and if those properties are in balance with each other and the constitution of the eater, the food is good. If it doesn’t fit the person, the food is harmful. There is a general concept that a healthy person should not have problems with any individual foods.

In the past, I used to be a relatively delicate individual. I was sensitive to a wide variety of foods, I was more emotionally delicate, and I tended to do a lot of qi gong. I was more prone to fluctuation, perhaps more sensitive to good things but also more sensitive to being out of balance. My lifestyle worked in a pristine place like Boulder, but I never would have been resilient enough to handle rural China. Now I am much tougher, but I wonder if there is any part of that delicate, sensitive qi gong guy that I’ve lost along the way. Obviously one wants to strike a balance wherein one has enough sensitivity but not too much. I wouldn’t want to be so dull and coarse that I couldn’t slip smoothly into meditation or couldn’t feel qi clearly with acupuncture or bodywork, but I also wouldn’t want to be so sensitive that I couldn’t handle lots of air travel and Peking duck.

Overall, humans tend to hold beliefs that we resonate with emotionally. We then go about looking for evidence that supports our beliefs and we tend to downplay evidence that goes against these beliefs. The beauty of the 21st century is that we can shop around for different cultural perspectives, and we can hold onto the perspectives that fit with what we want to find.

In the modern world, we have a lot of factors that never existed before in human history. A few hundred years ago, even a king would not have a library like we have here in our office. Even a king would not hop across different continents five times per year. We simply have opportunities that have never existed before in human history, and many such opportunities are still not possible for 99.9% of the world’s population.

I think that the opportunity to travel is a gift, and I almost feel like I must rise to the challenge of travel simply because humans didn’t have such a precious opportunity in days gone by. Thus, I think it would be tragic if my system was too delicate to handle the sudden changes of climate and hygiene that I experience every time I hop on a plane to some far-off place. In the past month, I’ve been in the bitter winter of Chicago, the gentle warmth of San Diego, the tropical heat of Hong Kong, and the dry frozen wind of Colorado. One day I eat an ultra-hygienic organic salad and the next week I eat spicy goat that is prepared in super third-world conditions. Surely some people would say that such a lifestyle is crazy. I’m inclined to think that it keeps my immune system on its toes, but I admit that I am inclined to think this because it justifies my continued pursuit of a lifestyle that I enjoy. At the end of the day, nobody knows because people have never done this kind of thing before.

Basically, we have some new questions in Chinese medicine at this time. If we change environments and travel from the first world to the third world overnight, the change in hygiene seems to test the body's defenses. We get a bit off in the gut for a few days, then we hit equilibrium and are back to something like normal. Over time, we seem to be able to accommodate the change in bacteria and such with greater ease. Furthermore, the plant sciences show us that many plants perform better when subjected to stress, and things like the increased rate of asthma in city kids from squeaky clean houses relative to farm kids suggests that the human immune system responds well to challenges. Healthcare workers such as CM practitioners and pediatricians tend to have strong immune systems from the constant challenge of treating patients with colds and such, so there is clear evidence that some degree of challenge to the immune system is of potential benefit.

But how much is too much? Clearly a worker in a mine gets overwhelmed by toxic exposure, and no one would argue that a diet of Micky D's would be good for the organism. However, what is the right line between protecting the immune system from harm and stressing it beyond its breaking point? Our immune system is an inherited rough, tough fighting machine that has endured far harder times than the modern day, and all these autoimmune diseases suggest that it needs a challenge or it will start a fight just to keep in practice. But clearly an overload of toxicity also cramps our style.

CM practitioners are encountering a phenomenon with little historical precedent, and we won't find language that explains it like this in the classics. We need innovative thinkers with a strong foundation in traditional theory, because the best way to come up with good solutions is to adapt the herbal combinations and theories from our historical texts and think about them in relationship to the modern day. We need new ideas based on a strong foundation. What do we do about these people with hyper-reactive immune systems? How do we treat patients that have lives that involve travel and abrupt climate change? How do we ourselves adapt to jet lag and climate change so that we don't lose our equilibrium? How clean is too clean, and how much is too much? Should we push ourselves harder or be more gentle to ourselves? We need to keep that adaptive edge and healthy stress, but we also clearly need to relax and have some downtime.

As Chinese medicine practitioners, I think it is important for us to be sensitive to the perspectives of our patients. We live in a very complex and diverse society, and different people respond to the same stimuli in different ways. As practitioners of Chinese medicine, I think we should always strive to be objective and flexible in our thinking so that our lifestyle advice fits the needs of our patients. Ultimately, many practitioners have opinions that are shaped by their own constitution and preferences, and I think it is important to recognize which of our beliefs can be traced to our own cultural bias and which of our beliefs can be traced back to Chinese medical theory. Chinese medicine is not fundamentally very judgmental, but many practitioners tend to intersperse their own judgments into it. As practitioners, we often need to put our own opinions on the backburner while we try to get an objective read on the patient in front of us. Talk about a challenge in sensitivity!