Balance has been an essential component and philosophical foundation upon which Chinese culture and thought has evolved over the centuries. Based on Yin/Yang theory in addition to the concepts of change and impermanence, the process of discovering one's harmonious place within the world and within one's body is the driving force behind the Chinese concept of health. It is no wonder that according to this tradition, in order to find one's place in the universe, we are directed to look inward, to the "center" of our being and heart of our experience. A vital aspect of this process medically speaking is in my opinion, to master our relationship with the middle burner; how we eat, what we eat, when we eat and of course digestion itself. Our relationship with food is an essential component in experiencing balance within our life. It is no surprise the Chinese have created an extensive system of working with food to assist in this endeavor.

A Brief History of Food as Medicine
The origin of our Qi and Blood stem directly from the Spleen and Stomach, hence diet and digestion are a fundamental component of maintaining health and also if abused, causing disease. The first recorded statements concerning food are found in the Nei Jing and are based on Five Element theory. Chapter 23 of the Su Wen states,

"Travels of five flavors: sour travels to the Liver, pungent travels to the Lungs, bitter travels to the Heart, salt travels to the Kidneys, sweet travels to the Spleen, and these are called the five entering routes." ¹

Chapter 78 of the Ling Shu says:

"Five travels: sour travels to the tendons, pungent travels to the Qi, bitter travels to the Blood, salt travels to the bones, sweet travels to the flesh. Such are called the five travels ...Only a diet comprised of all five flavors – sweet, bitter, pungent, sour and salty, can keep the bones straight, the sinews supple, the Qi and Blood flowing, the pores closed, and the functioning of the five major organs coordinated and balanced harmoniously. Conversely, persistent addiction to a certain flavor will lead to its accumulation within the body and, in the course of time, will result in loss of balance of the organs and bowels." ²

It also describes the pathology associated with an overindulgence of the five flavors:

"Too much sour causes Liver Qi repletion with consequent Spleen Qi exhaustion. Too much salt taxes the Qi of the large bones and withers the flesh in addition to repressing Heart Qi. Too much sweet causes Heart Qi to be full and stuffy, the facial color blackish, and the Kidney Qi not balanced. Too much bitter causes the Spleen Qi to loose its moisture and the Stomach to become too broad or distended. And too much acrid and pungent causes the sinews to be slack and the vessels stopped up while the spirit suffers disasterŠIf too much salt is eaten, the pulse will be sluggish and the complexion will lose its vitality. Too much bitter will cause the skin to dry and the hair to fall. Too much sour and the Liver will produce too much saliva, which in turn will stifle the functioning of the Spleen. Too much salt and the bones will become weak, the muscles and flesh will whither and the functions of the Heart will be suppressed. If sweet exceeds the other tastes, the function of the Heart will cause difficult breathing and chest distention, a black color will appear, and the kidneys will become imbalanced. If bitter exceeds the other tastes, the function of the Spleen will not be able to transfer fluids and the function of the Stomach will be too tense. If spice exceeds the other tastes, then the muscles and pulse will become slack and the Spirit will be injured." ³

With regards to individual foods however, these classics did not categorize or list foods by flavor and function. The first dietary compendium was compiled by the father of herbal medicine, Shen-nung during the Han Dynasty (25-220 A.D.). The text was called Sheng-nung Huang-ti shih-chin, literally "The Interdictions of Shen-nung and Huang-ti concerning Food." ⁴ Unfortunately, the actual work has been lost.

As an example of how specific foods were discussed and prescribed, a few ideas are presented here from the famous physician, Chang Chung-Ching. In his Chin Kuei Yao Leuh, "Remarkable Elements from the Golden Chest" he discussed the appropriate practices surrounding the consumption of organ meats as such:

"In spring liver should not be eaten; in summer heart should not be eaten; in autumn lung should not be eaten; in winter kidney should not be eaten; in all seasons spleen should not be eaten. The reasons for these prohibitions are several. In spring the liver reaches its climax of exuberance and depletes the spleen. The eating of liver augments the exuberance and further depletes the spleen, ultimately leading to an incurable condition. Also, during the liver's exuberant period, the genuine hepatic Chi should not be introduced into the liver, otherwise the soul will be injured. In all except the exuberant season, it is good to supplement the liver with liver. The rule applies to other visceral organs as well." ⁵

In the Shang Han Lun, he also discussed the importance of ingesting congee when one is using Cinnamon Formula for the initial stage of wind-cold in a patient of weak constitution. Zhou Feng-Wu further explained the importance of this practice in an article entitled, "The Indications of Decoction Ramulus Cinnamomi Composite:"

"The administration of hot dilute porridge aids the Stomach Qi, provides substance for the Ying and Wei, benefits the fluid, assists the distribution of the fluid of the Middle Warmer, and carries the hidden evil with the sweet towards the surface. It is to be noted that the drinking of hot dilute porridge is one of the essential components of the Decoction Ramulus Cinamomi Composite." ⁶

In A.D. 203, the Taisho Tripitaka: Cannon of Buddhist Writings in Chinese was translated into Chinese from Sanskrit. This doctrine discusses potential sources of illness and specifically lists as the words of the Buddha, nine causes for a premature and unexpected end to human life. Interestingly, five of those nine causes are related to food. They are:

"Eating what should not be eaten" which refers to eating things repugnant to the senses, eating out of balance with the seasons and eating directly after finishing a meal.

"Immoderate eating" a habit of over-consumption, or eating beyond what one needs.

"Eating contrary to custom" which means eating at odd hours and eating too much of a strange food in an unfamiliar culture.

"Failure to discharge the old before the arrival of the new" which means heaping more food on top of undigested food.

"Intentional retention of digested food" which means preventing the normal release of stool and urine, preventing a belch, vomit or wind." ⁷

In the official historical bibliographies of the T'ang period (618-907A.D.) there are several books listed called, Shih ching, Food Canons (definitive texts on food) but again most of them are long gone. These books were far more than your everyday cookbook. They were dietary guidebooks designed to instruct the elite on the preparation of a balanced meal which would support the internal biological ecology and promote longevity.

One seventh-century pharmacologist, Meng Shen, is most notably remembered for his food canon which only remains in fragments in a Japanese text, the I shin ho. Almost every recipe in the text is an instruction for a physician. One example was a recipe for baldness, which combined ground walnut meats and lead and was then to be applied topically.

The importance of dietary therapy was clearly illustrated in the statements attributed to Sun Si Miao. Sun Si Miao (581-682A.D.) authored the famous Treatise on Alchemy, the Dan Jing Yao Jiu, and in regards to food, said, "that when a person is sick, the doctor should first regulate the patient's diet and lifestyle. In most cases, these changes alone are enough to effect a cure over time. He said that only if changes in diet and lifestyle are not enough, should the doctor administer other interventions such as internal medicine and acupuncture." ⁸

By the Sung dynasty, "diet and the study of medicine were virtually indistinguishable." ⁹ This time period was sparked by an enthusiasm for new tastes, ingredients and dishes and the book Liang-fang, or "Good Recipes" could also be read as "Good Prescriptions". The distinction between what constituted healthy food and medicine was very difficult to define and being a time marked by curiosity and experimentation, many new substances were tried and in some cases, like that of mercury, led to the demise of the taster. During this time period the relationship between food and herbal decoctions such as the "secret-of-Yang pill," "the four divine pills for regulating the humors" and "powder of cinnabar" were all part of a common everyday approach to diet. ¹⁰

Concepts of what constituted the ideal diet were continuously debated for what seemed healthy for one person was problematic for the next. What was agreed upon though was that there were many considerations involved in determining a person's optimal diet Issues such as demographics, astrological relationships and an individual's constitution were all important factors. In addition, there were a few universal dietary guidelines that were emphasized during that time. Many common foods were seen as having a possible injurious action upon the body but if eaten in moderation, were not harmful. Over-consumption and gluttony were not only devalued from a medical perspective but within the framework of Confucian philosophy, were certainly viewed as inappropriate.

There was an emphasis on the natural aspect of food. Eating foods according to the proper season was important and also eating foods personally grown was seen as a superior dietary activity. There was an attempt to de-emphasize the rich and varied food of the city official and promote the simple meals of the mountain villager. Philosophically, it seems important to note that this emphasis on the simple and natural diet was in and of itself the intellectuals attempt to align themselves with the Confucian doctrines of social concerns, ethics and humility. Additionally, this naturalness included the idea of eating all edible plants, roots and mushrooms gathered in the local area and mountain regions. It included foods easily accessible and also a style of cooking that allowed for the foods inherent "clarity" to express itself. Meals which were simple yet elegant provided a sense of balance between food, man, his/her environment and heaven.

It is no surprise that during this time, a great physician Li DongYuan wrote the Wei Pi Lun, "The Treatise on the Spleen and Stomach" and founded one of the great schools of Chinese medical thought based on the function of the Middle Burner. He basically postulated that the health of the Spleen and Stomach is a primary consideration in the comprehension of health and pathology because all postnatal Qi is dependent upon its function. From this perspective then, I believe food is elevated to a very important position in relationship to health and consequently should be regarded and treasured as medicine.

According to Chang in Food in Chinese Culture, "Most medicines were ordinary plant and animal matter, and early Chinese physicians recognized the practicality of combining therapy with food. Needham paraphrases an eleventh century writer: ...old people are generally averse to taking medicine but are fond of food. It is therefore far better to treat their complaint with proper food than with drugs. Nutritional therapy should be resorted to first and drugs prescribed only after proper feeding has failed." ¹¹

Chang sites Needham as reporting the most important advanced in medicine during the Yuan period to be in the arena of dietary medicine. Namely, the publication of the Yin-shan cheng-yao, "Principles of Correct Diet" of 1330, written by Hu Ssu-hui. The essence of this document was "Many diseases can be cured by diet alone" and one main focus of the book was on supplementing deficiencies through diet.

Another fourteenth century writing, Chia Ming's Yin-shih hsu-chih, "Essential Knowledge for Eating and Drinking" was a text the emerged out of the experiential life of a man who attained great longevity. When he was asked by the emperor why he was able to live so long, he said "The essential is to be careful about what one eats or drinks" and thus the focus of this book is health prevention through diet. He states:
"Drink and food are relied upon to nourish life, yet if one does not know that the natures of substances may be opposed to each other and even incompatible with each other, and [one] consumes them all together indiscriminately, at the least, the five viscera will be thrown out of harmony, and at the most, disastrous consequences will immediately arise. Thus it is that persons nourishing [successfully] their lives have always avoided doing such damage to life." ¹²

For over two thousand years, Chinese dietary therapy has evolved into a comprehensive system for determining optimal nourishment for our bodies. Divided into two categories, health preservation and remedial therapy, specific foods may be selected to both support the individuals Righteous Qi and avoided to prevent further damage. Because Chinese medical theory maintains that there is usually one system in the body which is weak and get hit hard under times of over-activity/under-activity and stress, eating foods appropriate to ones constitution is a very logical and responsible means of self-care.

Clearly, the greatest Chinese physicians commented on and added to this basic theory of nutrition with great texts of dietary theory and food categorization, it seems obvious that a thorough comprehension of food and how to use it medicinally, would be an integral part of a strong foundation for the practice of any modern day, Chinese medical physician.

References

1. Prince Wen Hui's Cook Chinese Dietary Therapy, Flaws & Wolfe, p. 15, 1983. back
2. Prince Wen Hui's Cook Chinese Dietary Therapy, Flaws & Wolfe, 1983. back
3. Prince Wen Hui's Cook Chinese Dietary Therapy, Flaws & Wolfe, 1983. back
4. Medicine in China, Unschuld, p.113, 1985. back
5. Prince Wen Hui's Cook Chinese Dietary Therapy, Flaws & Wolfe, p.80,1983. back
6. Prince Wen Hui's Cook Chinese Dietary Therapy, Flaws & Wolfe, p. 85,1983. back
7. Medicine in China, Unschuld, p.311, 1985. back
8. The Tao of Healthy Eating, Flaws, p.1, 1997. back
9. Food in Chinese Culture, Chang, p.171, 1977. back
10. Food in Chinese Culture, Chang, p.172, 1977. back
11. Food in Chinese Culture, Chang, p.227, 1977. back
12. Food in Chinese Culture, Chang, p.228, 1977. back