A Post For TCM practitioners – A word about the value of using Chinese Nutritional Therapy in your clinic:
“When a person is sick the doctor should first regulate the person’s diet and lifestyle.”
Most practitioners of Chinese Medicine will be familiar with this quote from the ancient Chinese doctor Sun Si Miao. In my experience, addressing dietary issues with patients can dramatically improve clinical results, and also involves the patient much more in their own healing. In some cases this can lead to a lifelong improvement in health and well-being and a new found relationship with food.
It behoves us as holistic healthcare practitioners to encourage and empower our patients in this way, and also to use all the tools at our disposal to aid the healing process. Nutritional therapy is an ideal way of doing this.
This concept is part of the ‘Nourishing Earth’ school of Chinese medicine, which holds that the key to good health and well-being on all levels is the Earth element – or in other words, the digestive system. Both from the perspective of treating illness, and also in maintaining good health, the efficient functioning of the digestive organs, and the kinds of foods we eat, are absolutely crucial.
Many patients present with some kinds of digestive issues, even if only loose stools, bloating after eating, indigestion or food sensitivity. This alone should tell us that the Earth element needs to be addressed for these patients.
When treating severe deficiencies, using acupuncture or other complementary or holistic therapies alone can be very slow, and results are often poor. Using herbs can be more effective, but if the cause of the deficiency is poor diet, the herbal formula will only provide a temporary fix. In all these cases, nutritional therapy is indicated.
Applying Chinese Nutritional Therapy in Clinic
Many Chinese medicine practitioners in the West are poorly equipped to work with diet. I have observed (and experienced) a number of barriers to using nutritional therapy, which I would like to discuss in this article, with the hope that I can encourage more practitioners to engage with this powerful and important therapeutic tool.
The main problems I have observed can fall into three categories:
- Lack of knowledge regarding food energetics
- Uncertainty as to how to apply dietary interventions or advice
- Patient disinterest, or unwillingness to make dietary alterations
A lack of knowledge of experience in nutritional therapy can be a particular problem for acupuncturists, who may have had little or no training in Chinese food energetics. Herbalists are naturally more familiar with this territory because of the considerable overlap between Chinese herbal and nutritional theory. However, they may be lack the specific knowledge required to ‘translate’ their knowledge into working with food.
Thankfully, the lack of information available about Chinese nutritional therapy in the West is now being addressed, with gradually more and more texts and discussions about food energetics. I also offer my own 6-day training as a contribution to this body of knowledge.
The most important information to commit to memory to successfully use Chinese nutritional therapy in practice are the basics of a ‘Spleen friendly’ diet and the broad guidelines for specific imbalances.
For instance – The ‘healthy diet’ of Chinese medicine consists of a number of basic points which make digestion as easy as possible, in order to extract maximum goodness (in the form of Gu Qi) from our food. I call this ‘The Spleen Friendly Diet’:
- Always eat breakfast
- Don’t eat late at night (the weak time for the Spleen and Stomach is 7-11pm)
- Favour warm and cooked food over cold and raw food
- Chew well
- Don’t “flood the Spleen” by drinking too much fluid with meals
- Eat a varied diet, and avoid extremes
- Don’t eat ‘on the go’ or when emotionally agitated
- Avoid too much Damp producing food (dairy products, sugar, wheat etc.)
- Avoid unnatural, processed and refined food
- Don’t overeat
In addition, basic advice for the main imbalances can be quite straightforward to stat with. For example, for Yang deficiency we should avoid energetically Cold foods (mango, bananas, tofu etc), use hot cooking methods such as baking, and eat more Warming foods such as Lamb, Trout, and most spices. This will serve as a good place to start, and can be followed up with more detail, if required.
Putting it into practice
This is probably the biggest problem for many practitioners. Knowing exactly what to suggest to patients, and how, can be a considerable barrier.
Firstly, you need to know some detail of what your patient eats, and how. A detailed food diary can be useful in some cases, but may well not be necessary so long as you can get enough information about what and how your patient eats – for instance it is very helpful to ask the following kinds of questions:
How many meals per day do you eat, and when?
Are there any foods that you particularly enjoy?
Are there any foods that you find difficult or hard to digest?
Can you take me through a typical day’s food?
Do you snack and what on?
Do you eat meat, and if so, how often?
How much coffee and alcohol do you drink?
Patients are quite happy to answer these basic questions, and you can often get a lot of useful information at this stage – it also naturally leads to questions about digestion and elimination, which will be an important part of your diagnosis.
You should be looking for anything which is excessive or missing from the diet. In my clinic I commonly see the following kinds of issues:
- Too much meat in the diet, leading to Heat, Stagnation and maybe Phlegm
- Too many spicy or rich foods, leading to Heat, Dampness and Phlegm
- Too few vegetables, or a lack of good quality food leading to Qi and Blood deficiency
- Too many Damp foods (especially dairy products and sugar) leading to Dampness and Phlegm
- Too much coffee, leading to Yin deficiency and Heat
Spotting these kinds of broad dietary issues at this stage can give you a simple way to begin to give nutritional advice, without getting bogged down in very specific terms.
Once you have made your Chinese diagnosis you can revisit the discussion about food, and begin to make some general or specific recommendations. I will normally only give very basic suggestions at first (for instance, “try to cut down on coffee” or “eat a little more cooked and warm food, and fewer salads”.) More detailed or specific advice can be left until the second or third visits.
Sometimes I give nutritional advice very slowly, over the course of months. Swamping the patient with new information is very daunting, and it is important to judge each person individually in this respect. Leaving more specific advice until later sessions will also give you time to think through the best dietary approach and look things up if you need to.
For the newcomer to Chinese Nutritional therapy, I recommend focusing on the energetic temperature of different foods to begin with. For every patient with Heat (either Full or Empty) avoiding Hot foods will help, and for every patient with Cold (again, either Full or Empty) avoiding Cold foods will help. This is a simple but powerful way of starting to work with food, without getting too complex.
If in doubt, or if the case is very complicated, stick to the basic Spleen-friendly eating guidelines – these will help everyone. If there is a mixture of Deficiency and Excess, with some Hot and some Cold, as commonly found in the clinic, it is normally better to stick with the basics rather than try to make a very complex dietary plan that covers all angles. In fact, I would say that the more complex your patient’s diagnosis is, the simpler your dietary advice should be!
As your treatment progresses, remember to check in from time to time to find out how they are doing. If the pattern changes, you may need to alter your advice accordingly.
Getting The Patient On Board
In my opinion, it is very important to explain a Chinese diagnosis to a patient in everyday terms that they can understand. From here, you can go on to deliver dietary advice that will make sense to them, and which they are then much more likely to follow. If you sensitively explain to someone how the way they are eating may be making their condition worse, and suggest a realistic alternative, they will normally be keen to give it a try.
Just telling someone “you mustn’t eat this” is unlikely to meet with much success, unless the patient can understand the thought behind the recommendation. Phrasing your advice more along the lines “eat a little more of these things, and a little less of these” is a softer approach – it is more likely to be well received, and helps to ensure that the patient doesn’t go overboard; A well balanced diet is always important.
It is especially important to explain some of the Chinese theory when your advice is contrary to commonly held belief. For instance, almost everyone thinks that salads and raw foods are good for them, but easily see the sense in sticking to mainly warm and cooked foods when you explain how much extra effort is required to process the cold raw food. I use the analogy of the Spleen and Stomach as a cooking pot for this purpose (Bob Flaws gives a good description of this in his books.)
I find it very helpful to have a set of prepared diet sheets to hand out to people. I have one for general healthy eating principles, as described above, and a set for the most common broad disharmonies that I find in clinic (Yin deficiency, Qi stagnation, Dampness, etc..)
I supplement these with recipes or simple cooking advice when required. Bear in mind your patients may well not know an aduki bean from a mung bean, or have ever cooked certain kinds of foods. Don’t suggest something to your patients unless you know what it is, where to buy it, and how to use it!
Having some easy to prepare recipes or foods for different imbalances can be very useful. For instance, drinking ginger tea or chai is very simple for Yang deficient people, cabbage or beetroot soup for Blood deficiency, and lemon juice in hot water for Damp-Heat or Qi Stagnation.
Above all, you must be flexible in your approach. Dietary alterations should always be gradual. Patients will appreciate it if you work with them, and in a way that makes sense for them. Someone who has always eaten traditional ‘meat and two veg’ meals may not want to suddenly start eating tofu and mung bean stir-fry with brown rice! That doesn’t mean they can’t make adjustments that will help them though – it could be reducing certain meats, and using others in their place, adding different spices or herbs, or opting for certain kinds of veg above others.
Chinese Nutritional Therapy can improve the success of almost any treatment plan, and in some cases can be the missing element which is preventing remedial actions from working. All cases with a Chinese diagnosis of ‘Spleen disharmony’ or any case that presents with digestive issues will benefit from this approach.
Almost everyone can benefit from the basic ‘Spleen friendly’ healthy eating advice, and for deficiency cases, this alone can make a huge difference to a person’s health. Explain the principles to people in a way they can understand, and gently encourage them to make some small changes. Give them something written down to take away with them to give them a point of reference.
If they engage with this advice you can introduce more specific guidance on foods to increase and foods to reduce, based on their Chinese diagnosis. Again, make sure to give them written information, and be prepared to support them with basic cooking ideas or recipes if needed.
Above all, as a practitioner, I encourage you to learn how to put this vital knowledge into practice!
By working first with diet and lifestyle as Sun Si Miao recommended, we can really get to the root of many problems, and treat truly holistically. If you don’t already work this way, give it a try, and see the difference it makes!
My 6 day course on Chinese Nutritional Therapy for TCM practitioners is running this Autumn in Bristol, UK – All the details here