In the course of my practice, I was struck by the difference between the Western and Eastern concepts of what comprises a healthy diet. Many young women in their reproductive years, with a Western outlook, told me that their diets consisted mainly of salads and very little meat. They were proud of “eating healthy.” For them, this meant high fiber, low fat, and low calories. From the Eastern perspective, this diet is not considered healthful for young women.
TCM teaches that because of menstrual blood loss, women in their reproductive years tend to be Blood 
and Yang 
Deficient 
putting them in a Cold 
state. Their intake of food or herbs should be warming and tonifying to blood. Meats, which are considered warm, are more suitable for them than salads, which are categorized as cool. Arteriosclerosis and hypertensive heart disease are Yang conditions, usually more prevalent in males in midlife. For them, cool salads and meat reduction are in order. A woman in her reproductive years, however, is at low risk for this type of Yang condition. Unbalanced overconsumption of leafy vegetables, which are categorized as cool, is inappropriate for young women because it tends to magnify an existing Cold condition.
In 1989, on the day of the Loma Prieta earthquake in San Francisco, a young woman came to see me because of a persistent allergic skin condition. She gave a history of having been a vegetarian and a blood donor. My impression was that she was Yang and Blood deficient, so I advised her to stop donating blood and incorporate complete proteins such as poultry, meat, and fish into her diet. In the middle of our consultation the earthquake struck. It must have reinforced my message. She called me a while later to say she had taken my advice and her skin condition had resolved.
Another woman, also a vegetarian in her thirties, came to see me for pain in her spine. Four months before, she had fallen down some stairs with her infant baby in her arms. As a result, she sustained a fracture of her eighth thoracic vertebra. Fortunately, the baby was unhurt, but after the fall, my patient suffered from persistent pain and numbness at the site of the fracture. She had just quit her job, and she was breast-feeding her baby. I told her she was on the right track by quitting her job, thereby sparing her energy. I advised her to gradually add meat to her diet. With the change in her habits, and after seven acupuncture sessions, her symptoms resolved.
Influenced by their TCM heritage, Chinese patients customarily regard food and medicine as interchangeable. When they ask their Western physicians to advise them about diet, they are really asking about how best to balance their own deficiencies or excesses through choice of foods. The Western physician can advise about diet for some conditions: for diabetes, limit the glucose and simple carbohydrate intake; for heart disease and cancer prevention, increase fiber and antioxidant-rich foods, and avoid saturated fats. For many other conditions, though, there are no specific dietary recommendations from the Western perspective. In such cases, the physician would answer, “It doesn’t matter. You can eat anything.” The Chinese patient walks away disappointed. Without realizing it, doctor and patient are speaking from two very different paradigms.
Classifying people by type is common in most cultures. The Greeks have categories such as sanguine and phlegmatic. The Chinese classify not only people and disease types but also food types. Almost all foods fall into one or more TCM categories. Normally, foods are combined in such a way as to balance each other to neutrality. For example, leafy green vegetables, known to be cold, are often cooked with ginger, which is spicy and hot, to create balance. Meats, which are considered Yang, are sautéed with vegetables, which are considered Yin.
The cuisines of other countries also reflect this instinctive tendency toward balance. In French cuisine, buttery dishes, high in fat content, are balanced with garlic and onions, which tend to disperse and neutralize fats, thus discouraging harmful arteriosclerosis plaques from forming. Europeans also drink red wine, which neutralizes some of the harmful effects of the fats in their diet.
Environment is another factor in the TCM choice of foods. The Chinese, and probably other nationalities as well, prepare foods according to the season, with the thought of balancing the potentially detrimental effects of climate changes. In cold weather, more warming foods are eaten. In warm weather, we eat more cooling foods. Foods are also used therapeutically for their warming or cooling properties to balance a deficiency or excess in the host.
Toxic 
Foods
Over thousands of years, the Chinese have empirically found some foods to be less conducive to good health than others. They categorize these foods as toxic. In certain cases, these ancient beliefs have been validated by modern research. For patients whose total energy might be compromised, such as those with cancer, allergic conditions, painful arthritis, or those who recently underwent surgery, a TCM physician would counsel them to avoid certain foods considered toxic. The most common toxic food is shellfish. Interestingly, ancient Jewish dietary laws also proscribed shellfish. Modern science has discovered small amounts of arsenic in shellfish.
The other two foods in this toxic category are turkey and duck. Many Americans on low cholesterol diets have made turkey their meat of choice. I have to wonder if they are trading a benefit for a risk. Science has not yet found the basis for the Chinese belief in the toxic nature of turkey meat, so I refrain from commenting on this practice. Deep down though, I have reservations about whether turkey is the ideal meat touted by many. On the day after Thanksgiving, my grandmother used to make bitter melon soup for the family to counteract the toxic effect of the turkey consumed the previous day. Bitter melon is cool and has a cleansing toxin 
property. The term “cleansing toxin” can mean antibacterial, antiviral, or anti-inflammatory.
TCM’s dictum is to avoid or minimize toxic foods when the body is under excessive stress. If we consider the concept of economics of energy (see chapter 7), this makes sense. For patients with conditions that drain energy, such as wound healing or cancer, eating foods that contain anything requiring detoxification by the liver puts an extra demand on the body’s energy resources.
Energy Foods
For patients who are in a Deficient state, certain foods can restore energy. TCM considers the meat of animals that exhibit high energy to be a good source. Frogs’ legs are known to be the prime choice. The Chinese often prepare them for friends and family recovering from surgery or other medical conditions that deplete energy. Other meats in this category are lamb, beef, and venison.
Wet-Hot 
Foods
Mothers generally warn their children against eating too much candy or ice cream. Chinese mothers have an additional warning for their children—avoid too much Wet-Hot foods. I used to puzzle over why my mother warned me not to eat too many mangoes. This fruit is widely known among Chinese to be in the Wet-Hot category. I finally understood the meaning of this warning when I read that the allergen urushiol, found in poison ivy, is present in the skin of mangos. For people allergic to uroshiol, touching mango skin could set up a reaction similar to the one seen with poison ivy. The skin would get red and itchy; this is the “Hot” reaction. Blisters can form and often break and weep; this is the “Wet” reaction. If we keep in mind that TCM categorizations are based on observation, we can better understand the origins of the Wet-Hot category. The ancients may have observed that after ingesting certain foods, some people developed an allergic-type reaction, which, in TCM, is Wet (see chapter 4). With other foods, especially acidic fruits, certain other people might have an exacerbation of their arthritis, also known in TCM as Wind Wet (see chapter 4). So the general recommendation familiar to most Chinese is to avoid Wet-Hot foods if one has a Wet or Hot condition such as arthritis, allergic conditions, boils, or open wounds. In the absence of a Wet or Hot condition, these foods are not prohibited but should be consumed in moderation. Pineapple, mango, cherry, and strawberry fall into the Wet-Hot category. When advising patients, I used to be ambivalent about these foods. In the Western sense, they provide fiber and contain antioxidants and are considered virtuous, but from my Chinese cultural tradition, they have this Wet-Hot villainous side. I now think that these fruits have probably been unfairly maligned by generations of Chinese. My hunch is that in the absence of an allergy to them or an arthritic condition, they can be consumed with impunity. We need not feel the same guilt when eating them as when eating chocolates.
Hot 
or Fire 
Qi 
A familiar term in Chinese folk medicine is Hot 
(Cantonese) or Fire (Mandarin) Qi. It describes a state comprised of a constellation of ailments: acne, constipation, halitosis, dry mouth, nosebleeds, and sore throat. People with this condition are in a state of excess Yang Heat and deficient Yin. The condition can result from a number of causes. A common one is eating hot spicy foods. For me, curry will do it. A Korean couple who had more than the normal share of sore throats and styes came often to see me as patients. As we talked, I discovered that their diet included many spicy hot foods such as Kimchi. I advised them to eat less of that type of food, and the conditions that used to plague them became less frequent.
Another less commonly recognized cause of Hot Qi is taking certain drugs. Early in my practice, I prescribed a blood pressure drug for a Chinese patient. On her follow-up visit, she complained that the drug had caused her to have Hot Qi. Her symptoms were dry mouth and constipation. At the time, I was puzzled. I had never heard of drug side effects described as Hot Qi. Later, I recognized that many drugs do have a drying effect. The list includes antihistamines for allergies and the common cold, antidepressants, drugs to treat motion sickness (meclizine in the tablet form and scopolamine in the transdermal form are two common ones), and some blood pressure medications. They will cause constipation and a dry mouth. These side effects are symptoms of Hot Qi.
Traditionally, the Chinese know how to remedy their own Hot Qi conditions by eating cool 
Yin-promoting 
foods. A slightly more severe form of Hot Qi might be manifested by a sore throat. The mucous secretions in the mouth and throat are supplied with antibodies to fend off invading viruses and bacteria. When these secretions dry up, the immune defense mechanism declines, and the result can be a viral or even a bacterial throat infection. For mild sore throats, sometimes eating Yin-promoting foods is enough to resolve the symptoms. A more severe sore throat may indicate that an invading organism has breached the immune defense in the throat and clearing-Heat 
type herbs are needed. Incidentally, sore throat is the first warning sign of a decline in white blood cell count, a side effect of some drugs such as propylthiouracil for hyperthyroidism. The significance is the same: the normal immune mechanism has been breached.
In advanced Hot Qi states, when the secretions from various glands become dry and thick, there can be an obstruction to flow, resulting in acne or styes. This again might require a little more intervention than just a change in the diet. Along this continuum, an advanced stage might be severe constipation, leading to fecolith formation, as in the case of the boy I saw in the ER who developed appendicitis (see chapter 6).
Hot Qi foods include any kind of chips, popcorn, most nuts, and most spices, especially if the flavor is spicy hot. Cooking can move a food from neutral into the Hot Qi category. Any fried or barbecued food is considered to have Hot Qi. Chocolate is also a Hot Qi food. People who already have Hot Qi symptoms, such as acne, boils, constipation, and the like, should avoid these foods. In winter, the drying effect of cold air on mucous membranes often leads to symptoms like nosebleeds and sore throats. During this season, consumption of Hot Qi foods should be minimized. The Western custom of drinking hot chocolate on a cold wintry day is antithetical to the Eastern concept of an appropriate dietary habit. According to the TCM paradigm, frosty weather is the time to avoid chocolate.
Warming 
Foods
While some foods, such as fried foods and chips, are always considered unhealthy because they are in the Hot Qi category, not all Warm or Hot foods are considered bad. Sometimes Hot foods are used for their warming therapeutic properties. Many spices, such as cinnamon, pepper, and ginger, are considered warming. They seem to increase blood flow and may stimulate the immune response. Most meats are also considered warming. The Warming foods are therapeutic in the early stages of a viral infection when the body feels cold intolerance or chilly, but they are not so helpful later when there is fever and inflammation. Warming foods are useful in cool states such as during menses; when there is blood loss; during the convalescent phase of an illness; and when conditions such as diminished energy, slow metabolism, and poor circulation associated with aging exist.
Warming foods are also useful with arthritic conditions, which TCM classifies as Wind and Wet. TCM also describes arthritis as a Bi 
or an obstructed Qi, condition. In Western terms, we might think of it as poor circulation accompanying joint stiffness. Treatment calls for warming the patient, quelling Wind, and moving Blood and Qi. In essence, the goal is to improve circulation. Besides having a warming property, some foods in the warming category also quell Wind 
and dry Wet 
. Ginger, often taken by Chinese arthritics, is a prime example. Ginger is also widely used for nausea and gas. Studies show that it is as effective as any drug for that purpose (Micklefield, et al. 1999). In such cases, gas corresponds to the TCM term Wind, and the increased salivation and gastric secretion accompanying nausea correspond to the TCM term Wet.
My friend Ann, born in China in the 1920s before antibiotics had been discovered, told me that as an infant she became ill from a Heat disease, most likely an infectious disease. Her parents took her to see an herbalist who prescribed clearing Heat 
and cleaning toxin 
herbs, which are all categorized as cold. After she was given the cold herbs, her condition swung over to a very Cold state. Her parents later told her that she became pale, cold, and unresponsive, and her eyes became glazed. They presumed that she must have received an overdose of the cold herbs. Her Cold condition was so severe that the family gave up on her, but her grandfather came to the rescue. He boiled shaved cinnamon bark 
in water for her. After a teaspoonful, her parents said that life returned to her eyes, and after another, she began to look around. An interesting aside is that Ann has a Proustian aversion to the taste of cinnamon.
Cool 
Foods
Most leafy green vegetables, green beans, carrots, celery, and cilantro are cool foods. Some fruits such as banana, pear, and watermelon also fall into the cool category. These foods are recommended for excess Yang conditions like acne. For women who get acne before their periods, a soup of carrots, barley, and cilantro can help. A steady diet of predominantly Cool foods, though, can move a young woman into an excessively Cold state.
A young Chinese woman shared with me an experience she had. While living in Hong Kong, her diet for several months consisted mainly of vegetable soup. During that time, she developed prolonged and heavy periods to the point that she had to be hospitalized for anemia. Western-trained physicians were at a loss as to how to treat her. Finally, a Chinese herbalist diagnosed her condition as an excessively Cold state resulting from her predominantly vegetable diet. He made her a soup of eel, an energy food, and Angelica Sinensis 
, a warming and tonifying Blood herb often used for gynecologic maladies. After this dietary treatment, her excessive bleeding stopped. While eel is on the list of high-energy foods, it is less often used than frogs’ legs because of its high cholesterol content.
Postmenopausal women in their sixth decade, when they are no longer having hot flashes, sometimes ingest large quantities of bean curd (tofu) or soymilk for the phytoestrogen content. If overdone, this can be harmful. At that time of life, the kidney Yang energy is often low. If taken in large quantities, soy and bean curds, which are considered cool, need to be counterbalanced with warming foods.
Westerners have a one-sided view of foods. They consider consuming green tea, leafy green vegetables, and a variety of fruits as completely virtuous because they contain phytonutrients that prevent cancer by way of their anti-inflammatory effects. Many are antioxidants. Others, like flavanoids, also stimulate the COX-1 pathway to prevent inflammation (Perricone 2004, 48). Let us not forget, though, that there is a complex Yin-Yang relationship between COX-1 and COX-2 pathways (see chapter 5). Many of these foods containing the highly touted cancer-preventing phytonutrients fall into the Cold category in the Eastern paradigm. Excessive use of them can lead to an imbalance. If the patient’s constitution is thrown into a Cold state, adverse consequences might ensue. Inflammation is a Yang function. An excessively Cold condition can mean that the Yang energy necessary for immune function is suboptimal.
Yin-promoting 
Foods
In winter, when the cold weather dries the skin and mucous membranes, Chinese families often make soups with various squashes, dates, and figs. Slow, prolonged cooking with these ingredients and some pork will move vegetables in the cool category, such as bok choy or watercress, into a neutral position (neither hot nor cold). These soups are considered lubricating or tonifying to Yin because they help to moisten the mucous membranes.
The meat and shell of the turtle, a slow phlegmatic animal, is considered Yin. Turtle soup is believed to be therapeutic in Yin-deficient 
states, which include any condition where there is dryness. Flu, pneumonia, and radiation therapy all cause drying of a patient’s mucous membranes. The Chinese practitioner would recommend turtle soup, considered a delicacy, to restore Yin in these patients. Other meats that promote Yin are abalone, rabbit, and wild duck (as opposed to farmed duck).
Foods that seem to be especially effective in moistening the lung 
are loquats, cumquats, pears, and almonds, which are also frequently added to soups. These foods seem to not only nourish the Yin (enhance body fluid production) but also restore the normal consistency of mucous, which can become abnormally thick following a respiratory infection.
Dispersing Blood 
Foods
Some foods considered cold 
can also disperse blood 
, or discourage blood from clotting. Such was my discovery with bitter melon 
. Nellie was a Chinese patient of mine in her eighties. She suffered from chronic atrial fibrillation, a heart condition that put her at an increased risk for strokes. For stroke prevention, I prescribed coumadin to thin her blood. I adjusted her coumadin dosage by regularly monitoring her prothrombin time, which indicated how thin her blood was. After she had been on coumadin for quite a while, when the dosing requirement should have been stable, there were wide swings in her prothrombin time. Sometimes they were extremely high, indicating her blood was too thin. I would then have to tell Nellie to cut way down on her coumadin dosage.
Shortly before I retired, Nellie and her sister, also my patient, took me out to dinner. They asked me to pick something from the menu I liked, and I chose bitter melon sautéed with meat. Nellie commented that the dish was also one of her favorites, but she was afraid to eat much of it because every time she had bitter melon, she would receive my phone call informing her that her blood was too thin and that she had to reduce her coumadin dosage. I then realized that bitter melon, classified as a cool-cold vegetable, besides having antibacterial or antiviral functions, might also have anticlotting properties. I remember that when I was an adolescent, my mother advised me not to eat cool fruits like watermelon and bananas during my menses in order to avoid excessive bleeding. Perhaps the explanation is that these cool fruits also discourage clotting.
It is common in Chinese cooking to use ingredients that disperse blood 
. Many of these foods are in the fungus family, such as black mushrooms 
cloud ears 
, and wood ears 
. Years ago, I read in the New England Journal of Medicine about a case where researchers had to interrupt their study because of a puzzling development. The blood of the presumed normal subject, a Chinese researcher, intermittently had trouble clotting (Hammerschmidt 1980). The researchers discovered that the abnormality occurred on the days after the subject had eaten a dinner of Ma Paw Tofu 
, which contained wood ears 
, a common fungus. According to Chinese folk medicine, eating wood ear promotes longevity. This fungus most likely has antiplatelet properties, which help prevent strokes and heart attacks. We can think of it as comparable to taking one baby aspirin a day as so many older people in Western countries do.
In the 1950s, before the development of lipid-lowering drugs, my father would drink chrysanthemum 
tea before having blood drawn to test his cholesterol level. He relied on the tea to keep his cholesterol down to an acceptable level. Chrysanthemum is categorized as a cool 
herb. TCM practitioners use it for treating eye diseases and lowering blood pressure. Chinese lay people traditionally drink it after a greasy meal because they believe it somehow neutralizes the grease. The properties of chrysanthemum might be explained in Western terms as lipid lowering and decreasing sympathetic activity.
Table 5 summarizes the TCM classification of some common foods.
For thousands of years, the Chinese have used this ancient system of food classifications to keep themselves well. My grandmother, who lived to be ninety-nine, saw a Western practitioner only twice in her lifetime, once for gallstones for which she refused surgery and once for a broken hip for which she did have surgery. She otherwise kept herself healthy with traditional Chinese ways. When she reached ninety, she said that she needed to decrease sweets because she was getting old. This was long before the low-carb rage and the discovery that high glycemic index foods are bad for cardiovascular health. When we consider the escalating cost of drugs, learning from these dietary teachings may serve us well in the areas of preventive medicine and cost containment.
Table 5. TCM Classification of Common Foods.
“Nature, time and patience are the three great physicians.”