Herbal Explorations

Bridge the Cultural Gap: Traditional Chinese Herbs and American Health Consumers

By: Jeanine Adinaro, L.Ac.

Popular thinking holds that acupuncture services became available in the United States after President Nixon´s famous visit to China in 1972. In advance of that visit, James Reston, a New York Times correspondent covering the political happenings there in 1971, required an emergency appendectomy while in- what the West then referred to- as Peking. Though his surgery was unremarkable, his post-surgical gastrointestinal discomfort was successfully treated with acupuncture and moxibustion. And then the PR floodgates opened for acupuncture in the United States.

While it is true that the popularity and general availability of Oriental Medicine surged after Reston´s articlei, the reality is that acupuncture had been lurking in the shadows of American health culture for some time. Though the exact date of acupuncture´s arrival is unknown, it stands to reason that Oriental Medicine practitioners arrived here to practice their craft as part of the influx of Chinese railroad workers to California in the mid-19th century.

Why then an over 100-year gap between the appearance of Oriental Medicine in America and the familiarity of the practice by the English-speaking population? Paul Unschuld described the basic prerequisite for medical success best when he wrote, "The strength of a healing system in society rests only partly on objective success; equally important for its continuing acceptance and support is the anchoring of its medical notions in the world view, and especially in the sociotheoretical concepts of a population...."ii Simply put, when it came to acupuncture in the United States, prior to 1971, no one had made much effort to put the ancient practice into a cultural context that modern Americans could understand.

Today acupuncture holds a greater place of importance in America than ever before. Increasingly, the average health consumer has heard of acupuncture, knows someone who has benefited from it, and may even have health insurance coverage for such treatments. Sadly, Traditional Chinese Herbal (TCH) therapy has not achieved the same acclaim. As Oriental Medicine practitioners, it is left to us to change that. By keeping several key elements in mind, we can anchor TCH in the American world view.

Educate your patients on the purpose and intended effect of the herbs you prescribe
Too often, I have encountered people either in my acupuncture practice or as acquaintances seeking clarification on why they were given herbs by some other alternative medicine practitioner. I always ask them, "Didn´t your care provider tell you what these herbs are for?" Sometimes the answer is simply, "No," and other times they tell me something like, "Well, he said something about my gallbladder stagnation, but that doesn´t make sense since I had my gallbladder out 10 years ago."

Recently, a nuherbs Co. employee e-mailed me this story:

"...when I went to my acupuncturist for the first time (long before working for nuherbs), a lovely older Chinese woman who actually is a dean at AIMC, she just handed me the prescriptions I couldn´t read and I set off to an herb store in Oakland. (I found out later that day when I met Wilson [nuherbs VP of Sales and Marketing] for dinner that I had been sent to his Dad and got herbs from him!) I had no idea what the branches and roots were, just boiled them as instructed and drank it down. My parents had an acupuncturist/herbalist down in Santa Barbara so I didn´t really think twice about it because I knew the procedure and trusted that it worked. Most people, though, probably don´t come at it from the same place, and I think there can be a lot of fear!"

It is my firm belief that all patients, regardless of modality, should understand the intended effect of their therapies before leaving the prescriber´s office. Obviously, there is only so much we can do as practitioners to verify our patients´ understanding short of giving a pop quiz at the end of treatment, but we must make every effort to try. We are not merely practitioners of Oriental medicine, but ambassadors of Oriental medicine, tasked with the responsibility for bridging the cultural gap between thousands of years of Chinese history and modern American health consumers. That will not happen if we simply hand our patients bags of sticks, leaves, and twigs and tell them to take them.

Use western medical terminology or common nomenclature to describe conditions and the effect herbs are intended to have
Too often in their attempts to provide patient education, practitioners slip into TCH vocabulary. For example, I once witnessed an exchange between a student intern and a patient where the patient asked for a diagnosis and the intern simply said, "You have liver qi stagnation." The intern offered no explanation as to the nature of liver qi, or what its stagnation might mean regarding symptoms. The patient returned several weeks later and reported, "I went to my doctor and he ran some tests. He says my liver is just fine." I was not surprised when later the patient reported that he had not taken the Xiao Yao San teapills prescribed to him.

In order to gain the respect of our patients, we must speak to them in a language they understand. Translating TCH-speak into western medical terminology or common nomenclature can be challenging, but also rewarding. In the example above, imagine how differently things would have gone if the intern had spent time talking about the physiological effects daily life stresses can cause, giving examples of symptoms the patient himself was reporting. If she had then continued to explain the effect of Xiao Yao San in this case, I suspect the patient would have taken it.

American culture holds peer reviewed literature in high regard. Consider keeping copies of academic articles on hand to give to patients as additional information. For example, if you have a patient that you think might benefit from a modification of Liu Jun Zi Tang, give him an article on modern research and documented benefits of ginseng.

Make sure that herbs come with clear preparation, administration and dosing instructions
A practitioner friend of mine told me a story of a patient who came to his office complaining that the bulk herbs he had given her made her sick. The practitioner was confused because he hadn´t given the woman any herbs in several months. He asked her which herbs she was talking about, and she said, "Well, I had a bag of herbs leftover from last year. And another bag that you gave me 6 months ago. And another one that I´m not sure if it was mine or my husband´s. Anyway, I just mixed them all together and cooked them and took that."

As TCH practitioners we hear this story and laugh that a patient can be so silly. But this sort of misadministration of herbs is not uncommon. While it might mean more paperwork, my best advice is to make sure patients leaving with herbs also leave with unambiguous written instructions on how to prepare, administer and dose their herbs. Further, when sending patients home with bulk herbs, or packaged herbs that are labeled in Pin Yin, including an ingredient list of the common English names of herbs will help patients feel more at ease.

When using prepared herbs, make sure they are friendly to American consumers
As practitioners we too often get caught up in choosing the perfect herbal formulation for a patient and forget about presentation. Ultimately though, it does not matter how perfect an herbal formula is, it will not help the patient one bit if the patient does not take it. It is essential to remember that in the current climate of distrust toward Chinese manufactured goods, most Americans will simply not take herbs that don´t "look right."

As a practitioner, making herbs "look right" comes in several steps. It includes verifying that your source herbs are free of heavy metal, pesticide and biological contaminants. It also means that the packaging materials are written in clear, proper English. Finally, it means providing patients with a reasonable expectation of what they will find when they open that bag of herbs. If they aren´t expecting whole, dried centipedes, and that´s what they find, it´s not going to go well for anyone.

Keeping these simple strategies in mind when giving our patients herbs can make the difference between compliance and refusal. Bridging the cultural gap between TCH and Americans is not just about bringing the beauty and rich history of Chinese medicine to America, it is about facilitating health.

Jeanine Adinaro (jeanine@herbalogic.net) is a licensed acupuncturist and CEO of Third Coast Herb Company, Inc., a Texas company specializing in American friendly Chinese herbal remedies, and manufacturers of Herbalogic concentrated herb drops. For more information on specific herbal products, visit the Herbalogic products page.