UBC Theses and Dissertations

UBC Theses Logo

UBC Theses and Dissertations

The practice of Chinese medicine in the contemporary urban context : herbalism in Vancouver's Chinatown Kuprowsky, Stephan George 1982

Your browser doesn't seem to have a PDF viewer, please download the PDF to view this item.

Notice for Google Chrome users:
If you are having trouble viewing or searching the PDF with Google Chrome, please download it here instead.

Item Metadata

Download

Media
831-UBC_1983_A8 K86.pdf [ 3.81MB ]
Metadata
JSON: 831-1.0107103.json
JSON-LD: 831-1.0107103-ld.json
RDF/XML (Pretty): 831-1.0107103-rdf.xml
RDF/JSON: 831-1.0107103-rdf.json
Turtle: 831-1.0107103-turtle.txt
N-Triples: 831-1.0107103-rdf-ntriples.txt
Original Record: 831-1.0107103-source.json
Full Text
831-1.0107103-fulltext.txt
Citation
831-1.0107103.ris

Full Text

THE PRACTICE OF CHINESE MEDICINE IN THE CONTEMPORARY URBAN CONTEXT: HERBALISM IN VANCOUVER'S CHINATOWN by STEPHAN GEORGE KUPROWSKY B.Sc., Trent University, 1977 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENT FOR THE DEGREE OF MASTER OF ARTS in THE FACULTY OF GRADUATE STUDIES DEPARTMENT OF ANTHROPOLOGY AND SOCIOLOGY We accept this thesis as conforming to the required standard THE UNIVERSITY OF BRITISH COLUMBIA September, 1982 (c) Stephan George Kuprowsky, 1982 In presenting this thesis in partial fulfilment of the requirements for an advanced degree at the University of British Columbia, I agree that the Library shall make it freely available for reference and study. I further agree that permission for extensive copying of this thesis for scholarly purposes may be granted by the Head of my Department or by his representatives. It is understood that copying or publication of this thesis for financial gain shall not be allowed without my written permission. Department of k A J t l M L o Pot The University of British Columbia 2075 Wesbrook Place Vancouver, Canada V6T 1W5 Date 6 A b s t r a c t T h i s t h e s i s i s an e t h n o g r a p h i c s t u d y of the p r e s e n t day p r a c t i c e of t r a d i t i o n a l Chinese h e r b a l m e d i c i n e by the Chinese community of Vancouver, B r i t i s h Columbia. A q u a l i t a t i v e r e s e a r c h d e s i g n was used t o document the f a c i l i t i e s , a c t i v i t i e s , people and b e l i e f s i n v o l v e d i n the p r a c t i c e of C h i n e s e h e r b a l -ism. A d e s c r i p t i v e s u r v e y i s summarized f o r the 1 8 h e r b a l pharmacies found i n V a n c o u v e r ' s Chinatown. One h e r b a l pharmacy i s used as an example t o p r o v i d e a c a s e s t u d y f o r the h e r b a l p r o d u c t s a v a i l a b l e and the i n t e r a c t i o n s between the h e r b a l i s t and the c l i e n t e l e . The t h e s i s i s o r g a n i z e d around t h r e e key q u e s t i o n s . The f i r s t concerns the s o c i a l o r g a n i z a t i o n of t r a d i t i o n a l Chinese h e r b a l knowledge i n Vancouver. A t r i -p a r t i t e model i s used t o c o n c e p t u a l i z e t h r e e d i s t i n c t a r e a s of e x p e r t i s e and knowledge of t r a d i t i o n a l h e r b a l i s m i n the C h i n e s e community. These a r e t h e : ( i ) t r a d i t i o n a l C h i n e s e h e r b a l d o c t o r s ; ( i i ) f o l k p r a c t i t i o n e r s who a r e h e r b a l p h a r m a c i s t s ; ( i i i ) f a m i l y use of herbs i n s e l f - c a r e . A major f i n d i n g o f the study was the c e n t r a l r o l e the C h i n e s e f a m i l y p l a y s i n p e r -p e t u a t i n g the t r a d i t i o n a l use of herbs f o r both the p r e v e n t i o n and treatment of d i s e a s e . The second q u e s t i o n attempts t o determine how the p r a c t i c e of C h i n e s e h e r b a l i s m has changed due t o i t s t r a n s p l a n t a t i o n from A s i a t o Canada. The most s i g n i f i -c a n t d i f f e r e n c e was the minor r o l e p l a y e d by the t r a d i t i o n a l Chinese h e r b a l doctor i n Vancouver compared t o those i n Hong ii Kong. The t h i r d q u e s t i o n the t h e s i s a d d r e s s e s i s why "has Chinese h e r b a l i s m p e r s i s t e d i n a Western s e t t i n g where everyone has f r e e a c c e s s to a government supported h e a l t h c a r e system. The author examines both e t h n i c and c u l t u r a l e x p l a n a t i o n s t o understand the s t r e n g t h of the Chinese h e r b a l t r a d i t i o n i n Vancouver. Data on the e f f i c a c y o f C h i n e s e h e r b s on both p h y s i o l o g i c a l and c u l t u r a l - s y m b o l i c l e v e l s i s p r e s e n t e d t o demonstrate the v i a b i l i t y of t h i s h e a l i n g system i n a c o n -temporary c o n t e x t . The t h e s i s c o n c l u d e s w i t h a d i s c u s s i o n on the complementarity between the Western and C h i n e s e h e a l i n g systems from both a p r a c t i c a l and a t h e o r e t i c a l p e r s p e c t i v e . iii TABLE OF CONTENTS I . INTRODUCTION 1 I I . INTRODUCING THE FIELD SETTING 1 7 1 . A Survey of Chinese Pharmacies and Herb Shops 19 2. A D e s c r i p t i o n of a " T y p i c a l " C h i n e s e Pharmacy 25 3. H e r b a l Resources 28 4. Personnel of the Herb Shops and Pharmacies . 29 5. A c t i v i t i e s of the H e r b a l i s t 30 6. C l i e n t e l e . . . . . . . 33 7. H e r b a l i s t - C l i e n t I n t e r a c t i o n s 35 8. Chinese M e d i c i n e , Herbs and P r e s c r i p t i o n s . . 37 9. Some Examples of Common Chinese Herbs . . . 46 I I I . THE SOCIAL ORGANIZATON OF TRADITIONAL CHINESE MEDICAL KNOWLEDGE 55 1 . The P r o f e s s i o n a l S e c t o r 56 2. The F o l k S e c t o r 72 3. The Popular S e c t o r 78 I V . THE PLACE OF CHINESE MEDICINE IN CONTEMPORARY SOCIETY 107 V. CONCLUSION 1 2 9 BIBLIOGRAPHY 1 3 7 iv L I S T OF TABLES T a b l e I Medica l Q u e s t i o n s i n Two Chinese Community Surveys 9 T a b l e I I The Herb Shops and H e r b a l Pharmacies of V a n c o u v e r ' s Chinatown 22 T a b l e I I I H o t / C o l d Food C l a s s i f i c a t i o n i n Two Vancouver Chinese F a m i l i e s 84 T a b l e I V Type- of Food Eaten i n the Chinese Home . . . . 87 v L I S T OF FIGURES F i g u r e 1 . Map of Chinatown, Vancouver, B , C 20 vi ACKNOWLEDGEMENTS I would most of a l l l i k e t o g r a c i o u s l y acknowledge and thank a l l the i n d i v i d u a l s and f a m i l i e s i n the C h i n e s e community of Vancouver who p a r t i c i p a t e d i n t h i s s t u d y . Without t h e i r i n v o l v e m e n t , t h i s s t u d y would have not been p o s s i b l e . I would p a r t i c u l a r l y l i k e t o thank W i l l i a m Yee, Darwin and Grace Law and Moonie Kwan f o r the s p e c i a l a t t e n -t i o n and p a t i e n c e they gave me d u r i n g hours of q u e s t i o n i n g and probing the depths of the C h i n e s e h e r b a l system. i would next l i k e t o o f f e r my deepest g r a t i t u d e t o t h e members of my t h e s i s committee, Graham Johnson, Robin R i d i n g t o n and E l v i W h i t t a k e r f o r t h e i r i n s i g h t f u l a d v i c e and guidance throughout my y e a r s of t e n u r e as a graduate s t u d e n t i n the Department of Anthropology, UBC. I would a l s o l i k e t o thank Dr. A r t h u r Kleinman of the Department of P s y c h i a t r y and B e h a v i o r a l S c i e n c e s of the U n i v e r s i t y of Washington who guided me through my e a r l y s t u d i e s i n m e d i c a l anthropology and p r o v i d e d such a s t u n n i n g example of a r e n a i s s a n c e s c h o l a r t r u l y d e d i c a t e d t o h i s r e s e a r c h . I would a l s o l i k e t o thank P r o f e s s o r s Brenda Beck and Judy Pugh of the D e p a r t -ment of Anthropology and S o c i o l o g y who a s s i s t e d me d u r i n g the i n i t i a l w r i t i n g s t a g e s of t h i s t h e s i s . I would l i k e to acknowledge the a s s i s t a n c e p r o v i d e d t o me by the Canada C o u n c i l and the U n i v e r s i t y of B r i t i s h Columbia, which supported me dur ing a p o r t i o n of the r e -vii s e a r c h p e r i o d . Much thanks go t o E l a i n e Gee and Madeleine H o - A s j o e who so a b l y a s s i s t e d me w i t h the t r a n s l a t i o n s of r e s e a r c h d a t a . S p e c i a l thanks go out t o my t y p i s t s , Judy R o u s s e l l e of Vancouver and E l a i n e P a r r y of P o r t l a n d who p e r s e v e r e d through many hours of d i f f i c u l t t e x t and C h i n e s e names. I would l i k e t o thank w i t h the deepest a p p r e c i a t i o n t h e unswerving and f i r m encouragement I r e c e i v e d d u r i n g the long p e r i o d of w r i t i n g , from my dear f r i e n d s , Howard G r e e n s t e i n and Joan Anderson and my mother, Anna Soroka. F i n a l l y , but c e r t a i n l y not the l e a s t , I would l i k e t o thank my f r i e n d and companion, P a t r i c i a H u t t e r , f o r h e r u n f a l t e r i n g d e v o t i o n t o the complet ion of t h i s work. Without h e r l o v e and s u p p o r t , t h i s p r o j e c t c o u l d have never been s u c c e s s f u l l y completed. To h e r an e t e r n a l thanks of g r a t i t u d e . viii 1 I . INTRODUCTION T r a d i t i o n a l medic ine h a s u n t i l r e c e n t l y been r e l e g a t e d t o the museum of c u r i o u s p r i m i t i v e p r a c t i c e s by both a n t h r o p o l o -g i s t s and h e a l t h p r o f e s s i o n a l s . T r a d i t i o n a l m e d i c i n e i s e t h n o c e n t r i c a l l y d e f i n e d as the i n d i g e n o u s m e d i c a l p r a c t i c e s of e t h n i c c u l t u r e s b e f o r e the a r r i v a l of s c i e n t i f i c a l l y based b i o m e d i c i n e . The key d i s t i n c t i o n i s t h a t t r a d i t i o n a l medic ine r e p r e s e n t s the m e d i c a l system of a p a r t i c u l a r e t h n i c group whereas modern m e d i c i n e i s the m e d i c i n e of any s c i e n t i f i c , t e c h n o l o g i c a l s o c i e t y . Before the 1 9 6 0 ' s , a n t h r o p o l o g i s t s w r i t i n g g e n e r a l e t h n o g r a p h i e s would u s u a l l y i n c l u d e a c h a p t e r on the t r a d i t i o n a l m e d i c a l b e l i e f and p r a c t i c e s of the c u l t u r e they were s t u d y i n g . No attempt was made t o i n t e g r a t e t h e s e seemingly s t r a n g e b e l i e f s and p r a c t i c e s i n t o a l a r g e r c u l t u r a l framework. I n the 1 9 4 0 ' s , a n t h r o p o l o g i s t s were c a l l e d i n t o see why so many w e l l - f u n d e d p u b l i c h e a l t h programs were f a i l i n g i n T h i r d World c o u n t r i e s . The a n t h r o p o l o g i s t s found t h a t t h e s e w e l l meaning programs had f o r g o t t e n t o t a k e i n t o c o n s i d e r a t i o n the c u l t u r a l v a l u e s and m e d i c a l w o r l d - v i e w of the c u l t u r e s i n which they are being i n t r o d u c e d . They a l s o d i s c o v e r e d t h a t many t r a d i t i o n a l h e a l t h p r a c t i c e s had a r a t i o n a l b a s i s and worked b e t t e r than the c u l t u r a l l y i n a p p r o p r i a t e m e d i c a l i n n o v a -t i o n s proposed by Western d o c t o r s . T h i s l e d t o a renewed i n t e r e s t by a n t h r o p o l o g i s t s i n ethnomedical s t u d i e s of t r a d i -t i o n a l m e d i c a l systems. By the 1 9 6 0 ' s the s u b - d i s c i p l i n e of 2 m e d i c a l anthropology was born w i t h a strong t h e o r e t i c a l and a p p l i e d o r i e n t a t i o n . L a r g e l y due t o the work of a n t h r o p o l o g i s t s , the World H e a l t h O r g a n i z a t i o n r e v e r s e d i t s p o s i t i o n of r e p l a c i n g t r a d i -t i o n a l medic ine w i t h Western b i o m e d i c i n e . T r a d i t i o n a l h e a l e r s and m e d i c i n e s were r e c o g n i z e d t o have an important r o l e i n the h e a l t h c a r e of T h i r d World n a t i o n s . I n the l a t e 1 9 7 0 ' s the WHO began t o p u b l i s h a s e r i e s of p o l i c y statements r e g a r d i n g the v a l u e of t r a d i t i o n a l m e d i c i n e . The v a l u e of t r a d i t i o n a l h e r b a l remedies was o f f i c i a l l y r e c o g -n i z e d i n the f o l l o w i n g r e l e a s e (WHO 1 9 7 7 ) : The e f f e c t i v e n e s s of much of t r a d i t i o n a l m e d i c i n e s i s now an accepted f a c t . N e v e r t h e l e s s , t h e r e has been over the y e a r s a r e l a t i v e l a c k of a t t e n t i o n t o the use of m e d i c i n a l p l a n t s i n h e a l t h c a r e . . . . While many s y n t h e t i c drugs have s i d e - e f f e c t s which can be worse than the s i g n s , symptom and p a t h o l o g y of the c o n d i t i o n i t s e l f . . . t r a d i t i o n a l p r e p a r a t i o n s which have been used f o r many y e a r s a r e g e n e r a l l y f r e e from s i d e - e f f e c t s i f p r o p e r l y prepared and u s e d . F o l l o w i n g the e a s i n g of r e l a t i o n s w i t h C h i n a i n 1 9 7 3 , Westerners have become i n c r e a s i n g l y i n t e r e s t e d i n the s u c c e s s C h i n a h a s had w i t h i t s own system of t r a d i t i o n a l m e d i c i n e . I n 1 9 7 8 , the World H e a l t h O r g a n i z a t i o n r e p o r t e d (WHO 1978) The tremendous s u c c e s s of the C h i n e s e e x p e r i e n c e i n the i n t e g r a t i o n of Western medic ine and Chinese t r a d i t i o n a l medic ine c o n t i n u e s t o p r o v i d e a s h i n i n g example of the p o t e n t i a l which l i e s i n i n t e g r a t i o n for the promotion and development of systems of t r a d i t i o n a l m e d i c i n e . I n f a c t , C h i n a has not i n t e g r a t e d Chinese and Western medicine i n t o one s y n t h e t i c system. I t has succeeded i n promoting the c o e x i s t a n c e of these two v e r y d i f f e r e n t m e d i c a l 3 systems, s i d e by s i d e . I t has been the o f f i c i a l government p o l i c y t o r e c o g n i z e and s a n c t i o n t r a d i t i o n a l C h i n e s e m e d i c i n e ; t h u s r e v e r s i n g i t s e a r l y t w e n t i e t h c e n t u r y p o l i c y of r e j e c t i n g i t i n favour of Western m e d i c i n e . While the P e o p l e ' s R e p u b l i c of C h i n a (PRC) h a s g a t h e r e d a l l the p u b l i c i t y , t r a d i t i o n a l C h i n e s e m e d i c i n e c o n t i n u e s t o be p r a c t i c e d w i t h o u t o f f i c i a l support i n dozens of C h i n e s e com-m u n i t i e s o u t s i d e mainland C h i n a . During the p a s t t e n y e a r s , a n t h r o p o l o g i s t s have done a number of c a r e f u l s t u d i e s on t h e p o p u l a r use of t r a d i t i o n a l C h i n e s e m e d i c i n e i n the C h i n e s e communities of Hong Kong, Taiwan, S ingapore and M a l a y s i a . The r e s u l t s of t h i s decade of r e s e a r c h a r e summarized i n the p u b l i c a t i o n of the p r o c e e d i n g s of a U n i v e r s i t y of Washing-ton conference on the "Comparative Study of T r a d i t i o n a l and Modern Medic ine i n C h i n e s e S o c i e t i e s " (Kleinman et a l . 1 9 7 5 ) . T h i s r e s e a r c h has r e v e a l e d t h a t the C h i n e s e people l i v i n g i n t h e s e communities on the p e r i p h e r y of the PRC support a h i g h degree of m e d i c a l p l u r a l i s m . I n a d d i t i o n t o u s i n g the s e r v i c e s of Western m e d i c i n e , they seek the s e r v i c e s of t r a d i t i o n a l C h i n e s e d o c t o r s i n a d d i t i o n t o dozens of types of f o l k h e a l e r s ranging from shamans and f o r t u n e - t e l l e r s t o h e r b a l i s t s and b o n e - s e t t e r s . (Lee 1 9 7 2 , 1 9 8 0 ; Topley 1 9 7 6 ; Kleinman 1980; Ahern 1 9 7 5 ) . An e x t e n s i v e system of-home treatment u s i n g t r a d i t i o n a l Chinese h e a l t h concepts and t r e a t m e n t s has a l s o been w e l l documented (Anderson and Anderson 1 9 6 8 ; Choa 1 9 6 7 ; Topley 1 9 7 0 ; and Kleinman 1 9 8 0 ) . 4 S i n c e f i e l d - w o r k was d i f f i c u l t i f not i m p o s s i b l e t o do i n the PRC, t h e s e s t u d i e s r e p r e s e n t the b e s t source f o r compara-t i v e s t u d i e s of a m e d i c a l t r a d i t i o n t h a t extends back f i v e thousand y e a r s . T h i s i n t e r e s t i n t r a d i t i o n a l C h i n e s e m e d i c i n e h a s not been c a r r i e d over t o the o v e r s e a s C h i n e s e communities i n North America. To date t h e r e have o n l y been a few s t u d i e s of the use of t r a d i t i o n a l m e d i c i n e i n the major C h i n e s e communities i n the U . S . The p r e s e n t s t u d y attempts t o f i l l t h i s v o i d w i t h a s y s t e m a t i c s t u d y of C h i n e s e h e r b a l i s m . I chose t o r e s t r i c t t h i s study t o C h i n e s e h e r b a l i s m f o r s e v e r a l r e a s o n s . Although Westerners immediate ly t h i n k of acupuncture when C h i n e s e medic ine i s brought up, h e r b a l i s m p l a y s a f a r g r e a t e r r o l e on a day t o day b a s i s . I n the h i e r -a r c h y of C h i n e s e m e d i c a l t r e a t m e n t s , d i e t and h e r b a l t h e r a p y r e p r e s e n t s 90% of a l l t h e r a p e u t i c responses t o d i s e a s e . Acupuncture i s employed f o r o n l y the most s e r i o u s and r e t i c e n t of a l l d i s e a s e s and i s t h e r e f o r e a much r a r e r form of t r e a t m e n t . The reason f o r t h i s i s t h a t acupuncture must be p r a c t i c e d by s p e c i a l i s t s , whereas the Chinese people t r e a t themselves w i t h h e r b s on almost a d a i l y b a s i s . I n C h i n e s e s o c i e t y , h e r b s a r e an important p a r t of every day l i f e . Everyone knows something about the use of herbs f o r i n c r e a s i n g b o d i l y energy and c u r i n g s imple a i l m e n t s . H i s t o r i c a l l y , acupuncture was developed by the Northern Chinese peoples and the use of herbs f o r m e d i c i n a l purposes was d i s c o v e r e d by the Southern C h i n e s e . Today, the 5 Southern C h i n e s e a r e s t i l l known f o r t h i s e x t e n s i v e use of d i e t and h e r b s i n f o l k m e d i c i n e . S i n c e most of the C h i n e s e i n Vancouver o r i g i n a t e from Hong Kong and the s o u t h e r n C h i n e s e p r o v i n c e of Kuangtung, i t i s not s u r p r i s i n g f o r t h e r e t o be e v i d e n c e f o r the m e d i c a l use of h e r b s i n t h i s o v e r s e a s C h i n e s e community. The g o a l of my r e s e a r c h was t o document how t h i s h e r b a l t r a d i t i o n h a s been p e r p e t u a t e d i n Vancouver . My t h e s i s i s o r g a n i z e d around answering t h r e e b a s i c q u e s t i o n s about C h i n e s e h e r b a l i s m i n Vancouver. The f i r s t i s t o o u t l i n e t h e s o c i a l o r g a n i z a t i o n of C h i n e s e h e r b a l knowledge i n V a n c o u v e r ' s Chinatown. The most v i s i b l e keepers of t h i s t r a d i t i o n a r e the h e r b a l i s t s working i n t h e h e r b a l pharmacies i n Chinatown. U n f o r t u n a t e l y , many s t u d i e s of t r a d i t i o n a l h e a l i n g systems have been l i m i t e d t o t h i s aspect, of f o l k m e d i c i n e . The e x i s t i n g l i t e r a t u r e f o r t r a d i t i o n a l C h i n e s e medic ine i n d i c a t e s t h a t the C h i n e s e f a m i l y uses herbs e x t e n -s i v e l y through s e l f - m e d i c a t i o n . Using a t h e o r e t i c a l model of l o c a l h e a l t h c a r e systems developed by Kleinman ( 1 9 8 0 ) , I s e t out to r e s e a r c h the f u l l e x t e n t of t r a d i t i o n a l h e r b a l i s m i n the C h i n e s e community. The r e s u l t s i n d i c a t e t h a t e x p e r t i s e i n the Chinese h e r b a l system i s not r e s t r i c t e d t o t r a d i t i o n a l C h i n e s e d o c t o r s and h e r b a l i s t s p r a c t i c i n g i n Chinatown, but i n c l u d e d l a y people a t a l l s t r a t a of Chinese S o c i e t y . The f a m i l y use of t r a d i t i o n a l h e r b a l remedies h a s turned out t o be a key f i n d i n g of the s t u d y . The second q u e s t i o n t h i s t h e s i s addresses i s how much the 6 p r a c t i c e of C h i n e s e h e r b a l i s m has changed, i f any, due t o i t s t r a n s f e r from A s i a t o Vancouver. T h i s comparison i s p o s s i b l e u s i n g d a t a o b t a i n e d from Hong Kong (Anderson & Anderson 1 9 6 8 ; T o p l e y 1 9 7 6 ; and Lee 1 9 8 0 ) . I found t h a t the h e r b a l i s t i n the h e r b a l pharmacy f u n c t i o n e d i n the same manner as i n A s i a . The f a m i l y h a s a l s o r e t a i n e d i t s p r i m a r y r o l e i n s e l f - t r e a t m e n t u s i n g h e r b s . However, the C h i n e s e t r a d i t i o n a l h e r b a l doctor has become a l e s s important source of p r o f e s s i o n a l c a r e compared t o the s i t u a t i o n i n Hong Kong. The t h i r d main concern i s t o answer the q u e s t i o n of why Chinese h e r b a l i s m h a s p e r s i s t e d i n a North American c i t y where a government supported m e d i c a l system p r o v i d e s low c o s t h e a l t h c a r e . Data a r e p r e s e n t e d t h a t i n d i c a t e t h a t t h e r e i s a r e v i v -a l i s m i n the use of C h i n e s e h e r b s . To answer t h i s q u e s t i o n I examine the q u e s t i o n of Chinese e t h n i c i t y and the c o n t i n u i t y of a strong c u l t u r a l t r a d i t i o n i n t h e C h i n e s e community of V a n -c o u v e r . I a l s o examine e v i d e n c e t h a t demonstrates the e f f i c a c y of C h i n e s e herbs on both p h y s i o l o g i c a l and c u l t u r a l - s y m b o l i c l e v e l s . F i e l d Methods The b u l k of the f i e l d work, p a r t i c u l a r l y w i t h i n V a n c o u v e r ' s Chinatown, was completed i n the summer of 1 9 7 9 . However, because c o n t a c t s i n the wider community took some time t o develop, i n t e r v i e w s cont inued u n t i l the summer of 1 9 8 1 . T r a d i t i o n a l ethnographic t e c h n i q u e s were employed. I began the r e s e a r c h w i t h a survey of the Chinatown area 7 documenting a l l the p l a c e s where C h i n e s e h e r b s c o u l d be p u r -c h a s e d . I n t e r v i e w s w i t h h e r b a l i s t s were s t a r t e d d u r i n g t h i s p r e l i m i n a r y p h a s e . F o l l o w i n g t h i s i n i t i a l o r i e n t a t i o n , I began a s e r i e s of u n s t r u c t u r e d i n t e r v i e w s w i t h two key i n f o r m a n t s . One was a C h i n e s e p h a r m a c i s t who was t r a i n e d i n Western pharma-cology but f a m i l i a r w i t h the C h i n e s e h e r b a l system. The o t h e r was a C h i n e s e lawyer p r a c t i c i n g i n Chinatown. T h i s informant was a b l e t o i n t r o d u c e me t o the key people i n v o l v e d i n the h e r b a l f i e l d i n Chinatown. He was h i g h l y r e s p e c t e d w i t h i n t h e t i g h t l y k n i t community of Chinatown and was a b l e t o a r r a n g e i n t e r v i e w s t h a t I would not have been a b l e t o a c c o m p l i s h on my own. T h i s overcame some of the b a r r i e r s I had by b e i n g a Westerner and not speaking Cantonese. Although I had begun t o l e a r n the Mandarin language, t h i s proved t o be of l i m i t e d v a l u e i n the p r e d o m i n a n t l y Cantonese speaking community i n Vancouver. Most of my i n f o r m a n t s were b i l i n g u a l i n E n g l i s h and Cantonese. T h i s c e r t a i n l y f a c i l i t a t e d the r e s e a r c h . On those o c c a s i o n s when I had t o i n t e r v i e w a n o n - E n g l i s h speaking i n f o r m a n t , I was always a b l e t o e n l i s t t h e s e r v i c e s of a C h i n e s e f r i e n d who s e r v e d as an i n t e r p r e t e r . While some informants were i n i t i a l l y r e l u c t a n t t o speak about t h e i r knowledge of C h i n e s e h e r b a l i s m , I was a b l e t o d i s p e l any f e a r s they may have had by d e m o n s t r a t -i n g my e x i s t i n g knowledge of C h i n e s e " h e r b s and a genuine i n t e r e s t to l e a r n more. Many t i m e s , my keen i n t e r e s t was t e s t e d by o f f e r i n g s of samples of u n f a m i l i a r Chinese food and extremely b i t t e r m e d i c i n a l t e a s . 8 I i n t e r v i e w e d over 50 C h i n e s e - C a n a d i a n s , r e p r e s e n t i n g f i r s t , second and t h i r d g e n e r a t i o n s i n Canada. They r e p r e -sented a wide v a r i e t y of backgrounds i n c l u d i n g Western t r a i n e d p r o f e s s i o n a l d o c t o r s , n u r s e s , a p s y c h i a t r i s t , p h a r m a c i s t s , d e n t i s t , s o c i a l worker, a lawyer , t r a d i t i o n a l Chinese d o c t o r s and h e r b a l i s t s , businessmen, l a y p e r s o n s , u n i v e r s i t y and h i g h s c h o o l s t u d e n t s , housewives, mothers and grandmothers. The extremes i n a t t i t u d e r e p r e s e n t e d by t h i s sample ranged from an e l d e r l y grandmother who spoke no E n g l i s h and had l i t t l e formal e d u c a t i o n but had complete f a i t h i n the e f f i c a c y of Chinese m e d i c i n e , t o a young a r t i c u l a t e C a n a d i a n - e d u c a t e d p h y s i c i a n who r e l e g a t e d Chinese medic ine t o mere s u p e r s t i t i o n . No q u e s t i o n n a i r e s u r v e y s were used i n t h i s s t u d y , f o r two r e a s o n s : f i r s t , a l a c k of adequate r e s o u r c e s and Chinese i n t e r v i e w e r s , and s e c o n d l y , the p r o b l e m a t i c v a l u e of t h i s mode of r e s e a r c h i n t h i s s u b j e c t a r e a . Two community s u r v e y s have been done i n the Chinese e t h n i c community d u r i n g the p r e v i o u s e i g h t y e a r s . Each had one or two q u e s t i o n s concerning the use of Chinese medic ine by the C h i n a -town Chinese p o p u l a t i o n as summarized i n T a b l e I . T a b l e I M e d i c a l Quest ions i n Two Chinese Community Surveys 1974 Vancouver Chinese Community Study Graham Johnson ( 1974) Q: What k i n d of m e d i c a l p r a c t i t i o n e r have you seen i n the p a s t 6 months? Non-Chinese MD 25% Chinese MD 70% T r a d i t i o n a l C h i n e s e Doctor 6% T r a d i t i o n a l C h i n e s e Doctor and Western MD 5% n = 339 Q: Do you use C h i n e s e H e r b a l m e d i c i n e ? Never 50% Other 2% R a r e l y 21% F r e q u e n t l y 6% Sometimes 27% n = 339 1 9 7 7 S t r a t h c o n a Community Study M i c h a e l Goldberg ( 1 9 7 7 ) For the C h i n e s e p o p u l a t i o n i n S t r a t h c o n a : 1 1 % see h e r b a l i s t s The r e s u l t s from t h e s e s u r v e y s appear low compared t o what I would e s t i m a t e the f i g u r e s to be based on my i n t e r v i e w s w i t h C h i n e s e i n f o r m a n t s . * There a r e two reasons why t h e s e survey r e s u l t s may be i n a c c u r a t e . The f i r s t i s a problem of method-o l o g y . Chinese p e o p l e , i n an attempt t o appear modern do not l i k e t o admit to u s i n g t r a d i t i o n a l Chinese remedies , even i f the i n t e r v i e w e r i s C h i n e s e and speaks t h e i r d i a l e c t . I t t a k e s time t o develop the t r u s t of a Chinese i n f o r m a n t , u n t i l they f e e l comfortable to the p o i n t of speaking about t h e i r knowledge and use of h e r b s . The second problem i s t h a t the q u e s t i o n s i n t h e s e s u r v e y s are not framed i n a c u l t u r a l l y a p p r o p r i a t e 3% see a c u p u n c t u r i s t s n - 1 3 0 * I n a survey of 50 households i n T o r o n t o ' s Chinatown; 58% of the sample reported u s i n g Chinese herbs as home remedies (Yeung et a l . 1 9 7 3 ) . 10 manner f o r the C h i n e s e . The q u e s t i o n s focus on m e d i c a l p r a c t i -t i o n e r s ; whereas we know t h a t most t r a d i t i o n a l C h i n e s e m e d i c i n e i s f a m i l y b a s e d . Furthermore, many C h i n e s e f a m i l i e s use h e r b s i n t h e i r soups t o i n c r e a s e b o d i l y energy. T h i s i s not viewed as m e d i c a l t r e a t m e n t , b u t the normal everyday way of h e a l t h y l i v i n g . A s u r v e y s t r u c t u r e d along t h e s e l i n e s would have a b e t t e r chance of o b t a i n i n g c u l t u r a l l y r e l e v a n t and a c c u r a t e d a t a . For t h e s e r e a s o n s , I have r e s t r i c t e d t h i s r e s e a r c h s t u d y t o a r e a s of concern t h a t are b e s t approached u s i n g a q u a l i t a -t i v e r e s e a r c h d e s i g n . S i n c e t h i s i s the f i r s t s t u d y t o f o c u s on C h i n e s e h e r b a l i s t s i n North America and the f i r s t s t u d y of Chinese h e a l t h b e l i e f s i n Canada, i t should be c o n s i d e r e d as an e x p l o r a t o r y study and not a d e f i n i t i v e treatment of t h i s immensely complex t o p i c . Before I conclude t h i s i n t r o d u c t i o n , I would l i k e t o b r i e f l y review seven s t u d i e s t h a t have been p u b l i s h e d t o date on C h i n e s e medic ine i n North America . Most of the s t u d i e s p u b l i s h e d on t r a d i t i o n a l Chinese m e d i c a l b e l i e f s and p r a c t i c e s have been done or sponsored by h e a l t h p r o f e s s i o n a l s who needed more d a t a t o improve h e a l t h c a r e d e l i v e r y t o the Chinese p o p u l a t i o n . Two of the s t u d i e s were done i n New York C i t y ' s Chinatown ( C a t t e l l 1 9 6 2 ) , (Chan & Chang 1975) and the others i n B o s t o n ' s Chinatown ( L i et a l . 1 9 7 2 ; L i and L i 1 9 7 1 , 1 9 7 2 ) . These s t u d i e s uncovered a t h r i v -ing t r a d i t i o n a l m e d i c a l system i n the Chinatowns of New York and Boston. They found h e r b a l pharmacies s e l l i n g Chinese h e r b s , 11 h e r b a l i s t s , t r a d i t i o n a l Chinese d o c t o r s and a c u p u n c t u r i s t s were found t o be p r a c t i c i n g t h e i r t r a d i t i o n a l s p e c i a l t i e s . A common p r a c t i c e i n both New York and Boston was s e l f - t r e a t m e n t a t home u s i n g t r a d i t i o n a l h e r b a l remedies. The C h i n e s e p r e f e r r e d t o use both Western and C h i n e s e methods of m e d i c a l t r e a t m e n t . T h i s p a t t e r n of d u a l use was thought t o i n t e r f e r e w i t h the Western p h y s i c i a n ' s management of t h e i r Chinese p a t i e n t s . C a t t e l l ' s s t u d y r e v e a l e d t h a t the C h i n e s e b e l i e v e d t h a t the h e a l t h and w e l f a r e of the i n d i v i d u a l was the r e s p o n s i b i l i t y of the f a m i l y . However, C a t t e l l ( 1 9 6 2 : 8 8 ) a l s o found t h a t the k i n s h i p system which n o r m a l l y f i l l e d t h e s e needs was unable t o i n New Y o r k : I t i s the major c o n c l u s i o n of t h i s s t u d y t h a t the h e a l t h problem e x h i b i t e d by one s m a l l segment of the Chinese p o p u l a t i o n i s but one of the many m a n i f e s t a t i o n s of s o c i a l d i s o r g a n i z a t i o n brought on by the l a c k of a d a p t a b i l i t y of C h i n e s e s o c i a l s t r u c t u r e . The s i g n i f i c a n c e of t h i s study i s t h a t C a t t e l l e s t a b l i s h e d the c l e a r l i n k t h a t e x i s t s i n C h i n e s e c u l t u r e between the f a m i l y and h e a l t h c a r e . The s t u d i e s done by L i ( L i and L i 1 9 7 1 , L i , 1 9 7 2 , L i e t a l . 1 9 7 2 ) , who i s a Chinese MD show the problems t h a t the t r a d i t i o n a l h e a l t h b e l i e f s of the Chinese cause them t o d e l a y or r e j e c t "the proper therapy" ( L i 1 9 7 2 ) . He acknowledges t h a t t h e r e i s no c o g n i t i v e d i s s o n a n c e for the Chinese who use Chinese herbs for one s e t of d i s e a s e s and Western drugs f o r o t h e r s . The study by Chan and Chang ( 1976) i s one of the most 12 comprehensive s t u d i e s done on the t r a d i t i o n a l use of C h i n e s e medic ine i n an American Chinatown. They i n t e r v i e w e d a l l the t r a d i t i o n a l p r a c t i t i o n e r s p r a c t i c i n g i n New York C i t y ' s C h i n a -town and d i d a random s u r v e y of the h e a l t h b e l i e f s o f C h i n a -town's r e s i d e n t s . The purpose of t h e i r study was t o determine the p r e f e r e n c e f o r e i t h e r C h i n e s e or Western treatment when s e l f - t r e a t m e n t was used and when m e d i c a l s p e c i a l i s t s were employed. They d i s c o v e r e d t h a t a l though t r a d i t i o n a l medic ine was a v a i l a b l e i n New York C i t y , i t s o v e r a l l use by the C h i n e s e community was low. However, they found t h a t most C h i n e s e i n t h e i r sample used C h i n e s e herbs through s e l f - t r e a t m e n t i n a d d i t i o n t o Western d r u g s . T h i s concurs w i t h the d u a l p a t t e r n of use found i n the e a r l i e r s t u d i e s . Chan and Chang ( 1 9 7 6 : 1 3 5 ) conclude t h a t : H e a l t h problems i n Chinatown are generated not because the C h i n e s e use Chinese medic ine and t r a d i t i o n a l p r a c t i t i o n e r s as t h e i r source of c a r e . One h a s t o look f u r t h e r t o the c u l t u r a l , s o c i a l and economic f a c t o r s t o f i n d the causes f o r Chinatown's h e a l t h problems. I f the u t i l i z a t i o n of nearby h o s p i t a l s i s low, one cannot blame Chinese medic ine and t r a d i t i o n a l p r a c t i t i o n e r s . I n s t e a d the reasons may be found i n the low l e v e l of income, long working h o u r s , and language b a r r i e r s ; and i n the h o s p i t a l s , the long w a i t i n g t ime f o r t r e a t m e n t , the l o c a t i o n , h i g h h o s p i t a l c o s t s , u n a v a i l a b i l i t y of i n t e r p r e t e r s and the a t t i t u d e of the h o s p i t a l ' s s t a f f . The t h r e e other p u b l i s h e d r e p o r t s on C h i n e s e medic ine i n the U . S . were done by s o c i a l s c i e n t i s t s , and are t h e r e f o r e more concerned w i t h the t r a d i t i o n a l h e a l t h b e l i e f s of the C h i n e s e r a t h e r than the i s s u e of h e a l t h c a r e d e l i v e r y t o the C h i n e s e . The study done by H e s s l e r and a s s o c i a t e s ( 1 9 7 5 ) i s a 13 c a r e f u l l y d e s i g n e d s u r v e y of the h e a l t h b e l i e f s of C h i n e s e -Americans i n B o s t o n ' s Chinatown. They found four p a t t e r n s of m e d i c a l u s a g e : Nonpure Western, Nonpure C h i n e s e , Pure C h i n e s e and d u a l i s t s . Using m u l t i p l e d i s c r i m i n a t e a n a l y s i s the a u t h o r s t e s t e d f o r c o n s i s t e n c y u s i n g such v a r i a b l e s as age, sex, e t h n i c i t y , m e d i c a l b e l i e f s and p r e v i o u s h e a l t h c a r e u s a g e . They found t h a t f a r from being a homogeneous group, the C h i n e s e d i s p l a y e d a h i g h degree of i n t r a e t h n i c d i v e r s i t y i n t h e i r p a t t e r n s of h e a l t h c a r e s e e k i n g and u t i l i z a t i o n . They found t h a t o n l y a s m a l l p r o p o r t i o n of t h e i r sample used C h i n e s e medic ine e x c l u s i v e l y and t h a t most used both Chinese and Western medic ine t o a g r e a t e r or l e s s e r e x t e n t . However, the v a r i a b l e s e x p l a i n i n g t h i s d u a l use p a t t e r n were so complex as t o p r e c l u d e any one model of Chinese h e a l t h b e h a v i o u r . An important f i n d i n g was the c l e a r d i f f e r e n c e between sex and e t h n i c s o l i d a r i t y as p r e d i c t i v e v a r i a b l e s f o r h e a l t h c a r e u t i l i z a t i o n . H e s s l e r ( 1 9 7 5 : 2 6 2 ) concludes t h a t : The e x t e n t to which e x p l a n a t o r y v a r i a b l e s d i f f e r from males and females suggests t h a t sex i s an important f a c t o r f o r understanding i l l n e s s b e h a v i o r . I t suggests t h a t sex r o l e s permeate the b a s i c s t r u c t u r e of s o c i e t y t o e x e r t a much g r e a t e r e f f e c t on a t t i t u d e s and b e h a v i o r t h a n e t h -n i c i t y per s e . We s h a l l see l a t e r i n t h i s t h e s i s , the reason f o r t h i s f i n d i n g i s due t o the key r o l e t h a t the woman p l a y s i n the h e a l t h c a r e of the Chinese f a m i l y . The most complete study of Chinese h e a l t h b e l i e f s i s L i n d a Koo's ( 1976) d o c t o r a l d i s s e r t a t i o n based on f i e l d w o r k i n San 14 F r a n c i s c o and Taiwan. Koo attempts t o demonstrate t h a t the C h i n e s e have n u r t u r e d a c u l t u r e of h e a l t h m e n t a l i t y from the e a r l i e s t p h i l o s o p h i c a l w r i t i n g s t o the p r e s e n t h e a l t h b e h a v i o r of C h i n e s e i n America and Taiwan. She succeeds i n p r e s e n t i n g a r i c h v a r i e t y of d a t a t o support h e r t h e s i s t h a t the C h i n e s e a r e a remarkably h e a l t h - o r i e n t e d c u l t u r e . The b u l k of the work i s a d e s c r i p t i o n of Wei Sheng or the v a r i o u s ways of m a i n t a i n i n g h e a l t h . These i n c l u d e : s e x u a l p r a c t i c e s , v a r i o u s p h y s i c a l t h e r a p i e s , proper s l e e p and r e l a x a t i o n , p e r s o n a l , d i e t a r y and environmental h y g i e n e , s p i r i t u a l , mental and emotional f a c t o r s a f f e c t i n g h e a l t h , and food as a source of energy, i l l n e s s and t h e r a p y . A s i g n i f i c a n t f i n d i n g i s the key r o l e p l a y e d by women f o r the h e a l t h and proper d i e t of the f a m i l y . Koo d i s c u s s e s i n d e t a i l the C h i n e s e b e l i e f t h a t the c a r e f u l s e l e c t i o n of food i s n e c e s s a r y f o r the p r e v e n t i o n and cure of d i s e a s e . She f i n d s t h a t t r a d i t i o n a l concepts of d i e t are s t i l l h e l d by second and t h i r d g e n e r a t i o n C h i n e s e - A m e r i c a n women. The o n l y study done on C h i n e s e m e d i c i n a l remedies i s a s h o r t paper by S w i d e r s k i ( 1 9 7 8 ) on "Chinese American Patent M e d i c i n e s . " A p a t e n t medic ine i s a Chinese medic ine manufactured i n A s i a u s i n g t r a d i t i o n a l h e r b a l i n g r e d i e n t s but prepared i n t o p i l l s , powders, syrups or l i n a m e n t . S w i d e r s k i uses a symbol ic a n a l y s i s of the packaging and marketing of Chinese p a t e n t medic ines t o demonstrate the need of the C h i n e s e - A m e r i c a n f o r a t r a d i t i o n a l product packaged i n a contemporary medium. Chinese p a t e n t m e d i c i n e s are c r e a t e d f o r the Overseas Chinese 15 market c ombining both t r a d i t i o n a l and modern c o n c e p t i o n s of h e a l t h , i n the symbolism of the m e d i c i n e . S w i d e r s k i 1 s s y m b o l i c a n a l y s i s i s a p e n e t r a t i n g study of the h i g h l y s y m b o l i c n a t u r e of C h i n e s e m e d i c i n e . T h i s symbolism i s b e s t expressed i n the author 1 s own words: The p a t e n t m e d i c i n e s mark out a semantic c r o s s r o a d s where many i n f l u e n c e s have converged t o c r e a t e a s e t of p r o d u c t s which d e s c r i b e an i n t e r n a t i o n a l C h i n e s e m e n t a l i t y , a c c e p t -ed by the C h i n e s e - A m e r i c a n s among other n a t i o n a l i t i e s . The semant ics of t h e i r packaging and d e l i v e r y i s the semantics of p o p u l a r m e d i c i n e , housing the i n t e r a c t i o n between t r a d i t i o n a l and modern c o n c e p t i o n s of i l l n e s s and h e a l t h . ( S w i d e r s k i 1 9 7 8 : 1 0 1 ) . The p a t e n t m e d i c i n e s speak d i r e c t l y t o the body of how t h e r e i s no change, how a l l the o l d remedies are s t i l l a v a i l a b l e , e n c a s i n g them i n a r h e t o r i c t h a t feeds and assuages a l l the senses i n a way t h a t makes them have the f e e l of h e a l t h . H e a l t h thus appears as a c u l t u r a l s t a t e ; the m e d i c i n e s are i t s implements because they evoke the c o n t e x t i n which h e a l t h i s p o s s i b l e . They c r e a t e an a r t i f i c i a l c o n t e x t of h e a l t h by c r e a t i n g an a r t i f i c i a l t r a d i t i o n t h a t proceeds out of genuine, known t r a d i t i o n s , s e l l i n g i t as the means of a c h i e v i n g h e a l t h or s u s t a i n i n g i t . Chinese p a t e n t m e d i c i n e s h e l p r e s o l v e a n x i e t i e s about l o s s of c u l t u r a l i d e n t i t y by packaging t h a t i d e n t i t y i n a most i n t i m a t e form, and a s s o c i a t i n g i t w i t h b o d i l y w e l l -being by i m p l i c a t i o n . The medic ines are a c l o s e symbol system t h a t u n i t e s t r a d i t i o n , c u l t u r a l coherence and h e a l t h w i t h i n the same c o n s i s t e n t , m u l t i - d i m e n s i o n a l s e m a n t i c s . Chinese p a t e n t medic ines h e a l Chinese d i s e a s e s and b r i n g a C h i n e s e k i n d of h e a l t h . ( S w i d e r s k i 1 9 7 8 : 1 2 1 -1 2 2 ) S w i d e r s k i ' s paper i s the o n l y a n t h r o p o l o g i c a l a n a l y s i s of Chinese medic ine p u b l i s h e d t o d a t e . H i s concern f o r the symbolism of Chinese p a t e n t remedies touches on some of the concerns of the p r e s e n t work. However, i t d e a l s e x c l u s i v e l y w i t h p a t e n t m e d i c i n e s and o n l y t a n g e n t i a l l y covers i s s u e s surrounding the complex world of Chinese h e r b a l i s m . 16 An a d d i t i o n a l s t u d y i s the review a r t i c l e by G o u l d - m a r t i n and Ngin ( 1 9 8 1 ) . I t i s an e x c e l l e n t i n t r o d u c t i o n t o medic ine and C h i n e s e c u l t u r e . However, i t i s e s s e n t i a l l y a review a r t i c l e of the papers covered here and has o n l y minimal o r g i n i a l d a t a from Los A n g e l e s ' Chinatown. 17 I I . INTRODUCING THE FIELD SETTING The m a j o r i t y o f my f i e l d work took p l a c e i n what i s commonly r e f e r r e d to as ' C h i n a t o w n . ' Chinatown has been the c e n t r e of Chinese s o c i a l l i f e i n Vancouver f o r over 80 y e a r s . Before 1900, the g r e a t e s t percentage of B r i t i s h C o l u m b i a ' s Chinese p o p u l a t i o n r e s i d e d i n V i c t o r i a . However, a f t e r V a n -couver became the commercial c e n t r e of B r i t i s h Columbia, i n the e a r l y 1 9 0 0 ' s , i t h a s been home t o the g r e a t e s t p r o p o r t i o n of the Chinese i n the p r o v i n c e . Chinatown has always been i n the downtown e a s t s i d e o f Vancouver d e s p i t e g e o g r a p h i c a l s h i f t s of i t s c e n t r e over the y e a r s . I t s r o l e i n the Chinese community of Vancouver h a s a l s o changed a c c o r d i n g to the demographic s t r u c t u r e of the Chinese p o p u l a t i o n . For the f i r s t h a l f of the c e n t u r y , i t was the r e s i d e n t i a l , commercial and s o c i a l c e n t r e f o r the p r e d o m i n a n t l y male Chinese p o p u l a t i o n . Immigrat ion p o l i c y r e s t r i c t e d e n t r y t o Chinese males who were needed as u n s k i l l e d l a b o u r e r s i n B r i t i s h C o l u m b i a ' s economy. Changes i n immigrat ion p o l i c y r e g a r d i n g the Chinese i n 1947 and 1 9 6 7 , have r e s u l t e d not o n l y i n an i n c r e a s e i n the numbers of C h i n e s e - C a n a d i a n s i n Vancouver but a dramatic change i n the c h a r a c t e r of the Chinese community. The p a s t 30 y e a r s have seen a fundamental s h i f t from a p o p u l a -t i o n of s i n g l e Chinese males to a community of Chinese f a m i l i e s extending over a t l e a s t three g e n e r a t i o n s . Chinatown has been an important f o c a l p o i n t for V a n c o u v e r ' s Chinese p o p u l a t i o n 18 throughout t h i s p e r i o d . While Chinatown h a s remained a symbol f o r the C h i n e s e s u b c u l t u r e i n Vancouver, i t s r o l e i n the C h i n e s e community has changed along w i t h the demographic changes i n the C h i n e s e p o p u l a t i o n . For the f i r s t h a l f of the c e n t u r y , Chinatown has been the r e s i d e n t i a l as w e l l as community and s o c i a l c e n t r e f o r V a n -c o u v e r ' s Chinese p o p u l a t i o n . Today o n l y 1 0 p e r c e n t of the a p p r o x i m a t e l y 80,000 C h i n e s e i n Vancouver r e s i d e i n Chinatown. However, Chinatown remains the commercial , c u l t u r a l and s o c i a l c e n t r e f o r the m a j o r i t y of t h i s d i s p e r s e d community. Chinatown i s the major shopping a r e a where C h i n e s e foods may be p u r c h a s e d . Many Chinese c o n t i n u e t o come i n from V a n c o u v e r ' s o u t l y i n g d i s t r i c t s t o do t h e i r weekly g r o c e r y shopping. Chinatown i s the s i t e of a v a r i e t y of b u s i n e s s e s owned by C h i n e s e - C a n a d i a n s who s e r v e a l a r g e l y Chinese c l i e n -t e l e . Many Chinese p r o f e s s i o n a l s are l o c a t e d h e r e , i n c l u d i n g d o c t o r s , d e n t i s t s and l a w y e r s . R e s t a u r a n t s abound and are frequented by both Chinese and n o n - C h i n e s e . Sunday dim-sum has become a l o c a l i n s t i t u t i o n and an important s o c i a l o c c a s i o n f o r many Chinese f a m i l i e s . Chinatown i s an important c u l t u r a l c e n t r e , being the s i t e of many Chinese a s s o c i a t i o n s , i n c l u d i n g p o l i t i c a l c l u b s , benevolent a s s o c i a t i o n s , C l a n s o c i e t i e s , b u s i n e s s a s s o c i a t i o n s , a t h l e t i c c l u b s , music s o c i e t i e s , c h a r i t y f o u n d a t i o n s , Churches, Chinese s c h o o l s and l o c a l Chinese newspapers (Wickberg 1 9 8 2 ) . Chinatown remains the i n t e g r a t i n g l i n k between the o l d country and the new Canadian s o c i e t y f o r 19 many r e c e n t Chinese immigrants . I t i s the f o c a l p o i n t i n the l i v e s o f many n o n - E n g l i s h - s p e a k i n g Chinese immigrants as many m e d i c a l , s o c i a l and r e c r e a t i o n a l s e r v i c e s are a v a i l a b l e . Thus, a l though Chinatown i s no longer the r e s i d e n c e f o r most of V a n c o u v e r ' s Chinese p o p u l a t i o n , i t s e r v e s an important r o l e i n m a i n t a i n i n g a c u l t u r a l c o n t i n u i t y w i t h the C h i n e s e t r a d i t i o n s . Both r e c e n t Chinese immigrants and t h i r d g e n e r a -t i o n C h i n e s e - C a n a d i a n s use Chinatown t o adapt t o Canadian s o c i e t y , w h i l e r e t a i n i n g a c o n n e c t i o n w i t h t h e i r r i c h c u l t u r a l h e r i t a g e . Chinatown today extends over a 2 0 - s q u a r e - b l o c k a r e a , as r e v e a l e d i n F i g u r e 1 . T h i s a r e a r e p r e s e n t s the a r e a of c o n -c e n t r a t e d commerce run by C h i n e s e . The main s t r e e t i n C h i n a -town i s Pender, between Gore and C a r r a l . Pender has the h i g h e s t c o n c e n t r a t i o n of shops and b u s i n e s s e s t h a t a r e run by Chinese i n a l l of Chinatown. The s t r e e t i s always a b e e h i v e o f a c t i v i t y , f u l l of Chinese going about t h e i r b u s i n e s s , i n a d d i t i o n to V a n c o u v e r i t e s and c i t y v i s i t o r s . Both the C i t y government and the l o c a l Chinese b u s i n e s s e s r e c o g n i z e the a r e a ' s commercial importance. 1 . Survey of Chinese Pharmacies and Herb Shops A survey of the Chinatown area r e v e a l e d e i g h t e e n e s t a b -l i s h m e n t s where some type of Chinese herbs or m e d i c i n a l remedy could be purchased. S i n c e food items p l a y an important r o l e i n t r a d i t i o n a l Chinese m e d i c i n e , t h e i r number would have been 20 F i g u r e 1 . MAP OF CHINATOWN, VANCOUVER, B . C . AMv\ee.oA >- cute-itT * HfttXlM MAifiW^ 4- HfcR-<ifw PrtMUMvOj I rtC-SJi 21 g r e a t e r i f g r o c e r y s t o r e s s t o c k i n g common Chinese cooking i n g r e d i e n t s had been i n c l u d e d . These e i g h t e e n p l a c e s where herbs c o u l d be purchased ranged from dry good import s t o r e s h a v i n g a s h e l f of prepackaged Chinese m e d i c i n e s , t o complete Chinese p h a r m a c i e s . These pharmacies prepared t r a d i t i o n a l h e r b a l p r e s c r i p t i o n s which a r e put t o g e t h e r from an assortment of s e v e r a l hundreds of raw h e r b s . These e i g h t e e n h e r b a l d i s p e n s a r i e s can be d i v i d e d i n t o t h r e e b a s i c t y p e s , as l i s t e d i n T a b l e I I . The term ' C h i n e s e pharmacy' r e f e r s t o an e s t a b l i s h m e n t i n which the d i s p e n s i n g o f h e r b s and medic ine i s i t s p r i m a r y b u s i n e s s . There are four pharmacies f a l l i n g i n t o t h i s c a t e g o r y . Three are t r a d i t i o n a l Chinese p h a r m a c i e s , s e l l i n g nothing e l s e but Chinese h e r b a l and p h a r m a c e u t i c a l p r o d u c t s . The other two are Chinese pharmacies which are housed i n a Western-type pharmacy but run as a c o m p l e t e l y s e p a r a t e o p e r a t i o n . These Chinese pharmacies are more l i k e l y t o have someone who h a s r e c e i v e d some formal t r a i n i n g i n Chinese h e r b a l i s m or m e d i c i n e , i n China or Hong Kong. There are u s u a l l y a d d i t i o n a l h e l p e r s working t h e r e who work f u l l t ime a t d i s p e n s i n g herbs and have t h e r e f o r e r e c e i v e d some knowledge of Chinese herbs and t h e i r uses through a type of a p p r e n t i c e s h i p . There i s an e x t e n s i v e s t o c k of h e r b s a v a i l a b l e here f o r the p r e p a r a t i o n of t r a d i -t i o n a l p r e s c r i p t i o n s . I n s e v e r a l of these pharmacies , a l though p a t e n t Chinese m e d i c i n e s are a v a i l a b l e , the emphasis i s on the herbs t h e m s e l v e s . There i s a c o n s u l t a t i o n room i n the back 22 Table II The Herb Shops and H e r b a l Pharmacies of V a n c o u v e r ' s Chinatown Type I H e r b a l Pharmacies Dai Cheong L t d . K i u Shun T r a d i n g Co. Mandarin Drugs Canada Ginseng Co. 249 E. Pender 1 4 1 E . Pender 543 Main 33 E. H a s t i n g s Type 2 Herb Shops Chung Wah D i s c o u n t Centre ( 1 ) 135 E. Pender Chung Wah D i s c o u n t Centre (2) 299 E. Pender Kong Man Sun 236 E. Pender Yuen Fong Co. 242 E. Pender Wong Tong Co. 250 E. Pender Wing Hing Co. 280 E. Pender Grand T r a d i n g Co. 265 E. H a s t i n g s Wah Chun Tong E n t e r p r i s e s 207 E. Pender Type 3 Herb Counters T r a n s - N a t i o n Emporium L t d . Gim Lee Yuen L t d . Vancouver China Trade Centre Chung K i u Chinese Products Emporium Luan Hing Co. Le K i u Importing Co. 89 E. Pender 75 E. Pender 455 Main 617 Main 263 E. H a s t i n g s 262 E. Pender 23 where the t r a d i t i o n a l Chinese h e r b a l i s t / d o c t o r may c o n s u l t w i t h h i s p a t i e n t s i n p r i v a t e . These c o n s u l t a t i o n rooms are used when the Chinese doctor needs t o diagnose a p a t i e n t ' s c o n d i t i o n through e x t e n s i v e h i s t o r y - t a k i n g or t r a d i t i o n a l d i a g n o s t i c t e c h n i q u e s such as p u l s i n g . However, most c o n s u l t a t i o n s between the h e r b a l i s t and c l i e n t t a k e p l a c e over the c o u n t e r . These s t o r e s r e p r e s e n t the most e l a b o r a t e o r g a n i z a t i o n of t r a d i t i o n a l Chinese pharmacology. They a r e important i n s t i t u -t i o n s i n the p r a c t i c e of Chinese h e r b a l i s m , but do not dominate t h i s a c t i v i t y . The herb shops w i t h i n Chinese g r o c e r y s t o r e s r e p r e s e n t the second c a t e g o r y . These are e s t a b l i s h m e n t s where the s e l l i n g o f food items i s the pr imary b u s i n e s s . The h e r b a l b u s i n e s s i s a s p e c i a l i z a t i o n i n food and p l a n t products and may or may not be run i n d e p e n d e n t l y from the g r o c e r y s t o r e . For the s t o r e owner, i t r e p r e s e n t s an important source of s t a t u s and a d d i t i o n a l income. S i n c e food and herbs a r e c l o s e l y l i n k e d i n Chinese m e d i c a l p h i l o s o p h y , i t i s not s u r p r i s i n g for t h i s l i n k t o e s t a b l i s h i t s e l f c o m m e r c i a l l y . The f i e l d survey r e v e a l e d e i g h t e s t a b l i s h m e n t s where herbs were s o l d i n g r o c e r y s t o r e s . Four of these had f u l l - t i m e h e r b a l i s t s and h e r b a l i s t a i d e s working i n the herb shop. These were complete Chinese pharmacies and comparable, except i n s i z e , t o the r e g u l a r Chinese pharmacy as p r e v i o u s l y d i s c u s s e d . The herb shop i n a g r o c e r y s t o r e took up a s m a l l amount of the t o t a l s t o r e area and was u s u a l l y l o c a t e d i n the r e a r . They were manned by a t l e a s t one h e r b a l i s t or 24 h e r b a l i s t a i d e , who c o n s u l t e d w i t h c l i e n t s and prepared p r e -s c r i p t i o n s . Commercial t r a n s a c t i o n s were kept s e p a r a t e from the g r o c e r y b u s i n e s s . I n some of the more popular s t o r e s , the h e r b a l shop e q u a l l e d the g r o c e r y component i n terms o f the amount of b u s i n e s s . The second type of h e r b a l shop w i t h i n the g r o c e r y s t o r e , of which t h e r e were t h r e e , were q u a l i t a t i v e l y d i f f e r e n t from those p r e v i o u s l y d i s c u s s e d . These d i d not have a f u l l - t i m e h e r b a l i s t working a t the herb counter and t h e r e f o r e were s m a l l e r and l e s s busy than t h e i r manned c o u n t e r p a r t s . These tended t o have more p r e - p a c k a g e d m e d i c i n e s . The s t o r e owner or employee was a v a i l a b l e to prepare p r e s c r i p t i o n s on demand, but t h e y were o b v i o u s l y l e s s exper ienced and t h e r e f o r e a t t r a c t e d a s m a l l e r c l i e n t e l e . The h e r b a l component r e p r e -sented an o f f - s h o o t t o food s a l e s and was l e s s important t o t h e i r t o t a l b u s i n e s s . The t h i r d c a t e g o r y where herbs can be purchased i s the herb counter w i t h i n a dry-good import s t o r e . There were s i x s t o r e s i n t o t a l for t h i s group. Two of these had f u l l - t i m e h e r b a l i s t s working the herb c o u n t e r s and were s i m i l a r t o the pharmacies i n g r o c e r y s t o r e s . A dry-good import s t o r e u s u a l l y c a r r i e d a wide v a r i e t y of goods from mainland C h i n a . While some of t h e s e were frequented by Chinese customers, most appealed t o the l u c r a t i v e t o u r i s t t r a d e . T h e i r importance as h a r b i n g e r s of t r a d i t i o n a l Chinese m e d i c a l knowledge were s m a l l compared t o the two c a t e g o r i e s of s t o r e s p r e v i o u s l y d i s c u s s e d . Four s t o r e s had s i m i l a r d i s p l a y s of pre -packaged Chinese 25 remedies . While most of the owners of t h e s e s t o r e s c o u l d speak some E n g l i s h , t h e i r knowledge of the medic ines they s o l d was l i m i t e d . T h i s type of marketing appealed to the c u r i o u s Westerner who c o u l d read the E n g l i s h t r a n s l a t i o n of the medic ine f o r t h e m s e l v e s . The C h i n e s e c l i e n t e l e f o r herbs i n t h i s type of s t o r e was m i n i m a l . 2 . A D e s c r i p t i o n of a " T y p i c a l Chinese Pharmacy" T r a d i t i o n a l Chinese p h a r m a c i e s , whether l a r g e or s m a l l , are u s u a l l y o r g a n i z e d on a s t a n d a r d model t h a t i s hundreds of y e a r s o l d . H e r b a l pharmacies made t h e i r appearance i n C h i n a d u r i n g the Sung Dynasty , 960 - 1 2 7 6 A . D . (Chen 1 9 2 5 ) . Before t h i s t i m e , the p h y s i c i a n used t o c o l l e c t , prepare and a d m i n i s t e r h i s own h e r b a l remedies to h i s p a t i e n t s . However, as the number of h e r b s used f o r t h e i r m e d i c i n a l p r o p e r t i e s i n c r e a s e d , the r o l e of the h e r b a l p h a r m a c i s t became a s p e c i a l t y i n i t s e l f s e p a r a t e from the p h y s i c i a n who c o n c e n t r a t e d on d i a g n o s i s and t r e a t m e n t . While t h i s s p e c i a l i z a t i o n i s not always r i g i d l y adhered t o , the h e r b a l pharmacy remains an important i n s t i t u -t i o n i n the Chinese m e d i c a l system, both i n China and i n Chinese overseas communities. I n V a n c o u v e r ' s Chinatown, i t p l a y s a key r o l e i n m a i n t a i n i n g the c o n t i n u i t y of t h i s 5 ,000 y e a r o l d m e d i c a l t r a d i t i o n . I am going t o d e s c r i b e the o r g a n i z a t i o n of a " t y p i c a l " h e r b a l d i s p e n s a r y t h a t can be found today i n V a n c o u v e r ' s Chinatown. T h i s model h e r b a l d i s p e n s a r y i s the same f o r h e r b a l 26 pharmacies and herb shops, as I have c a t e g o r i z e d them. The o n l y s i g n i f i c a n t d i f f e r e n c e between the two i s one of s i z e . I am f i r s t going t o d e s c r i b e the p h y s i c a l l a y o u t of the pharmacy, then d e s c r i b e the a c t i v i t y t h a t t a k e s p l a c e t h e r e . As one approaches a Chinese pharmacy, b e f o r e one can even see the rows and rows of h e r b s s t o r e d n e a t l y i n t h e i r g l a s s c a s e s and b o t t l e s , one i s a s s a u l t e d by the pungent aroma of h e r b s emanating from the shop. Every herb shop, no matter how l a r g e or s m a l l i s dominated by a long g l a s s c o u n t e r . I t i s here where the important i n t e r a c t i o n s between the h e r b a l i s t and c l i e n t take p l a c e . I n s i d e the g l a s s c o u n t e r , i n c l e a r view t o the c l i e n t s , are where the most p r i z e d , expensive or e x o t i c herbs are k e p t . For example, t h e r e a r e dozens of d i f f e r e n t v a r i e t i e s and grades of ginseng kept under t h e s e g l a s s c o u n t e r s . I t i s s o r t e d a c c o r d i n g t o c o u n t r y of o r i g i n — K o r e a , Japan, C h i n a , the U . S . or Canada and a c c o r d i n g t o s i z e and age, which determines i t s q u a l i t y . A l s o on d i s p l a y i n the model shop I have s e l e c t e d a r e w i l d ginseng r o o t s which are q u i t e o l d and s e l l i n g for between $ 1 , 0 0 0 and $ 3 , 0 0 0 . These are a v a i l a b l e f o r the r i c h businessman who wants t o b r i n g good economic h e a l t h to h i s b u s i n e s s . Other herbs and medicaments p r o m i n e n t l y d i s -p l a y e d i n the g l a s s counters are both whole and s l i c e d r e i n d e e r horn, d r i e d deer t a i l s , d r i e d sea h o r s e s , d r i e d l i z a r d , v a r i o u s d r i e d i n s e c t s such as c i c a d a s and c a t e r p i l l a r s , g a l l b l a d d e r s from v a r i o u s snakes , g e n i t a l i a from t i g e r s , v a r i o u s stones and m i n e r a l s , l a r g e p i e c e s of wood and so on. 27 On top of the g l a s s counter i s another g l a s s c a s e c o n t a i n -ing a d d i t i o n a l r a r e h e r b s which are too s m a l l t o be d i s p l a y e d e lsewhere. Examples of t h e s e are t i n y p e a r l s and s m a l l packages of a p h r o d i s i a c s . Behind the g l a s s counter a g a i n s t the w a l l a r e rows and rows of unmarked drawers p r o v i d i n g the main s t o r a g e a r e a f o r the s h o p ' s h e r b s . There are two s i z e s of drawers commonly employed—a s t a n d a r d s i z e measuring a p p r o x i m a t e l y 10" by 8" and a l a r g e r s i z e about double the s i z e . The s t a n d a r d drawers are d i v i d e d i n t o 4 compartments c o n t a i n i n g 4 herbs used t o t r e a t s i m i l a r symptoms. The h e r b s are arranged a c c o r d i n g to the symptom or body p a r t they t r e a t . For example, a l l herbs used to t r e a t c o l d s are grouped t o g e t h e r , as are herbs for rheumatism, herbs f o r the l i v e r , k i d n e y s or l u n g s . T h i s p h y s i c a l p r o x i m i t y makes i t e a s i e r f o r the h e r b a l i s t t o prepare a h e r b a l p r e -s c r i p t i o n f o r a s p e c i f i c a i l m e n t . I n a l l , t h e r e are over a hundred of t h e s e unmarked drawers. On the same w a l l as the drawers, are s h e l v e s h o l d i n g l a r g e g l a s s b o t t l e s c o n t a i n i n g the most common herbs i n the Chinese m e t e r i a medica. These are h e r b s t h a t no t r a d i t i o n a l Chinese household i s without and which the Chinese c l i e n t would know and r e c o g n i z e . Some examples of these are Dong-quai ( A n g e l i c a s i n e n s i s ) , H u a n g - c h i ( A s t r a g a l u s ) , K o u - c h i - t z u ( L y c i i f r u c t u s ) and Tang-shen ( C o d o n o p s i s ) . D i f f e r e n t s i z e s and grades of each herb are arranged i n ascending order of c o s t . At the v e r y top of the drawers, out of reach without a l a d d e r , i s a whole row 28 of g a l l o n s i z e d metal c o n t a i n e r s of ginseng e x t r a c t . At one end of the c o u n t e r , c l o s e s t t o the door, i s a cash r e g i s t e r . At the o p p o s i t e end of the counter are the t o o l s and equipmnt used t o prepare the h e r b s such as a l a r g e g u i l l o t i n e -type k n i f e , an e l e c t r i c g r i n d e r , an e l e c t r i c s c a l e and a s m a l l hot p l a t e . At t h i s f a r end, on the w a l l a r e l o c a t e d s h e l v e s c o n t a i n i n g a l l the p a t e n t m e d i c i n e s . There are s e v e r a l hundred i n d i v i d u a l p a t e n t medic ines of a l l shapes and s i z e s . Located around the s t o r e a r e v a r i o u s p o s t e r s , s i g n s and r i t u a l p a r a p h e n a l i a a s s o c i a t e d w i t h the h e r b a l b u s i n e s s . Some s i g n s a d v e r t i s e s p e c i f i c p r o d u c t s from p h a r m a c e u t i c a l houses or c o u n t r i e s , n o t a b l y the Korean ginseng i n d u s t r y . Other s i g n s a d v e r t i s e the f a c t t h a t the h e r b s found i n t h i s s t o r e o r i g i n a t e from the P e o p l e ' s R e p u b l i c of C h i n a and not Hong Kong (though many h e r b s do come from Hong Kong). 3 . H e r b a l Resources The s i z e of the t o t a l Chinese m a t e r i a medica i s q u i t e l a r g e , h a v i n g over 6,000 items l i s t e d i n the pharmacopoeia. Although over 2,000 herbs are grown i n the PRC f o r m e d i c i n a l purposes, the average h e r b a l pharmacy i n Chinatown c a r r i e s about 1 , 0 0 0 herbs i n s t o c k . However, o n l y 100 h e r b s are i n common everyday u s e . These 100 herbs form the b a s i s for the p r e v e n t a t i v e t h e r a p e u t i c system of the Chinese f a m i l y and are known t o those Chinese h a v i n g some f a m i l i a r i t y or exper ience with t h e i r t r a d i t i o n a l m e d i c i n e . 29 Most h e r b a l pharmacies d e a l d i r e c t l y w i t h an herb t r a d i n g f i r m from Hong Kong. Most herbs imported o r i g i n a t e from Mainland C h i n a . I f an h e r b a l pharmacy i s a b l e to p l a c e a l a r g e enough o r d e r , then they are a b l e t o make an order d i r e c t l y from the PRC. Then i f t h e y have any e x t r a s t o c k , t h e y s e l l t h i s t o other s m a l l e r h e r b a l shops i n the Chinatown a r e a . 4. P e r s o n n e l of .Herbal Shops and Pharmacies H e r b a l shops may o n l y employ one person t o work b e h i h d the herb counter whereas the b u s i e r h e r b a l pharmacies may employ up t o 8 s t a f f working behind the c o u n t e r . The types of s t a f f working t h e s e s t o r e s can be d i v i d e d i n t o t h r e e groups depending on t h e i r l e v e l of h e r b a l knowledge. The person w i t h the most e x p e r t i s e and t r a i n i n g i s the h e r b a l doctor who h a s r e c e i v e d p r o f e s s i o n a l t r a i n i n g i n h e r b a l i s m from a C o l l e g e of T r a d i t i o n a l Medicine i n the PRC or Hong Kong. There are a c t u a l l y v e r y few h e r b a l d o c t o r s who work behind the counter of h e r b a l p h a r m a c i e s . A second type of s t a f f person i s the h e r b a l i s t , or more p r o p e r l y the h e r b a l d i s p e n s e r . T h i s i n d i v i d u a l , a l though v e r y knowledgeable about the Chinese herbs and p r e s c r i p t i o n s , has not r e c e i v e d any formal t r a i n i n g i n Chinese h e r b a l i s m , but has p i c k e d up h i s knowledge of h e r b a l d i s p e n s i n g through a p e r i o d of a p p r e n t i c e s h i p i n an h e r b a l pharmacy. Most of the men t o be found behind the counters of herb shops and pharmacies f a l l i n t o t h i s c a t e g o r y . I n the l a r g e r s t o r e s , t h e r e may be 1 or 2 s e n i o r h e r b a l i s t s who have c o n s i d e r a b l e exper ience and are i n 30 charge of managing the o p e r a t i o n of the pharmacy. A t h i r d c a t e g o r y of s t a f f person i s the h e r b a l a s s i s t a n t . T h i s person has v e r y l i t t l e h e r b a l knowledge and performs d u t i e s such as s t o c k i n g herbs and p r e p a r i n g herbs f o r s a l e under t h e d i r e c t s u p e r v i s i o n of an h e r b a l i s t . The a s s i s t a n t may or may not be under an a p p r e n t i c e s h i p t o l e a r n the a r t of h e r b a l d i s p e n s i n g . T h i s i s an i n f o r m a l a p p r e n t i c e s h i p i n which a person can l e a r n h e r b a l d i s p e n s i n g by working i n the s t o r e as an h e r b a l a s s i s t a n t . 5 . A c t i v i t i e s of the H e r b a l i s t S i n c e the h e r b a l i s t i s the person most l i k e l y t o be found working b e h i n d the counter of an h e r b a l pharmacy, I s h a l l d e s c r i b e h i s a c t i v i t i e s i n more d e t a i l . The p r i m a r y r e s p o n -s i b i l i t y of the h e r b a l i s t i s t o manage the r e t a i l s i d e of the h e r b a l b u s i n e s s . A good h e r b a l i s t t h e r e f o r e has t o have a b a s i c knowledge of the herbs he i s d i s p e n s i n g and t o be a b l e t o e f f e c t i v e l y d e a l w i t h a c l i e n t e l e which i s i t s e l f q u i t e know-l e d g e a b l e i n the C h i n e s e h e r b a l t r a d i t i o n s . The f i r s t t h i n g an h e r b a l i s t must know are the names f o r a l l the h e r b s c a r r i e d by the s t o r e and t h e i r l o c a t i o n s . Each s t o r e a r r a n g e s the herbs i n the drawers a c c o r d i n g t o g e n e r a l c a t e g o r i e s of t h e r a p e u t i c s , a l though the s p e c i f i c arrangement i s up t o the s e n i o r h e r b a l i s t i n the s t o r e . None of the drawers are l a b e l e d so the h e r b a l i s t s and t h e i r a p p r e n t i c e s must l e a r n t h e i r arrangement. I n some s t o r e s , t h e r e i s a 31 w r i t t e n key made f o r the l o c a t i o n s of a l l the h e r b s . T h i s a l l o w s a l e s s e x p e r i e n c e d h e r b a l i s t or a p p r e n t i c e t o d i s p e n s e herbs i n the absence of the s e n i o r h e r b a l i s t . I n other s t o r e s , t h e r e i s no key, so o n l y those h e r b a l i s t s who know the system can d i s p e n s e h e r b s . T h i s has the e f f e c t of r e s t r i c t i n g a c c e s s t o the h e r b s t o a s e l e c t few, t h e r e b y enhancing t h e i r s t a t u s and i n d i s p e n s a b i l i t y . I n a d d i t i o n t o the l o c a t i o n of the h e r b s , the h e r b a l i s t must know some b a s i c m e d i c a l uses for each h e r b . Although the h e r b a l i s t does not know the a c t i o n s of h e r b s a c c o r d i n g t o the C l a s s i c a l Chinese m e d i c a l t h e o r y , he does know what symptoms each herb can t r e a t . T h i s i s an important d i s t i n c t i o n f o r the s o c i a l o r g a n i z a t i o n of m e d i c a l knowledge and one to which we w i l l r e t u r n . T h e r e f o r e , s i n c e the h e r b a l i s t l a c k s the t h e o r e t -i c a l b a s i s f o r Chinese h e r b a l t h e r a p y , he cannot w r i t e an o r i g i n a l h e r b a l p r e s c r i p t i o n . I n t h i s way, he i s l i k e the Western p h a r m a c i s t who can o n l y f i l l p r e s c r i p t i o n s on a d o c t o r ' o r d e r s . He f i l l s p r e s c r i p t i o n s t h a t h i s c l i e n t s have o b t a i n e d from h e r b a l d o c t o r s or have o b t a i n e d from another source such as f r i e n d s , r e l a t i v e s or from a book on Chinese h e r b a l medic ine The h e r b a l i s t i s o f t e n asked t o g i v e a d v i c e for m e d i c a l c o n d i -t i o n s and o f t e n can recommend a w e l l known p r e s c r i p t i o n for a s e t of symptoms the c l i e n t has d e s c r i b e d t o him. I n t h i s way he i s an important purveyor of m e d i c a l a d v i c e . T h i s c o n s u l t a -t i v e r o l e i s an important one for the h e r b a l i s t . The b e t t e r the a d v i c e g i v e n , the b e t t e r h i s r e p u t a t i o n and the b u s i e r h i s 32 s t o r e w i l l b e . The h e r b a l i s t w i l l a l s o s e l l and recommend s u p p l i e s of s i n g l e h e r b s to i n d i v i d u a l s and f a m i l i e s who do t h e i r own p r e p a r a t i o n s a t home. A s i g n i f i c a n t number of t r a n s a c t i o n s are of t h i s t y p e , where the i n d i v i d u a l knows what he or she wants and the main q u e s t i o n i s g e t t i n g the b e s t q u a l i t y of herb for the b e s t p r i c e . I n t h i s way the h e r b a l i s t i s l i k e a salesman, spending c o n s i d e r a b l e time w i t h h i s customers e x p l a i n i n g the v a l u e and advantages of h i s p a r t i c u l a r product over a n o t h e r ' s . T h i s i s e s p e c i a l l y t r u e i n the s a l e of g i n s e n g , where t h e r e are l i t e r a l l y dozens of d i f f e r e n t grades and types of ginseng a v a i l a b l e . When a customer o r d e r s an herb or p r e s c r i p t i o n , the h e r b a l i s t must f i n d the herbs from the a p p r o p r i a t e drawers and then a c c u r a t e l y weight them o u t . Although some of the l a r g e r s t o r e s have e l e c t r o n i c s c a l e s , most weighing of s m a l l amounts of h e r b s i s done u s i n g a s imple but e f f e c t i v e Chinese b a l a n c e beam h e l d i n the hand. T h i s s c a l e , imported from Hong Kong c o n s i s t s of an i v o r y or p l a s t i c beam the s i z e of a c h o p s t i c k marked out i n Chinese u n i t s of weight and a b r a s s weight suspended by a movable s t r i n g . A Chinese ounce or l i a n g i s e q u i v a l e n t to 3 1 . 2 grams. A s k i l l e d h e r b a l i s t can weigh out a number of h e r b s q u i t e q u i c k l y u s i n g t h i s method. An h e r b a l i s t may a l s o use an abacus, as w e l l as being p r o f i c i e n t on an e l e c t r o n i c c a l c u l a t o r . Often, t h e r e i s some p r e p a r a t i o n i n v o l v e d before the herbs 33 are g i v e n t o the customer. I t i s common f o r r o o t s t o be s t o r e d whole and s l i c e d up f o r the customer a t the time of p u r c h a s e . The h e r b a l i s t w i l l o f t e n h e a t up the root s l i g h t l y t o s o f t e n i t and then use a huge c l e a v e r which i s a t t a c h e d t o a chopping b l o c k a t one end and p i v o t s , a l l o w i n g f o r a r a p i d up and down motion. A g a i n , t h e r e i s some s k i l l i n v o l v e d i n o p e r a t i n g t h i s t o o l and a v e r y f i n e c u t can be made. These more r o u t i n e t a s k s not i n v o l v i n g d i r e c t customer i n t e r a c t i o n are o f t e n done by the h e r b a l a s s i s t a n t . Other d u t i e s of the a s s i s t a n t a r e making up p r e s c r i p t i o n s under the s u p e r v i s i o n of the h e r b a l i s t and m a i n t a i n i n g the s t o c k s o f h e r b s i n t h e i r r e s p e c t i v e drawers and j a r s . E x t r a s t o r e s of the herbs are kept i n the basement of the. s t o r e and a r e used t o r e p l e n i s h the pharmacy u p s t a i r s . S u p p l i e s of h e r b s , e s p e c i a l l y those i n p u b l i c view such as the g l a s s j a r s , a r e never al lowed t o decrease and a r e always kept i n a f u l l s t a t e . Stock keeping i s an important a s p e c t of the h e r b a l b u s i -n e s s , s i n c e t h e r e i s such a long l a g p e r i o d i n v o l v e d i n o r d e r -ing h e r b s from A s i a . Therefore the s t a f f have t o keep t r a c k of the s u p p l i e s and s a l e s of each herb so t h a t they never run out of a p a r t i c u l a r h e r b , which would not be good for the s t o r e ' s r e p u t a t i o n . 6. C l i e n t e l e Chinese from a l l s o c i a l and e d u c a t i o n a l s t r a t a buy Chinese h e r b s , though the " t y p i c a l " customer i s an e l d e r l y Chinese 34 woman who had o n l y a grade s c h o o l e d u c a t i o n and who does not speak E n g l i s h . I t i s o f t e n the e l d e s t woman of a household who i s r e s p o n s i b l e f o r m a i n t a i n i n g and p u r c h a s i n g the f a m i l y ' s supply of h e r b s . Whereas g r o c e r y shopping i s o f t e n a d a i l y a f f a i r , the purchase of h e r b s i s done more i n t e r m i t t e n t l y i n response t o an i l l n e s s or d e c r e a s i n g f a m i l y s u p p l i e s . Herbal purchases are planned f o r a c c o r d i n g t o the f a m i l y ' s budget as they o f t e n i n v o l v e l a r g e and c o s t l y amounts. The more common herbs t h a t are used on a more r e g u l a r b a s i s are bought i n l a r g e r s u p p l y than those herbs t h a t are being purchased f o r a s p e c i f i c i l l n e s s t h a t cannot be t r e a t e d u s i n g the herbs a v a i l -a b l e a t home. S i n c e h e r b s are o f t e n used p r e v e n t i v e l y i n the absence of any s p e c i f i c d i s e a s e , a l a r g e s u p p l y of these w i l l be purchased a t one t i m e . The amounts of money i n v o l v e d are l a r g e r than the average Westerner would spend a t one time i n a Western pharmacy. B i l l s for herbs t o t a l l i n g $100 or more are not uncommon. From my i n t e r v i e w s w i t h Chinese f a m i l i e s , a g r e a t d e a l of v a l u e i s p l a c e d on these h e r b s and budgeted f o r even i n f a m i l i e s w i t h l i m i t e d incomes. One f a m i l y w i l l o f t e n d e a l w i t h a s i n g l e pharmacy t h a t they have e s t a b l i s h e d a r e l a t i o n s h i p w i t h . The b u s i n e s s r e l a t i o n s h i p i s an important one i n China and once t h i s i s e s t a b l i s h e d a s p e c i f i c s e t of o b l i g a t i o n s are brought i n t o p l a y and r e s p e c t e d by both p a r t i e s . The element of t r u s t and r e s p e c t i s b a s i c i n the area of medical herbs where the f a m i l y ' s h e a l t h and a g r e a t d e a l of money i s a t s t a k e . 35 7. H e r b a l i s t - C l i e n t I n t e r a c t i o n s The purchase of h e r b s or a p r e s c r i p t i o n i s an important s o c i a l r i t u a l . Even i f the purchase i s a s t r a i g h t f o r w a r d one i n which the c l i e n t knows e x a c t l y what t h e y want, t h e r e w i l l be c o n s i d e r a b l e d i s c u s s i o n r e g a r d i n g the q u a l i t y and v a l u e of the p a r t i c u l a r grade of herb s e l e c t e d . D i s c u s s i o n c e n t e r s around the m e r i t s of one grade over a n o t h e r , which grade r e p r e s e n t s the b e s t v a l u e and the e f f i c a c y of a p a r t i c u l a r herb t o t r e a t or p r e v e n t a s p e c i f i c c o n d i t i o n . A g r e a t emphasis i s p l a c e d on e x p l a i n i n g and v e r i f y i n g for the c l i e n t the v i r t u e s of the C h i n e s e h e r b . A t r a n s a c t i o n of t h i s type i s l e n g t h y compared to Western s t a n d a r d s and averages about a h a l f an h o u r . The h e r b a l i s t t a k e s g r e a t p a i n s t o answer h i s c l i e n t ' s q u e s t i o n s and t o make sure t h a t the c l i e n t l e a v e s h i s s t o r e both s a t i s -f i e d and c o n f i d e n t i n the herbs purchased and the h e r b a l i s t and pharmacy where they were p u r c h a s e d . The t r a n s a c t i o n i s i n t e n s e w i t h a g r e a t d e a l of communication t a k i n g p l a c e between the two p a r t i e s . I t o f t e n t a k e s on a v e r y t h e a t r i c a l and r i t u a l i z e d a i r , as the h e r b a l i s t t a l k s r a p i d l y and g e s t i c u l a t e s w i t h h i s hands and body b e f o r e a counter f u l l of herbs and an a t t e n t i v e customer. A g r e a t d e a l of t r u s t and f a i t h i s generated i n the course of such a t r a n s a c t i o n . At a meta-communicative l e v e l , what gets r e a f f i r m e d a t every t r a n s a c t i o n i s the v a l i d i t y and e f f i c a c y of the e n t i r e t r a d i t i o n a l Chinese m e d i c a l system. The h e r b a l i s t t a k e s g r e a t p a i n s to p l e a s e h i s customer. S p e c i a l l y v a l u e d customers are o f f e r e d a cup of ginseng t e a 36 which i s always brewing i n the corner of the busy s t o r e . C h i l d r e n of customers are acknowledged and o f t e n t r e a t e d w i t h some C h i n e s e candy d e l i c a c y . The t r a n s a c t i o n i s not s o l e l y a b u s i n e s s one but a s o c i a l one as w e l l . D i s c u s s i o n of p e r s o n a l matters forms an important element i n m a i n t a i n i n g the s o c i a l bond between customer and h e r b a l i s t . T h i s r e c a l l s the s p e c i a l form of b u s i n e s s r e l a t i o n s h i p known as kan c h ' i n g which was v i r t u a l l y an i n s t i t u t i o n i n t r a d i t i o n a l China (Young 1 9 7 4 ) . A b u s i n e s s r e l a t i o n s h i p once e s t a b l i s h e d was c o n s i d e r e d a s a c r e d t r u s t which took on more the c h a r a c t e r of a c l o s e f r i e n d s h i p t h a n a commercial t r a n s a c t i o n . I f a customer i s unsure of what remedy t o g e t , they w i l l seek the t r u s t e d a d v i c e of the h e r b a l i s t . On the b a s i s of h i s e x p e r i e n c e and s e l f - e d u c a t i o n , a good h e r b a l i s t can b u i l d up a wide c l i e n t e l e f o r h i m s e l f and h i s s t o r e . I f people are p l e a s e d w i t h h i s manner and a d v i c e , he w i l l develop a p o s i t i v e r e p u t a t i o n throughout the e n t i r e community by word of mouth. S i m i l a r l y f o r an h e r b a l d o c t o r , people are not so much concerned with c r e d e n t i a l s as they are w i t h the r e p u t a t i o n he has b u i l t up i n the community. An h e r b a l i s t always has t o be c a r e f u l t h a t what he a d v i s e s i s a c c u r a t e as some customers who are, f a m i l i a r w i t h the Chinese h e r b a l m e d i c a l system w i l l " t e s t " the knowledge of the h e r b a l i s t . Often a -customer who i s knowledge-a b l e of the a c t i o n s of herbs w i l l ask q u e s t i o n s of the h e r b a l i s t as a means of e v a l u a t i n g the h e r b a l i s t ' s competency. Thus there e x i s t s an i n f o r m a l r e g u l a t o r y system a g a i n s t incompetent 37 h e r b a l p r a c t i t i o n e r s . A f t e r the h e r b s f o r purchase are s e l e c t e d , the h e r b a l i s t must f i l l the order e f f i c i e n t l y . T h i s i n v o l v e s weighing out the h e r b s , making any p r e p a r a t i o n s n e c e s s a r y such as c u t t i n g and s l i c i n g and then wrapping the herbs up i n a l a r g e sheet of n e w s p r i n t - g r a d e p a p e r . 8. C h i n e s e M e d i c i n e , Herbs and P r e s c r i p t i o n s I n order t o understand Chinese h e r b a l i s m , i t i s n e c e s s a r y t o i n t r o d u c e some fundamental concepts of C h i n e s e m e d i c i n e . A l l of C h i n e s e medic ine i s based on a n a t u r a l i s t i c p h i l o s o p h y . T h i s view of the world i s known as the y i n / y a n g d o c t r i n e . The u n i v e r s e i s thought t o be the r e s u l t of the i n t e r a c t i o n between t h e s e two b a s i c p r i n c i p l e s : y i n and yang. Yang r e p r e s e n t s the c r e a t i v e , warmth, l i g h t , e x t e r i o r and male a s p e c t of a l l phenomena. The y i n r e p r e s e n t s the r e c e p t i v e , c o l d , d a r k , and feminine a s p e c t of a l l t h i n g s . Y i n and yang r e p r e s e n t i d e a l i z e d s t a t e s . N e i t h e r can e x i s t a l o n e . There i s always some y i n t o b a l a n c e the yang, and yang where y i n predominates. Together they are a n t a g o n i s t i c and complementary f o r c e s . Each i s c o n s t a n t l y changing and t r a n s f o r m i n g i t s s t a t e i n t o the o t h e r . Peace and harmony i n s o c i e t y and h e a l t h i n the mind and body r e s u l t e d when t h e r e was a b a l a n c e between these two p r i n -c i p l e s . Imbalance between t h e s e two f o r c e s r e s u l t e d i n d i s -order a t the l e v e l of s o c i e t y and d i s e a s e a t the l e v e l of the body. The h e a l t h y body i s c o n s i d e r e d to be c o n s t a n t l y changing 38 between y i n and yang s t a t e s . The t r a d i t i o n a l Chinese doctor encourages change i n h i s p a t i e n t but a v o i d s extremes. Any t ime the body became extremely y i n or yang, d i s e a s e i s thought t o r e s u l t . The g o a l of Chinese medic ine i s t o prevent i l l n e s s through the r e g u l a t i o n of energy between these two extreme c o n d i t i o n s . The C h i n e s e word for t h i s energy i s c h ' i . C h ' i or v i t a l f o r c e i s c o n s i d e r e d t o be the c r e a t i v e p r i n c i p l e behind a l l phenomena. I t i s c o n s i d e r e d t o be the u l t i m a t e cause and a t the same time the u l t i m a t e e f f e c t . When c h ' i animates form, t h i s i s c o n s i d e r e d t o be l i f e . When c h ' i s e p a r a t e s and w i t h -draws from form t h i s i s c a l l e d death. H e a l t h r e s u l t s when c h ' i flows u n r e s t r i c t e d i n the body. A proper b a l a n c e and d i s t r i -b u t i o n of c h ' i i s b e l i e v e d t o i n c r e a s e the b o d y ' s r e s i s t a n c e to d i s e a s e . I l l n e s s r e s u l t s when the c h ' i c i r c u l a t i o n i s b l o c k e d or when an organ s u f f e r s from an excess or i n s u f f i c i e n t amount of c h ' i . When food and other substances such as h e r b s are consumed and d i g e s t e d , t h e y are transformed i n t o v i t a l c h ' i energy and becomes e i t h e r a c o l d y i n f o r c e or a h o t yang f o r c e i n the body. The yang f o r c e i s thought to c i r c u l a t e on the o u t s i d e of the body and t o p r o t e c t i t from e x t e r n a l i n f i l t r a t i o n s such as c o l d , damp winds c a r r y i n g d i s e a s e . The y i n f o r c e i s thought t o c i r c u l a t e i n v i s i b l y on the i n s i d e of the body and t o s t o r e the v i t a l s t r e n g t h o f the organism. Imbalances i n these two f o r c e s r e s u l t s i n d i s e a s e which 39 can be c o r r e c t e d through e a t i n g the a p p r o p r i a t e "hot" or "cold" foods or by d r i n k i n g the a p p r o p r i a t e "hot" or "cold" h e r b a l t e a . The "hot" and "cold" r e f e r t o a symbol ic system of a s s o c i a t i o n s which i s r e l a t e d to but not i d e n t i c a l w i t h the y i n / y a n g p o l a r i t y . Whereas the y i n / y a n g system tends t o be r e s t r i c t e d t o more formal m e d i c a l d i s c o u r s e , the h o t / c o l d system i s known t o everyone. I t s e r v e s as the key c o n c e p t u a l model i n C h i n e s e f o l k medic ine ( G o u l d - M a r t i n 1 9 7 8 ; Ahern 1 9 7 5 ; Anderson and Anderson 1 9 7 5 ) . Using t h i s system, the average C h i n e s e person i s a b l e t o r e c o g n i z e and t r e a t i m b a l -ances i n the b o d y ' s harmony. Hot and c o l d do not s t r i c t l y r e f e r t o temperature but to a wider s e t of both symbol ic and p h y s i c a l p r o p e r t i e s . Hot and c o l d are most commonly used t o r e f e r t o the p r o p e r t i e s and c h a r a c t e r i s t i c s of food, herbs and d i s e a s e s t a t e s . I n g e n e r a l , t h i n g s which are d e s c r i b e d as being hot tend t o be s t i m u l a t i n g , n o u r i s h i n g and warming t o the body. Things t h a t are c o l d are r e l a x i n g , soothing and c o o l i n g t o the body. T h i s model of human f u n c t i o n i n g s e r v e s as the b a s i s f o r h e r b a l t h e r a p y . The s p e c i f i c needs of the i n d i v i d u a l body are determined by a number of f a c t o r s i n c l u d i n g c o n s t i t u -t i o n a l d i f f e r e n c e s , age, sex, geographic l o c a t i o n and season. I w i l l p r o v i d e f u r t h e r examples of t h i s system i n o p e r a t i o n i n a f o l l o w i n g c h a p t e r on f a m i l y - b a s e d h e a l t h c a r e . Chinese medic ine i s concerned w i t h treatment of the whole body. Symptoms are t r e a t e d as a whole and not s e p a r a t e l y . Treatment i s g i v e n on the b a s i s of a d i s e a s e and not merely the 40 a l l e v i a t i o n of symptoms. Chinese medic ine i s o r i e n t e d towards the p r e v e n t i o n of d i s e a s e through c a r e f u l adjustments u s i n g both food and h e r b s . Food and h e r b s are c o n s i d e r e d t o be complementary and o f t e n used i n c o n j u n c t i o n f o r the p r e v e n t i o n and the treatment of d i s e a s e , (a) C h i n e s e Herbs The use of herbs i n C h i n a predated the o r i g i n s of a g r i c u l t u r e . The f i r s t ev idence of h e r b a l use i s over 5 ,000 y e a r s ago dur ing the l i f e of the l e g e n d a r y emperor Shen Nung. Shen Nung i s the p a t r o n s a i n t of a g r i c u l t u r e i n C h i n a . He i s c o n s i d e r e d t o be the i n v e n t o r of the plough, the proper use of seed and s o i l , and d i s c o v e r e r of the m e d i c i n a l p r o p e r t i e s of h e r b s . He i s s a i d t o be the author of the O r i g i n a l H e r b a l (Pen T ' s a o ) which was f i r s t p u b l i s h e d i n 100 B . C . T h i s o r i g i n a l h e r b a l c o n t a i n e d 365 drugs of v e g e t a b l e , animal and m i n e r a l o r i g i n . A l a t e r v e r s i o n which was p u b l i s h e d i n 1596 was w r i t t e n by the g r e a t n a t u r a l i s t L i S h i h - c h e n and c o n t a i n e d over 2 ,000 herbs used f o r m e d i c i n a l purposes . Today, 2 ,000 herbs are c u l t i v a t e d i n the PRC f o r m e d i c i n a l u s e . While the m a j o r i t y of Chinese herbs are from v e g e t a b l e s o u r c e s , they a l s o i n c l u d e animal and m i n e r a l m a t e r i a l . T r a d i t i o n a l l y , a l l herbs are c l a s s i f i e d i n t o t h r e e c a t e g o r i e s . Upper c l a s s or s u p e r i o r herbs are n o n - t o x i c and can be used on a d a i l y b a s i s to t r e a t and prevent d i s e a s e . They are o f t e n s e l f - p r e s c r i b e d and known to most 41 Chinese laymen. The middle c l a s s of herbs are c o n s i d e r e d t o be t o n i c s w i t h e f f e c t s of a m i l d but t h e r a p e u t i c n a t u r e They a r e used l e s s f r e q u e n t l y than s u p e r i o r h e r b s . The lower or i n f e r i o r c l a s s of herbs are thought t o be t o x i c and poisonous ( t u ) . They a r e dangerous and t o be p r e -s c r i b e d by a doctor f o r the treatment of a severe d i s e a s e t h a t other methods have f a i l e d t o t r e a t . The c o l l e c t i n g , p r o c e s s i n g and s t o r a g e of herbs i s thought t o a f f e c t the q u a l i t y and potency of an h e r b . The Chinese have developed the p l a n t i n g , h a r v e s t i n g and p r o c e s s i n g of herbs i n t o a f i n e a r t . The potency of herbs i s thought t o depend on s e v e r a l f a c t o r s . The f i r s t i s the s p e c i e s . Many p l a n t s have s e v e r a l t y p e s of s p e c i e s , which may v a r y i n t h e i r content of a c t i v e m e d i c i n a l i n g r e d i e n t s . For example, t h e r e are a t l e a s t t h r e e d i s t i n c t s p e c i e s of ginseng which v a r y i n t h e i r reputed s t r e n g t h and b i o -c h e m i c a l c o n s t i t u e n t s (Veninga 1 9 7 4 ) . A l l Chinese herbs a r e grown i n C h i n a under c a r e f u l l y c o n t r o l l e d c o n d i t i o n s t o maximize t h e i r t h e r a p e u t i c e f f e c t . Growing l o c a t i o n and c l i m a t i c c o n d i t i o n s w i l l a l s o a f f e c t a p l a n t ' s potency Another f a c t o r taken i n t o account by the Chinese i s the time of h a r v e s t s i n c e d i f f e r e n t p a r t s mature a t d i f f e r e n t t i m e s . The p a r t s of p l a n t s u s e d i n c l u d e the r o o t s , rhizomes, stems, l e a v e s , f r u i t s and f l o w e r s . Proper p r o c e s s i n g i s thought t o i n c r e a s e the e f f i c a c y of an h e r b . The Chinese c l e a n , s o r t , wash, p u r i f y and dry a l l t h e i r 42 m e d i c i n a l h e r b s . They have developed an e l a b o r a t e method of sun and shade d r y i n g and steaming t o p r e s e r v e the b e n e f i c i a l q u a l i t i e s of an herb and t o remove or lower any drug t o x i c i t y i n the p l a n t . T h i s e l a b o r a t e p r e p a r a t i o n ensures t h a t Chinese herbs are unique i n t h e i r m e d i c i n a l p r o p e r t i e s . No other c o u n t r y h a s developed such an i n t e n s i v e system of p r e p a r a t i o n . T h e r e f o r e , no herb grown anywhere i n the world i s e q u i v a l e n t to a Chinese herb grown and prepared i n C h i n a . The Chinese i n the PRC have developed an i n t e n s i v e h e r b a l i n d u s t r y t o s u p p l y the needs of t h e i r domestic and o v e r s e a s market, (b) P r e s c r i p t i o n s Although some herbs such as ginseng are taken a l o n e , most h e r b s are taken i n combination with o t h e r s . Mixtures or p r e s c r i p t i o n s are p r e f e r r e d because s i n g l e herbs are thought t o have e i t h e r too strong or d i r e c t an a c t i o n on the body. A p r e s c r i p t i o n w i l l a l s o produce a s e t of e f f e c t s t h a t no s i n g l e herb can p r o v i d e . An a p p r o p r i a t e l y combined h e r b a l formula i s c o n s i d e r e d t o be e s s e n t i a l f o r the treatment of c h r o n i c a i l m e n t s where many organ systems are i n v o l v e d . The d e s i g n of an e f f e c t i v e p r e s c r i p t i o n i s a s u b t l e a r t developed by the Chinese h e r b a l doctor a f t e r many y e a r s of t r a i n i n g and e x p e r i e n c e . There are many types of p r e s c r i p t i o n s i n Chinese m e d i c i n e . The most d i f f i c u l t to des ign i s the i n d i v i d u a l p r e s c r i p t i o n based on a c a r e f u l reading of a p e r s o n ' s 43 symptoms and c o m p l a i n t s . The Chinese doctor d e s i g n s a formula unique to t h a t i n d i v i d u a l t o e l i m i n a t e the cause of the d i s e a s e and, as a consequence, the a l l e v i a t i o n of the symptoms. Other p r e s c r i p t i o n s are passed along a f a m i l y ' s d e s c e n d e n t s . They are kept i n a f a m i l y p r e s c r i p -t i o n book and a r e shared w i t h no one o u t s i d e the f a m i l y . A f a m i l y can produce a l i n e a g e of famous d o c t o r s by p a s s i n g down s e c r e t p r e s c r i p t i o n s . A more common type of p r e s c r i p t i o n are those t h a t have been t r i e d and t e s t e d over hundreds and thousands of y e a r s of u s e . They a r e p u b l i s h e d i n books of h e r b a l p r e s c r i p t i o n s and a v a i l a b l e for everyone t o u s e . H e r b a l i s t s and f a m i l i e s w i l l o f t e n employ these e s t a b l i s h e d p r e s c r i p t i o n s . These e s t a b l i s h e d p r e s c r i p t i o n s are used t o t r e a t common a i l m e n t s such as c o l d s , stomach upset and rheumatism. Every p r e s c r i p t i o n c o n t a i n s four c l a s s e s of herbs which perform d i f f e r e n t f u n c t i o n s i n the formula. The pr imary herb i s c a l l e d the chun or k i n g h e r b . I t i s the major component of the p r e s c r i p t i o n and d e a l s d i r e c t l y w i t h the major problem t h a t the formula i s used f o r . There are three secondary herbs which complement and enhance the a c t i o n of the pr imary h e r b . They are a l s o used t o add a d d i t i o n a l e f f e c t s not produced by the pr imary h e r b . The chen or m i n i s t e r herb i s a s u b s i d i a r y herb added to the formula to i n c r e a s e or enhance the a c t i o n of the k i n g h e r b . The t s o or a s s i s t a n t herb i s used t o e i t h e r decrease any p o s s i b l e 44 s i d e e f f e c t s of the k i n g herb or t o l i m i t the a c t i o n of the k i n g h e r b , i f i t i s a strong t o x i c h e r b . The s h i h or s e r v a n t herb i s added f o r i t s soothing e f f e c t on the system. I t makes the p r e s c r i p t i o n e a s i e r t o take and h e l p s r e l a x the i n t e s t i n e s so t h a t the h e r b a l p r o p e r t i e s are b e t t e r a s s i m i l a t e d . The C h i n e s e h e r b a l doctor must have a comprehensive u n d e r s t a n d i n g of the n a t u r e of an h e r b as d e f i n e d by Chinese m e d i c i n e . The n a t u r e of an herb i s d e f i n e d i n terms of i t s energy, f l a v o u r , t e n d e n c i e s , f u n c t i o n s and a f f i n i t y f o r organ m e r i d i a n s (Lu 1 9 7 7 ) . A l l herbs are c l a s s i f i e d a c c o r d i n g t o t h e i r "atmospheric" energy: h o t , warm, c o o l and c o l d . These a r e the symbol ic q u a l i t i e s which a r e a s c r i b e d to both food and h e r b s . T h i s i s the o n l y a s p e c t of h e r b a l p r o p e r t i e s t h a t l a y people are f a m i l i a r w i t h . There are f i v e f l a v o u r s of herbs which correspond t o the wu-hsing or f i v e energy phase t h e o r y . The wu-hs ing forms the t h e o r e t i c a l b a s i s f o r c l a s s i c a l Chinese medic ine and was f i r s t e l a b o r a t e d i n the Nei Ching or Y e l l o w Emperor's C l a s s i c of I n t e r n a l Medicine ( V e i t h 1966) which i s e s t i m a t e d t o be between t h r e e and four thousand y e a r s o l d . The wu-hsing r e p r e s e n t s f i v e b a s i c types of energy t r a n s f o r m a t i o n s and i s named for the f i v e b a s i c e lements : f i r e , e a r t h , m e t a l , water and wood. These elements are s y m b o l i c a l l y r e l a t e d to b o d i l y f u n c t i o n s , organs, h e r b a l f l a v o u r s , acupuncture m e r i d i a n s , emotions 45 and many e x t e r n a l i n f l u e n c e s on the body ( P o r k e r t 1 9 7 4 ; C o n n e l l y 1 9 7 9 ) . The f i v e f l a v o u r s of herbs are a c r i d , sweet, s o u r , b i t t e r and s a l t y . These f l a v o u r s d e f i n e an "herb's m e d i c i n a l a c t i o n s on the b o d y ' s p h y s i o l o g y . The C h i n e s e system of h e r b a l c l a s s i f i c a t i o n i s h i g h l y complex and r e q u i r e s c o n s i d e r a b l e s k i l l t o u t i l i z e i t . A s k i l l e d h e r b a l doctor w i l l use the combined a c t i o n of s e v e r a l herbs t o e f f e c t a complete cure of the b a s i c imbalances i n h i s p a t i e n t . An h e r b a l doctor w i l l c l o s e l y monitor t h e treatment of the p a t i e n t . He w i l l e v a l u a t e the r e s u l t s of the p r e s c r i p t i o n and a l t e r i n g r e d i e n t s and dosages a c c o r d i n g l y . I f a case i s d i f f i c u l t , he w i l l g i v e the p a t i e n t a s m a l l dose t o f i r s t e s t a b l i s h i f i t i s a p p r o p r i a t e . As I s h a l l d i s c u s s i n the next c h a p t e r , the r o l e of h e r b a l d o c t o r s i n V a n c o u v e r ' s Chinatown i s minimal , s i n c e h i s s t a t u s has not been l e g i t i m a t e d by e i t h e r l e g a l or m e d i c a l a u t h o r i t i e s . I f an h e r b a l i s t or l a y person wants t o check on the a c t i o n of a p a r t i c u l a r h e r b , a P e n - t s a o (Herbal) i s c o n s u l t e d . There are many e d i t i o n s a v a i l a b l e i n Chinese which are p r i n t e d i n Hong Kong, Taiwan or the PRC. S e v e r a l E n g l i s h v e r s i o n s are a v a i l a b l e which proved i n d i s p e n s a b l e t o my r e s e a r c h . The c l a s s i c r e f e r e n c e i s the t r a n s l a t i o n of L i S h i h - c h e n ' s P e n - t s a o by Smith and S t u a r t ( L i 1 9 7 3 ) . The most a u t h o r i t a t i v e contemporary t e x t i s the d e t a i l e d h e r b a l s e c t i o n i n the Barefoot 46 D o c t o r ' s Manual (Hunan, 1 9 7 7 ) . Another u s e f u l book i s the h e r b a l d i c t i o n a r y by Hu (1980) which c r o s s - r e f e r e n c e d the C h i n e s e , b o t a n i c a l , p h a r m a c e u t i c a l and E n g l i s h names for 2 , 0 0 0 h e r b s . K e y ' s ( 1 9 7 6 ) h e r b a l i s an important r e f e r e n c e on the c h e m i s t r y and botany of C h i n e s e h e r b s . Other u s e f u l books c o n t a i n i n g u s e f u l herb i n f o r m a t i o n a r e two g e n e r a l books on C h i n e s e h e r b a l medic ine by Hsu (1980) and H y a t t ( 1 9 7 8 ) . 9. Some Examples of Common Chinese Herbs I n t h i s s e c t i o n , I would l i k e t o d i s c u s s the most commonly used herbs i n C h i n e s e m e d i c i n e . The herbs chosen a r e a l l used by the C h i n e s e f a m i l i e s i n my sample. Most of these herbs f a l l i n t o the c a t e g o r y of energy t o n i c s which are used t o b u i l d up b o d i l y energy and r e s i s t a n c e and to t r e a t i l l n e s s e s . According t o an h e r b a l i s t , a wide v a r i e t y of t o n i c s are a v a i l a b l e and used a c c o r d i n g to the s p e c i f i c c h a r a c t e r i s t i c s and needs of the person u s i n g them. These v a r i a b l e s i n c l u d e the p e r s o n ' s age, sex, b o d i l y temperament and s p e c i f i c p h y s i o l o g i c a l problem and the geographic l o c a t i o n and season. Ginseng i s the most w i d e l y used t o n i c herb i n Chinese m e d i c i n e . However, s i n c e e n t i r e books have been devoted t o t h i s herb ( F u l d e r 1980; Veninga 1974) I s h a l l d i s c u s s the l e s s e r known but e q u a l l y important herbs i n Chinese m e d i c i n e . I n my d i s c u s s i o n of each herb, I w i l l i n c l u d e both f o l k knowledge and the c l a s s i c a l - p r o f e s s i o n a l d e s c r i p t i o n f o r the use and a c t i o n of each h e r b . 47 \ y (a) Dong-Quaj i /Tang-Kuei (Cantonese) : A n g e l i c a S i n e n s i s Dong g u a i i s renowned i n C h i n e s e medic ine f o r i t s a f f i n i t y f o r the female c o n s t i t u t i o n . I t i s c o n s i d e r e d t o be the b e s t female t o n i c a v a i l a b l e t o Chinese women. I t i s used by many C h i n e s e women i n Vancouver and was kept i n a l l the homes I v i s i t e d . The Chinese women b e l i e v e d t h a t Dong g u a i b u i l d s good blood and i s u s e f u l f o l l o w i n g c h i l d b i r t h and a f t e r m e n s t r u a t i o n . The women are thought t o have l e s s b l o o d than men, they need a t o n i c t o h e l p i n c r e a s e t h e i r blood s u p p l y . Dong-guai i s an impor-t a n t i n g r e d i e n t i n t h e soup g i v e n t o mothers a f t e r a b i r t h . I n the Pen T ' s a o ( L i 1 9 7 3 ) Dong-quai i s c o n s i d e r e d to be yang, h o t and good f o r the blood and c i r c u l a t i o n . I t i s p r i m a r i l y for female compla ints but i s a l s o used t o t r e a t the p a i n s of a r t h r i t i s and h e a r t problems s i n c e i t has a n a l g e s i c and c i r c u l a t i o n s t i m u l a t i n g p r o p e r t i e s . Dong-quai i s h i g h l y v a l u e d as a remedy f o r b u i l d i n g b lood, n o u r i s h i n g the female g l a n d s , r e g u l a t i n g monthly p e r i o d s , and c o r r e c t i n g menopausal symptoms. I t i s never g i v e n t o a woman dur ing pregnancy as t h i s would c o u n t e r a c t the y i n s t a t e the expectant mother i s i n . However, i t i s used a f t e r c h i l d b i r t h t o r e s t o r e the woman from the h i g h l y y i n s t a t e of pregnancy back to a more b a l a n c e d s t a t e . Chinese h e r b a l i s t s use i t as an emmenagogue to d i s s o l v e blood c l o t s and t o h e l p expel an a f t e r b i r t h t h a t has f a i l e d to 48 appear. Dong-quai i s the root of the p l a n t A n g e l i c a s i n e n s i s which has q u i t e d i f f e r e n t p r o p e r t i e s from the American and European A n g e l i c a a r c h a n g e l i c a . Recent p h a r m a c o l o g i c a l s t u d i e s (Keys 1 9 7 6 ; L i 1974) have shown i t t o c o n t a i n s u b s t a n c e s which account f o r i t s r e p o r t e d e f f e c t s . I t h a s been found t o promote e x c i t a t i o n and c o n t r a c t i o n o f the smooth muscle of the b l a d d e r , i n t e s t i n e s and e s p e c i a l l y the u t e r u s (Keys 1 9 7 6 : 1 9 7 ) . Dongaquai has been found t o c o n t a i n V i t a m i n E which i s b e n e f i c i a l f o r the c i r c u l a t i o n and a coumarin substance which i s an a n t i - c o a g u l a n t ( L i 1 9 7 4 ) . I t a l s o c o n t a i n s v a r i o u s h o r m o n e - l i k e s u b s t a n c e s which c o u l d h e l p t o r e g u l a t e hormonal b a l a n c e of the m e n s t r u a l c y c l e . (b) Tang-Shen (Fang-Tang i n C a n t o n e s e ) : Codonopsis Tangshen Tang-shen i s a root p l a n t which c o n t a i n s s i m i l a r c o n s t i t u e n t s to ginseng (Keys 1 9 7 6 ) . I t c o u l d be c o n -s i d e r e d t o be a poor man's ginseng s i n c e i t has s i m i l a r p r o p e r t i e s but i s one t h i r d the s t r e n g t h and c o s t s c o n -s i d e r a b l y l e s s . I t i s thought to be m i l d e r and s a f e r and can be used by both men and women over a long p e r i o d of time and on a d a i l y b a s i s . My informants t o l d me i t was good f o r h e a l t h y people to i n c r e a s e t h e i r b o d i l y energy and t o make them l e s s prone t o i l l n e s s . I t i s kept i n the homes of many Chinese f a m i l i e s and i s an important i n g r e -49 d i e n t i n an "energy soup" which i s made w i t h c h i c k e n or p i g ' s f e e t . A f a m i l y would t a k e t h i s soup w i t h t h e i r r e g u l a r meal and c o n s i d e r i t as a normal, everyday way of keeping h e a l t h y . Tang-shen i s used by C h i n e s e f a m i l i e s f o r the s e l f -treatment of sore t h r o a t s , t o i n c r e a s e the c i r c u l a t i o n and to make o n e ' s complexion h e a l t h i e r . Tang-shen i s p r o m i -n e n t l y d i s p l a y e d i n the C h i n e s e h e r b a l pharmacies and i s one of the most commonly purchased Chinese herbs by f a m i l i e s . I n C h i n e s e m e d i c i n e , Codonopsis i s thought to e n t e r the s p l e e n and lung m e r i d i a n s and to s t r e n g t h e n the s p l e e n and stomach (Barefoot D o c t o r ' s Manual; Hunan 1 9 7 7 ) . I t i s used i n combinat ion w i t h A s t r a g a l u s t o i n c r e a s e energy and r e s i s t a n c e t o d i s e a s e . I t i s used t h e r a p e u t i c a l l y t o t r e a t a l l d i s e a s e s a s s o c i a t e d w i t h weakness, d e b i l i t y and anemia i n c l u d i n g d i a b e t e s , e n t e r i t i s , i n f e c t i o n , i n f l a m -mation, h y p e r a c i d i t y and weak d i g e s t i o n . Recent r e s e a r c h i n the PRC h a s shown i t to d i l a t e blood v e s s e l s , b a l a n c e blood p r e s s u r e , i n c r e a s e red blood c e l l s and t o decrease i n f e c t i o n . (Hunan 1 9 7 7 . ) (c) Huang-Chi ( P a k - C h i i n Cantonese) : A s t r a g a l u s Hoangtchy T h i s herb i s a s l i c e d stem of a t r e e and i s almost always used i n combination with Tang-shen. I t i s an energy t o n i c used for g e n e r a l weakness and to i n c r e a s e 50 v i g o r i n both h e a l t h y people and those r e c o v e r i n g from any i l l n e s s . One o l d e r woman t o l d me t h a t i t was used t o p r e s e r v e c h i and was taken by women who were thought t o be weak. Another informant t o l d me i t was used f o r v o i c e problems and s h o r t n e s s of b r e a t h which c o l l a b o r a t e s w i t h the i d e a of p r e s e r v i n g a i r . An h e r b a l i s t s a i d t h a t i t i s g i v e n t o people a f t e r an o p e r a t i o n i n a soup made w i t h f i s h or l e a n p o r k , and was thought t o make i n c i s i o n s h e a l f a s t e r . According t o Chinese m e d i c i n e , i t e n t e r s the s p l e e n and lung m e r i d i a n s . I t s energy i s warm and i t s f l a v o u r sweet. A s t r a g a l u s i s c o n s i d e r e d t o be a s u p e r i o r herb and u s e f u l for any weakness or i l l n e s s , (d) Hung-Tsao: Z izyphus J u j u b a T h i s herb i s commonly r e f e r r e d t o as Chinese date and i s a common cooking i n g r e d i e n t as w e l l as being used i n h e r b a l p r e s c r i p t i o n s . I t i s another i n g r e d i e n t of the "energy soup." S i n c e i t i s a f r u i t , i t i s a l s o eaten by i t s e l f as a t r e a t . Chinese f a m i l i e s l i k e to use i t because " i t i s good for the b l o o d . " Many Chinese f a m i l i e s have t h i s herb i n t h e i r homes. I n Chinese m e d i c i n e , i t i s c o n s i d e r e d t o be a s u p e r i o r herb and a n u t r i e n t t o n i c which s t r e n g t h e n s the s p l e e n and stomach. I t i s used to t r e a t a v a r i e t y of a i l m e n t s i n c l u d i n g c o l d s , d i a r r h e a , d y s e n t e r y , insomnia and n e u r a s t h e n i a . 51 (e) K o u - C h i - T s u (Kai^-Tzi i n C a n t o n e s e ) ; Lycium Chinense T h i s i s a s m a l l red seed from an evergreen shrub. I t i s another common herb kept by many f a m i l i e s . One f a m i l y t o l d me t h a t i t i s "good f o r the eyes and good f o r the c i r c u l a t i o n . " T h i s i s a l s o an i n g r e d i e n t i n the energy soup. I n C h i n e s e m e d i c i n e , i t i s another s u p e r i o r herb and used as a n u t r i e n t t o n i c . I t i s c o n s i d e r e d t o be y i n and t h e r e f o r e a c o o l i n g h e r b . T h i s c o o l i n g p r o p e r t y i s used by C h i n e s e d o c t o r s t o reduce f e v e r s and t o remove t o x i n s from the blood by n o u r i s h i n g the l i v e r and k i d n e y . I t i s a l s o used t o t r e a t a v a r i e t y of eye problems i n c l u d i n g v e r t i g o , dark v i s i o n and e x c e s s i v e water ing of the e y e s . ( f ) C h u a n - C h i n g ; L i g u s t i c u m W a l l i c h i i T h i s herb from the s t a l k of an evergreen t r e e i s thought t o get r i d of a i r i n the head and i s used f o r headaches by C h i n e s e f a m i l i e s . I t i s used i n Chinese medicine f o r a n x i e t y , as a p a i n k i l l e r and for a v a r i e t y of m e n s t r u a l i r r e g u l a r i t i e s . I t i s thought to be good for the blood i n t r e a t i n g anemia, e s p e c i a l l y i n women. I t has been found t o reduce blood p r e s s u r e , c o n t r o l c e n t r a l nervous system a c t i v i t y and to have an a n t i - b a c t e r i a l a c t i o n . (g) S h e n - C h i a n g ; Z i n g i b e r O f f i c i a l e Fresh g i n g e r root i s one of the most common i n g r e -d i e n t s i n Chinese cooking. I t i s c o n s i d e r e d to be a hot 52 and a c r i d h e r b . Z i n g i b e r i s used t o warm up the middle r e g i o n of the body; t o remove c o l d ? to r e s t o r e yang energy; and t o f a c i l i t a t e energy flow i n the body. I t i s used t o t r e a t a v a r i e t y of c o l d i l l n e s s e s i n c l u d i n g stomach cramps and i n d i g e s t i o n ; t o r e s t o r e c i r c u l a t i o n t o c o l d l imbs and t o t r e a t rheumatism caused by c o l d damp winds. I t i s o f t e n served w i t h meats because i t i s thought t o h e l p d e t o x i f y the meat i n the i n t e s t i n e s . (h) L u - J u n g ; Cervus S i k a or P a n t u i T h i s i s the s l i c e d horn from the a n t l e r s of the s p o t t e d d e e r . I t i s v e r y expensive and prepared w i t h c h i c k e n i n a t r a d i t i o n a l c l a y b o i l e r . My informants t o l d me i t i s used t o f a t t e n people up and improve t h e i r blood s u p p l y . I n Chinese c u l t u r e , a robust f i g u r e i s c o n s i d e r e d a s i g n of h e a l t h . I t i s used as a t o n i c t o improve v i t a l i t y . L u - j u n g i s g i v e n t o p a l e , anemic people "to pump them up w i t h blood i f they have too l i t t l e b l o o d . " I t i s used most o f t e n i n the w i n t e r time when people are thought to be under a d d i t i o n a l s t r e s s due to the c o l d . L u - j u n g i s thought t o be hot and t o c o u n t e r a c t the e f f e c t s of the c o l d . I t i s g i v e n t o women i f they are c o l d i n g e n e r a l or t h e i r f e e t are c o l d . I t i s a l s o used by women dur ing pregnancy t o b u i l d b lood. T r a d i t i o n a l l y , i t i s used by Chinese d o c t o r s as a g e n e r a l t o n i c i n d e b i l i t y and o l d age and t o t r e a t im-p a i r e d v i s i o n and h e a r i n g , u t e r i n e hemorrhage and sperma-53 t o r r h e a among other d i s e a s e s . The R u s s i a n s , who have a g r e a t i n t e r e s t i n Chinese h e r b s , have begun t o t e s t the e f f e c t s of p a n t u i and found i t t o c o n t a i n a substance which has remarkable a n t i -f a t i g u e p r o p e r t i e s ( F u l d e r 1 9 8 0 ) . ( i ) Deer T a i l T h i s i s a h i g h l y s p e c i a l i z e d medicine which c o s t s $40 per t a i l . The t a i l i s d r i e d when bought and made i n t o a soup w i t h c h i c k e n . I t i s c o n s i d e r e d t o be good f o r back and s p i n a l a i l m e n t s and used most ly by o l d e r p e o p l e . A person would d r i n k the soup made from the deer t a i l once a y e a r . I t i s a l s o a v e r y potent male drug. I t i s c o n -s i d e r e d t o be extremely yang and t h e r e f o r e e f f e c t i v e i n i n c r e a s i n g men's s e x u a l a b i l i t i e s . ( j ) T u n g - C h u n g - T s ' a o : Cordyceps S i n e n s i s T h i s i s a s t r a n g e drug. I t i s the fungus which grows on the pupa of a p a r t i c u l a r c a t e r p i l l a r i n C h i n a . The Chinese r e f e r t o i t as a p l a n t i n the summer and an i n s e c t i n the w i n t e r . The Chinese name t r a n s l a t e s as -eold worm g r a s s . I t i s a v e r y expensive h e r b . Chinese use i t as a t o n i f i e r and t o improve the complexion. I t i s c o n s i d e r e d to be e s p e c i a l l y v a l u a b l e f o r the k i d n e y s and d i s e a s e s a s s o c i a t e d w i t h the lower h a l f of the body. Chinese h e r b a l i s t s use i t t o t r e a t e x c e s s i v e n i g h t u r i n a t i o n . I t i s cooked i n t o a soup and o f t e n prepared w i t h abalone or duck, which are c o n s i d e r e d t o be p r e c i o u s meats. 54 I n t h i s c h a p t e r I have d i s c u s s e d the i n s t i t u t i o n a l s e t t i n g where C h i n e s e h e r b s are bought and s o l d and p r o v i d e d a b r i e f i n t r o d u c t i o n t o the system of C h i n e s e h e r b a l m e d i c i n e . The h e r b a l pharmacies s e r v e an important f u n c t i o n by making a v a i l -a b l e imported C h i n e s e h e r b s t o t h e i r Chinese c l i e n t e l e . C e r t a i n l y , i t would be extremely d i f f i c u l t t o use Chinese herbs i f t h e y were not r e a d i l y a v a i l a b l e . However, the pharmacies would not s u r v i v e i f t h e r e was not a demand for t h e i r p r o d u c t s . Thus the i n t e g r i t y of the p r a c t i c e of Chinese h e r b a l i s m r e s t s on those who are knowledgeable of the system and c o n t i n u e to use i t . I n t h i s next c h a p t e r , I w i l l look a t t h i s l a r g e r q u e s t i o n of who i n the Chinese community r e t a i n s t r a d i t i o n a l b e l i e f s and p r a c t i c e s of Chinese h e r b a l i s m . 55 I I I . THE SOCIAL ORGANIZATION OF TRADITIONAL CHINESE MEDICAL KNOWLEDGE I n r e v i e w i n g the data on the sources of knowledge of t r a d i t i o n a l C h i n e s e h e r b a l medic ine i n V a n c o u v e r ' s Chinatown, one i s impressed by the f a c t t h a t i t i s not r e s t r i c t e d t o the few p r a c t i c i n g h e r b a l d o c t o r s . I n s t e a d of being r e s t r i c t e d t o a s e l e c t few, t h e r e appears t o be a f a m i l i a r i t y with Chinese medic ine throughout most of the community. H e r b a l i s t s d i s p e n s -ing h e r b s i n h e r b a l pharmacies appear t o have a g r e a t d e a l of knowledge of C h i n e s e h e r b a l m e d i c i n e , i n s p i t e of never h a v i n g to go t o a s c h o o l to l e a r n i t . On f i r s t examinat ion of the d a t a , one i s impressed by the degree of p e n e t r a t i o n of t r a d i -t i o n a l m e d i c a l knowledge i n the Chinese community. However, i f one i s t o look a t the data i n more depth, one n o t i c e s t h a t the m e d i c a l knowledge of the h e r b a l i s t i s not the same as the h e r b a l d o c t o r ' s or the female head of a household. I n order to d i s t i n g u i s h the d i f f e r e n t l e v e l s of m e d i c a l knowledge and p r a c t i c e i n V a n c o u v e r ' s Chinese community, I would l i k e t o draw on a s t r u c t u r a l model proposed by Kleinman (1980) to d i f f e r e n -t i a t e between the d i f f e r e n t s e c t o r s i n a l o c a l h e a l t h c a r e system. Kleinman ( 1 9 7 5 , 1 9 8 0 ) , i n a s e r i e s of p u b l i c a t i o n s , has developed a t r i p a r t i t e model of a l o c a l h e a l t h c a r e system for the p o s t - t r a d i t i o n a l or modernizing s o c i e t y of contemporary Taiwan where t r a d i t i o n a l forms of Chinese medicine c o e x i s t a l o n g s i d e modern b i o m e d i c i n e . T h i s model i s u s e f u l i n a n a l y z -56 i n g the t o t a l range of m e d i c a l a l t e r n a t i v e s a v a i l a b l e i n any complex s o c i e t y such as t h a t found i n North America or A s i a . The e v i d e n c e from the m e d i c a l a n t h r o p o l o g i c a l l i t e r a t u r e suggests t h a t t h e r e a r e d i s t i n c t m e d i c a l systems c o - e x i s t i n g a l o n g s i d e the p r e v a i l i n g and dominant m e d i c a l system i n most s o c i e t i e s . T h i s i s e s p e c i a l l y t r u e i n the c a s e of the C h i n e s e , who have a l o n g s t a n d i n g m e d i c a l t r a d i t i o n of t h e i r own. K l e i n m a n ' s model i s a g e n e r a l one t h a t i s a p p l i c a b l e t o any complex s o c i e t y and i s p a r t i c u l a r y u s e f u l i n l o o k i n g a t the l o c a l h e a l t h c a r e system of the Chinese i n Vancouver. Kleinman (1980) i n d e n t i f i e s any l o c a l h e a l t h care system as compris ing of t h r e e o v e r l a p p i n g sources of m e d i c a l c a r e : the p r o f e s s i o n a l , f o l k and p o p u l a r s e c t o r s . Each s e c t o r r e p r e s e n t s a s p e c i f i c m e d i c a l i d e o l o g y and d e f i n e s a s y s t e m a t i c way of d e a l i n g with episodes of d i s e a s e and i l l n e s s . 1 . The P r o f e s s i o n a l Sector of the L o c a l Chinese H e a l t h Care System The p r o f e s s i o n a l s e c t o r i n the model r e p r e s e n t s the o r g a n i z e d and s o c i a l l y l e g i t i m a t e d h e a l i n g p r o f e s s i o n s . I n most s o c i e t i e s t h i s i s Western b i o m e d i c i n e along with i t s a l l i e d h e a l t h p r o f e s s i o n s such as n u r s i n g , pharmacy, d e n t i s t r y and so on. For the most p a r t , b i o m e d i c i n e i s the dominant source of s p e c i a l i z e d m e d i c a l c a r e . I t s p r a c t i t i o n e r s are s o c i a l l y and l e g a l l y s a n c t i o n e d to p r a c t i c e t h e i r m e d i c a l a r t through t h e i r membership i n a p r o f e s s i o n a l medical s o c i e t y . P r o f e s s i o n a l membership i s s t r i c t l y c o n t r o l l e d by s p e c i a l i z e d 57 s c h o o l i n g , board examinat ions and l i c e n s i n g r e q u i r e m e n t s . Thus admittance t o the m e d i c a l p r o f e s s i o n i s r e s t r i c t e d and the p r o f e s s i o n i t s e l f i s s e l f - r e g u l a t i n g . I n many p o s t - t r a d i t i o n a l s o c i e t i e s , such as C h i n a , Japan and I n d i a , t h e r e a r e a l s o p r o f e s s i o n a l i z e d indigenous m e d i c a l systems e x i s t i n g a l o n g s i d e the Western b i o m e d i c i n e . I n C h i n a , a p r o f e s s i o n a l i z e d form of " t r a d i t i o n a l Chinese medic ine" developed which we s h a l l r e f e r t o as c l a s s i c a l - p r o f e s s i o n a l Chinese m e d i c i n e , a f t e r Lee ( 1 9 8 0 ) . C l a s s i c a l - p r o f e s s i o n a l Chinese medic ine represented the "great" t r a d i t i o n of m e d i c a l t h e o r y and p r a c t i c e . The important t h e o r e t i c a l achievements i n Chinese m e d i c i n e , i n c l u d i n g the y i n - y a n g t h e o r y of b a l a n c e , the wu-hs ing (or F i v e Phase T h e o r y ) , the c h i n g - l o or m e r i d i a n s , the concept of c h ' i ( v i t a l essence) are the r e s u l t s of the e f f o r t s of c l a s s i c a l Chinese m e d i c a l s c h o l a r s . The uses for thousands of m e d i c i n a l herbs was recorded by t h e s e s c h o l a r s i n pharmacology t e x t - b o o k s known as the P e n - T s a o . I n c l a s s i c a l C h i n a , t h i s m e d i c a l t r a d i t i o n was r e g u l a t e d by the s t a t e through a s t r i c t system of examinations so t h a t i t can be c o n s i d e r e d a p r o f e s s i o n as we d e f i n e i t . To g a i n admiss ion t o t h i s p r o f e s s i o n , the p r o s p e c t i v e p h y s i c i a n had t o be a member of the e l i t e l i t e r a t e c l a s s . Students had t o read and w r i t e Chinese and study the c l a s s i c s of Chinese l i t e r a t u r e as a p r e r e q u i s i t e for m e d i c a l s t u d i e s . C o l l e g e s of c l a s s i c a l Chinese medic ine were established i n China where they l e a r n e d 58 the d i a g n o s t i c and t h e r a p e u t i c s k i l l s t o become d o c t o r s of c l a s s i c a l Chinese m e d i c i n e . These s c h o o l s c o n t i n u e t o t e a c h Chinese i n the P e o p l e ' s R e p u b l i c of C h i n a (PRC), Hong Kong and Taiwan. Thus, a p r o f e s s i o n a l c l a s s of C h i n e s e c l a s s i c a l p h y s i c i a n s e x i s t e d i n C h i n a and c o n t i n u e s t o p r a c t i c e i n the PRC, Hong Kong, Taiwan and o v e r s e a s Chinese communities. I n Vancouver, the Western t r a i n e d MD p h y s i c i a n s dominate the p r o f e s s i o n a l s e c t o r o f the l o c a l C h i n e s e h e a l t h c a r e system. There a r e a h a n d f u l of c l a s s i c a l l y t r a i n e d Chinese p h y s i c i a n s p r a c t i c i n g i n Vancouver. However, they l a c k the p r o f e s s i o n a l r e c o g n i t i o n t h e i r c o u n t e r p a r t s a r e a f f o r d e d i n the PRC. No p r o f e s s i o n a l o r g a n i z a t i o n l i k e those i n Hong Kong and Taiwan e x i s t i n Canada. We s h a l l d i s c u s s both the Western and c l a s s i c a l Chinese p h y s i c i a n s , i n t u r n , w i t h r e s p e c t t o t h e i r r o l e i n the l o c a l Chinese h e a l t h care system. Western t r a i n e d Chinese MDs r e p r e s e n t the dominant source of p r o f e s s i o n a l h e a l t h c a r e to the v a s t m a j o r i t y of Chinese i n Vancouver. Although the Chinese i n B . C . were once excluded from the p r o f e s s i o n of m e d i c i n e , * t h e r e are now a l a r g e number of Chinese p h y s i c i a n s who see many p a t i e n t s of Chinese o r i g i n . For s e r i o u s i l l n e s s , most Chinese w i l l c o n s u l t w i t h a * B . C . once p r o h i b i t e d the Chinese from l i c e n s u r e i n both law and medic ine u n t i l the 1 9 3 0 ' s . Even i f a Chinese overcame the b a r r i e r s of language and d i s c r i m i n a t i o n , they were r e s t r i c t e d a c c e s s to these p r o f e s s i o n s . 59 MD of e i t h e r Chinese or n o n - C h i n e s e o r i g i n . Johnson's ( 1 9 7 4 ) study r e v e a l e d t h a t from a sample of 339 Chinese p e r s o n s , 70% had c o n s u l t e d w i t h a Chinese MD and another 25% c o n s u l t e d w i t h a n o n - C h i n e s e MD i n a p e r i o d of s i x months before the s u r v e y . Thus, from t h i s sample, 95% had c o n s u l t e d w i t h an MD and o n l y 5% had admitted t o s e e i n g a t r a d i t i o n a l c l a s s i c a l l y t r a i n e d Chinese p h y s i c i a n . As we s h a l l s e e , t h i s does not mean t h a t the l o c a l p o p u l a t i o n of Chinese i n Vancouver do not u t i l i z e t r a d i t i o n a l C h i n e s e medic ine but t h a t i n seeking p r o f e s s i o n a l care f o r a s e r i o u s m a t t e r , the f i r s t person c o n s u l t e d i s an MD. T h i s i s not s u r p r i s i n g s i n c e MDs a r e s o c i a l l y and l e g a l l y s a n c t i o n e d . They a r e h i g h l y educated p r o f e s s i o n a l s f o l l o w i n g a modern and s c i e n t i f i c approach t o m e d i c i n e . Secondly, the Chinese p o p u l a t i o n as a whole i n Vancouver i s becoming more educated and Westernized. T h i r d l y , MDs are covered by the government h e a l t h p l a n which i s f ree t o many low income Chinese Most Chinese MDs w i t h whom I spoke have a v e r y n e g a t i v e view of t r a d i t i o n a l Chinese h e r b a l m e d i c i n e . The p r e v a i l i n g a t t i t u d e among the Chinese MDs i n t e r v i e w e d was a c a r e f u l l y guarded s c i e n t i f i c c o n s e r v a t i s m which quest ioned the e f f i c a c y of Chinese h e r b s . There was a tendency t o view Chinese h e r b a l medicine as u n s c i e n t i f i c and based on s u p e r s t i t i o n . T h i s view appears t o be based on an ignorance of the t h e o r e t i c a l b a s i s of Chinese medic ine or any d i r e c t exper ience w i t h the use of Chinese h e r b a l p r e s c r i p t i o n s . T h i s a s s o c i a t i o n between b e l i e f and e x p e r i e n c e w i t h the t r a d i t i o n a l m e d i c a l system h e l d through 60 out a l l my i n t e r v i e w s w i t h Chinese p e r s o n s , r e g a r d l e s s of t h e i r l e v e l of e d u c a t i o n and degree of W e s t e r n i z a t i o n . That i s , those who had a d i r e c t e x p e r i e n c e w i t h the e f f i c a c y of C h i n e s e remedies were more a b l e t o i n t e g r a t e Chinese medic ine i n t o t h e i r w o r l d - v i e w . I t i s a l s o i n t e r e s t i n g t o observe t h a t other non-MD C h i n e s e h e a l t h p r o f e s s i o n a l s were more l i k e l y t o have had some e x p e r i e n c e w i t h C h i n e s e medic ine and t o have accepted i t i n t o t h e i r b i o m e d i c a l o r i e n t a t i o n . One C h i n e s e MD admitted t h a t t h e r e "may" be an a c t i v e i n g r e d i e n t i n C h i n e s e h e r b s , but t h a t they are p r e s e n t i n such minute q u a n t i t i e s t h a t the "pure e f f e c t s " of herbs get l o s t among a l l the other i n g r e d i e n t s . He c l a i m e d t h a t . C h i n e s e m e d i c i n e s have t o be a n a l y z e d s c i e n t i f i c a l l y f o r t h e i r e f f i c a -c i o u s i n g r e d i e n t s . Then the " a c t i v e " i n g r e d i e n t s have t o be e x t r a c t e d and prepared i n a c o n c e n t r a t e d form such as p i l l s . T h i s view goes a g a i n s t the v e r y g r a i n of t r a d i t i o n a l Chinese m e d i c a l thought and the l a t e s t s c i e n t i f i c e v a l u a t i o n of Chinese h e r b s . F u l d e r ( 1 9 8 0 ) , a p h a r m a c o l o g i s t , concludes t h a t t h e r e i s no s i n g l e a c t i v e i n g r e d i e n t t o e x p l a i n the reported a c t i o n s of Chinese herbs such as g i n s e n g . T h i s doctor a l s o q u e s t i o n e d the q u a l i t y c o n t r o l i n v o l v e d i n the p r e p a r a t i o n of Chinese h e r b a l p h a r m a c e u t i c a l s prepared i n the PRC. There have been c a s e s of poor q u a l i t y c o n t r o l of p a t e n t Chinese medic ines (McDowell 1 9 8 2 ) . He was, i n g e n e r a l , q u i t e s u s p i c i o u s about the e f f i c a c y of Chinese h e r b s . He f e l t t h a t a l o t of Chinese medicine i s the r e s u l t of s u p e r s t i t i o u s 61 f o l k l o r e . For example, he t h i n k s t h a t t a k i n g h e r b a l medic ines i n t e r n a l l y f o r broken bones and s p r a i n s i s f a l l a c i o u s . He cannot a c c e p t the p o s s i b i l i t y t h a t herbs taken i n t e r n a l l y can work f o r "what i s o b v i o u s l y an e x t e r n a l problem." I n f a c t , the Chinese treatment f o r broken bones i s a combination of h e r b s taken i n t e r n a l l y t o encourage h e a l i n g and the e x t e r n a l a p p l i -c a t i o n of h e r b a l p o u l t i c e . T h i s d o c t o r , however, d i d b e l i e v e t h a t t h e r e may be some t h e o r e t i c a l b a s i s f o r the s u c c e s s o f acupuncture t h e r a p y , a l t h o u g h he d i d not p r a c t i c e i t h i m s e l f . T h i s view i s not s u r p r i s i n g , s i n c e acupuncture has more or l e s s been accepted by the North American m e d i c a l community as h a v i n g some v a l i d i t y and a p l a c e i n the p r a c t i c e of Western m e d i c i n e . I n g e n e r a l , t h i s p h y s i c i a n h e l d a n e g a t i v e view of Chinese m e d i c i n e , but had l i t t l e knowledge of e i t h e r the p r a c t i c a l or t h e o r e t i c a l a s p e c t s of Chinese m e d i c i n e . I n t e r v i e w s w i t h other Chinese h e a l t h p r o f e s s i o n a l s r e -v e a l e d a more c o n c i l i a t o r y a t t i t u d e towards Chinese h e r b a l i s m . The two most f a v o u r a b l e responses came from Chinese p h a r m a c i s t s t r a i n e d i n Western pharmacy. One p h a r m a c i s t who turned out t o be a key i n f o r m a n t , was the owner of a r a t h e r unique pharmacy i n Chinatown. T h i s pharmacist (DL) runs a v e r y s u c c e s s f u l Western pharmacy i n Chinatown. Most of h i s c l i e n t s are Chinese who p r e f e r d e a l i n g w i t h a C h i n e s e - s p e a k i n g p h a r m a c i s t . He a l s o r e n t s out space to a Chinese h e r b a l doctor who runs a Chinese h e r b a l pharmacy i n one corner of h i s s t o r e . I n t h i s pharmacy 62 a t l e a s t , E a s t meets West. DL i s a l s o an a c t i v e promoter o f Chinese h e r b s , p a r t i c u -l a r l y g i n s e n g . T h i s i s not s u r p r i s i n g s i n c e he i s a d i r e c t importer of Korean ginseng which he s e l l s on a r e t a i l l e v e l through the Chinese h e r b a l doctor and w h o l e s a l e , d i r e c t l y t o p u r c h a s e r s o f l a r g e q u a n t i t i e s . DL i s q u i t e knowledgeable of t r a d i t i o n a l Chinese medic ine d e s p i t e h i s Western s c i e n t i f i c o r i e n t a t i o n . DL has h e l d an e x h i b i t i o n a t h i s s t o r e on " T r a d i t i o n a l Chinese H e r b a l Medicine" and always h a s a booth a t the P a c i f i c N a t i o n a l E x h i b i t i o n i n Vancouver, promoting h i s g inseng p r o d u c t s . Thus t h e r e i s a commercial m o t i v a t i o n behind h i s i n t e r e s t i n Chinese h e r b a l m e d i c i n e , as w e l l as a genuine i n t e r e s t t o educate the p u b l i c about the system of Chinese h e r b a l i s m . Yet DL i s e q u a l l y comfortable with both m e d i c a l systems; a good example of Chinese pragmatism. He says w i t h r e f e r e n c e to Chinese and Western medic ine t h a t , " I have one foot i n each, one i s Chinese and one i s Western." DL sees both systems of medicine as complementary. Each system has i t s m e r i t s and s u c c e s s e s . Chinese m e d i c i n e , he s a y s , i s most s u i t e d f o r the treatment of f u n c t i o n a l a i l m e n t s h a v i n g t o do w i t h the smooth f u n c t i o n i n g of the i n t e r n a l organs . Chinese medicine i s p a r t i c u l a r l y e f f i c a c i o u s for the i n t e r n a l treatment of d i s -orders such as coughs, c o l d s , a r t h r i t i s , k i d n e y and l i v e r d i s o r d e r s . DL h i m s e l f t e s t i f i e d t h a t he had been plagued for y e a r s w i t h lower back p a i n f o r which he t r i e d many Western 63 t r e a t m e n t s w i t h no s u c c e s s . However, h i s a i l m e n t c l e a r e d up never t o r e t u r n a f t e r one course of treatment with a Chinese h e r b a l remedy. Another W e s t e r n - t r a i n e d C h i n e s e p h a r m a c i s t , (LL) spoke q u i t e h i g h l y of the e f f i c a c y of Chinese h e r b s . He e x p l a i n e d to me the d i f f e r e n c e s between the development of C h i n e s e and Western p h a r m a c e u t i c a l m e d i c i n e . H e r b a l medic ine developed i n China because the C h i n e s e were an a g r i c u l t u r a l s o c i e t y l i v i n g v e r y c l o s e t o p l a n t s . The medic ine they needed was a s imple one which was r e a d i l y a c c e s s i b l e t o the p o p u l a t i o n , who were most ly p e a s a n t s . Chinese medic ine developed through a t r i a l and e r r o r system. Thus t o x i c i t y was s l o w l y e l i m i n a t e d from the m e d i c a l system over thousands of y e a r s , r e s u l t i n g i n a s a f e y e t e f f e c t i v e n a t u r a l h e a l i n g system. By c o n t r a s t , Western pharmacology evolved from European alchemy which m a i n l y concerned i t s e l f w i t h r e f i n i n g e x t r a c t i o n s of p l a n t e s s e n c e s . The e a r l y a l c h e m i s t s b e l i e v e d t h a t every substance had an "essence" which was r e s p o n s i b l e f o r i t s s p e c i a l p r o p e r t i e s . T h e r e f o r e , p l a n t s h a v i n g m e d i c i n a l q u a l i -t i e s c o u l d be made more potent by e x t r a c t i n g the essence from the p l a n t m a t e r i a l . Thus the s c i e n c e of pharmacology was born and the e n d l e s s p u r s u i t for " a c t i v e i n g r e d i e n t s . " T h i s p h a r m a c i s t was q u i t e f a m i l i a r with s c i e n t i f i c s t u d i e s done on ginseng p r o v i n g i t s e f f i c a c y and c l a i m s based on f o l k l o r e . LL , h a v i n g been t r a i n e d i n a Western s c i e n c e , has used t h i s p e r s p e c t i v e t o e v a l u a t e the s c i e n t i f i c b a s i s of 64 t r a d i t i o n a l C h i n e s e h e r b a l i s m and he concludes t h a t t h e r e i s a r a t i o n a l b a s i s f o r i t s e f f i c a c y . Other C h i n e s e h e a l t h p r o f e s s i o n a l s t h a t I i n t e r v i e w e d such as s o c i a l workers and n u r s e s , were more f a m i l i a r w i t h the t r a d i t i o n a l C h i n e s e system of m e d i c i n e . S i m i l a r l y , the female m e d i c a l d o c t o r s I i n t e r v i e w e d were exposed t o Chinese h e r b s through t h e i r mothers and grandmothers and g e n e r a l l y had a more f a v o u r a b l e e v a l u a t i o n of t h i s system than t h e i r male c o u n t e r -p a r t s . I asked my l a y informants whether t h e i r MD p h y s i c i a n s ever recommended they t r y Chinese m e d i c i n e . While none d i d so d i r e c t l y , one informant d i d r e p o r t t h a t her female Chinese MD d i d recommend she t r y "some soup and bones ," r e f e r r i n g t o t r a d i t i o n a l C h i n e s e h e r b a l remedies. Another female Chinese MD I i n t e r v i e w e d had a f a v o u r a b l e o p i n i o n of the herb soup g i v e n t o p o s t - p a r t u m Chinese mothers, a l though she f e l t i t was unnecessary t o take t h i s i n a d d i t i o n t o the Western drugs a d m i n i s t e r e d i n the h o s p i t a l . Thus i t appears t h a t female Chinese h e a l t h p r o f e s s i o n a l s are more r e c e p t i v e t o the p o s s i b l e b e n e f i t s of C h i n e s e h e r b a l medic ine than t h e i r male c o u n t e r -p a r t s . I n V a n c o u v e r ' s Chinatown, t h e r e are o n l y f i v e or s i x d o c t o r s of classical -professional Chinese medicine who have formal t r a i n i n g from the PRC or Hong Kong. Thus they are c o n s i d e r e d t o f a l l i n t o the p r o f e s s i o n a l s e c t o r of the l o c a l Chinese h e a l t h care system, a lthough they do not have p r o f e s -65 s i o n a l r e c o g n i t i o n f o r t h e i r m e d i c a l t r a i n i n g i n Canada. T h e i r s t a t u s i s t h e r e f o r e an ambiguous one. They cannot openly p r a c t i c e or a d v e r t i s e t h e i r p r o f e s s i o n as t h e i r c o u n t e r p a r t s i n Hong Kong or the PRC c a n . Some p r a c t i c e a more r e s t r i c t e d form of c l a s s i c a l C h i n e s e m e d i c i n e , w h i l e o t h e r s have become more i n v o l v e d i n the merchandis ing of herbs r a t h e r than m e d i c a l c a r e . I n Canada i t i s i l l e g a l t o d iagnose and t r e a t a d i s e a s e without a m e d i c a l l i c e n s e . A c u p u n c t u r i s t s and Chinese h e r b a l d o c t o r s do, i n f a c t , d iagnose and t r e a t d i s e a s e a c c o r d i n g to c l a s s i c a l C h i n e s e m e d i c a l t h e o r y , a l though t h i s i s done s u r r e p t i t i o u s l y and under r i s k of p r o s e c u t i o n f o r p r a c t i c i n g medic ine without a l i c e n s e . S e v e r a l a c u p u n c t u r i s t s have been charged i n the p a s t s e v e r a l y e a r s . To my knowledge, no h e r b a l -i s t s have ever been charged. T h i s may be because acupuncture h a s come under the j u r i s d i c t i o n of the v a r i o u s m e d i c a l a s s o c i a -t i o n s . The p r a c t i c e of acupuncture i n B . C . by anyone other than a p h y s i c i a n or not under h i s d i r e c t s u p e r v i s i o n i s i l l e g a l . T h i s has r e s u l t e d i n the s i t u a t i o n where an a c u p u n c t u r i s t from China w i t h y e a r s of t r a i n i n g and e x p e r i e n c e cannot p r a c t i c e acupuncture l e g a l l y , whereas a p h y s i c i a n who has taken a weekend course can. Chinese h e r b a l d o c t o r s are not so l i k e l y t o be p r o s e c u t e d by the C o l l e g e of P h y s i c i a n s and Surgeons because the MDs do not have any i n t e r e s t i n u s i n g Chinese h e r b s . They a l s o c o n s i d e r Chinese herbs to be indigenous f o o d s t u f f s r a t h e r than m e d i c i n e s . The h e r b a l d o c t o r s are an unorganized group and do not 66 have the same s t a t u s and r e c o g n i t i o n as they had i n A s i a . A few of the C h i n e s e h e r b a l d o c t o r s work behind the counter of h e r b a l pharmacies which they may or may not own t h e m s e l v e s . Here, t h e y spend most of t h e i r t ime c o n s u l t i n g w i t h customers about t h e i r h e a l t h problems over the c o u n t e r , much as an h e r b a l i s t would. However, s i n c e they are f u l l y t r a i n e d i n C h i n e s e d i a g n o s i s and t r e a t m e n t , they are a b l e to g i v e more cogent a d v i c e and w r i t e p r e s c r i p t i o n s f o r t h e i r customers. Otherwise, they s e l l and d i s p e n s e h e r b s j u s t as the l e s s e r t r a i n e d h e r b a l i s t s do. They are a v a i l a b l e f o r a more i n - d e p t h c o n s u l t a t i o n and w i l l , on o c c a s i o n , do so i n a back room of the pharmacy r e -served f o r t h i s purpose. I t i s here t h a t the doctor performs the t r a d i t i o n a l Chinese d i a g n o s i s . T r a d i t i o n a l Chinese m e d i c a l d i a g n o s i s i s r e f e r r e d t o as the four methods of d i a g n o s i s s i n c e i t i n v o l v e s four s e p a r a t e p r o c e d u r e s : q u e s t i o n i n g the p a t i e n t about t h e i r i l l n e s s and l i f e s t y l e ; v iewing the p a t i e n t , e s p e -c i a l l y the f a c e and tongue; s m e l l i n g the p a t i e n t ' s body odor and u r i n e ; and t o u c h i n g the p a t i e n t by t a k i n g the twelve p u l s e s on both w r i s t s . The doctor may employ one or more of these t r a d i t i o n a l d i a g n o s t i c t e c h n i q u e s . P u l s e d i a g n o s i s i s c o n -s i d e r e d t o be a h i g h l y s o p h i s t i c a t e d and a c c u r a t e method of determining the p a t i e n t ' s i n t e r n a l s t a t e and r e q u i r e s many y e a r s of t r a i n i n g and p r a c t i c e to become p r o f i c i e n t a t t h i s method. I n P o r t l a n d , Oregon, t h e r e i s a Chinese h e r b a l doctor who 67 does p u l s e d i a g n o s i s t o customers i n the f r o n t of h i s h e r b a l pharmacy. A f t e r t a k i n g the c u s t o m e r ' s p u l s e , he w r i t e s a p r e s c r i p t i o n f o r the c o n d i t i o n h e . h a s j u s t d iagnosed. H i s a s s i s t a n t then makes out the p r e s c r i p t i o n . The customer d o e s n ' t pay f o r the d i a g n o s i s , j u s t the p r e s c r i p t i o n . There i s no h e r b a l d o c t o r p r a c t i c i n g so openly i n Vancouver. I f one wants t h e i r p u l s e t a k e n , t h i s i s done i n the back room out of view of the busy pharmacy. T r a d i t i o n a l l y , a Chinese doctor i s not p a i d f o r a c o n s u l t a t i o n . While t h i s i s p a r t of the Chinese t r a d i t i o n , i t a l s o s e r v e s the purpose of making t h e i r a c t i v i t y l e s s i l l e g a l by not a c c e p t i n g payment f o r a m e d i c a l d i a g n o s i s . Often t h e C h i n e s e doctor i s p a i d u n o f f i c i a l l y through a r i t u a l t r a n s a c t i o n by an a p p r e c i a t i v e p a t i e n t . The Chinese doctor i s g i v e n a red p a c k e t c o n t a i n i n g money which i s c o n -s i d e r e d t o be "good l u c k money." T h i s money i s g i v e n f r e e l y by the p a t i e n t out of c o n s i d e r a t i o n f o r the honourable s e r v i c e performed by the d o c t o r . Otherwise, t h e r e i s no a d d i t i o n a l payment as the c o n s u l t a t i o n fee i s b u i l t i n t o the p r i c e of the p r e s c r i p t i o n . I n the case of an h e r b a l doctor working f o r an h e r b a l pharmacy, he i s p a i d a s a l a r y by the s t o r e owners and h i s customers expect f r e e c o n s u l t a t i o n u n l e s s a s p e c i a l s e s s i o n i s a r r a n g e d . A l l the h e r b a l d o c t o r s i n Vancouver have emigrated from e i t h e r Hong Kong or the PRC, where they have r e c e i v e d t h e i r t r a i n i n g . Some Chinese doctors who have r e c e n t l y immigrated t o Canada have not been a b l e t o i n t e g r a t e i n t o the l o c a l t r a d i -68 t i o n a l C h i n e s e m e d i c a l system i n Chinatown. I n s t e a d they work i n the s t a n d a r d immigrant o c c u p a t i o n s such as low p a i d r e s t a u -r a n t h e l p . Others , who come w i t h money, are a b l e t o s t a r t up t h e i r own h e r b a l pharmacy i n Chinatown and can become q u i t e s u c c e s s f u l as h e r b a l merchants. D e s p i t e t h e i r s u c c e s s , t h e s e d o c t o r s complain about the l a c k of p r o f e s s i o n a l Chinese medic ine i n Canada. One h e r b a l doctor who now owns h i s own pharmacy, complains about the l a c k of o p p o r t u n i t y f o r a Chinese d o c t o r i n Canada: "Here, I ' m j u s t a h e a l t h food merchant" (McDowell 1 9 8 2 ) . T h i s doctor (GC) has an o f f i c e i n the back of h i s h e r b a l pharmacy. Here he runs h i s h e r b a l b u s i n e s s and sees the o c c a s i o n a l c l i e n t f o r a c o n s u l t a t i o n . The o f f i c e i s open t o the r e s t of the s t o r e . The w a l l s are covered w i t h h i s m e d i c a l degrees from China and h i s membership i n v a r i o u s p r o f e s s i o n a l a s s o c i a t i o n s t o which he b e l o n g s . For h i s p a t i e n t s , he p e r -forms t r a d i t i o n a l m e d i c a l d i a g n o s i s such as p u l s e t a k i n g . S i n c e he speaks E n g l i s h , he o c c a s i o n a l l y sees a Western p a t i e n t ; one of the few Chinese d o c t o r s to do so. Another h e r b a l doctor a l s o runs h i s own herb pharmacy. He i s i n h i s s i x t i e s . He t r a i n e d i n C h i n a f o r four y e a r s and has been i n v o l v e d i n Chinese medic ine s i n c e he was 2 1 . He has over 40 y e a r s of exper ience and has p r a c t i c e d i n mainland C h i n a , Hong Kong and Cuba before coming to Vancouver. Other h e r b a l d o c t o r s work independently from the h e r b a l p h a r m a c i e s . They u s u a l l y work out of t h e i r homes or from 69 v a r i o u s s o c i a l g a t h e r i n g spots such as the Chinese Benevolent A s s o c i a t i o n s . They r e l y on c l i e n t s through word of t h e i r r e p u t a t i o n or through d i s c r e t e a d v e r t i s e m e n t s p l a c e d i n one of the C h i n e s e w e e k l i e s p u b l i s h e d i n Vancouver. Other p r a c t i t i o n e r s of c l a s s i c a l - p r o f e s s i o n a l Chinese h e r b a l medic ine a r e t e a c h e r s of k u n g - f u , a r e s p e c t e d Chinese m a r t i a l a r t known as Chinese b o x i n g . WH i s one such t e a c h e r and has an e x t e n s i v e knowledge of Chinese h e r b a l m e d i c i n e . He i s one of the foremost k u n g - f u masters i n Vancouver. He i s a p r a c t i t i o n e r of T i e h - t a , which i s the p r a c t i c a l a p p l i c a t i o n of C h i n e s e medic ine t o i n j u r i e s s u s t a i n e d i n the course of f i g h t -i n g . T i e h - t a i s the a n c i e n t a r t of h e a l i n g wounds and i n t e r n a l i n j u r i e s and p a r t i c u l a r l y r e f e r s to the a r t of bone s e t t i n g . I n Hong Kong and Taiwan t h e r e are s p e c i a l i s t s who are e x p e r t s i n the a n c i e n t a r t of h e a l i n g broken bones u s i n g herbs and s o f t c a s t s . While WH i s a boxing master by p r o f e s s i o n , he has formal t r a i n i n g i n the a r t of T i e h - t a a t the monastery s c h o o l where he r e c e i v e d h i s m a r t i a l a r t s t r a i n i n g . Chinese medic ine has a long h i s t o r y of a s s o c i a t i o n w i t h v a r i o u s Buddhist and T a o i s t m o n a s t e r i e s . WH r e c e i v e d h i s t r a i n i n g from a m a r t i a l a r t s monastery known as T s a i - l i - f o ( C h o y - l e e - f a t ) . T s a i - l i - f o i s a two hundred year o l d school i n Canton C i t y t h a t was e s t a b l i s h e d by Chen Hang who combined- the t h r e e systems of t h r e e famous t e a c h e r s , T s a i , L i and Fo. WH l e a r n e d t h i s p a r t i c u l a r s t y l e of k u n g - f u from t h i s s e c t and a l s o l e a r n e d the system of t i e h - t a from h i s t e a c h e r s t h e r e . He began t h i s study 70 a t the age of twenty, and has been a boxing master f o r 40 y e a r s . WH i s now i n h i s mid s i x t i e s and the most r e s p e c t e d boxing master i n Vancouver. WH t e a c h e s k u n g - f u a t h i s own s c h o o l e s t a b l i s h e d i n Chinatown and a l s o sees c l i e n t s who have r e c e i v e d e i t h e r an e x t e r n a l or i n t e r n a l t r a u m a t i c i n j u r y . Although k u n g - f u and t i e h - t a were a f u n c t i o n a l u n i t i n C h i n a , they are now s e p a r a t e p u r s u i t s by WH. He no longer i s a b l e t o t e a c h h i s k u n g - f u s t u d e n t s t h e a n c i e n t a r t of t i e h - t a due t o a language b a r r i e r . The younger s t u d e n t s are completely u n f a m i l i a r w i t h the s t r a n g e l e x i c o n of t r a d i t i o n a l Chinese m e d i c i n e . He has taught a few of h i s s t u d e n t s f i r s t a i d treatments of e x t e r n a l i n j u r i e s but s a y s i t i s i m p o s s i b l e to t e a c h them the s u b t l e and complex a r t of h e a l i n g deep i n t e r n a l i n j u r i e s . WH sees a l l t y p e s of people—young and o l d , Chinese and n o n - C h i n e s e . S p r a i n s and broken bones are the most frequent types of i n j u r y t h a t he t r e a t s . He says t h a t the Chinese approach t o t r e a t i n g s p r a i n s and broken bones i s r a d i c a l l y d i f f e r e n t from the Western approach. Herbal p l a s t e r s a r e a p p l i e d t o s p r a i n s , not o n l y t o a l l e v i a t e p a i n and t o reduce s w e l l i n g , but a l s o t o a s s i s t i n the h e a l i n g p r o c e s s of the t o r n l i g a m e n t . The Western approach, a c c o r d i n g to WH, o n l y t r e a t s the p a i n of the i n j u r y and does not cure the root cause of the p a i n . I f Western approach has been used, p a i n and rheumatism w i l l r e t u r n to the s i t e of an i n j u r y , many y e a r s l a t e r . The Chinese method i s s u p e r i o r because there are no r e c u r r e n c e s of 71 any p a i n or d i s a b i l i t y . Broken bones are t r e a t e d by WH a c c o r d -i n g t o the t r a d i t i o n a l Chinese method of u s i n g a s o f t s p l i n t made of wood and the a p p l i c a t i o n of an h e r b a l p l a s t e r t o promote h e a l i n g . WH sees many people who have been i n j u r e d i n automobile a c c i d e n t s . According t o WH, a l though t h e s e people may r e c o v e r from the a c c i d e n t , they are bothered by severe r e c u r r e n t headaches which can o n l y be t r e a t e d d e f i n i t i v e l y u s i n g Chinese methods. WH h a s a l s o cured many people w i t h a r t h r i t i s and rheumatism. There i s no s i n g l e remedy t o t r e a t rheumatism and a r t h r i t i s . WH does a c a r e f u l case h i s t o r y i n determining the a p p r o p r i a t e h e r b a l p r e s c r i p t i o n . The f i n a l p r e s c r i p t i o n t h a t p r o v i d e s a cure may o n l y be found a f t e r a t r i a l and e r r o r procedure of t r y i n g out s e v e r a l remedies. WH c l a i m s s u c c e s s i n h e l p i n g even c a s e s of rheumatism so severe t h a t the person had t o be c a r r i e d i n t o see him. WH has a view of body energy flow s i m i l a r to the concept of c h ' i found i n the c l a s s i c a l Chinese m e d i c a l t e x t s ( V e i t h 1 9 6 6 ) . He a l s o f o l l o w s the t r a d i t i o n a l Chinese concept of a b i o l o g i c a l h o r a r y c l o c k i n which energy e n t e r s an organ m e r i d i a n i n two-hour phases throughout every 24 h o u r s . He uses t h i s to p r e d i c t the t ime t h a t i s most v u l n e r a b l e for any p a r t i c u l a r organ t o be i n j u r e d . For example, the h e a r t i s most v u l n e r a b l e t o s e r i o u s i n j u r y between 1 1 am and 1 pm and the l i v e r between 3 and 5 pm. These views i n d i c a t e t h a t WH f o l l o w s c l a s s i c a l - p r o f e s s i o n a l Chinese m e d i c a l theory c l o s e l y and 72 t h e r e f o r e i s p r o p e r l y c l a s s i f i e d as a p r a c t i t i o n e r of c l a s s i c a l -p r o f e s s i o n a l C h i n e s e m e d i c i n e . WH i s h e l d i n g r e a t esteem i n Chinatown not o n l y as a master k u n g - f u t e a c h e r but a l s o as a knowledgeable p r a c t i t i o n e r of the a n c i e n t p r a c t i c e of t i e h - t a . WH sees many p a t i e n t s through p e r s o n a l c o n t a c t and r e -f e r r a l . He has a good r e p u t a t i o n i n being a b l e t o h e a l p h y s i c a l i n j u r i e s . He never c o l l e c t s a fee for h i s c o n s u l t a t i o n s w i t h p a t i e n t s . He does c o l l e c t a fee of about $20 f o r the p r e p a r a -t i o n of an h e r b a l p o u l t i c e t h a t he a p p l i e s on h i s p a t i e n t s . For o t h e r s who need a p r e s c r i p t i o n t o be taken i n t e r n a l l y , he w r i t e s i t down i n C h i n e s e so t h a t they can get i t f i l l e d a t a Chinese pharmacy. I n t h i s case i t i s a p p r o p r i a t e f o r WH t o r e c e i v e a red p a c k e t from h i s p a t i e n t . I n t h i s s e c t i o n , we have looked a t the b e l i e f s and p r a c -t i c e s of the h a n d f u l of p r o f e s s i o n a l Chinese h e r b a l d o c t o r s p r a c t i c i n g i n V a n c o u v e r ' s Chinatown. We have a l s o examined the a t t i t u d e s of Chinese MDs and h e a l t h p r o f e s s i o n a l s towards t r a d i t i o n a l C h i n e s e medic ine and found i t a mixed o p i n i o n w i t h the MDs e x p r e s s i n g the most doubt of the v a l i d i t y of t r a d i -t i o n a l C h i n e s e m e d i c i n e . 2. The F o l k S e c t o r of the L o c a l H e a l t h Care System The f o l k s e c t o r of the model r e f e r s to those n o n - p r o f e s -s i o n a l , s p e c i a l i z e d h e a l e r s found i n both t r a d i t i o n a l and i n d u s t r i a l i z e d s o c i e t i e s . While f o l k medicine has been used to d e s c r i b e the t r a d i t i o n a l m e d i c a l knowledge of a people, we are 73 u s i n g f o l k s e c t o r t o r e f e r t o p a r t - t i m e or f u l l - t i m e s p e c i a l -i s t s . F o l k medic ine i s a h y b r i d c a t e g o r y s i n c e i t may c o n t a i n both elements of the p r o f e s s i o n a l and popular s e c t o r s i n i t s m e d i c a l r e p e r t o r y . Most f o l k h e a l i n g has a s a c r e d and a s e c u l a r component, a l t h o u g h the d i s t i n c t i o n i s not always e v i d e n t i n p r a c t i c e . F o l k h e a l i n g i s c h a r a c t e r i z e d by i t s h i g h l y r i t u a l i z e d n a t u r e . I n p r e - l i t e r a t e s o c i e t i e s t h a t d i d not have a p r o f e s s i o n a l c l a s s o f h e a l e r s , f o l k s p e c i a l i s t s known as shamans had knowledge of c u r e s . I n many contemporary s o c i e t i e s where b i o m e d i c i n e dominates the p r o f e s s i o n a l s e c t o r , t r a d i t i o n a l and unorthodox m e d i c a l p r a c t i c e s are c o n t i n u e d by v a r i o u s f o l k h e a l e r s . I n t r a d i -t i o n a l s o c i e t i e s , f o l k h e a l e r s were taught by a f a m i l y member or served an a p p r e n t i c e s h i p w i t h a well -known h e a l e r . Even i n modern s o c i e t i e s , many m e d i c a l b e l i e f s and p r a c t i c e s w i t h e t h n i c , r e l i g i o u s , q u a s i - r e l i g i o u s , p s u e d o - s c i e n t i f i c and e m p i r i c a l t r a d i t i o n s are p e r p e t u a t e d . D e s p i t e the t e c h -n o l o g i c a l advances of b i o m e d i c i n e , t h e r e c o n t i n u e s to be a strong demand for a l t e r n a t i v e t h e r a p i e s o f f e r e d by f o l k p r a c t i c e s . The f o l k s e c t o r or " l i t t l e t r a d i t i o n " i n R e d f i e l d ' s terminology h a s been the p o t p o u r r i of m e d i c a l p r a c t i c e s i n C h i n a . H i s t o r i c a l l y , the c l a s s i c a l Chinese p h y s i c i a n s were a c c e s s i b l e o n l y t o the e l i t e and the l a r g e m a j o r i t y of peasants r e l i e d on an assortment of f o l k h e a l e r s as t h e i r source of s p e c i a l i z e d c a r e . The f o l k s e c t o r c o n t i n u e s to be an important 74 source of m e d i c a l c a r e i n Taiwan and Hong Kong. Ethnographers such as Kleinman (1980) i n Taiwan, Topley ( 1 9 7 6 ) , and Anderson and Anderson (1968) i n Hong Kong have documented the cont inued s t r e n g t h and importance of the f o l k s e c t o r i n the t o t a l m e d i c a l system of contemporary Chinese s o c i e t i e s . The C h i n e s e f o l k t r a d i t i o n i n A s i a h a s both s a c r e d and s e c u l a r components. The s a c r e d p r a c t i t i o n e r s of h e a l i n g i n c l u d e the t a n g - k i or s p i r i t - m e d i u m , shamans, s o o t h s a y e r s , geomancers, bonzes, and t d o - s h i h who were Buddhist or T a o i s t p r i e s t s . The s e c u l a r component i n c l u d e s p a r t - t i m e and f u l l -t ime s p e c i a l i s t s such as h e r b a l i s t s , p h a r m a c i s t s , masseurs, b o n e - s e t t e r s , ear and eye s p e c i a l i s t s , i t i n e r a n t d r u g - p e d d l e r s , quacks, and f o r t u r e - t e l l e r s . These p r a c t i t i o n e r s such as h e r b a l i s t s , though they a p p l i e d the p r a c t i c a l t e c h n i q u e s of the c l a s s i c a l - p r o f e s s i o n a l p h y s i c i a n s , d i d not draw on the r i c h d i s c o u r s e of Chinese m e d i c a l theory or t h e i r e x a c t i n g method of d i a g n o s i s . T h e i r m e d i c a l knowledge was l e a r n e d through appren-t i c e s h i p r a t h e r than formal s c h o o l i n g and t h e i r c a r e e r s e s t a b -l i s h e d on r e p u t a t i o n and exper ience r a t h e r than l i c e n s i n g or r o y a l appointments. While t h i s consort ium of h e a l e r s p l a y s an important r o l e i n the m e d i c a l care of Taiwanese and Hong Kong c i t i z e n s , * none have been t r a n s p l a n t e d t o overseas Chinese communities such as * A Hong Kong mother w i l l take h e r s i c k c h i l d to an MD for medical treatment and a t a n g - k i t o vanquish the e v i l s p i r i t i n h a b i t i n g the c h i l d ( T o p l e y : 1 9 7 0 ) . 75 Vancouver except the h e r b a l i s t s . There are no s a c r e d f o l k h e a l e r s such as the t a n g - k i i n Vancouver, d e s p i t e t h e i r numbers i n Hong Kong and Taiwan. The t a n g - k i , a l though they can become q u i t e w e a l t h y , appeal t o the poorer and l e s s educated Chinese who are l e a s t l i k e l y or a b l e t o emigrate t o North America. Those who do emigrate are f o r w a r d - l o o k i n g and modern i n t h e i r w o r l d - v i e w and want t o drop any m a g i c a l b e l i e f which would be c o n s i d e r e d s u p e r s t i t i o u s i n an o v e r s e a s Chinese community. Thus the o n l y p a r a - m e d i c a l group t o have s u r v i v e d the t r a n s -p l a n t a t i o n t o North America are the h e r b a l i s t or h e r b a l d i s -pensors who work i n the h e r b a l pharmacies . As we s h a l l see i n a l a t e r c h a p t e r , the p r a c t i c a l and e m p i r i c a l b a s i s of Chinese h e r b a l i s m has i n s u r e d i t s t r a n s p l a n t a t i o n t o North America. As we have p r e v i o u s l y d i s c u s s e d , the h e r b a l i s t s working i n the h e r b a l pharmacies of Chinatown have l e a r n e d t h e i r a r t through an a p p r e n t i c e s h i p system. The o l d e r h e r b a l i s t s working i n Chinatown have done t h i s i n h e r b a l pharmacies i n Hong Kong. They a r e the e l d e s t and w i s e s t of the h e r b a l i s t s working i n Chinatown and t h e r e f o r e gather the most r e s p e c t . The younger m i d d l e - a g e d h e r b a l i s t s are A s i a n born but have l e a r n e d t h e i r c r a f t i n Canada. The youngest are h e r b a l a s s i s t a n t s who are l e a r n i n g the a r t of h e r b a l d i s p e n s i n g . They are a l s o A s i a n born. To my knowledge, no Canadian-b©rn Chinese i s working as a h e r b a l i s t i n Chinatown. MK i s an h e r b a l d i s p e n s o r a t one of the b u s i e r h e r b a l pharmacies i n Chinatown. MK i s p r o f i c i e n t i n E n g l i s h and 76 became one of my key i n f o r m a n t s . He i s i n h i s e a r l y 60s and came t o Canada from Hong Kong 30 y e a r s ago. He i n i t i a l l y worked i n v a r i o u s Chinese r e s t a u r a n t s as a w a i t e r . I n 1 9 7 4 , he was asked by an owner o f a h e r b a l pharmacy t o a p p r e n t i c e as an h e r b a l i s t . S i n c e t h i s i s more p r e s t i g i o u s and i n t e r e s t i n g than r e s t a u r a n t work, MK accepted the j o b . S i n c e then, he has worked a t the two s t o r e s i n Chinatown t h a t belong t o the same c h a i n . He i n i t i a l l y worked i n the s m a l l s t o r e i n c l o s e a s s o -c i a t i o n w i t h the r e s i d e n t h e r b a l d o c t o r . Here, he l e a r n e d the h e r b a l t r a d e . T h i s i n v o l v e s a c o n s i d e r a b l e amount of memory work t o l e a r n a l l the names and l o c a t i o n s of hundreds of h e r b s . MK became q u i t e s k i l l e d a t d i s p e n s i n g herbs and h a s developed a good r e p u t a t i o n as an h e r b a l i s t , t h i s f a v o u r a b l e r e p u t a t i o n h e l p s t o i n c r e a s e h i s f i r m ' s b u s i n e s s . I n 1980, he was moved t o the f i r m ' s l a r g e r s t o r e which has a more c e n t r a l l o c a t i o n i n Chinatown. Up t o t h i s p o i n t , t h i s s t o r e , which s e l l s both food and h e r b s was not a popular p l a c e t o purchase h e r b s . With a rearrangement of the pharmacy t o the f r o n t of the s t o r e and the e x p e r t i s e of MK, the s t o r e has prospered i n t o one of the b u s i e s t pharmacies i n Chinatown. T h i s i n d i c a t e s the importance t h a t r e p u t a t i o n p l a y s i n d e t e r -mining the s u c c e s s of an h e r b a l i s t and pharmacy i n the Chinese s o c i e t y of Chinatown. MK has a l s o developed a f a i r knowledge of the m e d i c a l uses for the numerous herbs he d i s p e n s e s . He i s a b l e to recommend a v a r i e t y of herbs and p r e s c r i p t i o n s for c l i e n t s a s k i n g for 77 a d v i c e f o r t h e i r m e d i c a l problems. H i s a d v i c e i s based on a knowledge of the symptomatic a c t i o n of h e r b s . Although he has l e a r n e d much by working w i t h the h e r b a l d o c t o r , he l a c k s an i n t i m a t e knowledge of the c o m p l e x i t y of Chinese m e d i c a l d i a g -n o s i s and t r e a t m e n t . MK i s a good example of the r o l e s e r v e d by a l l the h e r b a l i s t s working i n Chinatown. The r o l e of the h e r b a l i s t i n the herb shop i s a d u a l one: d i s p e n s i n g p r e s c r i p t i o n s and g i v i n g a d v i c e . L i k e h i s Western c o u n t e r p a r t , the Chinese h e r b a l i s t p r e p a r e s p r e s c r i p t i o n s a c c o r d i n g t o d o c t o r ' s o r d e r s or d i s p e n s e s p r e s c r i p t i o n s a c c o r d i n g t o the c u s t o m e r ' s p r e f e r e n c e s . H i s secondary r o l e , a g a i n s i m i l a r t o the Western p h a r m a c i s t , i s t o p r o v i d e a d v i c e t o c l i e n t s seeking h e l p f o r t h e i r a i l m e n t s . T h i s u s u a l l y e n t a i l s the matching of the c l i e n t ' s symptoms w i t h the a p p r o p r i a t e h e r b a l p r e s c r i p t i o n . I n other words, l i k e so much of Western a l l o p a t h i c m e d i c i n e , treatment i s sought through the e l i m i n a -t i o n of symptoms through the s e l e c t i v e use of m e d i c i n e s . T h i s procedure i s a n t i t h e t i c a l t o the p h i l o s o p h y and p r a c t i c e of c l a s s i c a l - p r o f e s s i o n a l Chinese m e d i c i n e . * The c l a s s i c a l l y t r a i n e d Chinese p h y s i c i a n attempts to e l i m i n a t e symptoms i n d i r e c t l y , by t r e a t i n g the u n d e r l y i n g c o n d i t i o n s which may have obvious c o n n e c t i o n w i t h the p r e s e n t i n g symptoms The C h i n e s e p h y s i c i a n bases h i s treatment regime on a c a r e f u l * However, i t f i t s i n t o the pragmatic o r i e n t a t i o n of the f o l k p r a c t i t i o n e r who attempts to e l i m i n a t e h i s c l i e n t ' s major symptoms. 78 d i a g n o s i s of the p a t i e n t ' s i n t e r n a l p h y s i o l o g i c a l c o n d i t i o n . S i n c e the C h i n e s e do not t h i n k of the body i n terms of s p e c i f i c organs but f u n c t i o n a l systems, the i n t e n t i s t o r e s t o r e f u n c -t i o n a l b a l a n c e t o an organ system r a t h e r than t r e a t a p a r t i c -u l a r symptomatic p a t h o l o g y of an u n d e r l y i n g organ s i t e . S i n c e h e r b a l i s t s have n e i t h e r the t ime nor the t r a i n i n g t o perform Chinese m e d i c a l d i a g n o s i s , t h e i r r o l e has become one of a l l e v i a t i n g t h e i r c l i e n t ' s symptoms i n the o n l y way they know. While t h i s may not d i f f e r from how Chinese h e r b a l i s t s have always p r a c t i c e d , i t i s the b a l a n c e between t h e s e two t r a d i -t i o n s t h a t i s i m p o r t a n t . Through exposure t o Western m e d i c a l p r a c t i c e s , the Chinese who use t r a d i t i o n a l herbs are l o o k i n g f o r a s i m i l a r symptomatic r e l i e f t h a t they have come t o expect from Western d r u g s . The h e r b a l p h a r m a c i s t s are responding t o t h i s need of t h e i r c l i e n t s w i t h a p p r o p r i a t e recommendations. These h e r b a l remedies are o f t e n q u i t e e f f e c t i v e i n r e l i e v i n g the symptoms i n a d d i t i o n t o r e s t o r i n g the b o d y ' s i n t e r n a l b a l a n c e . S i n c e Chinese h e r b a l medic ine i s above a l l an e m p i r i c a l system, the remedies work whether the u n d e r l y i n g t h e o r y i s understood or u t i l i z e d . 3. The Popular S e c t o r of the L o c a l Chinese H e a l t h Care System The t h i r d s e c t o r i n the model i s the popular or f a m i l y based h e a l t h c a r e network. Although i t i s the l e a s t s t u d i e d a r e a of m e d i c a l c a r e , the f a m i l y i s the most important source of pr imary care i n the case of i l l n e s s . . Kleinman (1980) has 79 reviewed the l i t e r a t u r e on h e a l t h seeking b e h a v i o u r and demon-s t r a t e s t h a t u n i v e r s a l l y , between 70% and 90% of a l l s i c k n e s s e p i s o d e s are managed w h o l l y w i t h i n the p o p u l a r s e c t o r . T h i s s e c t o r i s the n o n - p r o f e s s i o n a l , n o n - s p e c i a l i s t arena where h e a l t h c a r e problems are f i r s t r e c o g n i z e d and managed. I t i s the domain of p o p u l a r c u l t u r e and i n c l u d e s the i n d i v i d u a l , n u c l e a r and extended f a m i l y , f r i e n d s , n e i g h b o u r s , s o c i a l networks and the whole sphere of the community. Whereas the p r e v a i l i n g view i s t h a t h e a l t h c a r e s p e c i a l -i s t s manage the h e a l t h c a r e f o r the l a y p o p u l a t i o n , the o p p o s i t e a c t u a l l y o c c u r s . I n d i v i d u a l s w i t h i n the c o n t e x t of the p o p u l a r s e c t o r d e c i d e the e n t r y p o i n t s t o the p r o f e s s i o n a l f o l k s e c t o r s of t h e i r l o c a l h e a l t h c a r e system. S p e c i a l i s t treatment i s e v a l u a t e d by the members of the p a t i e n t ' s s o c i a l network and a l t e r n a t i v e s t r a t e g i e s are d e c i d e d upon i f n e c e s s a r y . Before s p e c i a l i s t a s s i s t a n c e i s sought, s e l f - t r e a t m e n t i s attempted by most i n d i v i d u a l s i n almost a l l s o c i e t i e s . T h i s s e l f - c a r e a s p e c t of the l o c a l h e a l t h c a r e system i s an extremely important c o n t r i b u t i o n t o the o v e r a l l h e a l t h of i n d i v i d u a l s ; the impor-tance of which i s o n l y now becoming r e c o g n i z e d by h e a l t h p l a n n e r s , h e a l t h p r o f e s s i o n a l s and h e a l t h r e s e a r c h e r s . I n Chinese c u l t u r e , the f a m i l y i s the fundamental s o c i a l u n i t . The f a m i l y i s a l s o the primary" care u n i t and t h e r e f o r e c r i t i c a l t o the understanding of the l o c a l h e a l t h c a r e system Of the C h i n e s e . T r a d i t i o n a l l y , the Chinese view the f a m i l y as a c i r c l e (Jordon 1 9 7 2 ) . I l l n e s s breaks up t h a t s o l i d a r i t y , 80 t h e r e f o r e , a g r e a t d e a l of a t t e n t i o n i s p a i d t o both the p r e v e n t i o n and the treatment of d i s e a s e w i t h i n the c o n t e x t of f a m i l y l i f e . The Chinese are a h e a l t h o r i e n t e d c u l t u r e (Koo 1 9 7 6 ) . A g r e a t d e a l of v a l u e i s p l a c e d on the maintenance of good h e a l t h . C h i l d r e n are taught from an e a r l y age t h a t t h e i r b o d i e s are a g i f t from t h e i r a n c e s t o r s . They are t a u g h t t o a v o i d b o d i l y i n j u r y and to be r e s p o n s i b l e f o r m a i n t a i n i n g the h e a l t h y i n t e g r i t y of t h e i r b o d i e s . H e a l t h i s t h e r e f o r e a p r i m a r y s o c i a l v a l u e f o r the C h i n e s e , who a r e w i l l i n g t o spend c o n s i d e r a b l e e f f o r t and money t o m a i n t a i n i t . T r a d i t i o n a l l y , the Chinese f a m i l y was p a t r i a r c h i c a l (Levy 1 9 4 9 ) . The husband was r e s p o n s i b l e f o r the a f f a i r s o u t s i d e the home and the w i f e f o r a l l a f f a i r s w i t h i n the home. The w i f e , a l though she r e t a i n e d l i t t l e v i s i b l e s t a t u s w i t h i n Chinese s o c i e t y , r e t a i n e d much s t a t u s and r e s p o n s i b i l i t y w i t h i n the c o n f i n e s of h e r household. The w i f e managed the complete running of the household w i t h major r e s p o n s i b i l i t i e s i n l o o k i n g a f t e r the f a m i l y budget, cooking, the e d u c a t i o n of her c h i l d r e n and the g e n e r a l p h y s i c a l and mental w e l l - b e i n g of her e n t i r e f a m i l y . Often, the w i f e ' s mother or m o t h e r - i n - l a w would l i v e i n h e r household and command r e s p e c t from everyone i n the f a m i l y . H e a l t h was t h e r e f o r e the woman's r e s p o n s i b i l i t y w i t h i n the household (Wolf 1 9 7 2 ; Wolf and Witke 1 9 7 5 ) . S p e c i a l mention should be made of the importance of the grandmother's r o l e i n r e t a i n i n g the t r a d i t i o n a l use of herbs i n the Chinese f a m i l i e s of Vancouver. The Chinese f a m i l y has 81 t r a d i t i o n a l l y l i v e d t o g e t h e r as an extended f a m i l y u n i t . T y p i c a l l y , the w i f e would move i n w i t h h e r h u s b a n d ' s p a r e n t s t o form an extended f a m i l y u n i t (Levy 1949; Wolf 1 9 7 2 ) . I n Vancouver today, both the m a t e r n a l or p a t e r n a l grandparents are e q u a l l y as l i k e l y t o r e s i d e w i t h t h e i r c h i l d r e n ' s f a m i l y . J o h n s o n ' s ( 1 9 7 9 ) r e s e a r c h i n d i c a t e s t h a t almost a q u a r t e r of the Vancouver sample had a t l e a s t one grandparent l i v i n g i n the f a m i l y ' s home. I n my sample, the grandmothers c o n t i n u e d buying and p r e p a r i n g herbs t o ensure the f a m i l y ' s w e l l be ing i n the same way she had l e a r n e d to do so i n A s i a . I n t h i s way, she i s h e l p i n g t o p r e s e r v e the t r a d i t i o n a l use of herbs by the f a m i l y . I t i s important t o emphasize the r e l a t i o n s h i p between food and h e a l t h i n Chinese c u l t u r e (Chang 1 9 7 7 ) . Food i s used as the f i r s t vanguard i n both the p r e v e n t i o n and the treatment of d i s e a s e and i l l n e s s . There i s a l s o an important c o n n e c t i o n made between the h e a l i n g p r o p e r t i e s of food and h e r b s . S i n c e the woman i s r e s p o n s i b l e f o r both food and h e a l t h i n the Chinese household, she p l a y s a c r u c i a l r o l e as the pr imary h e a l t h c a r e p r o v i d e r . Women, t h e r e f o r e , become q u i t e knowledge-a b l e about the h e a l i n g p r o p e r t i e s of d i f f e r e n t foods and h e r b s . T h i s knowledge, a l though i t may draw from the p r o f e s s i o n a l and f o l k s e c t o r s for s p e c i f i c d e t a i l s , i s o r g a n i z e d and u t i l i z e d i n a completely d i f f e r e n t manner from the other two s e c t o r s . T h e r e f o r e , i t i s an important source of m e d i c a l knowledge w i t h i n the Chinese community and has to be c o n s i d e r e d as a s e p a r a t e and i n t e g r a l system w i t h i n the l o c a l h e a l t h c a r e 82 system of the Chinese i n Vancouver. One of the major f i n d i n g s of t h i s study i s how rooted the use of t r a d i t i o n a l Chinese h e r b s i s t o the f a b r i c of Chinese f a m i l y l i f e . As I s h a l l d i s c u s s l a t e r , the v e r y c o n t i n u a n c e of Chinese h e r b a l i s m i s due t o i t s acceptance and c o n t i n u e d use by the C h i n e s e f a m i l i e s of Vancouver. Any product or s e r v i c e r e q u i r e s p o p u l a r support f o r i t t o be v i a b l e and Chinese herb medic ine i s no d i f f e r e n t . I f p o p u l a r support f o r Chinese herbs was l o s t , then the h e r b a l i s t s , h e r b a l d o c t o r s and h e r b a l pharmacies would soon d i s a p p e a r from the s t r e e t s of Chinatown. I t i s my c o n t e n t i o n t h a t the cont inued support f o r Chinese h e r b a l i s m stems from the Chinese view of h e a l t h and the key r o l e of the f a m i l y i n h e a l t h c a r e . I n order t o demonstrate t h i s p o i n t , we s h a l l look a t the p o p u l a r a t t i t u d e s towards h e a l t h , t y p i c a l responses t o i l l n e s s i n the Chinese f a m i l y and the use of t r a d i t i o n a l herbs w i t h i n the c o n t e x t of the h o u s e -h o l d . Over the course of my f i e l d work, I had the o p p o r t u n i t y to speak t o many C h i n e s e - C a n a d i a n s r e g a r d i n g t h e i r a t t i t u d e s towards t r a d i t i o n a l Chinese m e d i c i n e . The Chinese community i n Vancouver i s h i g h l y v a r i e d w i t h r e s p e c t t o p l a c e of o r i g i n , l e n g t h o f time i n Canada, f a c i l i t y w i t h E n g l i s h and/or Chinese (Cantonese) , e d u c a t i o n , o c c u p a t i o n , and the degree of t r a d i -t i o n a l i s m . Due to t h i s d i v e r s i t y of backgrounds, i t i s impos-s i b l e t o c a t e g o r i z e a t y p i c a l or normative a t t i t u d e towards Chinese m e d i c i n e . T h e r e f o r e , the d i s t i n g u i s h i n g f e a t u r e of 83 C h i n e s e - C a n a d i a n a t t i t u d e s towards Chinese medic ine i s t h e i r marked h e t e r o g e n e i t y . A t t i t u d e s towards Chinese medic ine f a l l a long a continuum between complete acceptance and complete r e j e c t i o n . I n s t e a d of c a t e g o r i z i n g the popular h e a l t h b e l i e f s of the C h i n e s e i n Vancouver, I w i l l p r e s e n t the range of o p i n i o n s w h i l e emphasiz ing c e r t a i n themes t h a t emerge from the d a t a . The r e s u l t s of my study concur w i t h Koo's ( 1 9 7 6 ) c o n -c l u s i o n t h a t food and d i e t i s c o n s i d e r e d t o be the most important f a c t o r a f f e c t i n g h e a l t h . As Koo ( 1 9 7 6 ) summarizes, food i n C h i n e s e c u l t u r e i s c o n s i d e r e d t o be a source of energy ( c h V i ) , a cause of i l l n e s s or a means of t h e r a p y . When food i s d i g e s t e d i n the body, i t i s transformed i n t o a hot ( j e h ) c h ' i or a c o l d ( l e n g ) c h ' i . Herbs have the same e f f e c t and are c l a s s i f i e d i n p o p u l a r Chinese c u l t u r e a c c o r d i n g t o hot or c o l d f o r c e . T h i s forms the b a s i s f o r the h o t / c o l d c l a s s i f i c a t i o n system. While t h i s borrows from the use of hot and c o l d i n c l a s s i c a l Chinese m e d i c i n e , the h o t / c o l d c l a s s i f i c a t i o n system i s the h e a r t of the popular m e d i c a l b e l i e f system. Although t h i s d u a l i s t i c system may appear s i m p l i s t i c , i t p r o v i d e s the t h e o r e t i c a l b a s i s f o r c o g n i t i v e d e c i s i o n s regarding food s e l e c t i o n and the use of a p p r o p r i a t e herbs on a d a i l y b a s i s . Although no two informants w i l l agree e x a c t l y on the c l a s s i f i -c a t i o n of v a r i o u s foods, t h e r e i s enough c o n s i s t e n c y t o i d e n t i f y a s y s t e m a t i c b a s i s f o r c a t e g o r i z a t i o n . The r e s u l t s of my i n q u i r y about the food c l a s s i f i c a t i o n of two f a m i l i e s i s g iven 84 T a b l e I I I H o t / C o l d Food C l a s s i f i c a t i o n i n Two Vancouver Chinese F a m i l i e s HOT OR WARM Beef C h i c k e n G a r l i c C h i l i G inger L i c h e e Dates Duck Eggs Pork Chinese cabbage Soy Sauce S a l t Onions C h o c o l a t e Nuts Mutton Dog meat C o f f e e F r i e d Foods COLD OR COOL Watermelon Wintermelon Watercress Grapes Green Beans Banana Pear P i n e a p p l e Orange Bean s p r o u t s Chinese p a r s l e y Crab Beverages I c e Cream Chinese J e l l y NEUTRAL FOODS Steamed F i s h Tofu R i c e Tea 85 i n T a b l e I I I . One w i l l note t h a t i n a d d i t i o n t o hot and c o l d , warm, c o o l and n e u t r a l are a l s o used t o i n d i c a t e v a r i a t i o n s of i n t e n s i t y . The system, however, i s e s s e n t i a l l y a d u a l i s t i c one. When t h i s l i s t of food c a t e g o r i e s i s compared t o other C h i n e s e communities, such as Toronto (Yeung e t a l . 1 9 7 3 ) ; Hong Kong (Anderson and Anderson 1 9 7 5 ; Choa 1967) and Singapore (Wu 1 9 7 9 ) , an u n d e r l y i n g l o g i c emerges from t h i s system of c l a s s i f i c a t i o n . I n g e n e r a l , most Chinese from South C h i n a w i l l agree t h a t foods t h a t are h e a t i n g are s t r o n g e r , r i c h e r , s p i c i e r and more f a t t y . S i m i l a r l y , foods t h a t are c o o l i n g a r e thought t o be b l a n d , low i n c a l o r i e s and predominately v e g e t a l . The q u a l i t i e s of foods can be m o d i f i e d a c c o r d i n g t o the cooking methods used t o prepare the food. Apply ing h e a t i n the cooking p r o c e s s does not n e c e s s a r i l y "heat" the food i n a s y m b o l i c s e n s e , s i n c e the system does not operate on the b a s i s of temperature. For example, u s i n g water t o cook with as i n steaming or b o i l i n g w i l l have the e f f e c t of c o o l i n g . The i n h e r e n t h e a t i n a food l i k e pork can then be reduced by b o i l i n g i t i n water. On the other hand, b a k i n g , r o a s t i n g and deep f r y i n g foods w i l l g r e a t l y i n c r e a s e t h e i r h e a t . I n t h i s way, the v a r i o u s q u a l i t i e s of foods can be modif ied a c c o r d i n g t o a p e r s o n ' s p a r t i c u l a r needs. However, foods on the extremes of hot and c o l d w i l l remain t h e r e r e g a r d l e s s of the cooking method used. S t i r - f r y i n g i s c o n s i d e r e d t o be o n l y s l i g h t l y h e a t i n g and i s the p r e f e r r e d method of p r e p a r i n g many meats and v e g e t a b l e s . V e g e t a b l e s are almost never eaten raw, as t h i s i s 86 too c o o l i n g t o the body and a r e u s u a l l y l i g h t l y s t i r - f r i e d . The system makes more sense when i t i s a p p l i e d t o s p e c i f i c needs o f i n d i v i d u a l s . People v a r y i n t h e i r c o n s t i t u t i o n a l make —ups. Some people a r e c o n s i d e r e d t o be hot by n a t u r e (most men) or c o o l (most women). A person who i s hot by n a t u r e can upset t h e i r b a l a n c e by i n d u l g i n g i n too many hot foods, r e s u l t -ing i n a h o t d i s e a s e . The therapy for t h i s person would be t o "cool" the i r b o d i e s down by e a t i n g the a p p r o p r i a t e c o o l herbs and foods. The b a s i c p r i n c i p l e behind d i e t and food therapy i s the n e u t r a l i z a t i o n of the e x c e s s i v e f o r c e i n a g e n t l e manner w i t h the o p p o s i t e q u a l i t y . The end r e s u l t f o r the i n d i v i d u a l i s the r e s t o r a t i o n of the unique b a l a n c e p o i n t of hot and c o l d f o r t h a t s p e c i f i c i n d i v i d u a l . The same p r i n c i p l e i s used f o r the p r e v e n t i o n of d i s e a s e . I f , f o r example, a person i s p a r t i c u l a r l y prone to c o l d i l l n e s s e s , he or she w i l l p r o t e c t themselves by i n c l u d i n g e x t r a h e a t i n g foods and herbs i n t h e i r d i e t . The c l a s s i f i c a t i o n system i s used t o d e f i n e a s e t of d i e t a r y p r e s c r i p t i o n s i n v a r i o u s c i r c u m s t a n c e s . There are g e n e r a l p r e s c r i p t i o n s such as d o n ' t eat c o l d foods i n the morning. People who are i n s p e c i a l s t a t e s such as c h i l d h o o d , pregnancy, i l l n e s s and o l d age have s p e c i a l d i e t a r y needs. Foods can a l s o be used p r e v e n t a t i v e l y t o ward o f f d i s e a s e . I n the w i n t e r , one should eat more hot foods t o b u i l d up o n e ' s i n t e r n a l r e s i s t a n c e and s t r e n g t h , and t o ward o f f the harmful e f f e c t s of c o l d , damp and wind on the body. Seasonal a d j u s t -87 ments a r e c o n s i d e r e d n e c e s s a r y f o r the maintenance of good h e a l t h . The p r e s e n t s t u d y , along w i t h the other North American s t u d i e s (Koo 1 9 7 6 ; L i and L i 1 9 7 1 ; Yeung e t a l . 1 9 7 3 ) , demon-s t r a t e t h a t the symbol ic c l a s s i f i c a t i o n system of foods i s a v e r y strong p a r t of the p o p u l a r c u l t u r e of the C h i n e s e . How-e v e r , i t s h o u l d be p o i n t e d out t h a t awareness of t h i s system does not mean t h a t the system i s used t o determine food p r e f e r -ences and c o m b i n a t i o n s . For example, a l though many of the younger women i n t e r v i e w e d were aware of the h o t / c o l d system, they d i d not employ the system on a d a i l y b a s i s . I t appeared t h a t the system was most l i k e l y t o be used i f t r a d i t i o n a l C h i n e s e foods were being prepared and not a t a l l i f a Western s t y l e meal was being p r e p a r e d . Using J o h n s o n ' s ( 1 9 7 4 ) d a t a l i s t e d i n T a b l e I V , we can see t h a t Chinese food i s prepared i n the m a j o r i t y of households i n t e r v i e w e d . We c o u l d e x t r a p o l a t e from the d a t a of these two s t u d i e s t h a t the h o t / c o l d symbol ic system i s being used by a m a j o r i t y of Chinese f a m i l i e s i n V a n -couver i n the p r e p a r a t i o n of t r a d i t i o n a l food d i s h e s . Whether t h e s e same f a m i l i e s are u s i n g t h i s system to guide t h e i r h e a l t h b e h a v i o u r i s a q u e s t i o n t h a t cannot be answered a t t h i s t i m e . T a b l e I V . Type of Food Eaten i n the Chinese Home Chinese 64% Western 2% Source: Johnson ( 1974) Both 33% N 339 88 The a u t h o r s of the Toronto study of h o t / c o l d food c l a s s i -f i c a t i o n i n the C h i n e s e community (Yeung e t a l . 1 9 7 3 ) conclude t h a t t h i s system i s s t i l l v e r y much p a r t of Chinese c u l t u r e . T h e i r d a t a suggest t h a t t h i s i s b a s i c a l l y an o r a l t r a d i t i o n t h a t i s c o n t i n u i n g t o be passed along t o the younger C h i n e s e -Canadians through the d a i l y t r a d i t i o n a l meal of the Chinese f a m i l i e s i n t h e i r s t u d y . They i n d i c a t e t h a t the o l d e r C h i n e s e -Canadians a r e more f a m i l i a r w i t h the h o t / c o l d system and adhere to i t more s t r o n g l y t h a n the younger f a m i l y members. However, t h e y found t h a t w i t h r e s p e c t t o food p r e s c r i p t i o n s d u r i n g and a f t e r pregnancy, even the younger women fol lowed the t r a d i t i o n a l a v o i d a n c e of c o l d foods d u r i n g pregnancy. I found t h i s a l s o t o be t r u e f o r the C h i n e s e women i n my s t u d y , and w i l l p r e s e n t my d a t a on food and pregnancy i n a f o l l o w i n g s e c t i o n of t h i s c h a p t e r . The h o t / c o l d system i s not the o n l y c a t e g o r y foods are p l a c e d i n . The Chinese p l a c e g r e a t emphasis on food and herbs which are pva. Pu l i t e r a l l y means t o p a t c h or t o mend as i n t o add on or make up f o r some d e f i c i e n c y (Wieger 1 9 6 5 ) . G o u l d -M a r t i n ( 1 9 7 8 : 4 4 ) i n t e r p r e t s the meaning as " a d m i n i s t e r i n g r e s t o r a t i v e s or t o n i c s , i . e . making up d e f i c i e n c i e s whether of f a t e , h e a l t h , c l o t h i n g or e d u c a t i o n . " Koo ( 1 9 7 6 : 2 1 4 ) r e f e r s to them as "supplementing" or " n o u r i s h i n g f o o d s . " My informants r e f e r r e d to them as e i t h e r " p r e c i o u s " or " l u x u r i a n t " s i n c e they were r a r e and expensive foods t o o b t a i n . Foods thought to be p r e c i o u s i n c l u d e abalone, sea cucumber, s h a r k ' s f i n , swal low's 89 n e s t , t u r t l e , red and b l a c k d a t e s , snake meat, the l i v e r , h e a r t and b r a i n s of pork, i n a d d i t i o n t o many energy t o n i c herbs ( r e f e r t o Chapter I I , Sec. 9 ) . * I t i s b e l i e v e d t h a t by s u p p l e -menting o n e ' s d i e t on o c c a s i o n w i t h these r a r e foods, one c o u l d improve o n e ' s mental and p h y s i c a l f u n c t i o n s . They are a l s o used t o t o n i f y the body i n t imes of a d d i t i o n a l s t r e s s such as w i n t e r . Pu foods had nothing t o do w i t h h o t / c o l d foods as both extremes are r e p r e s e n t e d i n the c a t e g o r y of p r e c i o u s . However, an e x c e s s i v e use of these p r e c i o u s foods could be h a r m f u l t o the body and r e s u l t i n a i l m e n t s such as headaches or upset stomach.. As w i t h a l l of Chinese m e d i c i n e , a harmonious b a l a n c e between two extremes was c o n s i d e r e d the o p t i m a l p a t h . A r e l a t e d concept i s the d o c t r i n e of s i m i l a r s r e g a r d i n g the use of organ meats. I t i s b e l i e v e d t h a t e a t i n g a c e r t a i n p a r t or organ from an animal w i l l s t r e n g t h e n the corresponding organ of the person consuming i t . For example, i t i s thought t h a t e a t i n g monkey's b r a i n w i l l s t r e n g t h e n the b r a i n and thought p r o c e s s e s . The same l o g i c operates i n foods used m e d i c i n a l l y t o i n c r e a s e male potency, such as the p e n i s and t e s t i c l e s from v a r i o u s a n i m a l s . S i m i l a r l y , for weak l i v e r s , h e a r t , l u n g s , and k i d n e y s , the Chinese recommend the c o r r e -sponding organs from a n i m a l s . Choa ( 1967) c a l l s t h i s "organo-t h e r a p y . " I t i s a popular b e l i e f throughout the Chinese * T h i s i s o n l y a p a r t i a l l i s t t h a t I assembled. See Koo ( 1 9 7 6 : 2 5 5 ) for a complete l i s t i n g . 90 community. T h i s is. one a s p e c t of a l a r g e area of symbolism i n h e r e n t i n Chinese m e d i c i n e . I s h a l l d i s c u s s the i n t e r p r e t a -t i o n of t h i s symbol ic l o g i c i n Chapter I V . I t i s thought t h a t combining herbs cooked w i t h c e r t a i n meats such as c h i c k e n , p i g e o n , b e e f , pheasant and duck w i l l r e p l e n i s h o n e ' s b lood s u p p l y . Many foods are a c t u a l l y combined w i t h h e r b s and eaten for t h e i r m e d i c i n a l , as w e l l as t h e i r n u t r i t i o n a l v a l u e . I t i s o f t e n d i f f i c u l t t o d i s t i n g u i s h between the m e d i c i n a l v a l u e of a food from i t s d i e t a r y f u n c t i o n For example, many soups are prepared t o be eaten as p a r t of the r e g u l a r meal but a l s o have a p r e v e n t a t i v e or t h e r a p e u t i c e f f e c t . I t i s d i f f i c u l t t o s e p a r a t e these f u n c t i o n s . I t i s my c o n c l u s i o n t h a t the Chinese do n o t . There i s a merging of c a t e g o r i e s between f o o d s t u f f s and h e r b s for a l a r g e number of i t e m s . While t h e r e are substances t h a t c o u l d be c o n s i d e r e d t o be food or h e r b a l items e x c l u s i v e l y t h e r e i s a whole range of products f o r which the d i s t i n c t i o n between food and h e r b s are b l u r r e d . There are a l s o f o o d s t u f f s used e x c l u s i v e l y for m e d i c i n a l purposes and herbs used i n cooking s o l e y for f l a v o u r i n g . However, t h e r e i s a l a r g e area of o v e r l a p between foods and h e r b s . T h i s became e v i d e n t t o me i n the course of my f i e l d work. I asked my informants i n t h e i r homes to show me t h e i r h e r b s . They would always be s t o r e d i n a k i t c h e n cupboard i n c l o s e p r o x i m i t y t o other food i t e m s . They would then b r i n g out items t h a t I would c l a s s i f y as f o o d s t u f f s , but they c o n s i d e r e d or used as h e r b s . They were such t h i n g s as 91 C h i n e s e almonds ( a p r i c o t p i t s ) , p e a r l b a r l e y , seaweed, Chinese d a t e s , plums and f r u i t s . A f t e r the same s c e n a r i o o c c u r r e d i n s e v e r a l h o u s e h o l d s , I came t o the c o n c l u s i o n t h a t the Chinese do not make as r i g i d a d i s t i n c t i o n between m e d i c i n a l herbs and foods as a Westerner. To understand the c o n n e c t i o n between food and h e r b s , I would l i k e t o d e s c r i b e the c o n t e x t of h e r b a l use i n the Chinese household. I am going t o d e s c r i b e the households where Chinese h e r b s a r e u s e d . I s h a l l irefer t o t h e s e as " t r a d i t i o n a l h o u s e -h o l d s " t o i n d i c a t e t h a t Chinese h e r b s are used on a r e g u l a r b a s i s i n c o n t r a s t t o "modern households" where t h e y are n o t . I n the Chinese f a m i l y , p a r t i c u l a r l y where t h e r e i s an o l d e r mother or grandmother, Chinese herbs are l i k e l y t o be used. Many Chinese homes, e s p e c i a l l y i f t h e r e i s an extended f a m i l y l i v i n g t o g e t h e r , have a w e l l - s t o c k e d h e r b a l medicine cupboard which can t r e a t a l l the more common c o m p l a i n t s . However, a young couple who were born i n Canada and l i v i n g on t h e i r own are not l i k e l y t o have t h i s t r a d i t i o n a l medicine c h e s t . I n a t r a d i t i o n a l household, i t i s the woman who has a g e n e r a l knowledge of the more common Chinese h e r b s . She i s u s a l l y the mother or grandmother of the f a m i l y . Often, though not a lways , she can speak o n l y C h i n e s e . Her husband and c h i l d r e n do speak E n g l i s h as w e l l as Chinese ( t y p i c a l l y , Cantonese) . T r a d i t i o n a l households tend to have immigrated to Canada more r e c e n t l y . The female head of the household who has 92 h e r b a l knowledge i s u s u a l l y A s i a n - b o r n . For f i r s t and second g e n e r a t i o n h o u s e h o l d s , the keeper of the h e r b a l knowledge i s the o l d e r grandmother. The men i n my study who have a know-ledge of h e r b s were a l s o o l d e r or A s i a n - b o r n and r e c e n t immigrants . A l l o f the t r a d i t i o n a l households t h a t I s t u d i e d kept a l a r g e s u p p l y of b a s i c h e r b s and medic ines i n the home. A " t y p i c a l " t r a d i t i o n a l household would s t o c k between 20 t o 30 herbs i n a d d i t i o n t o v a r i o u s foods w i t h m e d i c a l p r o p e r t i e s and a number of p a t e n t (prepared) Chinese m e d i c i n e s . Herbs were kept t h a t c o u l d i n c r e a s e b o d i l y energy ( c h ' i ) , prevent or t r e a t s p e c i f i c a i l m e n t s and be used f o r f i r s t - a i d s i t u a t i o n s . The h e r b s most commonly found i n the Chinese homes were those t h a t f e l l i n t o the c l a s s of energy t o n i c s . These are t o n i f y i n g h e r b s which are used t o b u i l d s t r e n g t h and r e s i s t a n c e by r a i s i n g the l e v e l of c h ' i i n the body. They can be used e i t h e r p r e v e n t i v e l y or t h e r a p e u t i c a l l y . The Chinese were v e r y concerned w i t h m a i n t a i n i n g an o p t i m a l l e v e l of c h ' i i n t h e i r b o d i e s . An o p t i m a l l e v e l of c h ' i was equated with good h e a l t h . I f one was f u l l of energy ( c h ' i ) , then one was v i t a l and r e s i s t a n t t o g e t t i n g s i c k . Herbs w i t h the c a p a c i t y t o i n c r e a s e ch' i were the most common and l i k e l y herbs to be found i n the t r a d i t i o n a l Chinese household. T o n i f y i n g herbs c o u l d be of a g e n e r a l n a t u r e and food for everyone or for a s p e c i f i c need of a p a r t i c u l a r i n d i v i d u a l . A good example of the g e n e r a l t o n i c herbs are those t h a t 93 go i n t o making up the "hot, energy soup m i x t u r e . " The herbs i n c l u d e d i n t h i s formula a r e : T a n g - s h e n , ( C o d o n o p s i s ) , Huang-c h i ( A s t r a g a l u s ) , H u n g - t s a e ( Z i z y p h u z ) , K o u - c h i - t s u (Lycium) and Shan-yao ( D i o s c o r e a ) . Most of the i n d i v i d u a l p r o p e r t i e s of t h e s e h e r b s are d e s c r i b e d i n Chapter I I , s e c t i o n 9. The h e r b s can be used by themselves or i n other c o m b i n a t i o n s . I n t h i s formula, t h e y are used f o r the purpose of b u i l d i n g up o n e ' s h o t energy so as t o o f f e r i n c r e a s e d r e s i s t a n c e a g a i n s t the e f f e c t s of the c o l d and damp w i n t e r . The soup i s prepared with e i t h e r c h i c k e n or pork, which are both hot meats. The whole f a m i l y t a k e s t h i s soup w i t h t h e i r evening meal. The herbs are not eaten t h e m s e l v e s , but t h e i r goodness i s t r a n s f e r r e d t o the soup. I n t h i s way, many of the younger members of the f a m i l y , get the b e n e f i t s o f the herbs even i f they do not b e l i e v e i n Chinese m e d i c i n e . These younger members are the c h i l d r e n who are a t t e n d i n g s c h o o l and becoming a c c u l t u r a t e d t o Canadian c u l t u r e . There i s o f t e n a r e l u c t a n c e of the younger f a m i l y members t o use Chinese h e r b s . However, t h e y are d i f f i c u l t to a v o i d i f they are d i s g u i s e d i n a soup. T h i s soup mixture i s used o n l y once or t w i c e immediately before w i n t e r s e t s i n . T h i s m a x i -mizes the e f f e c t s of the i n g r e d i e n t s . Together, these herbs are thought t o i n c r e a s e c h ' i and h e l p prevent the f a m i l y from c a t c h i n g too many c o l d s dur ing the w i n t e r . Other herbal tonics might be prepared for a single indi-vidual's use. The type of tonic used depended on the specific characteristics and needs of the particular person using 94 them. These v a r i a b l e s i n c l u d e d the p e r s o n ' s age, s e x , bodily-temperament and c o n s t i t u t i o n and t h e i r s p e c i f i c p h y s i o l o g i c a l p r o b l em. Other v a r i a b l e s determining the type of t o n i c em-p l o y e d were the environment, weather and season. S p e c i a l t o n i c s a r e prepared f o r the aged, those w i t h weak c o n s t i t u t i o n s , those w i t h s p e c i a l problems such as eye problems and t o n i c s f o r men or women. A p o p u l a r method f o r the men of the household t o use h e r b s i s t o put a r a r e "men's herb" such as an e x p e n s i v e ginseng r o o t , a d e e r ' s t a i l or t i g e r ' s t e s t i c l e s i n t o a b o t t l e of b r a n d y . The brandy e x t r a c t s the essence of the herb and s m a l l s i p s are taken over a p e r i o d of t ime by the men. These male t o n i c s are used t o m a i n t a i n v i r i l i t y . There i s an obvious element of r i t u a l and symbolism which goes i n t o these p a r t i -c u l a r t o n i c s . One of the common themes i n my i n t e r v i e w s w i t h t r a d i t i o n a l f a m i l i e s was a concern f o r an adequate s u p p l y of b lood, e s p e -c i a l l y f o r women. Women are thought t o be more s u s c e p t i b l e t o "not enough b l o o d . " To c o r r e c t t h i s d e f i c i e n c y , they have t o t a k e a v a r i e t y of herbs to " b u i l d b l o o d . " Many of the h o u s e -h o l d ' s herbs were used to i n c r e a s e the amount and q u a l i t y of blood i n women. Good h e a l t h i s seen as dependent on an a p p r o -p r i a t e amount of "good b l o o d . " These herbs can be c o n s i d e r e d to be a type of t o n i c for the b l o o d . - The most commonly used herb by women t o i n c r e a s e t h e i r blood supply i s dong-quai which i s c o n s i d e r e d t o be the "women's herb" par e x c e l l e n c e . A l l the Chinese women I i n t e r v i e w e d knew about i t , i n c l u d i n g the 95 younger women. Although dong-quai can be taken by i t s e l f , the most common method of i n g e s t i o n i s t o p r e p a r e a s imple formula u s i n g i t as the p r i m a r y i n g r e d i e n t . T h r e e - q u a r t e r s of a Chinese ounce (24 gm.) d o n g - q u a i and o n e - q u a r t e r ounce (8 gm.) t a - t s a o ( b l a c k d a t e s ) a r e combined w i t h two h a r d b o i l e d eggs (peeled) w i t h 32 ounces of w a t e r . The mixture i s then s l o w l y b o i l e d down t o one 8-ounce cup i n a n o n - m e t a l l i c p o t . Rock sugar or honey may be added f o r t a s t e s i n c e the mixture i s v e r y b i t t e r . The mixture i s consumed immediately i n one dose. Another way of p r e p a r i n g d o n g - q u a i i s t o s l i c e the root and s l o w l y simmer i t f o r s i x hours i n a c h i c k e n b r o t h . Other p o s s i b l e meats t h a t can be used a r e lamb or r a b b i t . Many of the Chinese women I i n t e r v i e w e d use dong-quai on a r e g u l a r b a s i s to m a i n t a i n adequate blood s u p p l y and t o n o r m a l i z e and r e g u l a r i z e t h e i r p e r i o d s . I f used i n t h i s way on a r e g u l a r b a s i s , they are thought t o have h e a l t h y blood and s h o r t p e r i o d s w i t h a minimal amount of cramps and h e a d -a c h e s . To a c h i e v e these e f f e c t s , the Chinese women use dong-q u a i once immediately a f t e r t h e i r p e r i o d has ended and another t ime i n m i d - c y c l e . I was t o l d t h a t i f a woman took dong-quai d u r i n g h e r p e r i o d , t h i s "would p r e s e r v e her bad b l o o d . " Dong-quai i s never used dur ing pregnancy, but i s used e x t e n s i v e l y i n the p o s t - p a r t u m p e r i o d . Pregnancies are an important time i n the l i f e - c y c l e of the Chinese woman. Young women are u s u a l l y a s s i s t e d throughout t h i s p e r i o d by t h e i r 96 mothers and grandmothers. There a r e many t r a d i t i o n a l b e l i e f s s u r r o u n d i n g pregancy which are s t i l l e v i d e n t i n the Vancouver C h i n e s e community. One of t h e s e i s a s e t of p r a c t i c e s employed i n the f i r s t p o s t - p a r t u m month. T h i s i s c a l l e d t s o y u e h - t z u or "doing the month" ( P i l l s b u r y 1 9 7 8 ) . The new mother i s thought t o be v e r y v u l n e r a b l e t o the e f f e c t s of c o l d , dampness, and wind. Her body i s d e p l e t e d of the s t o r e s of b e n e f i c i a l h e a t . She must s l o w l y r e s t o r e h e r body t o i t s n a t u r a l b a l a n c e by a v o i d i n g c o l d foods and exposure t o the elements (which are c o l d and damp) and t o n o u r i s h h e r s e l f w i t h hot foods t h a t a r e h e a t i n g . T r a d i t i o n a l l y , C h i n e s e women would a v o i d the environmental h a z a r d s by s t a y i n g i n d o o r s f o r a month and a v o i d i n g any c o n t a c t w i t h c o l d water encountered i n b a t h i n g or washing the h a i r ( P i l l s b u r y 1 9 7 8 ) . I n Vancouver, the elements of these t r a d i t i o n a l p r a c t i c e s t h a t have been r e t a i n e d a r e the d i e t a r y p r e s c r i p t i o n s . S i n c e the mother i s not a l lowed t o do anything f o r the month f o l l o w i n g c h i l d b i r t h , h e r mother prepares a "hot" soup f o r h e r t o t a k e . T h i s soup t y p i c a l l y i n c l u d e s d o n g - g u a i , r i c e wine and c h i c k e n . A v a r i a n t of t h i s i s t o s u b s t i t u t e p i g ' s k n u c k l e s f o r c h i c k e n . Informants t o l d me t h a t even i f they never used Chinese h e r b s , they would take t h i s soup t h a t t h e i r mother made f o r them. Chinese mothers u s i n g V a n c o u v e r ' s h o s p i t a l s t o d e l i v e r t h e i r b a b i e s are most upset with the h o s p i t a l food p r o v i d e d them which i n c l u d e s such "cold" foods l i k e s a l a d s , v e g e t a b l e s such as s p i n a c h and c a r r o t s , and j e l l o . 97 T h e i r mothers w i l l o f t e n b r i n g them t h i s "hot soup" i n a thermos f o r them t o e a t i n the h o s p i t a l . Another h e a l t h concern was t h a t a person should not be too t h i n . C o n s e q u e n t l y , t h e r e were s e v e r a l herbs used t o " f a t t e n up" a person c o n s i d e r e d too t h i n . Again, good h e a l t h was being equated w i t h a j u d i c i o u s amount of f a t on a p e r s o n . As one informant put i t s "Fat i s good, i t g i v e s one s t r e n g t h . " A s i c k person i s someone who i s v e r y t h i n and p a l e and does not have enough blood i n h i s / h e r body. An example of an h e r b a l m e d i c i n e used t o t r e a t t h i n anemic people i s L u - j u n g or deer a n t l e r . . The a n t l e r i s s l i c e d up i n t o t h i n c r o s s - s e c t i o n s by the h e r b a l i s t and cooked i n t o a soup a t home w i t h c h i c k e n . I t i s used by women who are too c o l d and by women dur ing pregnancy t o ensure they are n o u r i s h e d . I t i s a hot medic ine and most o f t e n used i n w i n t e r . I t i s f e l t t h a t i f one sweats a f t e r t a k i n g i t , then the m e d i c i n a l b e n e f i t s are l o s t . A d d i t i o n a l m e d i c a l concepts employed by f a m i l i e s were the terms f o r a i r , wind, c o l d and damp. These terms were used i n a s i m i l a r way t o t h e i r c l a s s i c a l m e d i c a l usage. Y i n and yang were not used but t h e i r a n a l o g s , hot and c o l d , were*used e x t e n -s i v e l y . Hot and c o l d were used not o n l y t o d i s t i n g u i s h the symbol ic q u a l i t i e s of food and h e r b s , but were a l s o used to i d e n t i f y body types and d i s e a s e c o n d i t i o n s . T h i s corresponds to T o p l e y ' s ( 1970) f i n d i n g i n Hong Kong t h a t w h i l e none of her informants used y i n and yang, they used hot and c o l d i n a. f u n c t i o n a l l y s i m i l a r manner. T h i s r e a f f i r m s my t h e s i s t h a t 98 t h e r e i s a c o n f o r m i t y i n the core h e a l t h b e l i e f s between the C h i n e s e i n A s i a and Canada. D i s e a s e s thought t o be "hot" i n n a t u r e i n c l u d e headache, sore t h r o a t , sore e y e s , dry mouth and t h r o a t , f e v e r , n o s e -b l e e d , s k i n problems and any i n f e c t i o n or inf lammation (Yeung e t a l . 1 9 7 3 ; G o u l d - M a r t i n and Ngin 1 9 8 1 ) . D i s e a s e s which are "cold" i n c l u d e anemia, c h i l l s , c o l d s , d e b i l i t y and weakness, poor a p p e t i t e , d i z z i n e s s , nausea and s h o r t n e s s of b r e a t h (Yeung e t a l . 1 9 7 3 ; G o u l d - M a r t i n and Ngin 1 9 8 1 ) . Many of my i n f o r -mants were knowledgeable of t h i s c l a s s i f i c a t i o n , s i n c e knowing the type of a i l m e n t enabled the person t o t r e a t i t w i t h the corresponding b a l a n c i n g h e r b a l remedy. An example of a hot h e r b a l p r e s c r i p t i o n g i v e n t o me by a f a m i l y i s a combination of t h r e e herbs simmered w i t h water to make a t e a . The herbs a r e : Shan-yao ( D i o s c o r e a ) which i s a white C h i n e s e yam; K o u - c h i - t z u ( L y c i i u m ) which are the s m a l l red seeds from an evergreen t r e e ; and Hong-zo which i s a d r i e d C h i n e s e red p±4jm. Together they are c o n s i d e r e d to c r e a t e a hot f o r c e i n the body, thereby i n c r e a s i n g b o d i l y c h ' i and improving the blood c i r c u l a t i o n . T h i s h e r b a l formula i s used when people are i n a v e r y weakened ( c o l d ) s t a t e such as a f t e r s u r g e r y and c h i l d b i r t h . A s i m i l a r e f f e c t can be created- u s i n g Huang-chi ( A s t r a g a l u s ) and Tang-shen (Codonopsis) . These two are always used t o g e t h e r and r e p r e s e n t two of the most f r e q u e n t l y used herbs i n Chinese h e r b a l m e d i c i n e . They f a l l i n t o the c l a s s of energy t o n i c s 99 d i s c u s s e d e a r l i e r . These two h e r b s are cooked i n t o a soup u s i n g c h i c k e n or p i g ' s f e e t t o make a b r o t h . The e f f e c t i s t o i n c r e a s e c h ' i , improve the c i r c u l a t i o n and make the complexion h e a l t h i e r . I t i s g i v e n t o men or women who a r e c o n s i d e r e d weak. I t i s thought t h a t u s i n g t h e s e two herbs a f t e r an o p e r a t i o n w i l l h e l p make the i n c i s i o n s h e a l f a s t e r . Other formulas known t o the f a m i l i e s i n my sample were used f o r t h e i r c o l d n a t u r e . These were used t o combat an e x c e s s i v e h o t f o r c e i n the body or t o r e p l e n i s h a d e f i c i e n t y i n s t a t e . One example of a c o l d n e u t r a l i z i n g soup i s the combina-t i o n c o n s i s t i n g o f : H s i n g - j e n (Prunus) or C h i n e s e almond which i s a c t u a l l y the a p r i c o t seed; P e i - s h a - s h e n g ( G l e h n i a ) ; Y u - c h u (Polygonaum); and L i e n - t z u (Nelumbo) which are l o t u s s e e d s . T h i s m i x t u r e i s cooked w i t h l e a n pork or bones. Another v e r y c o l d soup i s Sun-yu which i s e e l cooked w i t h w a t e r c r e s s . U n t i l now, I have been d e s c r i b i n g h e r b a l remedies t h a t are m a i n l y cooked i n t o soups u s i n g v a r i o u s meats to make a b r o t h . I n g e n e r a l , herbs t h a t come from the r o o t s , seeds, stems or bark of p l a n t s must be simmered t o e x t r a c t t h e i r m e d i c i n a l q u a l i t i e s . Other herbs t h a t come from the l e a v e s , or f lowers of p l a n t s are not b o i l e d but made i n t o a t e a by i n f u s i n g the h e r b s w i t h b o i l i n g water and l e t t i n g the mixture seep. A t e a c a l l e d T z u - w o - c h a r i s used f o r colds, and upset stomach. I t comes wrapped i n a reed and i s a b l a c k , e a r t h y mass of some u n i d e n t i f i a b l e h e r b s . The tea was extremely b i t t e r t o my t a s t e . The f a m i l y a s s u r e d me t h a t t h i s ensured t h a t t h i s was a 100 v e r y e f f e c t i v e h e r b a l t e a . A s i m i l a r type of tea t h a t comes p r e - p a c k a g e d i n Chinese g r o c e r y s t o r e s i s c a l l e d Kam-wo-char. I t i s a mixture of over t h i r t y d i f f e r e n t h e r b s . I t i s not q u i t e so b i t t e r as the other t e a and i s used f o r the same c o n d i t i o n s . A package of Kam-wo-char comes i n a package of t e n i n d i v i d u a l l y wrapped p a c k e t s and c o s t s $ 1 . 4 0 i n Chinatown. F a m i l i e s are a l s o knowledgeable of v a r i o u s h e r b a l p r e -s c r i p t i o n s which can be used t o t r e a t s p e c i f i c m e d i c a l c o n d i -t i o n s . To t r e a t h y p e r t e n s i o n , a soup i s made from c e l e r y , yam, onion, tomato, water c h e s t n u t and g a r l i c . These v e g e t a b l e s are cooked w i t h f i v e bowls of water u n t i l one bowl of l i q u i d remains . The soup i s drunk j u s t p r i o r t o bed and can be repeated as o f t e n as n e c e s s a r y . A home remedy for burns i s t o mix the w h i t e s of two eggs w i t h soy sauce and honey. Each of these i n g r e d i e n t s i s thought t o be e f f e c t i v e i n t r e a t i n g b u r n s . Hemorrhoids are t r e a t e d w i t h the head of the y e l l o w f i s h cooked with l e a n p o r k . For swol len neck g l a n d s or mumps, seaweed i s cooked with d r i e d o y s t e r s . Headaches are t r e a t e d w i t h a t e a made from Chuan-chiung ( L i g u s t i c u m ) . * I t s e f f e c t s are e x p l a i n e d by r e f e r e n c e t o i t s a b i l i t y t o e x p e l excess a i r ( c h ' i ) i n the head. Excess c h ' i can be harmful i f i t c o l l e c t s i n the head and does not c i r c u l a t e throughout the body. A red powder c a l l e d T i - t a - f a i s used to stop b l e e d i n g . For b r u i s e s where * P h a r m a c o l o g i c a l t e s t s i n d i c a t e t h a t t h i s herb has c e n t r a l nervous system a c t i v i t y and reduces blood p r e s s u r e ( L i , 1 9 7 4 ) . 101 t h e r e i s i n t e r n a l b l e e d i n g , a p l a s t e r i s made u s i n g a l c o h o l and egg w h i t e s . T h i s powder c o n t a i n s the herb T i e n - c h i (Panax p s u e d o g i n s i n g ) which i s w e l l known f o r i t s h e m o s t a t i c e f f e c t s . F a m i l i e s a l s o c a r r y a s u p p l y of p a t e n t m e d i c i n e s . Red f lower and white f lower o i l a r e kept f o r a c h e s , s p r a i n s and t i r e d m u s c l e s . Po c h a i p i l l s are kept f o r stomach upset from e a t i n g too much. Although a l o t of h e r b a l remedies a r e a v a i l -a b l e i n p i l l form, the Chinese s t i l l p r e f e r t o take t h e i r herbs i n the t r a d i t i o n a l manner. The raw herbs a r e thought t o be s t r o n g e r . Chinese p a t e n t m e d i c i n e s a r e thought t o be b e s t f o r Westerners who do not l i k e t o use the o f t e n b i t t e r Chinese h e r b s i n t h e i r raw s t a t e . Although men can be q u i t e knowledgeable about h e r b s , i t i s the women who p l a y a key r o l e i n m a i n t a i n i n g the t r a d i t i o n a l h e r b a l knowledge of the C h i n e s e f a m i l y . One of the reasons f o r t h i s i s the c l o s e r e l a t i o n s h i p between food and h e r b s . Another i s the f a c t t h a t the f a m i l y ' s h e a l t h i s c o n s i d e r e d t o be the r e s p o n s i b i l i t y of the w i f e . A t h i r d f a c t o r i s t h a t women are thought to need h e r b a l medic ines more than men. T h i s i s because women are thought to be p h y s i c a l l y weaker than men because they menstruate and undergo c h i l d b i r t h . The C h i n e s e -Canadian most l i k e l y to use Chinese herbs on a r e g u l a r b a s i s has s e v e r a l of these c h a r a c t e r i s t i c s " : female, o l d e r , a r e c e n t immigrant from Hong Kong, speaks no E n g l i s h and has l i t t l e formal e d u c a t i o n . T h i s i s not t o i n d i c a t e t h a t a young, h i g h l y educated E n g l i s h - s p e a k i n g Chinese male i n Vancouver does not 102 use Chinese "herbs, but he i s l e s s l i k e l y t o do so compared t o h i s mother, grandmother, or even h i s s i s t e r . Although i t was d i f f i c u l t for me to o b t a i n data on the s t a t i s t i c s f o r the use of Chinese and Western medic ine by the Chinese i n Vancouver, I was a b l e to o b t a i n q u a l i t a t i v e d a t a on the p a t t e r n s of m e d i c a l u s e . There i s a s m a l l segment of the Chinese p o p u l a t i o n who use Chinese t r a d i t i o n a l medic ine e x c l u -s i v e l y . These are o l d e r Chinese who speak no E n g l i s h and show l i t t l e , i f any, degree o f a c c u l t u r a t i o n . Some do not belong t o the government m e d i c a l p l a n and depend s o l e y on Chinese h e r b a l -i s t s and a c u p u n c t u r i s t s f o r t h e i r h e a l t h c a r e . Most of t h e s e t r a d i t i o n a l i s t s r e t a i n a strong b e l i e f i n the s u p e r i o r i t y of Chinese medic ine and have a d i s d a i n f o r Western m e d i c i n e . T h i s segment of the p o p u l a t i o n , however, i s i n the m i n o r i t y . The other extreme r e p r e s e n t s the C h i n e s e - C a n a d i a n who has c o m p l e t e l y r e p u d i a t e d the o l d t r a d i t i o n a l Chinese ways. These Chinese are the more h i g h l y educated and are second or t h i r d g e n e r a t i o n C a n a d i a n s . T h i s a t t i t u d e i s r e v e a l e d by the a t t i -tude of a h i g h l y s u c c e s s f u l p r o f e s s i o n a l born and educated i n Canada. "We d o n ' t even t h i n k about going to anyone e l s e other than a Western d o c t o r . I wouldn't even t h i n k of going t o see a Chinese doctor u n l e s s I w a s n ' t cured by the Western d o c t o r . I t i s so easy with the m e d i c a l p l a n . With the government p l a n , you d o n ' t even have to pay the d o c t o r , but with the Chinese t r a d i t i o n a l d o c t o r , you do." Even though t h i s informant does not b e l i e v e i n Chinese 103 m e d i c i n e , he l e a v e s the p o s s i b i l i t y t h a t i f a l l e l s e f a i l e d , he might see a Chinese d o c t o r . The group r e j e c t i n g Chinese medic ine i s q u i t e l a r g e , a l t h o u g h i t p r o b a b l y d o e s n ' t r e p r e s e n t the m a j o r i t y of the Chinese p o p u l a t i o n i n Vancouver. While t h e r e can be a complete acceptance or r e j e c t i o n of Chinese h e r b a l m e d i c i n e , most C h i n e s e - C a n a d i a n s are l o c a t e d along the continuum between these two extremes. That i s , both Western medic ine and Chinese h e r b a l medic ine can be used a t d i f f e r e n t t imes f o r s p e c i f i c a i l m e n t s or contemporaneously f o r the same a i l m e n t . • T h i s i s r e v e a l e d i n the h i e r a r c h y of r e s o r t f o r m e d i c a l treatment by C h i n e s e - C a n a d i a n s i n Vancouver. When someone e x p e r i e n c e s the symptoms of a b o d i l y d i s t u r -bance such as a sore t h r o a t or p a i n , the f i r s t t h i n g t h a t i s done i s the person chooses a home remedy or s e l f - t r e a t m e n t . T h i s i s u n i v e r s a l l y t r u e , for Chinese and n o n - C h i n e s e . For the C h i n e s e - C a n a d i a n , depending on t h e i r o r i e n t a t i o n and e x p e r i -ence, they may s e l e c t a Western remedy or a Chinese one. I f t h i s works, then the eposide i s complete. I f i t does not work, then a d d i t i o n a l a d v i c e i s sought from f a m i l y and f r i e n d s b e f o r e f u r t h e r p r o f e s s i o n a l h e l p i s e n l i s t e d . I f the c o n d i t i o n c o n t i n u e s u n r e l i e v e d , then p r o f e s s i o n a l c o n s u l t a t i o n w i t h a doctor i s sought. T h i s i s most l i k e l y t o be a Chinese MD t r a i n e d i n Western m e d i c i n e . Some w i l l d i s c o n -t i n u e t h e i r use of Chinese medic ines a t t h i s p o i n t , s i n c e there i s the b e l i e f t h a t Western and Chinese drugs should not be mixed. Most f i n i s h one treatment, whether Western or Chinese 104 b e f o r e another type i s i n i t i a t e d . Others , however, are more concerned w i t h e l i m i n a t i n g the problem i n any f a s h i o n and c o n t i n u e t o use both treatment methods. For a v e r y s e r i o u s d i s e a s e such as stomach c a n c e r , i t would be a c c e p t a b l e t o use both Chinese and Western drugs s i m u l t a n e o u s l y . At t h i s p o i n t , i f the person has not r e c e i v e d s a t i s f a c t o r y r e l i e f from t h e i r c o n d i t i o n w i t h the MD, h e / s h e may seek f u r t h e r h e l p from a t r a d i t i o n a l Chinese doctor or Chinese h e r b a l i s t i n Chinatown. For c h r o n i c c o n d i t i o n s which Western medic ine has f a i l e d t o a l l e v i a t e , the C h i n e s e - C a n a d i a n w i t h a s c i e n t i f i c w o r l d - v i e w who h a s r e f u s e d t o even t h i n k of u s i n g a t r a d i t i o n a l Chinese remedy, may c o n s i d e r u s i n g one. As s t a t e d e a r l i e r , a Western-t r a i n e d p h a r m a c i s t , born and educated i n Canada, t o l d me t h a t he had a lower back p a i n f o r y e a r s which Western p h a r m a c e u t i c a l s had f a i l e d t o c u r e . He e v e n t u a l l y t r i e d a Chinese medic ine f o r k i d n e y a i l m e n t s which worked a f t e r o n l y one d o s e - s e q u e n c e . The h i e r a r c h y of r e s o r t f o r m e d i c a l treatment by C h i n e s e -Canadians r e v e a l s a pragmatic a t t i t u d e towards the d u a l use of two r a d i c a l l y d i f f e r e n t m e d i c a l systems. The treatment o p t i o n s are always managed by the i n d i v i d u a l i n a f a m i l y context so as to maximize the t h e r a p e u t i c b e n e f i t s from both t h e r a p e u t i c systems. Both systems are seen as complementary t o each other r a t h e r than e i t h e r / o r a l t e r n a t i v e s . s h a l l r e t u r n to t h i s important p o i n t l a t e r i n the t h e s i s . The o v e r a l l a t t i t u d e towards Chinese and Western medic ine seems to be governed by pragmatism. Western medicine i s seen 105 as powerful medic ine which works v e r y q u i c k l y and d i r e c t l y . I t i s the treatment of c h o i c e f o r sudden, acute and l i f e - t h r e a t e n -i n g a i l m e n t s l i k e a h e a r t a t t a c k or a p p e n d i c i t i s . Western m e d i c i n e i s a l s o the p r e f e r r e d o p t i o n t o t r e a t c h i l d r e n who a r e more l i k e l y t o get a c u t e i l l n e s s e s . However, i t i s not w i t h o u t i t s d i s a d v a n t a g e s . Western medic ine i s seen as h a v i n g u n d e s i r a b l e s i d e - e f f e c t s . Western drugs produce a c h a i n r e a c t i o n i n which the i n d i v i d u a l has t o take a d d i t i o n a l drugs t o t r e a t the s i d e e f f e c t s which i n t u r n produce more s i d e e f f e c t s . Western drugs a r e good a t a l l e v i a t i n g symptoms but t h e y do not t r e a t the cause of d i s e a s e . C h i n e s e medic ine i s seen as being l e s s t o x i c and g e n t l e r on the system. Chinese herbs are thought t o produce fewer s i d e e f f e c t s . S i n c e herbs are g e n t l e r on the system they have t o be t a k e n over t ime t o produce r e s u l t s . T h e r e f o r e , Chinese herbs a r e p r e f e r r e d f o r l o n g - s t a n d i n g c h r o n i c a i l m e n t s which r e q u i r e time to c u r e . Problems of aging are a l s o c o n s i d e r e d t o be p a r t i c u l a r l y amenable to Chinese h e r b a l t r e a t m e n t . Chinese herbs are thought t o not o n l y a l l e v i a t e symptoms g r a d u a l l y , but t o cure the cause of the d i s e a s e . They cure more i n d i r e c t l y than drugs because they work on i n c r e a s i n g the p e r s o n ' s s t r e n g t h and v i t a l i t y . Chinese herbs flow w i t h the needs of the body and proceed along t h e same path t h a t the body t a k e s to h e a l i t s e l f . Thus they are thought t o work w i t h the f o r c e s of nature r a t h e r than a g a i n s t them. Chinese medicine i s thought t o be a b l e to t r e a t c o n d i t i o n s which are u n t r e a t a b l e by 106 Western methods. These i n c l u d e c o n d i t i o n s such a s : stomach u l c e r s , asthma, rheumatic p a i n , v a r i o u s types of p a r a l y s i s , k i d n e y and l i v e r problems, h y p e r t e n s i o n and numerous "women's" problems and problems a s s o c i a t e d w i t h a g i n g . I n c o n c l u s i o n , i t i s the f a m i l y or p o p u l a r s e c t o r t h a t i s r e s p o n s i b l e f o r the c o n t i n u a n c e of the t r a d i t i o n a l system of h e r b a l medic ine i n Vancouver. Although t h e r e i s a g r e a t v a r i a b i l i t y i n the acceptance of Chinese m e d i c i n e , t h e r e i s widespread p o p u l a r support f o r the use of Chinese h e r b s . The women i n the C h i n e s e f a m i l y p l a y an important r o l e as p r i m a r y h e a l t h p r o v i d e r s and d e c i s i o n makers. The c l o s e r e l a t i o n s h i p between food and herbs i n the Chinese mind f a c i l i t a t e the p o p u l a r use of Chinese herbs i n the home environment. Although the Chinese f a m i l y l a c k s the h i g h p r o f i l e t h a t the h e r b a l i s t s and h e r b a l pharmacies h a v e , f a m i l y - b a s e d Chinese h e r b a l medic ine i s the most s i g n i f i c a n t domain of t r a d i t i o n a l C h i n e s e m e d i c a l p r a c t i c e i n Vancouver t o d a y . I t i s the r o l e of the C h i n e s e f a m i l y f o r s e l f - c a r e t h a t has been r e s p o n s i b l e f o r the c o n t i n u a n c e of t r a d i t i o n a l Chinese medic ine i n Vancouver. 107 I V . THE PLACE OF CHINESE HERBALISM IN CONTEMPORARY SOCIETY I n t h i s f i n a l c h a p t e r , I would l i k e to answer the q u e s t i o n of why t r a d i t i o n a l Chinese h e r b a l i s m has c o n t i n u e d t o p e r s i s t w i t h such s t r e n g t h i n a Western urban s e t t i n g . The d a t a s u g g e s t s t h a t i n s t e a d of r e c e d i n g and becoming a c u l t u r a l anachronism, Chinese h e r b a l i s m i s growing i n Vancouver. I would a l s e l i k e to look a t the c o n t i n u i t i e s and changes t h a t C h i n e s e medic ine has undergone i n i t s t r a n s p l a n t a t i o n t o Vancouver. Before I attempt to answer t h e s e q u e s t i o n s , I would f i r s t l i k e t o see what has happened t o Chinese medic ine as a whole i n i t s t r a n s p l a n t a t i o n t o Canada. The f i r s t c l e a r departure from i t s A s i a n r o o t s i s the absence of the s a c r e d or m a g i c o - r e l i g i o u s t r a d i t i o n of Chinese h e a l i n g i n Vancouver. Only the more r a t i o n a l p r a c t i c e s such as acupuncture and h e r b a l i s m from the s e c u l a r t r a d i t i o n of Chinese medic ine have s u r v i v e d i n V a n -c o u v e r . Thus when we speak of the c o n t i n u i t y of the Chinese m e d i c a l t r a d i t i o n , we are r e f e r r i n g t o the s e c u l a r domain of acupuncture and h e r b a l i s m . I t i s i n t e r e s t i n g t o observe how acupuncture has been accepted by the Western m e d i c a l e s t a b l i s h -ment and i n c o r p o r a t e d i n t o i t s sphere of a c t i v i t y and c o n t r o l . T h i s has made i t i l l e g a l f o r a c u p u n c t u r i s t s t r a i n e d i n A s i a t o p r a c t i c e , a l though many p r a c t i c e underground under c o n s t a n t f e a r of p e r s e c u t i o n and p r o s e c u t i o n . T h i s acceptance of acupuncture by the Western m e d i c a l e s t a b l i s h m e n t has h e l p e d t o 108 i n c r e a s e the c r e d i b i l i t y of t h i s c l a s s i c a l - p r o f e s s i o n a l Chinese m e d i c i n e . However, t h i s has not a s s i s t e d i n the o f f i c i a l acceptance of Chinese h e r b a l i s m . Herbs, whether they are Chinese or Western, are viewed by the m e d i c a l e s t a b l i s h m e n t as crude drugs and, t h e r e f o r e , a p r i m i t i v e and i n f e r i o r form of m e d i c i n e . Thus w h i l e h e r b a l i s m i s not s a n c t i o n e d l i k e a c u p u n c t u r e , the Chinese h e r b a l i s t s are not l e g a l l y t h r e a t e n e d the way Chinese a c u p u n c t u r i s t s a r e . H e r b a l d o c t o r s have to be c a r e f u l about p r a c t i c i n g too openly for f e a r of b e i n g p r o s e c u t e d for p r a c t i c i n g medicine without a l i c e n s e . Thus, Chinese h e r b a l i s m i s i n much the same p o s i t i o n as i t i s i n Hong Kong. I n Hong Kong (Lee, 1980) the o f f i c i a l government p o l i c y i s not t o i n t e r f e r e w i t h l o c a l customs and p r a c t i c e s . T h i s i s the s i t u a t i o n i n Vancouver, where t h e r e i s n e i t h e r o f f i c i a l s a n c t i o n nor r e g u l a t i o n by the l o c a l h e a l t h a u t h o r i t i e s u n l e s s t h e r e i s some danger to the p u b l i c . . One consequence of t h i s p o l i c y , both i n Vancouver and Hong Kong, i s the l a c k of standards for h e r b a l pharmacies, h e r b a l i s t s or h e r b a l d o c t o r s . Thus, anyone can open up an h e r b a l pharmacy or pretend to be an h e r b a l d o c t o r . T h i s l a c k of q u a l i t y c o n t r o l for h e r b a l i s m i s somewhat o f f s e t by an i n f o r m a l system of popular c o n t r o l . The s u c c e s s of an h e r b a l pharmacy or h e r b a l p r a c t i t i o n e r i s v e r y much dependent on a good r e p u t a t i o n being e s t a b l i s h e d through word of mouth e v a l u a t i o n s . I f an h e r b a l doctor or h e r b a l i s t i s found t o be incompetent, then he w i l l f i n d h i m s e l f l o s i n g a l l 109 h i s customers. On the other hand, a s u c c e s s f u l h e r b a l doctor or an h o n e s t h e r b a l i s t w i l l be rewarded by a busy p r a c t i c e . T h i s i s r e f l e c t e d i n Chinatown, where some herb shops never seem t o have any customers whereas o t h e r s are always b u s y . A p o s i t i v e r e p u t a t i o n based on honesty and e x p e r t i s e i s an important element of s u c c e s s not o n l y f o r the h e r b a l t r a d e but a l l b u s i n e s s e s and p r o f e s s i o n a l s i n Chinatown. Thus, r e p u t a -t i o n s e r v e s as an important form of s o c i a l c o n t r o l i n C h i n e s e s o c i e t y . T h i s i s a case i n p o i n t for the endurance of key f e a t u r e s of Chinese s o c i e t y . The s t r e n g t h of the Chinese has always been t o adapt t o changing c i r c u m s t a n c e s w h i l e m a i n t a i n -i n g c o n s t a n t the core v a l u e s and b e l i e f s of Chinese c u l t u r e , w i l l now t u r n t o look a t the s p e c i f i c c a s e of c o n t i n u i t i e s and changes i n the 5 ,000 y e a r o l d world of Chinese h e r b a l i s m . I n some r e s p e c t s i t can be s a i d t h a t the p r a c t i c e of Chinese h e r b a l i s m has been t r a n s p l a n t e d from South China and Hong Kong r e l a t i v e l y i n t a c t . One can c e r t a i n l y d e t e c t c o n -t i n u i t i e s w i t h the p r a c t i c e of h e r b a l i s m i n China t h a t extend back hundreds i f not thousands of y e a r s . The l a y o u t of the pharmacies are v i r t u a l l y i d e n t i c a l t o those e s t a b l i s h e d i n China hundreds of y e a r s ago. Herbs being used today are the same ones used i n China over f i v e thousand y e a r s ago. The c l a s s i f i c a t i o n system for the herbs „and the t h e o r e t i c a l system e x p l a i n i n g t h e i r a c t i o n s and uses i s a l s o i d e n t i c a l . A l l the herbs found i n the pharmacies are imported from Mainland China H e r b a l i s t s c o n t i n u e t o l e a r n t h e i r c r a f t through a p r o c e s s of 110 a p p r e n t i c e s h i p . The a p p r e n t i c e s h i p p r o c e s s i s a t r a d i t i o n a l and h i g h l y r e s p e c t e d method of l e a r n i n g c e r t a i n m e d i c a l p r a c t i c e s i n C h i n a (Lee 1980; H o l l b r o o k 1 9 7 4 ) . The f a m i l y -based knowledge of h e r b a l i s m i s a l o n g - s t a n d i n g o r a l t r a d i t i o n t h a t can be t r a c e d d i r e c t l y back to South C h i n a where almost a l l the C h i n e s e i n Vancouver have t h e i r o r i g i n s . Thus, t h e r e i s a strong body of ev idence t o suggest t h a t the h e r b a l i s m being p r a c t i c e d i n V a n c o u v e r ' s Chinatown r e p r e -s e n t s the c o n t i n u a n c e of a m e d i c a l t r a d i t i o n t h a t extends back i n C h i n a hundreds i f not thousand of y e a r s . However, i t i s important t o r e a l i z e t h a t Chinese medic ine i s not a s t a t i c system and t h a t i t i s always responding t o both e x t e r n a l and i n t e r n a l f o r c e s of change. Chinese medic ine i n Vancouver i s not the same as Chinese medic ine i n Hong Kong, Taiwan or the PRC. Although the p r a c t i c e of Chinese h e r b a l i s m i n Vancouver i s most s i m i l a r t o the s i t u a t i o n i n Hong Kong, i t i s not i d e n t i c a l t o i t . One of the most important changes i n the p r a c t i c e of Chinese h e r b a l i s m i n Vancouver i s the d e c r e a s i n g i n f l u e n c e of the c l a s s i c a l - p r o f e s s i o n a l s e c t o r i n the l o c a l Chinese h e a l t h c a r e system. D e s p i t e the presence of a few h e r b a l d o c t o r s i n Vancouver, they do not p l a y the c e n t r a l r o l e they perform i n Hong Kong. I n Hong Kong (Lee 1980), - t h e r e are twice as many C h i n e s e - s t y l e p r a c t i t i o n e r s as W e s t e r n - s t y l e d o c t o r s . I n Hong Kong, the Chinese h e r b a l doctors serve as a source of s p e c i a l -i z e d h e a l t h care and are c o n s u l t e d w i t h f a r g r e a t e r frequency Ill than t h e i r Vancouver c o u n t e r p a r t s . Here, the h e r b a l i s t s are o f t e n c o n s u l t e d i f a problem i s beyond the e x p e r t i s e of the f a m i l y . The h e r b a l i s t s , s i n c e they l a c k the c l a s s i c a l Chinese m e d i c a l t r a i n i n g , are becoming more symptom-oriented. Thus, the p r o c e s s of d i a g n o s i s i s becoming Westernized w h i l e the treatment remains t r a d i t i o n a l l y C h i n e s e . The h e r b a l i s t s i n Vancouver are p l a y i n g a g r e a t e r r o l e as s p e c i a l i s t s i n Chinese medic ine than t h e i r c o u n t e r p a r t s i n Hong Kong. Thus, the f o l k s e c t o r i s becoming the source of s p e c i a l -i z e d h e r b a l and m e d i c a l knowledge. The r e s u l t i s t h a t the c l a s s i c a l - p r o f e s s i o n a l t r a d i t i o n of Chinese medicine i s l o s i n g i t s importance i n the Chinese l o c a l h e a l t h care system. The l o n g - t e r m i m p l i c a t i o n s of t h i s s h i f t of s p e c i a l i s t knowledge from the p r o f e s s i o n a l t o the f o l k s e c t o r are d i f f i c u l t t o a s s e s s . At the moment, Chinese h e r b a l i s m appears to be g a i n i n g i n p o p u l a r i t y i n Chinatown. The s t r e n g t h of Chinese h e r b a l i s m s t i l l r e s i d e s w i t h i n the popular s e c t o r . The f a m i l y use of herbs c o n t i n u e s to be an important p a r t of Chinese l i f e . The f o l k s e c t o r i n the absense of a w e l l e s t a b l i s h e d p r o f e s s i o n a l c l a s s of h e r b a l i s t s i s responding to t h i s need. These t r e n d s r e a f f i r m t h a t Chinese h e r b a l i s m i s above a l l an e m p i r i c a l system t h a t f u n c t i o n s e q u a l l y w e l l with or without an u n d e r -l y i n g t h e o r e t i c a l framework. I w i l l -now t u r n d i r e c t l y t o the q u e s t i o n of why Chinese h e r b a l i s m c o n t i n u e s to be supported by a l a r g e segment of the Chinese (and non-Chinese) p o p u l a t i o n of Vancouver. 112 I s h a l l d i s c u s s the reason f o r the p e r s i s t a n c e of Chinese h e r b a l i s m i n terms of t h r e e r e a s o n s : the c u l t u r a l e x p l a n a t i o n the q u e s t i o n of the e f f i c a c y of Chinese h e r b s , and Chinese m e d i c i n e as an a l t e r n a t e m e d i c a l paradigm. To view the use of Chinese h e r b a l i s m as p a r t of a l o n g -s t a n d i n g c u l t u r a l t r a d i t i o n i s c e r t a i n l y the most l o g i c a l reason t o e x p l a i n i t s p e r s i s t e n c e . The c u l t u r a l e x p l a n a t i o n argues t h a t those t r a d i t i o n s which most c l o s e l y e p i t o m i z e the core v a l u e s of a c u l t u r e w i l l p e r s i s t i n the midst of a c c u l -t u r a t i o n and m o d e r n i z a t i o n . A n t h r o p o l o g i s t s have demonstrated t h a t h e a l t h b e l i e f s and p r a c t i c e s a r e one of the c u l t u r a l t r a i t s t h a t tend t o p e r s i s t the l o n g e s t i n the m i d s t of a c c u l t u r a t i o n and m o d e r n i z a t i o n . T h i s i s c e r t a i n l y t r u e f o r the C h i n e s e . The Chinese have m a i n t a i n e d a h i g h degree of i n s u l a r i t y and e t h n i c i d e n t i t y i n Canada (Wickberg 1 9 8 2 ) . T h i s has f o s t e r e d the p e r p e t u a t i o n of many t r a d i t i o n a l p r a c t i c e s i n c l u d i n g Chinese m e d i c i n e . D e s p i t e the u t i l i z a t i o n of Western m e d i c i n e , many Chinese f a m i l i e s s t i l l r e t a i n t h e i r f a m i l y - b a s e d system of home remedies. The strong c o n n e c t i o n of Chinese medic ine t o the f a m i l y i s a major reason f o r the v i t a l i t y of Chinese h e r b a l i s m The C h i n e s e f a m i l y i s one of the most enduring s o c i a l i n s t i t u -t i o n s and w i t h i t endures f a m i l y p r a c t i c e s such as the t h e r a -p e u t i c use of food and h e r b s . The c l o s e r e l a t i o n s h i p between food and herbs i s another important connect ion demonstrating the c u l t u r a l support f o r a 113 home-based, s e l f - h e a l i n g s y s t e m . D i e t a r y p r e f e r e n c e s a r e a s p e c t s of c u l t u r e t h a t a r e h i g h l y r e s i s t a n t t o a c c u l t u r a t i o n . The S o u t h e r n C h i n e s e a r e e s p e c i a l l y renowned throughout t h e C h i n e s e w o r l d f o r t h e i r h i g h l y d e v e l o p e d c u l i n a r y a r t s (Chang 1 9 7 7 ) . T h i s s p e c i a l a t t e n t i o n p l a c e d on food and cooking by t h e S o u t h e r n C h i n e s e p r o v i d e s them w i t h a s e n s i t i v i t y t o t h e e f f e c t s of d i f f e r e n t foods on t h e body. There i s a c l o s e s e m a n t i c l i n k i n the C h i n e s e w o r l d - v i e w t h a t l i n k s food c a t e -g o r i e s w i t h d i e t a r y h y g i e n e and on t o food and h e r b a l t h e r a p y . T h i s h a s p l a c e d t r a d i t i o n a l h e r b a l i s m i n t h e k i t c h e n which i s a t t h e v e r y h e a r t of C h i n e s e f a m i l y l i f e . S t u d i e s i n m e d i c a l a n t h r o p o l o g y have c l e a r l y demonstrated t h e key r o l e t h a t c u l t u r e p l a y s i n shaping a g r o u p ' s h e a l t h b e l i e f s and p r a c t i c e s . M e d i c a l a n t h r o p o l o g i s t s such as K l e i n m a n ( 1 9 7 3 ) , have a l s o r e v e a l e d t h a t embedded i n t o the v e r y m a t r i x of m e d i c i n e a r e the v a l u e s and w o r l d - v i e w o f a c u l t u r e . C h i n e s e m e d i c i n e i s concerned w i t h w h o l e n e s s , b a l a n c e , harmony and s e n s i t i v i t y t o change. These a r e q u a l i t i e s t h a t make up t h e C h i n e s e e t h o s . These a r e brought i n t o p l a y each t i m e the C h i n e s e person e x p e r i e n c e s some disharmony i n h i s / h e r body. To u n d e r s t a n d and communicate t h e changes i n the body d u r i n g i l l n e s s , t h e C h i n e s e w i l l draw on t h e m e d i c a l metaphors of h i s / h e r c u l t u r e . I n t h i s way, m e d i c i n e i s a " s y m b o l i c r e a l i t y " l i n k i n g the p h y s i o l o g i c a l e x p e r i e n c e s of the i n d i -v i d u a l w i t h a socio - c u l t u r a l world of meanings (Kleinman 1 9 7 3 ) . The e x p e r i e n c e of i l l n e s s i s moulded from t h e c u l t u r a l 114 s e t of meanings a v a i l a b l e t o the i n d i v i d u a l . T h e r e f o r e , i t i s important t o c o n s i d e r the t r a d i t i o n a l m e d i c a l id iom t h a t most Chinese people are f a m i l i a r w i t h . T h i s i s the language of h o t and c o l d , energy and blood t h a t the Chinese h e r b a l i s t s converse w i t h t h e i r c l i e n t s . T h i s i s the popular language of f o r c e s o p e r a t i n g o u t s i d e and i n s i d e the body. I t i s a r i c h meta-p h o r i c a l language t h a t i s h i g h l y e x p r e s s i v e and s y m b o l i c . So t h a t when the Chinese t a l k about t h e i r exper ience of i l l n e s s , they use f a m i l i a r metaphors t h a t are based i n an u n d e r l y i n g p e r s o n a l r e a l i t y . Lay people use t h i s m e t a p h o r i c a l language to express t h e i r m e d i c a l problems to o t h e r s . They can e s t a b l i s h a r a p p o r t i n t h i s language w i t h the h e r b a l i s t . I t i s more d i f f i c u l t f o r the Chinese to t a l k about winds and c o l d when they are speaking t o a m e d i c a l doctor who communicates i n an u n f a m i l i a r s c i e n t i f i c language. T h e r e f o r e , t h e r e i s a p r e f e r -ence, p a r t i c u l a r l y on the p a r t of o l d e r , l e s s educated Chinese t o use a h e a l i n g system t h a t r e s o n a t e s with the way they t h i n k and speak. T h e r e f o r e , language i s another reason for seeking t r a d i -t i o n a l m e d i c a l remedies. However, t h i s i s not the Chinese (Cantonese) language. T h i s reason i s d i s c o u n t e d by the f a c t t h a t Chinese MDs a l s o speak Chinese (Cantonese) . A c c e s s i b i l i t y of the h e r b a l i s t and h e r b a l pharmacy i n Chinatown i s another reason many new immigrants p r e f e r t h e i r t r a d i t i o n a l m e d i c i n e . A new immigrant or a Chinese not s p e a k -ing E n g l i s h has to d e a l w i t h an imposing b u r e a u c r a c y b e f o r e 115 they a r e a b l e t o see an MD on the m e d i c a l p l a n . I n s t e a d , t h i s person may f i n d i t both h a n d i e r and l e s s s t r e s s f u l t o e n l i s t the s e r v i c e s of a h e r b a l pharmacy where e v e r y t h i n g i s f a m i l i a r . E t h n i c i t y i s c e r t a i n l y a f a c t o r than cannot be ignored i n the case of the C h i n e s e . There i s a c e r t a i n e t h n i c p r i d e a s s o c i a t e d w i t h m a i n t a i n i n g o n e ' s unique c u l t u r a l t r a d i t i o n s . C e r t a i n l y t h i s i s t r u e f o r C h i n e s e h e r b a l i s m . The C h i n e s e a r e d e f i n i t e l y proud of the f a c t t h a t they have one of the o l d e s t s u r v i v i n g m e d i c a l systems i n the world. An extreme view, i n what amounts t o e t h n i c determinism, i s s t i l l h e l d by some of the o l d e s t members of the community. T h i s i s the view t h a t C h i n e s e medic ine i s the b e s t medic ine f o r the C h i n e s e p e o p l e . T h i s , n e e d l e s s t o s a y , i s not a widespread o p i n i o n . Most of my informants f e l t t h a t Chinese medic ine was e q u a l l y e f f e c t i v e f o r both C h i n e s e and n o n - C h i n e s e . A more widespread phenomenon t h a t has p l a y e d an important r o l e i n the renewal of i n t e r e s t i n C h i n e s e h e r b a l i s m was the re-emergence of the Chinese e t h n i c i d e n t i t y i n the 1 9 7 0 ' s (Wickberg 1 9 8 2 ) . The l a s t v e s t i g e s of d i s c r i m i n a t i o n a g a i n s t the C h i n e s e were not l i f t e d u n t i l 1 9 6 7 , when the immigrat ion a c t was r e v i s e d a l l o w i n g f a i r e r immigrat ion laws for the C h i n e s e . T h i s served to u n i t e many Chinese f a m i l i e s i n Canada and sparked a sense of e t h n i c p r i d e - i n the Chinese community. By the 1 9 7 0 ' s , a f t e r almost a c e n t u r y of d i s c r i m i n a t i o n , the Chinese were no longer ashamed of being C h i n e s e . I t was l e g i t i m a t e t o be C h i n e s e . T h i s l e d to a burgeoning i n t e r e s t i n 116 t h e i r c u l t u r a l h e r i t a g e . One of the r e c i p i e n t s of t h i s renewed f a i t h i n C h i n e s e c u l t u r e was Chinese h e r b a l i s m . P r i o r to 1 9 7 0 , t h e r e were o n l y a few herb shops and pharmacies i n Chinatown. I n the 1 9 7 0 ' s t h e r e was r a p i d growth i n the number of t h e s e e s t a b l i s h m e n t s where C h i n e s e herbs c o u l d be p u r c h a s e d . T h i s growth c o r r e l a t e s d i r e c t l y w i t h the l e g i t i -mation of the Chinese e t h n i c i d e n t i t y . While herbs have been used from the t ime the f i r s t C h i n e s e immigrants came to B r i t i s h Columbia i n the n i n e t e e n t h c e n t u r y , nothing l i k e the r a p i d growth of the 1 9 7 0 ' s had o c c u r r e d . Whereas i t may have been p r e v i o u s l y thought t h a t C h i n e s e medic ine was backwards, t h i s was no longer the c a s e . Chinese herbs were openly bought and s o l d . F u e l i n g t h i s r a p i d growth of Chinese h e r b a l i s m , was the i n c r e a s e of Chinese immigrat ion i n the 1 9 7 0 ' s . The newer immigrants had never l o s t touch w i t h the t r a d i t i o n of Chinese h e r b a l i s m and h e l p e d t o r e k i n d l e acceptance by the more e s t a b -l i s h e d C h i n e s e - C a n a d i a n s . The r e t u r n of t r a d i t i o n a l medic ine i s c a l l e d m e d i c a l r e v i v a l i s m ( L e s l i e 1 9 7 6 ) . C r o z i e r ( 1976) documents the r e c e n t r e v i v a l i s m of t r a d i t i o n a l medicine i n the PRC. T h i s l e d t o the i n t e g r a t i o n of t r a d i t i o n a l Chinese medic ine with Western m e d i c i n e . I n Vancouver, a s i m i l a r r e v i v a l i s m has l e d t o the p r e s e r v a t i o n of an e x i s t i n g t r a d i t i o p and not the s y n t h e s i s of a new type of m e d i c i n e . There i s evidence t o suggest t h a t Vancouver has w i t n e s s e d the r e v i v a l i s m of the t r a d i t i o n a l system of Chinese h e r b a l i s m . T h i s r e v i v a l i s m has been nurtured 117 by the l e g i t i m a t i o n of the Chinese e t h n i c i d e n t i t y and the new wave of Chinese i m m i g r a t i o n . T h i s m e d i c a l r e v i v a l i s m i s s t i l l i n p r o c e s s . I t i s too e a r l y t o t e l l i f t h i s i s a genuine r e v i v a l movement, or j u s t an a r t i f a c t due t o r e c e n t immigrat ion of more " t r a d i t i o n a l f a m i l i e s " from A s i a . Four new h e r b a l pharmacies have opened dur ing the f i r s t two y e a r s of the 1 9 8 0 ' s . Chinese h e r b a l i s m i s not merely m a i n t a i n i n g i t s presence i n the Chinese community but i s undergoing an unprecedented growth p e r i o d . There h a s a l s o been a g r e a t e r acceptance of Chinese medic ine v i a acupuncture i n the g r e a t e r community. People of a l l c u l t u r e s are becoming more i n t e r e s t e d i n Chinese medic ine and h e r b a l i s m for the reason t h a t i t works. We w i l l now t u r n t o the q u e s t i o n of the e f f i c a c y of C h i n e s e h e r b a l i s m . The q u e s t i o n of m e d i c a l e f f i c a c y i s d i f f i c u l t t o e v a l u a t e . I w i l l suggest t h a t no s i n g l e e x p l a n a t i o n i s adequate to encompass the d i v e r s i t y and complexity of the Chinese h e r b a l system. I propose t h a t the e f f i c a c y of Chinese h e r b a l i s m can be b e s t e v a l u a t e d a t both an e m p i r i c a l l e v e l of p h y s i o l o g y and a t a symbol ic l e v e l of c u l t u r a l meanings. Both l e v e l s have t h e i r own c r i t e r i a of e f f i c a c y and, t h e r e f o r e , the e v a l u a t i o n of e f f i c a c y must proceed along two s e p a r a t e d i r e c t i o n s . Medical a n t h r o p o l o g i s t s such as Kleinman (1980) have l a b e l e d t h i s important d i f f e r e n c e i n the f u n c t i o n s of medicine as the " c u r i n g of d i s e a s e " v e r s u s the " h e a l i n g of i l l n e s s . " The c u r i n g of d i s e a s e r e f e r s s p e c i f i c a l l y t o the c o n t r o l of 118 abnormal p h y s i o l o g i c a l events i n the body. Western medic ine has focused i t s a t t e n t i o n on t h i s component. The h e a l i n g of the i l l n e s s o c c u r s when p e r s o n a l and s o c i a l meaning i s p r o v i d e d t o the s i c k n e s s e p i s o d e . The p a t i e n t f e e l s b e t t e r through hope, f a i t h and s o c i a l s u p p o r t , which i n t u r n a s s i s t s the n a t u r a l h e a l i n g p r o c e s s of the body. Much of t r a d i t i o n a l m e d i c i n e i n the form of m a g i c a l and s a c r e d r i t u a l s has employed t h i s a s p e c t of h e a l i n g t o a c h i e v e a cure i n the p a t i e n t . C h i n e s e h e r b a l m e d i c i n e , I w i l l argue, i s p a r t i c u l a r l y e f f i c a c i o u s because i t a t t e n d s both to the c u r i n g and h e a l i n g of the p a t i e n t . One e x p l a n a t i o n f o r the r e l a t i v e e f f e c t i v e n e s s of Chinese h e r b a l i s m i s t h a t i t i s an e m p i r i c a l system. Herbs have been chosen and p r e s c r i p t i o n s formulated on the b a s i s of 5 ,000 y e a r s of c a r e f u l e m p i r i c a l r e s e a r c h . There i s evidence to suggest t h a t h a r m f u l remedies have been e l i m i n a t e d from t h i s system over a long p e r i o d of t ime. Chinese p h y s i c i a n s would determine the a c t i o n of an herb on themselves before they were t r i e d on t h e i r p a t i e n t s . T h i s t r a d i t i o n i s s a i d t o have been i n i t i a t e d by the legendary f a t h e r of Chinese h e r b a l i s m , Shen Nung, who i s s a i d t o "have t a s t e d the one hundred h e r b s . " Thus, herbs were chosen f o r m e d i c i n a l purposes because they were observed t o work. An e m p i r i c a l system such as Chinese h e r b a l i s m does not r e q u i r e an e l a b o r a t e t h e o r e t i c a l system t o e x p l a i n how herbs worked, a lthough one d i d e x i s t . The l a y people of China have 119 used "herbs f o r a m i l l e n n i u m without any knowledge of Chinese m e d i c a l c o n c e p t s . S i m i l a r l y , i n Western pharmacy many drugs ) are used without any knowledge of t h e i r mechanism o f a c t i o n , u Does t h i s r e q u i r e us t o a c c e p t on f a c e v a l u e t h a t Chinese herbs are p h y s i o l o g i c a l l y e f f e c t i v e ? Before I answer t h i s , I would l i k e t o p o i n t out t h a t Chinese h e r b a l i s m has c o n t i n u e d t o p e r s i s t i n t o the t w e n t i e t h c e n t u r y because people b e l i e v e they work. While t h i s b e l i e f i n t h e i r e f f i c a c y i s enough to ensure the s u r v i v a l of Chinese h e r b a l i s m , the r e s u l t s of pharmaco-/ l o g i c a l r e s e a r c h i n t o Chinese herbs has i n d i c a t e d t h a t t h e r e i s ( a r a t i o n a l component t o the system. Modern p h a r m a c o l o g i c a l r e s e a r c h i s b e g i n n i n g t o suggest t h a t many c l a i m s made f o r Chinese h e r b a l i s m are w e l l - f o u n d e d . A number of Chinese h e r b s have been shown t o c o n t a i n a c t i v e i n g r e d i e n t s t h a t have a s p e c i f i c a c t i o n on the body and are not merely p l a c e b o s . Most of t h i s r e s e a r c h i s being c a r r i e d out i n A s i a by the PRC, Japan, the USSR, Taiwan, Korea and Hong Kong. Over 2 ,000 a r t i c l e s have been p u b l i s h e d on ginseng t r y i n g to e x p l a i n i t s mechanism of a c t i o n . \ J o u r n a l s such as the American J o u r n a l of Chinese Medicine I and the B u l l e t i n of the O r i e n t a l H e a l i n g I n s t i t u t e a r e b e g i n -ning t o p u b l i s h t h i s A s i a n r e s e a r c h i n E n g l i s h . I t i s o n l y a matter of time before Western s c i e n t i s t s become i n t e r e s t e d i n performing r e s e a r c h on Chinese h e r b s . Stephen F u l d e r i s a B r i t i s h pharmacologist who has begun r e s e a r c h i n t o e x p l o r i n g the e f f i c a c y of ginseng and other 120 C h i n e s e h e r b s . F u l d e r ( 1980) has reviewed a g r e a t d e a l of A s i a n r e s e a r c h on ginseng and argues t h a t some of the t r a d i -t i o n a l c l a i m s for i t s h e a l i n g p r o p e r t i e s are w e l l founded. F u l d e r c a l l s ginseng a harmony drug because i t i s a b l e to r e s t o r e p h y s i o l o g i c a l homeostas is t o so many body systems. F u l d e r ( 1 9 8 0 : 1 1 6 ) attempts t o put the c l a i m s f o r ginseng i n t o p e r s p e c t i v e : I n summary, we can see t h a t ginseng i s perhaps the most important of Chinese remedies. E x o t i c and e x t r a o r -d i n a r y powers are c l a i m e d for i t , but c l o s e r examinat ion shows t h e s e t o be o v e r e n t h u s i a s t i c . A c a r e f u l probe of the way the Chinese h e a l e r s r e g a r d and use ginseng e n a b l e s us t o s t r e a m l i n e the c l a i m s . Ginseng then appears as a n o n - s p e c i f i c v i t a l i z i n g and harmoniz ing s u b s t a n c e . I t r e p a i r s Yang; and tunes and e n e r g i z e s body f u n c t i o n s . I t i s not c u r a t i v e . I t s use i n s i c k n e s s i s intended t o s e t the stage a d v a n t a g e o u s l y for the c o n f r o n t a t i o n w i t h the d i s e a s e , and f o r t h i s purpose i t i s combined i n a l a r g e p r o p o r t i o n of a l l compound remedies. F u l d e r ( 1 9 8 0 : 2 6 2 ) concludes t h a t f o r ginseng and some other Chinese h e r b s : The q u e s t i o n of whether these remedies work or not no longer r e q u i r e s debate. The evidence i s overwhelming, and the l a c k of any a p p r o p r i a t e s t u d i e s i n c o n t r a d i c t i o n i s a deafening s i l e n c e . The debate should move on t o another l e v e l , t h a t of r e l e v a n c e to our m e d i c i n e , our h e a l t h and our development. He i s convinced t h a t t h e r e i s sound data t o demonstrate the p h a r m a c e u t i c a l e f f i c a c y for a t l e a s t some of the Chinese h e r b s . Another i n t e r e s t i n g r e s u l t of t h i s r e s e a r c h i s t h a t even the most u n l i k e l y Chinese remedies of animal o r i g i n c o n t a i n a c t i v e i n g r e d i e n t s . The a n t l e r from the spotted deer i s a p r i z e d Chinese drug t h a t has been found to c o n t a i n p a n t o c r i n e 121 which h a s remarkable a n t i - f a t i g u e p r o p e r t i e s . The Chinese have t r a d i t i o n a l l y used deer a n t l e r s or p a n t u i as a g e n e r a l t o n i c f o r d e b i l i t y , o l d age, impaired v i s i o n and h e a r i n g , rheumatism and many other d i s e a s e s . Other e x o t i c remedies such as the gecko l i z a r d , r h i n o c e r o s h o r n , and t o r t o i s e s h e l l are b e g i n n i n g t o be taken s e r i o u s l y by some p h a r m a c o l o g i s t s . Often they f i n d t h a t an u n l i k e l y drug c o n t a i n s important a c t i v e i n g r e d i e n t s . For example, the s k i n s of c e r t a i n toads have been found t o c o n t a i n a d r e n a l i n . To the e a r l y Chinese p h a r m a c i s t , t h i s r e p r e s e n t e d the o n l y source for a substance he knew nothing about. However, he was i n t i m a t e l y knowledgeable of i t s e f f e c t s on the body, and used i t on t h i s e m p i r i c a l b a s i s . I n c o n c l u s i o n , Chinese h e r b a l i s m has i n p a r t operated as an e m p i r i c a l system based on a s imple but r e p u t a b l e system of c a r e f u l o b s e r v a t i o n . Contemporary e x p e r i m e n t a l evidence i s b e g i n n i n g to prove the c o r r e c t n e s s for some of these e a r l y e m p i r i c a l f i n d i n g s of Chinese s c i e n t i s t s . T h i s p h y s i o l o g i c a l e f f i c a c y of Chinese herbs has c o n t r i b u t e d t o i t s cont inued support by the Chinese populace i n A s i a and abroad. The second l e v e l of e f f i c a c y o c c u r s through the p r o v i s i o n of p e r s o n a l and s o c i a l meaning. T h i s form of h e a l i n g has nothing to do w i t h what k i n d of treatment i s g i v e n , but the r i t u a l c o n t e x t t h a t surrounds the treatment. H e a l i n g of t h i s type o c c u r s along "a symbolic pathway of words, f e e l i n g s , v a l u e s , e x p e c t a t i o n s , b e l i e f s and the l i k e which connect c u l t u r a l events and forms with a f f e c t i v e and p h y s i o l o g i c a l 122 p r o c e s s e s " (Kleinman 1 9 7 3 ) . Aspects important t o the e f f i c a c y of symbol ic h e a l i n g i n c l u d e the c o g n i t i v e meanings employed by a m e d i c a l system, the r i t u a l c o n t e x t f o r h e a l i n g , the h e a l e r - p a t i e n t r e l a t i o n s h i p and the s y m b o l i c a s p e c t s of t r e a t m e n t . Moerman ( 1 9 7 9 ) i n a paper on the "Anthropology of Symbolic H e a l i n g " has made an important c o n t r i b u t i o n t o the u n d e r s t a n d -i n g of the symbol ic e f f i c a c y of t r a d i t i o n a l h e a l i n g systems. Moerman ( 1 9 7 9 : 6 0 ) a r g u e s ' t h a t : . . . the m e t a p h o r i c a l s t r u c t u r e , the system of meaning, of a h e a l i n g d i s c i p l i n e i s d e c i s i v e i n i t s e f f e c t i v e n e s s , as important as any o t h e r " a c t u a l , " " p h y s i c a l , " "pharmaco-l o g i c a l " e lements. . . . T h i s i s not t o say t h a t h e r b a l m e d i c i n e s do not have s i g n i f i c a n t s p e c i f i c m e d i c a l e f f e c t s they c e r t a i n l y do. What I am arguing i s t h a t the symbol ic component of treatment i s s i g n i f i c a n t as w e l l , t h a t i t i s these h e a l i n g metaphors which p r o v i d e the symbol ic s u b -s t a n c e of g e n e r a l m e d i c a l t r e a t m e n t . C h i n e s e m e d i c i n e i s d e n s e l y embued w i t h symbolism and p a r t i c -u l a r l y amenable to the type of a n a l y s i s of symbol ic a c t i o n t h a t Moerman a d v o c a t e s . I t i s beyond the scope of t h i s p r e s e n t work t o a n a l y z e the symbol ic component of Chinese h e r b a l i s m . I n s t e a d , I would l i k e to draw a t t e n t i o n t o two important a r t i c l e s on the symbolism of Chinese m e d i c i n e . Kleinman ( 1 9 7 5 : 1 1 4 ) f e e l s t h a t : I t would be d i f f i c u l t to exaggerate or o v e r v a l u e the t h e r a p e u t i c s i g n i f i c a n c e of t h i s symbol ic use of herbs and d i e t . B e s i d e s the pragmatic i n t s t r u m e n t a l v a l u e they may p o s s e s s these measures a l s o have a placebo e f f e c t and, as we have a l r e a d y p o i n t e d out , r e p r e s e n t a c o n s i s t e n t e x p l a n a t o r y system which l i n k s i d e a s about i l l n e s s with i d e a s about and a c t u a l t reatment . Cooper and S i v i n ( 1 9 7 3 ) look at the whole q u e s t i o n of 123 symboli sm of C h i n e s e drugs and what c l a i m s t o e f f i c a c y t h i s may h a v e . The authors s e l e c t a s i n g l e group of d r u g s — t h o s e d e r i v e d from the human body; from the v a s t C h i n e s e pharma-c o p o e i a t o examine why and how those s u b s t a n c e s l a c k i n g p h a r -m a c e u t i c a l e f f i c a c y were r e t a i n e d . They a r r i v e a t the c o n -c l u s i o n t h a t : No s i n g l e f a c t o r among the three—known pharmacodynamic e f f e c t s , symbol ic procedures e s t a b l i s h e d w i t h i n f o l k m e d i c i n e , the t h e o r e t i c a l a b s t r a c t i o n s of the a n c i e n t s c i e n t i f i c t r a d i t i o n s — c a n account f o r the range of p r e -s c r i p t i o n s a t the o l d - f a s h i o n e d p h y s i c i a n ' s d i s p o s a l . The p o s i t i v i s t i c c o n c e p t i o n of C h i n e s e drug therapy as an e m p i r i c a l s c i e n c e analagous t o the c l i n i c a l l y t e s t e d t h e r a p e u t i c procedures does not stand up t o c l o s e and i m p a r t i a l s c r u t i n y . . . . Anyone whose concern i s t o comprehend t r a d i t i o n a l medic ine as an e n t i t y s u b s i s t i n g and changing through time w i l l , we b e l i e v e , f i n d i t a waste of time t o c o n f i n e h i s a t t e n t i o n t o what l o o k s i n t e r e s t i n g from the p o s i t i v e p o i n t of v iew. The c r u c i a l problem i s r a t h e r t o u n d e r -stand the b a l a n c e between e m p i r i c a l , r i t u a l and t h e o r e t i c a l f a c t o r s to understand and to d i s c o v e r the many modes of i n t e r p l a y . (Cooper and S i v i n 1 9 7 3 : 2 5 8 ) I would suggest t h a t t h e r e are m u l t i p l e ways t o e x p l a i n the e f f i c a c y of a p a r t i c u l a r h e r b . The most u s e f u l e x p l a n a -t i o n s w i l l e x p l o r e the i n t e r a c t i o n of both p h a r m a c e u t i c a l and symbol ic p r o p e r t i e s of h e r b s . There i s i n a l l l i k e l i h o o d no a b s o l u t e d i v i s i o n between these two modes of e f f i c a c y . For example, t h e r e are some herbs such as ginseng which can be p r o f i t a b l y a n a l y z e d from both p e r s p e c t i v e s . Research on ginseng has demonstrated t h a t i t does have i n g r e d i e n t s which are p h a r m a c o l o g i c a l l y a c t i v e ( F u l d e r , 1 9 8 0 ) . There i s a l s o a 124 f o l k b e l i e f t h a t the c l o s e r the root resembles a man, the s t r o n g e r and more powerful are i t s e f f e c t s (Koo 1 9 7 6 ) . Here i s a c l e a r example of the d o c t r i n e of s i g n a t u r e s . T h i s i s a s y m b o l i c l o g i c which d e c l a r e s p a r t i c u l a r e f f i c a c y f o r p l a n t s h a v i n g anthropomorphic form. On the other hand t h e r e are herbs such as "dragon's t e e t h " which a r e i n a c t u a l i t y f o s s i l i z e d hominid t e e t h t h a t have no e m p i r i c a l b a s i s f o r t h e i r i n c l u s i o n i n the m a t e r i a medica. However, a s y m b o l i c a n a l y s i s would r e v e a l m e t a p h o r i c a l reasons f o r i t s i n c l u s i o n . On the other extreme, t h e r e a r e remedies which are l a r g e l y used because of t h e i r e m p i r i c a l e f f e c t s and have o n l y minimal s y m b o l i c i m p o r t . I would draw a t t e n t i o n t o the v a r i o u s f i r s t a i d remedies such as Panax psuedoginseng which i s p l a c e d on open wounds to c o n t r o l b l e e d i n g . I would l i k e t o now focus on the r i t u a l s of the h e r b a l pharmacy and the symbolism of the herbs t h e m s e l v e s . One o n l y has t o step i n s i d e the door of a t r a d i t i o n a l h e r b a l pharmacy t o enter the symbol ic world of Chinese m e d i c i n e . One i s immediately immersed i n t o the s e n s u a l world of s t r a n g e odours, s i g h t s and a c t i v i t i e s . The herbs are c a r e f u l l y d i s -p l a y e d i n the g l a s s c a s e s and a p o t h e c a r y - t y p e j a r s or e l s e s t o r e d away i n unmarked drawers. The p h a r m a c i s t ' s t o o l s r e f l e c t both the o l d world and the new. The world of t r a d i -t i o n a l China i s suggested by i v o r y s c a l e s , the abacus, mortar and p e s t l e and l a r g e c l e a v e r . Juxtaposed a l o n g s i d e are the 125 e l e c t r o n i c c a l c u l a t o r , cash r e g i s t e r , g r i n d e r and s c a l e . Behind the counter i s the h e r b a l i s t , whose a c t i v i t i e s c o n s t i t u t e a t i m e l e s s r i t u a l pregnant w i t h symbolism. The good h e r b a l i s t i s p a r t showman, c a r e f u l l y and knowingly s e l e c t i n g , weighing and p r e p a r i n g p r e s c r i p t i o n s b e f o r e the w a t c h f u l eyes of h i s customer. He embues the h e r b a l p r e s c r i p t i o n w i t h an added potency through the r i t u a l of d i s p e n s i n g . The a c t as w e l l as t h e product of the p r e p a r a t i o n s e r v e s t o i n c r e a s e the e f f i c a c y of the h e r b a l remedy. The h e r b s themselves symbol ize the h e a l i n g power of n a t u r e . Not a l l Chinese herbs share i n the obvious symbolism of r h i n o c e r o s horn and t i g e r ' s t e s t i c l e s which symbol ize and t h e r e f o r e are used to i n c r e a s e male potency. The n a t u r a l raw s t a t e of the herbs r e i n f o r c e s the Chinese concept of r e s t o r i n g the n a t u r a l b a l a n c e of the body i n harmony w i t h the elements of the u n i v e r s e . The p r e p a r a t i o n of Chinese remedies i s a c a r e f u l r i t u a l of b o i l i n g them down and d r i n k i n g the remaining cup of t h i c k dark f l u i d . The i n t e n s e l y b i t t e r t a s t e i n s u r e s the r e c i p i e n t t h a t he i s r e c e i v i n g a powerful t r e a t -ment . The c o n c l u s i o n from t h i s b r i e f review suggests t h a t Chinese herbs operate a t a l e v e l of p h y s i o l o g i c a l and symbol ic e f f i c a c y . T h i s d u a l e f f i c a c y has i n s u r e d t h a t the consumers of Chinese herbs r e c e i v e b e n e f i c i a l r e s u l t s . Although t h i s t h e s i s i s concerned with the use of a t r a d i t i o n a l m e d i c a l system by the Chinese of Vancouver, I 126 cannot i g n o r e the i n c r e a s i n g i n t e r e s t i n t h i s t o p i c by W e s t e r n e r s . Westerners are a t t r a c t e d t o Chinese h e r b a l i s m i n i t i a l l y by i t s e x o t i c a and m y s t i q u e . L a t e r t h e y d i s c o v e r t h a t i t i s a s imple but e f f e c t i v e way t o c o n t r o l many common h e a l t h problems. Chinese h e r b a l i s m , l i k e many other t r a d i -t i o n a l m e d i c a l systems appear t o s e r v e a "need" t h a t i s being missed by contemporary b i o m e d i c i n e . T h i s i n c l u d e s the c o n -temporary t r e n d s towards n a t u r a l i s m and E a s t e r n or a n c i e n t wisdom. I b e l i e v e t h a t the p r e s e n t r e n a i s s a n c e of Chinese h e r b a l -ism goes beyond the world of fads t o a deeper world of e p i s t e -mology and paradigm s h i f t s . My f i n a l p o i n t f o r the p e r s i s t e n c e of C h i n e s e h e r b a l i s m i s t h a t i t r e p r e s e n t s an a l t e r n a t e m e d i c a l paradigm which i s complementary t o and not i n o p p o s i t i o n t o Western b i o m e d i c i n e . Whereas Western medic ine speaks i n a language of germs and p a t h o l o g i c a l p r o c e s s e s , Chinese medic ine uses metaphors l i k e v i t a l energy or hot and c o l d f o r c e s d i s r u p t i n g the b a l a n c e of the body. Each system addresses the same phenomena from a d i f f e r e n t p o i n t of v iew. There i s l i t t l e gained by t r y i n g t o e v a l u a t e which system i s more a c c u r a t e . Both systems are c o r r e c t w i t h i n t h e i r own frame of r e f e r e n c e and c u l t u r a l c o n t e x t . An important s h i f t i s underway which w i l l r e d e f i n e our ways of c o n c e p t u a l i z i n g h e a l t h and d i s e a s e . L i k e the f i e l d of p h y s i c s , the Chinese i n s i g h t s i n medicine appear to have 127 a n t i c i p a t e d our concerns by m i l l e n i a . The C h i n e s e achievements i n m e d i c i n e such as the concern f o r d i e t and n u t r i t i o n , the i d e a of a p r e v e n t a t i v e medic ine and the use of s a f e substances to f a c i l i t a t e the b o d y ' s own h e a l i n g c a p a c i t y are o n l y now b e i n g d i s c o v e r e d by Western m e d i c i n e . I n t h i s way Chinese m e d i c i n e i s v e r y contemporary and t i m e l y . N o t w i t h s t a n d i n g t h e s e growing s i m i l a r i t i e s , Chinese and Western m e d i c i n e remain d i s t i n c t l y unique m e d i c a l systems. Each system has i t s s t r e n g t h s and weaknesses, as my C h i n e s e i n f o r m a n t s c l e a r l y r e c o g n i z e . To most of my informants i t i s not a q u e s t i o n of u s i n g one or the other system. Those Chinese who s t i l l use t r a d i t i o n a l h e r b a l remedies a l s o u t i l i z e Western m e d i c i n e . The C h i n e s e are h i g h l y pragmatic i n t h e i r c h o i c e of m e d i c a l treatment and s e l e c t the b e s t t h a t each system has t o o f f e r . The C h i n e s e have always supported m e d i c a l p l u r a l i s m so as t o maximize t h e i r h e a l t h o p t i o n s . They p r e f e r the s e c u r i t y i n the knowledge t h a t i f one m e d i c a l avenue does not work o u t , t h e r e i s always another o p t i o n open to them. To the Chinese mind, t h e r e i s s t r e n g t h i n d i v e r s i t y and a l t e r n a t i v e s . The o l d Chinese t e a c h i n g of the complementarity of o p p o s i t e s i s s t i l l very much p a r t of contemporary Chinese l i f e . Given the c h o i c e of two r a d i c a l l y d i f f e r e n t m e d i c a l systems, the Chinese of Vancouver haye chosen not to r e j e c t e i t h e r but to i n c o r p o r a t e both i n t o t h e i r way of l i f e . The two m e d i c a l systems are not seen as being m u t u a l l y e x c l u s i v e . Rather they a r e seen as being complementary t o one another . 128 Seen from t h i s p e r s p e c t i v e , the two systems are not m u t u a l l y e x c l u s i v e but m u t u a l l y c o m p a t i b l e . The d a t a show t h a t where Western medic ine f a i l s , Chinese medic ine succeeds and where the C h i n e s e approach i s i n e f f e c t i v e , the Western i s e f f e c t i v e . I t i s t h i s g e n i u s t o r e c o g n i z e the complementarity of these two m e d i c a l systems t h a t has ensured the s u r v i v a l of C h i n e s e h e r b a l i s m i n V a n c o u v e r ' s Chinatown f o r today and y e a r s to come. 129 V. CONCLUSION C h i n e s e m e d i c i n e , l i k e a l l Chinese s c i e n c e i s born of a n a t u r a l i s t i c cosmology r e c o g n i z i n g the fundamental harmony and r e l a t e d n e s s of a l l t h i n g s . Chinese h e r b a l medic ine developed from an a g r i c u l t u r a l c i v i l i z a t i o n whose c i t i z e n s were concerned w i t h becoming masters of the m a t e r i a l s and f o r c e s of the n a t u r a l w o r l d . From t h e s e concerns developed a n a t u r a l h e a l i n g system based on the use of m i n e r a l s , p l a n t s , a n i m a l s and man h i m s e l f as agents t o r e s t o r e b a l a n c e w i t h i n the human body. Chinese h e r b a l i s m i s one of the o l d e s t and most c o n s t a n t m e d i c a l systems i n the world t o d a y . I n t h i s t h e s i s I have examined the 5,000 y e a r o l d system of C h i n e s e h e r b a l i s m as i t i s being p r a c t i c e d today i n the C h i n e s e community of Vancouver. We have seen t h a t f a r from being a c u l t u r a l a r t i f a c t p r e s e r v e d by a few v e n e r a b l e s o u l s , i t i s a t h r i v i n g t r a d i t i o n p r a c t i c e d by a s u b s t a n t i a l p o r t i o n of the Vancouver Chinese community. H e r b a l medic ine i s an i n t e g r a l p a r t of Chinese c u l t u r e h i s t o r i c a l l y and contemporaneously. I have attempted to document how Chinese h e r b a l i s m i s woven i n t o the f a b r i c of Chinese c u l t u r e i n Vancouver. To accompl ish t h i s t a s k , I s e t out f i r s t to d e s c r i b e i n d e t a i l the herbs themselves and the h e r b a l pharmacies where they are bought and s o l d i n V a n c o u v e r ' s Chinatown. I then looked a t the s o c i a l o r g a n i -130 z a t i o n of t r a d i t i o n a l h e r b a l knowledge u s i n g K l e i n m a n ' s ( 1980) t r i p a r t i t e model of l o c a l h e a l t h c a r e systems. T h i s l e d me t o examine the p r a c t i c e s and knowledge of C h i n e s e h e r b a l i s m f o r the p r o f e s s i o n a l , f o l k and p o p u l a r or f a m i l y h e a l t h c a r e s e c t o r s . I then attempted to answer the q u e s -t i o n of why C h i n e s e h e r b a l i s m has s u r v i v e d i n r e l a t i v e l y i n t a c t form i n the middle of a contemporary North American urban c e n t r e . S e v e r a l key themes emerge from the d a t a t h a t bear r e i t e r a t i n g a t t h i s p o i n t . The f i r s t i s the c e n t r a l r o l e t h a t the C h i n e s e f a m i l y has i n the p r a c t i c e of h e r b a l i s m i n Vancouver. While C h i n e s e h e r b a l i s m h a s had p r o f e s s i o n a l , f o l k and p o p u l a r p r a c t i t i o n e r s throughout i t s h i s t o r y , i t i s the p o p u l a r , f a m i l y - b a s e d system t h a t dominates i n t h i s North American urban c o n t e x t . T h e r e f o r e , i t i s the f a m i l y ' s use of herbs f o r s e l f - c a r e t h a t i s the dominant f o r c e behind the m a i n -tenance of t r a d i t i o n a l h e r b a l i s m i n V a n c o u v e r ' s Chinatown. Although most Chinese f a m i l i e s seek p r o f e s s i o n a l m e d i c a l c a r e from Western p h y s i c i a n s , many have r e t a i n e d the s e l f -c a r e component of t h e i r t r a d i t i o n a l h e r b a l system. F u r t h e r -more, due t o t h e i r c e n t r a l r o l e as care p r o v i d e r s , i t i s the women of the Chinese household who are r e s p o n s i b l e f o r a l a r g e p a r t of the management of the f a m i l y ' s use of h e r b s . The k i t c h e n , which i s the s o l e domain of the women of the household i s a l s o the c e n t r e of h e r b a l p r e p a r a t i o n . T h i s l e a d s us t o a c o n s i d e r a t i o n of the second theme 131 which i s the c l o s e r e l a t i o n s h i p between food and h e r b s i n Chinese c u l t u r e . The C h i n e s e , p a r t i c u l a r l y those from Southern C h i n a , are k e e n l y aware of the p o s i t i v e and nega-t i v e e f f e c t s t h a t d i f f e r e n t foods have on the body. They use the h o t / c o l d c l a s s i f i c a t i o n system t o d i f f e r e n t i a t e types of food and t h e i r p h y s i o l o g i c a l a c t i o n . T h i s system i s a l s o used to c l a s s i f y h e r b s , d i s e a s e s and t r e a t m e n t s . Thus t h e r e i s a v e r y c l o s e c o n c e p t u a l l i n k made between the m e d i c a l p r o p e r t i e s of foods and h e r b s . My c o n c l u s i o n i s t h a t the Chinese do not have as r i g i d a d i v i s i o n between foods and herbs as Westerners do. The Chinese are more i n t e r e s t e d i n d i f f e r e n t i a t i n g the e f f e c t s t h a t substances have on the body i n terms of t h e i r n u t r i t i o u s , t o n i f y i n g , t h e r a p e u t i c or poisonous q u a l i t i e s . The p r e p a r a t i o n of many h e r b a l p r e s c r i p t i o n s i n v o l v e s the making of an h e r b a l soup which i s o f t e n p a r t of the f a m i l y meal. Thus the f a m i l y ' s use of herbs i s i n t e g r a t e d i n t o the t r a d i t i o n a l Chinese d i e t . A t h i r d theme i s t h a t a g r e a t d e a l o f the use of herbs i n the f a m i l y i s for the p r e v e n t i o n of d i s e a s e and the maintenance of b o d i l y v i t a l i t y . Many h e r b a l p r e p a r a t i o n s are used t o make the i n d i v i d u a l more r e s i s t a n t to d i s e a s e by s t r e n g t h e n i n g t h e i r c h ' i ( v i t a l energy) or t h e i r b lood. The Chinese b e l i e v e t h a t a l o s s of b a l a n c e between the y i n and the yang f o r c e s i n the body r e s u l t s i n d i s e a s e . These imbalances can be recognized and t r e a t e d before the d i s e a s e 132 s e t s i n by the a p p r o p r i a t e d i e t and h e r b a l t h e r a p y . The C h i n e s e w i l l a l s o a n t i c i p a t e t imes of a d d i t i o n a l s t r e s s on the body. They prepare themselves f o r i t by b u i l d i n g up t h e i r r e s i s t a n c e and energy w i t h the a p p r o p r i a t e h e r b a l m i x t u r e . The Chinese a l s o use h e r b a l t o n i c s on a r e g u l a r b a s i s t o d e a l w i t h the s p e c i a l problems common t o men, women and the aged. Thus i t c o u l d be s a i d t h a t the t r a d i t i o n a l C h i n e s e m e d i c a l system h a s a p r e v e n t a t i v e o r i e n t a t i o n i n which as much emphasis i s p l a c e d on the p r e v e n t i o n of d i s e a s e as i t s t r e a t m e n t . The f o u r t h theme I would l i k e to draw a t t e n t i o n t o i s the f a c t t h a t a l though C h i n e s e h e r b a l i s m has p r o f e s s i o n a l , f o l k , and p o p l u a r t r a d i t i o n s i n A s i a , i t i s o n l y the l a t t e r two t h a t have become p a r t of C h i n e s e c u l t u r e i n Vancouver. I n both Hong Kong and the PRC, the p r o f e s s i o n a l h e r b a l doctor p l a y s a s i g n i f i c a n t r o l e i n the p r o v i s i o n of h e a l t h c a r e . T h i s i s the c l a s s i c a l - p r o f e s s i o n a l t r a d i t i o n , o f h e r b a l i s m which d a t e s back t o c l a s s i c a l t i m e s . However, t h i s component i s not v e r y s i g n i f i c a n t f o r the p r a c t i c e of Chinese h e r b a l i s m i n Vancouver. T h i s i s due t o the f a c t t h a t a p r o f e s s i o n a l form of medic ine a l r e a d y e x i s t s i n Vancouver which p r e c l u d e s the a d o p t i o n of any a l t e r n a t e m e d i c a l system i n t o the mainstream h e a l t h c u l t u r e . Thus Chinese medicine i s o n l y a b l e to s u r v i v e i n i t s n o n - p r o f e s s i o n a l form. Notwithstanding these l i m i t a -t i o n s , the " l i t t l e " t r a d i t i o n of Chinese h e r b a l i s m has found a n i c h e i n the Chinese community of Vancouver. Thus what has 133 s u r v i v e d i n the contemporary urban c o n t e x t i s the p o p u l a r and f o l k t r a d i t i o n of C h i n e s e h e r b a l i s m which i s e s s e n t i a l l y a s e l f - c a r e system based on an o r a l t r a d i t i o n of t e a c h i n g . T h i s s e l f - c a r e component of C h i n e s e h e r b a l i s m based on o r a l t r a n s m i s s i o n i s w e l l adapted t o the t r a d i t i o n a l f a m i l y system. For t h i s reason, C h i n e s e h e r b a l i s m c o n t i n u e s t o be p r a c t i c e d i n many t r a d i t i o n a l households of Vancouver. The f i f t h and f i n a l theme t h a t I would l i k e t o e l i c i t concerns the whole q u e s t i o n of the e f f i c a c y of Chinese h e r b s . There a r e arguments t h a t C h i n e s e h e r b a l i s m i s an e m p i r i c a l system which works because of the p h a r m a c e u t i c a l e f f i c a c y of the a c t i v e i n g r e d i e n t s w i t h i n h e r b s . A g r e a t d e a l of s c i e n -t i f i c r e s e a r c h has been done on C h i n e s e herbs i n an attempt t o document i t s t h e r a p e u t i c b a s i s . There i s the c o u n t e r i n g p o s i t i o n which argues t h a t Chinese h e r b a l i s m i s a symbol ic system of h e a l i n g which d e r i v e s i t s s u c c e s s through the p l a c e b o e f f e c t and any a c t i v e i n g r e d i e n t s are i n c i d e n t a l t o the pr imary m e t a p h o r i c a l impact . The data i n d i c a t e both these p o s i t i o n s t o be untenable i n the e x p l a n a t i o n of t h e r a p e u t i c e f f e c t i v e n e s s of C h i n e s e h e r b s . Evidence was presented i n t h i s t h e s i s t o i n d i c a t e t h a t Chinese h e r b a l i s m has a l a r g e r a t i o n a l component based on the e m p i r i c a l f i n d i n g s of Chinese p h y s i c i a n s for c e n t u r i e s . Contemporary p h a r m a c e u t i c a l r e s e a r c h i s beginning t o p r o v i d e a s c i e n t i f i c e x p l a n a t i o n for the e f f i c a c y of many herbs i n the Chinese m a t e r i a medica. However, the symbolic a s p e c t s of Chinese medicine 134 c o n t i n u e t o p l a y an important r o l e i n the p o p u l a r t r a d i t i o n of h e r b a l i s m i n Vancouver. The p o p u l a r m e d i c a l id iom of the f a m i l i e s of Vancouver i s a h i g h l y symbol ic system of hot and c o l d d i c h o t o m i e s . Based on t h i s s y m b o l i c c l a s s i f i c a t i o n of b o d i l y i m b a l a n c e s , an " a p p r o p r i a t e " h e r b a l remedy i s s e l e c t e d . Although t h i s p r o c e s s may r e s u l t i n the s e l e c t i o n of pharma-c e u t i c a l l y a c t i v e and a p p r o p r i a t e h e r b s , the d i a g n o s t i c c r i t e r i a are e s s e n t i a l l y s y m b o l i c . * I n a d d i t i o n t o t h i s s y m b o l i c c l a s s i f i c a t i o n system, many of the herbs suggest s y m b o l i c r e f e r e n c e t o potency and v i t a l i t y . A l s o , the whole p r o c e s s of buying and p r e p a r i n g herbs i s h e a v i l y o v e r l a y e d w i t h r i t u a l symbols and t h e r a p e u t i c metaphors. Thus we have t o conclude t h a t the Chinese h e r b a l s y s t e m ' s b a s i s of e f f i c a c y i s on the t i g h t l y woven i n t e r a c t i o n s between i t s e m p i r i c a l and s y m b o l i c e lements . Medical anthropology should conduct f u r t h e r r e s e a r c h and a n a l y s i s of not o n l y t r a d i t i o n a l m e d i c a l systems b u t a l s o contemporary b i o m e d i c i n e . F i n a l l y , I would l i k e to pose the q u e s t i o n of what i s the f u t u r e out look f o r Chinese h e r b a l i s m i n North America. For Vancouver, a t l e a s t , the d a t a i n d i c a t e t h a t i n sheer numbers, Chinese h e r b a l i s m i s expanding i t s scope i n C h i n a -town. I t i s too e a r l y t o t e l l whether t h i s i s due t o r e c e n t * Which may not be a l l t h a t d i f f e r e n t from Western " s c i e n -t i f i c " methodology. 135 i n - m i g r a t i o n of " t r a d i t i o n a l " f a m i l i e s or a genuine r e v i v a l -ism of i n t e r e s t i n C h i n e s e h e r b a l i s m by the C h i n e s e com-munity a t l a r g e . S i n c e f a m i l y h e r b a l i s m i s based on o r a l t r a d i t i o n s , i t w i l l t a k e one or two g e n e r a t i o n s t o t e l l i f the younger Chinese women have l e a r n e d the system from t h e i r mothers and w i l l c o n t i n u e t o p r a c t i c e i t i n the home s e t t i n g . I t i s my o p i n i o n t h a t once t h e y e x p e r i e n c e the l i m i t a t i o n s of Western medic ine t o t r e a t a l l a i l m e n t s , they w i l l c o n -t i n u e t o use c e r t a i n elements of t h e i r t r a d i t i o n a l h e r b a l system. However, i t i s s a f e t o conclude t h a t the p r e s e n t system of f a m i l y s e l f - c a r e u s i n g herbs w i l l c o n t i n u e f o r a t l e a s t one more g e n e r a t i o n i n Vancouver. A f u r t h e r v a r i a b l e determining the f u t u r e of Chinese h e r b a l i s m i s whether i t w i l l draw the widespread p u b l i c i t y t h a t acupuncture a c h i e v e d i n the 1 9 7 0 ' s . My d a t a i n d i c a t e t h a t more and more Westerners a r e becoming i n t e r e s t e d i n Chinese h e r b a l i s m through c o u r s e s , books and e x p e r i m e n t a t i o n w i t h C h i n e s e herbs bought i n Chinatown. At the p r e s e n t , t h e r e i s e v i d e n c e t h a t the c l a s s i c a l - p r o f e s s i o n a l component of Chinese h e r b a l i s m i s beginning t o be taught i n acupunc-t u r e c o l l e g e s i n Boston, S e a t t l e , San F r a n c i s c o , Los Angeles and Santa Fe. I t w i l l be i n t e r e s t i n g to observe i f t h i s component of Chinese h e r b a l i s m which has been v i r t u a l l y l o s t i n the Chinese community i s p r e s e r v e d by Westerners . Another v a r i a b l e t o c o n s i d e r w i l l be the impact of the p h a r m a c e u t i c a l r e s e a r c h now being c a r r i e d out on Chinese 136 h e r b s . W i l l C h i n e s e herbs become a new source of drugs for the p h a r m a c e u t i c a l i n d u s t r y and become i n c o r p o r a t e d w i t h i n the Western m e d i c a l model or w i l l i t s u r v i v e i n a more i n t a c t form as a v i a b l e , a l t e r n a t e h e a l i n g system? C h i n e s e m e d i c i n e i s a dynamic and a d a p t i v e system which has e s t a b -l i s h e d i t s e l f over a 5 ,000 y e a r p e r i o d . Chinese medic ine i s i n a p r o c e s s of d i f f u s i o n i n which i t i s both an a c t i v e and p a s s i v e p a r t n e r i n the p r o c e s s of m e d i c a l change. I t w i l l undoubtedly c o n t i n u e t o have an important impact on the h e a l t h of the world f o r many more y e a r s t o come. 137 BIBLIOGRAPHY Ahern, E m i l y 1 9 7 5 "Sacred and s e c u l a r medic ine i n a Taiwaneses v i l l a g e : A study of c o s m o l o g i c a l d i s o r d e r , " i n Kleinman e t a l . ( 1 9 7 5 ) . Anderson, E . and Anderson, M. 1968 "Folk medic ine i n Hong Kong." E t n o i t r i a 2 : 2 2 - 3 5 . C a t t e l l , S t u a r t 1962 H e a l t h , W e l f a r e , and S o c i a l O r g a n i z a t i o n i n Chinatown. New Y o r k : Community S e r v i c e S o c i e t y . Chan, C-W, and J . K . Chang 1976 "the r o l e of C h i n e s e medic ine i n New Y o r k ' s Chinatown," Amer. J . Ch. Med., 4 : 3 1 - 4 5 , 1 2 9 - 1 4 6 . Chang, K . C . ( e d . ) 1977 Food i n Chinese C u l t u r e . New Haven: Y a l e U n i v e r -s i t y P r e s s . Chen, K . K . 1925 "Chinese Drug S t o r e s . " Annals of Medica l H i s t o r y , 7 : 1 0 3 - 1 0 9 . Choa, G e r a l d 1967 "Some i d e a s concerning food and d i e t among Hong Kong C h i n e s e : C o n s t i t u t i o n and food t h e r a p y , " i n M. Topley ( e d . ) , Some T r a d i t i o n a l Chinese I d e a s and Conceptions i n Hong Kong S o c i a l L i f e Today, Hong Kong. C o n n e l l y , Diane 1979 T r a d i t i o n a l Acupuncture: the Law of the F i v e Elements. Columbia, MD: Centre f o r T r a d i t i o n a l Acupuncture. Cooper, W.C. and N. S i v i n 1973 "Man as a Medic ine: P h a r m a c o l o g i c a l and R i t u a l Aspects of t r a d i t i o n a l therapy u s i n g drugs d e r i v e d from the human body," i n S. Nakayama and N. S i v i n ( e d . ) , Chinese S c i e n c e : E x p l o r a t i o n of an A n c i e n t T r a d i t i o n . Cambridge: MIT P r e s s . ~~ C r o z i e r , Ralph 1976 "The i d e o l o g y of m e d i c a l r e v i v a l i s m i n modern C h i n a , " i n C. L e s l i e ed. A s i a n Medical Systems. B e r k e l e y : U n i v e r s i t y of C a l i f o r n i a P r e s s . 1 3 8 F u l d e r , Stephen 1980 The Tao of M e d i c i n e ; Ginseng, O r i e n t a l Remedies and the Pharmacology of Harmony. New Y o r k : D e s t i n y Books. Goldberg, M i c h a e l 1977 S t r a t h c o n a Community S t u d y . Vancouver: M i n i s t r y of Human R e s o u r c e s . G o u l d - M a r t i n , K a t h e r i n e 1978 "Hot, c o l d , c l e a n , p o i s o n and d i r t : Chinese f o l k m e d i c a l c a t e g o r i e s . " Soc. S c i . and Med. 1 2 : 3 9 - 4 6 . G o u l d - M a r t i n , K, and C . Ngin 1 9 8 1 "Chinese A m e r i c a n s , " i n Harwood, ( e d . ) , E t h n i c i t y and Medica l C a r e . Cambridge: Harvard U n i v e r s i t y P r e s s . H e s s l e r , R . , M. Nolan, B. Ogru and P. K.M. New 1 9 7 5 " I n t r a e t h n i c D i v e r s i t y : H e a l t h care of the C h i n e s e - A m e r i c a n s . " Human O r g a n i z a t i o n 3 4 : 2 5 3 - 2 6 2 . Holbrook, Bruce 1974 "Chinese P s y c h o - s o c i a l m e d i c i n e . " B u l l . I n s t . Ethnology, Academia S i n i c a . 3 7 : 8 5 - 1 1 0 . Hunan, P r o v i n c e R e v o l u t i o n a r y H e a l t h Committee 1977 A Barefoot D o c t o r ' s Manual. T r a n s l a t e d from the Chinese by the F o g a r t y I n t . C e n t r e . S e a t t l e : C l o u b u r s t P r e s s . H y a t t , R. 1978 Chinese Herbal Medic ine: A n c i e n t A r t and Modern S c i e n c e " New York: Schocken Books. Johnson, Graham 1974 Vancouver Chinese Community Study. Unpublished r e s e a r c h n o t e s . 1979 "Chinese F a m i l y and Community i n Canada: T r a d i -t i o n and Change," i n J . E . E l i o t , ( e d . ) Two N a t i o n s , Many C u l t u r e s : E t h n i c Groups i n Canada. Scarborough, O n t . : P r e n t i c e H a l l . Jordon, D. 19 72 Gods, Ghosts and A n c e s t o r s : F o l k R e l i g i o n i n a Taiwanese V i l lage". B e r k e l e y : U n i v e r s i t y of C a l i f o r n i a P r e s s . 139 Keys, John D. 1976 C h i n e s e Herbs: T h e i r Botony, Chemistry and Pharmacodynamics• R u t l a n d , Vermont: T u t t l e . Kleinman, A r t h u r 1 9 7 3 " M e d i c i n e ' s s y m b o l i c r e a l i t y . " I n q u i r y . 1 6 : 2 0 3 - 2 1 6 1 9 7 5 "The s y m b o l i c c o n t e x t of C h i n e s e m e d i c i n e . " AM. J . C h i n e s e M e d i c i n e . 3 : 1 - 2 5 . 1980 P a t i e n t s and H e a l e r s i n the Context of C u l t u r e . B e r k l e y : U. C a l i f o r n i a P r e s s . Kleinman, A . , P. K u n d s t a d t e r , E . R . Alexander and J . Gale ( e d s . 1 9 7 5 Medic ine i n Chinese C u l t u r e s : Comparative S t u d i e s of H e a l t h Care i n Chinese and Other S o c i e t i e s . Washington: Department of H e a l t h , E d u c a t i o n & W e l f a r e . Koo, L i n d a 1976 "Nourishment of L i f e : The C u l t u r e of H e a l t h i n T r a d i t i o n a l Chinese S o c i e t y . " Unpubl ished Ph.D. d i s s e r t a t i o n , Department of Anthropology, U n i v e r -s i t y of C a l i f o r n i a , B e r k e l e y . Lee, Ranee 1972 Study of H e a l t h Systems i n Kwun Tong. Hong Kong: S o c i a l Research C e n t r e , Chinese U n i v e r s i t y of Hong Kong. 1980 " p e r c e p t i o n s and uses of Chinese medic ine among the Chinese i n Hong Kong." C u l t u r e , Medicine and P s y c h i a t r y . 4 : 3 4 5 - 3 7 5 . L e s l i e , C h a r l e s 1976 A s i a n Medica l Systems. B e r k e l e y : U n i v e r s i t y of C a l i f o r n i a P r e s s . L e v y , Marion 1949 The F a m i l y R e v o l u t i o n i n Modern C h i n a . New York: Octogon Books. L i , C . P . 1974 Chinese Herbal Medic ine. Washington: John Fogarty I n t e r n a t i o n a l C e n t r e . L i , F r e d e r i c k # n 1972 " T r a d i t i o n a l Chinese medicine i n the U . S . J . A . M . A . 2 2 0 : 1 1 3 2 - 1 1 3 3 . 140 L i , F . , N . Y . S c h l i e f , C. Chang and A. Gaw 1972 "Health c a r e f o r the C h i n e s e community i n B o s t o n . " Amer. J . P u b l i c H e a l t h . 4 : 5 3 6 - 5 3 8 . L i , Shiang and F . L i 1 9 7 1 "The Y i n g - Y a n g ( c o l d / h o t ) theory of d i s e a s e . " J . A . M . A . 2 1 7 : 1 1 0 8 . L i , C h i h - c h e n 1 9 7 3 Chinese M e d i c i n a l Herbs, t r a n s l a t e d from the Chinese Pen T - s a o by F . P o r t e r Smith and G. A. S t u a r t . San F r a n c i s c o : Georgetown P r e s s . Lu, Henry 1977 Fundamental Knowledge of Chinese Herb Therapy. Vancouver: North American C o l l e g e of C h i n e s e H e r b a l i s m . McDowell, J . 1982 "West meets E a s t i n a C h i n e s e Drug S t o r e . " Westworld. 1 : 4 3 - 4 5 . Moerman, D a n i e l 1979 "Anthropology of Symbolic H e a l i n g . " C u r r e n t Anthropology. 2 0 : 5 9 - 8 0 . P i l l s b u r y , Barbara 1978 "'Doing the month': Confinement and Convalescence of Chinese Women a f t e r C h i l d b i r t h . " Soc. S c i . and Med., 1 2 : 1 1 - 2 2 . P o r k e r t , Manfred 1974 The T h e o r e t i c a l Foundations of Chinese Medic ine. Cambridge: MIT P r e s s . S w i d e r s k i , R i c h a r d 1978 "Chinese-American Patent M e d i c i n e s , " Ethnomedicine, 5 : 9 7 - 1 2 6 . T o p l e y , M a r j o r i e 1970 "Chinese t r a d i t i o n a l i d e a s and the treatment of d i s e a s e . " Man. 5 : 4 2 1 - 4 3 . 1976 "Chinese t r a d i t i o n a l e t i o l o g y and methods of cure i n Hong Kong," i n C. L e s l i e ed. A s i a n Medical Systems. B e r k e l e y : U. C a l . P r e s s . Unschuld, U l r i k e 1977 " T r a d i t i o n a l Chinese pharmacology: an a n a l y s i s of i t s development i n the t h i r t e e n t h c e n t u r y . " I S I S , 6 8 : 2 2 4 - 2 4 8 . 141 V e i t h , I l z a ( t r a n s . ) 1966 The Y e l l o w Emperor's C l a s s i c of I n t e r n a l Medic ine, t r a n s l a t i o n of the " H u a n g - t i Nei Ching Su Wen." B e r k e l e y : U n i v e r s i t y of C a l i f o r n i a P r e s s . V e n i n g a , L o u i s e 1 9 7 3 The Ginseng Book. F e l t o n , CA: Big Trees P r e s s . WHO 1977 "World H e a l t h O r g a n i z a t i o n Seminar on the Use of M e d i c i n a l P l a n t s i n H e a l t h C a r e , M a n i l a . " WHO 1978 The Promotion and Development of T r a d i t i o n a l Medicine" WHO T e c h n i c a l Report No. 622. Wickberg, E . ( e d . ) w i t h H. Con, R. Con, G . E . Johnson and W.E. Wilmott 1982 From China t o Canada: A H i s t o r y of Chinese Communities i n CanadaT Toronto: M c C l e l l a n d & Stewart." Wieger, L . 1965 Chinese C h a r a c t e r s . New York: Dover Pub. Wolf , Marjorey 1 9 7 2 Women and F a m i l y i n R u r a l Taiwan. S t a n f o r d : S t a n f o r d U n i v e r s i t y P r e s s . Wolf, M. and R. W i t t k e , ( e d s . ) 1 9 7 5 Women i n Chinese S o c i e t y . S t a n f o r d : S t a n f o r d U n i v e r s i t y P r e s s . Wu, D a v i d , . 1979 T r a d i t i o n a l Chinese Concepts of Food and Medicine i n S i n g a p o r e . O c c a s i o n a l Paper No. 55, I n s t i t u t e of Southeast A s i a S t u d i e s , S ingapore. Yeung, D . , L . Cheung, and J . S a b r i a 1973 "The h o t - c o l d food concept i n Chinese c u l t u r e and i t s a p p l i c a t i o n i n a C a n a d i a n - C h i n e s e community." j . Can. D i e t e t i c A s s o c . 3 4 : 1 9 7 - 2 0 3 Young, John A. . 1974 B u s i n e s s and Sentiment i n a Chinese Market Town. T a p e i . 

Cite

Citation Scheme:

        

Citations by CSL (citeproc-js)

Usage Statistics

Share

Embed

Customize your widget with the following options, then copy and paste the code below into the HTML of your page to embed this item in your website.
                        
                            <div id="ubcOpenCollectionsWidgetDisplay">
                            <script id="ubcOpenCollectionsWidget"
                            src="{[{embed.src}]}"
                            data-item="{[{embed.item}]}"
                            data-collection="{[{embed.collection}]}"
                            data-metadata="{[{embed.showMetadata}]}"
                            data-width="{[{embed.width}]}"
                            data-media="{[{embed.selectedMedia}]}"
                            async >
                            </script>
                            </div>
                        
                    
IIIF logo Our image viewer uses the IIIF 2.0 standard. To load this item in other compatible viewers, use this url:
https://iiif.library.ubc.ca/presentation/dsp.831.1-0107103/manifest

Comment

Related Items