Category Archives: Global Asian Medicines

Alternatives to Oriental-ism

[Although this post was written for practitioners of acupuncture and East Asian medicines working in the United States, I am posting it here in the hopes of inviting historians, anthropologists, and others working on related topics into this active conversation.]

Orientations:

Beginning in the wake of the protests memorializing George Floyd, Breonna Taylor, and too many others in summer 2020, two movements began to address a related issue of racism within our own scholarly and professional field. At the grassroots level, Influential Point launched a petition and campaign requesting that the U.S. acupuncture and oriental medicine (AOM) community remove this racist word from our professional discourse. At the administrative level, Dr. David Lee, the Academic Vice President of Alhambra Medical University in California, initiated a campaign among his peers to “repeal and replace” the word “oriental,” school by school, in school names and degree titles, with the goal of carrying this momentum forward into pressuring ACAOM and NCCAOM to do the same. Collectively, it would seem, the moment has come for making long-overdue, necessary change.

But after determining to not use this word, what other word should we use? And more importantly, how do we make that choice? How might we, the professionals impacted by the name and public face of our craft get a say in making it? If practitioners wish to have a voice in the decision about how we redefine the AOM profession to patients and our broader communities, step one is educating ourselves about the pros and cons of commonly proposed alternative names.

This list of terms, and breakdown of some of their more salient associated issues, is by no means exhaustive. This paper presents a starting point for opening an informed discussion based on something other than personal opinions. It is further my hope that it will help readers cultivate an appreciation for the many different filters through which different people can see the world, let alone a single word. For this reason, each term needs to be looked at from many possible perspectives. One person’s opinion is not going to decide this for us. Nor should it.

I am a clinician, philologically trained translator of classical Chinese, and historian-in-training. This is to say that I have spent countless hours researching and thinking closely about exactly what a word means, or what is the best way to translate X concept into Y language, or for Z type of audience. At the most fundamental level, any alternative would be better than the deeply embarrassing, racist word that we currently use. That said, how we choose our marginally better word matters, too. It is an opportunity not only for learning and self-reflection about the word “oriental” that we seek to replace. It is also an opportunity to recognize some of the many ways in which our field is Orientalist – perpetuating a reified notion of an exotic, but ultimately undifferentiated or falsely uniform, “alternative” or “other-than” medical culture.

Credit: World map in the form of an FFA of the retina. Credit: Jon Brett.

How much do we wish to engage in the work of examining Orientalism within our field – self and public perceptions – along with changing its presently Orientalist name?

To change the broader dynamics (removing Orientalism), rather than only the most visible external manifestation of those dynamics (removing only the word oriental), are two separate things. In my opinion, we should not neglect the former opportunity in our rush to correct the latter problem. The work of examining the Orientalism that permeates our field is important work because it can help us to clearly define and create a professional community. At present, the AOM field in the United States, with its crazy-quilt patchwork of organizations, state practice scopes, regulatory agendas, and heterogeneity of training, entirely lacks professional cohesion. Such fragmentation prevents us from standing united against threats to our scope of practice, such as dry-needling, let alone advocating more strongly for our potential role as first point of contact providers of healthcare in a country desperately in need of primary care providers.

How might we use the process of reflecting on replacement terms as a kind of professional praxis, forcing us to confront the ways in which words matter because words connote as well as denote, delimit, and define?

The idea that the name or definition of something matters – that a name should accord well with the thing it names – is not a new or radical one. Rather, we know that Confucius himself advocated for the “Rectification of Names,” warning against the confusion and social unmooring created by the drift between signs (names) and the things they signify. As we come together as a collective in exploring the full context of each possible term, we are also forced to open a conversation about what values undergird our selection strategy. Naming ourselves presents an opportunity to better define the dynamics of our profession as a whole, our individual positioning within these dynamics, and a collective re-envisioning of how we wish to define ourselves and our practice.

Click here to continue onto a term-by-term discussion of replacement words (document linked to preserve footnotes and formatting of the reference list included as a bibliography):

Can use of acupuncture delay proper medical treatment?

Introduction

Even though there is room for more thorough adverse effect reporting in acupuncture trials and a need for more studies about acupuncture safety (Ng et al. 2016; Turner at al. 2011), there already exists evidence concerning the safety of acupuncture. Based on the studies (Witt et al. 2009; Kim et al. 2016; McCulloch et al. 2015; Park et al. 2014; Houzé et al. 2017), we can conclude that generally acupuncture can be seen as a relatively safe practice. The adverse effects from acupuncture are extremely rare compared to reported adverse effects from conventional medicine. The FDA Adverse Event Reporting System (FAERS) Public Dashboard reveals 906,773 serious side effect reports and 164,154 deaths from side effects or malpractice in 2017 alone. This is an unfair comparison as the patient base and seriousness of the conditions treated are often very different, but it gives us a perspective to the safety of acupuncture in comparison with many other medical treatments. And even the most serious side effects like pneumothorax from acupuncture seem to be preventable with sufficient training in acupuncture education (Kim et al. 2016).

In the acupuncture studies about patient safety, the subject has been approached from the point of safety of the treatment itself. There seems to be a lack of studies about the possibility of delayed medical treatment in cancer or other severe medical conditions due to the use of acupuncture. This essay approaches the subject with reflection on a patient case.

Case background

The author first met the patient in 2011. The patient had suffered from recurring, almost constant uveitis for 15 years. Known causes of uveitis had been previously excluded by medical doctors. The only treatment offered to the patient was ophthalmic steroids. Prolonged use of the steroids had increased her intraocular pressure causing glaucoma that threatened her diminishing vision. The ophthalmologist wanted to start a more robust and constant medication for glaucoma with a drug having the side effect of flaring of uveitis. The patient wanted to try acupuncture as an alternative.

After five sessions of acupuncture, the symptoms of uveitis had clearly decreased and she had reduced the use of corticosteroids. She had permission from the ophthalmologist to dose corticosteroids based on need. During the following months, she used them only twice when she felt any peculiar feelings in her eyes. Five months later she visited her ophthalmologist who could not see any signs of uveitis. Due to increased intraocular pressure, they had agreed for regular follow-ups. Beside one occasion in 2012, she has been without corticosteroids and free from uveitis.

In addition to uveitis, she had a medical history of back and joint pains, and Ménière’s disease.

During her initial visits to author’s clinic, she expressed her growing frustration with medicine and how she felt like a test subject. The doctors could not give a reason for her symptoms, and to her it seemed illogical to use medication causing uveitis to treat problems caused by the medication for uveitis. She also felt that some doctors she had met had been unprofessional in their behaviour. Side effects and dissatisfaction to conventional health care are among common reasons for trying acupuncture (Jakes et al., 2014).

Radical change in patient’s health

In 2015, the patient wanted to try acupuncture for fatigue. She had already visited a medical doctor through occupational health care who didn’t find anything alarming. The author performed acupuncture based partly on her previous background information and her current symptoms. Afterwards, she reported a slight initial improvement, but the exhaustion soon returned and was non-responsive to further attempts with acupuncture.

After a third acupuncture treatment she caught a flu and visited another doctor who took a chest X-ray that revealed a cancerous growth in her lungs. The patient was treated with surgical removal of the tumour. Because of inappropriate joking by the operating doctor just before the surgery, she felt mistreated again even though the surgery was successful. Soon after the surgery she contracted pneumonia. During follow-ups later on, her papers were not read properly leading to surgical marks visible in the X-ray to be mistaken as a sign of pulmonary embolism. Two months of unnecessary subcutaneous injections added to her mistrust of the whole medical profession even though the surgery itself had been successful.

During these events the patient contacted the author and told him about the correct diagnosis. She didn’t blame the author for misdiagnosis. But for the author this caused concerns and a need for reflection. How could something this serious be missed even when the cancer was advanced enough to cause serious fatigue? Could this be prevented from happening again?

Meeting in 2017

In 2017, the patient reserved time from the author because of vertigo caused by Ménière’s disease. The prescribed medication was no longer effective. During the meeting she gave a detailed account of her experience with surgery and how she felt afterwards. She was angry and frustrated and said she had little faith left for the health care system even though she had been saved by the medical procedure. During the session she gave permission for using her case as a case study. After giving the permission, she was told that the treatments would be free of charge.

Meeting her after the incident produced conflicting thoughts. Because of her past, the current condition felt more alarming. Why did her medication suddenly stop working? Was the dizziness caused by Ménière’s disease, a simple benign positional vertigo or was it something more severe? What if this was somehow connected to her previous condition? There was also curiosity and a need to ask questions about her previous health concerns that might shed some light to the author’s wrong diagnosis.

She had already seen her physician to screen out anything serious but still the situation stirred some insecurity in the author. During the discussion and diagnosis she revealed that she had recently lost her job and was now unemployed. So she was particularly happy to receive free treatments. Lack of money combined with free treatments might also increase the possibility of an already vulnerable patient to feel more dependent on the acupuncturist or it could produce a feeling of groundless gratitude. Having less money might also mean that she might be less willing to see a doctor in case the acupuncture treatment did not work, especially with her experiences with the public health care.

While describing her experiences and expressing her mistrust with the medical profession, she didn’t seem to consider the author to be part of the medical profession. In Finland, the author is a registered health care professional due to being a licensed masseur, but an acupuncturist is not an accepted health care professional nor is there any legal regulation about the profession. The professional associations are working to self-regulate the field, set educational criteria, enforce the following of ethical guidelines, and ensure that the professionals have proper insurances.

For the author, it was important to meet the patient face to face after making a wrong diagnosis. There were no signs of blaming or mistrust from the patient. Her patient records had been reviewed in 2015 and again before the appointment. There was no evidence of neglecting of symptoms, and she had already visited a medical doctor beforehand. It was crucial for the improvement of practice for the author to become more aware of possible consequences. It made the author question his own responsibilities and also the boundaries of his practice.

Analysing the case

During 2015, the author had failed to recognize lung cancer. The examination and questions asked during the visit could have been more thorough. Owing to the fact that the patient was previously known, there was a possibility of using information gathered during earlier visits. This combined with the shorter time reserved for returning patients might have made it harder to be cautious enough. The TCM diagnosis based on the discussion, pulse, and tongue during the visit revealed what is known in Chinese medicine as a deficiency of blood and a weakness of lung qi. Relying on the patient history while formulating a picture of the current situation might have affected the understanding of the real reason for exhaustion and how serious her case was. The medical expertise of the author did not enable him to recognise the underlying reason. A similar mistake was probably made by the medical doctor in occupational health care who failed to see cause for further tests. Given the patient’s earlier bad experiences with health care, she probably might not easily go back for a second opinion. In this case, it was pure luck that the patient caught the flu and was sent to x-ray.

The seriousness of the situation also raises other concerns. What if the patient had gotten better results from the acupuncture treatment? In that case, could the better results have delayed a proper diagnosis and medical treatment? And what role does the therapeutic relationship play in a possible delay of proper treatment?

There exists some evidence that acupuncture is effective in treating cancer-related fatigue (Duong et al. 2017; Zhang et al. 2018; Zick et al. 2016). These studies focus on fatigue in connection with conventional cancer treatments, but acupuncture might also diminish the fatigue caused by cancer itself. Definite scientific evidence for the effectiveness of acupuncture for cancer pain is still lacking (Wu et al. 2015), but there is reason to believe that acupuncture might provide some relief from cancer pain (Hu et al. 2016; Chiu et al. 2017). So there is a possibility that acupuncture might prolong the time before the patient goes to see a doctor. An acupuncturist might see diminished fatigue and/or pain as evidence of successful treatment, which might in reality delay proper medical treatment. However, in case of pain, the same could easily happen with self-administered and commonly available pain killers. The fatigue might also diminish with energy drinks (Warnock et al. 2017), but the effects wouldn’t probably last for long. However, it could also be possible that by visiting an acupuncturist frequently, the acupuncturist could notice if there was no response to treatment or that the results were not as long-lasting as they should be. At least the acupuncturist would notice if the condition of the patient seemed to deteriorate despite the treatments. This could easily alarm a professional acupuncturist so, in this way, the acupuncturist would provide an extra pair of eyes watching for the patient’s health. In Finland, the acupuncture associations require the signing of ethical conduct which states that all acupuncturists refer cases to medical doctors when medical treatment is needed.

A study by Shorofi and Arbon (2017) offered some reasons why patients are opting to use CAM therapies instead of medical therapies. In the study, in all the people opting for CAM therapies, the most relevant reasons for this case study were that the problem was not seen serious enough to see a doctor (21.4%), a belief that these alternative treatments have fewer side effects than conventional ones (16.9%), and dissatisfaction with conventional treatments (6.8%). Combining these percentages with those of people who felt that CAM therapies were more fitting to their personal lifestyle or philosophy (37.7%), there is some evidence of a group of people who might not prefer to see a medical doctor in the first place. The study was done among hospitalised patients in Australia, but the author is in agreement over these patient groups and confirms similar numbers based on his own patient records and experience.

In serious diseases, like cancer in this case, medical diagnosis and intervention as early as possible is paramount. The symptoms, however, can begin with only minor health complaints. The 21.4% of population who use complementary modalities consider their problems not serious enough (Shorofi and Arbon 2017), but they might still find their way to the acupuncturist who, with adequate training, could be able to recognise the severity of the symptoms and could advise the patient to see a doctor.

The example patient in this essay had a medical diagnosis from her ophthalmologist for her previous condition. But in Finnish acupuncture clinics, it is very common to meet patients with medically unexplained physical symptoms (MUPS). These patients do not have a diagnosis and often feel that in conventional medical care they are misunderstood and their symptoms are not always taken seriously (Lipsitt et al. 2015). This same patient group generally obtains poor clinical outcomes from medical practice (Lipsitt et al. 2015), which might lead them to further avoid medical doctors. Some of these patients might feel more understood by CAM practitioners in general. Depending on the type of therapy, this could partly be due to the duration of initial interview and time used during the treatment, or more cosy clinical settings. It might be the CAM practitioner who first notices that their symptoms start to change or become worse, signalling that there might be a need to see a doctor. However, if the CAM therapist fails to see the alarming signs, the patient might get non-optimal treatment and believe that he gets all the treatment he needs. This could be preventable with proper education and further cooperation with medical doctors.

An even more alarming group than the MUPS patients who often burden health care with their constant visits (Lipsitt et al. 2015), are those who feel very dissatisfied with their medical care and are avoiding seeing doctors. This group is easily left without treatment by their own choice. Some of these patients might still be willing to see an acupuncturist. In that case, more serious and easily recognised problems might become apparent and they could be referred to health care, if they can be persuaded to make an appointment. Within these patient groups, there are people who feel vulnerable and, sometimes, they do not know where they should go and which symptoms they should tell their doctors. In their case, even one bad experience with a medical doctor can lead to further aversion of medical procedures and tests. For them an acupuncturist might be seen as a neutral bridge for communication to conventional health care.

CAM modalities are also often selected because of recommendations or wanting self-control over an illness (Shorofi and Arbon 2017). Many patients from the group who feel CAM therapies are more fitting to their personal way of life may not easily visit a doctor for any minor complaints. Based on the author’s experience, the people from these groups are generally willing to see a doctor when faced with any serious conditions or when told so by an acupuncturist. The problem for these patients is to recognise what is relevant and what is serious enough. Those seeing an acupuncturist with at least a basic education of medicine, could then be told by the acupuncturist to see a doctor if needed.

Conclusions

The failure to recognise lung cancer by the author and by a medical doctor in occupational health care was a human error. The proper acupuncture studies in Finland include a minimum of 14 to 30 ECTS of medicine, depending on the year of graduation, and lung cancer is one of the most difficult forms of cancer to diagnose even for general practitioners (Rankin et al. 2017). Mistakes can happen for any medical professional and CAM practitioner alike, but delays in treatment can lead to disease progression and missed opportunities for cure in a significant subset of patients (Rankin et al. 2017). In conventional care, it is customary to refer the patient to a specialist for diagnosis in case the general practitioner suspects cancer or another more serious disease. A similar attitude is crucial for patient safety among all CAM modalities. Wide cooperation with medical doctors would ensure patient safety and could also encourage some vulnerable patient groups to visit a doctor in time. It might also provide a bridge for communication to patients with MUPS or other patient groups who may feel more understood by CAM practitioners.

Based on these reflections, the author claims that there exists a possibility for certain groups of people to be left without early recognition of serious diseases in conventional health care and in clinics offering CAM modalities. In developed Western countries, most patients already go to a medical doctor in case they suspect anything serious. Those coming to see an acupuncturist or another CAM practitioner have often already visited a medical doctor (Eisenberg et al., 2001). Those who have considered their problems too minor for needing a doctor may still try acupuncture. In case the acupuncturists suspect any more serious health concerns, the professional acupuncturists always ask the patient to visit a doctor. In Chinese medicine education, it is necessary to teach acupuncturists to become aware of their own limitations. In acupuncture education, the students need to be taught to communicate with the patients honestly, if they cannot understand the symptoms or they have any suspicions.

The ability of an acupuncturist to recognise important clues about serious health issues depends on education and clinical experience. Even though Chinese medicine courses are not meant to produce medical doctors or to teach how to make a conventional medical diagnosis, they aim at providing enough understanding when it is necessary to refer the patient to medical care. As the popularity and acceptance of acupuncture is growing fast and more and more research about its effectiveness is emerging, the acupuncturists will receive more and more patients seeking alternatives. With growing public awareness of acupuncture, there will be more and more patients coming with grave illnesses that require conventional medical treatments. The need for basic medical education and continuous education for acupuncturists cannot therefore be stressed enough.

It is also crucial for acupuncturists, and other CAM practitioners, to network themselves with medical doctors whom they can refer the patients to or ask for an opinion. Awareness of these critical situations can also be improved with open discussion and sharing experiences with other acupuncturists or practitioners of other CAM modalities.

Some patients have withheld information from their doctors about their nutraceuticals recommended by their nutritional therapists or herbs recommended by CAM practitioners. In the study by Eisenberg et al. (2001), three fifths of CAM therapy used was not disclosed to doctors. The common reason is that the doctor didn’t ask and some patients were also afraid that the doctors would not agree or understand (Eisenberg et al., 2001). This can be very dangerous considering the potential interactions (Salminen, 2018) with drugs used in cancer treatment, for example. The possibility that the patient uses some CAM modality is ever increasing. According to Eardley et al. (2012) “the prevalence of CAM use varied widely within and across the EU countries” and could be even as high as 86% of the population in some countries. The most commonly used modality is herbal medicines. If the patients sense a strong dichotomy between CAM practitioners and medical professionals, it can cause the patients to withhold vital information. It is important that acupuncturists also recognize these dangers and are able to inform their patients and form patient relationships based on trust. They need to tell their patients to inform their doctors or practitioners of other CAM modalities about any treatments they give, especially if they prescribe any medicinal herbs or products.

The acupuncturists and Chinese medicine practitioners might also hear about the use of falsified medicines that can endanger the patients (Hamilton et al. 2016) or other unregulated and possibly harmful products. The acupuncturists can report these potentially harmful products to local authorities and inform their patients about possible dangers in their use. The author believes that information about the use of unregulated or falsified medicines might be left out during visit to a doctor just as easily as the patients withheld information, such as using CAM modalities, and an acupuncturist can instruct their patients to disclose this information.

With patients having any previous dissatisfaction with medical care, extra caution should be taken. In case of any suspicious symptoms, the patients should be instructed to see a doctor, if they have not already done so, to avoid a late diagnosis of serious medical conditions. Making patients agree to see a doctor probably requires building a good therapeutic relationship. The practitioner of any CAM modality also needs to be aware in his therapeutic relationships that a patient might also easily get a wrong idea of the effectiveness. The patient in this case reserved time to check if acupuncture could help with Ménière’s disease when medicine failed. She had already had made the assumption that vertigo was because of Ménière’s disease and that acupuncture might help. Currently, there is preliminary evidence that acupuncture might work for Ménière’s disease (He et al. 2016) but her expectations were high because of the previous success with uveitis. It is sometimes almost impossible to avoid giving false hope by just agreeing to treat any less commonly treated symptoms. Not treating or overly explaining that the treatment might not work might harm the therapeutic relationship and even prevent the referral to a doctor in case it is needed.

Reflecting upon therapeutic relationships and clinical skills after this incident, the author became more aware of possible consequences of his therapeutic practice. It would be unrealistic to think that these mistakes couldn’t ever happen in the future, but there are always ways to improve the practice. He will now reserve extra time for returning patients if a few years have passed from the last session. With this he tries to ensure that he has enough time to collect information. Even in cases of seemingly minor complaints that do not respond to acupuncture treatments, the patients will from now on be routinely encouraged to see a doctor upon termination of the course of treatment. Before, the patients have already been asked to see doctor if there have been any alarming symptoms, but minor health concerns might have been previously overlooked. The author himself sees the work of an acupuncturist very tightly interwoven with the medical profession and sees further cooperation between different medical modalities as a requirement for patient safety. The author also concludes that it is unlikely that offering acupuncture would generally cause delays in diagnosis and treatment of a serious disease like cancer, but there is definitely a lack of proper studies in this area.

 

References

Chiu, HY., Hsieh, YJ. and Tsai, PS. (2017) Systematic review and meta-analysis of acupuncture to reduce cancer-related pain. European Journal of Cancer Care. 2017 Mar;26(2).

Duong, N., Davis, H., Robinson, PD., Oberoi, S. Et al. (2017). Mind and body practices for fatigue reduction in patients with cancer and hematopoietic stem cell transplant recipients: A systematic review and meta-analysis. Critical Reviews in Oncology/Hematology. 2017 Dec;120:210-216.

Eardley, Susan., Bishop, a Felicity L., Prescott, Philip. Et al. (2012) A Systematic Literature Review of Complementary and Alternative Medicine Prevalence in EU. Forsch Komplementmed 2012;19(suppl 2):18–28

Eisenberg, David M., Kessler, Ronald C., Van Rompay, Maria I. Et al. (2001). Perceptions about Complementary Therapies Relative to Conventional Therapies among Adults Who Use Both: Results from a National Survey. Annals of Internal Medicine. 2001 Sep 4;135(5):344-51.

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Houzé B., El-Khatib H., Arbour C. (2017) Efficacy, tolerability, and safety of non-pharmacological therapies for chronic pain: An umbrella review on various CAM approaches. Progress in Neuropsychopharmacology & Biological Psychiatry. 2017 Oct 3;79(Pt B):192-205.

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Āyurveda, Modernity, and Time

Moderator’s note: Many practitioners of Asian medicine and Asian-based health modalities are grappling with questions concerning the historical roots and cultural status of their disciplines today as never before. In response, Asian Medicine Zone is launching a new series of practitioner essays exploring how changing conceptions of “tradition” and “modernity” are impacting their practice and field in the 21st century (these are organized under the tag “tradition/modernity”). If you’re interested in contributing to this seriesplease email a short description of your proposed essay to the moderators. Here, we’re pleased to share our third offering, a poetic reflection on the paradoxes involved in being an Ayurvedic educator/practitioner who’s well aware of the culturally contingent and politically contested nature of the practice.

On the morning I sat down to write this, the Nobel Foundation announced it had awarded the 2017 Prize for Biology or Physiology to the American scientists Jeffrey C. Hall, Michael Rosbash, and Michael W. Young for their work in the field of chronobiology. Over decades of meticulous lab work, the trio isolated the “period gene”, and described how the protein it encodes regulates each cell’s rhythm of vitality and rest in relation to cycles of light and dark.

The news made me smile.

After nearly 15 years of studying and practicing the narrow stream of Āyurveda to which I’ve had access – modernized, Anglicized, commodified, and merged with reconstructed European naturopathies – I’ve come to the personal conclusion that the most general gift this art form offers is insight into how human beings can heal our relationship to time.

My first Ayurvedic mentor said, “We are living in the most vāta-aggravated period in history, but we can take great comfort in the faithful stability of the solar cycle.” Using the mathematics of Jyotiṣa, he taught us the daily calculations for finding solar noon, and the precise transitions between the kapha, pitta, and vāta periods of day and night. He taught us how the stress of sundowning could be eased by meditation at dusk, about why we should avoid staying awake past the “pitta threshold” – that tripwire that gives us a second nocturnal wind, better applied to dreaming than internet browsing. He taught us how to calculate the pre-dawn moment of brahma muhurta, when the fluctuations of air and space seem to relax, and groundless anxiety can yield to expansive possibility.

The lessons communicated both primal dependability and existential maturity to an uncertain, insomniac, gaseous world. I began to feel that the “knowledge of longevity” for which Āyurveda is named is not so much about personal wellness goals as it is about making peace with time, which means making peace with change, which means making peace with death, the pole star of stress.

This core idea, fleshed out in the broad principles of dinacharya (“to follow the sun”, according to my teacher’s nirukta) has remained as stable for me as the solar cycle itself. It has survived the numerous waves of disillusionment I now see as natural to the interrogation of an unconsciously adopted religion.

My resonance with dinacharya has survived realizing that my exposure to Āyurveda has come through an alchemy of the neo-colonialism that wants to commodify it for export and the Hindutva ideology that wants to claim it as part of a saffronized patrimony. The former thinks it can be packaged and sold. The latter wants to deny that Buddhists played an essential role in its early formulation.

It has survived realizing that Āyurveda’s gender essentialism and heteronormativity – whether authentic to its historical roots or not – can be subtly oppressive to the women’s consumer market it claims to serve. (Not to mention wondering whether its obsession with human fertility is coherent in a world racing past its carrying capacity.)

It has survived realizing that modern global Āyurveda can provide sanctimonious cover for neoliberal propaganda, and contribute to the anxiety of privatized, aspirational responsibilism. Āyurveda in current practice can reinforce the punishing belief that self-care is the only care we can rely on, or that oil massage makes the world a better place, or that health is assured through kitchari and memorizing the doshic implications of red grapes versus green grapes.

It has survived watching friends from the country of the Nobel-winners use Āyurveda to faithfully but unsuccessfully manage cancer because they either distrust public medicine, don’t have health insurance, or both.

It has survived realizing the hypocrisy of Āyurveda’s marketing as a common sense, low cost, local economy wellness modality, whilst outside of low-income India it mainly flourishes as a lifestyle brand and leisure activity for the wealthy, consumable through long-distance spa vacations and carbon-heavy importation. Globalization popularizes and sells the notion of local authenticity through the process of destroying it.

It has survived realizing that Āyurveda’s premodern somatic poetry is elliptical enough to help contemplatives interrogate their internal sensations, but also vague enough to serve as a platform for Deepak Chopra to authenticate pseudoscience.

It has survived watching the rise of Baba Ramdev use Āyurveda as a tool of blood-and-soil purification: selling spiritually-inflected skin-lightening creams, or researching herbs that will cure homosexuality.

And today, it will survive both the grandiosity of biologists who have “discovered” that life has rhythm, and the patriotic fantasies of those who will claim that the “period gene” is described in the Vedas.

“Āyurveda is said to be eternally continuing because it has no beginning,” says Charaka (via Sharma). “Our understanding of Āyurveda has arisen a posteriori to Āyurveda’s eternal laws.”

I have only a dim understanding of where the cultures of Āyurveda have come from, and no real clue as to where they’re going, or how much trouble and joy they will foster. But between these mysteries lies a present, palpable phenomenon that points to the notion of “eternal law”. Even a deconstructionist such as myself can get behind it, and treasure it.

Through these histories of colonial, capitalistic and epistemological violence – histories that may cause more disease than the bacteria and viruses that Āyurveda cannot treat – the earth still turns in its measure. It faces the sun, and then faces away. The body radiates and grows dark. The identity extroverts and introverts. We wake and sleep. Dinacharya does not solve capitalism, climate crisis, or death. But it looks clearly at the rhythms of change, and perhaps relieves us of the suspicion that time is meaningless.

Zen training in the U.S.: tradition, modernity, and trauma

Mushim and son at Green Gulch Farm Zen Center in 1990 when she was a penniless single mother, following six years of monastic practice under a vow of poverty. (Photo credit: Jack Van Allen)

Moderator’s note: Many practitioners of Asian medicine and Asian-based health modalities are grappling with questions concerning the historical roots and cultural status of their disciplines today as never before. In response, Asian Medicine Zone is launching a new series of practitioner essays exploring how changing conceptions of “tradition” and “modernity” are impacting their practice and field in the 21st century (these are organized under the tag “tradition/modernity”). If you’re interested in contributing to this seriesplease email a short description of your proposed essay to the moderators. Here, we’re pleased to share our first offering, which artfully explores the encounter between traditional patriarchal authority and contemporary social justice commitments in the author’s life, practice, and community.

Having spent over 30 years of my adult life as a Buddhist practitioner in the U.S., I’m certain of only one thing, which is this: in the process of spiritual maturation, the path is not always clear and straightforward. In my personal experience as a practitioner, there’s been a lot of both/and – a particular experience can be abusive and traumatic, and it can lead to insight and breakthrough. Necessary spiritual surrender can mix potently with what Western psychology calls poor boundaries. And, it seems to me, some people will always be drawn to take paths of greater risk in varying degrees, up to so-called crazy wisdom. Others will develop by staying true to conventional mores with quiet patience.

In 1984, I was living as a renunciant under a vow of complete poverty in a Buddhist community in the United States. Our teacher, a strong-willed Asian man, resided most of the time in Canada, with periodic visits to our startup temple in the Midwest. Probably like most of our convert Buddhist community, I had moved into the temple full-time with a great deal of hope and projection that the teacher, who was described by his senior students as a Zen master and enlightened being, would be my major role model of elevated qualities of compassion and wisdom as I somehow imagined them to be.

I had immediately been appointed office manager and treasurer when I moved into the temple. I started the office with a landline phone, a cardboard box for petty cash and receipts, a checkbook, and a small wooden bench that could be used as a tiny desk if one sat cross-legged on the wooden floor. There wasn’t enough money in the bank to pay our utility bills and mortgage when I moved in, so we cut every corner and pinched every penny.

It was under these pressured circumstances that I was quietly working in the office when the “Zen master” suddenly walked in and began screaming at the top of his lungs at me for making a long- distance phone call for business reasons during a time when rates were higher. As Zen students, we were taught to “eat the blame,” so I did, and simply apologized until he went away. A few days later, having complained to the temple director who told him that the reduced rate times for calling were different in the U.S. than in Canada, he sheepishly reappeared in the office and said he hadn’t had full information. This was somewhat short of an “I’m sorry I unfairly vented my rage on you.” But it was the best I could get under the circumstances.

I couldn’t talk to anyone outside our temple system about such incidents because they would immediately say, “Why don’t you leave?” And the fact was, I was also learning a great deal. There were so many beautiful aspects of our communal temple life of meditating together and manual work, cooking and cleaning and eating together. The teacher was also immensely talented and caring in many ways. It was confusing, and in the Buddhist practice we were doing, it was okay not to know everything at once.

Traditional Zen stories and Zen lore are full of anecdotes that involve hitting and yelling and enduring unfair accusations. By the time I became a renunciant, I was an adult woman with a master’s degree. I’d been married and divorced. I had worked various jobs in the secular world. And I’d been exposed to the women’s movement and lived through the civil rights era in the U.S. I was open to going through some strong, and even traumatizing experiences for the sake of spiritual training.

Things continued to be a dynamic mess. I ended up in an Asian monastery for 8 months in 1987-88. There, my life and identity as I had known them continued to be blown up. As I said some time after I returned, I felt as though I got completely chewed up by the patriarchy.

It is also completely possible that if I had been smarter and had better boundaries, I wouldn’t have ended up as badly as I did.

But I survived. I got back to California, and, struggling continuously with extreme poverty, raised a Buddhist child, and continued my practice. I promised my son and myself that I would find a way to live in Buddhist community where power was more equally distributed, and codes of ethics and democratic structures were in place. Buddhist life might continue to be a mess. But I wanted, at minimum, a more workable mess that aligned with my cultural values. I distinctly remember thinking, upon returning to the U.S. from the Asian monastic system, “I don’t have to get my way, but I will be damned if I don’t at least get to vote. I am an American, and I want my vote!”

I didn’t want to overthink any of this. All systems and forms have limitations, and attachment creates suffering – this is a universal principle of Buddhism which I personally have never found to be untrue. That being said, the reason I began Zen meditation in the first place was because I wanted to find a situation in which I could live with other people with forms of practice that encourage well-being, kindness and justice, while at the same time providing support for Awakening. And I’ve been fortunate, because I’ve spent the last eleven years working with others to create a diverse and social justice-centered urban meditation center in Oakland, California, where I live. For me, and for many others, East Bay Meditation Center has been the intersection of Dharma practice and community-based social justice activism and awareness where I can constantly explore Liberation in ways that don’t separate the spiritual world from the real experiences of structural violence that I experience or witness every day.

As a Buddhist teacher at East Bay Meditation Center, I teach in trauma-informed ways that I have learned as a yoga student from the social justice-based Niroga Institute in Oakland, California. The traditional forms of spiritual training that require students to withstand humiliation and abuse from those above them in a hierarchical model are, I’m convinced, not essential to a 21st century Eightfold Path. Why? Because for most people, especially those in communities targeted for oppression, life is already full of traumatic humiliation and abuse. What we need are ways to become resilient, whole, and wise in seeking environmentally sustainable ways to coexist nonviolently and joyfully.

My Bodhisattva vows, the same as millions of others who have taken these vows, are “to save the many beings.” Where the rubber meets the road is that we are different from one another, love is not always the answer, and conflict is inevitable. I’m fine with this particular dynamic mess of imperfection, as long as it’s worked with in the service of systemic justice and equity.

“Health” in the Buddhism and Science Dialogue

This is a syndicated post that first appeared on Patheos.com.

In the current dialogue between Buddhist traditions and the sciences—an engagement dominated by Tibetan and Zen Buddhists on one side and psychologists and neuroscientists on the other—the subject of health is featured prominently. However, despite the shared term, participants aren’t actually talking about the same thing.

Early proponents of the Buddhism-science dialogue, like Paul Ekman, Richard Davidson, Matthieu Ricard, and Alan Wallace, have focused on the theme of psychological health. One prominent outcome of this dialogue has been the mindfulness movement, which has grown out of the clinical study of Buddhist-based meditation practices. Recently, Buddhist scholars such as Robert Sharf and Jared Lindhahl have pointed out the ways in which Buddhism and mindfulness diverge on meanings of health and well-being.

A picture of good health - via pixelbay.

Definitions of health, as they enter into a field of knowledge, also participate within fields of power, with social and economic consequences. The gay and lesbian social movements, for example, had to fight to remove homosexuality as a mental illness in the Diagnostic and Statistical Manual of Mental Disorders, in order to gain the right to be recognized as healthy. It took another 16 years for the World Health Organization (WHO) to remove homosexuality from its International Classification of Diseases in 1990. Conversely, individuals may wish to receive the unhealthy label because of the rights gained from such recognition, especially in the case of gray area or borderline conditions such as migraines, fibromyalgia, or chronic fatigue syndrome.

The current focus is on an individualized health, where the burden is placed primarily on individual autonomy to strive for improvement and maintenance. The power structure of contemporary society shifts responsibility away from corporations that are responsible for pollution and government policy that allow them to get away with it (or pay for carbon offsets) towards individuals who bear the consequences. In other words, social ills are pathologized or medicalized as individual disease. Reflecting on these assumptions of health is a first step in changing these conditions.

The concept of health is by no means easy to pin down. But just as with the definition of religion, so notoriously elusive, tackling and constantly revisiting definitions of health may uncover the unexamined assumptions that mask its social power. Definitions delineate and set bounds, but that is not the end goal. The intent is not to arrive at a perfect, unchanging definition of health, but rather illuminate what it means to be healthy and why.

Scientific studies of Buddhist meditation and mindfulness practices examine how they can promote mental and somatic health. Clinical research on these practices have done the most studies on stress, anxiety, depression, hypertension, cardiovascular diseases, and substance abuse disorders. Looking for the philosophical foundation of health on which this body of research rests allows us to examine how the Buddhism and science dialogue does not have a consistent idea of health.

The first definition to consider is by the WHO, drafted in 1946 and still unchanged: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” WHO, it should be noted, bases its approach in the Western scientific model of medicine, as evidenced by their exclusion of all else as complementary/alternative medicine. And like its conception of medicine, WHO’s definition of health assumes a paradigm situated in Western modernity. This definition of health, however, has been criticized as being vague, idealistic, conflating health with happiness, and difficult to operationalize or measure. Since scientific research need physically measurable and operationalized definitions, this is not the likely foundational model. For example, Erika Rosenberg et al.’s 2015 study that shows how meditation impacts compassion could not simply claim subjects showed more sadness when viewing upsetting images. Rather, they had to record physical data from all 44 muscle groups on the face to make the case that the subjects were indeed sad. This emphasis on concrete data suggests that the WHO’s difficult-to-operationalized definition does not support these studies.

A more likely candidate for  the philosophical foundation of such research is a negative formulation of health, which defines health as the absence of disease, in contradistinction to WHO’s positive formulation. Bjørn Hofmann argues there is no positive definition of health in the philosophy of Western medicine because the field can function without it. Christopher Boorse articulated a definition that accommodates scientific research: a biostatistical definition of health.

In his widely cited 1977 essay Health as a Theoretical Concept, Boorse gives the following definition: “health is normal functioning, where the normality is statistical and the functions biological.” For example, since the biological function of the heart is to pump blood, an individual is healthy if her heart is able to perform within a statistical range compared to  her peers. Boorse champions the biostatistical definition of health as “value-free”, which he considers a benefit, based on his desire to provide an objective scientific definition. However, his view has been criticized as not truly value-free, and also has been opposed by those who argue for “value-laden” accounts of health and illness. Problems with taking this definition for granted include reifying a statistical norm, which excludes the differently abled, neuroatypical, and other underrepresented minority groups (statistical, and otherwise) as healthy.

It is important to note the lack of attention towards this term in the Buddhism and science dialogue, despite its common usage. The surface compatibilities between the two conceptions of health dissolve upon further investigation, which reveals deep incongruities. For example, the studies on how Buddhism-based meditation can alleviate anxiety and prevent depression relapse presume the latter are unhealthy mental conditions. The contemporary understanding of these states associate them with loss of value, hopelessness, despair, distress, shame, and anger. Sharf develops Gananath Obeyesekere’s observation that these states reflect a good Buddhist who has overcome ignorance and are signs of Buddhist mental health, defined as wisdom and insight into the predicament of samsaric reality: that to live is to suffer. Lindhahl questions if the way suffering is addressed in mindfulness-based interventions is the same as how Buddhism addresses suffering. He notes that there is no agreed upon operationalized definition of suffering in psychology. Rather, there are components such as stress, anxiety, and depression. And the resulting reduction of suffering for the purposes of mental health rests in large part on reduction of symptoms. In contrast, he argues Buddhist models of health explains the origin of suffering, and thus the way to reduce, alleviate, or overcome it towards health and well-being, is in relation to ignorance, craving, and karma.

The Buddha said that health (arogya, literally the absence of illness), is “the highest gain (labha).” He is portrayed in the canon as the “king of physicians” (vaidyaraja), concerned with healing sentient beings from physical illness and soteriological dis-ease. The Four Noble Truths have been compared to four stages of medical treatment: diagnosis (the truth of dukkha), etiology (cause of dukkha), prognosis (cessation of dukkha), and cure (path to cessation). Pierce Salguero (2014) provides the following summary:

From its very inception in northeastern India in the last centuries BCE, the Buddhist tradition has advocated a range of ideas and a repertoire of practices that are said to ensure health and well-being. Early Buddhism also provided devotees with certain types of rituals to comfort the sick and dying, ascetic meditations on the structure and function of the body, and monastic regulations on the administration and storage of medicines. Buddhist texts also frequently used metaphors and narrative tropes concerning disease, healing, and physicians in discourses explaining the most basic doctrinal positions of the Dharma. As Buddhism developed in subsequent centuries, a number of healing deities were added to the pantheon, monastic institutions became centers of medical learning, and healer monks became famed for their mastery of ritual and medicinal therapeutics.

The above examples reveal that although Buddhism is concerned with health, its models of health are difficult to reconcile with the paradigm of health assumed by most researchers in this dialogue, who are conducting studies on how meditation affects health and well-being. To elaborate, the Pali canon mentions demons, imbalance of the four elements, and tridosa (the “three defects” or “three disturbances”)—Wind, Bile, and Phlegm—as causes of physical disease and suffering. Mental illnesses are caused by illusions or wrong views (greed, ill will, pride). In addition, Buddhist conceptions of health are intricately tied to ethics and karma. Unethical conduct may lead to karma that causes physical illness.

via pixelbay.

Though Buddhist meditation has been researched as a means to lower blood pressure and stress, in early Chinese Buddhism, meditation was prescribed as an activity to get rid of negative karma. According to Zhiyi’s classification of the causes of illness, one etiological category was improper meditative practice. Some Chinese and Japanese Buddhists warned of meditation sickness (禪病 Ch. chánbìng, Jp. zenbyō). Willoughby Britton’s work on “The Varieties of Contemplative Experiences” highlights potential adverse effects of meditation in Buddhist and other contexts. Thus, while meditation is currently promoted for health, it can have the opposite effect.

Even if one is not interested in Buddhist soteriology, or Buddhist conceptions of karma (which entails rebirth and is not a psychologized karma of “secular” or “atheist” Buddhist interpretations), looking to Buddhist models of health is a step away from accepting the contemporary biostatistical model. It is an open question if and how much Buddhist models can influence the current model. Nevertheless, raising this topic is a first step if the dialogue between Buddhism and science wishes to learn from each other.

What does a society look like if it treats the Buddhist poisons of greed and hatred quite literally as causing mental illnesses? What happens if people are deemed unhealthy when such greed and hatred leads to a lack of meaningful relationships to other sentient beings and the environment? Should there be more attention towards social defects and imbalances as causes of disease? While Buddhist societies in the past will never live up to a romanticized ideal, the supposed goal of the dialogue is toward mutual understanding and improvement.

Rather than leaving the term health unexamined, investigating science and Buddhism’s convergences and divergences on health sheds light on the relationship between the two fields, which are not monolithic unchanging entities. There may be few psychologists today who, taking after Freud, consider religion in general as a neurosis, or like his student Franz Alexander, understand the Buddhist obsession with self-absorption as mental illness. Yet, some scientists—like biologist Richard Dawkins and neuroscientist Sam Harris, or other “militant/new atheists”—consider religion as a social ill. On the other side, there are Buddhists like Tsültrim Lodrö, a contemporary Tibetan Buddhist scholar and head of a monastic college who criticizes the sciences as less rational than Buddhism. To invert Alexander, it is not difficult to imagine Buddhists who see modern psychology’s obsession with ego-self-development as deluded mental illness.

Image via pixelbay.

Looking at health also clarifies the relationship between Buddhism and mindfulness. Touted as a panacea, mindfulness has been advocated as mental hygiene, one of the newest health fads. Critics of the Mindfulness movement question what sort of mental health the practice of nonjudgmental, present-centered awareness cultivates. To obviate the problems with an unreflective definition of healthelucidating this term will lead to new directions in healthcare and clinical research, and provide fodder for the dialogue. It will challenge what it means for individuals, communities, and societies to be healthy.

 

Boorse, Christopher. 1977. “Health as a Theoretical Concept” Philosophy of Science 44 (4): 542-573.

Rosenberg, Erika L., et al. 2015. “Intensive Meditation Training Influences Emotional Responses to Suffering.” Emotion 15 (6): 775–90.

Salguero, C. Pierce. 2014. “Buddhism & Medicine in East Asian History.” Religion Compass 8 (8): 239–50.

When East Meets West

This is a syndicated post that first appeared at http://www.hopkinsmedicine.org/research/advancements-in-research/fundamentals/in-depth/when-east-meets-west

By Catherine Gara

In 1969, Chinese researcher Youyou Tu was recruited to Chairman Mao’s top-secret Project 523 to help find a new drug to treat malaria. This October, she was awarded the Nobel Prize in Physiology or Medicine for discovering the lifesaving drug artemisinin in extracts of Artemisia annua L., a plant known to Chinese to have medicinal properties since at least the fourth century. Her win has brought renewed attention to the dynamic relationship between Chinese and Western medicine. At Johns Hopkins, two faculty members from very different fields are exploring that relationship in their own ways: one by studying its history, the other by figuring out how one traditional Chinese medicine works.

From Plant to Pill

While Tu found inspiration in a document hundreds of years old, Jun Liu’s nudge toward Chinese medicine was more modern: a billboard. Liu, a professor of pharmacology and molecular sciences, was in China for a conference in 1993. “I walked out of my hotel, and there was this billboard advertising an extract from the thunder god vine as a novel immunosuppressant. I was already working on two immunosuppressive drugs isolated from microbes, so this piqued my interest. I went to the drugstore to buy a bottle of the extract and then read what I could find about it when I got back to my lab, then at the Massachusetts Institute of Technology.”

a Chinese billboard advertising thunder god vine extractThe Chinese billboard that inspired Liu to study thunder god vine extract.

Liu caught a break: Another scientist had already purified the active ingredient in thunder god vine and chemically characterized it 20 years earlier. But its mode of action was still unknown, making the compound exactly the type he likes to work on.

“We work with natural compounds that have already been purified, characterized and identified as potent against cancer or some other condition,” he explains. “Then, we figure out how they exert their biological activity.”

He says that knowing a compound’s mechanism of action facilitates its development into a good drug because compounds are often toxic or unstable, or don’t get to the organ they need to. Before tweaking a compound to try to resolve those issues, it’s best to first know which protein a compound interacts with and how. “That way, you know where you can make chemical modifications without losing biological activity,” says Liu.

thunder god vineTripterygium regelii, or thunder god vine
Credit: Qwert1234 [Public domain], via Wikimedia Commons

For the compound extracted from thunder god vine, triptolide, that story is still ongoing. Most recently, Liu’s team published results showing that the compound halts cell growth by binding to the XPB protein, which is involved in manufacturing RNA and repairing damages to DNA. Derivatives of triptolide are already in use in the clinic, but Liu thinks there’s room for improvement. “Right now, we think of triptolide as the explosives you pack into a missile. It’s too toxic to be let loose,” he says. “So we’re engineering a ‘missile head’ for it, to direct it solely to cancer cells. We should know in a few years’ time if it works.” If it does, traditional Chinese medicine will have provided another successful lead for Western medicine.

More Than a Second Language

The history of Chinese medicine and its relationship with Western medicine are some of the topics of Marta Hanson’s work. Now an associate professor of the history of medicine, she first encountered Chinese medicine as a teenager in the late 1970s when she started studying Chinese in high school and took a course in acupuncture. Puzzled that her acupuncture teacher knew no Chinese, she set out to read Chinese medical texts in their original language. She now studies those original texts in their historical contexts to better understand their history on their own terms as well as interactions between Western and Chinese medicine. “To understand our present, we need to know where it came from,” she explains. “I study the history of Chinese medicine not to extract something clinically useful, but to learn how and why things change over time.”

Hanson says Western and Chinese medicine met in the early 1600s when Jesuit missionaries arrived in China and began translating Western distillation techniques and anatomy texts into Chinese. Over time, Western influence led to the formalization of Chinese medicine, arguably culminating in Chairman Mao’s creation of integrated academic and medical institutions, like the one where Tu did her Nobel work.

artemisia annuaArtemisia annua
Credit: USDA-NRCS PLANTS Database / Britton, N.L., and A. Brown. 1913. Illustrated flora of the northern states and Canada. Vol. 3: 526.

Hanson calls researchers like Liu and Tu “medically bilingual.” “The two systems of medicine are often mutually incommensurable, so you have to know a lot more than just an extra language to be able to blend them together in a meaningful way,” she says.

According to Liu, even the meaning of “traditional Chinese medicine” is hotly debated, but it generally involves three components: herbal concoctions, acupuncture and the concept of “chi,” or vital “energy-matter.” Some call it nonsense because they claim that it has no grounding in quantitative science and randomized clinical trials, despite decades of scientific research on various aspects of its therapies. Others, like Hanson, claim it has not only historical value but also value as a treasure house of empirical knowledge—with caveats. “Chinese medical therapies wouldn’t be in demand around the world if they did not meet the needs of patients who either culturally feel more comfortable with them or are dissatisfied with what Western medicine is able to provide,” she says.

She thinks of traditional Chinese medicine as a mirror that reflects back to modern biomedicine not its full image in reverse, but its shortcomings. And the reverse can be said about modern biomedicine as a mirror on traditional Chinese medicine’s limitations. Namely, what biomedicine is good at—evidence-based medicine, targeted treatments, modern pharmaceuticals—traditional Chinese medicine has to work on; and what traditional Chinese medicine is good at—considering the whole patient, individualized treatment, natural remedies—modern biomedicine could work on. “I think we can learn from that mirror to better understand both systems and hopefully improve them in the process,” she says.

chart comparing chinese and western medicine

Women’s Qigong in America Tradition, Adaptation, and New Trends

Content previously published in Journal of Daoist Studies, 3, 2010.

Posted with permission from the editor of the Journal of Daoist Studies

ELENA VALUSSI, Loyola University Chicago

This article examines the following eight publications on women’s qigong techniques:

Videos
Chia, Mantak, 1998. Slaying the Red Dragon.
Lee, Daisy. n.d. Radiant Lotus: Qigong for Women.
Liu, Yafei. n.d. Nüzi qigong (Chinese/German).
Books
Chia, Mantak. 2005 [1986]. Healing Love through the Dao: Cultivating Female Sexual Energy. Destiny Books.
Davis, Deborah. 2008. Women’s Qigong for Health and Longevity: A Practical Guide for Women Forty and Over. Shambhala.
Ferraro, Dominique. 2000. Qigong for Women: Low-impact Exercises for Enhancing Energy and Toning the Body. Healing Arts Press.
Johnson, Yangling Lee. 2001. A Woman’s Qigong Guide: Empowerment through Movement, Diet and Herbs. YMAA Publication Center.
Zhang, Tinna Chunna, 2008. Earth Qigong for Women: Awaken Your Inner Healing Power. Blue Snake Books.

Female meditation techniques in China
The point of departure for this article is my research on female meditation techniques in China, also called nüdan 女丹, of female alchemy. Over the last few years, I have described the historical emergence of the nüdan tradition and its Chinese development both in my dissertation and several articles (see Valussi 2003; 2008a; 2008b; 2008c; 2009). Simply put, female alchemy is a textual tradition of Daoist meditation and physiological exercises for women, which emerged in China in the seventeenth century and developed throughout the nineteenth and twentieth centuries. It is part and parcel of the much older tradition of internal alchemy (neidan 內丹), which advocates the possibility to achieve immortality through the progressive refinement of the body, aided by meditation, breathing, visualization, and massage exercises. Unlike neidan, though, nüdan followers adapt theory, practice, and language specifically to the female body.
My research reviewed most of the historical literature available in Chinese on meditation techniques for women, as well as contemporary publications on female meditation techniques in Chinese and English. When talking about contemporary publications on the topic, while Chinese publications are mostly a contemporary rendition of historical texts, those in Western languages and especially in English reveal a vast contemporary market of healing, spiritual, and meditative techniques for women inspired by Chinese traditions. For the purposes of this paper, I chose to concentrate on American publications simply because I am more familiar with them, but I am aware that these techniques have reached Western audiences outside of the U.S., and one of the items on my list was produced in Germany (Liu Yafei video).

Historical Context
Historically, nüdan texts were produced within the Daoist tradition, mostly during sessions of spirit-writing, a form of communication between gods and the community of believers, starting in the seventeenth century. They were religious texts, guiding practitioners to immortality and ascension into heaven. This is definitely not the context in which these techniques are described, taught, and performed in the United States. Their aim, rather than complete transcendence, is health and well-being. Even though there is often, but not always, a clear spiritual component in these publications, it is seen as yet another way to help the healing process.
Offerings available on the American market are wide and varied. In some instances, language and techniques are quite similar to what is found in historical nüdan texts; in others the practices seem to have no link whatsoever with that tradition. Some contemporary publications have a strong focus on sexuality and its importance in the physical and spiritual well-being of practitioners: this is not present in nüdan works and generally uncommon in the neidan tradition. Yet despite the variety, I found that nüdan techniques and language are widely used and appropriated in Western publications. It is also useful to mention that most of the neidan techniques of old are now referred, both in China and in the West, as qigong, a more modern term that is less linked to a religious milieu and favors a health-scientific background.
The mysticism surrounding the techniques and the oral transmission between master and disciple of Daoist techniques, common in Daoist communities in traditional China until the late Ming dynasty, started to dissipate in the Qing when practices became available more widely to a larger market through cheap publications and open transmissions. Secrecy almost ceased in the 1930s, when inner alchemy transformed from a religious to a lay practice and its techniques became a political tool of nation strengthening. In the Republican period, intellectuals reformulated and reorganized alchemical knowledge in order to renew the Chinese heritage, which they thought needed reviving in the face of Western cultural and political onslaught as well as of the Japanese invasion. This effort was intended to help national strengthening and progress.
Under Communist rule after 1949, traditional techniques were not discarded but made even more accessible and public. Already in the 1940s Communists formulated a conscious policy for the “Liberated Areas” to make use of local medical resources within a “scientific orientation.” Mao called on modern-trained doctors to unite with traditional therapists who were closer to the people, encouraging them to “help them to reform” (Palmer 2007, 29). Accordingly traditional neidan techniques were “reformed” to meet contemporary “scientific” standards. Liu Guizhen, a local Communist cadre, who brought these practices to the Party’s attention, spearheaded this transformation from neidan to more “modern” and “scientific” practices, which eventually lead to the creation of qigong. Together with a group of other cadres, Liu “set to work on the task of extracting the method from its religious and ‘superstitious’ setting. The method was compared with techniques described in classical medical texts, its concepts and were reformulated, and its mantras ‘reformed’ (Palmer 2007, 31).

During the Cultural Revolution in the 1960s and 70s, qigong fell out of favor. It was rediscovered in the 1980s, the time of “qigong fever,” then made its way to the West both through Chinese and Western practitioners. The latter incorporated it in regimens that fit Western healing styles, some with more spiritual accents, others purely health regimens, others again with sexual overtones, and many marketed as forms of “spiritual healing”.
Much work has been done in the intersection between religion and healing; in the West the category of “spiritual healing” has widened to encompass many techniques that might at one point have been connected with specific religious traditions but that are now used in separation from their original religious context to heal a variety of ailments (see Cohen 2002-03). In the specific case of Chinese spiritual healing and qigong, too, some powerful studies have appeared, detailing the specificity of Chinese conceptions of the body and healing, as well as the political implications of the practice of qigong in China (e.g., Ots 1994; Chen 2003). There are also some studies on the transfer of knowledge to the West, notably in the field of acupuncture. Linda Barnes, in her 1998 article on the Western adoption of Chinese healing techniques and especially acupuncture, argues that “this indigenization of Chinese practices is a complex synthesis which can be described as simultaneously medical, psychotherapeutic, and religious” (1996, 1). She describes a process of acculturization that is at first uncritical, then becomes more and more inquisitive: “Initially, there was a tendency among the non-Chinese to adopt these teachings uncritically. Over time, however, they began to look for sources and methods through which to articulate questions, which, in some instances, they themselves had introduced into the Chinese practices” (1998, 415).
The process of questioning that acupuncture has undergone over the past three decades has yet to happen for qigong practices, especially those dedicated to women. Only now do critical views of some practices and the questioning of sources appear in American qigong circles. Where do the practices come from? What is the affiliation of the people who teach and write about them?
In many ways the traditional secrecy that had clouded the transmission of neidan and also qigong in China has been more accentuated with their transfer to Western practitioners. Books often describe the origins of practices as often shrouded in mystery or too ancient to be verifiable. This is entirely unnecessary. Both Chinese and Western scholars outline the historical development of neidan as well as qigong traditions, schools, and techniques (see Kohn and Wang 2009). For the modern period, especially the works of Xun Liu (2009) David Palmer (2006) and Nancy Chen (2003) trace the birth and growth of neidan and qigong during the Republican era and under Communism as a mixture of inner alchemical techniques and Western medicine. For the pre-modern period, many more monographs, articles and books are now available. At this stage Western practitioners should take these studies into consideration instead of describing the Chinese tradition as an ahistorical continuum that contains all techniques, schools, and teachers. The various presentations of women’s qigong discussed below would have greatly benefited from such consideration.

Nüzi Qigong

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This DVD is by the physician and qigong teacher Liu Yafei, the daughter of Liu Guizhen, the cadre responsible for the transition from neidan to qigong. Liu Yafei works at the Beidaihe sanatorium in northern China founded by her father and teaches widely abroad, mainly in Europe, but has not yet published Western language books on her practice. In her DVD and classes she keeps the practice firmly within the realm of medicine and healing, downplaying any spiritual or religious elements. This stance is partly related to the transformation that alchemical techniques underwent during the Republican and Communist periods, and partly due to the fact that her father had been harshly criticized for his involvement in the development of qigong. The repression of the Falungong religion and various qigong forms in China today, and the limits of religious expression also play a role.
Still, there are obvious similarities in Liu’s terminology and traditional nüdan texts, starting with the cosmological positioning and defining of men and women. “Men are strong and refine their qi, women are soft and refine their blood. Women have inner soft beauty. Men are high mountains, women are flowing water.” Both practices pay specific attention to the breasts, and especially to the point between them, historically considered the starting point for female practice and the activating point for women. Both also include extensive and repeated breast massages. In addition, they pay attention to the lower abdomen, and to the Meeting Yin (huiyin) point at the perineum. All of these points are located on an extraordinary vessel (Renmai, Dumai, Chongmai, or Daimai). According to Liu, they are essential for female health because they cross the front part of the body and intersect on the abdomen. She thus applies nüdan knowledge to Chinese medical readings of the body.
Another element essential in both practices is blood. However, whereas nüdan sees blood as a pool of energy to be transformed, nüzi qigong supports its normal function. The exercises accordingly serve to regulate menstruation and female hormones, to eliminate breast problems like cysts, to help in recovery after breast cancer as well as during pregnancy and menopause, and generally to maintain and improve the blood and energy flow in the body.
Not all of nüzi qigong derives from nüdan, though. Many elements also come from neiyang gong, internal nourishing, the other form of qigong Liu teaches. Her language in all cases is eminently biomedical, speaking of different health problems and of how this practice can help solve them. The questions asked by the practitioners during classes are equally focused on health and healing. No mention is made of a spiritual or religious dimension of this practice.

Radiant Lotus

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Daisy Lee is a qigong instructor certified by the National Qigong Association. The DVD, after showing a class of her students performing a series of exercises specific to female health, contains an interview on her practice. Lee notes that Radiant Lotus is designed specifically for women and addresses health issues unique to women like perimenopause, menopause, hot flashes, painful periods, low back pain, swollen ankles, intense emotions, as well as uterine and breast tumors. This is achieved through a series of movements, divided into four routines, all featured on the DVD: 1. Shaking and cupping 2. Self-massage (of breasts and reproductive organs) 2. Vibrational sound healing 4. Kwan Yin closing.
The first series of movements starts by tapping the center of the chest. Lee describes this center biomedically as the thymus gland. Nüdan texts call it the “milk stream” (ruxi) and name it as the starting point of practice and as one of the main locations where the practice returns. The next movements include cupping the breasts, the neck, face, and abdomen, as well as the legs; special attention is given to breasts and ovaries, echoing nüdan materials. The second section describes a massage routine which includes, among others: ovarian, abdominal, groin, vaginal, kidneys, and breasts. All these areas are essential in nüdan practice. The movements, moreover, are performed nine times, which is also the typical number of repetitions in the nüdan tradition.
Daisy Lee uses biomedical language (thymus gland, ovaries, perimenopause, etc.) to talk about the locations as well as the effects of the practice, and she does not dwell on spiritual effects. However, the fact that she uses Tibetan vibrational sound healing as well as the Kwan Yin (Guanyin) closing, reflects the fact that spiritual practices have been integrated into a health routine. She does not say who developed the “Radiant Lotus” method nor does she discuss the mixing of Daoist (nüdan), Chinese Buddhist (Guanyin) and Tibetan Buddhist (sound healing) elements.
Both Lee and Liu Yafei speak of women’s yin nature and define it in a similar way to nüdan manuals, as soft, flowing, and internally beautiful. Both note that this nature may be more attuned to natural processes and therefore be better suited to accomplish a qigong routine. “There is a natural flow in a women’s body that helps in how you move in qigong. …you find that women are more naturally drawn to qigong” (Lee, Intro.). This is, not surprisingly, what nüdan texts already say, albeit in different terms, in the eighteenth century.

However, while Lee sees this as “a place of empowerment for women,” traditional texts use the “special predisposition of women” to maintain a woman’s place in society: in the home and away from the public eye; not a place of empowerment but a reiteration of the status quo. Both Liu Yafei’s and Daisy Lee’s instructional DVDs repeat many exercises and focus on locations featured in nüdan texts yet do not resemble each other very much. Both techniques, it appears, have a similar source, but have been refined and influenced by other traditions.

Mantak Chia

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Mantak Chia was one of the first practitioners to bring neidan, or inner alchemy, to America in the 1970s. Since then, he has trained many Western practitioners to becoming full instructors while also publishing—in close cooperation with Michael Winn—a series of books that have strongly influenced the field of spiritual healing. Chia’s teachings have had a large impact on how Chinese healing and spiritual techniques are understood and adapted in the West. This is how he is described on many online sites selling his books:

A student of several Taoist masters, Mantak Chia founded the Universal Healing Tao System in 1979 and has taught and certified tens of thousands of students and instructors from all over the world. He is the director of the Tao Garden Integrative Medicine Health Spa and Resort training center in northern Thailand and the author of 31 books, including Fusion of the Five Elements, Cosmic Fusion, and the bestselling The Multi-Orgasmic Man.

In his many publications, Chia talks about inner alchemy and about the spiritual goals of the practice. His “Fusion of the Eight Psychic Channels: Opening and Sealing the Energy Body” describes the practice: “Advanced Inner Alchemy exercises that promote the free flow of energy throughout the body in preparation for the Practice of the Immortal Tao.” He credits several teachers for his knowledge of neidan practices, among whom Yi Yun “One Cloud Hermit” from Lone White Mountain, Cheng Yaolun and Pan Yu. However he does not give detailed explanation of their histories or of how the transmission of their knowledge (oral or written) to him took place. He does mention, however, that these teachers were already mixing elements from Daoism , Buddhism and Thai boxing in their teaching. To this knowledge, he added intensive study of Western medicine and anatomy.
Thus, while Chia’s publications make full use of the neidan ideology both in terminology and in the sequence of the practice, he also employs biomedical language. For example, ”When fully developed, the pineal gland becomes the compass that guides the spirit to the primeval Tao” (2005, 116). Differently from traditional neidan and nüdan manuals, he provides a profusion of details about the physical practices with many diagrams of the body, and especially of the genital area, and explains both practices and expected physical reactions in Western medical terms. Yet, he still describes the results in terms of transcendence, spirituality, and spiritual union. Thus Chia successfully maintains the esoteric nature and appeal of neidan while explaining its efficacy in a way that appeals to a Western audience.
In his Healing Love through the Tao (2005) on female practice, the technical language and description of the female body present several similarities to nüdan, starting with his use of language and the importance given to specific body locations: breasts and breast massages, ovaries, Governing and Conception Vessels (Dumai and Renmai)—all essential to female energy. He also presents an extensive discussion of sexual feelings; here is where his work differs significantly from traditional nüdan as well as from Liu Yafei’s and Daisy Lee’s modern take. Chia’s goal is to teach how to develop a better sexual relationship with a male partner through the strengthening of internal energy. Nüdan teachings, in contrast, acknowledge the emergence of sexual feelings during the practice, but teach the practitioner (who does not practice jointly with a partner) how not to dwell on them but sublimate them.
Last but not least, traditional nüdan texts talk at length about the practice of “Slaying the Red Dragon,” a technique of breast massage and internal visualization that results in the gradual disappearance of the menses. This is definitely not the message in Chia’s book.

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“Slaying the Red Dragon” is the title of Chia’s video where , together with  his wife Maneewan and one of their female practitioners, he describes their specific version of female practice. Despite the title, which is a clear reference to the traditional nüdan practice of eliminating the menstrual flow,   the video does not discuss the disappearance of the menses. Instead, it focuses on “a Taoist way to control menstruation” attained through the strengthening of female sexual power with specific techniques like meditation, breast massage, vaginal massage, and the strengthening of the perineal muscles with external devices. In other words, the video pairs visualization techniques and breast massages from traditional nüdan, with sexual techniques that were never part of this traditionally solo technique to form an entirely new way of female sexual empowerment. Throughout video and book, Chia maintains a good balance between spirituality, sexuality, and health. The work remains a point of reference for all later books on neidan, qigong, and sexual health by other practitioners, providing a strong focus on exercises for pelvic floor health, ovarian and breast massage, and female sexual health. His work differs from other recent books on female qigong, which all give sound exercises for the female body—some for specific illnesses, others for specific life phases— in that the latter have few spiritual overtones.

Earth Qigong for Women

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Tina Zhang starts her book in this way: “Earth Qigong is based on a special medical qigong developed and perfected over the course of 1,700 years by Daoists, Traditional Chinese medicine doctors, and qigong experts in China to address the needs of a woman’s unique anatomy” (2008, ix). She thereby equalizes Daoists, Chinese medical doctors, and qigong practitioners, mixing traditions and time periods into one unquestioned bundle. The term “Earth Qigong” and the Chinese subtitle to the book “Kungong”, which can be translated as “feminine practice,” are not explained. However, Zhang gives a general survey of the development of qigong and healing techniques in China, then focuses specifically on techniques for women. She says :

“This qigong program is designed to provide more movement than other qigong sets, some of which are based on seated meditation and do very little in motion. The basic goal of this program is to help women combat stiffness and the sedentary life that’s become too common. Its gentle approach helps women relax. Within this practice the deeper qi work will give positive energy to women, because it has the cultivation of the female center of qi as its main goal.” (2008, 48)

Zhang offers an apparently effective and comprehensive series of practices for women, called “The Earth Energy: Cultivating Female Energy,” “Creating Pelvic Health and Helping the Liver,” and “The Spirit of Vitality: Bringing out the Real Female Spirit.” These series focus on the pelvic area and on solving problems related to menstruation, breast swelling, and pre- and post-partum complications. Her sequences combine different styles of qigong while focusing on areas of specific female interest. She also discusses the importance of acupoints for women’s health, notably Meeting Yin at the perineum, Ocean of Qi (qihai) under the umbilicus, and Gate of Life (mingmen) between the kidneys in the back. She notes:

“Earth qigong includes several qi movements that exercise or massage the internal and external organs of the female body, some of which are not addressed in most other qigong routines or forms. These movement purposely move the blood and cultivate more of the female energy that women naturally have in their bodies in order to gain more inner power to ease and arrest uncomfortable symptoms during the different stages of menstruation, pregnancy, perimenopause and menopause.” (2008, 49). Zhang’s book betrays a deep knowledge of female physiology and offers good practical advice, but lacks historical perspective.

Women’s qigong For Health and Longevity

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This book by Deborah Davis addresses women over forty and divides into sections according to age (40 to 49; 50 to 64; 65 and over). It, too, focuses on specifically female concerns like pre-menstrual syndrome, breast-health, depression, menopause, insomnia, osteoporisis, heart health, and sexual issues. Davis combines her extensive knowledge of both qigong and women’s health to produce a manual of general qigong exercises that are beneficial to a woman’s body. Unlike both traditional nüdan, Liu’s nüzi qigong and Chia’s guidelines, her practices focus less on specifically “female” areas of the body and instead devote practices to whole-body health. Still, even Davis acknowledges that the “Uterine Palace” (zigong) is fundamental in the female body, and has exercises called “Soothing the Middle”, “Renmai Massage” and “Pelvic Floor Lift” that focus on the middle of the body.

Qigong for Women

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Dominique Ferraro, like Deborah Davis, uses her extensive knowledge of qigong and Chinese healing techniques, including her profound understanding of acupuncture, and applies it to the female body. The last two chapters of her book are devoted to “Qigong and Sexuality” and “Common Physical Problems of Women.” The chapter on sexuality introduces the concept of a healthy sexuality between men and women, recalling the tradition of Chinese sexual manuals; it refers directly to Mantak Chia’s work, then notes the importance of blood and its proper flow. The chapter on common ailments concentrates on bones, joints, teeth, memory, and hearing; only at the end does it turn to more specific gynecological problems and pregnancy. Again, this is a good manual for general health, but the advice is often not specific to women. As Davis’s work, her book is eminently interested in physical sequences and effects.

A Woman’s Qigong Guide

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This book by Yangling Lee Johnson (2001), as noted in the title, is not only about qigong but also about movement, diet, and herbs—albeit within the Chinese tradition. It provides a fairly long historical introduction about the development of Chinese medicine and qigong. The introduction also includes a personal perspective, and Johnson shares her story of self-healing during the Cultural Revolution and the hardship she underwent when relocating to the U.S.
Unlike other books of this kind, this work does not consist largely of detailed descriptions of practice postures. Only in Chapter 5 does Johnson begin to talk about “short forms,” i.e., quick postures to do in the morning, in the car, at work, outside, etc. These quick forms deal with problems such as sterility, depression, weight loss, the flu, amenorrhea, and the like. Johnson’s book contains various passages she herself translates from Daoist and Chinese medical texts, scattering advice about almost everything: alcohol intake, work, nails, sexual activity, sleeping, sweating, dieting, and more. The book concentrate on the physiology of women or on specific areas of the female body. In sum, it is not quite a qigong guide for women as advertised in the title, but rather a general guide on wellbeing for women that mixes psychological, dietary, and energetic advice.

Conclusion

In sum, I find that the field of women’s qigong publications in Western Languages is developing fast, and at the same time has a lot of room to grow. Some of the above publications are just beginning to discuss what it means to practice neidan and qigong as a woman, what are the important areas to concentrate on, and where the practice should take us. In most of the publications reviewed, there is particular attention to female physiology and to ailments that are specific to women, and there are a variety of techniques offered to relieve them. Some concentrate on health, other on sexuality, others again mix healing, sexuality and spirituality. Some are more thorough than others, but all of them, to a certain extent, lack historical perspective. Though I realize that not all are meant to include historical introductions to the field, paying attention to the historical significance and development of a tradition, as well as describing one’s affiliations with contemporary masters, and one’s place in that tradition, puts the physical practice in a clearer context. My interest in this review was to highlight the appropriation and adaptation of a Chinese tradition with roots in a religious practice. Pointedly, most if not all of the above publications do not portray women’s practices in any way as religious.

References
Barnes, Linda. 1998. “The psychologyzing of Chinese Healing Practices in the United States”, Culture, Medicine and Psychiatry 22: 413–443
Chen, Nancy N. 2003. Breathing Spaces: Qigong, Psychiatry, and Healing in China. New York: Columbia University Press.
Cohen, Michael. 2002-03. “Healing at the Borderland of Medicine and Religion: Regulating Potential Abuse of Authority by Spiritual Healers.” Journal of Law and Religion, 18.2
Kohn, Livia, and Robin R. Wang. 2009. Internal Alchemy: Self, Society, and the Quest for Immortality. Magdalena, NM: Three Pines Press.
Ots, Thomas. 1994. “The Silenced Body—the Expressive Leib: On the Dialictic of Mind and Life in Chinese Cathartic Healing.” In Embodiment and Experience: The Existential Ground of Culture and Self, edited by Thomas J. Csordas. Cambridge: Cambridge University Press.
Palmer, David. 2007. Qigong Fever: Body, Science and Utopia in China. New York: Columbia University Press.
Valussi, Elena. 2003. “Beheading the Red Dragon: A History of Female Inner Alchemy in China.” Ph. D. Diss., School of Oriental and African Studies, University of London, London.
Valussi, Elena. 2008a. “Female Alchemy and Paratext: How to Read Nüdan in a Historical Context.” Asia Major 21.2.
Valussi, Elena. 2008b. “Blood, Tigers, Dragons. The Physiology of Transcendence for Women.” Asian Medicine: Tradition and Modernity 4.1.
Valussi, Elena. 2008c. “Men and Women in He Longxiang’s Nüdan hebian (Collection of Female Alchemy).” Nannü: Men, Women and Gender in Early and Imperial China 10.2.
Valussi, Elena. 2009. “Female Alchemy: An Introduction.” In Internal Alchemy: Self, Society, and the Quest for Immortality, edited by Livia Kohn and Robin R. Wang, 142-64. Magdalena, NM: Three Pines Press.
Winn, Micheal, 2009. “Daoist Internal Alchemy in the West”. In Internal Alchemy: Self, Society, and the Quest for Immortality, edited by Livia Kohn and Robin R. Wang, 142-64. Magdalena, NM: Three Pines Press.
Xun, Liu, 2009, Daoist Modern; Innovation, Lay Practice and the Community of Inner Alchemy in Republican Shanghai, Cambridge and London, Harvard University Asia Center, Harvard University Press

On Thai Massage and Cultural Appropriation

Photo above: Is this cultural appropriation in action?

Recently, there has been much discussion online about yoga and cultural appropriation, and this has spilled over into the Thai massage world as many have begun to wonder about how this critique may or may not apply to our own practice.

What we shouldn’t do is simply write off the critique that Westerners practicing Thai massage is cultural appropriation. Clearly it is. Non-Thais traveling to Thailand, learning a traditional medicine technique, and returning to the West to use that technique to make a living is probably the very definition of cultural appropriation. The question is not whether or not this is cultural appropriation, but, rather, how we deal with the ethics of our crosscultural encounter.

I have just now written a blog post about the question of yoga as cultural appropriation. In that piece I argue that there is no simple way to resolve this issue if we are stuck in the binary of “neo-colonialism” vs. “freedom of choice.” What is needed to understand this issue at a more nuanced level is an awareness of history. If you didn’t get a chance to read that post, please do so before continuing here.

Turning specifically to Thai massage (or Thai Traditional Medicine, or Ruesri Dat Ton, or other Thai modalities, although that applies to far fewer people), I feel that the same sort of historical analysis can assist us greatly in navigating the ethical issues and deciding where we stand.

To begin with, I think it is helpful to remind ourselves that Thai massage is not some ancient practice that “dates from the time of the Buddha,” as its mythology would have us think. As I have explored in many publications, Thai massage is a product of a long history of cultural appropriation by the Thais themselves, which incorporates aspects of Buddhist, Tantric, Ayurvedic, Chinese, and indigenous Thai practices. I have discussed this in detail in this book, which in 2016 will have a second edition released by White Lotus Press. So, yes, we are participating in cultural appropriation, but it is also the case that we are part of a long tradition of the same.

We might also note that the form of Thai massage most often practiced by Westerners represents a very recent synthesis, dating back no further than the 1950s in its current form. This form of Thai massage was “revived” in the 1980s by the Thai government and leading traditional doctors, specifically in order to bolster the tourism and spa industries. So, yes, we are participating in cultural appropriation, but it is also the case that this cultural heritage was  packaged, marketed, and fed to us by Thai government and medical officials and institutions.

Lastly, it is worth pointing our that the Thai teacher most responsible for the popularity of Thai massage in the West (the “root teacher” of ITM, Sunshine, Lotus Palm, Thai Institute, and many other Western schools including my own) was Ajahn Sintorn Chaichakan of the Old Medicine Hospital in Chiang Mai. Ajahn Sintorn, in fact, repeatedly instructed his Western students (including me) to learn Thai massage in order to share it with as many people as possible in our own countries. So, yes, we are participating in cultural appropriation, but it is also the case that we have been actively encouraged by our Thai teachers to share this knowledge outside of Thailand.

So, clearly, it’s complicated. But, don’t misunderstand my argument: these extenuating circumstances don’t absolve us from considering the implications and ethics of our own participation in cultural appropriation. As a long-time practitioner and instructor of Thai healing, I have been thinking about the issue of cultural appropriation for a long time, and discussing it in my Thai massage classes (with all levels of students, including introductory) for almost two decades. Here are some of my thoughts about how to approach our practice of Thai massage and the question of cultural appropriation in an informed and proactive way:

  1. First of all, don’t simply deny the critique. Lean into it. Many aspects of modern Western culture can be critiqued as cultural appropriation.  Educate yourself about the issues, the ethical problems, and the history of each specific case. Adopt a proactive approach. Especially if it is meaningful to you (as a hobby, livelihood, etc.), you need to see the issues clearly and be able to articulate where you stand.
  2. If you are somehow earning a living from a Thai practice, give a portion back to Thailand in the form of charitable giving. In my opinion, setting a percentage and sticking to it is probably the best way to do this. (In my own case, 10% of the sales of my Findhorn books has gone to Thai charities.) The argument that you can’t afford to give charity doesn’t hold water, since even a small sum goes a long way when converted into baht.
  3. Honor the traditions and their Thai origins when you discuss, teach, and practice them. Educate yourself about Thai history and culture, and always remember that we have been able to “borrow” this knowledge because of our privileged position as educated, wealthy Americans/Canadians/Europeans.
  4. Perhaps most critical is to maintain humility. Constantly remind yourself that we are not the “masters” or “ajahns” of this tradition. We are translators, facilitators, and proponents of Thai massage, but we should always direct our students’ and clients’ admiration and gratitude back to Thailand as the source of any wisdom we think we have gained from this practice.

I share my thoughts here as someone who has been thinking about the issue of cultural appropriation for a long time, first as a practitioner, then as an instructor, and now as a scholar of Asian medicine. I have discovered that there is no simple, one-size-fits-all answer for the ethical questions this issue raises. Rather, each person needs to think through the issues on their own.

Where do you stand? Your thoughts on this issue are welcome in the comments. The most important thing is that we keep talking about this.

Is the 2015 Nobel Prize a turning point for traditional Chinese medicine?

This is a syndicated post by Marta Hanson, reproduced here with permission of the author. It first appeared at https://theconversation.com/is-the-2015-nobel-prize-a-turning-point-for-traditional-chinese-medicine-48643 Continue reading Is the 2015 Nobel Prize a turning point for traditional Chinese medicine?