Kelly Chen
Birmingham, Alabama, USA

Persimmon: cold, sweet, astringent. It opens up the nose and the qi of ears.

Scallion: warm, spicy, bitter. It treats cutting wounds and ulcer.

White winter melon: slightly cold, sweet. It rids one of watery swelling in the lower abdomen.

Dry ginger: hot, spicy. It treats vomiting caused by coughing.

These food prescriptions fill the pages of Recipes Worth a Thousand Gold, written by “China’s King of Medicine” Sun Simiao in 654 AD.¹ Sun’s text contains the first recorded use of the term “food therapy,” and he hoped that people would first choose food over drugs when suffering from an ailment. An extension of the opposing yet complementary forces of Yin and Yang, food therapy stated that foods had “hot” or “cold” energy running through them. Balancing intake of “hot” and “cold” energy was a medicinal principle, a belief that continues in Chinese culture today.²

In general, “hot” food is typically high-calorie, cooked at high temperatures, spicy or bitter, or hot in color (red, orange).³ Classic “hot” foods include red meat, baked and deep-fried goods, and alcohol. By contrast, “cold” food tends to be low-calorie, watery, or cool in color (whitish or green).³ Green vegetables and fruits make up the majority of “cold” foods. Being purposeful with food choices was the first step to preventing illness. Imperial physician Hu Sihui of the Yuan Dynasty recommended “cold” mung beans during the summer to combat the hot climate, and “hot” mutton or chicken to expel the cold of winter.⁴

Diet was not only key to maintaining good health, but also capable of restoring it when imbalance caused illness. Just like food, medical conditions were labeled as “hot” or “cold.”⁵ Traditional Chinese medicine made these designations largely based on symptoms. Inflammation, cough with thick yellowish sputum, red complexion, dry stool, dark urine, fidgeting, and other similar features were characteristic of too much “hot” bodily energy and thus treated using “cold” foods. A person suffering from hot red skin eruptions was advised to eat “cold” bamboo shoots and water chestnut to relieve symptoms.⁶ Similarly, a patient with pallor, watery feces, chills, or low body temperature was suffering from excess “cold” energy and treated with “hot” foods. Simple dishes like porridge with cinnamon and dried ginger would be the first attempt at restoring “hot” energy.² If the cold energy persisted, an even “hotter” dish like stewed mutton meat with antler gelatin would be recommended.

Remarkably, some of these ancient claims have been validated by modern science. Cardamom, for example, was noted in Recipes Worth a Thousand Gold to “cure heartburn and stomachache, stop vomiting, and get rid of bad breath.”¹ Scientists after the 1950s illuminated the active ingredients in cardamom oil, which were found to contain antioxidant, anti-spasmotic, anti-ulcer, and hepatic effects.⁷ Similarly, Sun preached that apricot kernels could “rid toxins of dog bites” but had to be eaten with caution as too many would “make the person blind, cause his eyebrows or hair fall, and arouse all kinds of chronic illnesses.”¹ Now known to contain hydrocyanic acid (poisonous at high quantities), people back then could only rely on unfortunate trial and error.⁸ Sun’s work shows the power of keen observation, an art form central to medical practice today.

Valuable as more than early medicinal work, Recipes Worth a Thousand Gold provides historical insight into ancient Chinese beliefs surrounding food. The text is filled with assertions that sound more magical than medicinal. He wrote that grapes could strengthen memory, enhance one’s strength several fold, and even elongate life.¹ These nonsensical claims can be attributed to the prized nature of the Asian grape at the time. Initially reserved for the imperial family, grapes captivated the Chinese imagination with their rarity and plentiful clusters of fruit. Naturally, they came to symbolize wealth and fertility, and the grape is still a staple at Chinese New Year celebrations. In contrast, foods like rice and Chinese cabbage were too common and plain to have medicinal properties and thus deemed “neutral” foods.¹

In another prescription, the horns of black sheep were said to treat “the disease of feeling frightened,” and the heart of gray sheep was said to “especially treat the feeling of sorrow and hatred.”¹ This prescription notably addresses emotional rather than physical ailments, reflecting how the sheep is a Chinese symbol of peace and kindness. In The Great Race story of the Chinese Zodiac, the sheep was rewarded for putting others before itself.⁹ Furthermore, the Chinese consider the way a young lamb kneels down to nurse as an action of respect and gratitude. More symbolic than scientific, many of Sun’s food prescriptions are relics of contemporary Chinese cultural beliefs.

Chinese food medicine spread throughout East and Southeast Asia and has persisted through time. In the mid-ninth century, Shi Yi Xin Jian built upon Sun’s work in the book Candid Views of a Nutritionist-Physician.¹⁰ Books of increasing specialization were written during the Song dynasty that followed, covering topics like how to feed the elderly to extend their life, wild food plants for emergency treatments, and a guide to delicacies of the sea.² Chinese dietary works have been cited in Japanese works as early as the tenth century, and in Korean food literature starting from the fourteenth century.¹¹ Today, standard Chinese foods such as tofu, soy sauce, and noodles are also dietary staples in Korea, Japan, and Indonesia.

Chinese food therapy also found its way to the western world, albeit later and to a lesser extent. In the 1960s, prolific author George Othsawa used the Yin-Yang philosophy to create the macrobiotics diet fad that swept the country.¹² The diet preached consumption of mostly whole grain cereals, legumes, vegetables, seaweed, fermented soy products, and fruit, but when followed to an extreme was found to lead to increased nutritional deficiencies.¹³ However, the general belief that specific foods have hot or cold properties persists in Asian Americans living in California.¹⁴

In the United States, traditional Chinese food therapy has never become as prolific as other diets, possibly due to the lack of rigorous scientific evidence supporting its use to prevent or treat certain conditions.¹⁵ Some Chinese studies have reported that a diet designed from Chinese food therapy principles may help control blood pressure, but these studies use more qualitative and conceptual evidence rather than the standardized and operational definitions used in western randomized controlled trials. For example, hypertension was described as “Yin deficiency.”¹⁶ In contrast, there have been a large number of clinical trials studying the efficacy of the DASH diet or Mediterranean diet, contributing to their popularity.

Chinese beliefs surrounding food as medicine have also morphed with the times. The core philosophy of Yin and Yang continues, and the value of core “hot” and “cold” foods has also largely remained the same. However, the processing and manner of cooking food has changed incredibly. Steaming, boiling, and skewer roasting were the main cooking techniques used in ancient China, since cooking oil was too expensive to use for consumption and was reserved for lighting lamps. These basic forms of food processing largely kept foods whole and nutrients intact. As a result, Chinese people spent much more time on cooking when compared with other countries, preparing food for an average of two to three hours every day.¹⁷ As occupations and technologies changed and the pace of life accelerated, stir-frying became popular in the 1940s because of its speed. Termed “blitz cooking,” stir-frying soon dominated Chinese restaurant kitchens. Deep-frying and stir-frying are now the most common cooking methods in China, yet they were unheard of in Chou and Han dynasty cooking.² Studies conflict on whether stir-frying leads to significant loss of food nutrients, and potential medicinal value, compared to other cooking methods.¹⁸ In contemporary times, perhaps Sun Simiao would have written an entirely new edition of Recipes Worth a Thousand Gold exploring how different modes of preparation altered the hot and cold medicinal properties of foods. Overall, Chinese food therapy is best viewed as an eclectic mix of history, fantasy, and ancient medicine.

Image credit

“Chinese woodcut, food incompatibilities.” Credit: Wellcome Collection. CC BY

References

1. Sun, S. Recipes Worth a Thousand Gold. 654.
2. Huang, HT. Science and Civilization in China, Volume VI, Part 5, Fermentations and Food Science, Cambridge, Eng.: Cambridge University Press; 2000.
3. Anderson, EN. The Food of China, New York, NY: Yale University Press; 2013.
4. Wu, Q, Liang, X. Food therapy and medicinal diet therapy of traditional Chinese medicine. Clinical Nutrition Experimental. 2018,; 18, 1-5. doi:10.1016/j.yclnex.2018.01001.
5. Li S, Lü A, Jia H. Therapeutic actions of the Chinese herbal formulae with cold and heat properties and their effects on ultrastructures of synoviocytes in rats of the collagen-induced arthritis. Journal of Traditional Chinese Medicine. 2002;22(4):296–302.
6. Dang, Y. “Properties of Food from a TCM Perspective.” Shen-Nong, Integrated Chinese Medicine Holdings Limited. http://www.shen-nong.com/eng/lifestyles/food_property_food_tcm.html . Accessed August 23, 2018.
7. al Zuhair H, el Sayeh B, Ameen HA, et al. Pharmacological studies of cardamom oil in animals. Pharmacol Res 1996;34(1-2):79-82. 8981560. https://doi.org/10.1016/j.jef.2015.11.004
8. Sayre JW, Kaymakcalan S. Cyanide poisoning from apricot seeds among children in central Turkey. N Engl J Med.1964. 270:1113-1115
9. Wu, S. Chinese Astrology. New York, NY: The Career Press, Inc; 2005.
10. Shi, YXJ. Candid Views of a Nutritionist-Physician. Ninth century.
11. Ro, S. Cookbooks and Female Writers in Late Choson Korea. Seoul Journal of Korean Studies, The Kyujanggak Institute for Korean Studies 2016; 29(1): 133-157. https://doi.org/10.1353/seo.2016.0000
12. Ferre, C. Essential Ohsawa: From Food to Health, Happiness to Freedom. New York, NY: Avery Publishing Group; 1994.
13. Roth RA, Wehrle KL. Nutrition & Diet Therapy. 12^th Cengage Learning; 2016.
14. Harrison GG, et al. Seizing the moment: California’s opportunity to prevent nutrition-related health disparities in low-income Asian American population. Cancer. 2005;104:2962-8. Doi: 10.1002/cncr.21514
15. Zou, P. Traditional Chinese Medicine, Food Therapy, and Hypertension Control: A Narrative Review of Chinese Literature. The American Journal of Chinese Medicine. 44 (8): 1579–1594. doi:10.1142/S0192415X16500889.
16. Shen, CZ, et al. The effect of Chinese food therapy on community dwelling Chinese hypertensive patients with Yin-deficiency. Journal of Clinical Nursing. 19 (7–8): 1008–1020. doi:10.1111/j.1365-2702.2009.02937.x.
17. Guansheng, M. Food, eating behavior, and culture in Chinese society. Journal of Ethnic Foods 2015, 2(4):195-199. https://doi.org/10.1016/j.jef.2015.11.004
18. Silveira CM, et al. Effect of cooking methods on the stability of thiamin and folic acid in fortified rice. Int J Food Sci Nutr. 2017 Mar;68(2):179-187. doi: 10.1080/09637486.2016.1226273.