Asia Pacific J Clin Nutr (1993), 2 91-95

Principles of diet therapy in ancient
Chinese medicine: 'Huang Di Nei Jing'
Ho Zhi-chien
Department of Clinical Nutrition,
San Yat-sen University of Medical Sciences, Guangzhou, PRC.
Huang Di Nei Jing, the first systematic Chinese
medical book, was compiled from the observations of imperial herbal
doctors in the Qin and Han periods (221 BC - 220 AD). From this
classic traditional source may be derived the concept of a balanced
and complete diet and probably the world's first dietary guidelines.
Basic to the tradition are han, re, wen and bu foods,
respectively 'cold', 'hot', 'neutral', 'strengthening'. Basic to
Chinese cuisine are jan and tsai- 'cereal' (the rice
staple and main meal) and 'dishes' to accompany the rice. Chinese
traditional medicine, as in Huang Di Nei Jing, considers
the nourishment of body and mind. It also emphasises that herbal
medicine and food have the same origin. Diet was essential to the
prevention of disease which a glossary of Chinese terms is given
at the end of the paper in the Chinese tradition, was superior to
treatment.
Introduction
The written history of Chinese medicine can be traced
back 2000 years. Huang Di Nei Jing (1), which literally means
'The Yellow Emperor's book of medicine', one of the first classical
Chinese medical books, was written during the Qin (221 BC - 207 BC)
and Han (206 BC ~20 AD) periods. Traditional Chinese medicine contributed
enormously to the health of the Chinese and its main theories were
exchanged with many countries around Asia1-3.
Huang Di Nei Jing4 was the first
systematic medical book to be published in Chinese. It stemmed from
the accumulation over centuries of clinical experience and epidemiological
observations by the imperial herbal doctors. The theory of Chinese
medicine was influenced by ancient Chinese philosophy, especially
that of cosmology and movement of the universe. It had been hypothesised
that things were compassed of five elements - gold (2), wood (3),
water (4), fire (S) and earth (6) - and that all material was in a
process of change between the universe and the human body. Doctors
believed that each individual is both a part of the universe and a
complete unit, so that a cosmic view of health was required.
Within this philosophy, phenomena were understood
in terms of contradictory relations, for example, the sun versus the
moon, the sky versus the earth, the day versus the night, the male
versus the female and the positive versus the negative. Ancient doctors.
analysed the physical signs and symptoms of a case by differentiating
the appearances into two opposite categories, for example, into yin
(7) (dark) and yang (8) (bright), han (9) (cold) and
re (10) (hot), xu (11) (weak) and shi (12) (strong),
superficial (13) (exterior) and internal (14) (interior).
It was thought that these extremes existed at the same time and were
interchangeable, moving to the opposite extreme when conditions changed;
for example, water became air when temperature rose. This was expressed
as 'things at one extreme must go to the opposite extreme' (15).
A healer needed to understand the mind (heart) and
the functions of organs before a particular treatment could be given
- a Chinese psychosocial and biomedical view of health and disorder.
The importance of preventive medicine was also stressed. 'The saint
can cure not only those who are sick but has the ability to cure those
who are not sick' (16) it was said. The prevention of disease was
considered superior to the curing of disease.
Although the theory of traditional Chinese medicine
survives to this day, it has evolved and developed into several schools
over the last 2000 years. The present paper reviews the basic principles
of the Huang Di Nei Jing.
The
concept of a 'balanced diet' and 'a complete diet'
The imperial herbal doctors, concurring with Confucian
schools, paid a lot of attention to the 'attainment of nourishment'
(17) by selecting appropriate food in a way which was somewhat philosophical.
By 'appropriate' (18) amounts of food was meant not too much or too
little, otherwise it was thought that one health extreme or the other
could result. Because there was no knowledge of energy or nutrients,
the word 'appropriate' probably referred to having various food sources
in the diet (ie a wide variety of foods).
In Huang Di Nei Jing, Chapter 81, section 22,
there were these following recommendations for food intake: (1) Poisons
(presumably substances like antibiotics to rid or destroy unwanted
principles in the body) and medicines provide cure. (2) Five cereals
(rice, sesame seeds, soya beans, wheat, millet) provide nourishment.
(3) Five fruits (dates, plum, chestnut, apricot, peach) produce complementarity.
(4) Five animals (beef, dog meat, pork, mutton, chicken) give advantage.
(5) Five vegetables (marrow, chive, bean sprouts, shallot, onion)
are for supplementarity. (6) In addition, if the food tastes and smells
good, eat it to replenish the body's needs. These were probably the
first dietary guidelines in the world, in which fulfilment of both
'the nutritional' and the 'organic needs' of the body was sought.
The first part of the quotation means that medicines
should be used to effect a cure. The following four parts of the statement
describe basic food groups and reflect principles, like having a variety
of cereal like foods in order to nourish the body. The number 'five'
(as in holding out a hand with five digits) does not mean a number
per se, but signifies the varieties of cereal, fruit, animal and vegetable
derived food. Cereals were considered basic and staple foods for nourishment
in daily life, and fruits were placed second because they compensated
for shortages in whatever cereals provided. Animal-derived foods,
like meats and meat products were seen to be important for the human
body, with its resemblance to the animal. Vegetables were perceived
in the ancient Chinese diet to provide an extended range of substances.
The end of the quotation, 'if it tastes and smells good then eat it',
indicates the importance of freshness, preparation and hygiene of
foods.
With modernization and time, people and their circumstances
change and cultural exchanges between countries include those of food
and technology. Sometimes cultures integrate. Thus the food produced
in the Chinese restaurants of today will not be representative of
the traditional diet because it will have been modified to suit the
taste of people in various locations and countries. However, it has
been shown in the 1988 National Nutrition Survey of China, that most
people living in the countryside and cities still follow traditional
food patterns5. The occurrence of certain degenerative
diseases in China is lower than that in industrialized countries,
which may in part be attributable to diet, which in turn is related
to the conceptual framework for eating.
The concept
of 'han' (cold) (19) and 're' (hot) (20)
'Han'
and 'Re'
Han and re are often translated to mean
'cold' and 'hot' (see Table). However, both han and re
mean more than these literal translations suggest. They refer, not
only to the body's status, but also to its function, reaction and
symptoms. For example, when a person has ingested cold food, he/she
may respond with related characteristics. Thus, han food may
cause diarrhoea and re food may cause constipation; han
foods may cause nausea while re foods may cause gut problems
such as heartburn. On the other hand, han food could combat
constipation and re food diarrhoea. These symptoms do not relate
to food temperatures, but to the relationship between food and the
human body6,7.
Whilst food was believed to provide our bodies with
nourishment, the body reacted or responded to food in different ways.
For example, if a person eats too much meat, its metabolic effects
through 'acid' production may be 'uncomfortable'. This is what is
described as re. However, not all meats are characterised as
re and not all re are meat. Modern nutritional science
concentrates on the nutrient components of foods and on the metabolism
of nutrients. It rarely acknowledges that there are both nutrient
and non-nutrient substances in food which might affect the body. Unripened
guava may cause constipation and this may be explained by contemporary
food chemistry in terms of tannic acid; this phenomenon is traditionally
described as re. Ripened guava does not have the same effect
and therefore is not considered as re. Efforts are now underway
to link contemporary science with traditional Chinese food and health
concepts. It has been argued that food which contains more or less
cation than anion can create a situation of either han or re,
although such a generalization is still difficult to accept at a point
in nutrition science where the effects of any one cation or anion
are recognized as complex. Most fruit and vegetables are considered
as han which means that food high in dietary fibre belongs
to the han category. That both han food and foods containing
dietary fibre can cause 'emptying of the bowels' is a proximation
of the two streams of thought.
Water
Chinese medicine also characterized the source or
location of water like spring water, well water, or water from a stream,
pond or river as han or re because the mineral composition
of these waters is different, causing different biological consequences.
Water which contained a lot of magnesium has been considered as han.
Table. Han, re, wen and
bu foods of traditional Chinese medicine.
Han |
Re |
Wen |
Bu |
(cold) |
(hot) |
(neutral) |
(strengthening) |
Kelp |
Ginger |
Rice |
Ginseng |
Wheat |
Pepper |
Beans |
Deer Velvet |
Vegetables |
Mutton |
Fish |
Dates |
Pork |
Unripened guava |
Beef |
|
'Wen',
'Wang', and 'Bu'
Food that is in-between han and re was
considered 'neutral' (21), see Table. Rice is an example of a 'neutral'
food. 'Neutral' and slightly re foods are considered as wen
(22), which has the characteristic of a 'tonic' (wang). Wen
food is usually compensated for by bu (23) food to avoid nutrient
insufficiency. According to Chinese medicine, wheats are slightly
han, beans are 'neutral', most fish are 'neutral' (halibut,
trout, carp, yellow fish, eel, garoupa, etc), beef is wen,
mutton is very re and pork is slightly han. Usually
han food is cooked with some re food to neutralize it.
For example, vegetables (a han food) are usually cooked with
ginger or pepper (re foods) to neutralise them. In the old
days, the Chinese noticed that a food or food substance behaved differently,
depending on what it was eaten with. More recently, similar observations
have been made by Wahlqvist et al8 and Jenkins and Wolever9
to show that a given amount of carbohydrate or carbohydrate containing
food can cause very different glycaemic responses. Such contemporary
nutrition science concepts may be regarded as analogous of
traditional Chinese food concepts.
The 'fan'
and 'tsai' principle - the concept of 'cereal'
(24) and 'dishes' (25)
The traditional Chinese meal contains two parts -
the staple food, ie 'cereal', fan and the rest of the meal, referred
to as 'dishes', tsai. Cereal is the staple food in the Chinese
diet and this may include rice, wheat, corn sorghum and millet. The
word 'dishes' (26) in Chinese is nowadays the same as that for vegetables,
because Chinese dishes mostly contain vegetables, with other kinds
of food added as ingredients. Therefore, the word has come to include
meat, fish, egg, vegetables, beans and more. It also means 'accompanying
food' (27) which indicates that 'dishes' is only a side dish to accompany
the main course - rice. The traditional Chinese diet is, by weight,
more than 50% carbohydrate from cereal, and dishes are comprised of
more than 50% vegetable with the remainder coming from animal sources.
Thence the notion, 'cereals are for nourishment'.
The concept
of 'nourishing the body' (28) and 'nourishing the mind' (29)
The first chapter of Huang Di Nei Jing points
out that diet and life should have a physical and psychological balance.
It says 'Control your diet, regulate your life, do not carry out unnecessary
tasks, and then you will have a healthy body and a good spirit. If
you carry this out all the time, you will live until you are a hundred
years old' (30) . A lesser ambition, for those unable to carry out
this admonition would be to 'Eat delicious food, do the same things
as friends, entertain like others, but without aspiring higher'. One
should be satisfied with what one has at present and be happy: one
should enjoy one's meals, improve and work as hard as one can, and
take care of the family's physical and psychological needs. This is
what is meant by 'nourish one's mind'. If food is only used to nourish
the body, the mind may not be satisfied.
Herbal medicine
and food come from the same origin' (31)
Chinese herbal medicines are part of the normal diet.
Chinese scholars believed that what we eat and drink should provide
nutrients and other substances that the body needs. Some medicines
may be used as part of a normal diet to maintain a healthy life. There
are some interesting examples of this concept which merit identification.
- Certain foods have preventive effects in a normal
diet. For example, linzhi (32), a kind of mushroom, is believed
to contain substances which may prolong life expectancy, and therefore
ought to be included in a normal diet.
- Even in ancient times, it was believed that liver
could cure night blindness, seaweeds could cure goitre, and that
black beans could cure anaemia and therefore that these should be
added to a normal diet. No knowledge of vitamin A, iodine or iron
was available for these assertions.
- Those herbal medicines used in a normal diet were
considered as foods. Those which were used for treatment of disease
were referred to as medicine. Chinese yam, rice, ginger, and green
onions are examples of items which may be ingested as food or medicine.
- Herbal medicines which were used as medicine were
sometimes also cooked as food in a combined dish. They were used
as bu, for example ginseng (33) and dates (34). These foods
or medicines were used according to the needs of the patient or
healthy person. However, some have become so popular that they are
part of a regular diet.
In traditional Chinese medicine, 'nourishing the body
with nutrition' is very important. The classical medical book Huang
Di Nei Jing, and other medical books, regarded nutrition as the
essence of a Chinese person's life. The principles of Chinese medicine
were in reality based on clinical experience and epidemiological observation.
Reviewing the thinking behind Chinese medicine helps us understand
its principles. The use of preventive medicine in a normal diet is
an important early Chinese concept. Chinese have traditionally regarded
food as containing both nutrient and equally valuable non-nutrient
substances which link food and health in an inextricable way.
Acknowledgments
- The author would like to thank Ms
Susan Lui for her help in the development of this paper
References
- Wang Z-G, Ren J. Pharmacology and toxicology of
traditional Chinese medicines- a historical perspective. In: A McLean
and ML Wahlqvist. Current problems in nutrition, pharmacology and
toxicology. London: John Libbey, 1988.
- Koo L. The use of food to treat and prevent disease
in Chinese culture. Soc Sci Med 1984;18, 757-766
- Koo L. Concepts of disease causation, treatment
and prevention among Hong Kong Chinese: diversity and eclecticism.
Soc Sci Med 1987;25:405-417.
- Huang Di Nei Jing. Tianjin Scientific Technology
Publishing Press, 1986.
- Summary of National Nutrition Survey. The Academy
of Preventive Medical Sciences of China, 1986.
- Ben Cao Gang Mu. People's Health Publishing Press,
1982.
- Shi Liao Ben Cao. Chinese Medical Pharmacy Scientific
Technology Publishing Press, 1990.
- Wahlqvist ML, Wilmshurts EG, Murton CR, Richardson
EN. The effect of chain length on glucose absorption and the related
metabolic response. Am J Clin Nutr 1978;31:1998-2001.
- Wolever TMS. The glycemic index. Wld Rev Nutr Dietet
1990;62:120 185.
PRINCIPLES OF DIET THERAPY IN ANCIENT CHINESE MEDICINE
Glossary of Chinese terms:


Copyright © 1993 [Asia Pacific Journal of Clinical
Nutrition]. All rights reserved.
Please note: this article has been scanned and reformatted.
to the top