By Micah Arsham
Keywords: Z’ev Rosenberg, chronobiology, acupuncture, nourishing life, Su Wen, autoimmune disease, ecological medicine
Sitting down with Z’ev Rosenberg to talk with him about his book projects, it’s hard not to get distracted by all the interesting material in his library: one can find the latest East Asian medical history and medical anthropology books, next to art books, next to books on science and health. Z’ev’s journals, essays, and lectures show how classical texts are the foundation of clinical practice, but the importance of keeping ‘the classics’ in mind is only one message he hopes to convey to the next generation of acupuncturists and herbalists. His current research focuses on the relationship of ecology to medicine, specifically, how the internal environment and external environment constitute and influence one’s health.
MA: Why did you choose to settle in San Diego? How does the climate influence what you see in your clinical practice?
ZR: I came to San Diego when I was offered a position at Pacific College of Oriental Medicine (PCOM) here. They needed an herbal medicine teacher—which were hard to find in those days (24 years ago)—so Ted Kaptchuk, who was returning Boston, recommended me. I had never been here before, but got to love the place, and it was a great town to raise kids. Even though San Diego has one of the best climates in the world, there are lots of different conditions to treat with Chinese medicine. There are seasonal, though subtle, changes in this Mediterranean climate. Surprisingly, there is a lot of respiratory stuff in the fall through early spring, which is largely because San Diego sits open to the relatively cold Pacific Ocean, and winds off the ocean can trigger wind strikes and cold damage disorders.
MA: When you diagnose a patient, what is essential to your thought process? What is the best way to unlock difficult cases?
ZR: In Chinese medicine, we do not rely on machines for diagnosing, and the diagnosis is more qualitative than quantitative. So one uses all of the senses, and then puts all that information into one’s mind and heart to synthesize the diagnosis. Experience and repetition makes diagnosis a yogic process. After awhile, feeling the pulse, looking at the tongue, palpating, hearing the voice, looking at the complexion, and smelling the patient tells you a great deal—and from this you already know what needs to be done. In terms of information, based on the Nan Jing (Classic of Difficulties), I use what I call the ‘time line’ method, which I first learned from Michael Broffman, where one looks back through cyclic periods in peoples lives (more or less seven years for women, eight for men according to Chapter 3 of the Su Wen
MA: What is chronobiology and how does it relate to traditional East Asian medicine?
ZR: Fully one third of the Su Wen (Plain Questions) is devoted to the theory of ‘five movements six qi’ (五運六氣wu lun liu qi), or chronobiology (捲 juan), as in chapters 69-77. One of the greatest secrets of classical Chinese medicine is that it is largely the practice of medicine through working with time. For example, acupuncture and moxabustion largely heal by changing the patient’s perception of time, and by allowing body systems to ‘catch up’ with themselves, so that they slow down or go faster, thus synchronizing bodily time as if fixing a watch. Through chronobiology as explained in the Su Wen (Plain Questions), we can calculate the best times to treat, the best methods to use according to time of day or season, and choose points appropriate to the time of day. Even more important than these are the chapters that explain how to predict epidemics and trends of disease by calculating the stems and branches of particular years and their intrinsic ‘qualities.’
MA: One topic in your upcoming book is ‘ecological medicine.’ What does this term mean?
ZR: Ecological medicine, as conceived in the Su Wen (Plain Questions), is defined as health of the individual, family, society, and natural environment gained from living by the laws of heaven and earth. When humanity lives according to the four seasons, weather changes, work, rest, diet and exercise according to the laws of yin and yang and the five phases, good health is the result. But just as the air, water, and soil are damaged by pollution due to war, over-population, poor farming practices, pesticides, coal-fired power plants and other byproducts of our technologically-advanced civilization, our human ecology is also damaged by these things. So working outwards, we should promote clean air, water, and soil; alternative energy sources such as solar and wind; and organic farming…this is the outward manifestation of cultivating one’s own health and nourishing life (養生yang sheng).
MA: What is bioregional herbalism? Why is it important?
ZR: While all traditional herbal medicine use imported ingredients to some degree, including China, India, Japan and Tibet, the core of all indigenous medical traditions is based on local medicines that grow in one’s own region. It is important to know the medicinal plants that are found where one lives, and to learn how to locate them in the wild, grow them, harvest them, and prepare them in order to have a broader-based knowledge of herbal medical practice. I marvel at the medicinal power of fresh, locally grown herbs.
MA: What constitutes a healing diet, and how important is patient compliance? What is the ‘clear and light’ diet espoused by traditional Chinese medicine?
ZR: The ‘clear light (bland)’ (清淡qing dan) diet of Chinese medicine was defined by Li Dong-yuan and Zhu Dan-xi during the Jin-Yuan dynasty. They emphasized the avoidance of strong flavors and additives such as excessively spicy, salty, bitter, and pungent flavors (such as vinegar); rather, one should eat foods in their natural state as much as possible, and use simple food combinations, based largely on grains and vegetables, with small amounts of fruits and animal products. This diet was elaborated in depth in 18th century Japan by a samurai/physician, Ekiken Kaibara. His work has been translated as Yojokun (養生論Yang Sheng Lun), or Treatise on Nourishing Life. It also is the root of George Ohsawa’s macrobiotic teachings, since ‘macrobiotics’ is just another translation of ‘yang sheng.’
MA: Is it important for students of traditional East Asian medicine to study Chinese language (or Japanese, Korean, Sanskrit, etc.), at least the medical terms? Why is a reading knowledge of Chinese helpful, and what effect has it had on your clinical practice?
ZR: Learning an Asian language is absolutely essential to study traditional East Asian medicine, at the very least medical Chinese, Korean, Sanskrit, etc. Otherwise one cannot adequately penetrate the logic of the language itself, which contributes greatly to understanding medical theory. My observation after twenty-five years of teaching is that without some Asian language knowledge, it is difficult for students to penetrate and apply the logic of five-phase theory, yin-yang theory, six-channel theory, and other foundational concepts of Chinese medicine. For me, even a basic knowledge of medical Chinese allowed me to access dictionaries, check translations, and greatly deepened my understanding of the medicine. It was if a veil was removed from my eyes.
MA: Which scholars have influenced you the most? How does the work of medical anthropologists, Sinologists, and translators change the way you think about traditional East Asian medicine? How exactly is such scholarship related to clinical practice?
ZR: For me, what helped me transcend my original education (in acupuncture college) was being exposed to the works of medical anthropologists such as Paul Unschuld (the Medicine in China series), Nathan Sivin, Manfred Porkert, and Joseph Needham (the Science and Civilization in the History of China series). Having a historical perspective is essential to understand a medicine that is two thousand years old, and furthermore, it exposes you to possibilities in clinical practice that surpass the limitations of textbook protocols that are relatively one-dimensional. Terminology is also crucial, and Nigel Wiseman gets my vote for his A Practical Dictionary of Chinese Medicine and for several works that teach how to read medical Chinese language. High quality translation is essential, and fortunately the level of Chinese medical literature has risen in the last few years, thanks to more practitioners learning medical Chinese, and thanks to great translators such as Sabine Wilms, Eran Evan, Sharon Weizenbaum, Chip Chace, and a few others.
MA: Often Sinologists specialize in one time period, such as medieval literature, or Han dynasty works. Are students of traditional East Asian medicine expected to grasp the entire history of medicine, from oracle bones to the global expansion of Traditional Chinese Medicine (TCM)? Do students have enough classes on the history of traditional East Asian medicine, and if not, what should they learn?
ZR: As Robert Plant sang, “There are two paths you can go by in the long run.” A Chinese medicine physician can work within a lineage, such as the Tian/Zeng lineage of Shang Han Lun (On Cold Damage) taught by Arnaud Versluys, but even then, one learns that to truly understand it, one needs to have a broader base in Han dynasty medical canons, such as the Su Wen (Plain Questions), Ling Shu (Spiritual Pivot), Shen Nong Ben Cao Jing (The Divine Husbandman’s Herbal Foundation Canon), Tang Ye Jing (Decoction Classic), and Nan Jing (Difficult Classic). A historical perspective is a must, to understand the full ‘time line of development’ in the East Asian medicine, but one can certainly focus at a particular point on a specific current or approach, such as, for example, Li Dong-yuan’s Spleen-Stomach School, or Nan Jing (Difficult Classic) approaches to acupuncture and moxabustion.
MA: How would you describe ‘integrative medicine’ as the public and Western medical establishment sees it? What is the best role for traditional East Asian medicine to have in relation to biomedicine?
ZR: I think the ‘integrative medicine’ movement was premature, as our profession is still very young in the West, and too few of us have the experience, depth of knowledge, or clinical skill to interact on an even level with biomedicine. We grew up in a culture quite familiar with biomedicine, where any layperson can point and click any procedure or medication on Google and find a huge amount of information. At the opposite end of the spectrum, without Chinese language skills, quality information about Chinese medicine is much more difficult to access. I think we need to strengthen our profession first, be more grounded, and interact with other health professionals, biomedical or otherwise, as equals in aligned professions, not as a new type of physician’s assistant that just carries out a doctor’s orders.
MA: At the Cleveland Clinic they now offer ‘Chinese Herbal Medicine’ as part of their wellness services. Is this the future, or will herbs always be marginalized? How is Chinese herbal medicine understood, and how is it misunderstood, by the public and by many biomedical professionals?
ZR: While I applaud the developments at the Cleveland Clinic, it will take a sea change of consciousness for herbal medicine to become mainstream, as it will never make as much money as the pharmaceutical companies need to see in profit, although growing and harvesting herbs is a great potential growth industry in the U.S. It is a nine or ten figure industry in China! The public on one hand sees herbs as food supplements, safe to use, and some herbs such as jujube, licorice, astragalus, ginger, and cinnamon are relatively safe in this way. Other people see herbal medicine as toxic substances that could interact with pharmaceuticals, and avoid it out of fear. Some herbal imports have been found with excessive levels of pesticides and heavy metals, which doesn’t help the situation. But herbal medicine must be taken on its own terms and cannot be understood by pharmacology alone without delving into the logical system that governs the harvest, preparation, and combining of herbal medicinal substances into formulas, formulas that are then used according to a specific system of diagnosis and treatment.
MA: Some pharmaceutical treatments for autoimmune diseases can have many side effects. Does traditional East Asian medicine have the upper hand when treating autoimmune disease? How is the approach different from that of biomedicine? Do you think autoimmune diseases are increasingly common? In which other specialties, such as dermatology, gynecology, or pediatrics, might traditional East Asian medicine have an advantage, and if so, why?
ZR: The real key in choosing to use biomedicine or alternative systems such as Chinese, Ayurvedic, or Tibetan medicine in autoimmune disease is how far along the disease track patients are. In early stages, East Asian traditional systems can manage a host of autoimmune disorders quite well. In middle to later stages, patients can either transition off of toxic pharmaceuticals to herbal medicine, along with dietary changes and acupuncture treatments, or use these to compliment the biomedical treatments. In later stages, the progression of the disease is quite difficult to reverse, and biomedicine is necessary to control the disease, and sometimes, to keep the patient alive. This is very general; as there are several diseases that are considered as ‘autoimmune’ today, from diabetes to allergies to lupus to multiple sclerosis, and each have their own understanding, names, diagnoses, and treatments in both traditional medical systems and biomedicine. Autoimmune problems are increasingly common as a result of dietary and environmental degradation, including: exposure to toxic chemicals in the environment, overdoses of pharmaceutical drugs, the sterilization of private and public sectors through the use of anti-bacterial soaps and chemicals, and high levels of emotional stress. Many people are living beyond the capacity of their bodies to survive on junk food and little sleep, and end up living counter-intuitively according to deadlines and ‘clock time’ rather than paying attention to their biorhythms. Traditional medicine systems can give great benefits to nearly all medical specialties, since traditional medicine systems are grounded in understanding the nature of human beings and their different phases of life, such as early childhood, pregnancy, post-partum, middle age, menopause, and old age.
MA: Volker Scheid leads cutting-edge, interdisciplinary research at EASTmedicine (East Asian Sciences and Traditions in Medicine) at Westminster University in London. Could that kind of interdisciplinary research occur in the United States, and if so, are there funding sources? Where in the U.S. do the most exciting applications of traditional East Asian medicine occur, and who are the leaders in the field?
ZR: I think Volker’s work is very exciting, but even at Westminster, the budget is quite small and limits what they can accomplish. We have barely started to develop these projects in the U.S., but small developments are occurring. I find the work of such individuals as: Arnaud Versluys at The Institute of Classics in East Asian Medicine; Ed Neal, Lorraine Wilcox, Stephen Boyanton and myself at the Xinglin Institute; and Sabine Wilms, Brenda Hood, Heiner Fruehauf and the crew at National College of Natural Medicine in Portland, Oregon, to be hopeful for the future of our medicine in the West.
MA: You interviewed translator and scholar Paul Unschuld in 2013, and prior to that co-taught a class with him for PCOM’s doctoral program. What is his legacy, and how do his publications and perspective differ from those of other scholars?
ZR: Paul Unschuld’s work is highly researched and produced according to the highest academic and translation standards. His Huang Di Nei Jing Su Wen: An Annotated Translation of Huang Di’s Inner Classic project took twenty-five years to complete, including an introductory volume, the primary text (with commentaries chosen from a bibliography of several thousand volumes and articles), a dictionary, and concordance. I can’t think of any other work to compare with this, and several of his other works are up to this standard.
MA: What problems haunt the profession? How can we overcome them? What are your hopes for future practitioners of traditional East Asian medicine in the U.S.?
ZR: The biggest problem in our profession is that the schools need to really ground the educational system in knowledge of medical Chinese language, classical source texts, and a broad history of the medicine, and pair this with mentorship upon graduation. But this is difficult because of licensing boards and their standards. Also, tuitions have soared, but new graduates find it hard to make a living, much less pay back their student loans. This makes it difficult to just trust their medical skills, relax, and live traditional East Asian medicine as a lifestyle practice as well as a profession.
MA: What can you tell us about your new books and works-in-progress?
ZR: Since I am now ‘retired’ from teaching master’s-level classes at PCOM on a weekly basis, I can focus on more advanced seminars and writing books. I’m planning a retreat next year in New Mexico for practitioners of Chinese medicine. In addition to studying Chinese medical classics, including the Su Wen (Plain Questions) and Nan Jing (Difficult Questions), we will also find and categorize “Chinese” herbs that grow locally in the mountains and deserts. I have two book projects: one for the general public, called Healing the Broken Vessel, which explains the core principles of Asian medical systems and how to apply them to daily life in terms of diet, lifestyle, exercise, daily habits, managing health and illness, how to choose one’s health practitioners, and living with the seasons. It is based squarely on the principles in Su Wen (Plain Questions), chapters 1-3, including the stages of life from birth to maturity to old age. The second book is called Return of the Yellow Emperor: Ecological Medicine for the 21st Century, and it’s written for health professionals and interested laypeople. It uses the Su Wen (Plain Questions) as a base to explain how the Chinese developed a medical system that rightly spread through the world because it was and is based on timeless principles that respect both the internal environment of the human bio-organism and the external environment of planet earth. They are interdependent, and to heal one, we need to heal the other. I’m very excited about both of these works.
Micah Arsham is a licensed acupuncturist, herbalist, and independent scholar, and is the editor of Z’ev’s forthcoming books. She holds a B.A. (cum laude) from Columbia University, and an M.S. from Pacific College of Oriental Medicine, where she is a teaching assistant. She has studied at Princeton University, the Freie Universität Berlin, and Liaoning University of Traditional Chinese Medicine.
I enjoyed reading this highly informative and deeply thought out interview. Well done!