Editor's note: Part one of this interview appeared in the February 2003 issue.
Brian Benjamin Carter (BBC): What would you say to a practitioner who has not worked with his or her patients' diets?
Juliette Aiyana (JA): First, change your own diet.
Second, cook. Cook for yourself and your friends. Experiment with new recipes, take recipes from Food and Wine and Gourmet, and learn how to cut the fat, butter, etc. by experimenting with healthy substitutes. Practice recipes from Vegetarian Times. I do it all the time, and the food tastes fabulous. Many of my friends and patients are surprised to find out that I'm not a vegetarian. I do eat vegetarian meals every day, but I've found that I'm much healthier when I eat meat daily, too. Some people need more, some less.
Don't beat your patients over the head with your beliefs, either. Keep your agendas to yourself and respect their choices.
BBC: Do you have any tips for how to talk to patients about changing their diet?
JA: Yes. I do the initial interview, and the tongue and pulse reading. Then I say, "Okay. I'd like to explain to you what I just did and what it all means, and then I will tell you your prognosis. First, I took your pulse - what I am feeling for are several qualities like fast or slow. Your pulse is 83 beats per minute, which is a bit on the fast side, which indicates to me there may be some heat. I'll tell you where that heat is coming from, and what we can do about it, as we continue this discussion. I also feel other qualities called 'slippery' and 'wiry.'"
Then I might smile and laugh. "That sounds funny, right? What is that supposed to mean?" The patient usually nods in agreement. "Well, slippery feels like water flowing under my fingers, and wiry feels a bit like a guitar string. This indicates to me that you have something called dampness in your body. Remember in the interview when you told me you feel sluggish and have leg heaviness and daily leukorrhea, and you've recently gained weight? When you soak a dry sponge, it gets heavy and wet, right? Water pours downwards, right? Well, you have those symptoms where the heavy dampness leaves you feeling sluggish, etc. This, combined with that thick white coating on your tongue, indicates dampness. Dampness is a pathogenic yin fluid. Your body has too much of it, so we want to dry it up. How can we do that? Well, let's talk about your spleen."
Then I tell the patient his or her story in detail. I tell the patient about each finger position, organ correlations and what I felt. I tell them how the Five Phases work, using my wall chart to demonstrate what is happening in the body. I tell them how emotions affect the qi. The patients are very excited to hear this, because I often explain things that no one else has been able to, and I find things based on the pulse or tongue reading that they did not tell me.
After I explain the pattern diagnosis, I'll say, "Okay. So where do we go from here? Well, I think that within X amount of time, we will see results by using acupuncture, Chinese herbs and dietary changes. I am not putting you on a special diet (although sometimes I do). I want to teach you how to choose foods that balance you out. For now, it is best if you avoid X foods and eat Y foods. We may get to a point where you can eat the foods on the avoidance list again - in moderation."
I give all patients a list of foods broken down into five categories: cold, cool, neutral, warm and hot. I draw an arrow next to the temperature heading I want them to emphasize, then I give an example meal and point to the foods on the list. I say with a smile, "Okay. So let's say you want to eat a baked potato and chicken and kale. The potato is cool, the chicken is warm, so together, they're neutral ... but we want to warm up that spleen of yours, right? So the kale is perfect because it is warming. You can also cook with ginger or garlic for more warmth." The patient is relieved to see how many things he or she can eat as long as the foods are balanced.
The list also has suggestions for various patterns, so one section is blood vacuity, which tells them to eat black beans; chicken; maybe some beef; meat & marrow broths; leafy green veggies; and yellow veggies. Some patterns have a list of foods to avoid, like for liver qi stagnation, avoid caffeine; too much chocolate; spicy foods; greasy fried food, etc. I put an arrow next to each heading that fits them. I assure patients that they can call me with questions.
When my patients understand the whole picture, they really get into participating. They also feel I respect their intelligence, because I explain all of this to them. They feel I have confidence that they can understand Chinese medicine, and they do understand it because I have trained myself to teach in a way that retains the integrity of Oriental medicine. I don't Westernize my explanations, although I do teach Western nutritional sense. For example, if you are a vegetarian, you should supplement with zinc.
BBC: What about patients who won't change their diets?
JA: There will be a small percentage of patients who won't change. Learn to accept that without judgment. As practitioners, our words have immense power. If we tell patients they will never get better, they might believe us.
Bedside manner is so important: It really impacts our patients and how honest they will be with us during follow-ups. I just matter-of-factly explain their diet's effects and leave the ball in their court.
BBC: Can you give us an example of a patient whose dietary changes made a big difference in their health?
JA: Wow. There are so many! Mainly people tell me they feel a huge difference in their energy level, and they see great changes in their digestion, such as regularity; firmer stool; better color; and no more abdominal bloating or gas. They get sick less often, and many have found a new or renewed source of creative relaxation in cooking for themselves, rather than eating out all the time or busting open a can of soup and nuking it in the microwave.
The results are amazing, and I really hope more practitioners will become inspired to apply this very important aspect of OM onto their lives and clinical practices. I encourage all practitioners to print out my articles and give them to their patients. Use the tools that are available. Seek out other resources that have handouts and checklists for dietary therapy. Be well and eat well.
As we say in Italian, "Salúte" (to your health).
Click here for previous articles by Brian Carter, MSCi, LAc.