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Introduction
Traditional Asian medicine is an ancient practice that many people today use as a
vital component of their healthcare (Bodeker 2002). In fact, the popularity of traditional
traditional Chinese medical research center with the intention of promoting holistic
healthcare across the globe (Starling, 2008). Many non-Asians are strong supporters of
traditional Asian medicine, but these traditional medical practices are especially
important in the culture and beliefs of Asian people who have recently immigrated to the
US (Uba 1992). Healthcare practitioners and public health policy makers in this country
should utilize Eastern medicine, along with Western medicine, when treating Asian
immigrants. This paper examines traditional Asian medicine and the role that it should
play in smoking cessation among Asian immigrants at Philadelphia Health Care Center
#N .
Asian Americans make up less than 5% of the total U.S. population, and many
people believe certain myths about Americans of Asian descent (Xueqin 1999). People
do not understand the diversity of different Asian cultures and beliefs, people think that
Asian Americans are a “model minority” (Xueqin 1999) that does not need public health
interventions, and people think that Asian Americans represent such a small percentage
of the U.S. population that their presence is almost insignificant (xueqin 1999).
However, Asian Americans make up a large percentage of the populations of big cities
throughout the U.S: 46% in Honolulu, HI; 18.4% in San Francisco, CA; 10.4% in Los
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Anne Spini Public Health 540: Behavioral Assessment
Professor: Renee Turchi, MD, MPH October 1, 2008
Case #1: Immigrant Health
17.92% Asian (US Census Bureau, 2001). Overall, Asian Americans smoke at slightly
lower rates than do other Americans (11% vs. 20%, respectively), but certain Asian
American populations smoke at very high rates (CDC 2006). Generally, high rates of
Southeast Asians (Vietnamese, Cambodian, and Laotian Americans) and Chinese men
move to anti-smoking states like California generally quit smoking (Zhu, et al., 2007).
Of the Chinese and Korean immigrants living in California who have ever smoked,
53.3% quit smoking, whereas 11.5% of smokers quit in China and 22.3% quit in Korea
component of smoking cessation among Asian immigrants, but public health efforts
aimed at helping this diverse population quit smoking need to consider the following
healthcare practitioners who treat Asian immigrant patients would benefit from learning
about and putting into practice several traditional Asian medical procedures and ideas.
Taking this step to make healthcare and public health programs more holistic would
Traditional Asian medicine has been used for thousands of years, and Traditional
Chinese Medicine (TCM), based on Taoist and Buddhist philosophies, is one of the
oldest forms of traditional Asian medicine. TCM is a holistic health approach that
includes acupuncture, massage, meditation, herbs, diet, and exercise remedies (Zheng, et
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Anne Spini Public Health 540: Behavioral Assessment
Professor: Renee Turchi, MD, MPH October 1, 2008
Case #1: Immigrant Health
al., 1995). TCM views the body as an interconnected system that is linked to the forces
of nature, rather than as flesh and matter, the way Western medicine views the body
(Zheng, et al., 1995). In China, modern and traditional medicine are both commonly
used, and TCM accounts for 40% of distributed health treatments (Zheng, et al., 1995).
The various systems of the body, such as yin and yang, as well as nature and the
cosmos, are integrated to create the perfect balance that correlates with optimal health
(Richardson, et al., 1986). Yin and yang describe any opposing forces in Chinese culture,
such as fall and spring, and this concept is used to describe the opposing forces of the
human body. Yin and yang are constantly conflicting with each other and sickness
occurs if either of them is out of balance (Richardson, et al., 1986). Yin and yang apply
to qi, the fundamental energy of the body systems, which flows through meridians, or
channels. Qi is the opposite of blood, the other substance that travels through the body
channels. Key to TCM is its unique map of the body, which describes blood, qi, and the
organs in terms of function and their unification with other body systems (Richardson, et
al., 1986).
This unique map of the body is used by acupuncturists, who insert needles into
certain points along which blood and qi flow in order to relieve pain or alleviate an illness
(Richardson, et al., 1986). In the TCM model of the body, qi should be free flowing and
relatively constant throughout the body, and the purpose of acupuncture is to fix
component of TCM. It is used extensively throughout China and increasingly in the US,
and it has even been used during surgeries as the sole form of anesthesia. Acupuncture,
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Anne Spini Public Health 540: Behavioral Assessment
Professor: Renee Turchi, MD, MPH October 1, 2008
Case #1: Immigrant Health
as well as other forms of TCM, is very difficult to fully learn, and TCM doctors must
therapy is a highly individualized treatment where the practitioner must analyze the
patient’s balance of yin and yang and concoct a suitable formula that will only work if all
the components are present in their exact quantities (Shaw, et al., 1997). Single
ingredients do not function in herbal therapy, but the mixture of all ingredients is
essential. Food and exercise treatments are also used to restore the balance of yin and
yang (Shaw, et al., 1997). Foods that increase yin are generally warmer and richer in
calories, so they can be used to alleviate a cold or hasten the circulation of blood and qi.
Yang foods, used to improve a fever or detoxify the body, are cooler, lower in calories,
milder, and generally contain more water (Shaw, et al., 1997). Massage, meditation, and
exercise therapies are also used to change the yin/yang ratio by increasing or reducing
blood flow, hydrating the body, and having a calming effect on the body (Shaw, et al.,
1997).
Traditional Southeast Asian medicine and traditional Korean medicine are similar
in many ways to TCM in that they use acupuncture and herbal remedies. However, in
addition to TCM practices, many Vietnamese, Cambodian, and Laotian doctors use a
procedure called coining to treat a variety of conditions. In this procedure, hot coins are
rubbed on the skin of the back, neck, or chest until red welts appear. These welts are
thought to create a way for “bad wind” (Sullivan 2005) to exit the body. Coining is used
to treat headaches, coughs, fevers, and to ward off evil spirits. There have been studies
reporting that coining causes burns, bruises, and brain hemorrhage (Sullivan 2005).
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Anne Spini Public Health 540: Behavioral Assessment
Professor: Renee Turchi, MD, MPH October 1, 2008
Case #1: Immigrant Health
Efficacy of Traditional Asian Medicine
There has been much debate over the effectiveness of traditional Asian medicine,
and findings remain inconclusive. Much research has been conducted on the usefulness
of acupuncture in alleviating the symptoms of several diseases, and some studies find it
to be helpful (Lee, at al., 2004) while others do not (Shaw, et al., 1997). Acupuncture has
been found to be effective in helping to treat some illnesses. Conditions that have been
shown to improve following acupuncture include nausea (Lee, et al., 2004), lower back
biological mechanism (Yang, et al., 2008). Acupuncture has been found to decrease
reinforcing effects of abused drugs by changing dopamine release, which affects several
other brain neurotransmitter systems (Yang, et al., 2008). This research is important
because it is one of the only conclusive studies on acupuncture and drug addiction that
provides biological data. Other research (White, et al., 2005) on the effectiveness of
acupuncture in smoking cessation has either been inconclusive or has concluded that
acupuncture does not help people stop smoking. Additional research needs to be
One traditional Chinese doctor in the US (Xueqin 1999) has found acupuncture to
decrease cravings for a cigarette by decreasing anxiety and increasing general well-being.
When asked to describe his methods, this particular doctor stated the following:
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Anne Spini Public Health 540: Behavioral Assessment
Professor: Renee Turchi, MD, MPH October 1, 2008
Case #1: Immigrant Health
“When patients are ready to free themselves from the unwanted smoking habits, I
individual needs. Normally, very small needles are inserted into certain reflex
points. They may feel a slight pinch, like a mosquito bite. The needles remain in
place for a few minutes when they relax. Most patients quit smoking after one
treatment. They may need one or two booster treatments if they are severely
often feel relaxed, uplifted, and self-confident. They no longer feel a physical
therapy and meditation for individuals with breast cancer, it was found that patients who
participated in this holistic therapy experienced lower levels of anxiety than did people
who were treated with only Western medicine. The mind-body-spirit group therapy,
which incorporated TCM and Western medicine in sessions over a two-month period,
was found to decrease apprehension and anxiety in breast cancer patients, allowing the
patients to experience better healing (Liu, et al., 2008). Therapy that increases general
There is also much debate over the effectiveness of herbal remedies and dietary
supplements (Shaw, et al., 1997). There exist several studies suggesting that certain
herbal treatments used in Traditional Asian Medicine can even be detrimental to the
body. In a study (Shaw, et al., 1997) conducted in the UK of 1297 individuals with new
health problems who had been receiving herbal treatments, 785 people were found to
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Anne Spini Public Health 540: Behavioral Assessment
Professor: Renee Turchi, MD, MPH October 1, 2008
Case #1: Immigrant Health
have liver problems, allergic reactions, and heavy metal poisoning caused by the herbal
remedies (Shaw, et al., 1997). Chinese herbal remedies are currently very popular in
Britain, and in another case, a skin cream, which consumers thought to be made of all
natural ingredients, was found to contain steroids (Graham-Brown, et al., 1994). This
skin cream is very misleading to consumers and also illegal, since medicines that contain
high levels of steroids cannot be sold without a prescription in Britain. Herbal treatments
can possibly be helpful for certain conditions, but consumers need to be aware of exactly
what they are taking. There has not been much research done on the use of herbal
remedies for smoking cessation, but these treatments are probably not helpful for this
A study (Xueqin 1999) was conducted on the healthcare access and usage of
Chinese immigrants in the US. Western medicine has a long way to go in recognizing
and accepting traditional healthcare beliefs and practices of other cultures. Because
many Western practitioners are completely ignorant about TCM (Xueqin 1999), some
Chinese immigrants are distrusting of these doctors. While many Chinese immigrants do
accept the validity of Western medicine, most of them do not solely use this type of
Houston and Los Angeles. Participants were all at least 25 years of age, and they were
reported among these individuals: 94.6% used alternative/home remedies; 45.3% used
both Western and traditional healthcare; 32% traveled to China or Taiwan for healthcare;
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Anne Spini Public Health 540: Behavioral Assessment
Professor: Renee Turchi, MD, MPH October 1, 2008
Case #1: Immigrant Health
25.3% used traditional Chinese clinics in the US; 21.3% primarily used Western clinics
(Xueqin 1999).
These results show that Western healthcare needs to become more holistic and it
needs to incorporate more alternative medicine in order for Chinese immigrants to feel
comfortable using it (Xueqin 1999). Another public health study (Uba 1992) found that
Southeast Asian refugees in the US suffer significant health problems due to physical
trauma and to a lack of sufficient healthcare in Asia, but that these immigrants under use
healthcare services in the US, even when they have access to these services (Uba 1992).
While Southeast Asian immigrants deal with significant economic barriers to healthcare,
the bigger problem contributing to their lack of healthcare might be cultural. Common
cultural beliefs of Southeast Asian populations include the idea that suffering is
unavoidable and that the human lifespan is predetermined (Uba 1992). Southeast Asian
than do other Asian immigrant populations, since they are the least acculturated of the
Asian immigrant populations (Uba 1992). Southeast Asians also do not understand
Asian medicine, but it has come a long way in the last 10-20 years (Xueqin 1999). In
1992 the National Institute of Health created the Office of Alternative Medicine to
conduct research on traditional healing (Xueqin 1999). This type of medicine had
become much more popular among the general public, and the Office of Alternative
Medicine was given a budget of $2 million (Xueqin 1999). Another study (Bodeker, et
al., 2002) confirmed the increasing popularity of traditional medicine. In 2002, about
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Anne Spini Public Health 540: Behavioral Assessment
Professor: Renee Turchi, MD, MPH October 1, 2008
Case #1: Immigrant Health
50% of people in developed countries used some form of traditional medicine, and public
health research is continuing to be conducted on the safety and effectiveness of this type
The fields of public health and medicine are making efforts to understand and put
into use traditional medical practices (Wetzel, et al., 1998). Integral to the development
in medical schools. In a study of the US medical schools (Wetzel, et al., 1998), 60%
were found to offer elective courses on traditional medicine. However, there are huge
differences in the content, format, and amount of material covered in these courses. To
better treat immigrant populations in the US, medical school curriculums need to be
smoking cessation programs for Southeast Asian populations in Philadelphia Health Care
Southeast Asian culture (Uba 1992) and the growing credibility of traditional medicine in
the medical and public health communities (Lee 2004), it is my recommendation that
behind traditional Asian medicine, and they should have substantial knowledge about
acupuncture and meditation. Physicians who are practitioners of these techniques should
Health Care Center #N. The leaders of the support groups and the physicians should
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Anne Spini Public Health 540: Behavioral Assessment
Professor: Renee Turchi, MD, MPH October 1, 2008
Case #1: Immigrant Health
collaborate, so that both providers are aware of how each patient is doing in all aspects of
cessation, it is expected that participants of the program will have a better chance of
Conclusion
Many Asian immigrants living in the US have very strong cultural ties to their
country of origin, so traditional Asian medicine is very important to these people (Xueqin
1999). Asian Americans are not very well understood by Western healthcare providers
and the US population in general (Xueqin 1999). Asian immigrants are seen as a “model
minority” (Xueqin 1999) that does not need to be the focus of public health interventions,
but in reality, many Asian Americans live in poverty and lack access to healthcare.
Oftentimes, Asian immigrants who do have access to healthcare do not make use of this
service due to cultural beliefs and distrust of Western medicine (Xueqin 1999). It is
thought that Asian Americans do not generally smoke (Xueqin 1999), but Chinese men
and Southeast Asians living in the US smoke at high rates (CDC 2006). Healthcare
providers and public health policy makers need to focus more on traditional Asian
doing so, these patients will be much more likely to seek out the services of healthcare
providers in the US, and smoking related illnesses will be prevented to a large degree.
Traditional Asian medical practices that help people stop smoking, such as acupuncture,
should be offered by more doctors in the US. These physicians also need to know how to
communicate better with their Asian patients so they can successfully advise them against
practices that might be detrimental to their health, such as dangerous herbal medicines
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Anne Spini Public Health 540: Behavioral Assessment
Professor: Renee Turchi, MD, MPH October 1, 2008
Case #1: Immigrant Health
and coining. More research needs to be conducted on the efficacy and the safety of
smoking cessation program at Philadelphia Health Care Center #N, the program will be
more effective.
1. How should healthcare providers respond when Asian immigrant patients insist
on using cultural treatments that have been shown to cause adverse side effects
and suffering, such as coining (some people who use coining on their children
schools?
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Anne Spini Public Health 540: Behavioral Assessment
Professor: Renee Turchi, MD, MPH October 1, 2008
Case #1: Immigrant Health
References
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