Traditional Chinese Concepts of Food and Medicine in Singapore 9789814377348

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-The Institute of Southeast Asian Studies

The Institute of Southeast Asian Studies was established as an autonomous organization in May 1968. It is a regional research centre for scholars and other spleGialists concerned with modern Southeast Asia. The Institute's research in· tetest is focused on the many-faceted problems of development and modemiza· tion, and political and social change in Southeast Asia. ·..

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The Institute is governed by a twenty-four-member Board of Trustees on which are represented the University of Singapore and Nanyang University, appointees from the government, as well as representatives from a broad range of professional and civic organizations and groups. A ten-man Executive Committee oversees day-to-day operations; it is chaired by the Director, the Institute's chief academic and administrative officer.

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Traditional Chinese Concepts of Food and Medicine m Singapore

by

David Y.H. Wu

Occasional Paper No. 55 Institute of Southeast Asian Studies 1979

How strong are folk traditions in the face of socio-cultural change or modernization? The effects of natural, political, and technological pressures on folkways are complex and are a function of numerous factors. Insights with the complex dynamics of cultural change or persistence can sometimes be gained by focusing on a limited aspect of a cultural system. This paper deals with traditional food classification and its medical significance among the Chinese population in Singapore. The author attempts to link, as a conclusion, this folk tradition with the emerging Singaporean nationalism and cultural identity. When medicine is considered as one component of the cultural system, one finds in Singapore a "pluralistic medical situation".l Traditional medical practitioners and spirit mediums intermingle with physicians trained in modem Western medicine, while traditional stalls of Chinese medicine stand side by side with Western-style drug stores. Several hospitals practising Chinese medicine are located in impressive multistorey buildings where patients go through a modern process of reception that parallels that found in a Western hospital. The patients have to be first registered, to wait for their turns in a hall, see the "doctor" in a private room for consultation and physical therapy, and finally they will receive prescribed Chinese medicine (usually in the form of bottled liquid or tablets that are abstracts of herb medicine) from the "pharmacy" of the "hospital". Many charitable and religious (Buddhist and Taoist) organizations sponsor Chinese medical clinics where free treatment and medicine arc provided for the poor. Although some of the clinics are housed in temples, many are accommodated m modern buildings with an outside appearance similar to the clinics of Western medicine. One of the oldest hospitals in Singapore, the Kwang Wai Siu, was originally a hospital of Chinese medicine. It now has sick beds, while both the Western medically qualified physicians and the Chinese medical practitioners are available to the patients. Nothing in this pluralistic medical situation would appear strange to people who are accustomed to it, as the Chinese are in Hong Kong and Taiwan . 2 Nor is it unique to other parts of the world where the emergence of modern European medicine never precluded or predated the indigenous medicine of an ancient tradition.3

R.W. Lieban, "Medical Anthropology," in John T. Honigmann (ed.), Handbook of Social and Cultural Anthropology (New York: Rand McNally College Publishing Company, 1974), pp. 1031-1072. 2 Rance P.L. Lee, The Stratification Between Modem and Traditional Professio11s: A Study of Health Services in Hong Kong (Hong Kong: Social Research Centre, The Chinese University of Hong Kong, 1974). 3 R.W. Lieban, op.cit., p. 1056.

. 2

Singapore is an unusual case because the persistence or even nou rishing of traditional Chinese medicine resulted from efforts of the private sectors of the society. The Singapore G overnment does no t endorse or encourage traditional, non-Western medicine as does the government in China or Ind ia, but the governm ent makes little intervention in the trade and practice of traditional Chinese medicine. 4 The Chinese medical institutions sometimes enjoy even unoffi cial government blessings for their contribution to public health care. This is evidenced by the attendance of high ranking officials at functions such as the opening o f fund drives for free Chinese medical clinics and graduation ceremonies of the Chinese medical schools. Although sociological studies indicate that the Singaporeans make full use of the mo dem, Western health care system which is of the highest standard among the Association of Southeast Asian Nation (ASEAN) countries5 it seems popular among all walks of life in Singapore to make supplementary use of trad itio nal Chinese medicine, especially in the case of taking Chinese herbs and tonics to strengthen health and body. This Singaporean situation has, however, yet to be exposed to a systematic exarnination.6 Although I have carried out a preliminary study of all aspects of the Chinese medical system in Singapore, I wish to con fine my discussion in this paper to only the concepts and practices relating to food and how these concep ts are relevant elements of the health care system . Furthermore, I am interested mo re in the cultural aspects of these concepts rather than their medical efficacy. Therefore, the aim of this paper is twofold: first, to explain the Chinese concepts of food in relation to health in Singapore as o ne element of the popular health culture; 7 and , secondly, to demonstrate the persistence of the traditional concepts

4 Stella Quah, " Health Policy and Traditional Medicine in Singapore." Paper presented at the 9th World Congress of So-ciology, Uppsala, Sweden, 14-19 August 1978.

5 Ibid. 6 Recently, Stella Quah conducted a survey o n social medicine in Singapore which included a

study of attitudes and practices of the folk medicine of the Chinese, Malays, and Indians. See Stella Quah, Utilization of Health Service s a11d Self-Medication in Singapore, SEAMEO Project, Department of Social Medicine and Public Health , Uruversit y o f Singapore, 19 7 5. But no in~epth ethno-medical research followed . Gwce Ah Le ng,a physician trained in Western medicine, initiated a research project on Chinese medicine, but stopped short of his goal for various reaso ns.

7 Charles Leslie distinguishes between the professional heal th culture and the popular health culture in his overall view of the medical system in literate civilizations. The fo rmer refers to the theory and prac tices of Western and indigeno us medical practitioners, while the la tter refers to the folk knowledge in disease classification and traditional measures of d isease prevention and therapy. See " Professio nal and Popular Health Cultures in South Asia: Needed Research in Medical Sociology and Ant hro pology ," in W. Morehouse (ed.), Under· standing Science and Technology in Ind ia and Pakistan (N.Y. : University of the State of New Yor k, 1967), pp. 27-42.

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and classification of food in the milieu of culture change and Westernization which is occurring among the "English" educated Singaporeans, namely, the young university students. It is believed that the Chinese concept of food and health is an undelineable part of the medical system in Singapore; an understanding of this concept helps to clarify or reveal the essential part of the cognitive system of health in the Singaporean cultural context. As the following presentation shall demonstrate, even the English educated university students, who are among the advocates of Westernization, have not completely abandoned their traditional health culture. The present paper shall deal first with the historical background of the Chinese perception and classification of food, which will then be followed by empirical field data collected in Singapore. 8

The Chinese belief and practice of dietary selection and their restriction of certain foods for health reasons must have been brought to Singapore by Chinese emigrants from the coastal provinces in Southeast China. It should be mentioned here that these concepts were enriched through contacts with other cultures, such as the Malay and Indian. Since their development has a long history within the Chinese medical system, it is necessary at this point to review very briefly their historical background before we can deal with the Singaporean material. Literature on humoral medical theory generally traces its origin to the Greek Hippocratic theory. The hot-cold theory of disease popular among Latin Americans, for instance, is indeed that of an European cultural diffusion. 9 Although Indian and Arabic healing practices based on the Ayurvedic theory were brought to China during the fourth century A.D., lO Chinese humoral theory was known much earlier.

8

The author is grateful to the Institute of Southeast Asian Studies, especially Professor Kernial S. Sandhu, for a Research Associateship during his visit from May to August 19 76. Lim joo· jock of the Institute and Chee Yun-chung of the University of Singapore Library made useful suggestions to my research; Dr. Chang Chen-tung and Dr. Eddie Kuo (both of the University of Singapore), Dr. Wong Yun-wah and Dr. Ku Hung-ting (both of Nanyang University) gave me great help and encouragement during my fieldwork. In 1977 Professor Ann Wee, Lim Joo-Jock and Dr. Ku Hung-ting were kind enough to read my preliminary draft, offering useful comments: however, I alone am responsible for the data and the points presented here. I would also like to express my appreciation for the help of Brenda Foster and Victor Askman in data analysis. My wife Wei-Ian participated throughout t he fieldwork.

9

Alan Harwood, "The Hot-Cold Theory of Disease," The j ournal of th e Am erican Medical Association (1971), 2 16 (7): 1153-58.

10

Donn V. Hart, B 'sayan Filipino and Mala yan Humoral Pathologies: Folk Medicine and Ethnohistory in Southeast A sia. Data Paper, No. 76, Southeast Asia Program, Department of Asian Studies (N.Y., lrhesa: Cornell Universit y, 1969), pp. 58-59.

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Joseph Needham: 1 who for many years has researched the science and technology of ancient China, rejects the belief that the Chinese medical system based on the YinYang concept is an example of direct cultural diffusion from Greece. He also points out elsewhere 12 that the Yin-Yang philosophy developed independently in China as early as the sixth century B.C. In addition to the dichotomy of external symptoms versus internal symptons in disease diagnosis which was conceptualized at such an early date, there was also a significant Chinese medical theory which emphasized preventive medicine over healing as the highest goal of medicine. The ancient text Kau Kung Chi ( 55c.I.,1E. ), which Needham believes to have been compiled from the fourth century B.C. through the Han dynasty (second century B.C. to third century A.D.), makes special mention of the Palace Dietician (shih yih it ~) who was in charge of the food provisions for the emperor and his court and who bears "in mind the nature of the various foods to be combined into a balanced diet and adopted at the same time to the cycle of the seasons". 13 The age-old tradition of emphasizing preventive medicine in China was also mentioned in Palos• 14 work on Chinese medicine. He explains, A correct balance between work, relaxation, and sleep and the "golden rules" of a moderate "clean" and correct diet help to prevent illness. 15 Among various forms of preventive measures and therapy are food restriction and dietary balance. This knowledge has apparently been transmitted into the Singaporean medical culture from China. We shall now consider field data from Singapore.

As the first step of the fieldwork, one could begin the collection of food classification by interviewing a representative sample of informants to enable one to construct an exhaustive taxonomy of food according to the Chinese humoral theory. I started with such interviews at the onset of my fieldwork. I soon realized, however, that it was pointless to construct a comprehensive taxonomy of hot-cold food, based on interviews with a large number of Singaporeans, for it 11

Joseph Needham, Science and Civilization in China, Vol. 4, part 2 (Cambridge: University Press, 1962), p. 246.

12

Joseph Needham, "Hygiene and Preventive Medicine in Ancient China," in J. Needham, Clerks and Craftsmen in China and the West (Cambridge: Cambridge University Press, 1970) p. 341.

13

Ibid., p. 346.

14

Stephan Pa'los, The Chinese Art of Healing (New York:

15

I:>Jd

it-.lics added.

Cambridge

Herder and Herder, 1971). p. 95.

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could never be definitive and would not help in understanding the changing medical culture in Singapore. E.N. Anderson and M.L. Anderson 16 point out how informants disagree among each other in the construction of a list. 17 Also, as already discovered by Donn V. Hart, l8 there are considerable disagreements with regard to food classification that exist among subcultural or sultlinguistic groups of one culture. If a person believes in Chinese humoral theory and has only a limited knowledge of it, he can always consult a Chinese medical practitioner for advice. In his report on Chinese medical tradition in Malaysia and Singapore, Fred L. Dunn 19 points out that Chinese medical practitioners always include food balance and food restriction as part of their recommended therapeutic measures. Nevertheless, data collected through initial interviews show how food is classified by the Chinese informants in Singapore. One of the persons interviewed was an illiterate female (aged about 50, but speal fru1t

Black bean Eggplant Chili pepper Mango Tang kuei ~Levisticum) herb medicine) Rambutan (fruit) Tangerine Sorghum

X

*

x• '

X X,* X

•

hot

mildly hot

• * X *

X X X X

•

Informant 1 (illiterate) lnformant 2 (university graduate)

X X X

•

name

extremely cold

Winter melon (squash) American ginseng Cool tea or herbs Mangos teen (fnilt) Lotus root Sugar cane Mung bean (green bean) Yam starch Green skinned raw banana Chinese cabbage (Won pak) Leafy vegetables Variety of squashes Melon Soy bean Bean sprouts Water chestnut Agar agar Water from yo ung coconut Bamboo shoot Cucumber Papaya Ripe banana

cold

mildly cold

x.• X X *

X

• •

X

•

•

X X

• X X X

• X

•

• •

X

• X X X

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its relationship to equilibrium in health. It seems that people who are older know more than those who are younger. The Si11gaporeans refer to food or drinks as "cooling" or "heaty", although these are not common English words. Subsequently, in the text following, the word "heaty", which is commonly used in Singapore and Malaysia, is replaced by the conven tjonal "heating". Second, there are both positive and negative attitudes directed towards this food classification, depending on whether a person identifies with Chinese or Western cultural tradition. It was my preliminary impression that the English educated university studentsseemed to be reluctant to adm it to any knowledge of this food classification, and perhaps even felt embanassed by such a "superstition", whereas the Chinese educated, especially the working class, would readily claim the efficacy of these food regulations to health. This phenomenon led me to ask: ( 1) whether or not the university students who consider themselves Westernized because of their acceptance of Western science and ideology, have been so assimilated to "Western" culture that they have become immune to these traditional concepts and practices and (2) whetiher or not only the English educated Chinese raised in upper class, Western oriented families, denounce or ignore the Chinese food classification. With these questions or hypotheses in mind, I began to develop a questionnaire on food classification and health to be administered at two universities -- one Western oriented and the other Chinese oriented. (Hereafter the terms "English University" and "Chinese University" arc used to designate these two universities.) The English University was established during colonial times and was staffed with expatriate facu lty, predominantly English. It is known even today as an institution of higher learning that produces the future English speaking social ;elite. In contrast, the Chinese University was established later than the English University by conservative Chinese for the unexpressed purpose of preserving Chinese culture and tradition. Prior to the communist reign in China, the wealthier Chinese families in Singapore used to send their youth to China for tertiary education, but this practice came to an end in the 1950s. Later, rather than risk losing their children to China, Chinese parents in Singapore found a local Chinese university an ideal substitute. It has been and still is staffed by a Chinese faculty and, until 1976 when English was adopted, used Chinese (Mandarin) as the medium of instruction. Most of the students in the Chinese University have had a "Chinese" education through primary and secondary schools, while the students in the English University have been predominately English educated, although a high percentage of the students who major in sciences at the English University were drawn from Chinese secondary schools.

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The questionnaire itself consisted of four major open-ended questions: What foods and beverages are considered cold or coolinq, accordin~ to traditional Chinese beliefs? \\That are considered hot or heating foods and be\erages? \\'hat food taboos arc associated with certain illnesses or diseases? \\'hat coor..ing methods enhance or neutralize the heating or cooling effects of food? The questionnaires were distributed in April 1976 to a social science class of sixteen at the English University and to one art class of seventeen at the Chinese University. For the former, the questionnaire was in English, but for the latter, it was in Chinese. An additional four English questionnaires were answered by four respondents who received either a secondary or tertiary education in English and who worked at the English University. Both the English and the Chinese groups sought help from their family members, but they were given the option not to answer the questionnaire if they felt they "know nothing" about the Chinese concepts of food and medicine. Subsequently, two students from the English (.;niversity returned the questionnaire blank. There was a total of thirty-nine replies, twenty-two of which were in English with two respondents not giving any answers. Compilation of all the answers obtained from both groups (hereafter referred to as the "Chinese sample" and the "English sample") yield a surprisingly long list of 287 items of food, 10 beverages, and medicine; over 100 items of disease or illness; and 8 types of cooking methods. This large number of items is explained by the fact that each individual provided a small mean number of items in the answers to each question. Furthermore, responses from each person, except in a few cases, do not coincide with those of other persons. It is, therefore, worth noting that thi long list of food and beverages by no means implies that individual students possess a comprehensive knowledge of food classification. Listed in Table 2 are the complete entries of food and beverages that are cold or cooling as indicated in the answers provided by the subjects from both groups, while Table 3 lists all the food and beverages that were considered hot or heating. (The numbers listed in the Tables indtcate how many times an item It should be pointed out that the subjects was recorded from the total answer.) were asked to enter their food items according to the degree of coldness or hotness to the best of their knowledge; however, onl} some of them could distinguish the differences in terms of degree. For the convcni p > 0.05

To conclude this brief study, I would like to hypothesize how food classification and popular health culture can be understood in the light of the emerging nationalism in Singapore. It is believed that the traditional concepts of food and health, instead of disappearing, have persisted along with the rising up of a new national cultural identity. George Foster28 in his discussion of nationalism among modem developing nations describes a general process of modernization and Westernization. He notes the initial rejection of indigenous culture and values among the intellectuals and political 'elites, but an eventual search for traditional cultural forms when they no longer find satisfaction in their emulation of things that are "Western". Among such items as language, customs, and art forms, Foster29 lists as cru~ial cultural symbols of nationalism, food and traditional medicine. "Successful nationalism", according to him 30 means 28

George M. Foster, Traditional Societies and Technological Change (New York: Row, 1973), p. 66.

29

Ibid., pp. 67-75.

30

Ibid., p. 6 7.

Harper &

• 27 .

the identification of a way of life as peculiarly one's o wn, a positive creation of the people concerned, and not as an importatio n or borrowing from o thers. In o ther words, food, mo des of food preparation, and popular medicine have an impo rtant symbolic value when people o f an emerging new nation are in search of, consciously o r unco nsciously, a new natio nal identity. It is in the light of this notion of nationalism or national identity that the author finds the present study meaningfuL The foregoing discussion has shown that university students in Singapore, even the English educated, are quite aware of and have access to the traditio nal Chinese concepts and beliefs on food, that is, how food consumption according to the principle o f hot-cold balance enhances health. This points to the fact that English education in Singapore does not necessarily change a person into a Western man. Instead, the person can still share a collective "Chinese" cultural knowledge which is learned through the process of enculturation, of which formal education is but a part. Since among this young, Western influenced 'elite group we find this prevailing knowledge, we would not be surprised to discover that Singaporeans in general recognize such traditional beliefs concerning food and the associated practices of preventive medicine. Nationalism, as cultural anthropo logists see it, is not as simple as a mere political movement; it sho uld be viewed, as far as the populace are concerned, as a process of enculturation and accultura tion. In the light of this cultural process, o ne can then appreciate the meaning of th e persistence in Singapore of traditional concepts of food and popular medicine. Th e manner by which traditional Chinese food classificatio n and related concepts of health become identity symbols may be revealed in Chinese immigration and settlement patterns in Singapore. In a new, harsh tropical environment where diseases prevail and medical facilities are scarce, the immigran ts had to rely on whatever means were available to protect their health. Food classification according to the hot-cold dichotomy as well as dietary manipulation were medical measures which were already familiar to the emigrants when they left Southeastern China. But these concepts were further elaborated in the Nanyang enviro nment. The maintenance and elaboration of these concepts and practices are more than health measures if the psychological uncertainty amo ng the immigrants is considered. Protecting oneself by taking great care in food selection and d ietary control seems to fu nction as a defensive mechanism in a hostile environment, releasing anxieties to some extent, and then intentionallr or

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unintentionally to enhance cultural, ethnic, and later, when a new state emerges, national identity. The Chinese immigrants valued these concepts for a practical reason; it helped to prevent and cure illness. Although recently Western medicine has played a dominant role in the medical system in Singapore, it has never completely replaced the traditional medicine. In a pluralistic medical situation where several traditions co-exist, the Chinese traditional concepts of medicine and related food selection naturally would be maintained, although nontraditional, non-Chinese traits have also been incorporated. It is an undeniable social reality that the ethnic Chinese plays a dominating role in the Singaporean socio-cultural activities. Chinese concept of food and medicine is a conspicuous part of the Singaporean cultural system because the concept expresses folk cultural beliefs and behaviour which are, to borrow Geoffrey Benjamin's words,3 1 "pushing up from the lowest domestic levels." He is right to point out in his discussion, "The Cultural Logic o f Singapore's 'Multiracialism' ", that ordinary people and the government mistakenly view ethnic, racial and cultural entities as coinciding with one another.32 As shown by the content of our tables, the Singaporean Chinese classification of food in terms of a hot