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5 Fitzgerald Health Education Associates, Inc., January 2015 fhea.com I understand that there are questions about cul- ture and healthcare on the exam. What should I know about traditional Chinese healthcare to make sure I offer appropriate care to my patients who follow these practices and answer questions about this correctly on the exam? Persons of Chinese descent are the largest Asian American population in the United States, with a population of approximately 4 million. 1 Many Chi- nese patients' views and beliefs about health and healthcare are informed, at least in part, by tradition- al Chinese medicine. In the larger population, tradi- tional Chinese medicine is embraced by many individuals. In addition, certain Chinese cultural val- ues, such as deference to authority, can lead to mis- communication in the practice setting. A basic understanding of certain aspects of Chinese culture can serve as a guide as you care for Chinese patients. Traditional Concepts About Health Yin and yang. The traditional Chinese approach to health, influenced by the philosophies of Confucian- ism, Taoism, and Buddhism, focuses on maintaining or restoring balance between opposite, complemen- tary elements or forces. This approach is expressed in the yin and yang concept. All things in the uni- verse, including parts of the body, foods, medicines, and illnesses, are classified as either yin ("cold") or yang ("hot"). The hot-cold classifications refer to in- trinsic qualities of the thing or condition, not its temperature. Health consists of maintaining a bal- ance between "hot" and "cold," and illness occurs when there is an imbalance between these forces. Thus, to treat a yin condition, traditional Chinese practice is to prescribe specific yang foods, medi- cines, or practices that will restore the harmony be- tween the two forces. For example, according to the traditional Chinese approach, patients with a cold or who are postpartum—"cold" conditions—should avoid "cold" substances like water or juice and in- stead consume hot liquids like tea. Qi. Another fundamental Chinese concept about health care is qi, which is the vital force or energy that flows through the body. Imbalances or disruptions in the flow of qi represent disease or illness. It is believed that qi can be accessed at specific points, and acu - puncture or acupressure at these points can restore its proper flow. With acupuncture, fine needles are insert- ed just below the skin at the qi access points, while acupressure involves massaging these points. Among many people of Chinese ancestry and members of the general population who embrace traditional Chinese medicine, there is a common be- lief that western healthcare is historically limited be- cause it focuses on individual ailments. NP practice is typically more comprehensive. Traditional Chinese practices take a holistic approach, focusing on the mental and physical health of the whole person. As such, patients who adhere to the principles of Chi- nese medicine often use traditional practices initial- ly, in an effort to self-treat, or alongside treatments recommended by clinicians. For example, traditional practitioners generally do not deny the effectiveness of antibiotics in treating infections, but might con- sider adding a traditional treatment to correct the imbalance associated with the infection. 2 Cultural Values Chinese culture emphasizes several values that can influence health behaviors and healthcare decision making. These include harmony in interpersonal rela- tionships, emphasis on family over the individual, and the concept of maintaining "face," or dignity. 2 The Chi- Certification Q&A; Traditional Chinese Health Practices Margaret A. Fitzgerald, DNP, FNP-BC, NP-C, FAANP, CSP, FAAN, DCC Continued on page 7