Traditional Chinese Medicine (TCM) is the system of ancient medical practice that differs in substance, methodology and philosophy to modern medicine. Understanding TCM is a vital part of my ability to be an efficient clinician. As a future holistic dermatologist and cosmetic acupuncturist, I will not be effective without understanding TCM modalities, including herbal medicine, acupuncture, cupping (heated cup therapy), tuina (massage), qigong (movement and breathing exercises) and moxibustion (burnt mugwort therapy). (Cheung, 2011) Moreover, I would need to know how these modalities present in patients, especially those with different skin tones.
Until today there is no clear guide for how many of these TCM modalities present in Black or brown populations. This lack of inclusion can be a deterrent for members of the BIPOC (Black, Indigenous and people of color) community. Studies have shown that a lack of diversity in any mode of medicine will lower quality of care; case in point: by having a diverse hospital staff, you improve the care of minority patients by having someone who is like them. (Authors, 2020) However, there is a severe paucity of TCM being documented in patients of color. Thus, when students in TCM graduate, and encounter BIPOC patients in their clinics and/or hospitals, they are not able to comprehend the disease or response to treatments properly.
I had the opportunity to have a cupping therapy session at my school clinic and chose to document my response to the treatment (Images 1 & 2), so one could observe a cupping treatment response in a darker skin tone:
Cupping therapy (CT) is one of the oldest methods of healing. From a historical perspective ancient Egyptians are known to have practiced it first. (Qureshi, Al-Bedah, & Abushanab, 2017) Subsequently, Chinese practitioners practiced cupping therapy for thousands of years, and consequently cupping therapy became an important component of TCM. (Qureshi et al., 2017) CT involves using different types of cups and applying them on the skin, either by vacuum pump or by fire, to create negative pressure inside the cups. (Qureshi et al., 2017) The created pressure within cup pulls the skin up. Skin marks are usually round and red to purple in color. In TCM, cupping may be used for making various diagnoses through skin color (Figure 1).
A purplish-red cupping mark means severe damp heat. A red cupping mark signifies severe heat. A bluish-purple cupping mark indicates severe cold dampness. Cupping marks with a dark color means signifies the intensity of the pathogenic qi, or life force. Cupping marks with a light color implies mild pathogenic qi. And no cupping marks means the absence of pathogenic qi (Qureshi, Al-Bedah, & Abushanab, 2017). Thus, when discussing skin type it is useful recall the Fitzpatrick skin type system developed in 1975. It remains a useful way to determine skin type of patients. So as one can see these cupping images are done on patients with Fitzpatrick Skin types 1 & 2; they do not highlight CT treatment response in BIPOC patients, who often have Fitzpatrick Skin Types IV-VI. How can one make appropriate diagnoses in patients with darker skin tones, if the literature lacks their diagnostic images?
Therefore, if clinicians treat patients of color, but are ignorant of how patients of color respond to certain treatments—as in the example of cupping therapy—it can be extremely hazardous to patient care and health. One study found that half of medical students and residents hold erroneous beliefs about biological differences, such as believing that Black people have thicker skin, that their blood clots faster and that they have less-sensitive nerve endings. (Khullar, 2018) Unsurprisingly, Black Americans are systematically under-treated for pain. Other research finds that doctors are less patient-centered and more verbally dominant with minorities and that they show less empathy in end-of-life conversations with them. (Khullar, 2018)
Implicit bias and racism are staples in our medical community, whether Western or Eastern. And if a Black patient’s clinical response to treatment is not documented, so that future medical students can study it—and garner that clinical understanding of the BIPOC interaction with certain healthcare treatments—this leads to learning deficits in medical education. Moreover, subliminally, it sends a social message that in the medical community, people of color do not seek or obtain these medical treatments. And this further perpetuates bias in medicine. Therefore, a clinical lack of diversity, and documentation of the BIPOC response to care promotes medical racism, and medical students remain ignorant of BIPOC needs and responses to certain treatments, and that is why racism is a public heath crisis.
If we do not address it head-on, it will continue to fester, and further segregate the medical community. In the end, diversity in the field of medicine must improve, and involve the bodies, and the voices, of the BIPOC community.