Susanda Yee still remembers the smell of the herbs they received after their first acupuncture session in their early 20s. Yee, who uses she/her and they/them pronouns interchangeably, had visited a traditional Chinese medicine (TCM) practitioner to help her manage period pain and a soccer injury. They recall the feeling of the acupuncture needles and how the herbs the practitioner gave them were neatly packed into a small parcel. “There were a lot of curiosities for me,” says Yee.
Growing up in a Chinese Canadian family in Calgary in the ‘70s, Yee first encountered Chinese medicine at home. “The language of it was always spoken,” Yee says. Their family often used the concepts of heat and cold in Chinese medicine to explain ailments and the properties. Once certain symptoms were identified as either hot or cold, food, herbs or other treatments with the opposite property would be used to return the body to a balanced state. A sore throat would be interpreted as the presence of too much heat in the body — a condition Yee would be encouraged to treat by eating haw flakes, which are small, sweet discs made from hawthorn fruit. “As a child, that’s very comforting and familiar,” they say.
But in acupuncture clinics, Yee didn’t always feel that same sense of ease. While Yee didn’t have the words to describe her gender fluidity in her 20s, she was hurt when acupuncturists assumed she was a young woman. It wasn’t until they started studying TCM that they began to understand how the medicine leaves room for nuanced interpretations of queerness and transness.
For many LGBTQ+ Chinese people, it’s affirming to know that Chinese medicine understands and values their intersecting identities. When the medicine is practiced through a queer- and trans-positive lens, practitioners and patients can get in touch with their ancestry and access healthcare without having to hide parts of their identity. “Chinese medicine is so much about survival,” says Yee. “It speaks a language for me as a queer person or alternative thinker, or as someone who has needed medicine and healing.”
Yee is part of a wave of practitioners working to centre LGBTQ+ people in Chinese medicine. While Chinese medicine has historically been understood and practiced in ways that uphold heteronormativity and the gender binary, these practitioners are championing a more expansive view of the tradition. They’re hoping to show that there’s room for queer and trans people in Chinese medical philosophy and make clinics safer spaces for LGBTQ+ patients.
Governments, educational bodies and groups such as the World Health Organization often use the terms “traditional Chinese medicine” and “TCM” to refer to a medical approach that employs treatments such as acupuncture, cupping and herbal remedies. However, the definitions of traditional Chinese medicine and TCM are contested within medical and academic circles.
Over much of its thousands of years of existence, Chinese medicine consisted of a range of pluralistic, often conflicting healing methods, says Hsiao-wen Cheng, an associate professor of East Asian languages and civilizations at the University of Pennsylvania. A shift in the 20th century saw biomedicine become the dominant medical model. “People started to have this belief that there was only one kind of science, and they opposed everything superstitious,” says Cheng.
As a result, in the 1950s, the Chinese government standardized and modernized the country’s diverse healing practices to better conform to the Western medical tradition. Many traditional Chinese medical concepts were watered down, and elements that were deemed folk traditions were omitted. The product was TCM, a system of medicine that prioritizes the Western scientific framework and only slightly resembles ancient Chinese medical practices.
Chinese medicine is heavily influenced by Daoism, one of China’s two key philosophies and religions. At the root of the medicine is the concept of yin and yang, which are two opposite and complementary forces. Everything in the universe can be interpreted as yin or yang, as all things are seen as relative: yin is cold and yang is hot, just as yin is water and yang is fire. Chinese medicine aims to facilitate balance and harmony between yin and yang in human life.
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When acupuncturist Rain Chan first learned about yin and yang, they felt an immediate connection to the concept. Chan, who practices in a clinic in Toronto, sees it as a way to understand their gender and sexuality. For them, the variety of relationships between yin and yang mirrors the diversity of genders and attractions that exist. Knowing that the concept existed thousands of years ago brings them comfort. “Way back in my ancestry, apparently, they’ve already figured it out,” says Chan.
Not everyone in the profession shares this understanding of the medicine. According to the 2021 census, there are 730 full-time TCM practitioners and acupuncturists across Canada. In TCM school, Chan’s teachers would use the idea of yin and yang as a spectrum to explain bodily systems and the properties of organs. At the same time, the teachers would take heterosexual, cisgender people as the norm. “The modern approach to TCM is quite heteronormative and very binary,” says Chan. “Even as they speak of yin and yang, they think of man and woman.”
Ancient Chinese medical literature does seem to advance a limited understanding of gender. Ping Yao, a history professor at California State University, Los Angeles, says the two foundational Chinese medical texts—The Yellow Emperor’s Classic of Internal Medicine and The Classic of Difficult Issues—were very clear in their use of yin and yang to interpret gender in a binary way. “When you talk about gender, yin is woman and yang is man,” says Yao.
Professor Cheng agrees. “In medical texts, man versus woman is always yang versus yin,” she says. “There’s no wiggle room in there.” Generally, gender wasn’t seen as a force that shifted in the same way yin and yang do in the hill analogy, despite what some contemporary practitioners suggest.
However, Cheng says it’s important to recognize that ancient Chinese medical texts were written in a very different context. Many early works were only concerned with men’s bodies, perhaps because the main clientele of Chinese physicians at the time were aristocratic men. Unlike the contemporary world, there was little interest in doctors’ views on gender and sexuality. Such questions would be directed to high officials or scholars, rather than physicians who were positioned lower in the social hierarchy.
Ultimately, the conclusions drawn by historical texts don’t invalidate modern interpretations of the medicine. “Any tradition has a flexibility,” says Cheng. “The degree of that flexibility is not determined by what was written in the tradition already. The flexibility is up to the people who care about the tradition and continue to make reference to it.”
Medical traditions have been recreated and rewritten throughout history, says Cheng. While scientific racism and the view of homosexuality as a disease were once considered objective science, they have since been disproved. “Even if you look at biomedicine, we are continuing to revise it,” says Cheng. “We continue to ask different questions, and we continue to challenge the presumptions that people had.” To many LGBTQ+ practitioners, the reading of the medicine as one that recognizes queerness and transness is a powerful and deeply meaningful act.
Adrienne Mak runs Earthsea Acupuncture in Toronto’s Koreatown. They are less interested in debating Chinese medicine’s historical interpretations of gender than centring the principle that things are perpetually in flux. “I apply what is at the root of the theory of yin and yang, which is that they are relative to each other,” they say. “It gives me a very simple way to look at all of my patients that don’t necessarily need to philosophically differentiate what their sexuality is or what their gender is.”
It’s an approach shared by Pauline Sok Yin Hwang, founder of Hillgreen Oncology Acupuncture & Herbs, which has clinics in Toronto, Vaughan and Northumberland County. Hwang says the practice and teaching of mainstream TCM often reflect the homophobic and transphobic viewpoints of some instructors. She wants to see TCM schools place greater emphasis on anti-oppressive practice during the faculty hiring process and across the curriculum. “You might have very racist, classist, homophobic or transphobic teachers,” Hwang says. “Then you’ve got one class that’s on anti-oppression and being inclusive to queer and trans people. You’re working against the grain.”
In the U.S., there have been recent efforts to develop more educational resources for Chinese medicine practitioners on LGBTQ+-affirming care. In 2019, Vermont-based acupuncturist Catherine Lumenello published Gender and Sexuality in Chinese Medicine, a handbook for practitioners and students that focuses on supporting queer and trans patients. For years before the pandemic, California-based acupuncturist Katrina Hanson provided training and consultations on trans medicine and LGBTQ+ care at acupuncture schools, teaching faculty and students about building an inclusive practice and providing care for patients who have undergone gender-affirming surgeries.
While there have been conversations about making Chinese medicine more accessible for LGBTQ+ people in Canada, the dialogue has largely been fragmentary, says Hwang. Discussions often take place over Facebook threads in regional groups for practitioners and acupuncturists. Hwang hopes there’ll be more internal dialogue.
In Ontario, recent discussions about Chinese medicine have focused on the provincial government’s bill to deregulate TCM, which was reversed a week after it was proposed in March 2022. But rather than pushing to have practitioners recognized as professionals and doctors, Hwang says the field’s priority should be serving marginalized communities. “It’s very tempting in TCM to go the route of wanting to be accepted into the mainstream and scientifically proven,” says Hwang, who holds a bachelor’s degree in cognitive neuroscience. She says scientific methods are limited albeit useful tools to examine the value of a healthcare practice. For instance, scientists can use pragmatic trials, which are held in real-world settings, rather than randomized controlled trials, which occur in sterilized environments. “A medicine is valuable to the extent that it can help people,” says Hwang. “I see [Chinese medicine] work in my clinic every day.”
To Hwang, Chinese medicine can fit within the contexts of healing justice, decolonization, reconciliation and other social movements. The practice’s connection to folk medicine means it has ties to healing approaches that prioritize accessibility and allow people to take care of themselves and each other, she says. Chinese medicine methods such as acupressure and the use of herbs can be learned, and people can bring those teachings to their families. “It doesn’t need to be so top-down,” says Hwang. “It can be part of self and community care”.
Mak similarly tries to facilitate this transfer of knowledge by leaving their patients with some homework at the end of each session. The goal isn’t just to treat the concerns brought by each individual, but to help them build habits that can improve their overall quality of life, says Mak. This knowledge can then be shared with even more people. “When we’re connected to ourselves, we’re connected to each other,” they say.
Meanwhile, Hwang is hoping to build ties to Indigenous medicine traditions, particularly those from the land she occupies as a settler. “How can I practice a plant medicine that’s from somewhere else when I’m settled here?” she asks. “And what kind of connections does that have to people who are trying to reclaim plant medicines from here, and reclaim all these other aspects of their culture?”
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Hwang and Mak recognize that the work of making Chinese medicine more inclusive to LGBTQ+ patients starts at their own clinics. Hillgreen’s website indicates that the practice is LGBTQ+ inclusive, noting the availability of gender-neutral washrooms. Hwang has also had conversations with staff about gendered language and pronouns, and the team works to familiarize itself with assumptions and health issues that trans patients often face.
Nadine Forde, one of Hwang’s patients, says Hwang’s efforts to make the clinic a safer space are noticeable. “It’s not with all practitioners that I want to talk about my relationships or even race,” she says. Forde has opened up to Hwang about everything from being Black and polyamorous to facing job stress. Having the chance to share those experiences has helped Forde realize how they’ve impacted her physical health. “There’s a lot that goes on that affects my body and affects my week, day and month,” she says.
At Earthsea, Mak ensures that intake forms use inclusive language and avoid gendered anatomical terminology. They also take time to explain procedures so that patients feel safe and informed. “In terms of queerness and transness, bodily consent is really important,” they say. “I’ll ask them if they want me to communicate out loud which part of the body I’m going to go to now, or what I’m going to do.”
As a queer and non-binary practitioner, Mak knows that having a practitioner truly see you is key to feeling safe. Mak estimates over half of their clientele are queer or trans, and they’ve noticed themes across their health concerns. Some LGBTQ+ patients experience pain and tightness related to chest binding, while others describe bladder issues from holding their urine because they don’t feel comfortable going to public washrooms.
In Chinese medicine, emotional challenges are viewed in the same way as physical health concerns. Acupuncture offers an opportunity for people to reunite their mind and their body, says Mak. “A lot of us are dissociated a lot of the time,” they say. “I respect that as a coping mechanism, and I also think it requires moments of connecting.” When patients are on Mak’s treatment table with needles inserted, they can reflect on the links between their mental and physical being, at least subconsciously. “Reassociating requires a feeling of safety in the self,” says Mak. “That’s what I want to help cultivate for people, so they can reconnect with themselves.”
For many LGBTQ+ Chinese people, engaging with Chinese medicine is a means of deepening their relationship with their ancestry. Having at times felt cut off from their heritage as a second-generation Chinese person, training in acupuncture allowed Mak to lean into their Chinese identity. “It was like a dialogue with my ancestors,” they say.
In many ways, Earthsea is a microcosm of Mak’s vision of community—one where BIPOC and LGBTQ+ people are prioritized, and people can tap into their intuition and their heritage. “My practice is a place for me to create the world that I want,” Mak says.
Tobin Ng is an associate editor at Maisonneuve Magazine. They live in Ottawa.
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