Sunday, July 8, 2012

Jewish dietary laws relative to Chinese Medicinal Substances

The  great medieval Jewish philosopher, scholar and physician Moses Maimonides (also known as The Rambam),  teaches in his magnum opus on Jewish law The Mishnah Torah,  that  physical pleasure  should be viewed as a  Divine gift, and  when  partaken in a permissible manner is both sanctified  and elevated  through  awareness and  practice.  This is the meaning, The Rambam says, of the verse in Proverbs (3:6)  "Know Him in all your ways, and He will straighten your paths." How though can mortal Man begin to know which pleasures and foods are permissible and which are not?   To answer this question, the observant Jew turns to the Torah, which is made up of the Written  (The Pentateuch) and Oral (The Talmud) laws, and encompasses both the revealed and mystical traditions for guidance.     
In Leviticus, the Torah explicitly lists which animals are  permitted to be eaten and which are not. According to the Jewish mystical tradition, one reason why the Torah restricted certain foods,  was because food is viewed as spiritually potent, and just as certain medicines can nurture one's Divine spiritual connectedness, so to, other foods can contribute to a spiritual dullness and physicality.    To understand this idea, the Midrash Tanchuma brings the following parable:

"A physician went to visit two patients. He saw that one of them was in mortal danger, therefore instructing the members of his household to, 'give him whatever he asks for.' He saw that the other was destined to live and said to them, 'He may eat such and such food, but may not eat other specific foods.' They asked him, 'Please explain why you say that the first person may eat any food he asks for while the second you say may not eat certain foods?"

The physician answered, "Concerning the one destined to live I said, "this eat and this you may not eat." But regarding the one destined to die I told them," Give him whatever he asks for, for he is destined to die anyway."

So, too, the Holy One Blessed be He, allowed idol-worshipers  to eat swarming and creeping thing. but  Israel who is destined to Life Eternal, he  told , "Be holy for I am holy," so don't make your souls abhorrent."

Beside the spiritual benefit that this Midrash addresses, it is interesting to note that many 
non-observant  Jews as well as non-jews, as well, often go out of their way to buy kosher meat and food products, in the belief that they are healthier and of  better quality. But is it so?

This issue is actually debated by the great medieval Jewish commentators.

The Rambam, explains in his Guide to the Perplexed (3:48), that  "It is not the signs of a kosher animal which make it kosher, nor the signs of the non-kosher animal that make it non-kosher. These signs only serve to indicate which animals are permitted and which are forbidden. Rather, the reason that forbidden animals and fish do not have these signs is because they damage people's health. G-d knows of the injury that forbidden foods cause to man."

The Spanish commentator Abravanel, on the other hand, says, "Far be it from me to believe this, for then the Torah given by G-d is no more than a minor medical treatise, and this is not in keeping with its holiness and eternity. In addition, we ourselves see that other nations do eat these forbidden foods, and they not in any way affect their health. In addition, if the reasons were medical, then there would also be various plants which are harmful, yet the Torah does not forbid them...therefore, the Torah prohibits the consumption of non-kosher foods because of spiritual destructive effects that they have on a person's soul."

This approach  seems to be consistent with the Gemara (Yoma 39a), which learns that the word "venitmeitem" (and you will become contaminated) Vayikra(11:43) also includes "venitamtem" meaning to be spiritually blocked.  Rashi explains that this means becoming insensitive to the entire Torah experience. With respect to the eating of forbidden foods,the Sefer Hachinuch (Mitzva 73) notes that the harm caused by eating these foods is not physical. Rather they prevent a person from being able to 'tune-in' to the A-lmighty, His Creation and His Commandments - and to reach a higher spiritual level.  For that reason the Rama rules that it is forbidden to give small children non-kosher foods (Yoreh Deah 81:7).

But what of non-kosher foods and medicines ingested not for nutrition or pleasure, but rather for purely medicinal reasons? Would they be permitted to be used internally?  It is interesting to note, that  in  both the Chinese Materia Medica and pharmacopeia as well as  
The Rambam's Glossary of Drug Names, though most,  perhaps  90% of the substances used do come from the vegetable kingdom, some most definitely are of   mineral and animal sources.  
 In all cases, when preparing formulas or prescribing medicines,  the Jewish observant practitioner needs to consider the following  questions:
1.   What is the degree of prohibited severity in  each substance considered, assuming that it would be used culinarily? The most severe prohibition involves ingesting insects (including their shells) and reptiles, followed by edible parts of non-kosher animals, animals not slaughtered in a kosher manner, prohibited  parts of kosher animals (ie. the sciatic nerve), non-kosher sea animals, and finally inedible parts of animals and inedible shells.With this in mind,  whenever possible one should display the greatest degree of care when considering the use of prohibited substances, even for medicine. A practical example of this would be the medicinal use of Quan Xie (scorpion) or Wu Gong (centipede) in the treatment of neurological conditions such as Parkinson's or Seizures.  When indicated, these should be taken  in capsule form and prepared with vegicaps.   
2.   Are the substances of animal origin  clearly inedible or bitter including such substances as sea shells, snake skins, and bear bile,  or are they edible or pleasant tasting? 
In my practice of traditional Jewish and Chinese medicine, I avoid using non-kosher ingredients in the preparation of formulas or the prescription of medicines in powdered or pill form, unless I am unable to achieve the desired effect or result without including them (for example, in cases of infertility, potentially life threatening illnesses or conditions, or conditions that seriously compromise a patient's quality of life), and when faced with the decision to  use these substances, whenever possible I will try to use substances whose prohibition is less severe and which are inedible.  That being said though, it is interesting to note that there is a section in the laws of blessings in the Code of Jewish Law, The Shulchan Aruch (Orech Chayim 204:8,9), that clearly states that if a non-kosher substance or medicine is used for medicinal purposes and it has a pleasant flavor, that one actually makes a blessing on it.
The bottom line, of course, is that the Jewish observant physician needs to consult with a recognized and competent Orthodox Rabbinic authority whenever in doubt, and needs to carefully consider all of his options when prescribing  non-kosher substances, weighing carefully the immediate and/or long term benefit of prescribing such substances  against the "timtum halev" (dulling of one's spiritual awareness) that we spoke of earlier,  when one eats them.