Monday, April 27, 2009

Utilizing Western Medicine in a different way

Within the past few years, more and more Western physician have begun to explore alternative therapies. This has given rise to a new field: Complementary and Alternative Medicine (CAM). The idea has been to use so called "alternative" therapies such as acupuncture, chiropractic and naturopathic medicine as adjuncts to conventional Western treatments.

The question of whether the practitioner of Chinese medicine, should enthusiastically embrace this approach will be the focus of this discussion. A clear distinction needs to be made between combining different modalities and integrating Western biomedical substances into the Chinese medical model. (By the way, this question is an area of controversy in China as well, and concerns acupuncture as well as herbal medicine there). I would contend that taking the approach of treating symptoms rather than people is patently flawed. This applies to any medicine (even natural or herbal medicine) that treats conditions and symptoms, rather than people, using the "whatever works" approach to attack the state of imbalance, whether due to repletion or vacuity.

The decision as to which model to use for diagnosis and treatment of the patient revolves around the following question: Does the physician treat with the goal of ameliorating his patient's symptoms, or does he treat with the goal of putting the patient in balance. With the goal of stopping pain or discomfort, the physician needs to consider the fastest, least complicated, least expensive and most efficacious therapy, and the approach with the fewest side effects. Should his goal be to promote balance, then the physician needs to choose a treatment protocol which best addresses the patient's patterns and differential diagnosis, constitution and history, including imbalances in the patient's biochemistry, biomechanics, and bioelectricity, as well as non-physical considerations. The former approach is pure Western Bio-medicine, and the latter is the approach of the Chinese and Jewish medical traditions.

I contend that in years to come, the Western Biomedicine model will go the way of the dinosaurs, an extinct remnant of an ignorant past, much as medieval alchemy and mercury therapies such as those used in Europe by Paracelsus and his peers are now considered. (Of course, there were the exceptional remarkable alchemists who did hone this dangerous skill and used it properly, but they were few and far between).

The time will come, I believe, (and I hope soon!) that there will be an "aha!" moment--when Western biomedical practitioners will wake up to the fact that their approach, of primarily treating symptoms, and not necessarily concerning themselves with the pathogenesis of the illness, nor of the interconnectedness of the body, is flawed. They will realize that medical acupuncture and folk healing which only treat symptoms (in the case of the former, local points or simple empirical patterns such as ST38 for shoulder pain or GB41 for headaches and in the case of the latter herbs or supplements hawked by health food store nutritionists) are no different. Medical acupuncture as practiced by MDs is no more than an introductory cookbook approach to a complex and detailed system of medicine, the network of acupuncture channels and collaterals. The learning is primarily done by video viewing, and involves a total of up to 200 hours of didactic studies and 100 hours of clinical observation and treatment. I have read case studies brought in medical acupuncture journals-by MDs and for MDs, which were embarrassingly inprecise in their methodologies and procedures! Rather, medicine needs to be appreciated as an art, and using a cookbook makes it neither art, nor medicine.

As I said, I believe that a seminal moment will come , just like the fall of communism, that supposedly "perfect" system of government, when practitioners will wake up to the fact that their patients no longer trust their methods of treatment. This patient rebellion will force MDs and even NDs and chiropractors to re-evaluate how they treat patients, and precipitate a paradigm shift in their diagnosis and treatment to truly practice complementary and integrative medicine.

A physician's approach should be to treat the "whole person," for if not, the whole person will not get well. Either there will be some other new condition, or the condition originally treated will return. The Mishna in Avos tells us, "He've dan es kol ha'adam l'cof z'chus." This is usually translated as, "Give every person the benefit of the doubt." But a more precise translation say the Chidushei Harim and the Sfas Emes is that "One should judge the whole person as meritorious." In other words, one should look at all of the factors making up a person before forming an opinion. I would suggest that physicians need take the same approach as well: to treat the whole person and not just suppress local symptoms causing side effects which resulted from the original flawed therapy. Furthermore, using tools wrongly, should not be considered much different than using a sophisticated electronic devise as a hammer.

On the other hand, who says that Western pharmaceuticals can't be used differently, as part of sophisticated, and balanced formulas to treat the whole person? Chinese medicine recognizes that all substances have specific properties such as temperature, flavor and channels. For example, antibiotics are energetically cold and would be indicated for someone who has fever, but not necessarily for someone who has flu-like symptom, and is achy but not hot. Again, the key would be treating the whole person and according to the patient's pattern. If Western meds could be used within this paradigm, I think that they could become more effective and eliminate their side effects. What must never be done, though, is to use medicine to suppress symptoms. Pain relief, for example, is not pain suppression. Dosage also, as with Chinese medicine can make a tremendous difference in terms of a harmonizing treatment. Micro-doses or even homeopathic doses of Chemo, NSAIDS or steroids, might potentially have wonderful benefits when integrated into herbal formulas, but not without adequate research studies and development. I would suggest that every medicinal substance should be evaluated in terms of its actions, interactions, indication and contraindications, specifically in conjunction with other planetary herbs and substances, just as Chinese medicine rarely uses single substances as formulas. Though some traditionalists may cringe, just as over the centuries, new substances from thousands of miles away were introduced to the Chinese pharmacopoeia, why shouldn't Western medicinals (and therapies) be utilitzed the same way?

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