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Taditional systems of medicine
Description
Indigenous medicine – a generic term referring to the traditional healing practices around the world – uses informal local knowledge and resources, such as herbal and homemade remedies. Shamanism is a spiritual tradition common to many cultures with a history of at least 30 000 years and addresses issues of change and growth, particularly rites of passage, such as birth, marriage, death, etc. Germane to its practice is the Shamanic State of Consciousness enabling the Shaman to access knowledge, insight and wisdom which are otherwise inaccessible. Shamanic healing involves exploring the meaning of the illness to the patient and the exploration of appropriate interventions acceptable to the patient, including drumming, dancing, chanting, dreaming and healing ceremonies.
Evidence:
There is little direct evidence of the individual systems of traditional medicine, but several studies have been undertaken on the effectiveness and safety of specific herbal remedies from many areas of the world. The professional literature in English seems to debate the biosocial aspects of traditional medicine use within developed and developing countries, with some covering the potential for herbal interactions with conventional pharmacological preparations and others exploring the cultural diversity and ethical issues inherent in what is essentially ‘folk medicine’. Other studies have investigated the specific elements of a particular medical system, such as acupuncture within traditional Chinese medicine, shiatsu in Japanese medicine, the use of various procedures and traditional practices, such as circumcision within African medicine or individual herbs from around the world.
Ayurvedic medicine
Description
There are also three mental states. Tridosha comprises three energies representing physical and psychological aspects of the individual, which make up the constitution. Imbalances between the doshas reduce the body’s natural resistance, leaving the person open to illness and disease. People are encouraged to lead their lives in accordance with their predominant dosha. Kapha or phlegm dosha, a combination of water and earth, is thought to regulate pitta and vata. Kapha is considered to be the cerebral core, responsible for keeping the body lubricated, also for tissues and for strength. Conditions in which kapha is dominant include catarrh, influenza, heart disease, excess weight, diabetes, water retention and digestive conditions. Pitta or bile, is a combination of fire and water, responsible for digestion and metabolism, courage and mental activity; resides in the middle body, primarily the stomach. Conditions in which pitta predominates include skin rashes, fever, inflammation, eye problems (e.g. conjunctivitis) and gastric upsets. Vata or wind, is a combination of air and ether, responsible for body movements and nervous energy and resides in the lower body, primarily the colon. When vata dominates individuals, they are likely to suffer from emotional illnesses, nervous system disorders, depression, anxiety, constipation and mental confusion. Chakras (wheels) – seven energy centres along the midline of the body – the crown, brow, throat, heart, solar plexus, sacral and base chakras, are responsible for the transmission and reception of energies from the consciousness through the endocrine and nervous systems to other parts of the body via a system of energy channels called Nadis. Each chakra has a different form, colour and energy vibration.
Ayurvedic diagnosis uses eight classical methods of examination: Nadi (pulse) is the most important aspect of diagnosis, involving palpation of the right radial artery in men and left radial artery in women, at the base of the thumb, with the clinician using three fingers. Pulse presentation depends on the dominant dosha, e.g. a pulse resembling a snake under the index finger indicates predominance of vata, a pulse resembling a frog under the middle finger indicates Pitta and pulse under the ring finger resembling a swan or peacock, a predominance of Kapha. Jihva (tongue) – the tongue is regarded as a reflection of the internal organs and its appearance, colour and shape will help to determine which of the tridosha is unbalanced. A whitish tongue indicates a kapha disorder with mucus accumulation; a red or yellow/green tongue indicates pitta disorder; a black or brown discoloration indicates a vata condition. A dehydrated tongue may indicate decreased Dhatu (vital tissue) or Rasa (plasma); a pale tongue indicates decreased Dhatu Rakta (red blood cells). A line down the middle of the tongue indicates that emotions are being held in the spinal column. Druga (eyes) – examination of the eyes may indicate imbalances within the tridosha, e.g. Vata eyes are small, blink frequently, may have dry scanty lashes and drooping eyelids, the white of the eye is muddy with a dark iris. Pitta eyes are of moderate size lustrous and sensitive to light, eyelashes are scanty and oily and the iris is red or yellowish. Kapha eyes are large, beautiful and moist with long thick lashes, the white of the eye is clear and the iris is pale blue or black. Mutra (urine, see below) is examined to determine dosha predominance, e.g. pale yellow urine indicates Vata; intense yellow, reddish or blue urine indicates Pitta, white foamy, muddy urine indicates Kapha. Other aspects of diagnosis include Mala (faeces); Shabda (speech and voice); Sparsha (physical examination by palpation) and Akruti, a general physical examination.
Yoga
Yoga – or union – involves postures (asanas), breathing exercises (pranayama) and meditation (dhyana), practised in various proportional mixes depending on the predominant philosophical ideas. There are many forms of the therapy, but all aim to enhance the flow of prana via the chakras. In Ashtanga yoga, breathing is synchronized with the postures increasing the purifying and strengthening qualities of the yoga practice. Bhakti yoga emphasizes selfless love and devotion. Hatha yoga is a forceful yoga used to purify and strengthen the body on its way to self enlightenment through asanas to restore and maintain well-being, increase vitality and flexibility and facilitate meditation. Iyengar yoga is characterized by precision and attention to detail, particularly in relation to the correct alignment of the body. Karma yoga is based on outward sacrifice and inward meditation and is the spiritual arm of yoga with the aim of attaining personal self realization. Kundalini yoga is a combination of coordinating postures, breathing, chanting and meditation aimed to awaken the ‘serpent power’ within the body, thus leading to spiritual emergence. Mantra yoga uses sonic vibrations to unify consciousness through recitation and contemplation of special sounds such as OM intended to elicit specific vibrational effects. Nidra yoga aids progressive relaxation of mind and body culminating in the ‘corpse pose’ and release of emotional tension. Patanjalis yoga aims for self realization and self knowledge. Polarity yoga involves stretches, sound and movement used in combination with other interventions during polarity therapy. Raja yoga is organized into eight aspects to purify mind and body. Sivananda yoga incorporates mantras and meditation, with an emphasis on breathing and relaxation.
Safety:
Certain postures are not advisable for those with hypertension, cardiac pathology and pregnant women. Many yoga sessions finish with a relaxation period which would be contraindicated in acute psychotic states or for those susceptible to psychosis. Caution if meditation is included in the session, trance-like states can lead to feelings of disorientation and depersonalization and should not be entered into for long periods. Emotional abreaction may occur. The varying philosophies and styles of yoga suggest that those intending to take up the practice should ensure the style they choose fits with their own personal philosophy.
Japanese medicine/kampo
Japan’s traditional system of medicine evolved from traditional Chinese medicine (TCM, see examples below) and is based on similar principles of re-balancing chi (ki in Japanese), but which has also developed its own emphasis, integrated with Shinto and Buddhist philosophy. Modern day practitioners must, under Japanese law, be western-trained doctors or pharmacists. Diagnosis is similar to TCM but techniques vary; treatment aims to restore and maintain homeostasis and address issues related to the environment. Treatment may include diet using balancing foods from land, sea and mountain, breathing and exercise, shiatsu, acupuncture, herbal medicine (kampo), energy healing such as reiki and other therapies such as hydrotherapy to treat deficient or excessive ki. Massage is also used, including anma which involves stretching, squeezing and massaging to stimulate to restore and maintain good health, through improving muscle condition, influencing the internal organs and re-balancing ki; ampuku, which is a form of abdominal massage, used both for diagnosis and treatment; and johrei, which aims to remove toxins from the body through touch and to promote a more natural way of life, which is particularly useful for stress-related conditions, allergies and chronic pain.
Reiki
Developed by the Japanese Dr Mikao Usui, reiki is a hands-on method of channelling the universal life energy from one person to another to restore internal harmony and release physical, mental or spiritual blockages. The practitioner attunes and places his hands on the patient, with fingers together, so that energy is transferred from giver to recipient, releasing tension and increasing blood flow, the hand positions corresponding with the chakras of Ayurvedic medicine. Treatment finishes with myofascial techniques and effleurage to close the energy channels.
Shiatsu
Shiatsu (meaning ‘thumb pressure’) is a modern version of anma, developed in the mid-20th century, in which the practitioner uses thumbs, arms and knees to stimulate pressure points along the meridians, stimulating the musculoskeletal system and inducing a feeling of deep mental relaxation. Diagnosis includes taking a history, observation, smelling, listening and palpating. There are several variations of shiatsu including namikoshi, which concentrates on physical techniques developed from anma, drawing on Western knowledge of anatomy and physiology and focusing less on the traditional concepts of meridians and Yin and Yang balance; tsubo therapy, which is based on research into the electrical resistance of the skin over tsubo (acupuncture) points and involves tsubo stimulation through massage, needles, electrical devices and moxa; Zen shiatsu which blends amna with the concepts of Yin and Yang, ki and meridian theory, including the five element theory and in which the whole meridian is worked, not just the relevant tsubos or acupressure points.
Traditional Chinese medicine (TCM)
Description
The concept of Yin and Yang is a naturalistic one based on early observation echoing aspects of the lunar cycle and the cycle of the seasons. Yang encompasses aspects of light, heaven, sun, day, spring, summer, hot, male, fast, upwards, outside, fire, wood. Yin encompasses aspects of dark, earth, moon, night, autumn, winter, cold, female, slow, downwards, inside, water, metal. The principle of TCM is to maintain the balance of Yin/Yang through tonifying Yang or Yin and/or eliminating excess Yang or Yin, as appropriate. In five element theory, it is thought that the universe comprises five elements – Water, Fire, Wood, Metal and Earth – which are in a state of perpetual movement, interacting with each other. These five states each relate to an aspect of the human body, enabling effective diagnosis and treatment in accordance with the state of the outside world. Treatment aims to treat disease from the root cause and eliminate evil influences (external pathogens); it incorporates dietary modifications based on analysis of the individuals’ tastes, including sour, bitter, sweet, pungent and salty flavours, exercise such as tai chi and qi gong, massage, acupuncture, moxibustion, cupping and herbal medicine in order to re-balance disharmonies within the body’s Qi.
Acupuncture
Different forms of acupuncture include: electro-acupuncture, laser acupuncture, which uses low emission laser beams instead of needles and auricular acupuncture, in which the ear is viewed as a micro-system of the body with points identified on it and stimulated in the same way as full body acupuncture. Acupressure uses finger or thumb pressure at the relevant points and can be effective for people averse to needles, including children. Trigger point acupuncture is a western modification, in which needles inserted into specific trigger points (foci of neural hyperactivity which refer pain to adjacent or distant structures) are used primarily to relieve referred pain; it does not comply with the holistic principles of classical acupuncture of TCM. Acupuncture has been used for analgesia – it has been shown that insertion of acupuncture needles, sometimes electrically charged, triggers release of endorphins which inhibit or modify the transmission of pain signals. Neurotransmitters involved include: dopamine, noradrenalin and somatostatin and serotonin.
Cupping
Cupping is a TCM technique, in which a warmed glass cup is placed over an area of congestion or an acupuncture point in order to create a vacuum, with the aim of withdrawing excess Qi.
Exercise
Various types of exercise are encouraged as part of TCM, including Qi gong, tai chi, meditation and breathing, fitness training and martial arts. Qi gong includes motor control, postural awareness, relaxation, breath control, visualization and meditation. Tai chi chuan is a dynamic form of Qi gong consisting of a programme of slow, controlled movements. It has become popular in the west as a gentle form of exercise and has been shown to be effective in improving a variety of symptoms, particularly in the elderly and for menopausal symptoms.
Chinese herbal medicine
A variety of indigenous plants are used in TCM to re-balance the flow of Qi, administered orally in teas and tinctures, dermally via compresses and poultices and occasionally via other routes. They often taste unusual or unpleasant when first ingested but the taste improves as the patient’s condition improves. Herbs are commonly prescribed in combinations of up to 15 herbs, there being nearly 6000 herbs available to qualified practitioners, plus some animal and mineral ingredients. In the west, Chinese herbal medicine is most often used to treat skin disease, allergies, digestive, gynaecological, respiratory and immune system problems, as well as pain and addiction.
Safety:
The chemical constituents of Chinese herbal medicines are diverse and there is little evidence available in the West regarding safety or potential toxicity. Dose limitations are applied, although this may be significantly more than the approved dose for similar substances used in the West, e.g. the maximum daily dose of ginger in the West is considered to be 1 g, whereas in China, up to 3 g daily may be used. Some Chinese herbal products may interact with each other and many interact with conventional pharmacological medication. Concern continues over the import of unlicensed herbal preparations, with blends of unknown constituents and there have been reports of serious side-effects such as lead poisoning, from contaminated batches brought into the UK and USA, one of the justifications for classifying TCM in Group 3 of the House of Lords Report on Complementary Medicine (2000).
Moxibustion
Moxibustion, sometimes called acu-moxa therapy, involves burning dried artemesia leaves directly or indirectly over relevant acupuncture points to re-balance Qi. Most commonly ‘moxa rolls’ are lit, the flame is quenched and the smoking stick is positioned 2 cm away from the skin, but in some cases moxa is applied directly to the skin, producing a scar or blister. Acupuncture needles may be inserted and the moxa applied to the handle and ignited, warming the needle. Moxibustion is used as a heat source to stimulate deficient Qi and has become extremely popular in the West, as an alternative treatment for correcting breech presentation in pregnancy.
Safety:
The main risk is from burns: patients whose manual dexterity is impaired should not self-administer moxibustion. Those with hypertension should avoid moxibustion. In maternity care, midwives should advise mothers wishing to use moxibustion as an alternative to external cephalic version or caesarean section for breech presentation to ensure that the practitioner whom they consult is adequately trained to identify exclusion criteria (e.g. low lying placenta, previous uterine scar, multiple pregnancy).
