1.3

By contrast, the term holistic is used to refer to a view that sees each part of a complex system as being inextricably linked with all other parts of the system, and the whole system being more than just the sum of its parts. A problem in one part will resonate widely throughout the system. Furthermore, this immediately brings the non-material aspects of life into the equation, the thoughts and emotions that form part of the whole person, as well as the environmental milieu in which the person is located. Some medical systems that might be described as holistic according to this definition are underpinned by the idea that the individual parts are linked and vivified by an underlying non-measurable energetic state. This is made manifest in the material body, but is more than just the physical body. This understanding of an underlying state, sometimes described as the vitalistic principle, is a concept now largely considered to be discredited, albeit not disproved, by the Western scientific community.25 Terms such as life force, Qi, Ki and Prana are used to describe this energetic state in different health disciplines.

With a holistic model of health, the body, the emotions, the mind and the spirit are seen as interdependent and intercommunicating. An illness of the body will impact on the function of the emotions, the mind and the spirit, and, conversely, a sickness of the spirit or mind will have repercussions that become immediately manifest in the physical body on examination.

This belief underpins diagnostic systems that focus on just one body part such as the pulse, tongue, iris, sole of the foot or abdomen (Hara). The interconnections within the body, mind and spirit will result in every illness being reflected throughout all parts of the system. By following diagnostic systems such as these, the focus of a skilled practitioner on a single body part could be expected to reveal information not just about the health of the body, but also about the state of the mind and spirit.

One important corollary of this holistic view of health is that symptoms of a disease may become manifest in a different body part, or indeed, at a different bodily level, from that in which a disease first developed. For example, the grief following a bereavement, which might be expected to be experienced at an emotional or spiritual level, may instead also become manifest in the body in the form of an asthma attack or skin rash. These emotional or spiritual correlates of physical disease are of great interest to many holistic practitioners. Some go as far as to suggest that most physical diseases have emotional or spiritual roots, and that some diseases consistently reflect specific emotional or spiritual blocks. A pain in the shoulders, for example, may be considered to represent a difficulty in shouldering the burdens imposed by a busy and complicated lifestyle.26

The idea that symptoms are expressions of imbalances throughout all the levels of the body, emotions, mind and spirit has implications when symptoms are treated medically. From a holistic perspective, if symptoms are not treated at their root origin, any other treatment of them may be considered to be potentially harmful. If the root imbalance persists, it makes sense to a holistic practitioner that it will find an outlet at another body site or within another level of the body. This idea, that symptoms treated in this way might re-emerge in a different form at a different body site or level, is a concept that is not tenable within a purely reductionist philosophy of health.

Conventional medicine as a reductionist system

It would be simplistic to state that conventional medicine is a purely reductionist health system. It is true that many of the ideas of modern medicine have sprung from the reductionist view of the world that dominated scientific thought in the 18th to 20th centuries. The Linnaean approach to classification of illness,27 which modern doctors use to define disease according to body system, is one good example. The tendency of doctors to specialize so that their focus is directed at single body systems or subsystems is also evidence of this approach. Medical training largely focuses on the diseases of body parts and of the mind, and categorizes them as distinct entities that merit defined and agreed treatment approaches.

However, an ever-deepening scientific understanding of the workings of the body and the mind over the latter part of the 20th century has begun to erode the more simplistic reductionist approach to disease. Increasingly, conventional practitioners recognize that the different body parts and the workings of the brain are inextricably interrelated and interdependent. Moreover, factors such as social class and standing, education, ability to deal with stress and general levels of happiness are now known to have very powerful effects on health and well-being. The healthy human being is no longer seen as a well-oiled machine that responds to a regular service of all parts. Instead, it is seen as a complex entity, the health of which depends on delicate physiological internal relationships and on relationships that exist within the context of the community in which the individual is placed.

This more holistic perspective of health is expressed clearly in the aforementioned World Health Organization (WHO) 1948 constitution, where health is defined as a “state of physical, mental and social well-being and not merely the absence of disease or infirmity.” The modern medical model has now more accurately been described as a biopsychosocial model28 in which biological, psychological and social determinants are readily recognized as contributing to the development of disease. It is also now accepted that treatment focused on a body symptom in isolation may not deal fully with the real root of the problem.

However, there remain important differences, and these can lead to misunderstandings between practitioners of conventional medicine and practitioners of those complementary health disciplines that hold to a more holistic perspective. One author and alternative medicine practitioner, Stephen Gascoigne,29 has summarized the differences between alternative medicine and conventional medicine, as shown in Table 1.3a-I.

This rather stark comparison perhaps unfairly places conventional medicine firmly in the reductionist camp. However, the comparison does illustrate some key differences between the conventional medical view of health and healing and those of medical disciplines such as Chinese medicine, Ayurvedic medicine, homeopathy and craniosacral therapy. All these disciplines adhere to concepts that suggest an underlying vitalistic principle and the interrelationship of the physical with spiritual as well as emotional and mental levels of health, and this is perhaps the most significant difference.

A discipline such as Chinese medicine, for example, recognizes that when one system is imbalanced, symptoms will always manifest in the physical, emotional, mental and spiritual realms. For example, the symptoms and signs of Heart Qi Deficiency include palpitations, shortness of breath on exertion, a thready pulse, listlessness, lassitude and mental cloudiness.30 A conventional practitioner will be less ready to make this claim that any disease that involves the heart inevitably includes mental and emotional imbalance. Whilst they may be ready to accept that heart disease can lead to low mood and troubled thoughts, the conceptual link made between the two will be less immediate. For the conventional medical doctor, the low mood of a patient with heart disease will be more a result of having to deal with the pain and disability that accompany heart disease and of carrying the weight of a poor prognosis. This contrasts with the holistic practitioner’s expectations that a disease in the system that influences the heart organ will also manifest naturally in the realms of emotions, mind and spirit.

However, while the stereotypical conventional and alternative practitioner may practice within very different conceptual frameworks, this does not necessarily mean that either has a more accurate grasp of an absolute truth. It is blindness to the possibility that there might be alternative ways of describing and treating the patient’s disease that arguably might contribute to limiting the potential for cure in the widest possible form. This book has been written from the perspective that conventional and complementary practitioners are working with different aspects of the same essential truth, and with the ultimate aim that practitioners from either perspective become more open to embracing the beneficial aspects of all forms of healthcare.

A helpful analogy can be found in the scenario of a concert violinist and a sound engineer who are both listening to a performance of a violin concerto. The concert violinist may be attentive to the sensitivity of the interpretation of the music, and may be deeply moved as he listens. The sound engineer may recognize the physical characteristics of the harmonics she hears and can comment on the acoustics of the concert hall. No one can deny that they have both been listening to the same piece of music. However, their philosophies for interpreting the music will shape their individual perceptions, and the result will be that what they actually hear can differ markedly.

Similarly, a complementary and a conventional practitioner can both offer valid insights about the health and need for treatment of an individual patient, although it is not always the case that either comprehends or can appreciate the view of the other.

It is also important to recognize that no practitioner, nor indeed medical practice, is wholly reductionist or holistic in focus, although the conventional/reductionist, complementary/holistic labels are frequently misused in this way. Many conventional practitioners adhere strongly to the holistic management of their patients, and are very responsive to individual need when counseling patients and selecting treatments. Conversely, the structured format of some complementary medicine texts and training courses might, through systematization of syndromes and treatment schedules, encourage a practice that is arguably highly reductionist in its nature.

For the patient seeking appropriate healthcare, it is important to recognize that the philosophical framework of any medical practitioner will have both strengths and weaknesses. Just as the violinist and the sound engineer both have a great deal to contribute to the production of a beautiful musical performance, so practitioners with different medical and philosophical frameworks can have truly complementary insights and skills to offer in promoting healing. Clarity about where these strengths and weaknesses lie will enable a patient to make an informed choice between which medical treatment is appropriate to their specific needs at any particular time.

The understanding of the way health and illness manifests in the body will, of course, influence the choice of treatment. A reductionist understanding of physiology and pathology will lead to the choice of allopathic treatments, that is, those that oppose the processes that are considered, after questioning, physical examination and tests, to be going wrong in some way. If the heart is pumping too fast, treatment will be targeted at slowing it down, if there is pain, an analgesic will be prescribed, and if there is spreading infection, an antibiotic. Allopathic treatments are largely understood to have a physical basis to their action, and this could range from a delicate biochemical change, to a macroscopic transformation such as a hip joint replacement. Many medical treatments in the psychological domain are also perceived to have a physical basis, for example, the neurochemical changes that are known to result from antidepressants, hypnotics and electroconvulsive therapy. Even counseling approaches such as the very popular cognitive behavioral therapy (CBT) might be interpreted as allopathic in that unhelpful thought patterns are identified and then helpful thought patterns are practiced.

A holistic approach will require the practitioner to seek the root cause of the health problem, and with those disciplines that have an underlying vitalistic principle, the root cause will lie within the energetic balance of the patient, and this balance is inextricably linked with the patient’s environment. Whilst it may be recognized that difficult or dangerous symptoms need to be controlled promptly, the fundamental task of the holistic practitioner is to work with the patient to engender change at a deep level. This is less likely to involve techniques that have easily measurable physical effects, and more likely to include healing modalities that might appear thoroughly unscientific to the skeptical. Chinese medicine tends to treat illness by means of a combination of lifestyle advice, and herbal and dietary therapy and physical therapy including acupuncture, massage and exercise programs designed to improve energetic balance and flow. Non-material factors such as environmental setting (the focus of Feng Shui), ancestral bequests and spirit-based influences may also be considered to impact on health, and so can be taken into account, particularly in the forms of Chinese medicine that predate the systematization of Traditional Chinese Medicine that occurred under Mao Zedong in the 1950s. The healthy lifestyle recognized by Chinese medicine is characterized by moderation, respect for ancestral values, virtue and spiritual practice, and there is great emphasis placed on living in accord with the seasons and not striving or desiring for much.31 Chinese therapies have been described as heteropathic rather than allopathic, a term intended to denote the fact that rather than opposing physical symptoms, they attempt to counter unhelpful imbalances in the flow of Qi.32

It might be appreciated that the essentially preventative and restorative nature of holistic therapy might be most effective in the early stages of disease. When disease has progressed to the level when there is marked structural bodily damage or change, it is accepted by many holistic therapists that invasive allopathic treatment could be needed in addition to holistic care. Obvious examples include emergency surgery for a ruptured appendix, cardioversion for ventricular fibrillation (heart attack) or intravenous fluid replacement in severe dehydration.

Tables 1.3a-II and 1.3a-III summarize some of the potential advantages and disadvantages of seeking treatment from complementary and conventional medical practices.

These have been drawn up as if from a patient’s perspective. Not all patients want to be actively involved in their treatment, or wish to have their world view challenged, and both these things are integral to some complementary therapeutic approaches. This explains why a statement such as “Requires the patient to be active in changing their lifestyle to enable healing” is listed as a possible disadvantage of complementary therapy, and “Treatment is not expected to challenge the patient at a deep level” as a possible advantage of conventional medical treatment.

Being clear about the distinctions between the philosophical foundations of conventional and complementary thought, and how these are likely to influence diagnosis and treatment, is essential when practitioners of different medical disciplines hope to develop a meaningful dialogue. It is important to be both clear and respectful of essential differences, and to avoid the tendency to over-generalize. This clarity becomes perhaps most useful in building up relationships with patients who have complex and enduring health needs, many of whom are likely to benefit by receiving the best aspects of treatment from contrasting medical perspectives.

1.3b Drugs from a complementary medical viewpoint

Section 1.2c introduced a method of categorizing drugs by mode of therapeutic action and the concept of iatrogenic disease (illness as a result of medical treatment). This section presents some complementary perspectives on the beneficial and adverse effects of drugs in the body. It also describes some principles of mapping Chinese medicine concepts to Western medical theory. These are introduced in some detail in the “Note to the Reader” at the beginning of this book. It might help to turn now to these pages by way of introduction to the rest of this section.

Suppression of symptoms

The concept of suppression of symptoms in homeopathic theory refers to the idea that the disappearance of symptoms or signs of a disease may not necessarily mean cure, but instead may be a consequence of the disease moving to a deeper, less immediately manifest level.33 This concept has a parallel with the Chinese medicine idea of disease having a manifestation (Biao) and a root (Ben). According to Chinese medicine theory, treatment that is targeted at the level of the manifestation, and which does not simultaneously attend to the root causes, may actually lead to a worsening of the root imbalance. This concept is expressed in texts as ancient as the Neijing Suwen (which presents diverse ideas from Chinese philosophical thought that were drawn together as early as 150 BCE). In the Neijing Suwen, the 65th chapter is dedicated to a discourse on when to treat the root and when to treat the manifestation of a disease process.34 The Yixue Rumen (Introduction to Medicine, written in 1575 by Li Chan) explains, “In general, to treat disease, first the Ben is treated and then the Biao is treated. If the Biao is treated first and the Ben is treated later, the pathogenic influence becomes stronger and that disease goes even deeper.”35 It is noteworthy that both these texts also emphasize that there are situations when the manifestation (Biao) needs to be treated as a priority, including those cases when life-threatening symptoms are present.

The Chinese medicine description of treating the manifestation (Biao) might be seen as analogous to the homeopathic idea of suppression. In both there is a suggestion that, although treatment may cause an alleviation of symptoms, without treatment of the root (Ben) there may be a worsening of disease at a deeper level. In Chinese medicine, however, the texts imply that in treating the manifestation and not attending to the factors that cause the root imbalance, the root imbalance will become more pronounced and may generate further symptoms. Homeopaths take this a stage further, and argue that the symptom may actually serve a useful purpose by providing some sort of release for the deeper root imbalance. When it is prevented from serving this purpose, it may directly cause the root imbalance to deepen and be expressed in a different and potentially more damaging form. According to both theories, the unattended root imbalance is believed to create more serious problems.

Figure 1.3b-I illustrates this concept of suppression. The bathtub with a running tap has a problem – it is leading to a dripping overflow pipe, thus causing damp to the exterior wall. This would ideally be fixed by turning off the taps, the root of the problem. However, someone outside the house might be tempted to deal with the manifestation of the problem. They could stop the dripping overflow and allow the wall to dry out by blocking the overflow pipe with a cork. This treatment would indeed solve the problem of the dripping pipe, but would, of course, result in a more catastrophic problem inside the house as the bath then proceeds to overflow on to the bathroom floor.

The use of treatment to palliate the uncomfortable or dangerous symptoms and signs of disease is very commonplace in conventional medical pharmacology. Conventional medicine practitioners do not, in general, recognize that the removal of symptoms of an underlying disease could be harmful. This view is reinforced by the fact that there is no obvious physiological or pathological theory to explain why preventing the expression of a symptom such as a headache or a sign such as high blood pressure would be harmful. In fact, in many cases of acute and chronic disease, symptoms themselves are potentially very damaging. Examples include the swelling of the brain in meningitis, recurrent seizures in children with high fever, escalating blood pressure, unstable angina, and emergence of cancerous tumors threatening the function of vital organs. Very few would debate the need for urgent allopathic treatment as a priority in such situations.

Suppression can be illustrated in a diagrammatic way in the form of a negative cycle of events, in which suppression of symptoms leads to worsening of the root imbalance (see Figure 1.3b-II).

Figure 1.3b-II The negative cycle of suppression

To the holistically minded complementary therapist, one marker of suppression would be that if a drug is withdrawn, the original symptoms can reappear and may be even worse than before treatment because the underlying imbalance has worsened. This, in some circumstances, may lead the patient to have to rely on the drug to feel well; in other words, they have become dependent on the drug.

According to Chinese medicine bronchitis might represent Phlegm Heat Obstructing the Lungs resulting from a combination of the Heating effect of smoking and also poor diet together with a possible aggravation by an Invasion of Exterior Wind Heat.36 Antibiotics will directly halt the inflammation induced by bacterial multiplication, and so will minimize acute damage to the material substance of the lungs. In Chinese medicine terms antibiotics are Cooling in nature and this explains their action in Clearing Heat. However, they do not have properties that can ameliorate the underlying profound energetic imbalances. Paradoxically, perhaps, their side effects (of rash, hypersensitivity and anaphylaxis) suggest that they might even introduce Toxic Heat into the system. As is well recognized, the health of the lungs will deteriorate steadily with the persistence of smoking. It is only the cessation of smoking and the change to a nourishing diet that will allow the natural balance of the Lung Qi to tend to reassert itself.

Introduction of drug-induced disease

When considering the energetic effects of medication, as hinted above, not all the harmful effects of a drug can be attributed to suppression. Few drugs target a particular symptom alone; they will often have other effects on the body. Aspirin, for example, recognized in conventional medicine to alleviate headaches because of its anti-inflammatory properties, also has an adverse effect on the lining of the stomach. In most people aspirin will cause inflammation and some degree of bleeding of the stomach lining. This effect is a direct result of the action of aspirin on the function of inflammatory chemicals (the prostaglandins) in the stomach lining. This might be described in Chinese medical terms as the introduction of the Pathogenic Factor (Evil Qi) of Heat into the Interior.37

There are some general effects of Western medications that might be recognized in Chinese medication to be relevant in many cases, and particularly with regard to the very powerful medications. The tendency for strong medications to be Cooling in nature whilst at the same time leading to invasion of Pathogenic Heat has been described. They can therefore be damaging to the Blood and Yang and also to the Yin in vulnerable individuals. Many drugs have side effects that include rash, fever, nausea and headache, damage to the blood cells, and damage to the hair listed in their side effects. Qi Stagnation with Damp or Heat are also common sequelae of Western medical treatment evidenced by patients commonly reporting headache, muscle aches and depression with diverse medications. The many hepatotoxic drugs seem to manifest in a syndrome akin to Damp Heat.38

The latter two categories of suppression and drug-induced disease will be difficult to distinguish in practice. In both situations the symptoms of the original condition have been improved, but at the cost of the appearance of other, newer symptoms. These other symptoms may either be a consequence of suppression (an old imbalance expressed at a deeper energetic level) or a drug-induced disease, or both.

One important distinguishing characteristic of drug-induced disease is that it will affect even a person who has no disease to suppress. If a well person were to take a high-dose aspirin on a regular basis, they would be very likely to experience symptoms of irritation of the stomach lining after some time, a consequence of the Heating properties of this medication (properties that also confer on it the beneficial aspects of being about to Disperse the Qi and Move the Blood).

Placebo

The placebo effect that results from the giving of either medication or physical treatments is well recognized in conventional medicine. Defined as “a beneficial effect…which cannot be attributed to the properties of the placebo itself, and must therefore be due to the patient’s belief in that treatment,”39 the placebo effectis classically recognized to occur when symptoms improve even when a prescription contains no active ingredient (such as sugar pills). However, the placebo effect may actually play a significant role in the healing response to even highly active medical treatments. It is known to powerfully influence the response to medications, but will also be active as part of the response to physical treatments such as physiotherapeutic manipulation or even surgical operations. It seems to be very much influenced by the packaging of a treatment, so a wide range of factors, from the name of the medication, to the way it is marketed, and the way the physician describes and prescribes it, are known to influence the outcomes in terms of a placebo response. These properties can be manipulated consciously (pharmaceutical companies are masters at this art), but are also influenced by factors that might be largely unconscious, including qualities relating to the physician such as confidence, ability to maintain rapport and intention.

The categorization of conventional drugs introduced in Chapter 1.2 can help with interpreting whether or not a medical treatment is likely to be curative or suppressive in action. Table 1.3b-I demonstrates how an energetic interpretation can be matched to each of the eight categories of mode of drug action, as described in Chapter 1.2.

It is noteworthy that stimulant drugs are also categorized as suppressive according to this interpretation of drug energetics. Although the term suppression evokes pictures of damping something down rather than stimulating it, the stimulant drugs do, in fact, also suppress a more natural state of events. For example, the stimulant drug caffeine suppresses tiredness, the stimulant drug salbutamol suppresses constricted breathing when inhaled, and ovulatory stimulants suppress the state of infertility.

The difference with stimulants is that these drugs force, or boost, a bodily state that would not otherwise have occurred. As drugs carry no nutritive value, they do not actually introduce materials to support growth into the body. Because of this, any boosting of a bodily state is very likely to be at the expense of reserves of the energy that would be described as Qi in Chinese medicine.

Figure 1.3b-III illustrates the effect of stimulant drugs in the form of a negative cycle.

It is important to clarify at this point that describing salbutamol as suppressive is not to say that this drug is always harmful. There is no doubt that, in severe asthma, drugs such as salbutamol are potentially life-saving, and are a good example of how suppressive treatment may be the best option for some patients. It is also noteworthy to explain that the Chinese herb ma huang has a very similar effect to salbutamol, and has been shown to contain comparable active chemical constituents (including ephedrine). It, too, is recognized to Move and Descend Lung Qi, but as part of Chinese herbal formulae tends to be prescribed concurrently with warming herbs.40 With this understanding, it would make sense to support a patient who is reliant on salbutamol with treatment and advice focused on nourishing and conserving Lung and Kidney Yin.

In a similar way, other stimulant drugs can be described as Moving of substances. Caffeine could be described as Moving of Heart Qi, and ovulatory stimulants could be thought of as Moving of Blood and Essence, and in the same way it would make sense that all stimulant drugs are ultimately depleting to the body’s energies.

Energetic action of drugs: from theory to practice

Some fictional case histories from conventional medicine will help these theories of the energetics of drug action come to life. These present different examples of drugs leading to cure, drug-induced disease and suppression. Each is followed by a brief discussion of the energetic interpretations of the action of the drugs described.

Related posts:

Conclusions Barriers to Disease and Susceptibility The Respiratory System The Cardiovascular System The Urinary System The Skin, the Eye and the Ear

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