Comparisons with Alternative Medical Viewpoints
1.3a Contrasting philosophies of health
This section is intended to promote the recognition that different health systems may be built on contrasting philosophical perspectives of the physiology of the body and pathology of disease. These perspectives can be broadly categorized as reductionist and holistic. There are crucial differences between these two approaches, and without asserting that either has greater or lesser value, these differences need to be clarified before the work of trying to compare one discipline with another can begin.
The term reductionist refers to the principle of analyzing complex things by considering them in terms of a collection of parts. Simply speaking, a reductionist view of the body will tend to examine and describe the workings of individual parts, without necessarily having to draw on an understanding of the workings of the body as an integrated whole. From a mechanistic perspective, this is similar to the approach of the engineer who, simply by identifying and replacing a faulty part, such as a distributor or fuel pump, can transform a faltering vehicle into an adequately working model. The process involves testing clearly defined systems within the malfunctioning vehicle, and then identifying and making good the faulty part.
From a reductionist perspective, the body may be described as a wonderfully intricate machine. In this model, illness or disease in one part of the body will not necessarily be manifest in or experienced by other parts. The faulty part will, as in the vehicle, display malfunction in the form of signs and symptoms, and the diagnosis of disease is then made by a thorough examination of all the body parts and systems. From this sort of viewpoint, the whole assembly is just a collection of individual parts, no more and no less.
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.
Table 1.3a-IA comparison between alternative and conventional medicine
Symptoms are useful pointers
Symptoms are to be removed
Disease is a group of symptoms (a syndrome)
Disease is a fixed entity
Cure is a move towards balance
Cure is removal of symptoms
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.
While modern medicine understands that the mind can affect the body, and vice versa, it attempts to explain this in terms of neural and endocrine connections rather than by means of a non-measurable energetic principle.
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.
Table 1.3a-II Advantages and disadvantages of complementary medical treatment
Recognizes and will treat a wide range of contributory factors in the disease process – holistic approach
May not recognize features of serious disease
Will be open to the patient’s point of view
Difficult to find out whether therapy is appropriate or if the therapist is adequately qualified
Will clarify to the patient how their lifestyle may have contributed to the problem
Makes the patient responsible in part for the cause of the problem
Empowers the patient to be involved in their own healing
Requires the patient to be active in changing their lifestyle to enable healing
Unlikely to harm
May not be powerful enough to cure advanced disease
Should result in a change at a deep personal level
Table 1.3a-III Advantages and disadvantages of conventional medical treatment
Usually available as part of a nationally or insurance-funded health service
May not be the time or willingness to allow the patient to be listened to or valued
Directed towards excluding serious disease
Minor functional symptoms may be ignored
The practitioner is likely to be following the recognized approach as accepted by the medical profession
The practitioner may be inflexible if the patient requires an approach that is contrary to the medically accepted view
Will often be consistent with the patient’s expectations
May not be tailored to the complex needs of the individual patient
Will often focus on the disease rather than causation, and so the patient need not change lifestyle
Lifestyle factors are not addressed adequately, and so the root of the problem is perpetuated
The practitioner takes responsibility for the healing process
The patient may feel out of control within the healing process
Powerful treatments are available
The risk of iatrogenic disease (disease resulting from side effects of treatment) is high
Not expected to challenge the patient at a deep level
May ignore the need for deep personal change, which could be ultimately the most health-giving
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.
Figure 1.3b-I An illustration of the concept of suppression
Consider the case of an overworked businesswoman who has been self-medicating every day with paracetamol for recurrent tension headaches; this provides us with an example of suppression of symptoms by medication. When questioned, the woman readily admits that she feels dependent on her painkillers. She explains that if she cannot take one for any reason, she suffers with an unusually intense headache.
This patient’s underlying condition might have been diagnosed in Chinese medicine in various ways according to more detailed questioning and examination that includes pulse and tongue diagnosis. In this case, let us assume the diagnosis is Liver Yang Rising resulting from a state of Deficiency (Kidney Yin Deficiency). Treatment of the Ben (root) with acupuncture, by Tonification of the Kidneys, would be considered to be beneficial, but alongside this an appropriate treatment of the root of the problem might also include a re-evaluation of working habits, the taking of appropriate rest, and ensuring a diet containing appropriately nourishing foods. All these treatments target the root problem and not the symptom.
However, the painkiller does not work in this way. Although it removes the symptoms (i.e. it subdues the painful headache, a symptom of Liver Yang Rising), it does not deal with the root problem of Depleted Kidney Yin. Its recurrent use may lead the businesswoman to ignore the reasons why her headache might have developed. In her case, one reason is very probably her stress-inducing lifestyle, which is likely to be Depleting of Kidney Yin. The headache symptoms could be likened to an alarm bell, alerting this patient to the fact something is going wrong for her. However, by taking the painkiller, the alarm bell has been temporarily silenced, and the underlying disease possibly allowed to progress.
The concept of suppression suggests that by taking a painkiller, the underlying imbalance that has led to the headache may now become more pronounced. One obvious reason for this is that the root cause, the pressured lifestyle, is left untreated. A further reason, in line with the homeopaths’ beliefs, is that the excess Heat that was being expressed in the symptom of a headache is still held within the energetic system, and instead has to be expressed in a different form such as, for example, agitated anxiety. As this symptom is understood in Chinese medicine to be at the level of the spirit rather than the body, this would suggest progression of the imbalance to a deeper energetic level.
In Chinese medical terms the mechanism for this might be that the painkiller has an energetic property that allows the movement of Stagnant Qi. Many painkillers have side effects (such as rash and gastritis) which suggest they are Heating according to Chinese medicine. This property will move Stuck Qi and release the Exterior, so pacifying Yang Rising, but the cost of this is Wasting of Yang and also toxic damage to Yin by the Hot medicinal. Thus the root problem has been exacerbated not healed, and the body has been energetically depleted overall.
The recognition that allopathic treatment may have deleterious effects, and also possibly lead to dependency, pervades complementary medical practice. Complementary medicine practitioners may support the ideal of patients withdrawing from suppressive medical treatment so that deep imbalance can be exposed and treated appropriately. As the healing of suppressed disease might also be associated with the emergence of suppressed symptoms, the patient might be expected to get worse before getting better. Suppressed disease, although pervasive in nature, is often thought to be subtle, and therefore very difficult to assess or quantify. It could simply manifest in a general sense of malaise or lack of vitality rather than in symptoms and signs that can be studied objectively using the scientific method, and so arguably may not be recognized as significant by conventional physicians.
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.
No conventional doctor would deny that allopathic treatments such as paracetamol for chronic pain or atenolol for high blood pressure are actually suppressing these symptoms and signs. These treatments do indeed suppress symptoms, as is evidenced by the fact that when they are withdrawn in chronic disease, the original condition tends to recur. However, the fact that drugs are available that can suppress unpleasant symptoms of chronic disease tends to be seen as largely positive (or at least the best choice out of all possible therapeutic options) from a conventional viewpoint. Moreover, without any physiological or pharmacological proof that suppression of symptoms might be harmful, the homeopathic understanding of the potentially deleterious effects of suppressive medication is incomprehensible to a conventional physician whose beliefs rest on scientifically proven certainties.
Conventional practitioners do, of course, recognize that drug treatment is not without risks, but they see these risks in entirely physical terms – as the harm that a drug may do because it is in some way toxic to the body. The likely benefits and risks of harm caused by a drug can be studied by means of observations of how the drug affects the physiology of the body and also by observing populations of patients who have been given the drug. In these ways the effects of drugs can be evaluated quantitatively. The risks and benefits associated with a particular drug treatment can thus be predicted, and the patient counseled accordingly.
The concept of suppression can be expanded further to help explore the different effects that a drug might have on the body in energetic terms. The term energetics is used in this text to describe the interpretation within certain complementary medicine disciplines of the action of a drug on the energetic body. In Chinese medicine, for example, the energetic body may be defined in terms of Yin and Yang, the Five Elements and the Vital Substances of Qi, Blood, Essence (Jing), and also the Pathogenic Factors (such as Cold or Damp) which may impact upon it.
The energetic effects that may result from any form of treatment may be one or more of the following:
•cure (treatment of the root imbalance)
•suppression (deepening of the root imbalance)
•drug-induced disease (addition of pathogenic factors to the root imbalance)
•placebo (promotion of self-healing of the root imbalance).
Within holistic complementary medical thought, when a treatment leads to cure, it is the appropriate remedy for the condition. The curative treatment deals with the root of the problem, and so leads to a move towards energetic balance, and an overall improvement in health.
In conventional medical treatment, replacement of iron in certain cases of anemia (i.e. those cases that are due to lack of iron in the diet) is an example of cure. Other examples of medical treatments that are aimed at restoring the body to balance by reversing the effects of an external cause of disease include the setting of a fractured bone, the surgical repair of a road traffic injury, the treatment of burns, the administration of fluids in dehydration and the treatment of poisoning. All these are treating the root problem and are examples of curative approaches.
In some cases, the appropriate treatment of an acute infection with antibiotics will restore the body to balance and might also be interpreted as curative.
Many forms of health promotion are potentially curative in their nature when successful, for example, stop smoking campaigns, weight loss clinics, exercise on prescription schemes and clean water provision in developing countries.
In suppression (illustrated earlier with the analogy of the overflowing bath), the treatment causes the disappearance of symptoms, but the underlying imbalance, the root of the symptoms, has not been rectified. As already described, within many holistic medicine systems, symptoms may even be seen as a natural expression of a particular energetic imbalance, and one through which the imbalance may be healed, or at least stabilized.
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.
Suppression of symptoms can be supported with curative treatment. For example, antibiotics may be given for an episode of bronchitis in a smoker, but the smoker is then encouraged to stop smoking and take care of their health in terms of improved diet. The antibiotics do not deal with the underlying vulnerability to infection, but the cessation of smoking will permit a natural recovery, and will likely be accompanied by excessive phlegm production for a while as toxins held in the lungs are cleared by the recovering lining cells of the airways.
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).
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.
Whilst the placebo effect is often described in scientific literature in a pejorative sense, with the implication that it indicates a treatment that has no medical value, actually the effect, by definition, is that the patient gets better. It is possible that what has been described as a placebo effect can indeed include the truly long-term healing response experienced by many patients who receive energetic-based complementary therapies. By describing genuine healing as a placebo effect the positive changes that result from the non-specific actions of healers are counted as unhelpful noise in scientific studies, and so may remain under-reported and under-investigated.
When is suppression of symptoms acceptable?
Sometimes suppressive treatment is the only option available to enable a person to cope with intolerable circumstances. Conventional medicine has adopted many suppressive treatments where there appears to be no available alternative to improve an intolerable or rapidly deteriorating situation.
Examples of this sort of necessary suppression include:
•chemotherapy in childhood leukemia (now known to save lives in a high proportion of cases)
•strong pain relief and other palliative measures in terminal cancer
•antidepressants or tranquillizers in an acutely suicidal person
•clot-busting medication to reverse the blockage in an artery that is causing an acute heart attack (also known to be life-saving).
Less extreme, and therefore more controversial, examples include:
•antidepressants prescribed to an overburdened single parent, who lives in a district in which social care is underfunded and waiting lists for supportive counseling are full – the prescription has undoubtedly helped the parent cope when no other care was available
•a contraceptive injection for someone who would be physically or emotionally traumatized by pregnancy
•antibiotics to reduce the disfigurement of acne in an under-confident and bullied teenager.
Many conventional medical treatments can be classed as suppressive in nature, but this may be true for many natural or alternative treatments, or for the substances with which many of us choose to self-medicate. In many cases the physician will also recognize these treatments as suppressive, and so will not necessarily consider them as the ideal treatment, but instead the best treatment when choices are limited. It might be considered, in view of their broad use in all cultures, that suppressive treatments are a necessary aspect of coping with the human condition, and because of this the therapist needs to work creatively with this aspect of human nature. The challenge for a Chinese medicine practitioner will often be not “how can I support the patient to stop taking suppressive treatments?” but instead, “how can I offer treatment which helps to treat the root problem in this case for as long as the patient continues to rely on suppressive treatments?”
Energetic effects of the eight categories of drugs
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.
Table 1.3b-I Energetic interpretation of each of the eight categories of mode of drug action
Mode of action of drug
1. Replaces a deficient substance that is normally obtained from the diet
Usually returns the body to a state of more balance: energetic cure
However, if given without attention to a deeper underlying cause of deficiency, e.g. iron replacement given to treat anemia due to ongoing heavy menstrual blood loss: suppression
2. Kills or suppresses the growth of infectious agents (microbes and other life forms that cause infection)
In infections that are a manifestation of strong Evil (Xie Qi) Pathogenic Factor (in Chinese medicine terms) in a healthy individual, the drug may enable full clearance of the bacteria that are causing the manifestation of the infection, and so will enable the restoration of balance as the healthy body can then easily recover naturally: energetic cure
In infections that have occurred as a result of an underlying imbalance in the individual, the treatment does not target the root cause, and so tends to be suppressive, even with full clearance of the bacterial overgrowth: suppression
In some cases the end result is one of Residual Pathogenic Factor, and this means that symptoms will continue to present at a deeper energetic level: suppression
3. Toxic to rapidly dividing human cells
These treatments always target the manifestation (a tumor) of a deep underlying imbalance: suppression
They are also very toxic to a wide range of healthy bodily tissues and are characterized by: marked drug-induced disease
4. Replaces a substance that is normally produced by the body
In cases in which the body will never be able to produce the essential substance ever again, the replacement treatment moves the body towards a state of more balance (e.g. insulin replacement in type 1 diabetes mellitus or chronic pancreatitis, both of which are due to total failure of the insulin cells of the pancreas): energetic cure
In cases when the body is under-producing an essential substance as a result of an ongoing deeper disease process, the replacement of that substance is suppressive (e.g. thyroxine replacement in mild hypothyroidism): suppression
5. Specifically stimulates the immune response by introduction of an antigen
Vaccines are given to well people. They involve the administration of a foreign substance, which primarily stimulates a natural immune response. In some cases this disease leads to serious symptoms, but in other cases, the individual regains a healthy state of balance as the artificial infection is overcome. This has to be classed as: drug-induced disease
6. Other drugs that stimulate natural bodily functions
These drugs may first stimulate a bodily function that perhaps should be occurring (e.g. lack of ovulation in female infertility) but is not due to an underlying imbalance. By ignoring the underlying imbalance and treating the symptom, these treatments will be depleting. Also, any drug that causes an increase in a natural bodily response (e.g. alertness induced by caffeine, or relaxation of the airways by inhaled salbutamol in asthma) could also be described as a stimulant. If stimulants mask the symptoms of an imbalance then this is: suppression
Stimulants can be used when there is no medical disease (e.g. in the case of recreational drug use). In this case their immediate effects might be classed as: drug-induced disease
7. Suppresses natural bodily functions
The suppression of a natural bodily function, either in a well or an unwell person, is, of course, classed as suppression as it is not targeting the root cause of the problem: suppression
8. Counteracts the damage caused by toxins
These treatments reverse the damage that would have been caused by an external toxic substance: energetic cure
Figure 1.3b-III illustrates the effect of stimulant drugs in the form of a negative cycle.
Figure 1.3b-III The negative cycle of stimulant drugs
Figure 1.3b-III illustrates how, from a Chinese medicine perspective, a stimulant drug may actually cause an impression of improving the energetic state of the body by the Moving of substances (such as Qi or Yang), a change apparent in the immediate improved functioning of an organ. One example might be the action of salbutamol, which reduces the wheeze of asthma. This action might be described as the Moving and Descending of Lung Qi despite the underlying condition of Deficient Lung and/or Kidney Qi. However, this drug does not cure asthma, except in the short term. The theory of suppression would suggest that repeated use might actually tend to deplete reserves of Lung and Kidney Qi, as its moving action is unadulterated and is not accompanied, as it would be in an herbal formula, with nourishing herbs. If Lung and Kidney Qi is depleted by this powerful action, in this way, the patient can become dependent on the medication.
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.
Box 1.3b-I Case history 1
Joe, a previously fit teenager, rapidly becomes very unwell after developing a flu-like illness and is rushed to hospital in a nearly unconscious state. Bacterial meningitis is suspected and later confirmed. Joe makes a dramatic recovery after five days of treatment with intravenous antibiotics. He is tired for a few days following his illness, but after two weeks of resting at home he is back to playing football for the school within three weeks. Six months later, he appears to be fully back to his previous level of fitness.