Chapter 1 Eastern Origins of Integrative Medicine and Modern Applications
Emaho, the Tibetan word for “wondrous,” aptly describes the history of healing. The healing art of medicine is neither fixed in one theory of disease nor has its origins in a single body of perceptions. Its roots reveal rich and fascinating strands to its heritage. Each strand has developed potent theories and recommendations that inform prevention, illness, and treatment. These differences profoundly influence the vision and values among the members of a given culture—how to live well and how to address illness and health. Specifically, the contrasts in Eastern and Western approaches have been like strangers from afar, and now as of the twenty-first century, have become increasingly aware of each other in the evolving field of integrative medicine. Each has its advantages and limitations. Recognizing and skillfully combining the best of both approaches is an ongoing challenge and a noteworthy, positive advance for humanity.
In the past 20 years, medicine in the West has begun to diligently examine and resume its inclusion of indigenous traditions in medical practice. The term “integrative medicine” emerged in the early 1990s to describe a paradigm shift in modern medicine. Integrative medicine believes that drawing from multiple traditions better serves people, rather than using only one medical system. At the core of the integrative medicine movement in the West is how to examine indigenous healing modalities with scientific rigor for safety and efficacy, while retaining respect for their history and culture. With its emphasis on quality research evidence, integrative medicine modalities have gained further acceptance in the West, while having spawned a resurgence of indigenous medicines in their countries of origin.
Eastern healing traditions have made some of the greatest advances in integration with modern medicine. In this chapter, the authors briefly review the historical origins of Eastern and Western traditions and the contrast in their philosophies and examine some Eastern healing traditions more closely to better understand the application of Eastern healing modalities to modern medicine. Please note that the following is only an introduction to healing traditions that have had some success in practice with Western medicine. The authors encourage readers to actively engage in learning about other healing traditions specific to their local community.
As the field of integrative medicine evolves, so does its terminology. “Modern medicine” in this chapter is used to describe the most mainstream medicine practiced and determined by the evolving scientific method, and “complementary and alternative medicine” (CAM) is used to describe practices that are not as well defined by the scientific method. Theories of medicine can also be grouped based on geographic origin: Western, originating from Greco-Roman philosophy, and Eastern, originating from Asian-Pacific philosophy. The term modern medicine implies fluidity, and it is fitting to use such terminology during the current period of expanding medical boundaries.
The foundation of several Eastern healing traditions inextricably embraces the philosophies of early Eastern thought, those of Buddhism, Taoism, and Hinduism. These philosophies still provide the underpinnings for many contemporary Eastern cultures, allowing Eastern indigenous healing traditions to maintain widespread acceptance and practice. Several unique but related traditions developed in the East before the Christian era and are still heavily practiced today as discrete systems, including Chinese medicine, Ayurveda (traditional Indian medicine), and Tibetan medicine. Other Eastern traditions enjoy moderate practice in their areas of origin, including Persian medicine, medicine as set forth in the Dead Sea Scrolls, and folk shamanism and animism. Chinese Ayurveda, and Tibetan medicine will be more closely examined and compared later in this chapter, along with their current transformations in the West.
In contrast, modern medicine in the West developed quite independently from religious thought. It was, and continues to be, shaped by science. Modern scientific thought evolved from the Greek philosophers beginning with Euclid around 300 BC and later Plato, Socrates, and Aristotle. The mathematic theories of these Greek philosophers set the foundation for Renaissance scientists more than 1500 years later, who further developed the scientific method. The scientific method, which describes a constant process of empirical observation, logical reasoning, and skepticism to discern knowledge, is still the thought process used today to validate modern medicine.
It was not until later in the twentieth century, however, that the scientific method became the mainstay of modern medicine. In the early nineteenth century, modern medicine was pluralistic in nature as “professional care was mostly provided by botanical healers and midwives, supplemented by surgeons, barber-surgeons, apothecaries, and uncounted cancer doctors, bonesetters, inoculators, abortionists, and sellers of nostrums.”1 During much of this same period, the profession of naturopathy flourished to the benefit of many. At this time, the medical profession was still in its early stages in the United States. By the early to mid-twentieth century, medicine was much more narrowly defined through the scientific method. In the past 20 years, however, medicine in the United States has experienced another shift, arguably a shift again to the medical pluralism from more than 100 years ago. This raises the question: is this merely historical pattern or the birth of a unique era?
If modern medicine is experiencing yet another paradigm shift, the culture will necessarily move beyond the older ethos of the scientific method that defined its previous paradigm. Master Hong succinctly commented on this point, “What this [Qi Gong] master possesses isn’t magic. It is just science that has not yet been examined.”2 In the twenty-first century, the culture of medicine is once again embracing its diverse options for health care, shifting yet again toward pluralism and reflecting the social landscape of a new generation. What is happening invites all healers to enlarge their ideas of disease and health and to welcome an expanded and deeper perspective.
“Vive la différence.” The differences in Eastern and Western medical traditions stem directly from their foundational differences in world views. Judith Farqhuar described these essential differences in world views as “the difference between a world of fixed objects and a world of transforming effects. Like the solid inertial world of modern natural science traditions, the … transformative world of Chinese medicine seems to exist prior to all argument, observation, and intervention. Perhaps with a certain discomfort, Western readers must acknowledge that ‘their’ abstractions about such things make as much sense as ‘ours’.”3
One of the most obvious and far reaching differences between Eastern and Western medical traditions is the concept of inter- and intra-personal relationships. Stemming from the Socratic model and Cartesian dualism, Western medicine heavily delineates between mind and body, between doctor and patient, and between healthy and diseased. In contrast, medicine originating in the East finds little distinction in these areas. Instead, it views continuity and balance as vital to health. Illness is defined by imbalances of patterns that should naturally be in harmony. Multiple aspects of the being, including the mind, body, and spirit, are integral to this harmony. In contrast, illness in modern Western medicine is described by a specific pathology, caused by discrete foreign pollutants, and often cured by another foreign element.
The fundamental concepts of Eastern healing traditions are deeply embedded in the philosophies of their cultures. Consequently, they are perceptions, ideas, and values shared by most society members. Although health is integral to one’s everyday life in Eastern societies, it is only one part of Western society. Likewise, health is defined in the East as a unity of individual, environmental, and societal factors. Although the Western definition of health has moved toward encompassing the physical, mental, social, and spiritual, each is still defined as a separate entity. In modern medical communities, divisions between physical and mental health and social work, are still at large, with these departments often not acting in concert.
These distinct differences shape the patient–doctor relationship. In Eastern traditions, a unique balance of these factors is critical to diagnosis and treatment of a patient’s disharmony rather than disease. Physicians in Western medicine often look beyond the patient–doctor relationship to an external body of knowledge to diagnose and treat, guided by categories of symptoms. A general comparison of Eastern and Western concepts with regard to health is shown in Table 1-1.
|Mechanism of disorder||Pathologic mechanism||Imbalance of harmonies|
|Foundational structure||Logic, mathematics||Eastern religions and philosophies|
|Patient–doctor relationship||Access external body of knowledge for diagnosis and treatment||Unique balance critical to diagnosis and treatment|
As mentioned, although several indigenous healing traditions in the East have been preserved, Chinese, Ayurvedic, and Tibetan medicine remain among the most heavily practiced traditions in their respective regions. All three traditions stem largely from similar philosophical foundations; thus in all, health and disease are seen as inextricably interrelated. They play integral parts in the delicate balance of harmony and disharmony. Table 1-2 provides a comparison of these three traditions.
Tibetan medicine and Ayurvedic medicine have similar historical origins, since Ayurveda is the root of Tibetan medicine. Ayurvedic origins are found as early as the second millennium BC in the Rig Veda, with its second classical stage in the Brahmanic period in 800 BC, where it continued as an unbroken lineage until the Moslem conquest of India in the thirteenth century. During that time in the sixth century BC, the historical Buddha, Shakyamuni, was born in India, and after achieving Enlightenment under a Bodhi tree in Bodhgaya and delivering the teachings of the Four Noble Truths, Buddhism was born.*
The Tibetan medical tradition offers that the Buddha, often called the “Great Physician,” taught the medical texts himself, including the Gyu-zhi, the most important Tibetan medical text. The Sanskrit version of the Gyu-zhi, however, was probably not written until around 400 AD.4 Although some scholars may debate whether the historical Buddha’s teachings are the precise origin of Tibetan and, thus, Ayurvedic medicine, Buddhism’s influence on these two healing traditions is unquestionable.
Like Ayurveda, the origins of Chinese medicine date back to at least the second millennium BC, to the era of the great Yellow Emperor, Huangdi (2698–2598 BC). The classic medical text written during his reign is Huangdi Nei Jing (The Yellow Emperor’s Inner Canon). Yet perhaps of more influence to Chinese medicine known today is the Nan Jing (The Classic of Difficult Issues), written around the first or second century AD. As Nolting notes in Chapter 31 on “Acupuncture” in this edition, the Nei Jing deals more with “demonological medicine and religious healing,” whereas the Nan Jing developed Chinese medicine as an original system, with well-defined and organized principles, diagnostics, and therapeutics.5
Chinese medicine also witnessed various transformations, most notably its recent evolution into Traditional Chinese Medicine (TCM), the modern form of Chinese medicine practiced in China and worldwide. Influenced by the advent of modern science, Chinese medicine was required during the 1950s to establish increased legitimacy in the face of the new Marxist ideology, which emphasized “natural science” and delegitimized Confucian influences. Initially, the People’s Republic of China denounced folk, demonic, and Buddhist temple medicine.6 However, in 1951, Mao Zedong revived and then canonized portions of the tradition with his “Chinese medicine is a great treasure-house” speech.7 In Mao’s Cultural Revolution, Chinese medicine was transformed to TCM and embraced as a means to preserve the “spirit of a nation.” The “new medicine” movement highlighted traditional medicine’s ability to arouse one’s own bodily defenses against illness while excluding metaphysical ideologies. TCM thus embodied one general theory of Chinese medicine and discouraged diverse readings and interpretations by practitioners and students.
Of the three traditions, Tibetan medicine enjoyed the most continuity in lineage until the Chinese invasion in 1959. With the Moslem invasion of India in the thirteenth century, much of the Ayurvedic medical system was destroyed, along with many Buddhist texts. Fortunately, by the seventh century AD, Ayurvedic medicine had traveled to Tibet and was safely preserved in the Himalayan Mountains. Once in Tibet, Buddhism and its medicine first adapted to the indigenous shamanic religious culture, Bon, whose greatest contribution to the Tibetan medical system was its knowledge of the indigenous medical herbs of the sub-Himalayan plateaus. With King Strongtsan Gampo’s formal introduction of Buddhism to Tibet in the early seventh century, the influence of Buddhism on its medicine flourished. This continued up until the Chinese invasion in 1959.
Despite its isolation in practice, Tibetan medicine shares several principles with other Eastern healing traditions. Its strongest ties are with Chinese medicine to the north and Ayurvedic medicine to the south. Eastern traditions of healing are undoubtedly intertwined in a rich tapestry, stemming partly from an extraordinary meeting of healers. During the seventh century, the Tibetan King Gampo held the world’s first recorded international medical conference. Noted physicians from India, China, Greece, Nepal, Persia, and Mongolia dialogued in a cross-cultural exchange, and texts from each medical tradition were translated.