Essentials of Complementary and Alternative Medicine (June 1999)

Major Indications
C
HRONIC
 C
ONDITIONS
Allopathic medicine uses powerful medications and has the technology to deal with acute emergencies. However, in chronic conditions, such as rheumatoid arthritis, 
stroke paralysis, or multiple sclerosis, allopathic medicine has less success. Ayurveda believes it can effectively treat these conditions with diet and lifestyle 
recommendations, cleansing programs, Ayurvedic massage, and rejuvenation. Ayurvedic treatment for any condition requires a commitment from the patient, and the 
patient needs to be questioned about his or her willingness to follow through with diet and lifestyle changes. A significant component of the treatment process is the 
patient's personal responsibility as well as a genuine desire on the part of the patient to heal.
There has been no study that we know of using the Western clinical trial method on Ayurveda as an entire  system of medicine. There are a number of studies on 
specific treatments and considerable literature on the pharmacological action of Ayurvedic herbs and their active ingredients. An example is guggulipid, a traditional 
Ayurvedic herb demonstrated to lower serum cholesterol in clinical studies (
1
). By consulting with experienced Ayurvedic practitioners, conventional researchers in 
India have discovered a number of useful herbs and have done so more rapidly and economically than those that have been discovered using the usual 
drug-screening and development strategies (
2
, 
3
). Laboratory and human experimental studies have indicated benefits of Ayurvedic products in conditions such as 
Alzheimer's disease (
4
), Parkinson's disease (
5
), and rheumatoid arthritis (
6
). These studies have also helped to identify potentially toxic substances (
7
) and 
drug–herb interactions (
8
), requiring knowledge and careful use of Ayurvedic products.
Transcendental meditation (TM) is a specialized meditation technique adapted from Ayurvedic traditions and is widely taught in Western countries. It has been shown 
to produce beneficial effects on a number of conditions, including reduction of blood pressure (
9
, 
10
); posttraumatic stress syndrome (
11
); anxiety (
12
); alcohol, 
nicotine, and drug abuse (
13
); and for general improvement in psychological health (
14
). Physiological effects of TM were reported three decades ago (
15
), and 
long-term practice may include electroencephalogram changes that persist during sleep (
16
). Meditation techniques derived from Ayurveda, with their emphasis on 
changing consciousness, may produce greater health benefits than those that simply teach relaxation (
17
). For example, a carefully controlled trial of TM 
demonstrated reductions in blood pressure in hypertensive, elderly African Americans who practiced the technique (
9
, 
10
).
Recently, data collected on the costs and health outcomes of individuals who regularly engage in the lifestyle and preventive practices of Ayurveda have shown 
considerably cost reductions because of less use of conventional health care services (
18
). When people take responsibility for their health and consciously engage 
in health-promoting behaviors, chronic disease is often mitigated or eased.
P
ERSONAL
 R
ESPONSIBILITY
Identifying the cause of one's disorder is the beginning of the process of returning to balance. An important step is the client taking responsibility for dealing with the 
issues that are causing the undesirable effects and eventually doing something about these issues. Although classical Ayurveda has powerful techniques and an 
extensive pharmacopoeia, its more limited contemporary practice in the West is generally more effective when there is time for recovery (e.g., when the disease is in 
the early stage or is not life-threatening). If a patient persists in habits and behaviors identified as causative for his or her health problems, the Ayurvedic approach 
will only be partially effective. Ayurveda is most effective when the individual faces the cause of his or her condition and applies remedies according to his or her own 
constitution.

Ayurveda is a philosophy and system that encompasses the body, mind, emotions, and spirit. Many medical systems are held within this philosophy—from herbology 
and diet to surgery and drugs. What medicines to use, when to use them, and in what combination and for whom is the strength and great contribution of Ayurveda.
Preventive Value
Modern medicine is just beginning to address the importance of preventive measures. Because of Ayurveda's emphases on the balance of body, mind, and 
consciousness and on the importance of appropriate diet, lifestyle, and exercise for one's constitution, it is called the Science of Life. Following this approach, it seeks 
to bring one to a state of perfect health and to enhance longevity.
ORGANIZATION
Training
In ancient times, the Vedic tradition in India passed this knowledge from  guru to disciple, teacher to student, and continued for many thousands of years as an oral 
tradition. Approximately 2000 years ago, much of this knowledge was recorded in print, Ayurvedic medical colleges were established, and training became more 
formalized. This ancient Vedic tradition can still be sought out.
Today there are approximately 200 Ayurvedic colleges and schools in India connected to universities in every state. An Ayurvedic specialist in India has an 
educational and internship requirement similar to physicians (MDs) in the United States. The title is Master of Ayurvedic Science (MASc). The course of study for the 
bachelors degree (Bachelor of Ayurvedic Medicine and Surgery; BAMS) is five years, plus a two-year internship. The curriculum is established according to the basic 
principles of Ayurveda. In the second year, the students begin clinical work in a hospital under experienced Ayurvedic physicians. After finishing the requirements for 
the BAMS, a student may elect graduate study. During the intern years, the student's guidance counselor helps the student decide a research topic, which culminates 
in a thesis. After the thesis is accepted, there is a series of examinations, both oral and written. If the student passes, he or she is declared an Ayurvedic specialist 
and is granted the MASc degree. It typically takes nine to ten years to obtain an MASc. In recent years the MASc degree has been changed to Doctor of Medicine in 
Ayurveda (MD in Ayurveda).
There is wide variance in how Ayurveda is practiced in the West. Because it is not yet recognized as a legitimate health care practice in the United States, there are 
only a handful of fully trained Ayurvedic physicians here. Although there are a growing number of schools in the West that teach Ayurvedic principles, the curriculum 
is limited and there is no consensus as to curriculum or requirements for graduation. These schools vary from small private schools, solely dedicated to Ayurveda, to 
a number of universities now beginning to develop programs of study. Ayurvedic physicians from India are sometimes brought to lecture for these new programs. 
However, a fully developed curriculum similar to those in India is not yet available in the West. Similarly, there is no licensing of Ayurvedic physicians, even for fully 
qualified Ayurvedic physicians trained in India. In the United States, licensed health care professionals, such as physicians, nurses, acupuncturists, and chiropractors, 
can incorporate Ayurvedic principles into their practice to the extent of their training and understanding. However, this practice becomes problematic in the West when 
a health care professional attends only a weekend seminar or other short course of study in Ayurvedic medicine, begins an Ayurvedic practice, and then has no 
further Ayurvedic medical training. An understanding of Ayurveda takes time and, although basic principles can be incorporated after some serious study, a thorough 
understanding of its proper application requires extensive study and commitment.
Quality Assurance
In most Western countries, health care is regulated by the government. The laws govern not only what a practitioner can call oneself or claim to be, but also whether 
one can practice at all. The language of modern health care law is based on scope of practice. When a practitioner wishes to diagnose and recommend specific 
treatment, it is considered to be the practice of medicine and hence requires a license that allows for that—MD, DO, ND, DC, and so on. Also, in most Western 
countries, the educational institution and the awarded degree are separate from the licensing and governing body that regulates the profession. Rather than endorse 
certain professions and practitioners, these licensing boards effectively control which health care options are available to people.
This regulation of health care in many Western countries affects Ayurveda in a dramatic manner. Even well-qualified and respected Ayurvedic physicians, those with 
a BAMS or MASc, who are approved to practice medicine in India are unable to practice in most Western countries. It is almost impossible for a person seeking 
professional Ayurvedic health care in most Western countries to obtain it. For an Ayurvedic physician to be able to practice medicine in most Western countries, he or 
she would literally need to go back to an approved medical school and obtain a degree in one of the licensable professions; all of this could take four to six years. 
This situation forces people who want Ayurvedic care to seek care from practitioners who are less knowledgeable in the Ayurvedic practice.
Currently, people in Western countries who want Ayurvedic care have two options: to choose a qualified and licensed medical doctor who has some training and 
understanding of Ayurveda, or to choose a unlicensed person with probably little or no formal medical education. The first choice will undoubtedly provide the patient 
with good medical care, but not necessarily expert Ayurvedic care. The second choice, although well intentioned, may not be able to provide the patient with good 
medical care.
There is a potential third option: a clinic with a licensed medical doctor, in the role of coordinating physician, who supervises the health care program of the patient 
and uses another person in the office who can provide expert Ayurvedic assessment and recommendations for treatment. However, there are few doctors or clinics 
currently providing this type of practice.
Reimbursement
For the patient who wants or needs insurance reimbursement, the best choice is to choose a doctor who is incorporating Ayurveda into his or her practice and whose 
services are covered by insurance. There are one or two new, smaller insurance companies that will provide coverage for alternative health care. The question for the 
consumer is how to find these companies and how to judge their stability. The costs of modern health care and health insurance make these decisions a difficult task.
Relations with Conventional Medicine
Modern allopathic medicine uses powerful and effective drugs, such as antibiotics, steroids, tranquilizers, and muscle relaxants. These drugs may have significant 
side effects. Knowledge of Ayurvedic principles can help an individual deal with some of these side effects. Ayurveda can complement conventional medicine by 
bringing insights to treatment of the patient, so that a drug can be selected for the person's  prakruti (i.e., unique constitution).
For example, some people may be sensitive to penicillin. Because, according to Ayurvedic principles, penicillin is  hot, sharp, and penetrating, it is pitta-provoking. 
Knowing this, a physician would carefully consider whether to prescribe penicillin to a  pitta person. The same approach applies to aspirin. A  pitta person is sensitive 
to aspirin. In that case, the doctor can suggest that aspirin be taken with bicarbonate of soda or  shanka bhasma, an Ayurvedic preparation. With this combination, the 
aspirin will still work but will not burn the wall of the stomach.
Steroids should not be given to a  kapha person because steroids have a  kapha-type of action. They slow down metabolism and can create steroid toxicity, resulting in 
a moon-face and water retention. Therefore, steroids should be given only in emergency and for a short period of time to a  kapha person.
In addition, Ayurveda can alleviate some of the side effects of modern pharmaceuticals. For example, when a cancer patient on chemotherapy loses his or her hair, 
which is a pitta symptom, the patient can apply Bhringraj Oil to the scalp and take  shatavari and guduchi. These herbs help prevent hair loss and  pitta provocation, 
and the person can more easily bear chemotherapy with reduced side effects.
PROSPECTS FOR THE FUTURE
Ayurveda has great prospects in the West, and the future of this system is bright. The medicine of the twenty-first century will incorporate the best of East and West, 
and the time-proven truths of Ayurveda will be a gift for all generations to come. Studying Ayurveda will give modern physicians additional tools for their practice, and 

the incorporation of Ayurvedic principles will bring improved health—to the body, mind, and consciousness.
S
UGGESTED
 R
EADINGS
Frawley D. Ayurvedic healing. Salt Lake City: Morson Publishing, 1989.
Frawley D, Lad V. The yoga of herbs. Santa Fe: Lotus Press, 1986.
Lad V. Ayurveda: the science of self-healing. Santa Fe: Lotus Press, 1986.
Lad V. Secrets of the pulse: the ancient art of ayurvedic pulse diagnosis. Albuquerque: The Ayurvedic Press, 1996.
Lad V, Lad U. Ayurvedic cooking for self-healing. Albuquerque: The Ayurvedic Press, 1994.
Morrison JH. The book of Ayurveda: a holistic approach to health and longevity. New York: Simon & Schuster, Inc., 1995.
Svoboda RE. Ayurveda: life, health and longevity. London: Penquin, 1992.
Svoboda RE. The hidden secret of Ayurveda. Pune, India, 1980; reprint, Albuquerque: The Ayurvedic Press, 1994.
Svoboda RE. Prakruti: your Ayurvedic constitution. Albuquerque: Geocom Limited, 1989.
C
HAPTER
 R
EFERENCES
1.
Satyarati GU. Gum guggul (Commiphoral makal): the success of an ancient insight leading to a modern discovery. Indian J Med Res 1998;87:327–335.
2.
Jain SK. Ethnobotany and research on medicinal plants in India. Ciba Found Symp 1994;153–164.
3.
Chaudhury RR. Herbal medicine for human health. World Health Organization monograph. New Dehli, 1991.
4.
Effect of Trasina, an Ayurvedic herbal formulation, on experimental models of Alzheimer's disease and central cholinergic markers in rats. J Altern Complement Med 1997;3(4):327–336.
5.
An alternative medicine treatment for Parkinson's disease: results of a multicenter clinical trial. HP-200 in Parkinson's Disease Study Group. J Altern Complement Med 1995;1(3):249–255.
6.
Studies on the mechanism of action of Semecarpus anacardium in rheumatoid arthritis. J Ethnopharmacol 1989;25(2):159–164.
7.
Arsenic and Ayurveda. Leuk Lymphoma 1993;10(4–5):343–345.
8.
Scientific evidence on the role of Ayurvedic herbals on bioavailability of drugs. J Ethnopharmacol 1981;4(2):229–232.
9.
Schneider RH, Staggers F, Alexander CN, et al. A randomized controlled trial of stress reduction for hypertension in older African Americans. Hypertension 1995;26(5);820–827.
10.
Alexander CN, Schneider RH, Staggers F, et al. Trial of reduction for hypertension in older African Americans II: sex and risk subgroup analysis. Hypertension 1996;28;228–237.
11.
Brooks JS, Scarano T. Transcendental meditation in the treatment of post-Vietnam adjustment. J Counsel Devel 1986;64:212–215.
12.
Eppley K, Abrams A, Shear J. The differential effects of relaxation techniques on trait anxiety: a meta-analysis. J Clin Psychol 1989;45:957–974.
13.
Alexander CN, Robinson P, Rainforth M. Treating and preventing alcohol, nicotine, and drug abuse through Transcendental Meditation: a review and statistical meta-analysis. Alcoholism 
Treatment Quarterly 1994;11:13–87.
14.
Alexander CN, Rainforth MV, Gelderloos P. Transcendental Meditation, self actualization and psychological health: a conceptual overview and statistical meta-analysis. J Soc Behav Pers 
1991;6:189–247.
15.
Wallace RK. Physiological effects of Transcendental Meditation. Science 1970;167:1751–1754.
16.
Mason L, Alexander CN, Travis FT, et al. Electrophysiological correlates of higher states of consciousness during sleep in long-term practitioners of the Transcendental Meditation program. 
Sleep 1997;20(2):102–110.
17.
Orme-Johnson DW, Walton K. All approaches to preventing or reversing effects of stress are not the same. Am J Health Prom 1998;March/April:12[4].
18.
Orme-Johnson DW, Herron RE. An innovative approach to reducing medical care utilization and expenditures. Am J Managed Car 1997;3(1):135–144.

CHAPTER 12. T
RADITIONAL
 C
HINESE
 M
EDICINE
Essentials of Complementary and Alternative Medicine
CHAPTER 12. T
RADITIONAL
 C
HINESE
 M
EDICINE
Lixing Lao
Background
 
Description
 
History and Development
Principal Concepts and Basic Theories
 
Yin-Yang Theory
 
Wu Xing (Five Element Theory)
 
Major Components of TCM
Provider–Patient Interaction
 
Patient Assessment
 
Differential Diagnosis
Therapy and Outcomes
 
Treatment Options
 
Description of Treatments
 
Treatment Evaluation
Use of TCM for Treatment
 
Major Indications
 
Adverse Effects and Contraindications
 
Preventive Value
Organization
 
Training
 
Quality Assurance
 
Reimbursement Status
Future Prospects
Chapter References
BACKGROUND
Description
Traditional Chinese medicine (TCM) is a well-developed, coherent system of medicine that has been practiced in China for thousands of years. The system views the 
human body as a whole and as part of nature. Harmony must be maintained within body functions and between the body and nature to remain healthy. Disease 
occurs when this harmony is disrupted. To restore the state of harmony, several therapeutic approaches are commonly used: Chinese herbal medicine, 
acupuncture/moxibustion, Tui Na (Chinese massage and acupressure), mind/body exercise, and Chinese dietary therapy. Disease prevention is an integral part of 
TCM.
History and Development
The origins of Chinese medicine are linked to three legendary emperors: Huang Di, the Yellow Emperor (2697 
BC
), known as the originator of the traditional medicine 
of China; Shen Nong (2698–2598 
BC
), the divine husbandman, considered to be the founder of agriculture and the originator of Chinese herbal medicine; and Fu Xi, 
the Ox tamer, known as the creator of acupuncture needles (
1
). Huang Di is said to be the author of the first classic work on traditional Chinese medicine, the  Yellow 
Emperor's Inner Classic (Huang Di Nei Jing). This text is divided into two parts:  Simple Questions (Su Wen), which delineates the theory of Chinese medicine, and the 
Spiritual Axis (Ling Shu), which describes the practices of acupuncture and moxibustion (a method in which a moxa herb is burned above the skin to apply heat to the 
acupuncture points for the alleviation of symptoms). Although the  Yellow Emperor's Inner Classic is believed to have been compiled by unknown authors circa 200 
BC
, 
long after the time of Huang Di, it has remained the most respected text of Chinese medical society throughout the long history of TCM.
Several key historical figures contributed to the development of TCM. During the Han dynasty (25–220 
AD
), a well-known physician, Zhang Zhongjing (150–219 
AD
), 
wrote Treatise on Febrile and Miscellaneous Diseases (Shang Han Za Bing Lun) (
1
, 
2
 and 
3
). In this book, he established the principle that treatment should be based 
on the differentiation of symptoms. This principle is considered a milestone in the development of TCM. The earliest book exclusively about acupuncture and 
moxibustion was written by Huangfu Mi in the second century 
AD
, between the Wei and Jin dynasties (
1
, 
2
, 
4
). This book described the meridians, the names and 
locations of acupuncture points, needling techniques and contraindications, and the detailed acupuncture treatment of many symptoms and diseases. It recorded 349 
acupoints, far more than the 160 recorded in the  Yellow Emperor's Inner Classic. During the same time period, The Classic of Difficult Issues (Nan Jing) emphasized 
the reinforcing and reducing methods that are considered important components of needling technique (
1
, 
2
, 
5
). Thirteen centuries later, during the Ming dynasty 
(1368–1644), Yang Jizhou (1522–1620) further developed the theory and practice of acupuncture. He summarized all of the previous important acupuncture literature 
and described 361 acupuncture points. This book became a very important textbook for the study of acupuncture (
1
, 
2
, 
6
).
The first Chinese herbal classic, written by an unknown author, is the  Divine Husbandman's Classic of Materia Medica (Shen Nong Ben Cao Jing) (25–220 
AD
). This 
book records 365 individual herbs (
2
). In 1578, Li Shizhen, a well-known herbalist in Chinese medical history, completed the  Grand Materia Medica (Ben Cao Gang 
Mu), which elaborated on the properties and functions of 1892 herbs (
1
, 
2
). By 1977, the number of Chinese herbal medicines identified increased to 5767 (
1
, 
7
).
Other Chinese medical techniques have also been practiced for centuries. Yi Yin, an emperor's chef who lived in the eleventh century 
BC
, was the founding father of 
Chinese dietary therapy (
2
, 
8
). The earliest Chinese massage (Tui Na) techniques were recorded inThe Ten Volumes of Huang Di and Qi Bo's Massage (Huang Di Qi 
Bo An Mo Shi Juan) during the Qin and Han dynasties (221 
BC
–220 
AD
) (
8
). Chinese mind-body exercise (e.g., QiGong) can be traced back more than 2000 years. A 
silk manuscript discovered in 1972 from a Han dynasty tomb, the  Ma Wang Tui tomb, recorded the movements of the early form of Qi Gong technique (
2
).