What is Integrative Medicine?

“Integrative medicine” is a term popularized initially by the Harvard physician Dr. Andrew Weil and subsequently by famous physician advocates such as Dr. Mehmet Oz to describe a kind of medicine distinct both from conventional Western medicine and also from so-called “complementary and alternative” medicine.  Integrative medicine neither rejects conventional evidence-based medicine nor uncritically accepts traditional medical systems such as classical Chinese medicine.  Perhaps most importantly, integrative medicine attempts to scientifically verify the effectiveness of classical medical treatments by designing experiments which take into account the conceptual paradigm in which the classical medicine is practiced.

Dr. Jiang Feng’s experience with the modern system of so-called “traditional” Chinese medicine or “TCM” developed by the government in the People’s Repubic of China following the Cultural Revolution left him with the strong conviction that the two systems (classical Chinese medicine & modern Western medicine) should not, and actually could not, be mixed.  Ideally the two should be practiced in an integrated fashion, separately but concurrently, as independent but contemporaneous modes of treatment – “integrated”.

The core problem with trying to “mix” the two (for example in the way that many modern TCM practitioners now base their acupuncture or herbal prescriptions on Western diagnostic techniques like X-rays and blood pressure readings) is that both systems approach the issue of sickness and health from such radically different paradigms that they simply cannot be reconciled with one another in a harmonious way.  Both paradigms are logically consistent, independent frameworks which attempt to understand the basis of illness and treatment, however any serious attempt to blend the two must either bend or break the logical consistency of each system.

The classical Chinese medical approach has at least two thousand years of unbroken “history of use” to back up its effectiveness.  But in our modern scientific age, why shouldn’t we hold it to the same evidence-based standard to which we subject conventional Western medicine?  This is a very important question.  The answer is that we absolutely should!  In our day and age it is indefensible to simply do something for no better reason than “that’s the way it has always been done”, especially in matters as crucial as one’s health.  The problem with all of this is the fact that it is incredibly difficult to design experiments to effectively test the outcome of classical Chinese medical treatments, due to the unique way that this system conceptualizes both illness and treatment.

The italicized statement above deserves further explanation.

First, doctors of classical Chinese medicine do not diagnose “illnesses” or “diseases” (病症), they “identify patterns of disharmony” (辯證). On the surface they may seem like the same thing, but a little further probing reveals profound differences. A “pattern” (證候) is a constellation of characteristics, some of which might be considered “symptoms” (症狀) by a conventional Western doctor, but the majority of which are not. For example 3 of the primary sources of information for pattern identification, namely palpation of the pulse, examination of the tongue, and examination of the whites of the eyes, are considered for all practical purposes irrelevant by conventional medicine.

Second, patterns identified by classical Chinese practitioners represent concepts totally alien to conventional medicine.  They have names which in translation sound like “Liver Yang Rising”, “Spleen & Stomach Damp Heat”, “Stomach Qi Deficiency”, etc.  Please keep in mind that while we translate some of these Chinese words as the names of organs like “heart” and “kidney”, in the language of classical Chinese medicine these words most emphatically do not refer to the organ itself but various functions associated with that organ, functions such as digestion, circulation, respiration, reproduction, immune response, etc.  Likewise words such as “heat” and “cold” are not literally referring to the patient’s temperature, but are analogies meant to describe certain aspects of a pattern of disharmony which resemble extremes in temperature.

Third, patterns of disharmony do not correspond directly or even indirectly to the illnesses recognized by conventional Western medicine.  For instance, two different men both diagnosed with identical stages of prostate cancer by a Western doctor might be identified as possessing two very different patterns when examined by a classical Chinese medical practitioner.  Concurrently, of two individuals identified by a Chinese practitioner as expressing same pattern involving the “liver” , only one might have a liver illness identifiable by conventional medicine, while the other might not yet exhibit any symptoms recognizable as liver illness by the Western doctor.

Fourth, because generally speaking classical Chinese medicine perceives symptoms as the “branches” and patterns as the “roots” of a given complaint, the spectrum of therapies available to the classical Chinese practitioner from herbs to acupuncture to qigong are not described in terms of the illness that they cure, but of the “direction” in which they effect a given pattern of disharmony.  A given herb might be described as “cool”, meaning that it helps to resolve a pattern described as “heat”, or a given acupuncture technique might be described as “dry”, meaning that it helps to resolve a pattern described as “damp”.

Now let us turn to the problem of experimental verification of the efficacy of a given treatment, the gold standard of modern Western biomedicine.  The entire structure of the double-blind clinical study, simply speaking, is based on the premise of testing a single drug’s effect on a single illness.  Western scientists have attempted to test Chinese herbs and acupuncture in this way since the first exposures to classical Chinese medicine, with minimal success.  They have had minimal success because they are not actually testing the therapies for their efficacy in accomplishing what they are said to be able to accomplish, namely the resolution of a given pattern of disharmony.

Further complicating the matter is that the classical Chinese medical pattern identification process by its very nature cannot be reduced to machine-performed standardized testing, and so the accuracy of the diagnosis relies directly on the skill of the practitioner making quality control within the profession practically impossible.  In addition a classical Chinese practitioner would almost never prescribe a single herb or a single acupuncture location, but instead a combination of herbs or needles, further blurring the incredible specificity required for accuracy in scientific experiments.

Fortunately there is growing recognition by the scientific community of these difficulties, and instead of throwing the proverbial baby out with the bathwater, scientists are increasingly interested in designing experiments in accordance with the principles of integrated medicine.

One such experiment might include a group of 100 patients all diagnosed with a specific stage of a cervical cancer, and scheduled to receive identical forms of chemotherapy and radiation.  50 of those patients would additionally be treated by a single classical Chinese practitioner, who might compound various herbal formulae as indicated by the pattern of disharmony detected by interviewing each patient.  After a sufficient period of time the results of the two separate groups would then be compared.

Such studies have already taken place, many with very promising results, and the growing list of academic medical institutions actively engaged in this kind of integrative medicine research includes some of the top institutions in the world (The Mayo Clinic, MD Anderson, Sloan Kettering, etc.).