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Seven
Core Principles of Integrative Medicine This article was provided by: Note:
The information on this website is presented for educational purposes
only. 1.
The Principle of Empiricism First, many African tribes empirically recognized association between malaria and mosquitoes long before the Italians and the English insisted it was caused by bad air (mal aire) of Italian swamps.9 And that was long before the malarial parasite was identified. Second, for decades all over the world, general practitioners empirically administered injections of vitamin B12 (but not of vitamins C or D) for their recognized value in relieving fatigue despite the ridicule of academics. A spate of recent studies have conclusively demonstrated the value of this vitamin for a variety of neuropsychiatric and disorders associated with fatigue.10-13 At the Institute, the author and his colleagues have observed greater benefits with larger doses of this vitamin (up to 20,000 mcg) in patients with fibromyalgia, CFS, chemical sensitivity, Alzh-eimer's disease, and dementia who suffer from severe cognitive difficulties. Third, the efficacy of intravenously administered hydrogen peroxide was empirically recognized.14 The author refrained from using this therapy for his patients with fibromyalgia and chronic fatigue syndrome on the ground that hydrogen peroxide is a potent oxidant and that ample clinical and experimental evidence clearly established those syndromes to be related to accelerated oxidative molecular injury.15 However, his recent high-resolution, phase-contrast studies of freshly prepared peripheral blood samples led him to recognize the paradox of an in vitro oxidant serving as an in vivo antioxidant.16 Now, the author and colleagues frequently employ hydrogen peroxide therapy with good clinical results in a host of patients with accelerated oxidative molecular injury. 2.
The Principle of Integration In the United States, the principle of integration has largely been ignored at an enormous cost to the sick. A critical issue never addressed in the prevailing pharmacologic model is the inappropriateness of prescribing four, five, or more drugs concurrently, and for years, when the drug combinations used have not been evaluated even for months. No one can testify to the safety of such drug regimens in their entirety. Two recent studies are cited below to define the magnitude of that problem. The first study reported the clinical efficacy of an integrated program for managing patients with advanced coronary artery disease. The program emphasized the role of all elements that improve rheologic characteristics of blood and reduce or prevent oxidative coagulopathy in circulating blood, including self-regulation for stress control, optimal food choices to prevent sugar overload and consequent hyperinsulinemic state, ample supplementation with antioxidant nutrients, herbs to restore damage to the bowel-blood-liver ecosystems, noncompetitive exercise, and EDTA chelation therapy. In a series of 26 patients with failed coronary bypass surgery, angioplasty and multiple drug therapies, complete control of symptoms and discontinuance of all drugs was achieved in 61%. In another 17%, symptom control and drug dose reduction of over 75% was reported.17 In the second study, by contrast, a non-integrative management plan focusing on coronary bypass surgery and angioplasty for patients hospitalized for acute coronary syndromes actually showed that such procedures increase the odds of death as compared to conservative management.18 Consider the following quote from the editorial published in the New England Journal of Medicine commenting on that study: With remarkable clarity and consistency, all four studies show that routine angiography and revascularization do not reduce the incidence of nonfatal reinfarction or death as compared with the more conservative, ischemia-guided approach. In fact, in the VANQWISH study of patients with non-Q-wave infarction, the aggressive strategy [which these investigators call "invasive"] was associated with increased mortality during hospitalization, at one month, and at one year.19 3.
The Principle of Integrity of Cellular and Tissue Ecologic
Relationships The essential strength of the Pyramid of Trios is that it focuses on: (1) a need for ecologic thinking that extends far beyond the limited notions of diseases as defined by microscopic study of tissues after they have been injured; (2) a model of living ecosystems that emphasizes relatedness among the various body ecologies; and (3) the essential role of the base trio of the bowel, blood and liver in the integrity of human defenses. The clinical validity of this schematic model has been demonstrated.17,20 4. The Principle
of Physician-Patient Reciprocity If a physician can shut up for long enough, the patient will tell him what is wrong, so went an old medical gag. But, is it just a gag? The chronically ill have an intuitive-visceral sense of what is wrong with them. Those suffering from depression, obsessive-compulsive disorders, schizophrenia and other "psychiatric" disorders have long known that some nutrient deficiency or chemical imbalance was the cause of their torment. Many in psychiatry ridiculed them for it. Yet, the sufferers held on to their intuitive-visceral senses. Now for the author (and a growing number of like-minded physicians), there is no question that there is a physical basis for every "psychiatric" hurt, though we cannot recognize the biochemical lesion in many instances. The author has closely followed many such persons who did very well with integrated programs designed to restore their battered bowel-blood-liver ecosystems. The veracity of those patients (and their intuitive-visceral sense of their ailments) simply cannot be questioned. How do the patients know the true nature of their suffering in many instances long before their physicians do? Because, in almost all cases the sufferers of "psychiatric disorders" have lucid periods during which they reflect on their suffering and suspect that there has to be a physical basis of their pain. We physicians must acknowledge that the patient lives with and suffers from his illness at all times, while we see that illness only for very short periods of time. So it is that the patient learns things about his suffering that escape his physician for years. At a deeper level, the sick do have a visceral-intuitive sense of their illness. 5. The Principle of Spontaneity of Oxidation This principle holds that the essential code of molecular injury is woven into the molecular structure and function. In 1983, the author published his hypothesis that the phenomenon of spontaneity of oxidation in nature is the core pathogenetic mechanism of molecular and cellular aging and forms the basis of molecular and tissue injury in all disease processes.5 The notion that a single molecular mechanism can serve as the core pathogenetic mechanism of molecular, cellular, and tissue injury in all disease processes (as well as the aging process) appears to be too simplistic to be valid. However, an extensive review of the literature pertaining to oxidative phenomena in biology in general, and human health-disease continuum in particular, fails to uncover any evidence to the contrary. Rather, the author's close examination of redox regulation in health and a survey of redox dysregulation in all diseases in which oxidative stress has been investigated yield strong evidence for his view.21-23 Such studies led the author to consider clinical implications of the hypothesis in integrative medicine in areas of nutritional medicine,24 clinical ecology and autoimmunity,25 lack of physical fitness,26 adrenergic hypervigilance evoked by lifestyle stressors,27 and clinical benefits of effective methods of self-regulation, meditation, and prayer. Specifically, the author proposed and marshalled evidence for his hypothesis that chronic fatigue syndrome results from accelerated oxidative molecular injury to diverse enzyme pathways of human antioxidant and immune defense systems, as well as of digestive-absorptive and energy functions. Recently, the author and his co-investigator, Omar Ali, introduced the concepts of oxidative coagulopathy and AA oxidopathy as the core pathogenetic mechanisms of ischemic heart disease. The term oxidative coagulopathy was introduced as an all-encompassing term for all oxidatively triggered events in the circulating blood that result in zones of plasma congealing and formation of microclots and microplaques. The term AA oxidopathy refers to a much broader spectrum of energetic-molecular dysregulation of the redox phenomena that affects not only the elements of circulating blood but also patterns of oxidative injury involving cell membranes, extracellular matrix, and intracellular organelles (such as mitochondria) seen in clinical states characterized by accelerated oxidative molecular injury. Such states include acute and chronic ecologic, nutritional, autoimmune, and degenerative disorders, as well as malignant tumors. 6. The Principle
of Spontaneity of Healing 7. The
Principle of Spiritual Surrender The ancient
notion of the mind-body-spirit trio is this: Whatever can be
experienced with the physical senses or perceived by the mind cannot
be spiritual. For the spiritual to be discrete from the body and the
mind, it must be beyond the reach of either. One cannot reach the
spiritual by seeing, smelling or hearing or by superior thinking.
Indeed, if that were true, there would be no need for the trio. The
popular press is infatuated with the mind-body connection! Has it lost
sight, then, of the third element? In What Do Lions Know About Stress the author suggested some simple ways to escape the tyranny of the thinking mindCthe relentless clutter of the cortical monkey. What that monkey cannot cope with is the silent energy of the spiritual. Specifically, I make two suggestions that I have found to be clinically useful: meditation with the silence of a candle flame in winter and with the silence of a stone during summer. For further details about these two methods, I refer the reader to the chapter, Is There Another Door? in the above-cited volume. In essence, with these simple approaches to meditative silence, one lets either the flame of a candle or the mellow color of a stone to lead him to perceive one's essential link with the larger presence. These simple approaches are usually far more rewarding and revealing than an elaborate ritual. The Holy Quran puts it thusly: Paradise is nearer to you than the thongs of your sandal. I have seen few exceptions to the clinical value of silence: for example, the early phases of severe anxiety states, frequent panic attacks and depression. Metabolic roller coasters in anxiety and panic disorders may make silence unbearable during meditation. In that case the practice of saying the rosary and mantras, chanting or listening to spiritual music often helps to reduce the inner turmoil that can make silence suffocating. Depression is a serious disorder of neuronal and neurotransmitter function, which is frequently made worse by metabolic roller coasters. In many cases meditative silence initially exaggerates these malfunctions. Here again, healing sounds can be of great value during the initial stages. After they are stabilized, I strongly urge my patients with anxiety-panic disorders and depression to learn the profoundly healing practice of silence. Indeed, in my clinical experience positive long-term results for such disorders cannot be obtained without persistent and prolonged spiritual work. One can know only as much divinity as exists within oneself, I wrote in What Do Lions Know About Stress this seems a befitting note to end the above brief remarks on the place of the spiritual in healing. Peer Review As I end this article, I am reminded of the words of the English philosopher and journalist, Walter Bagshot: "The House of Peers has never been a House where the most important peers were most important." Where would Galileo, Copernicus, and Pasteur be if their work depended on peer review? References 1. Ali M. A Changing Medicine
for a Changing Time. In RDA: Rats, Drugs and Assumptions, 1996 Life
Span Press, Denville, New Jersey. Comments?: E-mail
to Dr. Ali Copyright İMajid Ali İAging Healthfully, Inc. |