Yoga is considered a mind-body type of complementary and alternative medicine practice. Yoga brings together physical and mental disciplines to achieve peacefulness of body and mind, helping you relax and manage stress and anxiety. Traditional yoga philosophy requires that students adhere to this mission through behavior, diet and meditation. But if you’re just looking for better stress management — whether because of life’s daily hassles or a health problem you’re facing — and not an entire lifestyle change or way of life, yoga can still help.

Don’t know how to do yoga, or don’t have time? The Mayo Clinic also has a nice video to guide you through the basic poses.

Tai chi is another eastern art that emphasizes movements and balance. It can be quite graceful, and it is lovely here in Beijing to watch the hundreds of elderly Beijingers performing their morning tai chi routines in the parks. Who can benefit from tai chi? Here’s what they say in their review:

The intensity of tai chi varies depending on the form or style practiced. Some forms of tai chi are more fast-paced and exerting than are others, for instance. However, most forms are gentle and suitable for everyone. So you can practice tai chi regardless of your age or physical ability — tai chi emphasizes technique over strength. In fact, because tai chi is low impact, it may be especially suitable if you’re an older adult who otherwise may not exercise.

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(This is part 3 of new contributor Dr Alan Mease‘s series on Integrative Holistic Medicine. Part 1 and part 2 are here)

Integrative holistic medicine is the emerging medicine of the future. Its values are significantly different and are best described by The Declaration for a New Medicine from the Bravewell Collaborative.

Declaration for A NEW MEDICINE

• We value the treatment of the individual in a holistic manner and the fulfillment of the needs of mind, body and spirit.
• We recognize the sacred and healing nature of the relationships between patients and healthcare providers and acknowledge that humanism, compassion and caring are central to health and healing.
• We believe that the empowered patient is the responsible central actor in healing, self-care and prevention and that a person’s emotions, trauma and stress levels directly affect the risk and course of disease.
• We will work for a healthcare system that creates an environment which supports healing relationships and recognizes that in order to be healing and empowering, healers themselves must be restored and whole.
• We will support truly integrative medicine that offers the highest standards of excellence in a full and complete array of care modalities.
• We embrace the spiritual dimension of life and acknowledge the importance of context and intention in the healing process for patients, caregivers and healers.
• We acknowledge that the risks of many serious illnesses, such as cancer, cardiovascular disease and diabetes, can be reduced with scientifically based nutrition, exercise and mind-body interventions.
• We believe in giving voice to the patient, in the openness of healers, and in honest and supportive communications among all members of the healthcare community.
• We will support the efforts of healers to develop integrity and spiritual qualities, which are as important as medical knowledge and technical skills to the process of healing.
• We dedicate ourselves to the change necessary to bring about the new medicine in an optimal healing environment.

Health care is in a time of crisis- a crisis of care, confidence and cost.  The NEW MEDICINE is emerging based on these values.  This has not been without obstacles.   The primary obstacle to this emergence has been a lack of a comprehensive conceptual framework.  The modern-day philosopher Ken Wilber’s four-quadrant model now provides a powerful tool for conceptualizing health and illness, investigating the efficacy of different treatment modalities, informing research methodology and medical education.  It offers a way to clarify the otherwise vague concepts of “integrative” and  ”holistic”.  This model will be reviewed in Part 4.

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Those of you with high cholesterol will be happy to learn that there are some legitimate options to your statin pills. Many people cannot tolerate the extremely popular statin pills, especially from side effects of muscle aches. But there’s now some very strong evidence that herbal medicines, including red yeast rice, can be at least as effective as a statin, and without the side effects. Too good to be true? Maybe not…

Red yeast rice is a bright reddish purple fermented rice, which acquires its colour from being cultivated with the mold Monascus purpureus. Red yeast rice is known as Zhi Tai when in powdered form but is called Xue Zhi Kang in alcohol extract form. This has been used in China for many centuries for many reasons, but researchers have been very interested in its effectiveness in lowering cholesterol and preventing heart disease (similar benefits from statins). It seems that the main active ingredient is indeed the natural form of a common statin, lovastatin — but researchers feel that other ingredients inside may add more protective effects. There is an official patented Chinese TCM formulation, called Xue Zhi Kang (xue2 zhi1 kang2 jiao nang 血脂康 胶囊), which has the equivalent of 10mg of lovastatin. The ScienceDaily website has a nice 2008 review of a well-designed study, printed in American Journal of Cardiology, which followed 5,000 persons after their first heart attack, and divided them into two groups taking either xuezhikang or placebo. After 5 years:

Frequencies of the primary end point were 10.4% in the placebo group and 5.7% in the XZK-treated group, with absolute and relative decreases of 4.7% and 45%, respectively. Treatment with XZK also significantly decreased CV and total mortality by 30% and 33%, the need for coronary revascularization by 1/3, and lowered total and low-density lipoprotein cholesterol and triglycerides, but raised high-density lipoprotein cholesterol levels. In conclusion, long-term therapy with XZK significantly decreased the recurrence of coronary events and the occurrence of new CV events and deaths, improved lipoprotein regulation, and was safe and well tolerated.

This is impressive data, and the study design is very well done, which means the evidence is quite strong. One co-author, Dr Capuzzi, has a nice summary:

“It’s very exciting because this is a natural product and had very few adverse side effects including no abnormal blood changes,” said Capuzzi. “People in the Far East have been taking Chinese red yeast rice as food for thousands of years, but no one has ever studied it clinically in a double-blind manner with a purified product against a placebo group until now and we are pleased with the results. However, people in the United States should know that the commercially available over-the-counter supplement found in your average health food store is not what was studied here. Those over-the-counter supplements are not regulated, so exact amounts of active ingredient are unknown and their efficacy has not been studied yet.”

In another randomized trial study, printed last year in the Annals of Internal Medicine, patients who had previously failed treatment of statins due to side effects were given 1800mg of red yeast rice twice a day versus placebo. The red yeast rice group had a significant improvement in cholesterol numbers — with no major reports of severe muscle aches they previously had on the statins.

There are other studies that also show similar benefits. In fact, the evidence is so strong that it is classified as Grade A evidence: “Strong scientific evidence for use”. This is the highest grade that any therapy can get. There are a number of good reviews of red yeast rice in Western literature, including from Medscape; the Mayo Clinic; WebMD; MedlinePlus; and NCCAM. There’s also more informal information from the TCM blog Qi Spot. You can find more scholarly information in the 2008 review from Chinese Medical Journal.

The Bottom Line

I’m impressed enough by all this to start stocking it in my clinic’s pharmacy, and I will start to discuss this option with patients as well. The evidence for this herbal medicine is unusually strong, and this could become one of China’s more popular medicines around the world, as it seems to have similar cholesterol reducing properties as the statins — without those liver and muscle side effects. Please note that people already on statins and very happy with them should not add this medicine, as the active ingredient is about the same. But for those who couldn’t tolerate the statin side effects, or even those newly diagnosed with just slightly elevated cholesterol who want to avoid “prescription” medicines, you may want to consider discussing red yeast rice with your doctor.

But it’s also important to buy the proper Chinese version of xuezhikang, since there are reports of pills being doctored with actual statin medicines. The photo above shows the official patented Chinese version. There seem to be other patents in other countries, including Lipascor. In America, the pills Cholestin are pure red yeast rice.

What Else Works For Cholesterol?

There’s a nice summary of herbal medicines, including red yeast rice, from Natural Medicines Database. There’s also pretty good evidence for the omega-3 in fish oil; at least 1 gram a day of the supplement may help, independently of statin’s benefits. And the mineral niacin can also be extremely effective for certain people, although the flushing side effects can be severe when using the immediate release tablet, and dosing is tricky.

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What makes man unique is his consciousness, which exists even in infants and can be simply understood as the realms of waking, dreaming and deep sleeping. Central to the unifying theory of integrative holistic medicine is the existence of an energy field associated with the body-mind. The existence of a body with each realm of consciousness is taught in most healing traditions. This is due to the increasing complexity of the physical body-mind.

The 3 bodies of increasing complexity are the physical body-mind, the subtle body-soul and the casual body-spirit associated with three realms of consciousness, waking, dreaming and deep sleeping. Each of these is associated with the increasing complexity of human consciousness. (see below)

Modern medical science studies the exterior of each of these. The body-mind was incrementally understood in term of structure, anatomy; function, physiology and biochemistry. Treatments of body-mind dysfunction/disease use either a surgical/anatomic approach or chemical/drug approach to restoring normal physiology/function. Physical energies including radiation, electromagnetic and light are used in modern medicine and can be easily measured.

Ancient healing traditions teach that there are increasingly subtle energies associated with the increasing complexity of the physical body-mind. These are called subtle energies associated with the body-mind, the body-soul and then the body-spirit. The latter are equivalent to soul and spirit respectively. Each of these is represented in the interior consciousness of the human condition. More precisely the greater the degree of exterior complexity of physical form the greater the degree of interior consciousness within. This allows preservation of the enduring truths of the traditions without the outmoded interpretative frameworks. It also provides a model for continued human development through adulthood.

These subtle energies have been long recognized in traditional Chinese medicine (TCM) as Qi. Manipulation of Qi is used in acupuncture, meditation and Qi Gong. Tai Chi or Taichiquan is a form of internal Qi Gong. Dana Farber Cancer Institute’s Zakim Center for Integrated Therapies in Boston, Massachusetts is running a trial on the efficacy of Qi Gong compared with aerobic exercise as an adjunct therapy for cancer patients. See also Dr. Saint Cyr’s article on Tai Chi and Arthritis.

Newer healing methods using subtle energy include applied kinesiology, thought field therapy, therapeutic touch, reiki, polarity therapy, homeopathy, and healing traditions of indigenous peoples. There is an increasing body of evidence today supporting the effectiveness of these methods in certain situations. Prayer and spiritual healing may also be the result of activating subtle energies. Subtle energy is beginning to be understood and measured by physics therefore gaining credibility as the unifying principal of integrative holistic medicine.

Next Week: Part 3 – Why does Integrative Holistic Medicine Work?

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The same good folks at Mayo Clinic also have a nice, free weekly e-newsletter called “Housecall”, which you can subscribe to on their first page.

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As a physician I have long recognized that caring for patients requires more than an understanding of the science of modern Western medicine. The human experience is so much more than physical. The success of medical science in treating diseases of the body and more recently the mind is remarkable but it is only a recent phenomenon less than 100 years old. It is increasingly recognized by both patients and doctors that there is something missing. This has led patients to seek alternative treatments and physicians to develop an approach called integrative holistic medicine. Integrative holistic medicine is the art and science of healing that addresses the whole person: body, mind, soul and spirit.

All good physicians realize that healing is more than treatment of the disease and requires an understanding of the whole person with the disease. A person is a very complex conscious being consisting of body, mind, soul and spirit. Today we have access to both modern science and the wisdom of all ancient healing traditions to help us understand the whole person. The terms soul and spirit are confusing because of religions connotations but these are important elements of the whole person. Correct understanding of these terms requires preservation of the enduring truths of the traditions without the outmoded interpretative frameworks. These truths then need to be integrated with new research showing that human bodies produce energy fields which are influenced by external energy fields.

Integrative holistic medicine has expanded its concept of healing to incorporate a human energy field which is the foundation of Eastern medical systems such as Traditional Chinese Medicine (TCM) including acupuncture. Physical energies including radiation, electromagnetic and light are used in modern medicine and can be easily measured. Ancient healing traditions teach that there are increasingly subtle energies associated with the increasing complexity of the physical body-mind and consciousness. There is recent scientific evidence for the existence of these subtle and difficult to measure energies interacting with the human energy field. At the center of this is an integral physiology with the pineal gland converting energies into all the body’s systems. “The pineal gland is the cornerstone of the biochemical interface with our environment and the subtle energy that both supports and transcends our sense perceptions and sustains our body…”1 The enormous contributions of Western medicine with the profound insights of the Eastern systems of human energy and health are united by the new science and by the recent philosophical work of integral thinkers like Wilber2. If Western medicine accepts the new research documenting a truly cohesive physiologic system it must incorporate a unifying theory that accounts for the existence of energy fields within as well as outside the human body. Out of this comes a new form of medicine which is truly holistic and integrative.

- Dr Alan Mease

Sources:
The Scientific Basis of Integrative Medicine, Leonard Wisneski and Lucy Anderson, CRC Press, Boca Raton, Florida, 2000
The Integral Vision: A Very Short Introduction to the Revolutionary Integral Approach to Life, God, the Universe and Everything, Ken Wilber, Shambala, 2007

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We Speak Different Languages, on Many Levels

One fundamental issue is that even the question, “which TCM works for the common cold?” isn’t a properly formed question in many Chinese eyes. That’s because the disease definitions themselves are different. For example, the common cold in Western eyes is the same description no matter what time of year you get it. But in traditional Chinese doctor’s eyes, there are many types of “ganmao” or flu depending not only on weather but other physical symptoms they see on exam; it may be wind-cold, or wind-heat, or a deficiency, among others.

So, when I talk to my clinic pharmacist or  TCM doctor about which medicine is best, they would say similar things like “this is better for winter cold” or “no, this helps expel heat, but not sore throat”. And the actual indications on the box say the same thing; nothing would just say “for common cold”. And many TCM doctors would also stress that the pre-packaged formulas are usually not as effective as the pharmacy-made medicines, as each illness each time may be different, so the herbal brews may need to change. That may be true, but again, from my perspective of providing evidence-based care to my patients, I need concrete indications of illness and similarly stable choices of medicines, more in line with Western medicines. Perhaps this wide perception gap will never be closed, but I will continue to believe that certain TCM herbal compounds will show consistent results over placebo and would pass the same stringent randomized controlled trials that every medicine in the West must pass.

Back to the Common Cold: What TCM Works?

As I’ve said, I’ve had difficulty finding good research (translated into English) regarding TCM and the common cold or flu. There are a lot of internet sources discussing treatments, but I’ve yet to find any that are quoting any randomized clinical trials that prove effectiveness over placebo. One website of note is the Cochrane Database, whose main purpose is to perform strong reviews of many common questions, including which Chinese medicines or acupuncture work. This year they put out a review of chinese medicines for the flu. Unfortunately, their plain-language summary states:

…This review assessed the prophylactic and therapeutic effects as well as safety of Chinesemedicinal herbs as an alternative and adjunctive to other commonly used drugs for uncomplicated influenza. Two studies involving 1012 participants were included in the review. The trial quality and evidence were poor and do not support or reject the use of any Chinese herbal preparations for influenza. Well-designed trials are required.

There are a couple other excellent websites (from Natural Medicines Database and Medscape) which mention specific “alternative” ingredients which are common to many Chinese medicines that may indeed help the common cold and flu. But again, it’s difficult to make that next leap and decide which packaged TCM medicine has those ingredients.

Where To Find Evidence-Based TCM?

Many Western doctors are very interested in Chinese medicine and, like me, would love to see the same level of clinical research as we are used to with our standard Western medicines. I assume there is a lot of research done only in Chinese, and the main problem for me is access. Many Western research groups are indeed trying to study Chinese medicines with a more Western definition of diagnoses, but the research will take many years. In the meantime, I’ve found a few websites which provide objective, evidence-based analysis:

• Cochrane Database – Complementary Medicine Reviews – a bit hard to slog through, but they provide some of the best meta-analysis so far of TCM and acupuncture
• Evidence-Based Journal of Complementary & Alternative Medicine – an outstanding, free-text journal that is publishing exactly the type of high-quality papers that TCM needs to expand its use worldwide.
• National Center for Complementary and Alternative Medicine - from the US National Institute of Health, again offering good evidence-based reviews, including herbs at a glance
• Chinese Medicine News – a nice blog/website with a good collection of stories, including a nice post on an herb to help fight the flu.

Stay Tuned…

I would love this post to be the beginning of a good discussion here, and I encourage anyone out there to please send me the best studies that prove TCM’s effectiveness for the common cold and flu. Hopefully, in a few weeks I can truly be comfortable offering more treatment alternatives for my patients.

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The Data, Please

One of my favorite websites to review natural medicines is the U.S. National Institute of Health’s National Center for Complementary and Alternative Medicine. They have excellent, readable reviews of many herbs and therapies, as well as good referencing of relevant studies. They have one page dedicated to bladder infections and commonly used cranberry, as well as saw palmetto’s effectiveness in the male-centered problem of enlarged prostate.

The best studies to date show that regular intake of cranberry juice does have some effect on decreasing the recurrence of bladder infections in women that get them often, but a 2009 review by the Cochrane group found no great evidence that it helps decrease an acute infection. It’s possible that it does; it just didn’t find enough high-quality studies to prove either side.

As for saw palmetto helping men with prostate symptoms, Cochrane and other reviews do show some improvement in men’s symptoms, and the medicine is considered safe as well. But the overall endorsement still recommends further studies.

Bottom Line?

I think cranberry juice does little harm, and women who suffer from frequent bladder infections may benefit from a daily intake of cranberry after discussing with their doctor. As for men, I think there’s enough data to support saw palmetto as a safe alternative for those with minor symptoms, again as long as they’ve discussed it with their doctor and ruled out more serious causes of their symptoms.

Other Websites?

There is a lot of misinformation out there regarding alternative medicines, and it’s crucial to stick to the most honest sources. Besides the links above, another of my favorite websites for evidence-based natural medicine is the Natural Medicines Database. They have one page dedicated to bladder infections and another for prostate problems.

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As we all know, there’s precious little that Western allopathic medicine can do to prevent, or even treat, the common cold. That’s why complementary and alternative therapies are very popular, but it’s very difficult to sift through the internet and find evidence-based data. I’ve mentioned a few great sources of information before, especially the webpage from Natural Medicines Database. Now, there’s a new review of the best data from the well-regarded Medscape. The article is called Complementary and Alternative Medicine Therapies for Cold and Flu Season: What Is the Science?. I’ll let the two articles speak for themselves. People should also be aware of a good U.S. government website, the NIH’s National Center for Complementary and Alternative Medicine specifically set up to research all types of such medicine.

Personally, I am a big fan of jumping on natural medicines as soon as I feel any symptoms coming on. That would usually include Airborne tables, but I recently discovered and switched to ColdWar tablets that I found in America. Overall, my main focus involves vitamin C, zinc, elderberry, andrographis — and of course, black chicken soup with fresh ginger and garlic! What do you use?

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