Traditional Medicine: Alive and Well

It’s impossible to discuss global health options for patients comprehensively without acknowledging traditional medicine and the important role it plays in the delivery of primary and family healthcare. The World Health Organization estimates that in some Asian and African countries, 80% of the population depends on traditional therapies for primary care (and in many cases all healthcare) needs.¹ While slivers of alternative medicine have emerged in the US, traditional medicine is very real and influences how many patients perceive and consume Western medicine. Having basic knowledge (and some first-hand experience) with varied approaches to traditional medicine has significantly helped in the process of understanding the full spectrum of healthcare in a number of countries. It has also been critical for communication with physicians in interviews to understand its role alongside Western delivery (and the challenges of delivering care) – as some physicians hesitate at first and look for recognition, “does she get it?”

Often referred to in the US as complementary and alternative medicine (CAM), the World Health Organization defines traditional medicine as follows:

"The health practices, approaches, knowledge and beliefs incorporating plant, animal and mineral-based medicines, spiritual therapies, manual techniques and exercises, applied singularly or in combination to treat, diagnose and prevent illnesses or maintain well-being."

While my knowledge about traditional medicine is by no means comprehensive, I was fortunate to research business opportunities in traditional medicine during my time at Deloitte. Within the first few hours of research, I was wholeheartedly intrigued. This is actually a very large industry: herbals are the dominant financial driver for traditional medicine brining in over US$14 billion in China alone (and an estimated US$5 billion in Western Europe). As the global mixing pot of the world, the US market for traditional medicine has been built over the years by those who have brought therapies with them from other countries. Their trusted remedies and brands are often available in bigger cities (although you would usually have to seek them out) and I think have the potential to grow dramatically in the general US market. Whole Foods is a good indication of this trend in recent years. Many of their health products might be considered traditional medicine, but packaged and marketed for quality – these are now “premium” items consumed by many households all over the states.

In addition, many Western companies have had to adapt their products to cater to traditional medical approaches or beliefs. For example, in India turmeric is often used ground and used as an ointment to stop bleeding for cuts and wounds. When Johnson & Johnson entered the Indian market with Band-Aids, their entry strategy was a failure at first because it was in direct competition with this free (and seemingly effective) solution. It wasn’t until they created a new product specific to the market, a turmeric-coated Band-Aid, that the product started selling as a trusted and effective remedy. Very interesting!

While there are many nuances among countries and regions on the method of traditional healthcare delivery, there are a few themes that I’ve seen cut across most of them.

1) Nature-based ingredients: herbals are the foundation of much of traditional medicine. Because all “medicines” are from natural plants, herbs, and occasionally animals – there is the belief that there are NO side effects. This has an impact on how they are consumed and perceived compared to Western medicine, which may be seen as “imperfect” or risky due to the apparent side effects.

2) Focus on self-strengthening: The healing approach for traditional medicine is, in some ways, the opposite of Western medicine: rather than kill the toxin, the goal is to strengthen the body’s natural resistance “from within”. Remedies are administered to enhance or stimulate disease-fighting agents from within through changes in diet, herbals, blood flow (e.g. yoga), often with a focus on specific organs or bodily functions. This is an important point because strong believers in traditional medicine see antibiotics’ removal of good AND bad bacteria as depleting the body of its natural defenses (and therefore harmful – this is why you are more prone to getting other illnesses while on strong antibiotics).

3) Holistic health solutions. Rather than focusing on treatment-only methods, traditional medicine usually involves changes in diet and exercise routines (also including meditation, sleeping requirements, tea “prescriptions,” and mental health recommendations) in addition to a prescribed medicinal regimen (in this case herbals). This is extremely interesting from a chronic disease standpoint where lifestyle changes (eating and exercising patterns) are central to care. It also acknowledges that health solutions treat the person, not the disease, acknowledging that activity throughout the day (especially what we consume) affects the body’s processes: stress levels, working energy, physiological chemistry, mental health, and on and on.

4) Age-old techniques. In every country and region, the methods developed have been tested and adjusted since the birth of the culture itself. This has a significant impact on the perception of the patients. I interviewed a number of patients in India and China with Deloitte and this point is what leads people to firmly believe that traditional health techniques really work. I had one interviewee that went as far as to say that Western medicine (since it hasn’t been tested as long) is merely a fleeting fad, developed by corporations to make money. While this may be extreme (I do believe that despite being for-profit organizations, healthcare companies truly want to help people), it was a radically fascinating point of view. Really? A fad? But, when looking at the side effects and antibacterial resistance stemming from many Western therapies, perhaps I too would believe the same if I’d grown up with a foundation in Eastern medicine.

There are countless variations of traditional medicine; however, I’d like to provide some general background on a few of the most prevalent below. This space is extremely interesting. The more I learn about alternative medical approaches, the more I want to learn. How did these techniques develop? How are they used today? Do they work – or is it placebo? What role does willpower / the mind play in healing? There are many questions I can’t answer, but like music or architecture, these are cultural developments that have shaped their societies’ perceptions, actions, and values over the years.

Traditional Chinese Medicine (China):

Traditional Chinese Medicine or TCM by far is the best known among traditional medical techniques globally. TCM practices include such treatments as Chinese herbal medicine, acupuncture, dietary therapy, and both Tui na / Shiatsu massage (stress is predicted to cause 75% of all illnesses). What I didn’t know until recently is that modern TCM was systemized nationally in the 1950’s, pulling together what was until that point known as family medicine. Based on age old Taoist, Confucius and Buddhist principles, TCM approaches vary but aim to emphasize the individual’s intimate relationship with the environment on all levels.

Traditional Chinese medicine is largely based on the philosophical concept that the human body is a small universe with a set of complete and sophisticated interconnected systems, and that those systems usually work in balance to maintain the healthy function of the human body. The balance of yin and yang is considered with respect to qi ("breath", "life force", or "spiritual energy"), blood, jing (other bodily fluids), the Wu Xing (emotions), and the soul or spirit (shen). TCM has a unique model of the body, notably concerned with the meridian system. Unlike the Western anatomical model which divides the physical body into parts, the Chinese model is more concerned with function. Thus, the TCM spleen is not a piece of flesh, but an aspect of function related to transformation and transportation within the body… correlating to the mental functions of thinking and studying, for example.

Diagnosis with TCM usually involves patient observation. Some may also refer to the need to “have their pulse read” - I have heard that some TCM doctors can identify several diseases and even determine if a woman is pregnant by the pulse (rhythm, intensity, frequency). Herbal medicines are core to the treatment regimen for TCM, often in the form of herbs that are boiled for lengthy periods of time into a tea-like mixture. Acupuncture, meditation, cupping, breathing exercises, and massage are all other methods of treatment to restore balance in the body. I have been an advocate for TCM massages in the US focused on “acupressure” techniques, targeting specific pressure points along the spine and meridian system (they are also very inexpensive compared to spa-like massages). The goal is to stimulate the flow of the "chi,” or essential life-force that flows through the body to problem areas for healing.

TCM is the most widespread traditional medicine present in the world. For instance, in the Middle East, the majority of alternative therapies available are derived from Asian. In addition to herbals, TCM also incorporates a number of animal products that are believed to have healing effects on the body (e.g. bear bile, rhinoceros horn, and shark fin). However the therapeutic approach is holistic with food and exercise lifestyle interventions, similar to Ayurveda.

Ayurveda (India):

Balance is at the heart of Ayurvedic approaches to traditional medicine. As the basis for traditional medicine in India, ayurveda literally translates from Sanskrit as “science of life.” The technique is said to be grounded on the metaphysics of the five “great” elements that comprise the universe: earth, water, fire, air, and ether (no, not “heart” for you Captain Planet lovers). It is believed that each of us is composed of different ratios of the elements – when they are in balanced state, the body is healthy, and when imbalanced, the body has diseases.

What is fascinating to me is that ayurvedic techniques actually classify mental and physical personality types that are used as diagnostic/treatment “lenses” for ayurvedic doctors. The three areas or “doshas” are based on our dominant elements: vata (air & space), pitta (fire & water), and kapha (water & earth).² Identifying your dosha requires answering about 100 questions about bodily function and environmental preferences (e.g. Do you prefer hot or cold? What time of day do you have energy? How do you respond to stress?). There are many online “dosha” tests that will do this for you now (you can try one at What’s Your Dosha.com!).

According to the ancient practice, every individual has a mind, body, and spirit which must be cultivated respectively with mediation, ayurveda, and yoga. Ayurveda believes that building a healthy metabolic system, good digestion, and proper excretion leads to vitality in life. It’s focus on exercise, yoga, meditation, and massage reinforces the belief that the body, mind, and spirit/consciousness need to be addressed both individually and in unison for proper health management.

One of my favorite Ayurvedic techniques is known popularly in the Western world as the “neti” pot. Although I have never met a person in India who uses the neti pot, it is a great example of a traditional technique (in my opinion) with a high value proposition. It is simplistically a teapot that flushes out your sinuses with a saline solution – it sounds gross but it does work. One of the reasons I like it (as a chemical engineer) is that It uses both physical and chemical agents to address the health problem (vs. oral medication which is purely chemical). Additionally, the treatment if localized which increases efficiency and control in treatment. They do sell them at Whole Foods so you, too, can bring ancient Ayurveda therapies into your home!

Traditional African Medicine (Africa):

Traditional African medicine has a more “spiritual” approach to therapy than TCM or Ayurveda. It is considered a holistic discipline involving indigenous herbals and African spirituality, typically involving diviners, midwives, and herbalists. Practitioners of traditional African medicine claim to cure various and diverse conditions such as cancers, psychiatric disorders, high blood pressure, cholera, most venereal diseases, epilepsy, asthma, eczema, fever, anxiety, depression, benign prostatic hyperplasia, urinary tract infections, gout, and healing of wounds and burns.³

Diagnosis is reached through spiritual means and a treatment is prescribed, usually consisting of an herbal remedy that has not only healing abilities, but symbolic and spiritual significance. Traditional African medicine believes that illness is not derived from chance occurrences, but through spiritual or social imbalance. In the past, modern pharmaceuticals and medical procedures remain inaccessible to large numbers of African people due to their high cost and availability in urban areas. In recent years, this has improved substantially but African traditional techniques remain a strong part of the health culture.

Traditional practitioners use a wide variety of treatments ranging from "magic" to biomedical methods such as fasting and dieting, herbal therapies, bathing, massage, and surgical procedures. Migraines, coughs, abscesses, and pleurisy are often cured using the method of "bleed-cupping" and hot rubs are used after which an herbal ointment is applied with follow-up herbal drugs. Steam baths and induced-vomiting are used to cure some diseases, for example, raw beef is soaked in a steam drink of an alcoholic person to induce vomiting and nausea and cure alcoholism.⁴

I personally have very limited exposure and experience related to African traditional techniques, but look forward to learning more in a few months during my research with Project HOPE in Kenya and South Africa.

Homeopathy (Germany):

Homeopathy is a very interesting form of alternative medicine as it originated in the Western world. It was based on medieval principles developed in the 16^th century, but then fully developed by a German physician, Hahnemann, in the 18^th century. At that time, mainstream medicine employed such measures as bloodletting / purging and used laxatives and enemas which often worsened symptoms and sometimes proved fatal. Hahnemann rejected this approach as irrational and built a therapeutic discipline based on the concept that small doses of “what makes a man ill also cures him.” What is fascinating to me is this is the same principle used for developing vaccines. He favored the use of single drugs at lower doses and promoted an immaterial view of how living organisms function, believing that diseases have spiritual, as well as physical causes (similar to African medicine). Interestingly, Hahnemann also advocated various lifestyle improvements to his patients, including exercise, diet, and cleanliness.

According to homeopathy, illnesses are the result of disturbances in the life-force (similar to TCM), and believes the body has the ability to react and adapt to internal and external causes (referred to as the law of susceptibility). Again you see the strengthening from within as a pillar of this traditional approach. Any disturbance in the body, or miasm, is treated with natural remedies.

Today homeopathic medicine can be found in generally two forms: as either liquid solutions with (with an eye dropper) or very small pill-sized tablets that are melted in the mouth under the tongue. I have a number of friends and colleagues who are strong believers or use this as their “first-line” defense for treating illnesses like a cold or flu. There is a good chance you may have had your own experiences with homeopathy. Since its origins are scientific and less “mystical,” it is often easily blended with Western medicine in primary or preventive care.

Thoughts on Traditional Medicine:

As the US moves towards more preventive and holistic models for patient care, I’m curious to see if East-meets-West approaches become more of a reality over time. There are several leaders who have been working on this both in the US and Western world. In fact, my first encounter with homeopathic approaches was with a close friend’s mom, who practices both Western and homeopathic medicine. I visited her for my typical sinus infection in high school (product of lack of sleep and strenuous study / extracurricular schedule), and she prescribed an herbal medication for me. At first I was a little miffed. I paid to see a doctor and didn’t get a prescription – what? But, what I realized later is that I’d already started becoming fairly resistant to amoxicillin; at that point, I had no resistance whatsoever to the bacteria in my body. After some careful research (and developing a paper in college on antibacterial resistance), I stopped taking antibiotics unless I was desperately ill. The first year I had about 4-5 infections; the second 2; the remainder hardly any. Not to say that everyone should stop taking antibiotics as they’ve done wonders over the years, but there is something to be said about how and when they should be used – and what effect overconsumption can have on the body (and collective public / environmental health).

It’s also important to mention that few scientific studies or clinical trials have been conducted to thoroughly test many alternative therapies. Much of this has to do with the fact that they don’t need to be conducted for the remedies to be sold (and they would serve little purpose in regions where many are already 100% convinced they are effective). For Western countries to accept any herbal or alternative therapy, clinical testing is an imperative to drive adoption. Some “lifestyle” changes have already been acknowledged in studies like the DPP trials for diabetes (largest clinical trials conducted for diabetes), which has shown lifestyle changes to be almost twice as effective as any pharmaceutical remedy for Type 2 patients. Similar trials also exist for CVD and COPD which show that exercise and diet can reduce the risk factors and diseases that limit the quality and longevity of patients’ lives.

It’s unquestionable that traditional medicine plays an important role, to varied degrees, all over the world. Understanding its origins, uses, and impacts on perceptions and delivery of health is an imperative for gaining a full perspective on care for chronic diseases around the world. I’ve asked a number of times - could training traditional healers to advocate lifestyle changes for obesity, CVD, or diabetes could be an effective method to reach patients that are out of touch from the “mainstream” healthcare systems? So far, the responses haven’t been overly enthusiastic, but it’s another idea that could be explored potentially in rural areas. At least to some extent, I hope that my efforts to understand its role in each country have aided my ability to assess the current patient needs, program opportunities, and implementation challenges for Project HOPE.

Sources:

1. World Health Organization: Traditional Medicine Fact Sheet http://www.who.int/mediacentre/factsheets/fs134/en/

2. India Department of Ayurveda http://indianmedicine.nic.in/ayurveda.asp

3. Helwig, D. "Traditional African medicine", 2010.

4. Onwuanibe, pp. 25-27