The Basic Concepts of Alternative Medicine and their Impact on our Views of Health
 
Dr. Stephen Fulder
 

Conventional medicine can be said to have been the dominant medical system in the post-industrial world for not much more than 150 years. Prior to that, although differential diagnosis was the main diagnostic method used, physicians had to compete with traditional practitioners and bonesetters, and apothecaries with Galenicists. Traditional and ancient medical concepts such as the four humours, the elements, the vix medicatrix naturae, and crasis/dyscrasis (i.e. that health is based on inner and outer balance) only went out of fashion during the early part of the last century.(1) In its short history, modern medicine has proved to be so apparently effective, and so well adapted to the industrial world view that it gave the impression that indigenous, ancient or traditional medicine had no validity, and was well-nigh extinct. In fact, this was not so. It clearly existed in the East and the Third World, and in hiding in western culture, where it took a defensive cultic posture in the face of modern medicine's self-confidence.

 

 However  in the last 20 years there has been a radical renewal of interest  in,  and use  of,  traditional  or alternative medicine. So much so, that we  are  re-entering  a period  in which scientific medicine and its  services share and compete  for  customers with  alternative medicine, within a pluralistic national medicine.(2) Indeed the  British Medical Association's new report acknowledges that alternative medical systems are full systems,  that they are here to stay, that doctors must learn about them even at  undergraduate  level, and if a doctor wishes to study them, he or she must undertake  a  full course  of  instruction.(3)  Alternative medicine is becoming available  on  the  National Health Service throughout the UK.(4) The scale of the current use of alternative  medicine is  not  always appreciated. Surveys have shown that in Europe roughly a  third  of  the population have used alternative medicine.(5) and roughly the same proportion in the USA.(6) Polls  of  doctors   have shown that 3/4 of British General  Practitioner  trainees  and nearly  half of those in practice  want to learn one or more alternative  medical  techniques,(7) that virtually all doctors in primary care want alternative medicine to  become fully  part  of national medicine.(8) In addition, where doctors work  with  complementary practitioners,  complementary  medicine is highly popular.(9) Demand  outstrips  supply. (10) These developments may have profound implications on the concepts of health, which  will  be  examined below. The implications arise from a growing familiarity within society  of alternative explanatory systems concerning health and disease.

 

 Common  Features  of Nonconventional Medicine.

 

Nonconventional medicine is an aggregate term for a variety of ancient or traditional  medical systems in their modern forms. They include the specialities in Fig.1  which are grouped according to broad similarity.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Fig. 1. Therapeutic Modalities of Complementary Medicine

 

Some of the above modalities are complete medical systems with their own  diagnostic and  therapeutic methods based on a unique, global and self-consistent theory of health and disease (e.g. acupuncture, herbalism, homeopathy and naturopathy). Others, (such  as the  physical  and manual therapies) are subsidiary techniques. Practitioners  of  these subsidiary methods do not consider themselves to be first-call primary care  practitioners. Compatibility of alternative theories with conventional medical theory also varies.The physical therapies such as chiropractic, medical herbalism and to some extent  naturopathy  utilise  essentially conventional diagnosis together with concepts  of  disease which  are  different  from, but understandable by, conventional  science.  For  example chiropractic  is based on conventional anatomy and physiology, but extends knoledge  of  the  pathogenesis  and treatment of musculoskeletal problems (such  as  "adhesions"  and "subluxations")  into  subtle areas that are regarded as invisible and unproven by  conventional  medicine.  Herbal medicine recognises and uses conventional  descriptions  of  disease  such  as eczema. However it chooses medicines that affect the  supposed  deeper imbalances (e.g. that allergies originate in part  from inadequacies in the liver house keeping  functions)  as well as treatments that attempt to restore proper  local  tissue function.  On the other hand homeopathy, naturopathy and Oriental medicine employ   different  concepts  of  disease, based on an alternative world-view which  is  not  easily translatable or compatible with scientific medicine. It has been difficult or impossible  to  map  these systems onto conventional medicine or vice versa. Even  in  China,  where strenuous  efforts  have been made, there is still no agreement on  whether  acupuncture meridians or Oriental viscera such as "kidney" correspond to any known anatomical structures.(11)

 

Characteristics  of  Alternative Medicine Relevant to  Descriptions of  Health

 

There  are certain basic features of the practice of alternative medicine  that  involve a view of health radically different from that implicit within modern medicine and modern  life.  I  would like to review some of these features here and then discuss their  implications for our perspectives on health.(12). Not all therapists will employ these concepts. However they represent the foundation of authentic alternative medicine, are laid out in  the texts  and taught in the colleges, even if the therapy has compromised towards the  biomedical model during the current struggles between various competing systems. For  example many acupuncturists  find themselves called upon to focus on symptoms more  directly at  the expense of the slower restoration of energetic balance, because of the  expectations of patients who are conditioned by modern medicine to expect a fast restoration of comfort.

1. Self-Healing is Paramount.   The in-built natural healing process is respected and recruited  during  treatment, although it is not necessarily understood.  Resistance  is improved  by  preventive measures. Particularly in Oriental and  Ayurvedic  medicine,  a considerable  proportion of traditional practice is devoted to the restoration of  vital force  and  self-healing energy. For example in Western herbal medicine  there  is  very frequent use of a category of herbs called 'alteratives' or 'blood purifiers'. These are herbs  such  as  echinacea (Echinacea purpurea),  cleavers  (Gallium  aparine),  burdock (Arctium lappa), sage (Salvia spp) and myrrh (Commiphora mol-mol). They are used  during the treatment of most acute and chronic infections and inflammations, along with fasting or special diets and nutrients, and other herbs to promote circulation of lymph and body fluids, all of which is intended to awaken a more powerful immune response and encourage long term immune function. Other natural remedies such as garlic or thyme may be used as natural  antimicrobials, but they are not the primary tools. This is also a  fundamental position of naturopathy and homeopathy.

2. Working With, not Against, Symptoms.    Symptoms are a guide in the journey to  a cure. They are managed, not suppressed. For example the daily ebb and flow of a  symptom  such  as headache may be used by an acupuncturist or homeopath as a guide to the  course of treatment of deeper problems with organ function. For example  a migraine-type  headache  could  be  seen by an acupuncturist as arising from  overactive  liver  metabolism (liver 'fire' or 'yang'). Real treatment involves an adjustment to the propensity of the liver  to create inflammation, not merely relief of symptoms by analgesia. The type  and location of the headaches (frequency, severity, vertigo, sharpness, one-sidedness, etc.) is constantly monitored throughout the treatment as a guide to the effectiveness of  the draining of the liver's excess. Accompanying symptoms, such as nausea, may be an indication of the energetic state of other organ systems such as the spleen.

3. Individuality   Each person's condition is different, has arisen from  different reasons,  against a different constitutional background, and requires a  different  path for  treatment. Decisions are personal and individualistic, not statistical. One of  the indications of the richness of the medical system is the development of a typology  with which  individual differences in health, disease and response to the environment can  be understood.  For example the constitutional picture  in Ayurvedic medicine is  a  highly detailed art, which integrates thousands of characteristics of body, skin,  personality, habits,  etc. are defined in terms of  Vata ('airiness'), Pitta ('fieriness') and  Kapha ('wateriness') integrated. This establishes an individual's susceptibilities,  strengths and weaknesses, and guides both prevention and treatment. Western (Thompsonian) herbalism  by contrast does not make extensive use of constitutional differences,  and  modern medicine ignores it completely unless there are inherited pathologies.

 4. Integration of Human Facets. Individuals are regarded 'holistically' in  diagnosis and treatment. There is less a priori division between Mind-Body-Spirit or  Environment-Society-Individual. 'Holism' is just one of the approaches that may or may not be incorporated  within a therapeutic modality. It is not a medical system in  itself,  although the  term 'holistic medicine' is sometimes loosely used. Alternative medicine is  essentially  more  holistic.  In homeopathy and Oriental medicine,  for  example,  emotional, psychological   and behavioural signs are always included in diagnosis. This  is  rather less  so  in naturopathy, herbalism and the manual therapies, but even  here  holism  is  often applied as an approach of an individual practitioner.  For example naturopaths may encourage relaxation and imagery along with diet and herbs to treat high blood pressure. Or  osteopaths and chiropractors occasionally  explore the  psychosocial  stresses  that may give rise to a repeated musculoskeletal problem in a certain patient.

5. No Fixed Beginning or Ending  There is no defined or determined state of  illness where  treatment must begin and wellness where treatment must end. Such points  are  defined  contextually. One patient may require assistance to reach a state  of  well-being and  accommodation to his cancer. Treatment will finish when this is achieved,  although in  conventional  terms  he is still seriously ill. Conversely, another  client  may  be treated  so as to improve his energetic balance and condition or vitality. He  may  seek treatment  with  Oriental  medicine to cope with an addiction,  an  energetic  dullness, convalescence  or even to  improve  Shen, i.e. to bring light to his eyes. Treatment  in this case, in conventional terms, is of a healthy person.

 6. Conformity to Universal Principles. Remedies are discovered and employed in  conformity  to  patterns of relationships (such as yin/yang) between all  living  creatures and their environment. These patterns are often subtle and involve energetic rather than material  phenomena.  For example Ch'i in Chinese medicine is a tangible  but  invisible vital  force which operates continually as the basis of all function. In Oriental  medicine it is sensed and utilised in much the same way that modern man would sense and also utilise gravity. Despite the fact that Ch'i is so universal, it is enormously elaborated as an explanatory principle to describe detailed changes in function, e.g.  constrained, stagnant,  wild, deficient, excess, etc. of liver, spleen, kidney, etc. This is in  contrast  to  conventional  medicine, which derives from reductionist  science.  Therefore processes in the body are examined as discrete entities, unconnected to basic forces and elemental  qualities. Consider again the use of Ch'i in the diagnosis of  'Excess  Liver 'Ch'i'  rising' for a migrainous headache, in contrast to the conventional medical  view of 'overstimulation of local vascular serotonin receptors at the pain site'.

 

A Meta Model for Complementary Medicine

 

It  is  possible to summarise many of the features of complementary  medicine  in  a descriptive,  qualitative  manner. The basic axioms or concepts have been  given above. When put together a working model would look something like this. The human being  moves through  his personal time and space, which is mapped out by  biological,  psychological and  biographical  events.  He is in constant dynamic relationship  with  his  internal, familial,  physical and social environment,  requiring constant adjustment  and  adaptation.  This is a learning process for both body and mind. Some health related  behaviour is always required so as to harmonise this relationship, and if the disharmony increases beyond  a subjectively determined limit, it becomes time  to seek  professional  assistance,  for  example,  if the seasons change and the person feels  chronic  pain  in  the joints.  Alternative medicine functions: a) To monitor the extent of the disturbance  or distortion in the psychobiological field. b) To understand the inner and outer constitutional  picture  of the person, and the special susceptibilities of the  person  to  his environment. c) To evoke appropriate self-healing capacities. d) To provide remedies for both  mind,   body  and even spirit so as to restore health in  an individualistic  and holistic  manner, and to combine this with appropriate instruction so as to reduce  susceptibility in the future.  e) To halt and reverse disease processes and repair  damage. If  the  distortion  is too great, the damage too severe, the disease  acute  or  highly infectious  or  life-threatening, the condition becomes more suitable for  the  stronger methods  of  conventional,  allopathic medicine. In such cases the  patient  is  usually referred  by the complementary practitioner or self-referred to allopathic  health  care systems.

 

The Conventional Perspectives on Health

 

Within conventional medicine there are two separate kinds of health definition:  the practical/medical and the utopian. The practical/medical is that found in medical  texts and that which medical students learn in university. A healthy person is a  symptom-free person.  Symptoms  are defined as abnormalities which are recognised  by  professionals. They  are not necessarily connected to the patient's subjective experiences of  illness. For example a patient with non-specific discomfort, malaise, reduced function, withdrawal,  insomnia and feeling off colour may not be recognised by the doctor as  being  ill, and  may therefore remain untreated. Even if the doctor wishes to help he may find  that extremely  limited treatment options available within modern medicine for problems  outside its definitions of sickness. However the patient may indeed feel subjectively  very  ill.  A specific example of this is the so-called post viral  syndrome (M.E. or  Myalgic Encephalomyelitis).  Patients were not recognised as having a legitimate  disease  until they  mounted  an international public campaign to have their disease named  and  recognised. Only then could it be taken seriously in treatment and research. There has been a long  critique of this biomedical description of  health, beginning with  Illich(13).  The main points of this critique are the  lack of acknowledgement of the wider influences on health, including social forces, psychological disposition, stress, etc, and the  pathological  bias  that sees in health a simple negative, an absence of  disease,  which  is essentially a statement that there is no such thing as health.

 

There  are those within modern medicine, especially  paramedics such as  art  therapists, occupational therapists, speech therapists, physiotherapists, etc., who do recognise  the need to go beyond this restrictive view of health, and who  attempt to  expand it in practice to include function and social relations. However with only a few minutes per  patient, the conventional model dominates  primary medical encounters, and it  certainly is the conceptual basis for secondary (i.e. hospital) care. The  utopian model goes beyond this. It is typified by the definition arrived at  by the  World Health Organisation in its 1977 conference at Alma Ata: "A state of  complete physical,  mental, and social well-being, and not merely the absence of disease  or  infirmity".  It is an ultimate definition of health, determining it as the fulfillment  of the  human potential. However it is of limited usefulness, because modern medicine  does not have the tools nor the ability to serve the human potential. There are no well-being medicines in the pharmacopoeia. This definition is unrealistic even in western countries where there is a cultural awareness of human performance issues. However in  Third World countries,  where  most of the World Health Organization's efforts are  directed,  their definition  is  even more inappropriate as a basis for action. Modern medicine  is  hard pressed  to contain life-threatening diseases such as malaria, AIDS, tuberculosis,  bilharzia,  etc. In Third World countries, well-being is often identified as having  enough to eat, and easy access to clean water. Thus there are obvious limitations with both the above definitions of health.

 

The Folk Depiction of Health

 

A  further perspective is that based on common sense and life experience, and it  is embedded in folk culture and ordinary language. Here health is one of those terms  which run  right  across cultural and individual consciousness like   'goodness',  'life',  or 'rightness'.  Everyone  will define it in a different way. For example someone  who  has chronic  pain will define health as a pain-free period. In the modern fitness  movement, health will be defined as physical performance. However in traditional village cultures, health is often defined as peaceful undisturbed existence. In rural France, the  average lifespan of women is several years longer than those in the US or northern Europe.  They smoke,  drink wine, and eat meat, and view the essence of health as being close  to  the family, and being able to rest and do little. They regard the fitness obsessions in  the Anglo Saxon countries as  driven and therefore fundamentally unhealthy.(14) Folk  views  of health are set by role models and cultural norms. In  some  cultures fatness  is  a sign of health, in some thinness, and European culture has  had  both  at various  times  in its history. Ancient Greece viewed health as perfect  bodily  proportions.  The American Indians viewed it as endurance to physical strain. In China  health is  regarded as equivalent to longevity, by definition. In India health is  regarded  as the luster of the skin and the shine in the eyes. All of these perspectives are  partial signs  of health,  none is all inclusive. Such common-sense views of health  change  all he  time and are a reflection of present-time experience. Since they are changing,  and they  reflect  human function and well-being rather than symptoms, the folk  views   are closer to those of alternative rather than conventional medicine.

 

Biopsychosocial Descriptions of Health

 

There  has  been  a  movement on the fringe of medical science   to  break  previous disciplinary  boundaries and introduce social, ecological and cultural/political  issues into the considerations on health and disease.(15) The introduction of new fields such  as medical sociology, social epidemiology, and community medicine, imply a wider  theoretical  basis to disease causation and the nature of health than that described  above.  It has  become clear that most of the major advances in health during the last part of  the last  century  and  the early part of this century were the result  of  hygienic  social measures and not of medicine or the biomedical model.(16) Today, at a time  when the  main causes  of  morbidity  and loss of life are degenerative  chronic  diseases   which  are strongly  influenced  by the habits of the modern world, such as  smoking  and  chemical pollution  of the biosphere, the emphasis is returning once more to the  social  sphere. Many  studies have demonstrated that diseases such as heart disease are much  higher  in groups  such  as  poor  urban blacks in the USA, which are  under  social  pressure  and stress.(17) There is a complex relationship between risk factors such as obesity or  smoking and social pressures, such that it is quite clear that we cannot consider individual health  behaviors in isolation from the social and cultural environment.   Consideration of these aspects has led to a number of descriptions or definitions of health which  are based on the way humans negotiate through the sea of environmental, social and  informational influences.

 

These  concepts  are  often  based on systems theory, since  they  imply  a  complex hierarchy of relationships. Health is a process of alignment to  norms of human function and well-being that are defined by society and by professionals. Illness implies deviancy from these norms. These norms will vary from time to time and social group to  social group.  Health  is a process, not a fixed defined condition of the organism as   in  the biomedical model. The process is one of dynamic balance where the capacity of the organism to self-repair, self-support and renewal is not overwhelmed by the interactions with the  world within and outside the organism. The organism, in this case, is not only  the individual,  but also the community, and the entire socioecological system, so that  one can talk about the ill-health of a group as well as of a person. (18) Health is  determined by  two aspects, namely the degree of distortion or stress imposed by  the  environment, which can be described as the  'health balance' and the extent to which the organism  is able  to  cope, that is the resources of the individual or group available  for  coping, which  can  be described as 'health potential'. This kind of systems thinking  has  been very useful in developing the field of health promotion. For example the improvement  in health  potential  of a community will include promoting  nutritional  status,  physical fitness,  immunological capacity, healthy lifestyle and health knowledge. Improving  the health  balance  will imply actions to reduce stress in the  workplace,  pollution  from chemicals, radiation (such as from computer screens) and noise, and social integration. Perhaps  the best known proponent of the biopsychosocial concept of health is  Antonovsky.  He  had very little sympathy with the biomedical position, not  because  it  is mechanistic, since Antonovsky's position was also mechanistic, but because it is concerned with the individual. According to Antonovsky, concepts of disease as an external  influence  ignore the ability of the individual or group to cope and adapt, and concern  with individual behavior, i.e. risk factors for disease, is  blaming  the victim. The biomedical  definitions  are a kind of medical imperialism in which  medicine  defines  health according to its interests, and for the sake of its continuing power.(20) Instead he  proposed that there is a spectrum from ease (salutogenesis) to dis-ease (breakdown) according  to  the  individual's ability to cope with stresses.  The  stresses  are  generally social, and include war, lack of food and clean water, family discord, unemployment, and discrimination. Salutogenic influences would include social stability, rewarding occupations,  and social acceptance and integration. Antonovsky continued by considering  that the  way  these influences act on the individual in his world is by  information.  Input that is conflicting and chaotic (e.g. anxiety, persecution) or excessive ( e.g.  classical  stress) or lacking (e.g. isolation, loneliness) will reduce the sense of  coherence of  the individual in his society and create conditions of stress and dis-ease.(21)   This view is the other extreme from that in which the individual is responsible for his fate. Indeed Antonovsky  has some harsh words for the well-being movement,  described  below, which  "prevents  understanding  the social burdens that pressure people  to  behave  in pathogenic fashion and that block them from behaving salutogenically. From a moral point of view the focus on the 'health within' is at the very least a passive and unconscious approval  of the social status quo...........the world of technomedicine is not  better. This  comforts  me not at all."(21) As we shall see, the social and  systems  approach to health  is  a step towards the more open descriptions implied by  alternative  medicine, because  it stresses health as a balance, an ecological process, within and without  the individual.

 

The Well-being and Autonomy Perspective

 

The  well-being  movement arose in the United States as a response  to  the  extreme mechanistic  and  reductionist  position of technical medicine.  It  defined  health  as  feeling good, performing well, being fit and on top of the world. It expressed an interest in the psychosomatic origins of disease, but transcended it to embrace the psychosomatic  origins of health. Health is a result of consciousness, of positive thinking,  of affirmation.  Health is achievable by mind-body techniques, such as meditation,  relaxation, dance, massage, vitamins  and having a good holistic physician at your disposal.(22)  The perspective here is individualistic, stressing personal responsibility and  freedom. The  late Norman Cousins discussed this approach in his personal journey to health,  and described health itself as such a personal odyssey, a process of fulfillment, of  becoming what you truly are.(23) To which Antonovsky has commented that it is all very well  if  you can afford it.  Such  observations on the nature of health have arisen from considering those people who know themselves to be healthy, and indeed arrive at health by themselves even in the face  of devastating illness or social conditions. Studies of cancer patients who  cured themselves  or  lived far longer than expected found that they seemed to get  better  by individualistic  health promoting attitudes and practices, rather than by therapy.  Psychological treatments and psychotherapy which started with the question: "what is  wrong with this person, and how did she or he get this way?" were less effective than  asking: "what  is right with this person, what are her or his unique strengths, enthusiasm,  and zest  for life?"(24) In addition, there is some research on those who cope well,  who  are healthy and  appear to live long. The qualities which appear to be  expressed  by  such people are those of activity, exercise and energy, involvement in life and commitment to some engaging life activity, a conviction that life has meaning, and good social connecions. (25) A summary of the characteristics of health based on such surveys of healthy  people, and  those overcoming major health problems has been collected by Rijke (25) and is  listed below:

 Autonomy

Will to Live

Experience of meaning and purpose in life

High quality of relationships

Creative expression

Body awareness

Consciousness of inner development

Individuality: the experience of being a unique part of a greater whole

Vitality, energy.

 

These characteristics of health are not all expressed at the same time. Indeed  they suggest a superhuman psychological disposition. However research on ordinary people, the neighbour  next door, does suggest that these qualities are to some extent expressed  in most  naturally  healthy people. These qualities reveal what in Jungian terms  might  be described  as individuation - becoming a full person. According to Rijke, the  discovery and development of autonomy is crucial, and is not an easy process. It involves a realisation  of a deep will to be well, and a knowledge and affirmation of that wellness.  It is a freedom from a life determined by unhealthy factors towards true choosing a  wholesome and constructive life influenced by benign factors. In this sense it answers  Antonovsky  by  the stating that a person need not be a mechanical  subject  of  ineluctable social forces, but has the ability to swim upstream, to choose and negotiate her or  his way through them.

 

It  is  interesting that the 'will to be well' is a quality that is agreed  even  by modern medical doctors to be important in recovery and the maintenance of health. Psychoneuroimmunology has shown that depression is one of the most prevalent and devastating  threats to immunity, and is certainly a major cause of general ill-health and morbidity.  However the process by which the 'will to be well' manifests in health  is unclear. A behavioural perspective would argue that this  results in healthy behaviors and positive  lifestyle changes. However one could also argue that much of the operation  of  the  will to be well is a subconscious affirmation, like a positive hypnotic  suggestion or the placebo effect, which recruits the power of life in support of health and resistance.  This  is certainly a part of the perspective of  alternative  medicine  described below, and is far from the biomedical model of health and disease.

 

 The Alternative Perspective

 

Health  within  alternative  medicine is drawn from a tradition which  is  far  more ancient  than that of conventional medicine. Because of that it does not need to  formu­late   its perspectives on health with biomedicine in mind, either in accord with it  or in opposition to it. Thus it would view the symptom-based definition of health of biomedicine, the function-based definition of the WHO, the fitness-based definition of the well-being  movement, the autonomy-based definitions of the psychological movement,  and the  systems theories of the salutogenic movement as partial and limited. It would  draw on all of these as needed, but transcends them all. It is much more vitalistic and  life oriented,  without the need to constrain itself into western  mechanistic,  reductionist models  of how the human being functions. The definitions of health arise from the  main themes  of alternative medicine described earlier. Considering these themes will  demonstrate the inclusive yet pragmatic definitions of health implied within them. For  example,  health in Oriental medicine involves a harmonious relationship with all the  energies  and influences within which man is immersed. These include but are not limited  to material,  natural,  environmental and social influences. But it also implies  having  a good  constitutional  and genetic basis, termed 'inherited  energy',  and  corresponding perhaps  to the systems theory's 'health potential'. In addition, it is recognised  that health  is a mind-body-heart issue, without acknowledging any boundaries  between  them. Oriental  medicine  and the major alternative medical systems never passed  a  Cartesian phase,  so there is no need to postulate or evoke concepts like psychosomatic,  or  even autonomy. These are qualities observed  naturally within the mind-body-heart  continuum, expressed as the total energetic body of man.

 

In  alternative  medicine both patient and practitioner share an  alternative  world view based  on the themes described above. It is a more  open,  contextual  definition. Health  is viewed, in the clinic and in the home, as a process without a  beginning  and end. There is no absolutely healthy person, and no absolutely diseased person. There is, rather, a journey in which greater and greater health is achieved through a combination of life wisdom and health practices. For example, alternative medicine has a  major role to  play in the area between complete symptom-free well-being, and actual disease. This 'third  state'  or pre-disease state, is viewed as a lack of health  needing  attention. "Why  dig  a well after you are thirsty?" states the Oriental medical   classic:  Yellow Emperor's  Book of Internal Medicine. Thus some of the work of alternative medicine may be  with essentially symptom-free people. Alternative medicine deals not only with  disease,  but  also with vulnerabilities, concerning which it has a huge  knowledge  and  a large  catalogue of remedies.(27) The skills of prevention and health maintenance rely  on  a  concept of health in which all the many subtle levels of susceptibility and risk  are regarded as states of health requiring assistance.

 

Since  conventional  medicine has drawn a line at the symptom boundary  it  has  few tools for health maintenance (apart from public health). In consequence it also lacks an operational  language  to assess health itself. The  various states of health  are  describable  only in common language (e.g. 'well-adjusted', 'vital',  'energetic',  'glowing') even by doctors. Whereas in alternative medicine the practitioner is able to  call on  a  rich  language to describe subtle states of health, and  to  differentiate  these different  states  of health by diagnostic signs. For example in Oriental  medicine  the practitioner  determines the flow of energy and materials through organs and  the functioning  of   the main organ systems. He may ascertain that an organ is  too  'full' or 'empty',  'hot' or 'cool', etc. The quality of the 'chi' or vitality of the  organ  systems may be stuck or scattered, rising or falling, or  balanced, spread in the right way around  the body, full, resistant, etc. In other alternative systems this subtle  health measurement  is   made  using different conceptual frameworks and  languages.  Thus the balance  between elements or fluids is tested in herbalism and naturopathy. Health is  a dynamic  state  where these qualities are well-adjusted, and heat,  moisture,  etc. are balanced and in their right proportion and location relative to the constitution of the individual.  In addition there are measures of the quality of organs  (skin  elasticity, brightness  of  eyes, clarity of skin, warmth, firmness of body, lack  of  waterlogging, etc.) which are similar to folk descriptions and  to some signs used by good conventional doctors.

 

Although health is relativistic, alternative medicine does have some standards. Very often these standards are set by the therapist himself who is required and assumed to be healthy.  In  Oriental medicine the speed of pulse and breathing of the patient  can  be measured against that of the therapist himself. In therapy further measures of pulse are taken  which  reveal the individuality and characteristics of the patient, and  build  a  constitutional picture which would then act as a reference point. For example a  patient may  naturally  have  a very deep and slow pulse. This is his state  when  healthy.  The therapist  will attempt to raise and lighten the pulse a little by means of  acupuncture so as to adjust the patient towards even better health and reduce his natural  vulnerability to  cold diseases. If the patients pulse became too light, erratic or  fast  the therapist would know a disease was brewing and be able to take corrective action.

 

The definitions of health employed in alternative medicine have as their philosophical  basis a view of nature different from that underpinning the modern world. There  is more respect for what is 'natural', meaning unfabricated and less manipulated according to  transient  human intentions. There is a greater sense of co-ordination  with  global flows  of  energy. There is a strong vitalism. There is a lack of urgency  to  construct explanatory  models  - an empiricism incorporating a greater sense of  the  unknown and respect that goes with it. This leads directly to the lack of strong interventions that characterizes  alternative medicine compared to conventional medicine, and  the greater trust of self-healing capacities even if they cannot be understood.

 

Some  Characteristics  of Health Arising from the Vitalistic World View  of Alternative Medicine

 

It is not easy to give one formula describing health within the various  alternative medical  systems.  However some features of health that are common can be  listed. They give the flavour of the definitions of health implicit within the alternative techniques and traditions:

1. Living a nontoxic life

2. Being sensitive to deep signs of function and dysfunction.

3. Understanding of your constitution and its patterns and needs.

4. Tending towards a state of harmony and balance between internal and external worlds, e.g. seasons, environment, social relations.

5. Respect for the unknown, indeterminacy, the wild side of life and change.

6. Knowing health as a journey, a process.

7. Discourse with therapeutic activities: knowing when to use  what remedies or professional help.

8. Vitalistic, life-affirming  attitude: the will to be well.

9. Longevity

10. Energy

11. Subjective sense of well-being

12. Total accommodation to life - and death.

 

Consider,  for  example, the case of a young man of 40, Dennis,  who  had  childhood diabetes.  At  the age of 25 he went blind as a result of  diabetic  pathology.  Doctors noticed  that  his kidneys also began to fail as a result of his diabetes.  Besides attempting  to keep his keep his blood glucose levels as constant as possible,  there was very  little the doctors could do to protect his kidneys. His doctors could  only helplessly  record the deterioration towards an inevitable kidney transplantation.  In this case, the definition of health of Dennis was exclusively that of his diabetic symptoms, and  not  at all of the total energetic functioning of all his organ  systems and  life processes.  However one day he went to a traditional acupuncturist.  The acupuncturist, using a different  model of health, asked how each of the organ systems were functioning and  adapting to the problem of erratic glucose supplies. The acupuncturist  essentially worked with the processes of adaptation within the body to strengthen them  and the  coordination  of all the organ functions and life processes. He began to feel  psychologically better, less threatened and depressed about his future, and more fit and  energetic. His general health indices, including the stability of his blood glucose,  improved. Then  his kidneys began to improve, something that is inconceivable within  conventional medical explanations.  Dennis's kidneys are now fine, and he is well through the use  of acupuncture and herbal and dietary treatment, although he must also take insulin.  Years later, Dennis was still in good health and leading a constructive life despite his blindness  and diabetes. It seems that only the subtle methods of complementary medicine  can help Dennis to adjust to his disturbed glands. Conventional medicine (insulin) is  keeping him alive. Complementary medicine is helping him live.

 

Implications of Alternative Descriptions of Health on Health Care

 

We are not getting more healthy today despite a massive and crippling investment  in health  services. In the UK, in the last 20 years, there has been a 50% increase in  the percentage  of  the Gross Domestic Product spent on health. Yet there has been  a third increase, to 34% of the population, in those suffering from long term illness, and a 64% increase in incapacity, or days of certified sickness.(28)  More than half a million Americans will die of cancer this year, and cancer death rates continue to rise steadily. The US President's Cancer Panel were told, in 1993, that the "decades of war against  cancer have been an unqualified failure".(29) There has been a 43.5% increase in the incidence of cancer  since the 1950's, (adjusted for age), and only a small  improvement in  the 5-year  survival  rate  after treatment.(30). Though life expectancy has  risen,  largely because of the drop in infant mortality, US statistics show a steady rise in ill-health: from an average of 0.82 episodes of disabling illness a year in 1920 to 2.12 in  1988.(31)This is the age of "the vertically ill".

 

Evidently  something  has gone wrong. All of the many people who have  offered critiques  of the biomedical approach have provided partial answers to what is  wrong, and there is no doubt that the biomedical model is in a slow crisis and in process of change towards a more holistic paradigm, in the Kuhnian sense. Here I propose that the  limitations of the biomedical model are inherent in its definition of health. This definition, though  largely implicit and unconscious, nevertheless  informs everything that is  carried  on in the name of medicine. More than that, the definition of health produces  the kind of results in the population that are inherent in that definition. Thus the definition of health as freedom from obvious symptoms has created a generation which are  free of obvious symptoms, but are not fully well either.  The clarity with which acute  sickness  can  be  defined as ill-health compared to chronic and  early  stage  degenerative conditions  has resulted in huge numbers of chronic cases, which, as the death  certificates show, are largely untreated and untreatable.

 

Scientists and health professionals could learn a great deal  from alternative medicine about  defining  and measuring health. Health care today  would  benefit  from  an awareness of more meaningful ways of describing and measuring  health offered by alternative  medicine, for example by including constitution and the quality of vitality. It could   also  provide a rich source of ideas and criteria for assessment to  efforts  at prevention, some of which (including lower fat, raised fibre, vegetables and food supplements  to  lower cancer  risk, the health risks of food additives) have already been acknowled by modern medicine.  That new criteria for assessment are urgently required is illustrated by  the example  of  blood cholesterol. The question whether lowering it contributes to  overall  health  has  been tested using billions of dollars of research money and many  years  of investigation,  yet  the question is still not finally decided, and official  advice  on this question remains ambiguous. If more appropriate assessments of health were used  it would  be  much easier to ascertain what is healthy and what is not,  for  each  person, and design appropriate ways of assessment of therapeutic interventions. These are some of the principles about health which could impact deeply on  conventional ways of thinking:

1. Depth. Alternative medicine could provide much deeper signs of the proper functioning of the human organism, for example the voice, spread of warmth, pulse etc. could be read and utilized.

2.  Individuality.  The acceptance of variability and individuality  would  make  health definitions  more valid and realistic. The nature of individual variation can be  learnt from alternative medicine.

3.  Constitution.  This essential basis of all medicine has been  lost  in  conventional medicine and needs to be relearned.

4. Process. Alternative medicine could provide knowhow on how  to track more sensitively the  change of health through time, for example an  understanding of the  various stages in the process of healing and recovery.

5.  Respect. Alternative medicine can teach a way to have respect for the patient's  own natural processes and experiences, including the natural processes of being born,  being alive, and of dying. This is possible because such life and death processes come  within the implicit broader definitions of health.

6.  Expansion.  Alternative medicine can contribute health practices and  actions  which begin    before  the disease state, and end after the point of  so-called  incurability, where conventional medicine runs out of options.

 

Alternative medicine is rapidly increasing in popularity. As its conceptual basis is prior to, and in many respects opposite to, conventional medicine, it provides a  challenge to it which has not yet been accepted. Alternative medicine's  concentration  on healing the healthy as well as  the sick, and its familiarity with the origins of  disease  on  the ground of human life, give it special skills at  understanding  states  of  health.  It sees health as a process which is intricately related to the way a  constituion  and personality develops through time within the matrix of all the influences  and relationships that are experienced.

 

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