Special Focus on Women's Health Atternative Therapies RCM Eo) Pera Cees a tran With Black Cohosh (Prevention of Cancers in Women ST eet ery Dietary and Lifestyle Changes for Cardiac Health Peet SPV ee ets ECU Cs elo DS RSet ferry a ras ond ee eee Nees Cd ra oN eT ee ane Taber SCE Con aoA Tibetan Medical Perspective on Irritable Bowel Syndrome Building A Means of Discourse for Integrative Medicine Eliot Tokar and Ariana Vora Introdus highly regarded Tibetan physi- A cian in West Bengal, India, recent- Iy said that he was wary of the negative effects when younger Tibetart doctors feel they must address Western medical diagnoses. He said that such information does not help the doctor to make an accurate Tibetan medical diag nosis and instead spreads the hegemony of Western medicine ‘This isa persuasive argument. As eco- nomics and the influence of Western medical approaches endanger the more classic, holistic approach of traditional medical systems, the most important Issue regarding Tibetan medicines its complete preservation. Already, Tibetss medicine is beginning to be promoted as a hot new commodity in the new alterna tive medicine industry. In this environ ment the use of classic treatment protocols will increasingly give way to the use of Tibetan herbal pills as an over- simplification of Tibetan medical treat- ment. This creates a scenario easily exploitable by the growing nutriceutical industry that is always looking for poten- tial new products. ‘The active cooperation of various sys- tems of medicine is an important goal, but a hasty integration will limit us to a "Disney World” version of these vast and varied medical approaches. That is, we will find ourselves using only some of the form and some of the substance of com- plex traditional systems of natural medicine squeezed into easily maketable and salable forms. “Complementary medicine” has already become a ubiqui- tous term in current discussions of alter- native medicine. Simply creating a field of "complementary medicine” as a new Industrial category does not honor the intelligence expressed by the American people for the past three decades through their grassroots effort to investigate and use alternatives in healtheare, However, adopting the isolationist pet spective of the aforementioned Tibetan physician is not the only way to preserve Tibetan medicine. We must work to understand the system and teach its true meaning so that health care consumers can discern what is real and what is com- ‘mercial. Before a system of truly comple- ‘mentary medicine can exist in the United States, the essence of traditional natural ‘medicine practices needs to be properly understood by allopathic health profes- sionals and more fully incorporated into American sensibilities, The first step in that process is developing a means of dis- course so that lay people, allopathic physicians, and practitioners of tradition- al natural medicine can speak to and edu ‘ate each other. To begin establishing a complemen- tary approach to medicine, we must cre ate a common language through which traditional doctors and allopathic doc- tors can communicate clearly about their disciplines. For example, traditional Asian medicine is not about acupuncture points, herbal remedies, or other thera: peutic devices. Rather, i is about the sei- entific, cultural, and spiritual knowledge that gives rise fo and defines the clinical indications for those applications. Creat- ing such a language is a complex but essential task that, at worst, is over- looked and at best is attempted in an intellectually and scientifically inade- quate fashion, ‘the following example is offered as an iMlustration. A meeting was recently held at Columbia University New York, New York with two Ayurvedic physicians and 2 group of Western health professionals. In the question-and-answer session one ‘Western practitioner, who was working at 2 hospital unit that utilizes complemen: tary medicine, asked the Vaidyas if ond how they treat multiple sclerosis (MS). ‘They answered that they did treat MS and then attempted to explain their approach to troatment. As they spoke, the American practitioner posed numerous additional queries regarding the details of MS. As this happened, the discussion became progressively obtuse and frustrating. Based on my experience in traditional Asian medicine, offered the comment that the Vaidyas were actually not diag- nosing or treating MS because it does not exist as a diagnostic category in Ayurvedic medicine. recommended that ‘we share some case studies of their own patients with a Western diagnosis of MS and discuss in detail the condition they had diagnosed and the results of their treatment. The discussion immediately became a more organized and clear di logue. It ceased to have the tone of an inguisition or the strain of a person strug siling to fit the wrong size shoe onto the ‘opposite foot. After the meeting the Indi= an doctors told me, “this often happens to us at meetings of this kind where we are asked about Western diagnoses. To accommodate the Western doctors we answer, but it is never adequate” Western diagnoses such as irritable bowel syndrome UBS), cancer, and dis. betes are notin fact ilinesses; rather, they are conceptual descriptions of the etiolo- ay of illness with related treatment proto: cols. When we appreciate this point, the 38x ALTERNATIVE & COMPLEMENTARY THERAPIES—OCTORER 1998 IBS is the most common gastrointestinal disease in Western clinical practice. [Eliot Tokar (ight) and his teacher, Dr. Yesht Donden (left). Dr. Labsang Tenzin is seated let concepts of Tibetan medicine or any other system of medicine can be considered on equal terms with the concepts of the Western model. Only then can we create 2 language that enables meaningful dia Jogue among different medical systems, ‘The develapment of such a language is an often ignored prerequisite for an effective Integrative analysis. This article contributes to this language of discourse with the long-term objective of creating such an analysis. As a starting, point in building this language, the cond tion defined by Western medicine as IBS provides an example of a useful model for comparative analysis with the same condition as defined by Tibetan medicine IBS: Diagnosis and Treatment in Western Medicine According to Harrison's Principles of Internal Medicine, irritable bowel syn- drome (IBS) js the most common gastroine testinal disease in Western clinical practice! Its etiology is not clearly under- stood by Wester medicine, and it has no known organic disease as ts basis? Psy- chological conditions ranging from stress and anxiety to deeper disturbances fre- quently trigger exicerbations of symp- toms.! Compared with the general population, patients with IBS have an Increased frequency of psychiatric diag- noses including personality disorders, anviety, depression? Symptontatcaly, IBS is experienced as either abdominal pain, intermittent diar- ‘hea o constipation, bloating, and excess £28.) 1S is a disorder of motility or sen- Sory function in the gastrointestinal tract, often leading to rapid transit of food to the small imestine. 13 A diagnosis of 18S is supported by symptomelogy of a chronic and intermittent ature, an absonce of physical signs of deteriortion, and emotional stress.! The rest of the diagnosis is established based on the exclusion of other conditions, such as infection, neoplasia, thyrotoxicosis, obstruction, and malabsorption.! 1BS is considered treatable but not cur- able-! Dietary treatment includes fiber supplements, osmotic laxatives, and eas 1y digested carbohydrates.* Symptoms can be medically controlled with antidias- rheals, prokinete agents, tricyclic antide- pressants and or anxiolytics.! Because [BS is though to be incurabie, patients are advised to adapt to the symptoms.t In cases of great severity or where patients do not respond to treatment physicians often recommend psychotherapy, hyp- notherapy, or biofeedback Comparative Diagnosis Figure 1 illustrates a basie difference in the diagnostic approaches of the Tibetan and Western systems. Consider two pyra mids, one inverted and the other upright ‘Wester diagnosis can be graphically rep. resented by the inverted pyramid, In the process of performing a Western diagno- sis, the physician begins by considering the broad spectrum of a patient’s chief ‘complaints, history of present illness, past medical history, and social history. The Western physician then progressively arrows the diffexental, eliminating what is rogarded as extraneous or secondary. Finally, a singular definition of disease is reached, such as IBS. Once this diagnosis is established, information about treat- ment options and expected prognosis can be accessed from statistical and experi ‘mental research tested in study popula tions. However, in this approach very little is understood about the difference between one individual with [BS and another individual with the same diagno- sis. Beyond the subjective observation of the Western physician, no satisfying explanation is available regarding why individual patients experiance the disease differently, with varying symptoms, course, prognosis, and quality of life. Tibetan diagnosis can be graphically represented by the upright pyramid. At the apex of the pyramid is the individual ‘The Tibetan physician places 2 particular emphasis on individuality because all + nesses are rooted in each patient's unique background and situation, This concept of the individual is then expanded to inelude the chief complaint, accompany- ing symptoms, and relevant medical, per sonal, dietary, and spiritual history. Through this process, the physician per- ceives the broader complex that charac terizes the illness. Once the illness is diagnosed on such terms, the root cause of the entire complex of symptoms and conditions can be understood. It is this oot cause of illness in addition to theALTERNATIVE & COMPLEMENTARY THERAPIES—OCTOBER 1998 4S The Tibetan physician places a particular emphasis on individuality because all illnesses are rooted in each patient’s ui ue background and situation. acute symptoms that Tibetan physicians diagnose and treat, In this approach, each patient's diagnosis, treatment plan, and. prognosis are determined on an individu- al basis. Therefore, what might be per- ceived as one disease in Western medicine is actually perceived as a range of conditions in Tibetan medicine Diagnosis of the Condition in Tibetan Medicine It follows that the etiologies and mani- festations of illness can be understood within several diagnostic categories in Tibetan medicine. These categories relate to three principal systems that give rise to and regulate all functions of the body and. ‘mind: Liing (Wind), Tripa (Bile), and Bed kén (Phlegm). Below is a rudimentary description of the three systems and a brief discussion of their relation to the diagnosis of IBS. The three principal systems that create and sustain all the body’s functions (Ling, Tripa, Bidkén) are created at various stages of development in the womb by an interaction of the mind's developmental process and the five physical elements {discussed later in the section on diet). Embryologically, the mind acts as the basis for the creation of each individual's three principal physical systems. A mate- alist view of the world, based on igno- rance of a spiritual perspective, is inherently related to Lig. In Buddhism, stress can be defined at its most basic level as the conflict created between the pursuit of worldly desires and the inevitable limitations in fulfdling these desires: Therefore, stress is a reac: tion rather than a response to given cir- cumstances. This reaction results in psychologic and physical reactions which disturb Ling, The results of stress can. include improper diet, harmful lifestyle (eg, erratic sleep habits), and poor adap- tation to one’s physical environment (eg, overexposure fo cold in winter or to heat {in summener) TBS is frequently triggered by an emo- tional stress reaction resulting in symp- toms such as diarrhea and/or constipation, Therefore, a characteristic etiology of this condition is the distur- bance of what in Tibetan medicine is called Ling (Wind). Ling gives rise to all, ‘circulation in the body. As the basis of cir- ccalation, iti associated with processes of the human organism characterized by movement, from the intangible (e.g., thoughts) to the physical (e.g., nerve impulse, blood, and lymphatic circulation and movement of chyme through the digestive and excretory systems). A disturbance of Lifng can occur alone ‘or in combination with dysfunctions of ‘one or both of the other principal systems. When it occurs alone, this disturbance is termed a Ling disorder. Typical symp- toms of such a disorder include erratic and diffuse pain, lower back and hip pain, dry skin, abdominal distention, con stipation, diarrhea, anxiety, anorexia, depression, mood! swings, insomnia, psy chosomatic disorders, irregular blood pressure, and metastasis of tumors. The second principal system is Trips (Bile). Tra is associated with thermoreg= ulation, metabolisen, vision, liver and gallbladder function, and blood produc ton. It allows the mine to function with discriminating intelligence. A distur bance of this system can include such conditions as anger, hypertension, vomi ing, gastric acidity, hepatic dysfunction, and the development of fast-growing tumors. see Eliot Tokar (lef) and his teacher, the Tibetan lama and physician Dr. Trogawa Rinpoche (eigho. Cases of IBS defined by the basic Ling disorder in combination with a Tripa dis order are called Ling /Tripa disorders. ‘They can include symptoms such as errat- ic episodes of hypertension, sharp pains that move around the body, fluctuating fevers, reflux, regurgitation, and a combi- nation of symptoms of both Ling and ‘Trin disorders, Buidken (Phlegm) is the third principal of physical and psychologic function. Iris, associated with the proper breakdown of food in the initial stages of digestion, the ‘maintenance of the body's internal fluids, and the proper functions of the senses overall. Typical manifestations of Biden disorders can include a sensation of phys ical or mental heaviness, kidney disor-346 ALTERNATIVE & COMPLEMENTARY THERAPIES OCTOBER 1998 The first consideration in treatment is the principle that all illness ultimately originates in the mind. This does not mean that all illness is psychologic or psychosomatic. ders, hypotension, slow metabolism, hypersensitivity to cold, weakness, diar- thea, the development of soft cysts, and slow tumor growth progression. If the case of IBS is characterized by a Lang disturbance combining with the principal system of Badin, itis called a Ling /Bakén disorder and is character- ized by an inability to break down foods properly at the initial stages af digestion. In this case, the IBS is accompanied by. symptoms such as hypersensitivity to cold, mucus or undigested food in the Stoo), excessive urination, and a combina tion of Lig- and Blidkén-derived patholo Finally, ifthe condition derives fram a complex dysfunction of all three main principal systems mentioned above (Lang, Tripe, anc Bidken), itis termed a Badken Mukpo (literally brown phlegm) disorder and reflects a combination of Liver and stomach dysfunction that chron ically undermines digestive and assimila~ tive processes, This results in variety of symptoms, inclucing intestinal pain, sour vomiting, indigestion, nausea, lack of appetite, blood in the stool, and constipa ton. In more severe cases, or if left untreated, this condition may lead to tumorigenesis. ‘Appropriate diagnosis of the condition is determined through an interview and physical examination, in which the patient's history and presenting symp- tome are elicited. Next the physician ana lyzes a urine sample, feels the 12 distinct pulses on the radial artery of each wrist, observes the tongue artd the sclera of the eyes, and, if necessary, applies pressure to appropsiate points on the body. Treat nent is then tailored to address the spe cific etiology of the individual's condition, ‘Treatment in Tibetan Medicine ‘Treatment is specific to each of the four diagnostic categories. The first considera- tion in treatment is the principle that all illness ultimately originates in the mind ‘This does not mean that all illness is psy chologie or psychosomatic. Rather, it ‘means that, due to ignorance, we misper ceive the nature of reality and act in ways that create suffering, such as illness, Given this basie principle, when treating an illness, physicians begin by recom mending specific behavioral and lifestyle modifications. If this is not sufficient, then physicians work at the level of dietary therapy. If these are not enough to cure the problem, physicians use herbal medicines or, if needed, physical thera- pies such as acupuncture. As stated by Dr. Trogawa Rinpoche, the treatment ulti= rately must fit the patient; that is, treat= ment must be formulated ina manner that can and will be effective for that indie vidual Behavioral Modifention Behavioral modification can include meditation instruction, spiritual advice, counseling, exercise, or the reorganization of habitual patterns such as sleep habits and eating schedules. Inkkial stages of meditation generally Include simple breathing practice and working with one’s thoughts in a manner that calms the mind. Meditation then evolves beyond that point to include spe- cific contemplations and visualizations, which begin a process leading to a new understanding and perception of the world. This aspect of the treatment may vary slightly with the diagnosis. For example, in the case of Ling disorders, meditation may be specifically directed toward understanding the impermanent nature of physical phenomena as a cure for materialism and attachment. In the case of Tripa disorders, emphasis may be placed on generating a deep feeling of Jove and compassion as a cure for aggres- sion and anger. In Badiom disorders, med: tation will focus more on developing ‘wisdom as a cure for ignorance. What follows is a basic meditation for people experiencing anxioty and depres- sion, which are fundamentally Ling dis- orders. Because it calms Ling, this meditation can be helpful in some etiolo- gles of IBS, After awakening in the morn- ing, patients are asked to sit with their backs to the sun in a place where they can Took at the clear blue sky. If this is not possible, they can simply visualize the lear blue aky in their minds. Patients are then taught some simple breathing prac- tice. When thoughts arise, they must not try to suppress them or to become involved with them, rather, they shoukd allow them to arise in the mind and pass away. Such relaxing practices allow patients to focus and calm their minds, Patients are then asked to look at the sky, taking particular notice ofits expanse into infinity, Next, they are told to focus on their minds and locate their conscious- ness. Then, on the exhalation, they are taught to project their consciousness out of the body and into the sky where the consciousness diffuses into an infinite blue expanse. Although it is very basic, this meditation bogins to train patients who are gripped with mental turmoil to let go of their thoughts. In Tibetan medicine, this grasping onto thoughts is considered an exacerbating factor of an ty and. depression. Physical activity, lifestyle, exercise, and habits are also considered. For example,ALTERNATIVE & COMPLEMENTARY THERAPIES OCTOBER 1998 Food is analyzed based on its qualities and nature as defined by a five-element theory. patients with Ling disorders are told to pay special attention to regularity of litestyle (eg, esting, sleeping, and excre: tory function), find time for calm aetivi- ties and socializing, and exercise in ways that promote good overall circulation, using techniques such as yoga. Aa indi- vidual who suffers from a Tripa disorder should stay away from situations causing conflict. Such people should avoid direct, ‘excessive exposure to the sun and engage in physical activities that relax them. Patients with Badkén disorders should keep warm and perform vigorous exer cise such as running or dancing. Swim- ming is not appropriate if it involves immersion in cold water. I the ease of a combined disorder such as Buihén Mupo, behavioral modification is tatlored to the particular form the illness takes. Diet In recommending an appropriate diet, ‘Tibetan physicians consider which types of food are harméul and which might be beneficial the amount of food to be eaten, the number of meals per day, and the proper meal times. Food is analyzed based on its qualities and nature as defined by a five-element theory. All of the material that makes up our universe is based on the qualities of five basic ele- ments that are described in the ancient physics depicted in the texts of Tibetan ‘medicine, Ancient Tibetans lived in direct contact with the natural environment. ‘They understood through experience and stady that the forces manifest in nature directly correlate with and influence the functioning of the human organism. Jn the theory of the five elements, we see an effort to define the qualities of the basic forces that exist in nature. Once defined. they are named for their most identifiable Diagnosis of sease Va Diagnosis a iiness complex anes root cause Indiieal Direction | of diagnose of dagnosee anaysie nas Figure 1. Graphic description of difference between Tibetan and Western medical dlagnosis. ‘manifestations: earth, water, fire, wind, and space. The characteristics and there- fore the nature of all matter then result from the qualities of these elements indi- vidually oF in combination. Specific arrangements of the five ele- ments that occur during embryolog development form the three basic princi ples of physical function (Liing, Tripa, Baidkén). This is important because the laste of different foods, their resulting natures, and therefore their effects on the human organisnt are also dictated by the specific arrangements of elements that make up the food. This principle enables practitioners to think intelligently about diet and healt. relative to each individual patient’s lifestyle, environment, and health condition ‘The recommended diet for IBS varies significantly depending on the specific etiology experienced by the individual patient, Because stress is a significant trigger in IBS, Lang is usually a con. tributing factor. Therefore, a proper therapeutic diet must usually treat Ling imbalances. Depending on the presence of imbalances of Tripa and/or Badken additional foods must be added to or removed from the diet. Ling Diet Pationts benefit from a diet of heavy nutritious foods, such as meat, cheese, butter, and soups made with bones (eg, chicken soup). In the case of a Ling /Tripa disorder, or some Budkin ‘Mukyo disorders, or ifthe patient is a veg- etarian, animal-based foads can be replaced with other foods. Substitutes include avocadoes, vegetable-, legume-, or grain-based soups, onion, asparagus, and oats Foods that are irritating or “rough” in nature should be avoided because they would impede or distort the movement ‘and circulation that is essential for the function of Ling. These include foods that are burned in cooking or processing (eg, grilled meat, over-toasted bread, coffee, chocolate) because they induce stagnation of the circulatory energy; sugar, molasses, and artificial sweeteners; puffed grains such as rice cakes; monosodium gluta- mate; improperly processed foods (e.g., distilled vinegar, low-grade say sauce) and green tea, These foods, which might atherwise be benign or useful, are con-48 Herbal treatments range from simple to very complex, in a compound using approximately 3 to 150 herbs per formula. /E & COMPLEMENTARY THERAPIES—OCTOBER 1998 Additional References ‘Gyud ZH ‘Dharamsala, India: Tibetan Medical & Astrological Instcuce, 1994 ‘Shel Gong Shel Pang ‘Dharamsala Ind: Tibetan Medical & Astrological Institue, 1994 Go Rig Zin Tg Gees Padus: A Treatise On Tibetan Medicine By. Kon sPrul Leh, Lada nda: Mrs. DW. Tashigang, 1983) ‘Bo Dur sNon Po By sD. S.rGyamTsho Lah, Ladakh, Indi: TY. Tashigangpa, i973 ‘The Heong Power of Mind By T. Thondup Boston: Shambala Publications. 1996 Lecures on Tbeton Medicine BY LD. Khangkar Dharamsala, Indias Library of Tiberan | Works & Archives, 1986 Tibetan Medicine (gSo), Vols t=-12 ‘Dharamsala, India: Library of Tibetan | Works & Archives, 1980-1989 Gude to the Exhiien on Tecan Medicine & ‘Astrology Dharamsala, India: Men-Tsee-Khang, 1995, Tibeton Medical Pointing: Mustraions othe ‘Blue Ben Treatise of Songye Gyartso By Y. Pafionoviteh, G. Dorje, and F. Meyer New Tork Harry N. Abrams, Inc. 1992 traindicated in this situation for two rea sons: (2) because they are irritants causing fan exacerbation of stress-related symp- toms, and (2) because they impede proper circulation inthe body. Tripa Diet. These patients observe the Ling dietary guidelines when appropriate ‘while incorporating additional principles that are tailored to the Tripu condition. In this case a simple vegetarian diet is sutt- able, including legumes, potatoes, cumin, coriander, fenugreek, artichoke, bitter veg etables (e-g., dandelion), and turnips Foods that are heating in nature should be avoided. These include peanut butter, mustard, spices, garlic, ginger, onion, alco- hol, meats (especially lamb), oily and ‘greasy foods, and soups made with bones. Badkin Dict, These patients adopt a heating diet with respect to both the nature and the temperature of the food. For example, they consume hot water, cooked foods, pomegranates, sheep ‘cheese, yogurt, radish, honey, ginger, anc garlic. They avoid cold drinks and raw foods such as salads, potatoes, tomatoes, ‘eggplant, bell peppers, and sugar. ‘Baldkén Mukpo Diet. Badken Mukpo is the combined dysfunction of all three energies. This is a complex chronic condi- tion in which each of the imbalances ulti mately affects the digestive and metabolic functions. The dict includes fresh, cooked foods to facilitate the severely compro: mised digestion that is typical of this con- dition. Recommended foods include fresh, meat, dairy products, vegetables, fruits, ‘and whole grains, This condition is ex cerbated by garlic, tomatoes, eggplant, bell peppers, and foods that are aged, fer- mented, cured, smoked, sour, chilled, oily, or processed Herbal Medicines Ifthe above approaches are not sufficient in relieving the condition, herbal medicines are prescribed. In Tibetan medicine, herbal treatments range from simple to very com- plex, in a compound using approximately 3 to 150 herbs per formula. Each formula or et of formulas is prescribed to fit the mani= festation of the disease and the evolving condition of the individual patient. As a result, herbal medicines often need to be modified at each visit ‘Typically, two to four formulas are pre- scribed, to be taken each day at specific times. Morning remedies commonly include those for Badken disorders o7 digestive disorders, Afternoon remedies are typically used to treat Tripa disorders. Remedies given in the late afternoon or evening are usually given to treat Ling disorders, Ultimately, the organization of the preseription is based on both the doc: tor’ judgment and the patient's lifestyle. Although prescriptions are specifically tailored to each case, some herbs are more frequently found in formulas applicable to cases defined as IBS by Western, medicine. For example, a set of three herbs (Terminalia chobuda, Terminaliabeleri 2, and Embliea officinalis) are often given together as a mixture or included as ingredients of a complex formula ‘Additional herbs are typically pre seribed for each individual's condition. Herbs such as Aquilaria agolloca, asofedi- ta, Saussurea lappa, Areca catechu, car damom, nutmeg, and clove are often found in Ling disorder medications.> Swertia chivata, Saussurea lappa, and Berberis are commonly used in Tripa disor der formulas. Badkin disorders are com: monly treated with pomegranate seeds, Piper longum, black salt, cardamom, and cinnamon.> Commonly used ingredients for relevant Baidkén Mukpo disorders are Saussurea lappa, Emblica officinalis pomegranate seeds, cardamom, Piper longum, Veronica ciliata, ana calcite > Physical Therapies Other therapies may also be used if the 1 sufficient. They Massage. Massage is calming and pro- ‘motes good circulation. For cold condi- tions such as Liing and Baidken disorders, -massage oils should be heating in natuce, such as sesame oil or mustard oil. Tibetan acupuncture. Tibetan medicine has its own unique acupuncture system In addition to the application of needlesALTERNATIVE & COMPLEMENTARY THERAPIES—OCTOBER 1998 308 Herbs such as Aquilaria agollocha, asofedita, Saussurea lappa, Areca catechu, cardamom, nutmeg, and clove are often found in Liing disorder medications. Tibetan physicians also use moxibustion, which may be used in conditions such as Buin and Ling. Inhalation therapy. This modality is best illustrated by the medicinal use of incense formulated specifically to treat Ling con- ditions, When indicated, patients are pre- scribed such incense and asked to inhale the smoke as it diffuses into the air during times of the day when the Ling predomi- nates, such as in the late afternoon and before bedtime, Conclusion ‘The process of introducing new ideas regarding medicine and creating a new, integrative paradigm is already present in the history of Tibetan medicine. Centuries ago, before Buddhism entered Tibet, Tibetans like all ancient people had some degree of medical knowledge, According tofraditional sources, in the beginning of the fourth century many new ideas regarding medicine began to enter the country. At first influences came from India in the form of what is now called Ayurvedic medicine, as well as more spir- itual and psychologic systems from Bud- hist and other sources. Around the 7th to 8th century, government-sponsored conferences were held in Tibet, where doctors skilled in the medical systems of China, Persia, India, and Greece came to present and debate their ideas on health and the treatment of illness. Those with superior abilities were invited to stay and contribute to the country’s medical knowledge base. It was not until the 11¢h century that this knowledge was integrat- ed into a unified system. This system con- tained a synergy of various principles of physical and psychologic medicine imbued with a spiritual understanding, For the past 30 years the American peo- pple have said that the medical system that Jas dominated this country for most ofthis century is wot wholly adequate. The recent explosion of interest in alternatives in health care from allopathic doctors, researchers, the government, and industry creates two possibilities. One is a renais- sance atmosphere in which doctors, researchers, andl independent practitioners ‘of natural medicine meet on equal ground, freely exchanging ideas, experience, and knowledge and thereby creating great ben- efit for patients, The other is evidenced by the new presence of people in the health care industry who are seeking to co-opt and, contol this renaissance through profession- al, politcal, legal, and commercial means. People rust learn to negotiate the land- scape of alternative health modalities However, Americans need a better under- standing of the theory and practice of these disciplines before thelr efficacies can be truly understood. When understanding is achieved, Americans can gain benefit from Tibetan medicine's insights into how to maintain health and cure illness, based ‘on centuries of accumulated knowledge of ‘the spiritual, ecological, psychologic, and physical aspects of health Given the speed of covelopments in the :modern world, it will probably not take us the seven centuries the Tibetans utilized to create a new paradigm of integrative ‘medicine. However, we must not allow the agenda to be set by the rapid pace of economics and technology that has nega~ tively affected our American health care system. The above material is an illustra~ tive example of how diagnoses can be understood across two disciplines. Addi tional dialogue is required to explain the meaning of basie concepts such as “blood quality,” “slow metabolism.” or “sweet taste” in Tibetan medical terms. More work needs to be done 10 create a lan- ‘guage that allows fox clear and construc- tive dialogue between systems Practitioners of natural medicine need to become more sophisticated in the lan~ guage of allopathic medicine rather than. using it as an inaccurate convealence or 28 ‘way to pass in the health care system Allopathic physicians and researchers need truly to understand the approach of natural medicine rather than seeing itas a collection of therapeutic devices that can be cut and pasted into the existing paradige, When this work is fully accom- plished, we can reach a point where dif- ferent systems of medicine can act independently or in a complementary fashion where appropriate for 2 patient's condition, Once freed from the dangers of hegemony and dedicated to equality, “complementary medicine” will Fulfil it: promise in broadening American health care a References 1. Lynn, RB, Freeman, LS. Irritable bowel syndrome, In: Fanci, AS, et al. (eds), Harr ‘S's Principles of ternal Medicine, Ath edition, [New York: MeGraw-Hil, 1998, pp. 1616-1688 2.Glanze, W., etal. The Mosby Medical Encylo pedis Neve York: Penguin Books, 192, p. «33 3. Heuman, D, Mill, A, McGuire, H,Gostoen- ‘ergy. Piladelpaia: WB, Sasoders, 1997, pp. a 4. LaMont, T, sselbacher, KJ. Initable bowel syndrome. Tn: Isselbacher, KJ, etal. (eds), Harrison's Principles of Internal Medicine, 130h ‘edition, New York: MeGravs-Hill, 194, pp. 21-422, 5. Tearong, TJ. Handbook of Traitionat Tieton Drugs: Their Nomenclatre, Composition, Use and Dosage. Kalimpong, India: Tibetan Medical Publications, 1985, pp. I-88. Bliot Tokar is a New York City-based practs luoner of traditional Asian medicine, Ariana ‘Vora was the 1997-1998 National Coordina- torof the American Medical Student Associa- tion's National Froject on Complementary and Alternative Medicine. She is carzently 3 Student at Mt Sinai School of Medicine, New York, New York.