Complementary Medicine: A User's Guide
Before the advent of modern science, traditional systems of medicine made healing available to the world population, with an often surprising degree of sophistication. Forms of surgery were practiced thousands of years ago in Africa and India. Although such procedures did not rival organ transplants, history argues against dismissal of traditional medicine as primitive. Some of the ancient systems, notably Traditional Chinese Medicine, Ayurveda, and Tibetan Medicine, remain intact and available today. Even in present-day New York City, there are populations in which traditional ways have never fallen out of favor.
Currently there is an unprecedented interest in both these comprehensive traditional systems -- traditional here meaning rooted far back in different cultures, not "conventional" as in modern Western practices -- and in therapies such as massage and aromatherapy that have left their traditional roots and stand alone in today's health care supermarket.
The array of complementary therapies (sometimes called "natural" therapies) is vast, unsystematized, and largely without regulation. Nonetheless, these treatments carry a widening appeal and, especially in the face of chronic illness, merit investigation by both consumers and medical professionals. Although science has made great strides in managing HIV, the epidemic has also highlighted the limits of high-tech medicine. Complementary therapies aim not for cure but for healing; not fixing, but improved well-being.
Traditional approaches can address quality of life and prevention of opportunistic infections, as well as relieve end-of-life suffering. Perhaps most importantly, they usually involve a quality of interaction between caregiver and client that is emotionally satisfying to both, and which engages people in their own care. Patients who are actively involved in their healing often enjoy better outcomes.
From a traditional perspective, health is a state of dynamic balance. Maintained in this state, the body is in the strongest position to carry the burden of infection and process side effects of necessary medications. Each person has a unique state of balance, one that includes all aspects of being and is constantly affected by internal and external conditions. Because the balance is overall, the treatment approach must be holistic and individualized. There is no one-size-fits-all approach in traditional medicines. Treatment plans are customized and then adjusted over time.
What are the cautions in using complementary therapies? Opinions vary. The highly individual treatment plans used for many natural therapies make it difficult to scientifically document their benefit. Many people with HIV don't feel the need to wait for the results of research that may never be done, and turn readily to the comfort and support provided by traditional therapies. Consulting a physician may not be helpful, as doctors frequently are unfamiliar with natural treatments.
Toxicity must always be considered, but is not a great danger with traditional therapies. Deaths linked to herbs are extremely rare and usually attributable to wrong usage. The best protection lies in being an informed consumer, engaging one's primary physician in a discussion of one's options, and using common sense.
Reductionism vs. Holism
In preparing oneself to use complementary therapies, it's wise to start with an appreciation of holism, the underlying philosophy of all traditional medicine. Holistic approaches from all traditions share several perspectives:
Whereas scientific medicine reduces the body to separate pieces attended to by specialists (reductionist philosophy), each traditional therapy addresses the entirety of a person's being (holistic philosophy). A complementary therapist is a specialist in taking care of a whole person with a particular technique (such as reflexology or homeopathy) or system of techniques (such as Traditional Chinese Medicine and Ayurveda). Strictly speaking, holistic therapies do not address side effects or specific symptoms separate from the whole person. Two people may have identical symptoms for different reasons. Each person is evaluated and treated as an individual.
At its best, holism extends into the person's environment and relationships, including that between practitioner/teacher and client/student. In evaluating a client's nutrition, for example, a nutrition specialist would limit his attention to what the client is eating. By contrast, a truly holistic practitioner would also discuss how, when and with whom -- the entire emotional/social/spiritual climate of nurturance.
Holistic practitioners of any modality value the quality of the practitioner/client relationship as a powerful ally in healing. They do not separate themselves from the client with an authoritarian manner, but rather create a safe, nurturant space with clear expectations and parameters in which all participants can grow. Such a relationship sees the practitioner and client working together for a common goal, empowering the patient as co-healer. Being a holistic practitioner is as much about manner as modalities. Herbalist Tieraona Low Dog, MD, medical director for the Treehouse Center, a primary care facility in Albuquerque, NM, says, "The most holistic physician I know doesn't do anything alternative."
Categories of Complementary Therapies
Empowered patients can organize a holistic approach to their health care without piling up a stack of practitioners or going off their budget. Although the field of complementary therapies is vast and unorganized, one can make sense of it by simply identifying all the areas of self-care that contribute to well-being.
Natural therapies offer people many opportunities to engage in their healing on a daily basis. Everyone can combine professional care and self-care to create a complementary "cocktail" that meets one's own needs and lifestyle. Educating oneself about the options is the first step. What follows is an overview of the different categories of complementary care and how they work together to contribute to overall physical and emotional wellness.
Food and Nurturance
Everyone's nutritional needs are different, and change constantly. There simply is no one diet that is right for everyone all the time. There are also seasonal considerations -- we tend to eat lighter foods in the summer and well-cooked stews in winter, for example.
Ayurveda, the traditional medicine of the Indian subcontinent, includes skills for identifying individual needs. Students come to understand how to use foods in a balanced way, and to appreciate the value of eating in a relaxed, peaceful setting. Although some people find rigid diets a relief from the confusion of choice, most do better with some flexibility around eating. Foods freshly prepared, especially by oneself or a loved one, are most nourishing both physically and energetically.
Nutritional supplements are often misidentified as complementary medicine. Supplements, "designer foods," and power bars with their RDA listings are more closely aligned with a scientific rather than holistic approach.
Eating is a difficult behavior to modify, but changes can be beneficial. Pacing is important. Start by avoiding or minimizing unhealthful food, substituting with something both healthful and appealing because the pleasure of eating is part of the nourishment. Chewing is the beginning of digestion. Food that is swallowed whole, taken on the run, is likely to cause digestive upset, especially in a body compromised by HIV.
Herbs can be a useful addition to one's nutrition. Many Western herbs are considered nutritive rather than medicinal, and can be easily integrated into the diet. With few exceptions, it is preferable to use whole herbs from a reliable source, either raw or in tincture (an alcohol dilution), rather than standardized extracts of the active ingredient. It is not simply the active ingredient but all the ingredients that account for the herb's effect, with the non-active ones often helping to balance the active.
Dr. Vasant Lad, director of the Ayurvedic Institute in Albuquerque, NM, and the leading exponent of Ayurveda in America, cautions that extracting active ingredients moves the product closer to a drug (an estimated 50 percent of conventional medicines are derived from botanicals) and invites side effects. There is the further danger that science may not have accurately identified the active ingredient. For example, it was long thought that the active ingredient in St. John's Wort, a common remedy for depression, was hypericin. It is now believed that the active ingredient is hyperforin.
Traditional Chinese Medicine (TCM) offers many useful products. Unlike Western herbs, which may be used singly or in combinations, Chinese herbs are generally combined. Both Chinese and Western herbalists follow nature's lead when combining, choosing herbs that support and balance one another, thereby minimizing the potential for toxicity. TCM has introduced America to adaptogens (herbs that normalize the body's functions) such as ginseng and astragalus, and immuno-stimulating mushrooms such as reishi and cordyceps, which can be added to food or taken as supplements.
Ayurveda also uses rejuvenative herbs and foods, notes Scott Gerson, MD, who practices Ayurveda in New York City. Although Gerson stresses that Ayurvedic treatment is most effective when individualized, many people may benefit from using herbs to support various systems in the body, such as gingko or cayenne for the circulatory system and red clover or yellow dock root for the blood and lymph. Milk thistle is supportive to the liver. In addition, Gerson says, chywan prash is a deeply nourishing, rejuvenative Ayurvedic jam of Indian gooseberry and other herbs and fruit that can be eaten daily and used indefinitely. Consult a qualified herbalist whenever possible.
Breathing and Subtle Energies
Fortunately, no one has to remember to breathe. Or do they? According to John Douillard, author of Body, Mind and Sport, and owner of Lifespa, an Ayurvedic clinic in Boulder, CO, people frequently breathe through the mouth, taking shallow, emergency breaths that keep the body and mind agitated. Remembering to breathe through the nose calms the body and mind and better oxygenates the blood. Hatha yoga, a branch of Ayurveda, offers a number of breathing techniques called pranayama. Some can be mastered through reading, others are best learned at yoga class.
TCM takes a similar view towards breathing. According to New York City-based Master Yu Wen Ru, who teaches t'ai chi and qi gong (two Chinese practices for manipulating subtle energy), the benefits of practice and therapy can be easily lost in improper mouth breathing because harmful energy (or chi as it is called in Chinese) enters more easily through the mouth than through the nose. The state of the breath directly affects one's state of mind. Pausing to take a few conscious breaths throughout the day effectively reduces stress, bringing one back to center.
Watching the breath opens one to an awareness of subtle energies. TCM diagnosis evaluates the circulation of an individual's chi. Acupuncture, acupressure (shiatsu), or qi gong (energy healing) may be used to move chi that is stuck, and to facilitate the flow of chi to undernourished organ systems.
Reiki is a low-tech form of energy balancing facilitated through light touch that people can easily learn to do on themselves, or receive in treatment. Because it is completely non-invasive, Reiki is especially useful for those who are very sensitive or traumatized. Practiced regularly, its stress-reducing benefits support recovery from substance abuse.
Margo Davis practices Reiki in New York at Gay Men's Health Crisis (GMHC), an AIDS services organization, and at the HIV/AIDS Center of St. Luke's-Roosevelt Hospital. "Students go through a remarkable transformation over the four sessions of the Reiki training," she says, "as they realize they now have a tool to help themselves whenever they are anxious or in pain."
Homeopathy and Flower Essences
Homeopathy is a system of natural healing that mines the subtle energies of natural substances. A classical homeopath chooses one remedy at a time to slowly release the subtle imbalances underlying physical disease. It is especially useful for emotional, mental and behavioral patterns that are difficult to address with standard medicine. Homeopathy can also be used at home to address daily disturbances. Although remedies are believed to be non-toxic, it is wise to restrict self-treatment to low potencies.
Edward Bach (1886-1936), a British physician, developed the first system of flower essences, now called Bach Flower Remedies, which are dilutions that are either squirted in the mouth or sipped in water. These subtle, non-toxic remedies are used primarily to address mental and emotional states. Because of their safety and simplicity of use, they are well-suited for self-help and for psychotherapy. In recent years, other systems of indigenous flower essences have been developed in the U.S. Both homeopathy and flower essences are deemed too subtle to interact adversely with prescription medicines.
Essential oils provide another gentle avenue for healing that can have surprising results. The volatile oils are extracted from plants through steam distillation or cold-pressing and can be used topically, generally in a carrier oil such as almond or grapeseed, or diffused through the air. Lavender and tea tree oils can usually be applied directly, but always start with a small amount to test potency. Aromatherapist Rose Bryant Bianco of Topical Solutions in Belleville, NJ, suggests testing the purity of oils by putting a drop on paper. Pure essential oils evaporate, leaving no trace. If there is an oil mark, the oil has been cut and should be identified as such. Always work with oils that appeal to you.
Bianco suggests lemon oil for home use because it is inexpensive (starting at $10 for half an ounce) and has a refreshing scent. Bianco markets an aromatherapy formula she created especially for HIV/AIDS. Mercedes Hnizdo, director of the Institute of Aromatherapy in Denville, NJ, notes that her clients have found essential oils useful in addressing symptoms like insomnia, muscle aches and pains, fatigue, fungal skin infections, depression and emotional disturbances such as anger, fear, and anxiety.
Considerable research supports what every mother knows -- touch is healing. The documented benefits of massage include muscular relaxation, increased circulation, lymphatic drainage, reduced blood pressure and heart rate. A recent study at the Touch Research Institute at the University of Miami revealed that HIV-positive adults who received a 45-minute massage five times a week for one month showed both a decrease in anxiety and depression and an increase in killer cell production and activity.
Massage is one modality that easily combines with other techniques, such as aromatherapy, to enhance the healing experience. Massage comes in many varieties to meet the needs and preferences of the client. Some people are drawn to open-hand, soothing Swedish massage. Others need the intensity of deep tissue work to release tension. Rolfing, or structural integration, is a kind of massage that releases not only current tension but also habitual patterns of holding stress in the body. Such realignment can support on a structural level the type of improved energetic circulation stimulated by acupuncture or shiatsu and create greater ease of movement.
If there are medical reasons why a full body massage is not advisable, massage of the hands and feet (reflexology) can be both soothing and stimulating to the entire body. Cranial sacral manipulation, done gently with the hands, is subtle and focuses on removing obstructions to the flow of cerebral-spinal fluid. Ayurvedic marma point therapy gently stimulates 108 vital points on the body that are seen as the juncture between consciousness and matter. Ayurveda also teaches a simple practice of self-massage with sesame oil that helps move toxins out of the joints so that the body can eliminate them.
The human body needs to move. Movement is pleasurable, stress-reducing, stimulating to the cardiovascular and lymphatic systems, and strengthening. Research shows t'ai chi improves balance in seniors, reducing the likelihood of falling. Dr. James Gordon, author of Manifesto for a New Medicine and an early practitioner of complementary medicine, encourages his patients to just turn on some music and dance. Walking is one of the most beneficial and accessible forms of movement.
Whereas it's true that life is more difficult when one lacks physical strength, and it's easier to feel courage when the body is strong, Asian practitioners find it perplexing that Westerners readily equate muscles with health. Dr. Lad explains that each type of body tissue is for a particular use; over-stimulating any one of them is unbalancing. The overall approach to movement and exercise is important. The "no pain, no gain" attitude that dominated fitness since the aerobic revolution 20 years ago is now considered debilitating, while moderate exercise seems more conducive to long-term well-being.
Ayurvedic practitioners recommend exercising to half one's capacity. In his book Body, Mind, and Sport, John Douillard explores the relevance of ancient guidelines for modern health, and stresses the importance of keeping exertion at the level where one can still nose-breathe. Although nose-breathing means slowing down initially, it will overhaul the cardiovascular system. Typically, performance levels return and often rise a few months.
Hatha yoga is very popular among people with HIV for its therapeutic and strengthening effects. Many studios offer HIV classes at reduced fees. Iyengar yoga has a specific series of postures for HIV, including more backbends and upside-down positions to stimulate the immune system. James Murphy is a New York City Iyengar instructor with many years' experience teaching yoga to people with HIV. His advice? "Be intelligent and be careful. Anyone can hurt themselves doing anything." But that doesn't mean avoiding class when feeling under the weather. According to Murphy, "Students can still practice yoga when they're not feeling up to par. Use quiet poses to rejuvenate, restore, and stimulate the body and mind."
Instructors agree that people with HIV need not attend an HIV-specific yoga class. It's more important to be in a group small enough for individual monitoring with an experienced teacher sensitive to each person's needs. Paula Macali, an independent yoga instructor in New York City who has taught at St. Luke's-Roosevelt Hospital HIV/AIDS Center, notes, "We always need to work with the individual. It's the teacher's responsibility to know what is appropriate and what is not. Beware of classes that are so large that students are not getting enough individual attention."
Texas-based yoga teacher John Friend, who has worked with people with HIV for years, practices a style called Anusara yoga -- an open-hearted approach based on universal principles of alignment. His students receive detailed training intherapeutic uses of yoga.
Labyrinths offer an opportunity to walk slowly and contemplatively through a fixed path either drawn on the floor or created three-dimensionally in nature. Wayne London, MD, of Brattleboro, VT, theorizes that walking a labyrinth may be a healing metaphor that subtly reorders one's being. Labyrinth walking accommodates privacy issues. As Elizabeth McGowan, a New York City labyrinth artist, says, "When people come to walk, no one asks them why." Tracing a hand labyrinth with one's finger or the eye has similar centering effects, and may be used to lower stress or begin a therapy session.
The therapeutic value of self-expression is often overlooked. Expressing oneself through words or art gives form to one's feelings, allowing for release, revelation, and re-evaluation. Artistic self-expression strengthens one's identity as a creator, builds confidence in problem-solving, and brings a sense of satisfaction. No talent? Can't draw? Put aside the critic, photocopy family pictures, cut and arrange into a collage. Embellish with rubber stamps colored with brush markers, and voila! A home course in art therapy!
Then there's writing therapy. A 1996-7 study by Dr. Joshua Smyth, an assistant professor of psychology at North Dakota State University, showed that arthritis and asthma sufferers had significant long-term improvement from short periods of writing about an upsetting life experience. Louise de Salvo, professor of English at New York City's Hunter College and author of Writing as a Way of Healing, underlines the importance of linking details of the event with the emotions that accompanied them; dwelling on one or the other alone is not therapeutic. Writing in this way may excavate hidden feelings. Those under professional care should enlist the guidance of their therapist and explore the possibility of group writing.
Healing traditions around the world often involved groups of people in ways that anticipated modern group therapies. Today, considerable research (much of it documented in the book Love and Survival by Dean Ornish) suggests that strong social support improves medical outcomes. People who have partners or a strong social network are less likely to succumb to illness, and recover more quickly when they do. Addressing family issues can be crucial in maintaining health. Dr. Wendee Schildhaus, PhD, a therapist who works in the New York area with both traditional and unconventional family units dealing with illness, notes that there are still many secrecy issues associated with HIV, and that many people let shame isolate them, cutting them off from the possibility of family support. Schildhaus cautions, "Keeping the secret may be worse than telling."
Our environment impacts our well-being in ways that may not be readily apparent. Asian approaches examine energy flow in the environment as well as in the body. Feng shui (the Chinese art of arranging both interior and outside spaces for maximum flow and harmony) is best known, but the therapeutic advantage of being in harmony with one's surroundings is widely recognized throughout Asia, where practitioners advocate placing small water fountains or even pictures of water or nature in the home. Modern research also validates the healing benefits of nature.
The Tamarand Foundation gathers talent and funds to create restorative gardens in HIV facilities such as the Joel Schnaper Memorial Garden on the roof of Terence Cardinal Cooke Health Care Center in Manhattan. Horticultural therapist Donna Arabian assists residents there in planting herbs familiar to them to make into medicinal teas or add to meals. Arabian encourages people with HIV to keep a plant on the windowsill. "It's empowering to care for something and be needed," she observes.
Possibilities for support do not end with friends, family and environment. The company of the mind often invades solitude with thoughts that are less than supportive. Why not cultivate the mind like a healing garden by "planting" thoughts from Henry Dreher's Immune Power Personality? This well-researched and engaging book offers both hope and skills to enhance immunity. Repeating affirmations may also be useful, as might writing personal affirmations and then imagining their realization in one's own life. Louise Hay's Healing Your Body A-Z is a classic in the field.
Guided imagery, which brings the imagination process into the visual realm, is another tool to engage the mind in the healing process, using pictures instead of words. The January-February 1999 issue of Oncology Nursing Forum printed an abstract of a study that found women with early stage breast cancer undergoing radiation therapy who used guided imagery had overall higher levels of comfort than those women in the control group. Pamela Murphy, MD, of Cleveland, Ohio, finds that the HIV-positive teens in her practice especially enjoy guided imagery.
Traditional African medicine recognizes spiritual growth as essential for healing. Charles Finch, MD, director of international health at Morehouse School of Medicine, Atlanta, GA, who has worked with traditional African healers for many years, explains that in traditional African healing, "the psycho-spiritual dimensions of illness have to be managed before health is restored. Empirical methods are used, but at the service of the psycho-spiritual."
Richard Elion, MD, in private practice in Washington, D.C., views spirituality as "the sense of connectedness with self and the world around you." There are many ways to connect with one's spirituality, such as meditation, prayer, contemplation, silence, chanting, service, worship, ritual, acknowledgement, gratitude. One can choose according to one's temperament. Daily practice is most beneficial, but any time spent in reflection will increase self-awareness and uncover inner strengths.
Natural healing offers much to enhance day-to-day self-care, which often improves patients' attitude towards their medications. "At first, I went for complementary therapies because I didn't get help from [Western] medicine," says Sonia, a New Yorker with HIV, whose embrace of natural remedies helped improve her relationship with both combination therapy and her primary care doctor. She continues to do Reiki everyday, receives weekly acupuncture treatments and takes yoga at the Iyengar Yoga Center in downtown Manhattan. "I feel really well supported by all the things that I'm doing," she says. "I know I', doing the best I can."
This article was provided by AIDS Community Research Initiative of America. It is a part of the publication CRIA Update. Visit ACRIA's website to find out more about their activities, publications and services.