Asian Medicine and Mental Health Care
How biomedicine and Asian systems of medicine can benefit from one another.
Posted Oct 23, 2019
The confluence of Western biomedicine and Asian medicine
Traditional Tibetan medicine (in Tibetan ‘Sowa Rigpa’ 'the science of healing'), Ayurveda (the traditional medicine of India), and Chinese medicine are coherent, highly evolved, sophisticated Asian systems of medicine that have been refined over millennia and (in some cases) empirically validated by Western-style research studies. Traditional Asian healing practices are widely used in their parent cultures for maintaining wellness and treating illness, and are being increasingly used in Western countries. Accumulating research findings support that Asian medical treatments including acupuncture, herbal formulas, and energetic approaches are generally well tolerated and that select herbal formulas consistently result in symptomatic improvement of depressed mood, anxiety and schizophrenia.
This post is offered as a brief overview of the strengths and limitations of Asian medicine and biomedicine focusing on mental health care. In-depth reviews of the three major Asian systems of medicine: Tibetan medicine, Ayurveda, and Chinese medicine (also called ‘traditional Chinese medicine’), with respect to mental health care can be found in Millard (2013) (see full reference below), Aung (2013) and Prathikanti (2007) (see full reference below).
Western biomedicine and Asian medicine are based on disparate assumptions
Biomedicine is the dominant model of health and illness in Western culture. Biomedicine equates health and sickness with normal and abnormal biological functioning, respectively, and assumes that symptoms reflect dysregulation in biological processes in the human body. Following this logic, biomedical psychiatry holds that mental health problems can be adequately explained by dysregulation of neurochemical processes in the brain.
In contrast to biomedicine, Tibetan medicine, Ayurveda and Chinese medicine rest on fundamentally different assumptions about the nature of the human body, the role of consciousness in healing, and the influences of biological, psychological or postulated ‘energetic’ factors on health and illness. Advances in functional brain imaging including functional magnetic resonance imaging (fMRI), quantitative electroencephalography (QEEG) and positron emission tomography (PET) may eventually permit researchers to empirically test claims of energy healing techniques used in Asian medicine. Quantum mechanics (QM) and complex systems theory are yielding novel conceptual frameworks that may eventually help explain mechanisms underlying some complementary and alternative medicine (CAM) treatments including ‘energy’ medicine.
The widespread use of Asian medicine in Western countries: prospects and challenges
After decades of widespread use of Chinese medicine and Ayurveda, and rapidly increasing popularity of traditional Tibetan medicine in Russia and many European countries, there is still a paucity of reliable information on which herbals and prescription medications may be safely combined avoiding toxic interactions. However, practitioners trained in biomedicine and Asian systems of medicine acknowledge the unacceptable risks associated with combining select herbals and prescription medications, for example, the herbal Ma huang (Ephedra sinica) which contains ephedrine, and antidepressants or blood pressure medications. Combinations of Ma huang and these medications can result in serious and potentially fatal consequences. Even less is known about the potential risks of combining prescription medications with herbal treatments used in Tibetan medicine and Ayurveda.
A review of pharmacologic studies of Chinese herbal formulas used to treat mental health problems (which are often similar to herbal formulas used in Ayurveda and Tibetan medicine) found that Western psychopharmacology and herbal formulas used to treat mental illness rest on mechanisms of action involving the same neurotransmitters including serotonin, norepinephrine, GABA and others (Shorter 2013). Relatively few human clinical trials have been done. Placebo-controlled studies are needed to confirm the safety and efficacy of combinations of particular herbal formulas and psychotropic medications for specific psychiatric disorders. In view of the limited information on safe and appropriate combinations of herbals and psychotropic medications, it is prudent to always err on the side of caution and to avoid particular combinations that could potentially result in toxicity.
Many individuals in Western countries and Asia receive both Western biomedical therapies and Asian medical treatments for medical and mental health problems. In industrialized countries, the majority of individuals who seek treatment from a practitioner of Asian medicine have already been diagnosed by a Western-trained physician, and many are taking prescription medications for one or more medical or mental health problems. Individuals who are being treated by a practitioner of Asian medicine seldom disclose this information to their Western-trained medical practitioner who is treating them for the same problem. By the same token, the majority of individuals who are taking medication or other biomedical treatment on the advice of a physician do not disclose this information to a practitioner of Asian medicine treating them concurrently. Nondisclosure of treatment information may lead to potentially serious safety concerns when combinations of medications and herbals result in toxic interactions.
Western biomedicine and Asian medicine have different strengths and limitations
Treatments used in Asian medicine and in Western biomedicine have beneficial effects and adverse effects. In North America, Europe, the United Kingdom and Australia, where both Asian medicine and biomedicine are widely used patients choose treatments based on perceptions of comparative effectiveness, convenience, cost and adverse effects (Lam 2001). Biomedicine rests on diagnostic technologies that guide research and clinical decision making including laboratory tests of the blood and urine, functional magnetic resonance imaging (fMRI) and other functional brain imaging technologies, and the genetic analysis of the causes of disease. In contrast, Asian systems of medicine rely on traditional diagnostic approaches that require extensive training and decades of practice to master including taking the energetic pulse, analysis of subtle findings in the physical appearance of the tongue and eyes, and other techniques that cannot be reduced to empirical methods. For the most part, treatments used in biomedicine have more potent and more rapid effects than Asian herbal medicines, acupuncture, and other treatment modalities.
While often safe and efficacious, Western medications may cause adverse effects. For example, widely prescribed antidepressants, antipsychotics, and other psychotropic medications are associated with a variety of adverse effects. In some cases, the risks associated with psychotropic agents may outweigh their potential benefits. Examples include antidepressants that often interfere with normal sexual function, cause weight gain; and so-called atypical antipsychotics like risperidone, quetiapine, clozapine, olanzapine, and ziprasidone. Long-term use of antipsychotics may result in debilitating permanent movement disorders, life-threatening cardiac arrhythmias, and toxic metabolic syndromes that increase the risk of obesity and diabetes.
Unlike Asian systems of medicine, around-the-clock services are available to individuals seeking urgent care in Western hospitals and emergency rooms. Urgent access to care is especially important for individuals with severe mental illnesses who may require rapid stabilization and hospitalization for their safety. In cases of severe mental illness, it is often prudent to start treatment with potent prescription medication and, when there is a question of suicide risk, to undergo urgent evaluation at the nearest emergency room. After symptoms of severe mental illness have responded to a psychotropic medication it may be appropriate to try an Asian medical treatment including herbal formulas, acupuncture or others, when there is evidence of both efficacy and safety for the particular treatment(s) being considered. There is a growing body of research evidence on herbal formulas used in Chinese medicine and Ayurveda to successfully treat neuropsychiatric disorders including depressed mood, schizophrenia and neurodegenerative disorders (Ven Murthy 2010).
An important attribute of Asian systems of medicine is the availability of disparate therapies that result in a series of responses ranging from subtle effects with few or no adverse effects, to more potent therapies resulting in marked physiological or energetic changes that may have more frequent or more serious adverse effects. The same general principle is also at the heart of conventional Western biomedicine which has the parallel goal of achieving an adequate therapeutic response via the safest available interventions addressing a postulated disease-causing agent. This principle is embodied in a fundamental principle of biomedicine, Primum non nocere (first do no harm) which warns physicians against using interventions for which the potential risk may outweigh likely benefits.
All Asian healing traditions are patient-centered and when practiced according to traditional principles each patient receives treatments that address the unique imbalances that manifest as physical, mental or emotional symptoms. Highly individualized person-centered approaches used to assess and treat symptoms in Asian healing traditions are performed to ensure a close match between the underlying causes of symptoms and the effects of treatments at various levels of body and mind. Western-trained physicians use an approach that is analogous. For example, when a skillful and experienced Western-trained physician or Asian medical practitioner arrives at an appropriate treatment choice, he or she has identified a close match between a specific treatment and postulated biological or energetic causes underlying symptoms. Finding the best match between putative biological or energetic causes of symptoms and the most appropriate biomedical or Asian medical intervention will ideally result in few or no adverse effects.
When skillfully administered 'external' therapies such as acupuncture, energetic massage and somatic therapies practiced in traditional Tibetan medicine (i.e. “Sowa Rigpa”), Ayurveda and Chinese medicine are seldom associated with adverse effects. In contrast to such ‘external’ therapies, herbal formulas may carry a significant risk of adverse effects however the majority of herbal formulas used in Asian healing traditions are compounded from unrefined herbal materials or other natural products and have limited physiological potency and are hence associated with relatively little risk of severe adverse effects. Further, Asian herbal formulas are typically prescribed on an individual basis reflecting each patient’s unique energetic constitutional pattern. All of these factors result in few adverse effects when Asian herbal formulas are prescribed by skilled medical practitioners.
Restoring balance is a central concept in both Western biomedicine and Asian medicine
The belief that good health is a reflection of harmony is embedded in many World healing traditions and is an easy concept for non-Asians to grasp. Unlike biomedicine Asian systems of medicine treat the whole person not a particular symptom, organ or illness condition based on the concept that the body is an integrated whole, and that the core causes of illness can only be eliminated when the entire organism is restored to a healthy state of harmony with nature. In contrast to biomedicine which uses highly technical language to convey information to patients, Asian systems of medicine rely on metaphors referring to energy that are easy to understand and help patients visualize a disease process or the health-promoting benefits of treatment. In Asian systems of medicine illness is a manifestation of loss of energetic harmony between oneself and the world.
According to this metaphor curing illness entails making changes in lifestyle or taking treatments that restore life to its natural state of harmony or balance with the universe. Treatments used in both Western biomedicine and Asian medicine restore balance when skillfully administered by a trained clinician but may also cause pathological imbalances and adverse effects when applied erroneously or by a poorly trained or unskilled practitioner. In traditional Tibetan medical theory “wind” is an important metaphor used to describe the energetic principle of ‘rlung’ related to disorders of ‘balance’ or harmony that manifest as physical, emotional and cognitive symptoms (Yoeli-Tlalim 2010). According to the Rgyud bzhi (“Four Tantras” authored in the 12th century AD, is the basis of Tibetan medicine) depending on the particular causes involved, disorders of ‘wind’ can manifest as a wide range of neuromuscular and psychosomatic disorders including the ‘life-wind illnesses,’ syndromes that resemble depressed mood, panic disorder, generalized anxiety (Jacobsen 2007) (see full reference below).
Increasing acceptance of Asian systems of medicine in Western countries is resulting from research progress elucidating the mechanisms of action of herbal formulas at the level of neurotransmitters. In parallel with this trend, Asian medical practitioners are increasingly using Western biomedical interventions to augment the beneficial effects of Asian medical treatments both for promoting optimal wellness and for treating particular mental health problems. These trends will continue and lead to more holistic and integrative approaches to diagnosing, treating and preventing mental illness taking into account the strengths and limitations of Western biomedicine and Asian medicine. Large placebo-controlled studies are needed to further characterize the safety, efficacy claims, and optimal dosing of specific herbal formulas and other Asian medical treatments of mental health problems.
Lhundup, T., and Lake, J. "Integrating Asian Healing Traditions Into Biomedicine," Ch 8, pp. 97-112, in (eds Moodley, Lo & Zhu) Asian Healing Traditions in Counseling and Psychotherapy, Sage, 2018.
Chinese Medical Psychiatry: A Textbook & Clinical Manual : Including Indications for Referral to Western Medical Services, Lake, J. & Flaws, B., Blue Poppy Press, 2000.
Millard, C. Tibetan medicine and the classification and treatment of mental illness, The Journal of Traditional Tibetan Medicine, No. 5 pp. 8-15, 2013.
Jacobson E. 'Life-wind illness' in Tibetan medicine: depression, generalized anxiety and panic attack. In Soundings in Tibetan Medicine: Anthropological and Historical Perspectives. Mona Schrempf (ed.) Proceedings of the Tenth International Association for Tibetan Studies, Oxford, 2003. Charles Ramble (series ed.). Leiden: Brill. 2007.
Pratikanti, S. Ch 10 Ayurvedic treatments, pp. 225-272 in Complementary and Alternative Treatments in Mental Health Care, Eds. Lake, J. & Spiegel, D, American Psychiatric Publishing, Inc., Washington D.C., 2007