Prevention, i.e., the avoidance of causes and the strengthening of patients’ self-efficacy.
Balancing methods, i.e., nutritional, organizational, and phytotherapeutic.
Channeling methods—via the intestine, the blood, or the nose—i.e., douches, enemas, or nasal applications. This also includes therapeutic vomiting, the use of leeches, and bloodletting. External excretions are stimulated by oil massages, Scotch hose treatments, sweat baths, rice poultices, or intensive manual therapies. In the Ayurvedic concept, surgery is also important and categorized as a channeling procedure.
Another independent area is spirituality. Ayurveda without spirituality, without a direct connection to meditation and yoga, is unimaginable. That is another asset, because numerous studies have proven that religious or spiritual entrenchment is accompanied by a better prognosis and better chances of recovery.7, 8, 9
In 2011, the Indian government established a database called DHARA (dharaonline.org), in which studies and reports of healing are collected and the results of earlier studies are documented. Ayurveda is not a simple healing model but a highly complex one. One also can’t allege that it is possible to get rich from it quickly. It’s an elaborate therapy, from the pharmacological production of the medications to the intensive personal care of the treatments.
This may pose a challenge in the future. When the number of studies on the positive effects of Ayurveda grow, our healthcare system will have to discuss whether the costs for Ayurvedic treatments will be absorbed by health insurance companies, and if there are cheaper alternatives (even if these cheaper alternatives may be subject to more side effects). For now, Ayurvedic therapies have to be paid for out of one’s own pocket—with one exception: Since our department for Ayurvedic medicine in Berlin is part of the Charité’s university hospital outpatient clinic, patients with public health insurance can use the opportunity to have Ayurvedic nutrition counseling.
Regarding the cleanliness of medicinal plants and phytotherapeutic preparations, I recommend buying Ayurvedic medicines and preparations only in pharmacies that carry out purity controls. Still, to be honest, it’s possible that even legitimate Indian manufacturers of medications deliver batches of heavily contaminated medication. This is due to the rasa shastra, a branch of Indian pharmacology in which small doses of heavy metals such as lead and mercury are used for therapeutic measures. In keeping with our Western knowledge, such a use cannot be approved of by any means.
THE PRINCIPLES OF AYURVEDA ARE UNIVERSAL
According to the principle of hormesis, it’s theoretically not to be ruled out that this negative opinion may be revised at some point, because even toxic substances in small doses can have positive effects. But that is pure speculation. At the moment it must be assumed that the administration of even small amounts of heavy metals can cause severe damage. What’s problematic is that some manufacturers aren’t separating the production areas and as a result, volatile mercury contaminates other medications. Additionally, the soil and the air in India (as in China) are heavily polluted by environmental toxins.
We advise our patients to use selected manufacturers with very strict controls. Beyond that, Christian Kessler and Elmar Stapelfeldt have developed concepts for substitution plant-based Indian medications based on a selection of foods and European spices. It’s also conceivable to choose selected European medicinal plants according to the teachings and the standards of Ayurveda in some recipes—because the principles of Ayurveda are universal. They can be adjusted for every form of nutrition and drug administration. It might even be more sensible for people of European origin to use European foods and plants, since our genetic code and our constitution are adapted to them. This would reinforce the recommendation to eat seasonally and locally (albeit with the disadvantage of not utilizing the potential and the ancient knowledge of Ayurveda to the fullest extent).
Ayurveda is a multimodal treatment method and medicinal system with an abundance of therapeutic details and a distinct focus on individualization that maximizes therapeutic success. Additionally, it possesses highly developed methods of pulse and tongue diagnosis.
We can all feel our heart rate in our chest and in our pulse. When we’re excited our hearts jump or race. There are countless proverbs that point out this experience of our heart. This is significantly different from all the other organs of the human body that do their work without us being able to feel it. We don’t notice our liver detoxing or our kidney producing urine, but we do feel our heart pumping blood into our lungs and limbs.
In Ayurveda as well as in Traditional Chinese Medicine the art of feeling the pulse plays a rather essential role. Not only is the speed of the pulse (pulse rate) evaluated, but also how voluminous, tense, soft, or hard the pulse feels. The wealth of knowledge on pulse diagnosis is astonishingly great, but until now, science has been unable to explain unambiguously how intricately these categories are actually connected to tangible diseases. It’s very easy to detect the fact that the pulse rate is subject to change for yourself. If you feel your pulse at the same time every day for several weeks, you’ll find out relatively quickly that it does indeed feel weaker or stronger some days, that it may at times seem tense or jumping. With some practice it won’t be hard to notice how this actually does relate to the condition of the body’s strength and health.
I for one am convinced that we shouldn’t underestimate the significance of this historically proven phenomenology despite all the euphoria for the rapid progress in epigenetics and molecular biology. It should be our goal to conserve the old—on a scientific basis—and apply it as part of modern concepts.
ACUPUNCTURE: SUCCESSFUL IN TREATING PAIN
Traditional Chinese Medicine encompasses a number of different therapeutic methods: diet, phytomedicine, massage (tuina), meditative movement patterns like qigong and tai chi. In the West, it’s predominantly acupuncture (from the Latin acus meaning “needle,” and pungere meaning “to jab”) that has prevailed, which doesn’t actually play an essential part in China itself. But since it’s the method whose complexity was most easily reduced to Western understanding, it has firmly situated itself in medicine and is now employed by many European physicians. It is that method of complementary medicine that has been researched in the best and most extensive manner.
The starting point for this development was President Richard Nixon’s state visit to China in 1972. An accompanying reporter from the New York Times, James Reston, had to undergo an appendectomy there. He was subsequently treated with nothing but acupuncture and was able to avoid pain medication completely, an experience he described enthusiastically. His reportage made its way around the globe and awoke the international interest in acupuncture. By now we know that acupuncture can indeed be an excellent way to treat pain.
The largest worldwide studies on acupuncture were conducted in Germany. Thousands of patients with different pain disorders were treated with acupuncture in precisely predetermined settings at the Charité Hospital and the Ruhr-University in Bochum. The effect was then compared in sophisticated clinical studies—to pain medication, but also to feigned acupuncture (where, unnoticed by the patients, the needle was not inserted), or to minimal acupuncture (where the needle penetrated the skin, but not at the traditional acupuncture points). This was designed to clarify whether the pricking with needles didn’t simply have a great placebo effect.
The results of the studies proved two things very clearly: First, that acupuncture relieves pain very well in many pain disorders, for example in chronic lumbar back pains, neck pain, shoulder pain, but also in pain caused by arthrosis, headaches, and migraines, or a neuropathy (disorders of the nervous system). Second, that the effect consists of two components, a specific effect that is actually achieved by the precise pricking at the traditional acupuncture points, and the psychological effect of the treatment situation, the ritual and the penetration of the skin wherein the traditional ac
upuncture points are no longer relevant.10, 11, 12, 13 The results were so convincing, particularly where back pain and arthrosis of the knees were concerned, that ever since then, the costs for acupuncture treatment have been absorbed by health insurance companies in these cases.
Still, the studies were unable to explain how and why acupuncture is effective. That acupuncture also achieves effects when the traditional points aren’t stimulated was taken as evidence by critics that it’s just a placebo therapy after all. The supporters pointed out the overall excellent treatment successes. For example, supplementary acupuncture was compared to the standard treatment by GPs and orthopedists—patients who had received acupuncture were doing significantly better. And in my opinion, that’s what counts first and foremost.
The studies taught us doctors that things can’t be simplified too much. Part of the effect of acupuncture is created by trust in the therapist, by the atmosphere of care and calm in the treatment situation—just as it is in every doctor-patient relationship. Another part is created by the pricking of the needle itself. This can have an effect on all the organs in the body. Every student of medicine knows the so-called Head’s zones, skin areas each body possesses. Each of these zones is supplied by a nerve. This nerve enters the spinal marrow at the spine and sends nerve signals to the brain. Since that’s where nerve signals from the inner organs also arrive, there is a direct contact between our outer skin nerves and the internal nerves of the organs and the connective tissue. That’s why the stimulus of an acupuncture needle can cause an effect in the deeper layers of the connective tissue and even in the inner organs. The Head’s zones are broader than the narrow meridians described by Traditional Chinese Medicine. So, it is not surprising that the acupuncture needle doesn’t have to be placed accurate to the millimeter to have an effect.
Beyond that, however, there are also very precise, point-specific effects. According to the data derived from the largest study on acupuncture so far, the Acupuncture Trialists’ Collaboration with more than twenty thousand subjects, this point-specific effect constitutes about a third of the overall effect.14 To understand this, we don’t necessarily have to accept meridians or chi as a concept. There are enough special trigger points or receptors in our fasciae on an anatomic basis that are very important for pain to develop and that show very strong consistency with the traditional acupuncture points.
It would be interesting to know how people in ancient China came to this realization roughly three thousand years ago. The traditional concept of acupuncture is impressive with the sophistication of its detailed knowledge and its figurative language. It assumes that the energy necessary for life (qi) flows through the body along specific pathways (meridians). When the flow of energy is disrupted, for example by environmental influences like cold, warmth, air drafts, or incorrect diet, emotional strain, and overexertion, physical symptoms can develop. The flow of energy can be influenced in a therapeutic manner at more than seven hundred specific points (acupuncture points) through pressure (acupressure), warmth (moxibustion), or the jabbing with a needle (acupuncture).
Even though acupuncture’s specific mechanism of action has not yet been explained fully from a Western point of view, certain aspects are known. What has been observed are the increased release of pain-relieving endorphins, neurotransmitters, and tissue hormones which are conducive to relaxation. Furthermore, stimuli that have an effect inside the body are applied via the skin areas—just like a disease of the gallbladder can cause pain in the right shoulder blade, a classic phenomenon of internal medicine. That’s why acupuncture has been able to gain a foothold particularly in pain therapy.
But acupuncture can also be effective in the treatment of other diseases. In a methodologically sophisticated study, my colleague Benno Brinkhaus at the Charité Hospital randomly divided more than 420 patients with severe hay fever (seasonal allergic rhinitis) into three groups: The first received commonly used antihistaminic drugs if needed, the second received mock-acupuncture, and the third received point-specific acupuncture. All of the patients were allowed to take antihistamines as emergency medication in case their symptoms were too grave. Ultimately the group that received traditional acupuncture did significantly better in comparison, and the effect was noticeable even one year later. This study, funded by the German Research Foundation, is further proof for the fact that acupuncture mustn’t be dismissed as a pseudo-therapy.15
Acupuncture can also serve well as a supplementary cancer treatment. It relieves nausea and vomiting and even nerve disorders caused by chemotherapy. The fatigue from which cancer patients suffer, and which is usually difficult to treat, can be alleviated and treated with acupuncture.16
In China the schism between “modern medicine” and “traditional medicine” doesn’t exist. Since 1982, Traditional Chinese Medicine (TCM) has been officially recognized next to Western medicine. All major specialist disciplines can be found at the hospital of the renowned Sun Yat-Sen University in the metropolitan city of Guangzhou, from gastroenterology to rheumatology; on every floor there is one completely conventional and one integrative department, in which nutritional therapy, acupuncture, and medicinal herbs are used as supplementary treatments. When I visited the hospital, I immediately noticed the large research building next to the hospital. In China, it’s quite commonplace for the TCM physicians working at the hospital to conduct scientific work in some form or other as well. This gives cause to hope that this is where a scientifically grounded medicine is making its way.
THE HEALING POWER OF PLANTS
The biggest potential of TCM lies in its herbal medicine. The 5,600 officinal (from the Latin officina, meaning “workshop” or “pharmacy”) components of Chinese pharmacology include medicinal plants and mineral substances as well as mushrooms and products of animal origin. A selection of roughly 500 plants is used particularly often, but only a few of these are known in the West (these are plants such as ginseng, ginkgo, Japanese mint, rhubarb, or licorice). The origins of China’s pharmacotherapy are ascribed to the mythological figure of Shennong (“God Farmer”). It is said that he was testing plants for their potential powers as early as the third century BC. The script Wushi’er Bingfang, Recipes for Fifty-Two Ailments, written in the third century BC, copied onto sheets of silk, and found as a burial object in Mawangdui, is the first written compendium.
There are many questions about the safety and quality of Chinese medicine. Imports from China may be contaminated, sometimes even counterfeit. When the bales of exotic dried herbs arrive, the identity and purity of the substances they contain ought to be tested. Unknown interactions are particularly problematic, especially in patients suffering from chronic diseases who take multiple medications at the same time. Beyond that, it’s possible that some substances have an additional hormone-like effect. That’s why a therapy with Chinese medicine requires a lot of knowledge and experience as well as a continuous monitoring of its effects.
But this shouldn’t deter us from further research and application of this enormous therapeutic potential. If such interactions are considered and examined further, if the imports are controlled and the medicinal plants are grown locally (as was done in an experiment in Bavaria), and finally, if the art of the correct application is mastered, Chinese pharmacotherapy, similar to Ayurveda, is greatly suitable in a combination with Western therapies in integrative medicine.
In all the major traditional healing arts around the world, plants—in the form of compresses, teas, spices, or foods—occupy center stage. I have already mentioned this for Ayurveda and in Traditional Chinese Medicine. But it should be assumed that the therapeutic use of medicinal plants is as old as humanity itself. Plants, animals, and humans have evolved in reciprocal adaptation. Through evolution, a lavish abundance of substances developed over the course of millions of years, among them those that were, and still are, important for the survival of the plants: These phytochemicals serve to lure insects or other animals so th
at pollination or dissemination of the plant is ensured—they lend the plant a certain color or create aromatic oils. Other phytochemicals are bitter constituents or the poison digitalis—they ward off predators or microbes. Some of these substances are so potent that the plants merely develop them in harmless preliminary stages and only transform them into the poisonous final product that has a much stronger effect in case of an emergency, for example when a larva bites into a leaf.
It’s mainly these substances—next to nutritional components such as carbohydrates, proteins, and oils—that are responsible for the healing potential. Generally, they are bitter, spicy, or otherwise unpleasant. Humans probably followed their instincts when they resorted to using them in certain circumstances, like in case of a fever. Animals can be observed to ingest special plants that wouldn’t normally be part of their diet when they are ill. Bugs, for example, start eating medicinally effective plants when they are infested by parasites. When healthy, they would avoid this “medicine.”17 The “self-medication” of animals by changing their feeding behavior has by now become its own, young branch of research in biology, called zoopharmacognosy. Our herbal medicine (phytotherapy) can learn a lot by observing it. For instance, African elephants search for borages before giving birth. These have a labor-inducing effect, and by now extracts of these plants are used in Kenya by pregnant women when they give birth.18
The body is able to detoxicate small amounts of toxic substances in the intestine or in the liver. Sometimes it’s enough to give the plant a little time and to imitate nature: The hot mustard oils derived from crucifers such as broccoli or kale change into particularly effective and very healthy sulforaphanes when the plants are cut. This process is a defense strategy against insects, when they hurt/bite the plant skin. The plant releases enzymes that activate the precursor substances of sulforaphanes, which are detrimental to small insects but healthy to humans. By cutting broccoli and leaving it for about thirty minutes before cooking, the natural process can be imitated.19
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