2 Ayurveda and Modern Medicine: Where the Twain Meet The human body is a complex creation that runs on multiple biochemical reactions and physiological processes. These ensure optimal functioning of the body in spite of various external and internal challenges. The mind and body, often considered as two different aspects of the being, are actually two faces of the same organism. The activities and functions of the human body are coordinated by the nervous and endocrine systems, which work together to create a perfect homeostasis. Modern medicine acknowledges the coordination between these two systems. The catecholamines (eg, adrenaline, noradrenaline, and dopamine) function as hormones and run the autonomic nervous system as well. Neurotransmitters operate the central nervous system and manage mood by acting both in an endocrine and paracrine manner. The gut–brain axis, as well as other such constructs, bears testimony to the close cooperation between the body and the brain. This linkage is not limited to homeostasis and health; it extends to dysfunctions and diseases as well. While psychosomatic diseases are a huge topic in itself, the effect of the mind on weight and glucose control has been well-documented. The activity of themind can be utilized for diagnostic and therapeutic purposes too. Magnetic resonance spectroscopy and cognitive behavioral therapy are examples of the same. Ayurveda has, for long, appreciated the concept of mind–body medicine. While the tridosha construct lists Vata, Pitta, and Kapha as the 3 basic phenotypes, the triguna rubric of Rajasikta, Satvikta, and Tamasikta provides a “mental phenotype,” “mentotype,” or “emotional type” counterfoil to the same. Ayurveda accepts that there may or may not be concordance between physical phenotypes and emotional makeup. It recognizes various combinations of phenotypes and mental states. Ayurvedic wisdom also finds resonance in the modern descriptions of body types (mesomorph, ectomorph, and endomorph), metabolic classes (eubolic, catabolic, and maladaptive anabolic), and autonomic nervous states (autonomic balance, sympathetic, and parasympathetic). This knowledge is of immense use to the health care professional. While managing any disease, including metabolic syndrome, one must pay adequate attention to both the mind and body. Ensuring autonomic hygiene and mental relaxation is the first, and perhaps the major, rate-limiting step toward achieving metabolic health. While Tamas + Kapha phenotypic persons need to be motivated and encouraged to be more active, Rajas + Vata personalities require assistance in slowing down and relaxing. Whether simultaneously or sequentially, a combination of behavioral and pharmaceutical therapies can be planned to correct existing disorders and achieve the desired outcomes. Awareness about the mechanism of action of drugs helps choose the right treatment for the right person. People with diabetes who have a catabolic habitus may benefit from insulin and appetite-enhancing nutraceuticals, while those with obesity require drugs such as glucagon-like peptide 1 receptor agonists and sodium-glucose co-transporter 2 inhibitors, as well as weight-reducing interventions. Modern medicine is a complex arena. An understanding of mind–body medicine, as elucidated by Ayurvedic physicians of the past and enunciated by researchers of recent times, helps us collate these chaotic complexities into a simple, sturdy, and scientific structure. This, in turn, allows us to offer effective evidence-based therapy to our patients in an efficient and error-free manner. Autonomic hygiene/balance eubolic (Pitta Satvikta) The Tripod of the Mind, Body, and Soul Sympathetic catabolic (Vata Rajasikta) Parasympathetic maladaptive anabolic (Kapha Tamasikta) In the forthcoming issues of Alloveda, we will explore and expound upon the similarities between Ayurvedic science and the modern school of thought. We will continue to dissect the details of mind–body medicine. We will recognize and realize how mind–body medicine is ancient in thought, and how Ayurveda is modern in deed. Dr Sanjay Kalra and Dr Vaishali Deshmukh Integrative medicine is a concept that has gained attention and appreciation in the recent years. Though the first PubMed citation on integrative medicine dates back to 1951, the bulk of the research has taken place in the last few years. A PubMed search for “integrative medicine” shows 64,556 results, of which 2066 are clinical trials (1584 randomized clinical trials) and 1133 are metaanalyses. The first article was published in 1951, and it took 25 years for the 10th article to be listed. In contrast, 20,000 articles have been published on integrative medicine in just 2 years, that is 2021 and 2022. Integrative medicine means a collaborative approach between various schools of medicine, public health policy makers, health care system administrators, clinicians, and different health care specialties. Most important of all, it means the integration of the “reductionist” or elemental approach of medical science with a holistic or person-centered approach. This includes integrating biomedical health with psychosocial well-being and offering comprehensive, psychosomatic management through the integration of evidence-based therapy with communicative “empathy.” Definition One of the most comprehensive definitions of integrative medicine was published in 2018 by the Academic Consortium for Integrative Medicine and Health (ACIMH). Integrative medicine reaffirms the importance of the relationship between the practitioner and patient, focuses on the whole person, supported by evidence, and involves appropriate therapeutic and lifestyle approaches, health care professionals, and disciplines to achieve optimal health and healing. In India, the concept of integrative medicine has been Integrative Medicine: The Way Forward discussed and debated for decades. It is important to understand what integrative medicine stands for, as our nation’s health depends on it. We, therefore, conceptualize integrative medicine as follows: integrative medicine is an approach and practice of medicine that involves all schools of evidence-based science and all relevant health care professionals, along with people seeking health care and their caregivers, in the spirit of person-centered teamwork to achieve optimal holistic well-being. The accompanying Table lists the domains of integrative medicine. Critical Analysis The above definition is similar to the one proposed by ACIMH. It reinforces the need for evidencebased praxis (techniques), appropriate approaches, professionals and disciplines (tools of therapy), the relationship between the practitioner and patient (teamwork), a focus on the whole person (target), and a final goal of optimal health and healing (terminus). It strengthens the earlier definition by mentioning schools of evidence-based science, thus adding structure to integrative medicine. These schools include, but are not limited to, modern medicine, Ayurveda, Homoeopathy, Unani, and Siddha medicine, as well as physiotherapy, nutrition, and psychology. Dr Sanjay Kalra and Dr Hemant Bhargav The new definition also highlights the responsibility of integrative medicine professionals to adhere to evidence-based standards of care. It mentions caregivers as an important contributor to integrative medicine, thus highlighting the role of family, friends, community, and society in health care. The use of the phrase “person-centered teamwork” underscores the rights and responsibilities of all participants and ensures shared “ownership” of health. The Way Forward As the world changes and evolves, so do our health challenges and so should our strategies and solutions. Integrating all our strengths and support systems into a unified structure will improve our societal health. A focus on constructive collaboration, rather than competitive confrontation, will promote harmony and happiness and ensure healing and health. Table. Domains of Integrative Medicine l Macro-Level Structures w Schools of medicine, eg, modern medicine and alternative medicine w Levels of health care, eg, primary, secondary, and tertiary w Health care ecosystems, eg, private and public health initiatives and clinical care l Macro-Level Stakeholders w Payers, eg, health insurance providers w Health care professionals, eg, medicine and nursing w Branches of medicine/surgery l Micro-Level Concepts w Biophysical and psychosocial aspects of health w Evidence-based therapies and communicative empathy w Domains of responsible person-centered care l Micro-Level Players w Health care team members and caregivers w Providers and the patient (or person) w Technical skill provision and humane care
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