Abstracts for Integrative Approaches for Health: Biomedical Research, Ayurveda and Yoga

Chapter 1: Advocacy for Integration

This chapter begins within the context of advocacy for integrative approaches, followed by a review of the global health status. The diversity of challenges in different parts of the world gives few glimpses of the seriousness and magnitude of the health care crisis. The authors discuss the evolution of health care systems, with medical care as a component, and suggest that the present focus is more on treatment of diseases than on health protection. Despite spectacular advances in biomedical sciences, the developing world has not been able to eliminate age-old diseases; in the developed world, newer diseases attributable to lifestyles have sprung up. These unresolved challenges call for a close look at today’s health care solutions, and new, imaginative approaches in health and medicine. In exploring their complementary roles in health care, we survey important advancements in biomedical sciences, and basic concepts from Ayurveda and Yoga. The authors suggest a possible meeting ground for the integration of diverse systems such as Ayurveda, Yoga, and other traditional and complementary medicines (T&CM), with modern medicine. Issues related to medical pluralism, and definitions of T&CM practices are discussed to indicate possible meeting grounds. Discussed in this chapter are the rationales, and constructs of integrative approaches, and their relevance and importance to learning, in light of biomedical sciences, Ayurveda, and Yoga. While making the advocacy, authors do not take any sides—be it modern medicine, Ayurveda, or Yoga but try to strike a balance between the two seemingly diverse yet complementary philosophies.

Chapter 2: Evolution of Medicine

This chapter describes the philosophy, history, and evolution of science and medicine from ancient times to Aristotle and Hippocrates, and to Osler of modern times. A comparative account of the philosophy and history of science provides an analytical perspective of important events from the West, and the East. In the West, modern biology and modern medicine evolved through the use of reductive logic, mostly after the Renaissance. Anatomical dissections led to a better understanding of physiological processes such as the description of the function of the heart, and the circulation of blood by William Harvey. In the West, scientific and technological advances facilitated the emergence of disease-centric modern medicine, with powerful drugs, pharmaceuticals, and surgical innovations. In the East, ancient systems like Ayurveda, Yoga, and Traditional Chinese Medicine (TCM) continued with a holistic approach to health, disease, and wellness involving body/mind/spirit. The Eastern approaches give wider recognition to the role of diet, nutrition and exercise, and lifestyle through the practices of Ayurveda, Yoga, TCM, Kampo, Chi Gong, acupuncture, and natural medicines. A short review of important developments in Eastern and Western medicine helps to understand transitions in social, cultural, and behavioral aspects. The historical and philosophical underpinnings discussed in this chapter provide a rationale for integration, and lay the foundation for rest of the book.

Chapter 3: Concepts of Health and Disease

This chapter discusses concepts and definitions of health, wellness, illness, and medicine. A discussion on determinants, indicators, and dimensions of health help to understand the limitations of the definition of health. The authors highlight health as a positive concept where an individual actively participates in a process of attainment of health; treatment of disease is a passive process where doctors and hospitals have larger roles. The individual’s quest for health is based on many factors including lifestyle, behavior, attitudes, and philosophy of life. The authors suggest that mainly due to reasons of convenience, our current health care approach focuses on diseases and treatments, which has led to the medicalization of society. The authors discuss concepts of health and disease from the viewpoints of modern and traditional medicine. The Ayurvedic concept of health is holistic at the levels of body/mind/spirit, where the three Dosha are in a homeostatic state leading to well-being and bliss. Ayurveda and Yoga emphasize lifestyle, cultural practices, and harmony with nature. They offer advice for seasonal changes in lifestyle, daily activity, diet, and meditation practices. Health as a transborder subject has to be considered from individual to planetary levels.

Chapter 4: Evidence-Based Medicine and Ayurveda

This chapter reviews the nature and application of evidence as a basis of practice for various systems of medicine. It describes the natural history of diseases, and the evolution of therapeutic intervention from intuitive practices to scientific, evidence-based medicine (EBM). The authors refer to major initiatives like Cochrane Collaboration, which contributed to the emergence of EBM. Every system, including CAM, needs an evidence base. Ayurveda, Yoga, and T&CM have an experiential evidence base, which by its nature is different from mere experimental base. Placebo response and other confounders are also discussed as issues related to bias and quality of evidence. The authors differentiate epistemologies of modern medicine, Ayurveda, and Yoga in order to address issues related to the value of clinical observations, randomized controlled trials, systematic reviews, and systematic analysis of published studies in the process of EBM. Finally, the authors try to configure a construct of evidence-based, integrative medicine for the future.

Chapter 5: Systems Biology and Holistic Concepts

Systems biology is an important emerging approach, which considers the interdependence of cells, tissues, and organisms in complex, yet interconnected metabolic networks. The message from systems biology is that one should not consider any biological molecule, process, or phenomenon as parts in isolation but view them as interdependent parts of the whole organism. These concepts have startling similarities with the holistic concepts of Ayurveda and Yoga. This chapter recalls the basic concepts of Ayurveda, which explain the relationships between the microcosm and macrocosm. The authors present a comparative picture of principles of systems biology, and the holistic concepts of Ayurveda. This chapter provides a brief account of a few ongoing research projects studying the basic principles of Ayurveda and biology. The authors discuss how Ayurvedic concepts may open new research avenues for future biomedical research.

Chapter 6: Lifestyle and Behavior

This chapter discusses the role of lifestyle and behavior in health and disease. The authors suggest that therapeutic approaches should be holistic, involving body and mind. In recent times, many new approaches such as behavioral medicine, lifestyle medicine, mind–body medicine, and mindfulness have emerged. This may be due to growing dissatisfaction with current drugs, and their limitations to treat psychosomatic conditions. Most of them draw from traditional knowledge systems like Ayurveda, yoga, tai chi, and qigong, among others. Ayurvedic therapeutics involves drugs, diet, and lifestyle advice as a part of a healthy living doctrine known as Swasthavritta; and body cleansing detox procedures known as Panchakarma. Yoga involves physical exercise and mental interventions through specific postures, and meditation. Integrative approaches involving biomedicine, Ayurveda, and yoga can offer effective remedies for chronic, psychosomatic, and lifestyle-related diseases. A few case studies related to the application of lifestyle medicine in health care are discussed.

Chapter 7: Food and Diet

Diet is a primordial strategy for disease prevention and health protection. This chapter offers an interesting history of food, and the evolution of modern and Ayurvedic concepts of nutrition. The chapter highlights the importance of digestion as part of nutrition, in addition to concepts like calories, and proximate principles. Varying diet according to season and the nature of the individual are practiced by many communities. The authors discuss the physiological effects of fasting, calorie restriction, and special diets prescribed during various stages of the life cycle. Emerging data supports the importance of gut microflora, pre- and probiotics, and diet and immunity. Ayurveda prescribes dos and don’ts regarding diet, which are based on principles to maintain, or regain homeostasis. Ayurveda considers diet and nutrition specific to the individual constitution, which is similar to the nutrigenomics approach. Ayurveda concepts of Prakriti and Agni as regulators of metabolism are also discussed. The chapter provides case studies in order to indicate potential areas of research, which are important in health care.

Chapter 8: Health Supplements

This chapter discusses health supplement categories, such as nutraceuticals, functional foods, dietary, and herbal supplements. The authors describe various vitamins and minerals along with their rationale, and the evidence for use in specific conditions. With the help of systematic reviews and meta-analyses the authors discuss evidence for the claims of various health benefits made for antioxidants, vitamins, minerals, probiotics, fibers, and phytochemicals. Most of the scientific studies do not justify the use of health supplements. The market-driven approach of pushing supplements without sufficient evidence is under criticism. There is a consensus among many credible, professional associations that it is better to consume natural food, than to depend on health supplements.

Chapter 9: Drug Discovery and Ayurveda

Since ancient times, drugs have been an essential part of the therapeutic and preventive armamentarium. Drugs can be natural products, synthetic chemicals, or biologicals. Advances in chemistry and biology have opened ways for powerful and specific drugs. However, today, new drug discovery is facing major challenges. Many drugs are failing due to toxicity and safety reasons. Currently, drug discovery is facing an innovation deficit. Ayurveda and Traditional and Complementary Medicine(T&CM) have described thousands of drugs and formulations. The authors explain the value of traditional knowledge, like Ayurveda, as a valuable resource for new drug discovery. A few case studies on drugs and adjuvants for metabolic and chronic diseases are presented to illustrate the potential of Ayurveda-inspired drug discovery. The issues related to quality control, standardization, and safety of botanical drugs, as well as the controversy surrounding mercury, and metal-based drugs will be discussed, with help of available scientific research. The authors suggest that the current one target–one drug discovery process needs to move toward formulation discovery, so that multiple targets are systematically addressed. The safe and rational combination of botanical drugs, psycho–neuro–immune–endocrinal and restorative regimens could be the key to future integrative medicine.

Chapter 10: Longevity, Rejuvenation, and Rasayana

Aging is not a disease, but a physiological state, which applies to every living form. Current approaches to healthy aging, longevity, rejuvenation, and regeneration are examined in this chapter. The authors discuss interesting research on longevity, and quality of life. Stem cells and regenerative medicine are opening new avenues in therapeutics. The authors present a discourse on the latest research on Rasayana, and their potential for triggering tissue-specific regeneration. A paradoxical situation is emerging where some people wish to live longer, while many others are desperate to end their lives. The authors suggest that Ayurveda and Yoga can play a vital role in addressing problems related to aging, and longevity. Ayurveda treatment helps in nourishing and strengthening tissues, and improving immunity. Specialized antiaging therapies like Rasayana for rejuvenation may provide new clues for regenerative biology, and geriatric medicine.

Chapter 11: Personalized Approaches for Health

All human beings are almost identical genetically, yet every person is unique. Increasingly, a better understanding of the human genome and advances in pharmacogenomics are shaping today’s modern medicine. However, the promised personalized medicine expected to emerge at the conclusion of the Human Genome Project did not materialize, due to the all-pervading influence of epigenetic factors. On the other hand, one of the special strengths of holistic systems such as Ayurveda, is the person-centric approach where each individual requires tailor-made health, wellness, and therapeutic approaches. Initially, during Hippocrates’ time, modern medicine accorded due importance to understanding individual variation. This understanding formed the basis for personalizing diet, lifestyle, and individualized health. Such an approach was the basis of therapeutic interventions in Chinese, Korean, and other traditions. This chapter further discusses case studies on pharmacogenomics, and Ayurveda-related research, which may expedite the progress of personalized health and the medicine of the future.

Chapter 12: Integrative Approaches for the Future

The review of history, evolution, and advances in biomedical sciences, philosophy, precepts, and practices of medicine define the urgent need for a paradigm shift in modern medicine toward an integrative approach for health. No single approach—be it one of modern medicine, Ayurveda, or Yoga—can meet the changing requirements of global health. The authors discuss various ongoing efforts in integrative health care happening in different parts of the world. This chapter reiterates the need for a change in mind-set from illness-, disease-, and drug-centric curatives, to person-, health-, and wellness-centric approaches. The systematic promotion of health, early prediction, and prevention of ill-health should be given priority, so that the dependency on treatments and therapies can be reduced. The approaches should be personalized, where people are empowered to actively participate in maintaining their own health. The edifice of integrative health for the future must meld transdisciplinary scientific approaches, to create a confluence of modern medicine, and traditional systems. The authors hope that the deliberations in this book will help to facilitate new trends toward integrative approaches for health.

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