Most physicians are familiar with the Hippocratic oath, the ancient Greek text that all physicians swear to as they are officially inducted into the field of medicine. Hippocratic tradition valued health promotion, interventions on trauma care, mental care and art therapy. Health promotion included physical activity as an essential part of physical and mental health, and emphasized the importance of nutrition. Furthermore, “Hippocratic tradition emphasized environmental causes and natural treatments of diseases, the causes and therapeutic importance of psychological factors, nutrition and lifestyle, independence of mind, body and spirit, and the need for harmony between the individual and the social and natural environment” (1).
Moving forward 2,000 years, the discovery of germ theory by Louis Pasteur in the 18th century and the discovery of antibiotics by Alexander Fleming in 1928 revolutionized modern medicine. The advances in surgery and pharmaceuticals further tipped the balance in therapeutic options offered. Although lifestyle, stress management and environmental influences are still important, these are less likely to be discussed with patients when there are many more therapeutic options available. Despite the advances, the prevalence of chronic disease continues to rise, and the financial, emotional and physical burdens also continue to rise (2).
This is not news. As an allopathically trained physician, who is board-certified in internal medicine and pediatrics, I was a primary care physician for many years. One of the joys of being a primary care physician is the privilege of getting to know my patients well. Everyone has their own story, challenges and successes. However, as each evidence-based standard of care guideline releases, patients were reduced further into sets of data and numbers. Even more frustrating, they were not getting better. Those with chronic medical conditions still have them; they were just on more medicine. It was disheartening, yet this was all I knew. I believed wholeheartedly that I was doing the best I could to help my patients.
I was forced to reassess my beliefs, however, after the loss of my father. My family emigrated from Taiwan in the 1980s in search of a better future. While in Taiwan, we ate traditional Taiwanese food: lots of fresh vegetables and fruits, some meat and lots of fish, all seasonally prepared. When we came to the United States, our budgets were tight. Our dinners were still as traditionally prepared as possible, but my father’s breakfast and lunch were often bagels and muffins from the big box warehouses.
Through the hard work of my parents, our circumstances improved but starchy food remained predominant in our diet. Like many Asians, my father had hepatitis (later identified as hepatitis C). He did not tolerate the side effects of treatments, thus was monitored by his physicians. His liver functions were stable. His job was physically active but stressful. At 62, he retired early and spent his days gardening, golfing and traveling. He was seeing his doctors regularly and he seemed to be in good health. In the summer of 2008, his best friend died suddenly. That October, my father developed a cold that turned into bronchitis. Six weeks, three doctor visits, three courses of antibiotics, steroids and inhalers later, he reported having white stools. A same-day CT showed a liver mass and metastasis, and 20 days later he passed away.
What caused a man who previously never had lung disease to have persistent bronchitis? What caused the liver inflammation to get out of control, and what caused the liver cancer to grow now? Why did his doctor, who saw him multiple times in the weeks leading up to the diagnosis, miss the progressive jaundice? Why did I, as a daughter who visited him often, miss his ailing health?
These questions led me on a journey of self-discovery and healing, eventually to integrative medicine, traditional Chinese medicine (TCM), and other healing modalities such as herbal medicine and energy medicine.
Integrative medicine is a medical practice that evaluates a patient’s health through a mind, body, and spirit perspective. Body is about how people physically take care of themselves: how they eat, sleep and exercise. Mind is about what they expend their mental energy on, stress level and belief system. Spirit is about whether they feel supported by their family, community or religious beliefs. This holistic view harkens back to the Hippocratic tradition, but also reflects TCM and Ayurveda (traditional Indian medicine).
TCM dates back more than 3,000 years. TCM philosophy states we are made of not just blood, muscles and bones, but we also are made of energy (qi). Disease develops when the energy is disrupted internally (emotions), externally (environment), or through poor lifestyle choices (3).
Ayurveda has more than 5,000 years of history. It also acknowledges we are made of energy (prana), that health is not simply the absence of disease, but is a state of balance among body, mind and consciousness (4). Both systems believe (I) human bodies have innate healing ability, (II) illness is an imbalance of the body’s natural functions, (III) food and herbs are medicines, (IV) emotional health and physical exercises are important to overall health, and (V) to remove disease, we need to remove the root cause of the imbalance. Integrative medicine combines the tools and understanding from allopathic (conventional) medicine and from other healing traditions such as TCM, Ayurveda, western herbalism and other energy medicine modalities. It is through these lenses that I want to share some of my clinical experiences as an integrative medicine specialist in herbal and energy medicine.
Herbal medicine is the oldest form of medicine. Neanderthal remains in El Sidrón from 50,000 years ago were found to have yarrow and chamomile in their diet. Both are plants with significant medicinal properties (5). Use of herbs is foundational in TCM and Ayurveda, and Egyptians used herbs in their medical texts as far back as 1850 BC (6). Indeed, modern medicine often has its roots in herbal medicine. Salicylic acid, an active ingredient of willow bark, was cited in ancient Egyptian text, Ebers papyrus, and was developed into aspirin in the 1800s (7). Popular anticancer drugs, etoposide and teniposide, are derived from yew trees, Taxus brevifolia.
Herbal medicine is the study or practice of medicine and the therapeutic use of plants (8). Plants can be used in many forms, such as teas, decoctions, tinctures, aromatherapy, and of course, as food.
Food, tea, aromatherapy and other preparations
With the advance of farming and agriculture, a modern Western diet is often rich in animal proteins and grains, but deficient in seasonal vegetables and fruits. Most of our chronic diseases are inflammatory in nature, and a pro-inflammatory diet high in starch, saturated animal fat, processed foods and low in plant-based food is certainly the main culprit. As part of a comprehensive therapeutic plan to promote health and healing, a well-balanced diet rich in vegetables and fruits, clean protein, healthy fat, and limited processed food is of utmost importance.
Since we all have to eat and drink, this is also the perfect place where we can start any herbal intervention. Adding anti-inflammatory herbs and spices to daily meals is a great way to use the healing power of plants. Another easily accessible form of herbal medicine is tea. The act of making tea—boiling the water, choosing the tea and the time it takes to steep the tea—is a golden opportunity for self-care. It is a quiet moment in an otherwise busy day that allows for a brief rest. Many of the leafy herbs can be steeped as tea. In addition to the physical component of the tea, the aroma also is medicinal, a form of aromatherapy.
Aromatherapy is the inhalation or bodily application (as by massage) of fragrant essential oils (as from flowers and fruits) for therapeutic purposes (9). As plants are heated through cooking or steeping, the volatile oils are released into the air. These oils can be further concentrated through distillation into essential oils. It takes approximately 250 lbs. of lavender to make 1 lb. of lavender essential oil, and 5,000 lbs. of rose petals to make 1 lb. of rose essential oil. Essential oil thus is a concentrated form of herbal medicine. As public interest in aromatherapy rises, more and more studies are being done to evaluate the efficacy and safety of aromatherapy. Many studies focus on the mental benefits of aromatherapy and have found positive impact on stress, pain, anxiety and sleep (10,11). Indeed, the sense of smell is the quickest way to change one’s mood. Studies also show some essential oils have antimicrobial and anti-inflammatory properties (12,13). As with any intervention, essential oils—if used inappropriately—can be harmful. As a general rule, I do not suggest oral ingestion of essential oils unless directed by a trained herbalist. However, essential oils can be used easily through inhalation or as topical treatments.
Finally, herbs can be extracted in high concentration for medicinal use, in the forms of glycerite extractions, alcohol tinctures and compounded pills. TCM practitioners often offer herbal mixtures that are made as decoctions (boiling of the plants to make a concentrated tea). The purity and the formulation of these products are critical. In general, these interventions should be used under the guidance of trained practitioners.
Common herbs and uses
Ginger and turmeric
Studies show ginger rhizome (Zingiber officinale) is an effective anti-inflammatory, antioxidant and anti-microbial (14,15). Ginger also is well known for its anti-emetic and -spasmodic qualities, excellent for nausea, intestinal cramping and gastrointestinal upset (16). I often suggest that patients add ginger to their diets when they have body aches, pains, stomach upsets, or when they have respiratory infections. This is a spice that can be easily introduced into stir-fries, sautés, soups and stews. It also is excellent as a tea or decoction.
Turmeric (Curcuma longa) rhizome is another herb that has been well studied. The active compounds, collectively known as curcuminoids, have anti-inflammatory, anti-oxidant, anti-catabolic, neuro-protective, anti-cancer, insulin-sensitizing, and gut healing properties (17-19). Turmeric can be used similarly as ginger. However, turmeric is poorly absorbed. To optimize bioavailability, turmeric or curcumin should be taken with black pepper (active ingredient bioperine), which increases curcumin bioavailability by up to 2,000% (20). The therapeutic dose for curcumin is 1,000–2,000 mg, which is often difficult to obtain through diet alone. Thus, this is one supplement I may recommend that patients consider adding into their regimen. It is important to note that any anti-inflammatories that impact the prostaglandin pathway also can increase bleeding risk. We see this with pharmaceuticals such as non-steroidal anti-inflammatories, and similar side effects can be seen with botanicals.
Chamomile and peppermint
German chamomile (Matricaria recutita) is perhaps one of the most well-known herbal teas in the world. Chamomile flower is known for its anti-inflammatory, antioxidant, antidepressant, anti-microbial, anti-diarrheal, hepato-protective, and anti-diabetic properties (21). It has been shown to support mood (22), sleep (23), intestinal health (24), and is safe to use in all ages. Peppermint (Mentha x piperita) leaves have antioxidant, antiviral, antimicrobial actions. Peppermint is known for its benefits to the GI system as an anti-spasmodic, as well as having a calming effect on the nervous system (25). Both are wonderful for anxiety and nervous stomachs, and are easily available as teas.
Lavender and tea tree
Lavender (Lavendula angustifolia) was used in the 1800s in hospitals as an anti-septic and -microbial. It is well known for its relaxing properties (10,26), but it is also an antioxidant, analgesic and anti-inflammatory (27). One can cook or make tea with lavender. It is part of the herb de Provence spice. If used too liberally, the dish can taste soapy. The intense aroma of lavender, however, lends itself to be used as aromatherapy, through sprays, diffusers, perfumes, massage oils and creams. Tea tree (Melaleuca alternifolia) is well known for its antimicrobial and anti-inflammatory properties (28). Tea tree essential oil can be used topically to treat simple bacterial or fungal infections, or added to water as an anti-bacterial. It is important to note that essential oil is quite strong, and tea tree essential oil can be toxic to infants and little animals (29,30). Use with caution.
Let’s try a little experiment. Rub your hands briskly until your palms feel warm, then separate your palms by one to two inches and move them around each other. Do you feel anything? In my clinical experience, about half who try this feel something—a sense of heat, vibration or pulling. What is it?
TCM calls this qi (chi), Ayurveda calls this prana. Both are names for energy. The concept of energy medicine may be foreign to most physicians, but it is foundational in many healing traditions. TCM and Ayurveda believe we are not only made of blood, muscles and bones; we also are made of energy. Energy circulates in our body through energy pathways, just like blood circulates through blood vessels. A healthy energy system is as important as a healthy circulatory system. If the energy becomes stagnant, then the corresponding organ system may become dysfunctional.
This may sound esoteric and hard to believe, but there have been a number of studies demonstrating the presence of the energy pathway (known as meridians) in TCM (31,32). The palm-rubbing exercise is a simple way to demonstrate qi. People have variable sensitivity to the energy flow. Some are more sensitive than others, but we all have this energy. From a holistic view, food is energy, emotion is energy and activities—whether physical or mental—can either restore or deplete our energy. A person complaining of fatigue may be eating too much sugar in their diet, which may lead to a quick energy spike followed by a persistent lull. Fatigue also can come from not getting enough restorative energy from sleep, exercise, joyful activities, or from using too much energy with mental anxiety, stress or exercise in excess. The environment and the people around us also impact our energy.
As an integrative medicine physician, I always review patients’ food intake, exercise and sleep patterns, stress level, relationships and work history to get a holistic view. It is important to look at the physical aspects to tease out the root cause of illness. For those that physical patterns are not enough to explain their illnesses, I turn to energy medicine for therapeutic ideas.
The Me-Too movement and the lower chakras
More than 100 million Americans suffer from chronic pain (33), more women than men (34). Women may be more sensitive to pain and have more opportunity for pain (from monthly menstrual cycles and childbirths). However, the “Me-Too” movement in 2018 reminded us that many people have unresolved emotional trauma that has not been discussed or addressed. A study of New York City at-risk youth found men were more likely to be physically and emotionally neglected, but women were more likely to be physically, emotionally and sexually abused. Women are at higher risk for depression, anxiety and post-traumatic stress disorder (35). Women also are at higher risk for irritable bowel syndrome (36), chronic pelvic pain (37), and autoimmune conditions. Are these related?
Ayurveda believes we have seven main energy centers known as chakras that span from perineum to the crown (38). The root chakra, located at the base of the spine, is associated with the adrenal gland and a sense of security. The sacral chakra, located at the pelvis, is associated with sex organs, creativity, emotion and sexual energy. The third chakra, or the solar plexus, is located just above the naval region and is associated with the pancreas, a sense of power and self-expression. If a person has been abused, threatened, disempowered or felt insecure, the corresponding energy system can become stagnant and may manifest in the adrenals (adrenal fatigue, chronic stress), intestines (irritable bowel, obesity) or sex organs (dyspareunia, dysmenorrhea, pelvic pain).
It is important to look at the physical causes. Sometimes, gut issues and obesity are due to poor diet and have nothing to do with emotional health. However, in individuals who have been to numerous physicians, tried many interventions and still are not improving, the cause of the disease may lie in the emotional body. Full healing may require psychological therapies to release this emotional trauma.
Heart, lung and emotions
In TCM, every major organ is associated with a specific meridian, emotion and circadian rhythm. If someone has a symptom that tends to happen at the same time, it may suggest that meridian is not working well. By looking at the associated organ system and emotions, it may help us further define the cause of illness. Shortness of breath, for instance, is a serious complaint that requires a thorough cardiac and pulmonary work-up. However, sometimes no cardiac or pulmonary causes were found. Often, these individuals may have suffered significant losses within the last 6 months to a year. My father never had lung disease, but 6 months after his best friend’s passing, he developed recurrent bronchitis. Women with miscarriages and losses often present with similar complaints of frequent lung infections or the sensation of unable to take a deep breath. In TCM, lungs hold the emotion of grief. In a time of loss, the lung meridian may not work well and one may be more likely to develop lung symptoms or infections. As the individual works through stages of grieving, the energy stagnation of lung meridians usually resolves.
Another helpful tool is the TCM clock. In TCM, each organ energy peaks at a certain time of day. If a person has symptoms at the same time most days, it is worthwhile looking at the organ system associated with that time. Insomnia, for instance, can be caused by environmental noise, stress and other factors. If someone tends to wake up at 2 am, that time is associated with the liver meridian (1–3 am). The liver may be overworking or the person may be holding onto unresolved anger, which is the emotion associated with the liver meridian. This is another tool that helps identify the causes of illness.
Energy medicine modalities
A healthy energy system is supported by balanced emotions, proper nutrition, regular movement, restorative sleep and a healthy environment. I often recommend that patients consider exercises such as tai chi, qigong or yoga, which are known to support healthy energy flow in the body. Mindfulness practices and meditation are helpful at calming the nervous system. In those individuals whose health is impacted by emotional triggers, holistic psychotherapy and biofeedback can be very helpful. Acupuncture is excellent for energy support, massage therapy and chiropractic manipulations also can be supportive. In addition, there are energy healing practices such as reiki, healing touch, and cranial sacral therapy by trained energy medicine providers and can be effective in supporting a healthy energy system.
Many scientific discoveries in the last two centuries have revolutionized medicine, leading to longer survival and a prolonged lifespan. We want to live those years with vitality and with ease. Modern medicine is excellent at treating symptoms and acute illness, but the rising prevalence of chronic diseases and ballooning medical costs suggest something fundamental may be missing. I hope to share with you a different way to approach patient care. Integrative medicine promotes a holistic view of a person and his/her concerns, reduces disease by removing the root cause of the illness and supports our body’s innate healing ability. Herbal medicine and energy medicine are two of the modalities we integrate into this holistic practice, allowing the health and healing to start at home.
Conflicts of Interest: The author has no conflicts of interest to declare.
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Cite this article as: Lin Y. An integrative medicine physician’s perspective on herbal and energy medicine. Longhua Chin Med 2019;2:5.