Informatics Publishing Limited

S. R. Narahari , Terence J. Ryan , M. Guruprasad Aggithaya

Abstract

Integrative medicine (IM) is developing in India and has been described as frugal innovation contributing to the health design for well being of patients affected by chronic illness. There has been some claim that yoga protocols which are part of IM for lymphoedema are a reverse innovation. The Prince of Wales advocated for integrated health care. IM intensely engaged the most thoughtful of Indian Ayurveda and Yoga leaders. Albeit at the bottom of the evidence pyramid, there are a few success stories of Ayurveda treating patients who could not be managed by Allopathy.

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S. R. Narahari ¹, Terence J. Ryan ², M. Guruprasad Aggithaya ¹

Affiliations
1 Institute of Applied Dermatology, Uliyathadka, Madhur Road, Kasaragod 671 124, IN
2 Department of Dermatology, Churchill Hospital, Oxford, Headington OX3 7LE, GB

Abstract

This paper discusses the future research direction for integrative medicine. Structure of clinical methods and objective outcomes of biomedicine should be integrated for patient examination of Ayurveda. This helps to identify exact clinical features of the disease for selection of herbal formulations. Defining such a holistic clinical presentation is a prerequisite for patient selection before conducting reverse pharmacology studies. The latter will reveal underlying mechanisms of drug action and lead to 'holistic drug development'.

Keywords

Biomedicine, Complimentary and Alternative Medicine, Integrative Medicine, Physician Scientist, Reverse Pharmacology.

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S. R. Narahari ¹, Madhur G. Aggithaya ¹, Sara E. Morrow ², Terence J. Ryan ³

Affiliations
1 Institute of Applied Dermatology, Uliyathadka, Madhur Road, Kasaragod 671 124, IN
2 Chelsea and Westminster Hospital, London, GB
3 Department of Dermatology, Churchill Hospital, Oxford, Headington OX3 7LE, GB

Abstract

Doctors who use biomedicine with complementary and alternative medicine (CAM) in a carefully integrated way offer benefits from both systems to chronic patients without compromising on safety. The Institute of Applied Dermatology, Kasaragod has successfully developed a model of integrative medicine (IM) and effectively managed lymphoedema patients. This article describes the process of developing IM treatment adopting 'standard protocol items and recommendations for interventional trials'. All patients were examined by a team of doctors, biomedical and CAM, and nurses, thus enabling each patient's condition to be understood from these different perspectives, and diagnosis and management through an IM approach. A minimum of 30 min counselling is essential for every patient before informed consent is gained. The 'systems-based' conclusive process follows the standard guidelines in each therapeutic discipline. IM management is achieved following 'bedside discussion'. The minimum requirements for a clinical setting to conduct IM studies, documentation, patient selection and follow-up are described, utilizing biomedical outcome measures to demonstrate the effectiveness of IM. Components of the IM case record algorithm are described here. The process of clinical examination for Ayurveda is described along with comparative biomedical explanation. Biomedical confirmatory study, maintaining records of primary outcome measures, transcription of IM discussions and follow-up entries of patients under IM are also explained. Improving IM protocols for patient care has involved input from global experts together with feedback from patients who have received IM treatment. The IM treatment protocol should evolve as a patient-oriented approach. The protocol discussed here focuses on biomedical systems and structures to measure its effectiveness. This article provides a method for conducting evidence-based clinical studies to develop new IM therapies for chronic skin diseases.

Keywords

Integrative Medicine, Lymphoedema, Patient Care Protocol, Skin Diseases.

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Sanju Arianayagam ¹, Terence J. Ryan ²

Affiliations
1 The Hillingdon Hospitals NHS Foundation Trust, Oxford, GB
2 Department of Dermatology, University of Oxford, GB

Abstract

Biomedicine has not provided a complete explanation with fully effective therapies for disorders of pigmentation. Biomedicine emphasizes the role of melanocyte for protection from UV rays and as a determinant of skin colour. These important properties acquired a genetic basis much later than other functions, many relating to cell contact as in the keratinocyte - melanocyte unit, or as with the synapses of the neurological system. There are other roles, biochemical and mechanical, of melanocyte. Management that is inclusive of a maximally holistic approach justifies the use of diverse herbals, yoga and concern for cultural awareness provided by integrated medicine. Vitiligo provides a model which demonstrates that Ayurveda has a richer view of its presentations, possibly a stronger line on its pathogenesis, and a huge range of herbals, many now backed by studies from ethnobotanical laboratories, awaiting research into the many possible mechanisms by which they may act in the wide and complex field of melanocyte biochemistry.

Keywords

Albinism, Defensins, Melanaocyte, Melanin.

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Dilraj S. Kalsi ¹, Terence J. Ryan ²

Affiliations
1 St. Catherine’s College, Manor Road, Oxford, OX1 3UJ, GB
2 Green Templeton College, University of Oxford, GB

Abstract

In this review of Sanskrit translations in traditional Ayurveda texts studies on skin and gut health we consider the integration of complementary and alternative medicine (CAM) with biomedicine (BM). We focus on irritable bowel syndrome (IBS) as a problem affecting 22% of the population with multiple known causes and unresponsive to biomedical and CAM intervention, but for which integrated medicine (IM) might be more useful. As up to 80% of medical patients concurrently use CAM alongside BM, it is imperative that doctors are able to understand and discuss its use with patients. In order to facilitate these therapeutic combinations, we must identify safe and effective CAM treatment protocols for their administration. CAM offers many treatment options, especially for IBS; however, its presentation can prove a barrier to understanding these options. Here, we consider the example of Ayurveda: a traditional Indian system of medicine in which derangements of the digestive system are well described but with unclear English translations. Forceful language and opinions are sometimes used to support traditional medicine. These unscientific obstacles detract from the multitude of treatment options CAM provides. If CAM were presented in a more scientific manner, modern medical practitioners would take IM more seriously. Research of CAM often lacks scientific rigour, leaving questions regarding its evidence base. Moreover, CAM literature does not utilize advances in the understanding of disease and epidemiology. BM has been less successful at disease prevention and managing chronic conditions while CAM focuses on optimizing health, even in the absence of obvious pathology. Patients are now more focused on health optimization leading to increased uptake of CAM. The onus is on us as health professionals to make sure that they are able to do this as safely and effectively as possible.

Keywords

Biomedicine, Complementary and Alternative Medicine, Gut, Irritable Bowel Syndrome, Skin.

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