The integrative medicine movement is gaining much momentum in the United States and the rest of the world, where many leading universities like Harvard, Johns Hopkins, University of California, Mayo Clinic and others have dedicated departments for it. It provides a platform for healthcare practitioners to expand their traditional training to include other healing modalities that enhance clinical outcomes of their patients/clients. Integrative medicine is defined in many ways.[1,2,3] All of which emphasizes principles like accounting for the whole person, mind, body, soul, personalized recommendations, evidence-based treatments, collaborative efforts, partnership with client, focus on health, and prevention, among others.
Consider a case of a conventional medicine practitioner who is primarily trained to investigate and prescribe pharmaceutical agents. An ability to advise her patients about nutrition, physical therapy, mindfulness, acupuncture, herbs, and other modalities is certainly advantageous. She may either choose to provide these directly in her office (core integration) or collaborate with experts (peripheral integration) who are primarily trained in those fields. Either way, this orientation to identify strengths and weaknesses of different systems with an intention to inform patients and improve outcomes is the central ethos of Integrative medicine.
Unique Needs for Integration with Traditional Health Approaches
The National Council for Complementary and Integrative Health (NCCIH) considers traditional Ayurvedic and Chinese medicine to be health approaches distinct from health practices like biofeedback or massage therapy. Its practitioners use all possible means of health just like Integrative medicine does, including medicinal herbs, food, behavior, lifestyle, therapeutic procedures like massage, panchakarmas, exercises, and counseling, among others. Their recommendations are based on a systemic logic which encompasses multiple spectrums: physical, mental, emotional, and spiritual, from health to disease, and internal and external environments. Clinical recommendations for each individual are made considering states of the energy imbalances, digestion & metabolism, age, sex, environment and geography, strength and immunity, mental and emotional resilience, and body constitution.
Biological systems are complex, networked hierarchies being actively studied in a field called systems biology. It uses computational data models to understand the horizontal and vertical relationships between different biochemical, metabolic, proteomic, genomic, epigenomic and other markers. These methodologies can be tapped to study the effects of Ayurvedic recommendations, as most affect multiple targets in the body.[8,9,10]
Currently, the use of Ayurveda in integrative medicine is limited to some medicinal plants found to be effective in the randomized controlled trials. However, there are many other beneficial principles and practices missed in this selection. In order to provide the full range of benefit of this system and effectively communicate what elements of Ayurveda will be available in the Integrative consult, we suggest a stratification into core vs peripheral integration.
Stratifying the Therapeutic Encounter with Ayurveda
The scope of integration of two systems of medicine is influenced by the ‘resource of time’ amongst other financial, legal and regulatory constraints, Consider a) Time available to learn about a new system of medicine, b) time taken to learn how to practice it and c) time needed to apply the whole system assessments and recommendations for an individual in the office setting.
Peripheral integration approach is when a healthcare practitioner has been trained over a few weeks or months to know what an Ayurvedic practitioner does and how s/he thinks and thus knows when and when not to refer to one. Such a practitioner may also suggest evidence-based treatments from Ayurveda and common health practices, which Ayurveda considers beneficial for everyone.
Core integration approach is when a healthcare professional is trained to think and practice with Ayurvedic logic. The practitioner will have many more tools for assessment and recommendations know of traditional medicine properties, formats, indications, and contraindications as well as understand the therapeutic scope, along with prognosis. Such practitioners will also need to refer for integration with other healthcare professionals like psychologists, primary care physicians, chiropractors etc.
Classifying these therapeutic encounters will aid clients/patients to know what to expect when an integrative healthcare professional offers ‘Ayurveda’. It will enhance cross-talk among different systems, and ensure that there are fewer lapses and strengthen the offerings of our healthcare systems as a whole.