REVIEW ARTICLE

https://doi.org/10.5005/imcr-11021-0004
Integrative Medicine Case Reports
Volume 5 | Issue 2 | Year 2024

Global Integrative Health Paradigm

Monika Gautam1, Akshay Anand2, Priyanka Vinod3, Pramod Avti4, Krishan Kumar5, Raghavendra M Rao6, Hosakote S Vadiraja7

1CCRYN-Collaborative Centre for Mind Body Intervention through Yoga (CCRYN), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India

2Neuroscience Research Lab, Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India; CCRYN-Collaborative Centre for Mind Body Intervention through Yoga, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India

3Department of Neurology, All India Institute of Medical Sciences, (AIIMS), Bhopal, Madhya Pradesh, India

4Department of Biophysics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India

5Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India

6,7Central Council for Research in Yoga & Naturopathy (CCRYN), New Delhi, India

Corresponding Author: Akshay Anand, CCRYN-Collaborative Centre for Mind Body Intervention through Yoga, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India; Neuroscience Research Lab, Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India, Phone: +91 9815968102, e-mail: akshay1anand@rediffmail.com

How to cite this article: Gautam M, Anand A, Vinod P, et al. Global Integrative Health Paradigm. Integr Med Case Rep 2024;5(2):64–69.

Source of support: Nil

Conflict of interest: Dr Akshay Anand, Dr Pramod Avti and Dr Krishan Sony are associated as the Editorial board members of this journal and this manuscript was subjected to this journal’s standard review procedures, with this peer review handled independently of these Editorial board members and their research group.

Received on: 05 March 2024; Accepted on: 01 July 2024; Published on: 24 October 2024

ABSTRACT

Health is the most important attribute in human thinking and survival. The dissociation between various disciplines of science calls for integration, science translation, and the welfare of society. The health system is slowly moving toward the integrative health system globally.

Global integrative health is emerging with the concept of integrating health and healing process, which condemns the modern health system, where concern is more toward the outer symptoms than treating the causative aspects. It lays emphasis on patient charge, which requires a mindset for a holistic approach that leads to the merge of modern medicine with alternative medicine and equal participation of patients toward healing, as well as knowledge of the condition and why the disease has occurred. This brings the concept of integration as well as mind body medicine.

There are various forms of integrative medicine (IM) modules prevailing throughout the world that require analysis. Among traditional sciences, Yoga and Ayurveda are now widely accepted, practiced, and taught globally. The aim of this review is to understand the prevailing integrative health systems globally. We also focus on the use of IMs as a system in non-communicable disorders. It is likely to guide new research based on IM.

Keywords: Complementary and alternative medicine, Integrative health, Integrative medicine, Traditional Chinese medicine.

INTRODUCTION

It’s now realized that over 60 years, we have been living with a “pill-popping” attitude that has no demands from the patient’s side. Recently, there has been a shift to reidentify the inborn capacity of the body to heal. That reduces the dependence on the pharmaceutical industry for our health and has largely made us passively participate in personal health care and blame attitude.It’s a high time where society needs to understand their own role toward health and well-being. The emerging concept of “global health” in the 21st century is that exercise is a more comprehensive claim and paves the way for the upcoming idea of complexity.1

Integrative medicine (IM) is being often argued as the potential solution for health care. The care it provides is patient and healing-oriented. It also uses therapeutic perspectives from complementary and alternative medicine (CAM).

The existence of CAM has been there since 4000 years ago; in mid-2000, it completely vanished, and now the cycle is repeating from where it started years ago.2 “The group of practices from the ancient healing and healthcare practices which generally are not the part of modern medicine” considered as CAM. One step further, IM tries to combine conventional medicine with CAM modalities for its safety and effectiveness.3 Increasing demand for IM leads to many new names of systems; one among all proposed is integrative health and healing (IH2). The root principle of IH2 is based upon the model of patient-centered care. It gives responsibility equally to the healthcare giver as well as to patient taking the lead role.

Several categories of integrative medical therapies are reliable and popularly used worldwide, out of which Yoga, Tai-chi, the ancient healing technique of Ayurveda, herbal plant and herbs, natural therapies, needle stimulation, and Traditional Chinese Medicine (TCM) are most common. Its basic concept is the use of biologically active therapies that utilize substances extracted from nature, including herbs.

The body functions can be enhanced by mind-body medicine such as Yoga, mindfulness, and meditation. The most common among all are group counseling, behavior therapy, guided meditation and relaxation, hypnosis, healing with music, and chanting. The manipulation techniques are massage, movement of one and more parts of the body through chiropractic, and osteopathy. Therapies that generate energy fields or help to balance energy levels, like reiki healing, acupuncture, and pranic energization techniques, are most common.4

LITERATURE REVIEW: WORLDWIDE INTEGRATIVE THERAPIES

The most common among all integrative therapies and the most acceptable and practiced worldwide are Western Integrative Medicine (WIM) and TCM.

In the surveys done by the Fraser Institute in 1997, 2006, and 2016, 50–80% of the Canadian population use at least one CAM modality. The most commonly used therapies among that were manipulation (44%), osteopathy (42%), Yoga (27%), acupuncture (22%), and Meditation and relaxation (25%). The gross national product (GNP) of the United States is going to rise 3–5% by 2024, as spend now is 17% of overall.5,6

The wrong medical treatment, drug error, and preventable drug adverse reactions are the causes of death in the United States. The selection of treatment always has to be scientific so the unwanted bias can be avoided.7–10

The National Health Interview Survey (NHIS) 2012 in the United States found that 15–17% of population takes dietary supplements other than vitamins and minerals.11 The prevalence of homeopathy treatment was 12 months, reported in 24 surveys of adults and children and found to be similar (median 1.5%, range 0.2–8.2%). The economical consistency ranged stable over the time in different survey, i.e., 0.2–2.9% (1986–2012).12

The role of CAM in European countries (EU) has been increasing, but evidence is lacking.13 The prevalence of CAM use varies widely within and across EU countries (0.3–86%). Most commonly, CAM users were females who used it for musculoskeletal problems.14 In the German health care system, around 15.7 million Germans are practicing Yoga as a precautionary and preventive measure.15

The sub-Saharan Africans are one among the world who use the traditional CAM to prevent and treat communicable and non-communicable diseases, and most of their population rely on it for their well-being and health.16 The 5.6% of the National Health Budget trades in traditional medicines in South Africa, which is estimated to be around 2.9 billion (US$2.2 million) per year, representing 5.6% of the National Health Budget.17 Traditional medicine includes different herb therapies, chiropractic, mind-body therapies, maternal care, mental health, manipulation, aromatherapy, music healing, and homeopathy.18

The prevalence of CAM use in the Indian community in South Africa was about 38.5% (95% confidence interval 31.745.6%). Use of plant/herb-based medicine and spiritual healing, including vitamin supplements, were the most commonly used modalities, which is almost 42–48% of CAM usage. The conditions used in CAM include day-to-day life stress and tension headaches, different types of arthritis, diabetes mellitus (DM), skin diseases, mechanical back pain, high blood pressure, and nasal disorders.19

In India, a separate department was established in March 1995 to promote the indigenous and ancient system of medicine, which is known as AYUSH (Ayurveda, Yoga and Naturopathy, Unani, Siddha, Homoeopathy). The acceptability toward these ancient systems of healing is high among the Indian population.20

The paradigm of IM in most countries combines conventional medicine with CAM, whereas practices followed in China differ from IM, which utilizes TCM instead of CAM. Another approach for IM is methods/techniques of mind-body medicine (MBM). The active participation of patients in their own treatment, e.g., with diet therapy, physical therapy, fasting therapy, and self-encouragement, are a few basic and important features of IM. According to Sackett, evidence-based therapy should be chosen for better effectiveness as well as the personal experience of a physician with particular diseases.21

Traditional Chinese Medicine

Traditional Chinese Medicine is highly admissible and evidence-based, which brings harmonize balance between body, mind, and soul. Many Asian and western countries have started combining TCM with western medicine and consider it one of the major modalities among CAM. The belief and increasing evidence of medicinal herbs and combinations of herbs have been proven to impart pharmacological effects, which make it more preferable medicine over western medicine.22

Western drugs in combination with TCM have shown a positive impact on its implications, as TCM uses herbs, herbal preparations, and the contents of herbs, which are now being widely studied and applied. Its global use suggests that these herbal remedies are safe and efficient and can generate evidence that supports its scientific analysis. Due to its efficacy and simple use, TCM is now being used in combination with other drugs. In communities where western drugs are less common, herbal medicines are widely available. Some drugs that are manufactured are extracted from herbs and later on go through complex preparations. Herbs interact with similar properties as drugs, such as in metabolism, absorption, distribution, and excretion. Since most of the herbs that are available in nature are being analyzed every day, there is an abundance of herbs found in nature with different species. Not all herbs provide beneficial effects. For their safety use in health care, knowledge about their different interactions and metabolic properties has to be increased and widely studied.23

METHODOLOGY

Aim of the Research

To understand the need and acceptance of IM worldwide.

To understand the uses of IM in treating diseases.

Research Question

To know the acceptance and efficacy of IM worldwide.

Data Sources and Search Strategy

This review was conducted using different search engines without any barrier of time or language to consider the existing body of literature. The following electronic databases: PubMed, Google Scholar, Scopus, and the NHS Economic Evaluation Database were searched. All databases were explored with the same text words and subject headings. The primary search was conducted using the following algorithm: “Integrative History,” “Various Integrative therapies,” “Integrative treatment in treating diseases,” “Integrative medicine uses worldwide,” and “Integrative medicine acceptance worldwide.”

Study Selection

The data were selected, which focused on IM history, its implications, and treatment for various diseases.

DATA EXTRACTION, ANALYSIS, AND SYNTHESIS

The literature review was framed from all the data available. The data was reassessed with respect to study selection to reach a final outcome to understand the history and present implementation of IM.

EXPECTED OUTCOME

The reader may come to know the importance of IM.

It may lead to further studies following the integrative approach in treating diseases.

The paper is just an attempt to understand the basic concept of IM.

The Clinical Research

Integrative Medicine in Heart Diseases

Complementary and alternative medicine therapies have been useful in the past to prevent the risk of cardio vascular diseases (CVD), coronary heart diseases (CHD), and stroke. Regular exercise and weight loss followed through integrative therapies reduce the risk of CHD.24 The previous study shows favorable and evident effect on emerging cardiovascular risk factors like systematic inflammation, chronic stress, and improper cardiac autonomic functions.25 There have been studies that show that Yogic techniques like meditation, Yogic relaxations, and Yogic breathing are the safest and adjunct therapy for hypertension but not for the prehypertensive.26 Transcendental meditation (TM) has been proven to reduce the cause of mortality, myocardial infarction, or stroke in black men and women with coronary heart diseases, which makes it a secondary measure for prevention.27

The coronary lesions, myocardial perfusion, and modifiable risk factors help in prevention and reverting back by changing a sedentary lifestyle to Yoga-based lifestyle. This change in lifestyle explains the therapeutic beneficial effect in coronary artery diseases.28–30 There has been a study that shows highly significant opening of coronary blockage following the “Healthy and Happy Lifestyle Program” by Brahma Kumari’s at their ashram in Mount Abu.31

Integrative Medicine and Pain Management

Pain is the most common factor involved with every health condition. The most common and foremost factor is “pain,” which could be acute or chronic. Alternative health systems are proven to be better in the management of pain in the long term, looking at the side effects of medication.

Complementary and alternative medicine therapies have been proven to reduce low back ache32 and ache and agitation due to dementia.33 The availability of information, growing patient acceptance, and chronic symptoms of pain will always keep complementary and alternative therapies as part of the healthcare system. The evidence in different fields of CAM has potential to treat chronic pain.34

The pain causes physical and mental suffering and influences the psychosocial context of the individual. The root cause of pain has to be considered whenever the treatment modalities are selected. The mind-body intervention and manipulative therapies should be the first line of treatment if pain originates due to anxiety, fear, depression, or sleep disturbances or if pain leads to psychological distress. This can be helpful to avoid undesirable effects of opioid therapy; in addition, acupuncture can also be an alternative therapy for pain management and to lower the dose of medication.35

Labor is the most crucial and emotional time. Studies have shown that integrative therapies like massage, warm, and thermal packs can help to reduce pain, reduce time of labor, and help women to experience better emotional state and self-control.36

Few meta-analytical and systematic reviews show that Yoga helps to improve disability due to chronic low back pain and enhance quality of life by reducing pain.37 A randomized control trial shows spinal changes after the regular practice of Yoga.38

Usha Kiran (1989), who conducted a study on 121 patients over 3 months suffering from headache, showed 91.2% relief in pain after practicing Raj Yoga meditation and lifestyle modifications.39

Integrative Medicine and Diabetes

Diabetes mellitus is being heard every day and is affecting more and more people across the globe. The prevalence rate of DM shows a sharp rise that is now a concern among the health and scientific community. A lot of investments and research have been put forward but aren’t sufficient to provide solutions to the common man suffering from DM, thus making approachable and affordable mediums likely; proper diet counseling, regular exercise, knowledge about diabetes and its complications, along with factors that affect diabetes such as stress, lifestyle, intake of medications, and active participation of patients also have to be considered while providing a solution for DM.40

Absent-minded activities unfold a lot of misjudged decisions and create a haphazard nature that in the long run affects lifestyle and attention toward one’s own body. Mindful activities bring a certain pattern of discipline attitude. Mindfulness is a budding concept in the context of DM that helps individuals channel energies and create a sense of awareness in everyday movements. Mindfulness is a state of being aware of every single moment that is being done in everyday life, and it can be intensified through regular practice. These mindfulness-based interventions not only keep one aware and awake but also improve different perspectives of health.41

Spiritual healing, herbal medicines, nutritional counseling, nutritional supplements, and relaxation techniques are a few CAM therapies that are popular among diabetic patients. Around 17–72.8% prevalence rate has been registered of patients with diabetes who used CAM.42 It also helps to generate evidence and knowledge that will provide a framework for diabetic care. Yoga, a mind-body practice, has been shown to reduce diabetic complications and attain better glycemic control when practiced daily.43

Yoga as a daily activity has been proven to have good glycemic control as well as avoid unnecessary complications and risk of it.44 CAM may help to promote an integrative, participatory model of diabetes care that relies upon provider knowledge of evidence-based therapies and patient disclosure of CAM use.45

Yoga is an ancient practice that has been proven to have good control in diabetes and maintain good glycemic control. The practices of Yoga include movement at the physical level, breath awareness, body-mind relaxation, and meditation.46–48 These practices are more body-centered, where an individual focuses on postures and breath control while maintaining a calm state of mind, which later enables him to experience every moment of his surroundings. Also, an individual experiences bodily sensations that were ignored due to absentmindedness in day-to-day activities. Yoga, since it provides an opportunity to experience one’s own bodily sensations, can contribute as mindfulness – based activities.49,50 Management of diabetes can be possible with these mindfulness programs, as it leads to recognizing the stressors and skillfully coping with them. It also helps to strategize effective coping strategies. Mindfulness not only helps to control stress but also helps to create discipline in everyday life, which leads to healthy eating habits, taking medication as scheduled, regular exercise, and improved quality of sleep. Research shows Yoga interventions have improved diet control on adults at risk for cardiovascular disease.51–54 Thus, the positive impact of Yoga can be achieved through stress management, diet control, and self-care tasks.

Integrative Therapies and Cancer

Previous studies have shown that pain in cancer patients should include integrative therapies as a mode of treatment, as it helps to reduce stress due to health conditions, anxiety, and fear of diseases.35

Different CAM therapies have a role to play in managing physical and mental suffering due to treatment in cancer survivors. These therapies include manipulation, dietary changes, increased supplements like vitamins, mind-body therapies, acupuncture, and counselling, all of which may play a role in the management.55,56

The collaboration of integrative oncology with cancer care, including non-biased family discussion and educational guidelines, was developed by the International Society of Pediatric Oncology. These guidelines will help with better cancer care management and bidirectional educational opportunities.57 Therapies like manipulation and acupuncture are beneficial in cancer care and have minimal risk of interfering with conventional treatment.58

The prevalence for usage of CAM in the cancer patient was assessed through many systemic reviews and found that 31% of the population in 13 different countries uses some form of CAM.59

The post-effects of chemotherapy, like mood disturbances, short-term pain, sleep disturbances, and fatigue in patients have shown reduction in symptoms by adding therapeutic massage and healing touch to standard treatment by inducing a relaxed state.60

DISCUSSION

In the last two decades, the demand for western medicine has been encouraged for the governance of health. The focus has been shifted toward the biological and pathological diagnosis more than the actual interaction between humans and environments. This shift has led us to a new approach toward health, i.e., IM. The body’s natural ability to heal itself has to be taught to individuals and educated about the basic principles of IM. The whole idea of integration is that combined therapeutic effects can be attained by combining conventional with CAM. The approach toward the illness and its treatment will be changed by the idea of integration. The practices of IM followed worldwide are already a component of Chinese IM; Chinese medicine has a major role in the advancement of IM.

However, the scientific evidence is required for western IM to support their CAM modalities, which differ from Chinese medicine.

The variety of treatment modalities in IM are applied to cure chronic medical conditions, e.g., chronic pain, rheumatic disorders, respiratory disorders, and chronic inflammation.61 Other fields of medicine, such as general medicine, neurology, obstetrics and gynecology, pediatrics rheumatology, oncology, geriatrics, and psychiatry, can be seen as effective and beneficial. Many a time, in particular health conditions, to avoid the complications and side effects of medicine, IM has been beneficial.23

CONCLUSION

To conclude, IM has been beneficial for many health perspectives, and people have used it in one or the other form of medicine. It is a thought to the base of complete healing but needs further clinical and database for its acceptance globally. The upcoming idea of IM is basically on listening, adaptation, and responding toward it. Ancient science or healing practices represent a connection between body, mind, and soul, whereas modern medicine is disruptive and chaotic.

Hippocrates wrote that “physicians should always comfort first, often heal and sometimes cure.”

Hippocrates also wrote that “the body has its natural tendency to heal itself and that is greatest force of healing.”

The shift in health paradigm is evolutionary as well as revolutionary, as the system is returning to roots. The idea behind evolution relates to growth in technology and refined procedures, which enhance with time and revolution by adopting ancient systems of healing from the roots. The focus of integration has always been on self-importance.

Simply adding CAM modalities to the conventional approach will not make it integrative until there is a complete focus toward the healing and wellness of an individual. Utilizing IM has been beneficial from many health perspectives, and people have used it in one or the other form of medicine. It is a thought to the base of complete healing but needs further clinical and data base for its acceptance globally. The new idea of integration takes a path towards collaboration between health sectors and a multidimensional approach towards health for socioeconomic development. It also encourages “appropriate technology” through the active participation of the community in health care and prevention. IM considers not only physical and mental well-being but also focuses on psychosocial dimensions and encourages patients to heal through active involvement of the patient in sharing the responsibility of the healing process in accordance with the caregiver. For the integrated paradigm to work, interprofessional collaboration and communication are a must, and further research focus needs to be oriented to this aspect.

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