A PERSONAL PERSPECTIVE OF INTEGRATIVE MEDICINE
Majid Ali, M.D.
I have been a student of medicine for forty-six years. In 1958, I joined King Edward Medical College, Lahore, Pakistan. In 1963, I began my training in surgery at Mayo Hospital, Lahore. In 1965, I traveled to England for further training in orthopedics and general surgery. In 1966, I came to the United States to continue my surgical training. In 1968, I passed the examination given by the Royal College of Surgeons of England and was awarded the diploma of FRCS. Later that year I began residency training in pathology. In 1972, I received certification from the American Boards of Anatomic and Clinical Pathology. From 1974 to 1996, I served as chairman of the Department of Pathology and Laboratories, Holy Name Hospital, Teaneck, New Jersey. From 1972 to 1997, I also served on the faculty of the College of Physicians and Surgeons of Columbia University, New York.
In 1996, I accepted the presidency of Capital University of Integrative Medicine, in Washington, D.C., and proposed that integrative medicine be defined as a philosophy of medicine that requires physicians to offer their patients all that is safe and effective without subservience to one or more schools of medical thought. The Capital ‘tribe’ gave me a treasured gift of close links with many of the most intuitive and incisive minds in medicine in the United States and other countries.
In 1999, I published Nature’s Preoccupation With Complementarity and Contrariety, the first of eight volumes of The Principles and Practice of Integrative Medicine. In the opening paragraph of the preface of that volume, I attempted to define seven aspects of healing phenomena, which seemed central to my clinical work, with the following text:
This first volume of The Principles and Practice of Integrative Medicine is about five aspects of human biology. First, oxygen is the organizing influence of human biology and governs the aging process. It is also a molecular Dr. Jekyll/Mr. Hyde par excellence— ushering life with one sleight of the hand and terminating it with another. Second, human biology is an enormous web of webs—a vast and intricate network of energetic-molecular pathways.
Everything in that web is connected to everything else. Third, the webs of human biology form a panoramic kaleidoscope. When something in that kaleidoscope changes in one way, everything in it changes in some way. Fourth, spontaneity of oxidation in nature—sustained by oxygen above all else—provides the primary metabolic drive for all human life processes. It also assures that no oxygen-utilizing life form lives forever. Fifth, persistent and progressive oxidosis sets the stage for dysoxygenosis —a state of dysfunctional cellular oxygen metabolism resulting from abnormal expression of genes, enzymes (oxyenzymes) involved with oxygen utilization. All clinical work of a practitioner of integrative medicine—in my view—should be based on a clear understanding of those five energetic-molecular aspects of human biology.
Two other issues in clinical medicine are of transcendent importance: (1) the spiritual serenity that is essential for long-term good health; and (2) chronic anger and sadness that fan the fires of oxidosis and dysoxygenosis. The so-called mind-body-spirit-trio is an artifact of thinking. Preoccupation with that trio is, in reality, an expression of our inability to sense, feel, and know the wholeness of the human condition. I have never seen anyone dissect a human and delineate where the body ends and the mind begins, or where the mind ends and the spiritual begins. I address the issues of spiritual serenity and chronic anger as well as those of hope, belief, and love in The Principles and Practice of Integrative Medicine Volume II: The History and Philosophy of Integrative Medicine.
My personal perspective of integrative medicine evolved over a period of more than three decades. In 1969, it began with the study of one single pathology specimen that led to the need to think ecologically. As a pathology resident I received a specimen of an inflamed and distended colon. It filled a large basin. Copious bloody fecal matter was spilling out of some tears in its wall. It was not much fun to
clean that bowel and take tissue samples for preparing microscopic slides. The next day I examined the slides and observed the expected microscopic features of ulcerative colitis: acute and chronic inflammation, dead and dying immune and other types of cells, ulceration of the lining mucosa, disruption of the general architecture of the colon wall, and pockets of pus. After finishing my study, I took the case to one of my professors. He examined the slides and agreed that it was a case of ulcerative colitis.
The next day, something unexpected happened. Without purpose, I picked another slide of that colon, looked at it, and chanced upon a cluster of large, pale cells forming a discrete round structure. Such a formation is called a granuloma and is considered diagnostic of Crohn’s colitis. “Look at that!” I said to myself in surprise. “Now, that granuloma makes it Crohn’s colitis, doesn’t it? Yesterday it was ulcerative colitis. Today it seems to be Crohn’s colitis. Interesting!” I marked the microscopic field with ink and took the slides to a second professor, since the first one was out of the department. He looked at the case and readily diagnosed Crohn’s colitis.
The next day as I prepared to carry the slides to one of the secretaries for filing, I picked another slide from the same case and started gazing at an area that showed discrete layers of tissue debris covering small patches of the inner surface of the bowel wall. Those are the features of another common type of colitis called pseudomembranous colitis. “Aha! Another diagnosis!” I exclaimed. “Let’s see if I can get someone also to agree with me.” That time I purposefully looked for a third professor and decided not to tell him about the diagnoses made by the other two. I pointed out to him the membrane-like structures and he agreed that we had a case of pseudomembranous colitis. I returned to my desk triumphantly. I knew I had a story to tell. Some time after that a question arose in my mind: Can you make more slides from that colon and see if you can get another professor to diagnose yet another type of colitis from the same colon? The thought amused me. Worth a try, I murmured to myself.
I went back to that colon and took many more sections of tissues. A technician looked at me, a little annoyed because she had to prepare the slides from all those sections. The next day she brought me several trays of slides and I went to work. In one of the slides, I found areas that showed well-preserved bowel architecture, congested blood vessels, pooled and disintegrating red blood cells in the tissue, and small surface erosions. Bingo! I knew those were the features of another type of colitis called ischemic colitis. I continued my search. I was not disappointed. I found some microscopic fields that showed diagnostic features of a type of colitis called collagenous colitis. “Ah! Another diagnosis!” I congratulated myself and continued study of the case with yet other slides. There were many fields which could only be diagnosed as nonspecific colitis. With some more persistence I found other areas qualifying for other forms of colitis. Getting my teachers to agree to those various diagnoses with different slides of the same colon did not prove to be difficult either. I spoke to Talat, my wife, about my discovery: Given sufficient patience and diligence, I could make any diagnosis I wanted from a colon removed for ulcerative colitis. I decided not to tell my professors about it. I did not know how some of them might take it.
Next I turned my attention to my pathology textbooks for a critical study of the causes of those various types of colitis. That turned out to be a yet more fruitful search. I made the second and equally important discovery: The cause of none of those types of colitis was known. It was not that dozens of pages of those texts were not filled with discussion of the etiology of all those types of colitis. For every type of colitis, some immune disorder, infectious agent, or vascular event was suspected or proposed, but in every case the final conclusion was always the same: The cause is not fully understood.
That search led me to a third important discovery: There is such a large overlap in the clinical symptomatology, microscopic appearances, and suspected causes that there was hardly any point in slavishly adhering to the system of classification of colitis which I was being taught as “science.”
The Bowel Ecosystem
The young pathologist in me was jolted by his three discoveries. An image of several blind men surrounding an elephant arose in my mind’s eye. In that story, the first blind man touched the tail of the elephant and thought the elephant was a snake. The second blind man moved his hand on the side of the animal and considered it to be a breathing wall. The third stroked the elephant’s ear, called it a fan. The fourth wrapped his arms around one of the elephant’s legs and yelled, “A tree that’s moving! Amazing.” During the months that followed my experience with the colon described above, with similar studies conducted repeatedly, I became convinced that the same was true also of various types of autoimmune disorders of the thyroid gland, joints, blood vessels, and other organs.
Some time later, a vague, ill-defined notion of altered states of bowel ecology began to evolve in my mind. It took me several years before I could muster courage to begin writing about what I thought were my awkward notions of the bowel ecosystem, expecting to be heartily laughed at.
In the late 1970s I introduced the terms “bowel ecosystem,” “blood ecosystem,” and “liver ecosystem,” to express my view that we clinicians need to think ecologically and focus on the relationships among those ecosystems rather than be bound by the prevailing one-cause/one-disease/one-drug model. In a series of essays published in the Curriculum of the American Academy of Environmental Medicine, I focused on the impact of environmental factors and the body’s redox homeostasis.
Spontaneity of Oxidation and Molecular Duality of Oxygen
In 1983, I published Spontaneity of Oxidation in Nature and Aging, a monograph in which I explored the relationship of the phenomenon of spontaneity of oxidation to the health/dis-ease/disease continuum. During a chance reflection on why stale buffers lose some of their buffering capacity with time, I wondered why butter turns rancid spontaneously, but does not turn “unrancid” spontaneously. Fruit on the kitchen table spoils spontaneously but spoiled fruit does not unspoil spontaneously. Unmindful of the evident relevance of the second law of thermodynamics to those questions, I put forth a hypothesis that spontaneity of oxidation in nature is the primary driving force in molecular and cellular injury, and hence of aging and all disease processes.
In Spontaneity of Oxidation, I also addressed the subject of the essential molecular duality of oxygen—how it ushers life in and also terminates it. Deeper reflection led me to the conclusion that a full comprehension of myriad Dr. Jekyll/Mr. Hyde roles of this molecular spin doctor was essential to a clear understanding of the health/dis-ease/disease continuum. Those two simple ideas of spontaneity of oxidation and functional duality of oxygen have preoccupied me ever since, and form one of the principal themes in the various volumes of The Principles and Practice of Integrative Medicine.
The Leaky Cell Membrane State
In 1987, in Leaky Cell Membrane Dysfunction, I presented the biochemical and clinical consequences of an increased cell membrane permeability state caused by relentless oxidative stress. The cell membrane gets shot full of holes, so to speak, and begins to leak. As a consequence of that, what is inside the cell hemorrhages out and what is on the outside of the cell floods the cell’s innards. For example, intracellular levels of calcium in health are far below those of the extracellular compartments and a leaky cell membrane permits pathologic calcium influx. Excess of intracellular calcium then triggers a host of pathogenic molecular pathways, including induction of cell death by apoptosis. Concurrently, excess magnesium leaves the cell and functional magnesium deficiency impairs the function of many enzyme systems for which the mineral serves as a cofactor. From those considerations, I drew comparison between the ever-increasing indication of calcium channel blockers in pharmacologic medicine and ever-sharpening focus of nutritionist-physicians on magnesium supplementation. Of course, the consequences of a leaky cell membrane state are not merely confined to the changes in intracellular calcium and magnesium levels.
Absence of Health
In 1990, with The Cortical Monkey and Healing, I began a series of nine volumes for the general readership. In those volumes, I strived not only to underscore the crucial importance of the notions of spontaneity of oxidation and functional duality of oxygen, but also addressed the equally important concept of absence of health. The following quote from that book shows my focus on that subject then:
I use the term molecular medicine to refer to a practice of medicine based on molecular events which occur before the cells and tissues are injured by the disease. Molecular medicine is not based upon what we observe in cells with microscopes after the cells have been damaged.
In The Cortical Monkey, I introduced the terms aging-oxidant molecules (AOMs) that cause premature aging and life span molecules (LSMs) that provide a counterbalance and prevent accelerated and premature aging. Under certain conditions, LSMs can turn into AOMs. For example, milk proteins serve as LSMs in people without milk allergy and as AOMs in those who suffer from such reactions. The simple AOM/LSM model allowed me to present states of health and that of absence of health in molecular-energetic terms. It also permitted me to put forth a model for assessing health (as opposed to diagnosis of disease) based on energetic-molecular and morphologic bases. Two good examples of tests for health assessment are: (1) the measurement of urinary excretion of organic acids, revealing the state of oxygen homeostasis and redox equilibrium in the body; and (2) phase-contrast microscopic study of freshly prepared unstained smears of the peripheral blood. For assessment the degree of oxidative stress, specifically whether the changes of oxidative coagulopathy are present. By contrast, a suitable example of diagnosing a specific disease is a biopsy for breast cancer.
In The Cortical Monkey, I also addressed the subject of psychosomatic disease with the following words:
Psychosomatic and somatopsychic models of disease are artifacts of our thinking. Diseases are burdens on biology. These burdens are imposed upon our genetic make-up by elements in our external and internal environments. The intensity of suffering caused by these burdens is profoundly influenced by a third element: the choices we make in our response to those burdens.
My focus in that discussion was on the spiritual dynamics of health and disease. I devoted What Do Lions Know About Stress? and Healing, Miracles and the Bite of the Gray Dog to present my clinical and philosophic perspectives on that subject.
Physics of Health and Chemistry of Disease
In 1995, in RDA: Rats, Drugs and Assumptions, I wrote the following:
Given an informed choice, a vast majority of people prefer nondrug therapies based on physics of health rather than drug regimens based on chemistry of disease.… Drugs are used to inhibit, inactivate, block, mimic and manipulate molecules in the body. The synthetic chemicals give you tools of your trade for the acutely ill. The problems begin when you fail to see the difference between the needs of the acutely sick to interrupt destructive processes and the requirements of the chronically ill to restore damaged enzyme systems.
Advances in laser and related technologies now allow clinicians to offer therapies based on physics of health rather than on the chemistry of disease. Some encouraging clinical results obtained with light and sound therapies are also being reported. Clearly, this is the direction integrative medicine is following at present.
During the late 1990s, my work at Capital University gave me access to the minds of many astute clinicians and meticulous researchers who were exploring the so-called energy medicine. Their observations were— and continue to be—tantalizing. This is clearly one of the most challenging and rewarding frontiers in medicine. The emerging technology is now allowing us to validate many of the empirical observations of the ancients and others who were not so ancient.
Oxidative Regression to Primordial Cellular Ecology
In 1998, I introduced the term oxidative regression to primordial cellular ecology (ORPEC) for a state resulting from chronic oxidosis. Below, I reproduce the abstract of the original paper in which I proposed the ORPEC hypothesis:
In clinical states characterized by chronically accelerated oxidative stress, enzyme systems involved in oxygen transport and utilization, redox regulation, and acid-base equilibrium are severely impaired. Such oxidative states include fibromyalgia, chronic fatigue syndrome (CFS), Gulf War syndrome, severe immune disorders, and malignant neoplasms. It is proposed that normal “oxygenative” cellular ecology in such states undergoes an “oxidative regression to primordial cellular ecology” (ORPEC) in which state progressive anoxia, acidosis, excess reactive oxidative species, and accumulation of certain organic acids create cellular ecologic conditions that closely simulate the primordial state. The ORPEC state results in rapid multiplication in blood and tissues of pleomorphic anaerobic organisms with yeast-like morphologic features, which are designated “primordial life forms” (PLFs) for lack of precise nucleotide sequence and taxonomic data. PLFs are readily observed with high-resolution phase-contrast and darkfield microscopy in freshly prepared and unstained smears of peripheral blood. Strong homology among yeast and mammalian DNA sequences indicates that the genetic codes for PLF growth may already exist in human cells and that organisms observed in this study may not indicate an infection from an outside source. Rather, the clinical syndromes associated with PLF proliferation may represent a novel “microecologic-genetic” model of illness. Organic acids and other toxins produced by the growing number of PLFs further feed the oxidative flames of the ORPEC state, thus generating oxidative cycles that feed upon each other and are damaging to antioxidant and oxygenative enzyme systems of the body.
Dys-Ox and “Yeastization” of Human Cells
In 1999, I introduced the term dysoxygenosis (Dys-ox) for a state of cellular oxygen dyshomeostasis as an extension of the ORPEC hypothesis. I put forth the hypothesis that dysoxygenosis is caused by impaired function of enzymes involved in oxygen homeostasis (“oxyenzymes”) and leads to altered expressions of genes induced by hypoxic environment (“oxygenes”). The webs of oxyenzymes are vast, with each entity linked to every other through multiple pathways. The webs of oxygenes are seemingly more complex. All such webs are exquisitely aware of changes in oxygen availability in their microenvironment and vigorously respond to them. When one thing changes in those webs in one way, everything changes in some way. Dysoxygenosis, then, is discerned as a state caused by rich diversity of elements but one that creates the same cellular oxygen dysfunction. In 1999, I also introduced the terms dysfunctional oxygen metabolism and oxygen disorder for readers without medical or biomedical background. Below, I reproduce some text from Dysoxygenosis and Oxystatic Therapies, the third volume of The Principles and Practice of Integrative Medicine, to underscore the crucial importance of dysoxygenosis in clinical medicine:
In health, human cells harness energy with an energy-efficient respiratory mode of ATP production. A yeast cell, by contrast, is engaged in an energy-inefficient anaerobic glycolytic mode of ATP production. A human cell generates about 28 moles of ATP per one mole of glucose, a yeast cell obtains only two moles of ATP from the same amount of sugar. What would happen if human cells were to be ‘metabolically degraded’ to the level of yeast cells? Evidently, that means such cells would be extremely energy-deficient. But does that ever happen? Indeed, it does—and does so with regularity in chronic energy disorders, such as fibromyalgia, chronic fatigue syndrome, environmental sensitivity syndrome, severe autoimmune disorder, and in subjects receiving chemotherapy agents. The concept of oxidative regression to primordial (glycolytic) mode of energy production evolved during my work with nearly 5,000 healthy volunteer subjects and patients with a host of chronic energy disorders. I investigated the phenomena of chronic oxidosis and dysoxygenosis—as well as the clinical consequences of those states—with high-resolution phase-contrast and darkfield microscopy and analysis of urinary excretion of organic acids which would be expected to accumulate during glycolytic mode of cellular energetics.
I use the expression ‘yeastization of human cells’ to explain, in simple terms, to my patients the essential nature of the cellular metabolic shift in ORPEC. Specifically, that phrase allows me to explain the dire energetic consequences of that shift in chronic energy states. Oxidosis, I elaborate for them, is the state of energy loss through excessive loss of electrons. Chronic oxidosis impairs or inactivates enzymes involved with the physiological respiratory ATP generation, and so initiates the process of ‘human-to-yeast’ shift of cellular energetics. Unrelenting oxidosis eventually affects genes responsible for those enzymes, making that process self-perpetuating. That is the real explanation of why the recovery of patients with fibromyalgia, chronic fatigue syndrome, and related energy disorders can be disconcertingly slow.
In all eight volumes of The Principles and Practice of Integrative Medicine, I make a case for shifting the clinical focus from ‘diseases’ thought to be caused by malfunction of individual genes, proteins, and other classes of molecules to altered states of the various macroecologic tissue-organ and microecologic cellular ecosystems of the body. The basic research in those areas, of course, will take decades, if not longer, and enormous funds. However, clinicians need not wait that long.
A Discipline of Wholeness
Human biology is a wondrous web of energetic-molecular happenings—a kaleidoscope brought to life by bursts of innate energy, colored by cellular mosaics, moved by paradoxes of complementarity and contrariety. When one thing moves in a web one way, everything in it moves in some way. Within the injury-healing-injury cycles in that web, life begets death and death begets life.
We physicians have not been ecologic thinkers. We need to be. To paraphrase Leonardo daVinci, every part is destined to unite with the whole so that it may escape its own incompleteness. In recent years, there have been astounding advances in the dissection of the molecular pathways of healing and dying. The clinician can now see the whole with increasing clarity. Health must be seen as harmony among the molecular and cellular ecosystems of the body —forms of sickness need to be recognized as ecologic disruptions caused by spiritual, nutritional, and ecologic elements. A part can be understood only through its relationship with the whole. That, for me, is the fundamental message from da Vinci, Darwin, and others.
“I will speak of the functions of each part in every direction, putting before your eyes a description of the whole form and substance of man,” da Vinci wrote. Today, that “every direction” must include not only the essential aspects of spiritual equilibrium—of which da Vinci was acutely conscious—but also the other fundamental issues of oxidosis and dysoxygenosis. It is not enough to speak of lymphocytic thyroiditis or renal lupus as ‘diseases’ nor is it sufficient to merely substitute echinacea for erythromycin for recurrent infections or to replace Hydrodiuril with hydrogen peroxide foot soaks for leg edema. We need a discipline of wholeness—a model of medical holism which would have brought smiles to Socrates, da Vinci, and Darwin.
Notwithstanding the possible virtues of controlled and blinded studies for evaluating the short-term efficacy of drugs, the prevailing pharmacologic blockade medicine for chronic disease is essentially flawed. Nutritional, ecologic, autoimmune, and degenerative disorders cannot be reversed by synthetic chemicals. It saddens me how often “control-crazed” clinicians deny the sick wonderful opportunities for healing with natural measures only because they think that it is not scientific. Those words may irk some readers, but if I succeed in raising a few disconcerting questions in these volumes, my purpose will have been served.
In recent years, much has been written about what might or might not constitute alternative medicine, complementary medicine, and holistic medicine. What we ought to be searching for—it seems to me—is civilized medicine. Below, I reproduce some text from my message to the Capital University community published in the inaugural issue of The Journal of Capital University of Integrative Medicine in 2000, in which I submitted some personal thoughts on the issue:
At Capital University, we strive to be a tribe of civilized medicine. It is a medicine about human dignity—dignity of the sick as well as those who care for the sick and prevent disease.
A practitioner of civilized medicine grows in three stages: knowledge, understanding, and wisdom. Learning the facts of natural phenomena in biology is the first stage of knowledge. Searching for relatedness among those biological phenomena is the second stage of understanding. Bringing that knowledge and understanding to the care of the sick is the third stage of wisdom. In civilized medicine, the practitioners seek the wisdom of:
Keeping the sick is at the center stage— the wisdom of letting the sick guide them as they guide the sick.
Doing his healing work only within the “matrix of belief” about the observable as well as the unobservable in the healing phenomena—again, keeping their belief subordinate to that of the patient.
Holding nutritional, ecologic, and stress-related aspects of modern life as the central focus of their work.
Recognizing Nature’s preoccupation with molecular complementarity and contrariety in the health/dis-ease/disease continuum.
Bringing a gardener’s sense of soil and roots to nurturing the sick.
Recognizing the bowel, blood, and liver ecosystems as the soil and the root of the human organism.
Searching the energetic-molecular basis of the health/dis-ease/disease continuum.
Not hiding behind hollow diagnostic labels.
Not subordinating the empirical observations regarding hurt humans to the experimental observations regarding mutant mice.
Not sacrificing painstaking studies of astute clinicians at the altar of double-blind, cross-over medical trials.
Not mindlessly using synthetic chemicals to treat disease caused by chemicals.
Not politicking for legislative and regulatory fiats to squelch competition from other healing arts.
At Capital, our tribe of civilized medicine is utterly committed to true advances in our Star Wars medical technology. Those advances allow us to observe human suffering with increasing sophistication. Our high-resolution microscopes show us the vibrant dance of cells bathing in the fluids of life. Our high-resolution chemiluminescence technology gives us windows to the true-to-life electron dynamics of the health/dis-ease/disease continuum. There are other examples of such technical advances in focus at Capital.
At Capital, the essential spirit is not of leadership. It is of service. During the last six years, the primary difference between the faculty and students has been that the former were teachers without salaries and the latter taught while paying tuition. That has been the singular manifestation of the tribal spirit at Capital.
At Capital University, our tribe of civilized medicine has a belief that all of our healing work must be conducted in the state of spiritual surrender to that higher Presence that permeates each of us at alltimes. For the mystery of healing will forever transcend the human faculty for comprehension.
Integration in medicine is a matter of integration of the spiritual dynamics of the injury/healing/injury cycles with energetic-ecologic concepts of health and disease. And those concepts must be solidly grounded on sound biomechanical, morphologic and empirical observations.
Oxygen Homeostasis: Complexity and Simplicity
The study of complexity in any field is of limited value unless it allows one to recognize a workable simplicity there. In eight volumes of The Principles and Practice of Integrative Medicine, I explore in depth the enormous range of complexity of oxygen homeostasis and redox equilibrium in health as well as dysoxygenosis and redox dysequilibrium in the states of absence of health and disease. In closing this brief outline of how my view of clinical medicine has evolved since I became a physician, I might offer the reader the following workable simplicity: All states of absence of health and chronic disease result from either spiritual dysequilibrium or altered states of bowel ecology. And all energetic-molecular derangements encountered in those states are mediated by persistent cellular and matrix oxidosis, acidosis, and dysoxygenosis.
The above workable simplicity has a strong explanatory power for diverse clinical observations concerning health and disease. Beyond that it provides the clinicians rationale and sound scientific basis for designing integrative management plans for preserving health as well as reversing chronic disease. A clear view of the fundamental issues of redox equilibrium and oxygen brings into a sharp focus the utter futility of disease prevention with pharmacologic agents that block cellular receptors, channels, enzymes, pumps, and mediators of healing responses. Regardless of how necessary the use of drugs for treating acute clinical entities may be, the ‘oxygen model’ forces us to address the fundamental energetic-molecular dynamics of the health/dis-ease/disease continuum. It compels us to be holistic and integrative in our thought.
The Sun-Soil Concept of Healing
The oxygen homeostasis model of health/dis-ease/disease model led me to another simplicity that dominates my thinking now: the “sun-soil concept of healing.” In this simplicity, the sun represents the healing energy of the Presence that surrounds us at all tmes and the soil represents the trio of the bowel, blood, and liver ecosystem. Healing in chronic illnesses, then, can be seen as occurring through the medium of oxygen sustained by luminouas sunlight and nurtuing soil. That simplicity holds whether I manage a case of breast cancer or of heart disease, of disabling chronic herpes infection or incapacitating fibromyalgia. The clinical applications of that simplicity need to individualized for individual patients but the essential sun-soil holism stays.
Of Union and Disunion
Unlearning is harder than learning. That is easy to understand. Learning, at its core, is forming unions with one’s beliefs and thoughts about the meaning of what is ‘learned.’ Unlearning is rupturing that union — a “disunion” that is as traumatic to the person as it is to a plant uprooted from the soil it is embedded in. At one level, that is the struggle that physicians face during their life time. In this personal perspective on integrative medicine, I include some reflections on the subject of unions and disunions.
We physicians do not remain aloof to unions and disunions of the persons we attend to for long, nor to our own unions and disunions. The past imprints the present. The clinical consequences of that imprinting are often profound, as significant for physicians as those are for their patients. My main point in The Cortical Monkey and Healing was this: The Monkey in the Man forever recycles past misery and, when that is not sufficient, precycles feared future misery. And that Monkey cannot be banished with clever thinking. The past cannot be returned, but there is choice in how it may be revisited.
Here, I briefly recount my personal struggle with unions and disunions. As a child, unions came easy to me and in profusion. Disunions also came in equal profusion, but each was difficult in its own way. Early in my childhood, that profusion created a secret place to which I escaped with regularity, though then I did not know what it meant to escape to one’s own secret place of life. Nor that it was a place of private unions and disunions. With time, the place grew into an enormous space of happenings that fascinated me. There were also happenings that were not good. I did not know then what happiness was, nor what the absence of happiness might be. More years passed and my private place grew and teemed with things, people, and events. I began to have a sense of things — of why I liked some happenings but not others. I had not yet learned that grown-ups had a word for it: daydreaming. (The word daydreaming—it seems to me — is not quite the right word for all those happenings.)
Also in my early years, I did not know about the problem of thinking too much, nor about how not to think. (It would be decades before I understood the problems caused by too much thinking and began to wonder how to “unthink.”) Some more years passed. I learned that grown-ups had a name for the happenings which I did not like: unhappy. My moments of not being happy turned into something more unwanted, deeper, troublesome. Another word was added to my vocabulary: sad. Vague notions of unexplained sadness began to evolve in my developing mind. I did not share that notion with anyone. How could I? I did not even know what any of that meant. I went to high school, then to college, then to medical school. My teachers always lost me within minutes of beginning instruction — or, I lost them, transported back to my place, which had grown much larger and richer by then. Sometimes during those years the voice I heard became louder and I began to put words together just to cope. But the periods of heaviness persisted and the notion of ugliness that made no sense took hold in my mind. Later, I recognized that as unexplained sadness. It would be many years before I learned that psychologists had a name for all those happenings: ADHD (attention deficit and hyperactivity disorder)
My earliest unions—memories, I suppose, might be a better word—were of tracking with my mother. Those unions started when I began to tag along with her. Those unions were the simplest and purest of all I would ever experience, though I did not know that then. Tracking in the market occurred when I was big enough to accompany my with mother when she went out for shopping. That was a wide world of new unions — a bustling world of women in burqas and men in broken sandals, of open sewage ditches running through narrow alleys, of rotting vegetables tossed away from vendor’s carts. There was many things there for a boy to observe — accidental palpations of women’s bodies by bearded holy men when they took measurements for sewing dresses, and the like. There were with g ls (loudly delivered obscenities), brown ghuur (sugarcane candy) blackened by flies, and khotaas (donkeys) with fungus-eaten hides who seemed ever so ready to relieve themselves in public with loud noises. Whatever I saw in the market inhabited my space. The place blossomed.
Then one day I suddenly found my mother wrapped in a white shroud overlaid with bright red flowers. I was eight years old then. There was much crying in the house. (Many years later, looking at my mother’s only photograph in the family album, I realized that the eyes of my father and all of my siblings were swollen from crying. Mine were not. The picture showed me staring into the space before me.) Then, my mother simply faded away. She would return many years later to inhabit my private world again.
Then followed unions from tracking to and within the mosque — a blessed place, so I was told. That was a colorful world of shait n (Satan) and farishates (angels) —of people burning in enormous fires of hell, and of hooris bathing in riverlets of honey and milk in heaven, ready to receive holy men of Islam. What is a virgin? I wondered. Later I learned who a virgin was. Why would any man want so many virgins?, the thought crossed my mind sometimes. I thought of shait n much more often than of farishates, who seemed to flutter around, aimlessly, doing nothing. It was obvious to me that shait n was always busy and successful. Farishates, in contrast, seemed useless. They never seemed eager to stop bad people from doing bad things. The mosque was also where my earliest unions with the evils of Hindus, Jews, Christians — even Sunni and Shia Muslims — formed. How could all of them remain blind to the only truth of Ahmadiyyat in Islam? In India and in Europe? And in America? And for centuries?, I often wondered. But there was something reassuring there. I was a follower of the true Promised Messiah. My very dear father was an Ahmadi Muslim, and so were others in the family. After all, wasn’t being an Ahmadi the only thing that mattered? The Hindus had their own hells to pay for. The Christians and the Jews, they were going to be held accountable for their transgressions. Of that, there could not be any doubt.
More unions came my way while tracking in medical wards in Lahore. That was a world of great men in white coats. There were scalpels and sutures, and, of course, much blood. There was high drama of suffering and even higher drama of arrogance. The professors were always right, even when they contradicted themselves. The seeds of union with the medical dogma were sown deep into the mind of the young medical student. Everything was made out to be either black or white. There are educated doctors and there are quacks, I was told. And the educated doctors were not to have nothing to do with the charlatans who called themselves hakims (naturopaths) and homeopaths in Pakistan then. I was told to shun all those imposters. Of course, we students ate that up. We were also told that real doctors never let their patients influence their judgment. We took that as gospel truth. (It would be decades before I realized how stupid that advice was. Whose life were we talking about anyway?) Those medical school years gave me deep convictions — or so it seemed then. Those unions grew deep roots into my private space as well. Medical students are too busy cramming to think about “uncramming.” One has only so many functioning neurons. The idea of disunion was years away in the future.
Then came tracking in deeper recesses of the mind. New alleys formed in my space. A dark world of
doubt and uncertainty opened up. What is real? What is true? Who knows the truth? Who may be trusted? The awkward questions came from nowhere. In England and later in the United States, I met Christians and Jews, and they seemed no less decent — or more evil — than the holy men in the mosque of my unions. I moonlighted with Hindu interns and residents. They were gentle, kind, and caring young women and men. Cracks began to appear in the armour of my Islamic convictions. Yet more ugly questions appeared. We doctors are supposed to heal the sick. Instead, I saw the sick getting sicker. During pathology residency, every week I processed so many uterus specimens that I began to look at women in shopping malls and wonder which ones had been hysterectomized. Who gained? Who lost? More ugly questions. Men making money by mutilating women? Oh God! No. Not in my chosen profession. No, it couldn’t be, my mind would recoil. Well, yes! It is so! Why deny? The questions were endless. Others also raised those questions. In the end we merely gave each other knowing smiles. Antibiotics and other drugs saved many lives. Those drugs also hurt many people. I began to wonder if those hurt by drugs outnumbered those helped by them. I heard some friends ask that question as well. We physycians saw that happening but kept quiet. Speaking against drugs, we all knew, was bad for our business. Yes, medical practice was enriching, but it was also depleting. Toeing the party line of organized medicine became irksome. Conflicts — beginnings of disunions — multiplied.
Then came tracking in mines of toxicities— of the body tissues, of emotions, of intellect, of environment. The New England Journal of Medicine (NEJM) pronounced dioxin to be the most potent known carcinogen in rats. It then reassured its readers that a large study in New Jersey had found no evidence of toxicity in people exposed to the chemical. The U.S. Department of Defense declared that its soldiers who claimed to have been made sick by dioxin — and other chemicals used for defoliation — had been delusional. JAMA reassured mothers that there was no evidence sugar was bad for their children. NEJM claimed that ear tubes were good for little children. One of the participants of that study cried foul, insisting that the reported data was fudged. NEJM refused to publish that letter. We would not have known that except that JAMA published that letter four years later. Many prestigious journals published editorials under the names of esteemed professors. Later, it became known that those editorials were actually written by drug companies.*
Blatant lies in medical literature accumulated at a much faster rate than I could cope with. The editors of prestigious medical journals began to appear as villains, brazenly safeguarding the interests of their paymasters at drug companies, relentlessly insulting holistic physicians, forever declaring natural therapies — of which they knew nothing — dangerous. Conflict and distrust grew. Old unions of ideology ruptured. Disunions became larger, deeper.
Many patients related the circumstances of their healing that defied the prevailing medical dogma. It would have been easier to simply dismiss their accounts as apocryphal. But I could not. Instead I began trafficking in the mysteries of healing — of belief in the possibilities of injured tissues recovering, following some internal cues. Of healing by helping others to heal. Of healing with giving and love. That brought me newer unions. I recognized that what is given, stays; what is received, well, that lasts for moments. And that love that is given, sustains; love that is demanded, depletes. A physician’s true work, I realized, is not about curing. It is about giving and love. In that, a physician’s life is, in reality, climbing a mountain, knowing full well that the top shall not be reached, nor that the climb may be discontinued. He does have the option: He can see the sick as wild flowers on the climb, or as thorns on his sides. In the corrupted world of healing arts, a physician has to make some attempts at decency, no matter how feeble however ineffectual. A notion of a civilized medicine arose. I began to see that there were no controversies in medicine, only levels of understanding and enlightenment.
From my simple rural Islamic roots I had wandered into the dizzyingly fabulous worlds of merchants of medicine and of dealers of religion in New York and Washington. I recognized a new medicine — Star Wars medicine, I thought, was an appropriate name for it — which saw sick women and men merely as substrates for it machines. I saw the high priests of that Star Wars medicine sitting on their lofty perches, doling out wisdom about the sick whom they never saw.
*See RDA: Rats, Drugs and Assumptions for specific citations of those and many other deliberate statistical deceptions in medical literature.
They happily sacrificed caring and compassion for the sick on the alter of the ‘science’ of medicine. Those high priests had little patience for the words of the ill, which they dismissed as ‘soft and subjective’ trivia. They had nothing but disdain for holistic physicians who offered nutrient, herbal, and self-regulatory therapies. High priests of religion were no different. Their “cyber-spirituality’ had enriched them beyond their wildest dreams. They knew their cyber-spirituality did not mix well with anguish of the suffering humans. But they ‘healed’ millions through their telecasts.
Finally, it occurred to me that I had come full circle. All my unions had turned into disunions, except those I had formed with my mother — and later with my father and some others.
I recognized then what was common among all the lasting unions — those immune to disunions — was kindness, giving, and love. My unions of the market, of the mosque, of the medical ward, of dogmas of medicine, of the high priests on editorial boards, and of my own sense of my intellect had been tricks played on me by my cortical monkey. There had been no giving in them, nor love. I also saw clearly for the first time that for any union to be true, it had to be immune to disunion. It had to be a union of giving and love. And that is the true nature of knowledge.
One Can Know Only as Much Divinity as Exists Within Oneself
The mystery of the healing phenomena has deepened for me over the decades. The longer I work with my patients, the more aware I become of the fundamentality of the spiritual in health and disease. How does one define the spiritual? In 1994, in The Canary and Chronic Fatigue I could not resist walking that definitional tightrope with the following words:
The spiritual to the early Man was unknowable. So we sort through our intellectual assertions and return to where we started from: The spiritual is being outside the capacity of our bodily senses and the reach of the mind. Spirituality lies outside the needs of the body or the demands of the mind. Good teachers of spirituality may take us to the limits of our bodily and mental experiences—to the gates of spirituality—but they cannot lead us into it. No one can show anyone else what is the spiritual, no one can make anyone else spiritual. This is what the early Man must have known—through some spiritual journey—when he conceived the mind-body-spirit dimensions.
In 2003, in Integrative Cardiology, the fourth volume of The Principles and Practice of Integrative Medicine, I made a second feeble attempt to put my notion of the spiritual in words as quoted below:
My working definition of the spiritual, which I have used for several years, is this: It is a state of surrender to the larger unknowable Presence that one recognizes only by the way one changes through the light and love of that Presence.
One can know only as much divinity — it seems to me — as exists within one’s self. One sees that vividly only when in throes of pain and suffering. We physicians, by and large, insist on the ‘hard’ evidence of blinded studies. We are uncomfortable with notions of healing with spirituality and one’s own divinity. I once read somewhere that it is better to say nothing and be considered a fool than to speak up and leave no doubt. That has never kept me from speaking out about my personal quarrel with the mysteries of healing. I seldom have had difficulty seeing the fool in me. But the fools do have wonderful insights sometimes. So I persist.