Integrating complementary and alternative medicine (CAM) and conventional diagnoses

Abstract

For many years research has tried to address how to integrate complementary and alternative medicine (CAM)/traditional medicine with western biomedical diagnoses. In many Asian countries CAM and conventional medicine operate in parallel, but often with considerable difficulty. This is particularly true for a diagnosis such as a homeopathic constitutional diagnosis or for a Traditional Chinese Medicine (TCM) diagnosis which may not easily relate to a conventional diagnosis and poses issues regarding patient centred communication. It also makes communication between practitioners difficult and can be further confusing for patients, especially when they receive a TCM diagnosis in the context of a Western cultural environment. It is all very well for the TCM doctor to consider that their “liver may need some tonifying” but when faced with their family physician and normal liver function tests this can open to ridicule. There are some major philosophical differences between traditional approaches and Western medicine. Most traditional approaches value the individual’s symptom based presentation. One individual with stroke or lung disease may be very different, both constitutionally and in terms of proposed TCM treatment, to another. Conventional medicine generally looks at populations of patients’ with illness and then attempts to design appropriate interventions for those populations. Patients at risk of cardiovascular disease will generally be prescribed statins in a conventional context whereas traditional medicine may have a wide variety of approaches while both systems will certainly value very similar advice in relation to diet and cardiovascular disease. Individualized traditional systems often identify what one might loosely define as “pre-pathology”. A TCM doctor may diagnose that the pathogen damp affecting the spleen as a cause for indigestion and the conventional physician may not identify an ulcer or the need for triple antibiotic therapy, yet the patient still has same complaint. Logically one would suggest that the individual is prone to a particular condition and beginning to suffer from symptoms but has not yet developed an overt or identifiable conventional diagnosis. Some TCM practitioners may claim that their diagnosis is an important and individualized approach to “preventative medicine” but because there may be nothing material or definite, the Western physician is confused, distrustful and consequently unbelieving. These somewhat nebulous, non-material traditional diagnoses are very difficult to pin down so communication between physicians can become both fraught and misunderstood.