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C HAPTER 41 / Complementary and Alternative Approaches in Cardiovascular Disease 909
Rajas (motion, action), and Tamas (inertia resisting motion, ac- prescribed movements such as qi gong and tai chi. Herbs have
tion). Diagnoses are based on history, observation, palpation, and energies and are characterized as yin or yang. Herbs with cold en-g g
inspection, particularly of the pulse, tongue, eyes, and nails. Ther- ergy treat hot syndromes; herbs with hot energy treat cold syn-
apeutic goals in AM are to maintain or restore harmony between dromes. For example, anemia or weak pulse might be considered
the individual and cosmic forces (mind, body, spirit). This in- a cold syndrome; treatments would warm the blood and
volves increasing Sattva while reducing Rajas and Tamas. The AM strengthen the energy.
approach is holistic; treatments are customized to match the indi-
vidual’s characteristics (i.e., constitutional type or Prakruti). Ap-i i Traditional Native American Healing
propriate food, sleep, and sexual activity are pillars of good health
in AM. Many treatments utilize vegetable-based botanicals such as Native American healing methods are based on the accumulated
cardamom, cinnamon, and turmeric. Treatments emphasize men- knowledge and skills from hundreds of generations of traditional
tal and physical hygiene and discipline, adherence to moral and healers. The medicine person (traditional healer) holds a place of
spiritual values, massage, exercise, meditation, herbs, sunlight ex- honor within the tribe; he or she is chosen by their tribe, by an
posure, and controlled breathing. Strict adherence to diet (Yama)a older healer, by a tribal medical society, or as a result of a personal
and behavior (Niyama) is part of AM. Treatments include access- vision quest. Practices are typically not written down. They are
a
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ing pressure regions (Marma), similar to acupuncture. Meditation handed down verbally from one practitioner to another and not
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and yoga exercises are essential components of AM, with stress on shared with those outside of the group. Mastery of the Native
the ability to bend, flex, extend, and stretch. Physical fitness from American healing requires many years of training and disciplined
the AM viewpoint involves a capacity to withstand heat, cold, spiritual practice. Native American healing practices were illegal
hunger, thirst, and fatigue. in the United States between 1887 and 1978, but traditions were
handed down and practiced covertly. Today, Native Americans are
Traditional Chinese Medicine more likely to use traditional healing than other ethnic and racial
9
groups. The majority of the two million Native American and
TCM has been practiced for thousands of years; it relates health Alaska Native people consult with traditional healers regardless of
to concepts about a person’s energy. The practitioner’s role is to whether they live on or off the reservation. 9
guide the patient toward restored energy balance and, thus, Tribal groups vary in terms of rituals and ceremonies but, in
health. Several types of energy are involved. Qi (pronounced general, disease is believed to relate to problems of the person’s
chee) is the energy of life. In disease, qi is imbalanced. Related to spirit. The underlying Native American belief system conceptual-
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qi are yin (associated with cold, moist, internal aspects) and yang izes each person as consisting of mind, body, and spirit. Wellness
(associated with heat, dry, external aspects). Yin and yang are involves harmony between the three components of the inner self
constantly interrelated; when imbalanced, illness results (Fig. and with the outer universe. Illness is attributed to negative men-
41-1). Qi flows along channels called meridians (Fig. 41-2). Dis- tal, physical, or spiritual activity, or to imbalances of the environ-
ease blocks qi flow and upsets the balance between yin and yang. ment; violation of a sacred or tribal taboo could be involved. In-
In TCM, five elements (water, fire, earth, wood, metal) describe terventions are designed to heal the spirit; they include energy
a person’s physical and emotional characteristics. TCM assess- field manipulation, sweats, religious ceremony (song, dance), herb
ment involves history taking and physical examination, particu- lore, and sand painting. In Native American culture, medicine
larly of the tongue, pulse, and abdomen. Treatments prescribed and religion are not separate, but one concept. Most traditional
include acupuncture, the inserting of needles at specific points religious ceremonies are also healing ceremonies because spiritual-
along the meridians to improve qi flow (Fig. 41-3). Moxibustion ity is the cornerstone of healing practices. Typically, each person is
treatments involve holding a burning herb to provide heat along believed responsible for his own health care. Healing ceremonies
a meridian. Cupping treatments involve placing a warmed glass implicitly include family, patient, the traditional healer, and tribal
over the skin; as the cup cools, the resulting vacuum pulls blood members. The traditional healer may include rituals, prayers,
toward the area. Other TCM treatments include consuming singing, sweat lodge, body manipulation, or herbal remedies as
proper foods (nutrition), preparing and ingesting Chinese herbs part of the healing process.
(herbal medicine), massaging, and exercising the body through
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Chiropractic Medicine
Chiropracty is the fourth largest health care profession in the
United States with 53,000 active practitioners in 2006. 20 Chiro-
practors have 4 to 5 years of postbaccalaureate education includ-
ing at least 4,500 supervised classroom, laboratory, and clinical
hours; they are licensed and regulated in all 50 of the United
States and in more than 30 other countries.
Chiropracty focuses on manipulation of the structure of the
body to influence the body’s innate ability to restore and optimize
■ Figure 41-1 Yin-yang symbol. In TCM, yin and yang are con- health. Special emphasis is placed on spinal alignment. Care is
stantly interrelated forces; disease results when these forces are imbal-
anced. Yin is associated with cold, moist, and internal aspects and provided by realignment of subluxations through manipulations
yang is associated with heat, dry, and external aspects. (From Lewis, of joints and vertebrae. Subluxation or a subluxation complex is
S. M., Heitkemper, M. M., & Dirksen, S. R. [2004]. Medical surgi- defined as an abnormal function of a joint and the associated
cal nursing: Assessment and management of clinical problems [6th ed.]. muscles, nerves, tendons, ligaments, and discs. Treatment goals
St. Louis: Mosby; used with permission.) for chiropractic joint realignment include restoration of proper