Cindy Mason: Symposia for
Institute for Future Health Care Technology, Boston, Mass., 2003.
Global Medicine Technology
Cindy Mason, Ph.D.
Visiting Research Scientist
Stanford Research Institute,
Abstract
In little more than a decade, linkages between
health care technologies of different cultures and continents have merged,
resulting in global medicine technology. The next generation of young scientists
and clinicians from both the research and clinical communities are merging
established ancient technologies from outside the
1. Introduction
In this article we briefly
discuss some key ideas in eastern mind training technologies and point to
some of the ongoing activities in both clinical and research settings. Most of the ideas presented here embrace the notion that
there is a relation, in fact a dialogue, between mind, brain and body. Concepts
like self-awareness, mindfulness, forgiveness, and honesty, are also big
players in the ancient technology of healing and the mind. Also included in this new health landscape are the ideas
that mind, brain and heart are not separate organ systems, and that mind
and body refer to the same concept. Mind training
technologies were not developed in a laboratory nor do they rely on silicon
chips or pharmaceuticals, rather, they were developed and passed down by
"gurus" or teachers, sometimes religious leaders, who have developed deep
insight into human nature and human behavior. Culture has preserved the teachings.
Clinical success has kept them alive. They do not replace nor compete with
western technology but are a marriage made in heaven for an ailing healthcare
system, where patients feel alienated, hospitals are going broke, and doctors
yearn for a system in which they, too, can slow down and provide compassion.
In the article we discuss the role of healthcare culture in global medicine
in the
2. The Culture of Healthcare
"It is probably true that, in general, the most fertile developments in the history of human thought are born at the intersection of two currents of ideas. The currents may originate in the midst of totally different cultural conditions, in diverse epochs and places."
Heisenberg, physicist
A revolution in western medicine, like in physics, will come from realizing that our method of questioning is limiting our solutions. The need to separate mind from body in order to describe and explain them fails to capture the interplay between mind and body. This interplay now appears to be fundamental in theories of healing and disease formation. Without realizing this interplay we will fail to utilize our full capacity to address not only clinical and financial healthcare issues but administrative ones as well. The fMRI diagnostic technique provides much needed evidence for western cultures to understand why and how some of these ancient medical teachings work - not only how they awaken, regulate, and influence the body's own healing mechanisms but how they work together with western medicine. Such evidence provides the key to our ability to integrate these methods successfully and transform an ailing healthcare system and restore the level of standards and scrutiny we have grown to expect from western medicine.
3. Mind-Brain-Body Dialogue
What we in the west are now referring to as the mind-brain-body dialogue is at the heart of traditional healing practices of Theravadan, Zen, and Tibetan Buddhist meditation. Other meditation practices involve repetitive slow body movements or repetitive thought exercises. These practices include yoga, tai chi, chi gong, chanting, prayer, and repetitive exercise. More than 35 years ago, researchers at Harvard were studying the origins and effects of stress and the cultivation of a relaxation response via meditation[20],[21],[22].
Clinical results of these practices, along with positive clinical results of acupuncture and acupressure, and studies of the mind during these practices, indicate there are a number of effects occurring in the mind/body as a result of these ancient "technologies". Recent research in brain and cognitive sciences using fMRI, SQUID, and enhanced EEG show remarkable and highly positive changes occur in brain function as a result of prolonged meditation practice[27]. General information about fMRI and fMRI studies can be found at websites for a variety of places with on-going programs involving fMRI [23][24][25][26]. The invention of the fMRI provides details of the brain “in action” in a way previously imagined impossible. As shown in Figure 1, the fMRI does not require an IV, thus it is less invasive than PET scans (for an introduction to fMRI, see [27],[28]). It also requires fewer brain images to capture brain activity. We are now in a position never before experienced to understand how the mind creates changes in brain function over time, to watch the ways our mental and emotional lives affect our brain function, and to see the body’s relationship to the brain. It is now possible to watch how persistent mind training produces enduring changes in the brain, beneficial for physical, emotional, cognitive and behavioral health.
Figure 1. Functional MRI pictured below. The
man is getting his head examined. Photo source: Radiology
Info™[25]
Because many of the mind-body-brain technologies are relatively inexpensive, these studies have positive implications for a medical system pushed to its limits to find economical ways to help patients find solutions
A core idea in many health
cultures is that the link between mind, brain, and body is the breath, also
known as prana, and qi.[3] Most if not all meditation instruction calls the student
to develop practices involving the breath. Concentration
practices and mindfulness practice are systems of mind training practices
with core teachings relating to the breath, attention,and self-awareness. Figure
2 shows fMRI and EEG images that deomonstrate the influential relationship between meditation and brain activity. This study was performed at the Gollub
Neuroimaging Lab at
Figure 2. Physiological effects of meditation. Functional MRI images on the left,
EEG on the right. Source: Gollub Neuroimaging Lab,
The next set of fMRI images in Figure 3, also from Gollub Neuroimaging Lab[27], shows the influence from body to brain, as an acupuncture needle insertion causes changes in the brain. The figure below illustrates the multiple effects of using acupuncture to needle an area of the body known as the Hoku point, Hegu point, or Large Intestine-4 (LI-4), located on the top side of the hand, in the highest place on the mound of tissue between thumb and index finger (think about the area where children draw faces on their hands and animate them, the inside corner of the mouth on that face points to LI-4). The area is one of the more well known acupuncture/acupressure locations and is commonly associated with pain relief but has multiple uses. The preliminary results of the study suggest that acupuncture needle manipulation on either hand relates to activity in the limbic system and subcortical structures. For more details on this project see [37].
Figure 3. Physiological effects in brain from needle manipulation
of the hand area known as Hoku or Large Intestine
4 (LI-4) point. Source:
Gollub Neuroimaging
Lab,
To become a practitioner who works with prana, or qi, one of the more important aspects of training is to develop your own meditation practice. The strength of your practice and the quality of the teachers you encounter are central to the quality of care you will ultimately provide as a practitioner who works with qi or prana. Knowledge about meditation practices is passed down through oral teachings. As a result, the lineage of the teacher as well as access to the teacher is important. The path to health prescribed by lineage teachings includes systemic mind training such as meditation and spiritual practices as well as certain types of body meditation including yoga, qigong, tai qi, which work with the mind-brain-body dialogue using movement and breath together. Body meditation practices release tension in the body, freeing the breath, and uses postures and movements that open the spine, joints, and limbs, encouraging body fluids to move, at the same time relax the mind.
What type of meditation
practices work for an individual is not a one-size-fits-all prescription. Generally, styles
of meditation are a result of recommendations by friends or a result of
personal inquiry. Often more than one type of meditation
is explored before finding something satisfying, as there are many aspects
to showing up for such teachings on a regular basis including location, availability
of a teacher we feel comfortable with, the surroundings and social support
offered in meditation community, family support in allowing time and space
to develop the practice. Often there are weekend retreats and cost is still
sometimes a factor when housing or travel is involved. Many
hospital facilities and HMOs are beginning to offer education and support
for these activities as a means of addressing patient needs.
The idea that meditation
and mind training can influence health is not new. As
long ago as 1975, Dr. Herbert Benson studied meditation and the development
of a practice for cultivating the “relaxation response” as a means for combating
hypertension[10]. What
is new is the invention of technologies that allow us to see changes in brain
activity as a result of such mind training practices. Recently
Tibetan meditation has drawn the attention of neuroscientists and is the
focus of studies at the
4. Self Care
An important
aspect of the soft technologies is that of self-care. Many
lineages encourage individuals not to become dependent upon a healthcare
practitioner but to learn self-care methods. While
these techniques are not in fact a substitute for seeing a practitioner,
they are useful until that can be arranged, and help extend the benefits
of other medical treatments. It is interesting to
note that many individuals report being naturally drawn to taking better
care of themselves as a result of their meditation practices, gaining the
courage to make changes in habitual behaviors, increasing personal happiness
that seems to spill over into every aspect of their life including their
health.
Destructive
behavior is at the root of many health problems, ranging from obesity and
diabetes to domestic violence. The relation between
emotional and physical health is most obvious among patients with heart
problems [32] which are rated as the leading cause of death in this country. Although it is common sense to many of us reading this
paper, there is now considerable scientific evidence that letting go of
anger and resentment can reduce the severity of heart disease. In some cases, the release of anger has been shown to
prolong the lives of cancer patients. Considering
the relation between stress and the immune system, or stress and the adrenal
response, the results of such studies are not surprising.
Technological advances in surgical instruments, anesthesia, artificial
hearts and heart valve materials may help patients manage symptoms of heart
disease, but without fundamental changes in habitual responses, including
emotional health, in a manner of speaking, we are pissing in the wind.
Destructive
emotional lives have a price not only on health, but on social structures. Families, workplaces, and schools all feel the price of
violence, suicides and bullying that accompany emotional disharmony. Public institutions and school systems that cope with
these problems are pressed to their limits to understand and prevent them(e.g.
In an unusual
example of global medicine, patients at Stanford University Hospital, Lucille
Salter Packard Children’s Hospital, Kaiser Permanente of Redwood City, Mills
Peninsula, California Cancer Center of Marin, and
other hospitals in the San Francisco Bay Area, are using the Japanese art
of self-care known as Jin Shin Jyutsu physio-philosphy, to help manage side effects and
emotional upheavals that adversely affect patients during major health projects,
such as chemo, heart surgery, or transplants, and the treatments they involve
[33],[34],[35],[36]. Used in support of whatever treatment
regime the patient is undergoing, patients subjectively report less fear,
worry, and depression. During sessions with practitioners, individuals learn
to monitor feelings and use simple recipes on themselves involving gentle
touch to harmonize difficult moods, attitudes, or symptoms. These self-care methods can be used by even the sickest
patients throughout the day and evening or when other treatments are unavailable
to help with nausea, sleeplessness, pain, and anxiety, and other signs and
symptoms. Practitioners quietly
inspire a philosophical focus on reducing dependence on care providers by
self-care training/instruction that guides
individuals to use self-care exercises based on how they are feeling – physically,
emotionally, mentally, and spiritually[36]. Interested readers are encouraged
to try the Japanese exercises in self-care found at the end of the chapter. There is also an exercise that supports harmony of the
spine and related functions. Jin Shin Jyutsu
self-care is taught around
the world by self-care instructors[36] and can be found on CD-ROM [33].
10. Conclusions
Future progress in solving some of the most pressing issues in
healthcare will come by innovation and adaptation of ideas and methods that
work. Healthcare access (especially preventative care)
for a large number of uninsured, shortage of nurses, and the rising cost
of healthcare in an aging population explosion are among just a few of the
reasons to consider using global medical technology along side high-technology. Self-care education and meditation training are comparatively
cheap ways of reducing the current pressures on our medical systems in the
APPENDIX A
JIN SHIN
JYUTSU SELF-CARE EXERCISE
Figure 4
illustrates a self-care exercise called the “Main Central” for harmonizing
spine functions as perceived in the Japanese healing art known as Jin Shin
Jyutsu physio philosophy[36]. As prevention
or maintenance, this exercise may be done upon waking, and/or before retiring
at night. Use pillows as necessary for comfort. It may also be used as needed when working with health
projects. It usually takes about 20 minutes when
done properly, but may be interrupted and resumed without difficulty or
loss of benefit. As this exercise proceeds, it is
useful to visualize the breath coming up the back as you inhale, and down
the front as you exhale. Figure 4a shows the physical
locations for hands. Figure 4b gives directions for six hand positions referenced
in Figure 4a. Fingertips are often used, but palms,
back of hands, or entire hand can also be used. It
is important to be comfortable during the application of the exercise, avoiding
noise, drafts, etc. Quiet music may be useful if
you have trouble relaxing.
Figure 4a Diagram shows hand positions used to administer
self care described in Figure 4b. R1 refers to Right Hand position in Step1. L1
is the Left Hand position in Step 1, L2 is the Left Hand position in Step 2, and so on. Source: Jin Shin Jyutsu Insitute [36].
.
Figure 4b.
gives the directions for a self care “recipe”. There
are six steps that move the hands according to descriptions below and follow
the illustration in Figure 4a.
Step 1: Place the fingers of the right hand on the
top of the head (where they will remain until step 6). Place the fingers
of the left hand on your forehead between your eyebrows. Hold for 2 to 5
minutes or until the pulses you feel at your fingertips synchronize with
each other.
Step 2: Now move the left fingertips to the tip of
the nose. Hold them there for 2 to 5 minutes, or until the pulses synchronize.
Step 3: Move the left fingertips to your sternum (center
of your chest between your breasts). Stay there for 2 to 5 minutes, or until
the pulses synchronize.
Step 4: Move your fingers to the base of your sternum
(center of where your ribs start, above the stomach). Hold them there for
2 to 5 minutes, or until the pulses synchronize.
Step 5: Move your fingers to the top of your pubic
bone (above the genitals, center). Stay there for 2 to 5 minutes, or until
the pulses synchronize.
Step 6: Keep your left fingertips in place and move
your right fingertips to cover your coccyx (tailbone). Hold for 2 to 5 minutes
or until the pulses you feel at your fingertips synchronize with each other.
Notes: The right hand remains on the top of
the head while the left hand moves down the body until the final step. The practice is typically performed while lying flat,
using pillows as necessary to maintain comfort. General
instruction regarding the breath during the self care practice is to envision
the breath inhaling up the back of the spine/body and exhaling down the front
of the spine/body.
References
[1] Future of Health Technology Summits 1996-2002,
www.fhti.org
[2] National Institute of Health, www.nih.gov
[3] The National Academies Institute of Medicine,
www.iom.edu
[4]Bushko, R., Defining Future of Health Technology: Biomechatronics, in Future of Health Technology, Renata Bushko, ed., IOS Press,
[5] Mason, C. and Lieberman, H., Intelligent Agent
Software for Medicine, in Future of Health Technology,
Renata Bushko, ed.,
IOS Press,
[6] Piburne, S. and
Pell, C., The Dalai Lama a Policy of Kindness: An Anthology
of Writings by and About the Dalai Lama/Winner of the Nobel Peace Prize Snow Lion Publications,
[7] Mason, C., “Reduction in Recovery Time and
Side Effects of Stem Cell Transplant Patients Using Physio-philosophy,”
in Psychoneuroimmunology Research Society Conference, 2003, www.pnirs.org
[8] V.A. Barnes et al., Proceedings of
the 11th International Interdisciplinary Conference on Hypertension in Blacks,
[9] Norris, K., Stress Reduction in the Prevention
and Treatment of Cardiovascular Disease in High Risk Minority Populations,
presentation at The Congressional Prevention Coalition on Health Care for
Minority Populations: Prevention of Hypertension and Heart Disease, on June
3, 1999 .
[10]Herbert Benson, http://www.mbmi.org/
[11] Center for Mindfulness, University of Massachusetts
Medical School , www.umassmed.edu/cfm/
[12] International Tibetan Qigong Association,
www.tibetanqigong.org
[13] http://www.stanfordhospital.com/clinicsmedServices/clinics/complementaryMedicine/index.html,
[14] www.columbiasurgery.org/divisions/cardiac/staff_oz.html,
[15] http://nccam.nih.gov/clinicaltrials/,
National Institute of Health,
[16] Gollub RL, Hui KKS, Stefano GB. Acupuncture pain management coupled to immune stimulation.
Acta Pharmacologica Sinica. 20(9):769-777, 1999.
[17] Harvard Medical School Neuroimaging Lab, www.mgh.harvard.edu/depts/neuroimaging/gollublab
[18] Lazar, S., http://www.mgh.harvard.edu/depts/neuroimaging/gollublab/meditation.html
[19] Lazar, S.W., Bush, G., Gollub R.L., Fricchione,
G.L., Khalsa, G., Benson, H. (2000) Functional
Brain Mapping of the Relaxation Response and Meditation. NeuroReport. 11:1581-1585.
[20]Benson H, Beary
J, Carol M. The relaxation response.
Psychiatry. 1974;
37:37-46. [21]Benson H,
[22]Benson H. Your innate
asset for combating stress. Harvard Business Review.
1974; 52:49-60.
[23] A Public Repository of Peer Reviewed fMRI studies and their underlying data, National Science
Foundation, W.M. Keck Foundation, National Institute of Mental Health, Sun
Center for Excellance for Neuroscience, www.fmridc.org
[24] www.fmri.org
[26] www.brainmapping.org,
[27] http://www.mgh.harvard.edu/depts/neuroimaging/gollublab/meditation.html
[28] http://tezpur.keck.waisman.wisc.edu/ W.M. Keck Laboratory for Functional Brain Imaging and
Behavior
[29] http://www.fmrib.ox.ac.uk/fmri_intro/
[30]Health Emotions Research Institute, Scientifically
Determining How Emotions Influence Health,
[31] Complimentary and Alternative Medicine Program
at Stanford, http://camps.stanford.edu
[32]Allison TG, Williams DE, Miller TD, Patten
CA., Bailey KR, Squires RW, Gau GT. Medical
and Economic Costs of Psychologic Distress in
Patients With Coronary Artery Disease. Mayo
Clinic Procedures. 1995; 70:734-742.
[33] Mason, C., Integrating Self-Care Into Your Own Recovery, www.21stcenturymed.org
[34] Sempell, P., Integrating
The Healing Art of Jin Shin Jyutsu Into Western and Surgical Practice,
[35] http://www.marin-oncology.com/
[36] Jin Shin Jyutsu
Institute, www.jinshinjyutsu.com
[37] http://www.mgh.harvard.edu/depts/neuroimaging/gollublab/acupuncture.html
[38]