WORLD INTEGRATED MEDICINE MASTER

World Integrated Medicine Master Ka-Kit Hui

INTRODUCTION OF KA-KIT HUI

Ka-Kit Hui, the professor, founder and director of UCLA Center for East-West Medicine, the Wallis Annenberg Chair in Integrative East-West Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, and the chair of UCLA Collaborative Centers for Integrative Medicine,is a clinician, an educator and researcher whose broad-based knowledge of comprehensive medical care stems from multiple areas of specialization - internal medicine, clinical pharmacology, geriatrics,traditional Chinese medicine and integrative medicine. His basic and clinical investigations, as well clinical practices as both generalist and consultant, have provided him with unique insights into the concepts of regulation, homeostasis and balance, as well as the complementarity of modern medicine and traditional Chinese medicine. Dr. Hui has served as a consultant to the FDA, U.S.A, National Institutes of Health, World Health Organization, health insurance companies, drug companies and the media and holds visiting and honorary professorships in various universities throughout the world.introduced you to me! 25 years have passed and you have truly achieved much in the integrated medicine field.

Prof. Zou:Hello, Dr. Hui. I am so glad to see you again at the China Academy of Chinese Medical Sciences(CACMS). Because the Institute of Basic Research in Clinical Medicine (IBRCM), invited me to attend the 2018 2ndAnnual International Advanced Training Course in Traditional Chinese Medicine: Development of TCM in Clinical Practice and Research, we again had the opportunity to meet.

I remember clearly 25 years ago, we first met at the Institute of Information, CACMS. Academician of the China Academy of Sciences, Professor Chen Keji

Today, as the Associate Editor-in-Chief of WJIM, I will interview you about your journey and achievement.Would you tell the readers of the Journal about your journey, your mission, and unique vision of integrative East-West medicine?

JOURNEY AND VISION

Dr. Hui: How to begin? My whole journey is a miracle. I was born in Hong Kong, but UCLA is where I have spent half a century. I arrived at UCLA in early 1969 to study chemistry. Then, I wanted to introduce to the western world a new drug from the Chinese herbal pharmacopoeia, like what the 2015 Nobel Prize winner Tu Youyou did in introducing the antimalarial drug,artemisinin. Instead, my dream turned a different corner:a UCLA Regent Scholarship to attend medical school enabled me to begin creating a new integrative health model by blending the best of both modern western medicine and traditional Chinese medicine to make healthcare better for all.

Prof. Zou:It's lucky for both China and America that you had this foresight early on! So, can you tell us more about the Center for East-West Medicine (CEWM)at UCLA?

Prof. Hui:Certainly, because it is at UCLA, that my vision of establishing this integrative health model of comprehensive care with emphasis on health promotion,disease prevention, treatment and rehabilitation through integrative East-West has been realized.

Prof Zou: It's a good way of describing a complex picture.

THE UCLA CEWM MODEL OF EAST-WEST MEDICINE

Dr. Hui: (Laughs) What we practice at the CEWM of UCLA is like a well thought-out dinner menu, with the best and most appropriate therapies (including acupuncture, massage therapy, and diet/herb/drug therapy) from the west and the east, selected and targeted to the needs of each patient.

This UCLA model has been successful during the last 25 years of the Center. We receive referrals from more than 500 UCLA physicians from different specialties.At CEWM, we also teach hundreds of students annually through our many educational programs including a summer course for trainees from around the world, medical student courses, resident rotations and 2-year East-West primary care and specialty fellowships. We are now moving into primary and population care and expanding our collaboration and teaching in the global arena.

Prof. Zou:We all know that new medical thinking and models require so many years of sacrifice and dedication.

CONDUCTOR OF AN ORCHESTRA

Dr. Hui: Correct! But my vision requires a whole team; I'm only the conductor of the orchestra, so to speak.Much hardship, strategic thinking and contributions from so many people! For example, all former trainees who have taken a gamble in career development during the early stages of the CEWM and helped to build the field in their own brilliant ways, including 3 who are each building one of the CEWM's 3 clinics and one who is building the in-patient program at UCLA. Also, my family, patients,colleagues, friends, donors and foundations that have come forth at different points on my life's path to turn my modest vision into a much bigger reality.

Prof. Zou:Can you elaborate?

Dr. Hui:Shirley Hui, my late beloved wife married me when I was in medical school four and half decades ago. She truly believed in me. Without her, I could not devote my full energy to realizing this dream, even using part of our income to launch the Center before philanthropic support became available. Stress related to this early phase of our Center's development contributed to her developing metastatic breast carcinoma. That took her away from me - but integrative medicine kept her going for 11-and-a-half years to enjoy our 5 beautiful grandchildren.

Prof. Zou:I'm happy, still, to hear of a marriage and partnership of devotion and like minds between you and your late wife, Shirley.

Dr. Hui:Yes, I consider myself a fortunate and blessed man. Let me tell you a story. Out of sheer luck, I have had the great fortune to have Dr. Sherman Mellinkoff, dean emeritus, as my mentor for the last 40 years. Our relationship started when I was a fourth-year medical student during my externship. Fast forward 20 years, his letter of support provided guidance for me in developing the CEWM: "Your proposal for an expanded UCLA Center for East-West Medicine strikes me as an inspiring plan. Its implementation could be of great value in medical education, medical research, cost-effective and compassionate care of patients, prevention of illness and synergistic application of principles originating in eastern and western civilizations. The beacon you have already ignited at UCLA could, through this Center, grow in luster to the benefit of all mankind."

ALLIES AND SUPPORTERS

Prof. Zou:It's important for modern Chinese medicine to have western allies and supporters, if we are to become truly globalized in the 21stcentury.

Dr. Hui:I very much agree, Prof. Zou. In terms of allies, let me also mention Alan Fogelman, the chair of the Department of Medicine at the David Geffen School of Medicine at UCLA, enabled me to launch the Center in 1993. He also continues to provide mentorship and support and I appreciate his more than 25 years of encouragement.

Let me not forget many of my patients who have entrusted their life to me, helped teach not only me,but also our trainees, and some who even provided philanthropic support. Without the early support of Janet Stein of the Balm Foundation from New York,the endowed chair from Wallis Annenberg and Charlie Weingarten at the Annenberg Foundation, as well as the continuing support of Gail and Gerald Oppenheimer and Andrew and Peggy Cherng, and too many others to list, my vision would not be a reality. The Beatles were correct. We all need a little help from our friends!

Prof. Zou:Yes, you know the Beatles were even popular in China as I recall!

Dr. Hui:With the rise of the crisis in the healthcare system globally, we are provided with a golden opportunity to collectively transform the current system into one that is patient and public oriented and will provide us and future generations with healthcare that is safe, effective, accessible and affordable for all. I want to take this model global - providing a "new song" of health and wellbeing for all.

CONCEPTUAL MODEL OF HEALTH AT CEWM

Prof. Zou:Dr. Hui, could you share with us more in detail your definition of health, and the conceptual model of health care at the Center for East-West Medicine?

Dr. Hui:Yes. CEWM follows these basic principles,as follows:

- A harnessing of biomedicine's strengths in disease detection, acute condition management and vital system stabilization

- Reliance on traditional Chinese medicine's concept of balance, flow and spirit

- Trust in the body's innate ability to heal

- A flexible, holistic and comprehensive approach for personalized care

- Commitment to finding the root causes behind the manifestation of symptoms and diseases

- Commitment to treating the whole patient by addressing both the local and the global factors

- Active engagement in prevention and the cultivation of health

- Safe, effective and affordable care

Prof. Zou: So, essentially you are taking a holistic approach to health and healing, right?

Dr. Hui:Yes, because as we all acknowledge, health is an integral component of one's existence. But what is health? It is a term that is difficult to define and something that means varying things to different people. Yet, it often is an element valued most when it has been lost.

In an effort to address the increasing cost and decreasing effectiveness of our current health care system,the UCLA Center for East-West Medicine (CEWM)has developed an evidence-based health model that incorporates principles originating in traditional Chinese medicine (TCM) and western medicine, and applies them in a synergistic manner. Practitioners at the Center take a system approach to address the needs of the whole person, and to restore balance and well-being.

Prof. Zou:I'd agree. I know that the World Health Organizations current definition of health is: to help the person achieve a "state of complete physical, mental and social well-being and not merely the absence of disease or infirmity."

Dr. Hui: That is our belief. As for the East-West Medicine Model of Care, I have summarized it as "by using western medicine to look at the trees and Chinese medicine to look at the forest, we have a much more comprehensive view of health."

EAST-WEST PRACTITIONERS

Prof. Zou: You are talking about a coherent and systematic way of integrating both the Chinese and western approaches, which is great. Now, what exactly do your practitioners do?

Dr. Hui: At the CEWM Clinic practitioners operate within the bio-psycho-social framework developed in the west, while also incorporating diagnostic approaches and therapeutic modalities originating from traditional Chinese medicine.

First, patients are evaluated by board-certified internists with varying levels of background in traditional Chinese medicine, and care is delivered by a team of dual-trained internists, nurse practitioners, acupuncturists,and health educators.

Secondly, our clinicians design an individualized,low-tech, low-cost, and high-touch treatment plan for each patient that comprises a combination of lifestyle coaching, medication adjustments, and diet recommendations, as well as techniques such as acupuncture, trigger point injections, therapeutic massage, and body-mind exercises.

BIOMEDICINE AND CHINESE MEDICINE APPROACHES

Prof. Zou: So, I see that western medicine is still useful in the integrative approach?

Dr. Hui: You are correct. Let me clarify. The unique integrative East-West approach at CEWM is characterized by the following:

We utilize biomedicine's strengths in disease detection, acute condition management, and vital system stabilization. Certainly, the approach of western biomedicine has proven its value in allowing scientists to break down complicated systems into manageable parts for analysis and comprehension.

It is at its best in disease detection using advanced technologies, as well as in local and acute conditions management. It has also proven effective in stabilizing the body's deteriorating system. CEWM practitioners draw upon these strengths in managing patients' illnesses and monitoring their condition.

Prof. Zou: And the Chinese approach?

Dr. Hui: Similar to the concept of homeostasis in western medicine, one of the underpinning principles of traditional Chinese medicine is the concept of balance.In TCM, balance is important to consider both at the physiological level as well as in terms of lifestyle choices.Continued stressors of different types will deplete the body's reserve, leading to chronic imbalance and resulting in the disruption of the smooth flow of energy and blood in the body. Such stagnation often leads to muscle spasms, which hinders blood flow and results in inflammation. Complications from these symptoms result in further health consequences if not addressed at an early stage. For this reason, CEWM clinicians rely on TCM diagnostic approaches that assess the body's state of balance or imbalance early-on, and treat accordingly.

THE BODY'S ABILITY TO HEAL

Prof. Zou: Dr. Hui, what do you think of the body's innate ability to heal?

Dr. Hui: Biomedicine is indispensable when the illness becomes too overwhelming for the body. When this happens, more invasive or potent interventions such as synthetic drugs, surgical procedures, or radiation are often implemented. On the other hand, TCM, like many other forms of complementary and alternative modalities,embraces the body's innate ability to heal, and utilizes therapeutic methods targeting at harnessing the body's own chemicals and maximizing the body's own healing mechanisms.

Prof. Zou: So you don't just rely on an either western or eastern approach, but select the best from both?

Dr. Hui: Within the East-West health framework,practitioners at CEWM have developed an approach that is flexible and can be adapted to each patient's particular needs for that specific point in time. Our body is in a state of constant flux, and we prescribe individualized recommendations with the knowledge that as the body gradually makes improvements towards health, treatments must be modified according to the state of the person. Our clinicians place strong emphasis on therapeutic interventions that can naturally stimulate the body to repair itself. They utilize a combination of external stimulation of trigger and acupuncture points,along with lifestyle counseling and health coaching. Our teachings about self-care include the safe and effective use of dietary measures, supplements, over-the-counter medication, and body-mind exercises.

WHOLE SYSTEMS APPROACH TO THE INDIVIDUAL

Prof. Zou: So, what are some of the root causes,in your view behind the manifestation of symptoms and diseases?

Dr. Hui: Before practitioners can help patients deal with their symptoms, they must identify and understand the root causes of their ailments. Biomedical approaches often miss these underlying conditions due to an emphasis on acute symptoms. Practitioners at CEWM thus begin by gathering a detailed medical history of their patients,including their upbringing, experiences at all stages of life, work, exercise routine, and psychosocial, nutritional and other lifestyle factors. Inadequate coping strategies,chronic stress, and even remotely traumatic experiences are some of the common causes of underlying imbalance.In-depth knowledge about the whole person informs the diagnosis and helps the formulation of treatment strategies. This process requires time and, most importantly, a trusting relationship between provider and patient.

Prof. Zou: I can see that this approach requires time, commitment, and attention to the individual. This is the most difficult with increasingly bigger populations and bigger costs. Even in China.

Dr. Hui: That's why we must do our best to promote and expand integrated health across nations, across seas.People may be different in culture and race, but peoples'bodies (biologically speaking) are fundamentally the same.

From the whole systems standpoint, each organ system in the body functions as a complex entity that interacts with all other systems in the body. The therapeutic interventions utilized at CEWM are based on the interconnectivity between all the systems in the body.In addition, stressors originating from the social and physical environment correlate directly with a person's well-being. These factors range from family relationships and work pressures to pollution of air and weather changes.

Prof. Zou: I agree, family, gender, environmental,and societal factors may differ in China and America,yet they all influence the individual in society, and an individual's health. Let me ask you then, how does the CEWM model seek to make health care more effective and affordable in the U.S.?

ACTIVE PARTICIPATION OF BOTH PATIENT AND PRACTITIONER

Dr. Hui: Before I answer your question, I'd like to say that in the East-West model of care, the journey towards health requires the active participation of both the patient and the practitioner. While the practitioner's role includes getting to know the patient and administering appropriate care to each individual, the patient must understand that prevention and cultivation of health remain a personal responsibility. As one ages, the body's internal reserve slowly deteriorates, and its innate ability to heal itself gradually becomes compromised. Yet by embracing the elements necessary for the prevention of illnesses and incorporating components essential to successful living into one's life, wellness can be achieved and maintained.

HEALTH AFFORDABILITY

Prof. Zou: And the affordability factor?

Dr. Hui: With health as the foundation for all other activities in life, the rising cost of medical care,coupled with the declining well-being of the national population, has led to crisis at all societal levels. This means decreased quality of life for the individual, stress and tension in the family, and decreased productivity for the work force. In fact, many American personal bankruptcies have resulted from medical expenditures. By using less invasive treatment and lifestyle modifications,the integrative East-West model of care does not require highly advanced technologies or expensive procedures.

PERSON-CENTERED BIOMEDICINE

Prof. Zou: I'd like to end this interview with a brief discussion of your ideas on person-centered biomedicine,as I've read some of your academic papers on this. Can you share with us in brief?

Dr. Hui: Yes, my papers provide a more detailed historical trajectory around the evolution of my ideas.Here, however, I'd like to tell readers that as early as 1957, around 8 years after the establishment of People's Republic of China, the psychoanalyst Balint proposed putting the therapeutic relationship between doctor and patient at the center of medical care. As he saw it, the relationship itself was as essential part of the healing process. He created the phrase "the drug doctor" meaning not that the doctor prescribes drugs but rather that the most powerful drug is the doctor himself, or herself,administered through the special relationship he has with his patient. In other words, the patient-physician relationship is the key to the future health and wellness of the patient.

Thus, this is an instance of the bio-psycho-social model replacing the biomedical model and providing the foundation for a more personalized and humanized system of care.

Prof. Zou: We always need to be reminded and appreciate our own roles as physicians, friends, and allies to patients rather than merely scientists. Finally, for the sake of discussion, what about the patients' role in all of this?

PATIENTS' ROLE: KEY TO WELLNESS

Dr. Hui: Wellness and health requires both an engaged patient as well as an engaged physician. There is, medically speaking, therapeutic value in being an active patient - and this dynamic has been associated with improved health outcomes. You should realize that in the U.S. key events such as the Civil Rights movements of the mid-20th century influenced the development of patient-centered are. Self-care and community health movements encouraged patient empowerment and selfreliance, which often questioned traditional biomedical authority, demanding that doctors pay more attention to their patients as complex individuals. Out of this emerged a discourse of patients' rights.

TOWARD A DISCOURSE OF PATIENTS' RIGHTS

Prof. Zou: I can see where you are going with your person-centered model. It's truly global in that patients'rights might be considered a part of human rights for all,regardless of a country's particular culture or ideology.

Dr. Hui: On this note, let me end by saying that Chinese medicine is inherently person-centered. For this reason, many westerners who are seeking more recognition of the person in healing have been drawn to practicing it. Thus, western practitioners who are trained in Chinese medicine have greatly influenced clinical settings and changed the biomedical discourse into one that is more person-centered. Thus, a large part of the mission of CEWM is centered on education: the education of physicians and health professionals, of communities, of families, and of individuals. We all work together to form this orchestra of health.

EAST-WEST WORKING TOGETHER IN CONCERT

Prof. Zou: Dr. Hui, it's been enlightening to speak with you and my distinct pleasure. Thank you for your time. I think that the East and the West, working together"in concert" can create a healthful world at all levels to your health, and to the continued expansion of the CEWM model at UCLA and throughout the United States and beyond!