Finding the right medicine: skillful means.

unique physical and metaphysical needs, will allow us to go beyond our current classification of diseases and use skillful means to apply the right medicine, whatever its derivation. We have come to accept the vertical taxonomy of medical specialization as fact, and we use it to navigate diagnosis and treatment. Yet perhaps a horizontal taxonomy built on deeper understanding of basic processes that underlie all illness can help us practice “The Right Medicine.” The Tibetan view that the same illness may arise from different causes and may require entirely different treatments is at variance with the intimate link between conventional International Classification of Diseases, Ninth Revision (ICD-9) taxonomic diagnoses and prescribed therapies, be they pharmaceutical, surgical, or radiological. The question then becomes, “How do we find the right medicine— that is, the right medicine, at the right dose, for the right person, at the right time, and for the right amount of time?” What is the “right” or most appropriate relationship to a particular problem and what are the “right” means with which to handle it? Open inquiry might lead us to find that pharmaceuticals are most appropriate for treatment of an acute myocardial infarction, but that an improved diet, exercise, and meditation are the most effective means of preventing chronic atherosclerosis. The concept of upaya, or “skillful means,” outlined in the Lotus Sutra (the original teachings of Shakyamuni Buddha) can guide us in moving from an us-versus-them, conventional-versus-alternative medicine polarity to a unified approach based on finding the most skillful means to treat a particular illness or disease regardless of the modality. The real question we must ask with each patient is: How is he or she both the same and yet different from all the others we have seen with the same condition? Why do two people with exactly the same diagnosis respond differently to the same therapy? Why does one live and the other die? What clues are there in the unique story that opens the door to “skillful means” in finding the cause and cure of their illness? How can we find the particular key to their healing—is it medication, a change in diet, surgery, vitamins, herbs, energy medicine, acupuncture, Tibetan medicine, Ayurveda, Traditional Chinese Medicine, prayer, psychotherapy, exercise, or exorcism? Skillful means, or upaya, is an appropriate perspective to navigate the confluence of many points of view and ways of seeing in the healing world in the early part of the 21st century. Skillful means will guide us to “The Right Medicine” beyond doctrine, whether it echoes from the deepest corridors of academia or the Mark A. Hyman, MD, is the Editor in Chief of Alternative Therapies in Health and Medicine. (Altern Ther Health Med. 2005; 11(2):10-12.)