Book Reviews
the information you need to take charge
of your perimenopause. In the midst
of typing this review, my secretary
asked if she could borrow the book, and
a colleague, reading the review over
her shoulder, took it home for the
weekend, certainly an indication that
there is an eager audience for it. Their
reviews are still pending. The book is
clearly written and encourages healthy
behavior as well as educating the
reader about available medical/surgical
treatments. Instead of being a passive
and worried patient, the reader can be
informed and take an active role, work-
ing with her physicians to obtain the
best medical care possible, and can be
reassured that she is not alone in her
concerns. The more knowledgeable a
woman is in understanding how her
body should function, in understanding
what is changing and why and what she
can do to feel better, the better prepared
she is to see that everything that can be
done is done. The physiological expla-
nations might be more than the average
reader wants to know, but a medical
professional could comfortably rec-
ommend it to a patient or friend strug-
gling to make sense of the demands of
a changing body. For a medical audi-
ence, Dr. Corios book is informative
and easily read, and her simple expla-
nation of complex physical processes
could also serve as a welcome review
or refresher for the physician willing to
overlook the sometimes too cute
chapter titles: Not Tonight, Honey!
Can Somebody Open a Window?
and Im Losing My Mind! tended to in confronting the growing pains of
set my teeth on edge. However, moving
beyond this, the book is worthwhile not
just to patients but for psychiatrists and
other mental health professionals who
want to understand the etiology of the
physical complaints they are hearing
about from their patients and who
would like to know more about alter-
natives that might help ease these tran-
Psychosomatics 43:4, July-August 2002
sitions. The professional reader will
nd much of value in this book but may
nd the case vignettes less helpful.
Each is marked by unwavering patient
compliance and gratitude and physi-
cian omniscience that may leave the
reader wondering (a) Why arent my
patients as nice as Dr. Corios? (b) Why
arent I as smart as Dr. Corio? and
(c) Maybe I should call Dr. Corio for
an appointment!
Having moved into the second half
century of my own life, many of the
topics discussed by Dr. Corio were fa-
miliar old friends to me. I can only
speculate on the impact of reading this
book earlier in life, before passing
through my perimenopausal years. De-
spite the cheerful, take-charge mes-
sage, the litany of complaints, compli-
cations, and treatments might have
been too disheartening, and the pano-
ply of vitamins and herbs suggested
might have overwhelmed me (or my
pocketbook or even my medicine cab-
inet!). While we will all certainly age,
if we are lucky, not every woman will
be tormented by every symptom and
syndrome discussed. For some women,
menopause will be just a blip on their
physical and emotional radar, while
even the most unfortunate could not
possibly be so unfortunate as to expe-
rience every disturbing symptom de-
scribed herein or even a majority of
them. On the other hand, to be fore-
warned is to be forearmed, and with
this book in hand, the educated reader
should feel less alone and less helpless
and concepts. The book has an excel-
perimenopause.
An Elementary Textbook of
Ayurveda: A Six Thousand Year
Old Healing Tradition
By Frank John Ninivaggi, M.D.
Madison, CT
International Universities Press
286 pages $28.75
ISBN 1887841334
Reviewed by Andrew L. Stoll,
M.D.
A huge proportion of our patients
are either openly or surrepti-
tiously using complementary and/or al-
ternative medicine treatments. Now,
Yale psychiatrist Dr. Frank J. Ninivaggi
has written a concise yet surprisingly
comprehensive book for the Western
audience on Ayurvedic medicine.
Ayurveda is the traditional healing sys-
tem from India that dates back many
thousands of years. It has not received
as much attention as other forms of
complementary and alternative medi-
cine treatments, such as herbal reme-
dies and traditional Chinese medicine.
Ayurvedic medicine is a complex and
an unambiguously Eastern system of
healing. Many of its diagnostic and
treatment principles were later incor-
porated into traditional Chinese medi-
cine. An Elementary Textbook of Ayur-
veda is intended for a professional and
an educated lay audience. In the text,
Dr. Ninivaggi discusses the relation-
ship of Ayurveda to Western (Allo-
pathic) medicine. He clearly respects
both systems and is a strong proponent
of the integration of Ayurvedic prac-
tices and Western medicine.
Dr. Ninivaggi has an engaging
writing style and provides clear de-
nitions of sometimes confusing terms
lent glossary and ample references. In
the rst two chapters, Dr. Ninivaggi de-
scribes the history and philosophical
underpinnings of Ayurveda. Later
chapters are devoted to the Ayurvedic
view of the anatomy and physiology
of health and diseases, as well as the
principles of Ayurvedic therapy, in-
cluding nutritional interventions, life-
345
Book Reviews
style changes, and more specic tech-
niques of yoga and herbal remedies.
The chapters introducing the his-
tory, philosophy, and treatment princi-
ples of Ayurvedic medicine were fas-
cinating. A reader familiar with
traditional Chinese medicine and acu-
puncture will recognize some of the
key concepts of Ayurveda. For exam-
ple, Prana is identical to the traditional
Chinese medicine concept of chi (or
qi), which is the life force that ows
through the bodys energy channels
(meridians). Dr. Ninivaggi describes
Ayurvedas method of diagnosis, which
he divides into four steps. The rst step
is pratyaksha, dened as a multisen-
sory understanding of each individual
patient, where the ve senses of vi-
sion, hearing, touch, smell, and taste
are used in conjunction with a thorough
history to arrive at the second step, an-
umana. Anumana is dened as infer-
ence, or hypothesis generating. The
third and fourth steps are sabda (or ap-
topadesha) and upamana, which are the
traditional knowledge base handed
down through oral teaching and texts
and the use of analogy with known
cases to make a diagnosis, respectively.
As in Western medicine, a specic
diagnosis directs the clinician to a spe-
346
cic treatment. However, Ayurvedas
principles of pathophysiology are quite
distinct from those in Western medi-
cine. In addition, diagnoses and treat-
ments are much more highly individu-
alized than in Western medicine.
As in traditional Chinese medi-
cine, Ayurveda uses an empirical ap-
proach honed over thousands of years
to diagnose and treat illness. Western
medicine also advances with empirical
discovery, although innovation based
on the scientic method and reduction-
ism is the underlying philosophy in the
West. Also unlike Western medicine,
Ayurveda admirably stresses preven-
tive medicine, with self-inquiry, self-
realization, and self-actualization as
central themes. The principles of
treatment are based on the notions of
samanya, dened roughly as like in-
creases like, and vishesha, where op-
posites balance and so cure each other.
These treatment methods are carried
out with specic manipulations of diet,
lifestyle, or the introduction of yoga
practice and specic herbal therapy.
All in all, An Elementary Textbook
of Ayurveda is a great resource. How-
ever, the lack of an index made it dif-
cult to nd items in the text quickly.
More information on specic herbal
treatments would have also been use-
ful. Another challenge, not adequately
described in the book, is specically
how to integrate Ayurvedic practices
into a conventional (Western medicine)
psychiatry practice. One other aspect
not fully addressed in the book is how
or even whether Ayurvedic medicine
evolves or makes advances. Is there
research and new additions to the
knowledge base, or is Ayurveda stag-
nant or dogmatic? Despite its philo-
sophical and tangible differences with
Western medicine, the efcacy and ef-
fectiveness of Ayurvedic treatments
could be tested with standard con-
trolled clinical studies. It is hoped that
this book will inspire some readers to
design and carry out scientic studies
to conrm or refute the utility of Ayur-
vedic treatments. This would be a rst
step toward a genuine integration of the
worlds best medical traditions.
I highly recommend this book as a
way to simply and quickly access the
complex world of Ayurvedic medicine.
One basic and commonsense principle
of Ayurvedic medicine is familiar: Live
in moderation, without deprivation or
excess. This is excellent advice for all
of us.
Psychosomatics 43:4, July-August 2002