Calihan: The Medicine of Why

By Martha Calihan, MD

Medicine is changing … the landscape is evolving and we have an increasing array of options and solutions to our symptoms. We live in an era and in an area where we have the best of what Western medicine can provide, including sub specialty care for the most challenging and rare of conditions, for which we should be, and are,  enormously grateful.

But there can be another side to this great abundance … and sometimes the focus gets so narrow that we lose sight of the big picture. Sometimes when this happens we can fall victim to the “there’s a pill for every ill” approach to symptoms, and it can be hard to see the big picture and how the pieces fit together. More often than not though, when we look we can in fact see the relationships and the connections.

This is the description of Functional Medicine. I call it the “Medicine of Why”, and I could also call it the “Medicine of How”. Functional Medicine is interested in the underlying factors contributing to a symptom or an illness. A Functional Medicine assessment will consider all sorts of possible triggering and perpetuating factors, from lifestyle to environmental factors. By that I mean to include nutritional issues, perhaps nutrient insufficiencies or deficiencies, genetic factors, possible environmental toxins, the effects of medications, and mental and emotional factors.

I liken the Functional Medicine approach to peeling back the layers of an onion, and when peeled back sufficiently, the root imbalances can often be found and then we can connect many of the dots that looked unconnected. It is more of a systems approach; and the systems reflect imbalances such as inflammation; assimilation, communication, etc., instead of being separated into organ systems such as gastroenterology, cardiology, dermatology, etc.

As an example, consider a very common condition such as Irritable Bowel Syndrome. Thousands of people suffer from the symptoms of this condition, and those symptoms can range from abdominal cramping and pain to altered bowel function, including constipation and diarrhea, often in an alternating pattern. We have medications to help relieve the symptoms, which can be effective, but they don’t address the potential underlying causes.

A person might be suffering these symptoms for a variety of reasons, including a lack of digestive enzymes, inflammation in the gut, food intolerances, or, as we see very commonly, an imbalance in the microbiome of the gut. This can be because of, and exacerbated by, a number of factors, including infections and the use of antibiotics. When we are able to understand the story as to how the condition evolved, and take a look at the myriad potentially contributing factors, then we begin to be able to develop a plan to change what is driving the symptoms, the perpetuating factors. When we can understand these factors better, we can take steps to help restore balance to the system and the condition can be reversed and the person healed.

This is the Medicine of Why, and this approach encourages us to try to understand the factors that contributed to the condition and offers ways to help restore balance to the system. This is Functional Medicine, and I will be sharing more about this new and exciting medicine in the weeks and months ahead.


Dr. Martha Calihan has practiced Family Medicine for more than 20 years, during which time her interests and her practice have gradually evolved into a holistic, integrative approach to medicine. She is licensed to practice acupuncture and is also trained in both Mind-Body Medicine and Functional Medicine. She is the founder of the Five Stones Healing Arts & Wellness Center in Leesburg.

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