2.1 ALTERNATIVE AND COMPLEMENTARY MEDICINE (Part 2)

I. NATUROPATHIC MEDICINE

Naturopathic medicine is more than a system of health care; it is a way of life. It is a distinct medical system that stresses health maintenance, disease prevention, patient education, and patient responsibility. Unlike allopathic orthodox medicine, it views health as more than just the absence of disease. The goal of the Doctor of Naturopathic Medicine (ND) is restoration of normal body function.

Naturopathy has had a complex and somewhat turbulent history. One of its variants was hydrotherapy. You are acquainted with the most famous of the hydropaths when you reach for your morning Frosted Flakes. John Henry Kellogg got into the breakfast food business with the intent of producing health foods. Don't you wonder what he would say about the sugar-coated cereals?

The program of naturopathic cure is as follows: elimination of 'evil' habits such as over eating and the use of tobacco; corrective habits such as exercise; improved living styles with a healthful diet; natural healing, and a recognition of Nature herself as the one true healing force. These principles date from Benedict Lust, a German immigrant schooled in hydrotherapy.

In the years after World War II, naturopathic medicine declined as a lack of insurance coverage, lost court battles, and a hostile legislative perspective progressively restricted practice until the core naturopathic therapies became essentially illegal and practice of naturopathy was no longer financially viable.

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Naturopathy reemerged in the counter cultures of the late 1960s. America's increasing disenchantment with orthodox medicine and its prohibitive costs resulted in an increasing respect for alternative medicine. A new wave of students were attracted to the precepts of the profession.

The establishment of an accredited school, Bastyr University (Seattle, WA) in 1978 to teach science based natural medicine has been a turning point for revival of the discipline. As of 1996, there are three accredited colleges of naturopathy in the U.S.

Modern naturopathic medicine stresses the healing power of nature, often using medications that you would consider to be herbals. They follow the time-honored dictum of pharmacology which is: First do no harm! Another principle stressed today is to find the cause of disease--and help the patient eliminate that cause. In this sense, they are close to the biomedical model of treatment based on diagnosis. Naturopathic practitioners seek to help the whole person. Another principle is something to think about: the doctor as teacher. The original meaning of the word doctore is teacher. A central theme in modern naturopathy is to educate the patient and emphasize one's own responsibility for health. They also recognize the therapeutic potential of the doctor-patient relationship. In naturopathy, the doctor is expected to be a role model for their patients.

Contemporary naturopaths practice as primary care physicians. They make a conventional Western medicine diagnosis using the same standard procedures as allopathic physicians. They also make a naturopathic diagnosis and freely use a range of natural therapies. Where state law allows, they perform outpatient surgery, give vaccinations, and can prescribe drugs. NDs are recognized in several western states, but no states in the Midwest recognize them. Bastyr University has received NIH money for research and there is now a peer reviewed journal. These trends bode well for naturopathy.

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Resources:

American Association of Naturopathic Physicians, P.O. Box 20386, Seattle, WA 98102

Bastyr University, Seattle, Washington.

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II. AYURVEDA

This ancient system of medicine dates back in India some 3000 years. According to Ayurveda, the cosmos is composed of five basic elements: earth, air, fire, water, and space. In human beings, these five elements occur as the three doshas, forces that, along with the seven dhatus (tissues) and three malas (waste products) make up the human body. When the three doshas are in balance, they maintain health. When they are not in balance, there is disease. Note: this is only a very brief summary! (As your read this, notice how different this model is from the biomedical system in our own culture.)

If you have seen Deepak Chopra, M.D. on Public Television when they are having their fund drives, you have had an introduction to Ayurveda.

In Ayurveda, restoring a person to health is not viewed simply as the eradication of disease. It entails a complete process of diagnosis and therapeutics that takes into account

both mental and physical components integrated with the social and physical worlds in which the patient lives.

Ayurveda established a detailed system of diagnosis, involving examination of pulse, urine, and physical features. After a preliminary examination by means of touch, visual observation, and interrogation, the ayurvedic physican undertakes an eightfold method of detailed examination to determine the patient's type of physical constitution and mental status and to get an indication of abnormality.

Ayurveda recognizes two courses of treatment, based on the condition of the patient. The first is prophylaxis, for the healthy person who wants to maintain a normal condition based on his or her physical constitution and to prevent disease.

The second is therapy, for an ill person who requires health to be restored. Once healthy, Ayurveda recommends continuous prophylaxis based on diet, regimen, medicines, and regular therapeutic purification procedures. When a person is diagnosed with a doshic imbalance, either purification therapy, alleviation therapy, or a combination of these two is prescribed.

Ayurveda prescribes a rich store of natural medicine that has been collected, tested, and recorded in medical treatises from ancient times. That tradition of collecting and preserving information about medicine in recipe books called Nighantus continues to the present day. The most traditional source of ayurvedic medicine is the kitchen.

The botanically based medicines include juices, powders, infusions, decoctions, pastes, oils, pills and suppositories.

Traditional Ayurveda is a sophisticated system of medicine that has been practiced in India for over 2,500 years. Like other forms of alternative and complementary medicine, it focuses on the whole organism and its relation to the external world, in order to reestablish and maintain harmony in the body and its environment.

Very few reliable sources for traditional Ayurveda are available in English. Most of the works are by and for specialists and are virtually inaccessible to the reader without knowledge of Sanskrit.

Resources:

College of Maharishi Ayurveda Health Center, P.O. Pox 282, Fairfield, IA 52556

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III. ACUPUNCTURE AND MOXIBUSTION (aka Moxabustion)

Chinese medicine is so varied and complex. It is necessary to limit this article to just two disciplines within it. Everyone has heard of acupuncture; we associate it with needles. Less well known is moxibustion, which is the burning of dried leaves on or near the skin.

The therapeutic goal of acupuncture is to regulate the qi. Qi and blood flow through the body, its organs, and channel pathways in the body. When the qi flows unimpeded, the body is in a state of health. When something interrupts it, such as an evil, mental state, or trauma--illness results and pain occurs. (Do understand as you read this that Chinese medicine perceives the body differently than your Western system does.)

Pain is directly linked to an injury or an interruption of the flow of qi. Acupuncture is used to remove the obstruction. Acupuncture is used to remove the obstruction. Acupuncture needles are sharp with a gently tapering point; they are not hollow like a hypodermic needle. The aim of the acupuncturist is to obtain qi at the needling site. The patient may experience a local temperature change or a distinct 'electric' sensation. (Personal note: I had it done in a classroom demonstration and felt nothing.)

The needle may be removed immediately or left in place for a period of time, up to several days. In all instances, the goal of the clinician is to influence the movement of qi. Some acupuncture is limited to the ear. It is called auriculotherapy. The belief is that the ear has over 100 acupuncture points, which affect the flow of energy around the body. Stimulation of these points by pressure, needle insertion, electric current and even laser light is used. It aims to ease pain in various parts of the body. Other points on the body can be stimulated in these ways. In this country, acupuncture is used occasionally for drug and alcohol rehabilitation.

Americans spend about $500 million a year for acupuncture (as of 1996). But, does it work? A panel at the prestigious National Institutes of Health found acupuncture effective in treating painful disorders of the muscle and skeletal systems. It won qualified endorsement as a supplement to standard remedies for drug addiction, carpal-tunnel syndrome, osteoarthritis and asthma.

Acupuncture's great advantage over Western medicine is that it does no harm and is virtually free of side effects.

The puzzling aspect of acupuncture is that the points and meridians don't correspond to any known biological systems in the body. Some suspect that acupuncture works by releasing opioids (popularly known as endorphins) into the nervous system.

Moxibustion also is intended to affect the movement of qi. The traditional moxibustion technique involves a practitioner placing a small pile or ball of moxa, the leaf of the Chinese mugwort (wormwood tree) on the end of a needle and igniting it. The moxa smoulders without a flame It is said to be acrid and bitter. When it is used as moxa, it has the ability to enter the channels of the body said to carry qi. Direct moxibustion involves burning a small amount of moxa, perhaps the size of a grain of rice, directly on the skin. Moxa is used on the points of the body where acupuncture is applied. Together, acupuncture and moxibustion are used to treat, or at least ameliorate, a wide range of conditions and symptoms.

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Resources:

"Acupuncture Works" Time, November 17, 1997 p 84.

National Acupuncture and Oriental Medicine Alliance, P.O. Box 77511, Seattle, Washington 98177-0531.

Rosenfeld, I. "Acupuncture Goes Mainstream (Almost)" Parade Magazine, Aug 16, 1998 pp 10-11

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IV. AROMATHERAPY

Aromatherapy is the therapeutic use of essential oils from plants. The term was coined in 1928. The food and perfume industries are the largest users of essential oils. Essential oils are the odoriferous part of plants. These extracts are distilled and are applied to the body by message, inhaled, used as a compress or inserted into a bodily orifice.

Modern day aromatherapy is one of the fastest growing complementary therapies. Skeptics reject aromatherapy as lacking in scientific basis and for a lack of clinical trials.

The use of essential oils is in fact ancient. They were widely used by the ancient Egyptians. You know one from the stories in the Bible. Have you heard of myhrr? Vases of essential oils were found with Tutankhamen in 1922. They still retained their distinctive fragrance after 3,000 years. Essential oils are commonly mixtures of over 100 different organic compounds.

Aromatherapy is used for a wide range of physical, mental and emotional conditions, including burns, severe bacterial infections, insomnia, depression, hypertension, and arrhythmias (irregular heart beat). Essential oils are not innocent merely because they are 'natural.' Side effects include neurotoxic and abortive qualities, allergic reactions, and liver damage.

The basis of the action of aromatherapy is thought to be the same as that of modern pharmacology, but in using smaller doses. The chemical constituents are absorbed into the body, affecting particular physiological processes. Aromatherapy oils are taken into the body via the oral, dermal, rectal, or vaginal routes--or simply by olfaction (smell). (My note: it is an old rule in pharmacology that the route of administration influences both effectiveness and side effects.)

These reasons have been proposed for the administration of aromatherapy in conventional medical settings: relaxation, stress and anxiety relief, pain and discomfort relief; insomnia and restlessness, infections and wound healing, burns, enhanced self

image, stimulating immune function, and treatment for constipation.

(My note: Like herbalism, aromatherapy is, for the most part, not regulated. Interestingly, this exemption for herbals dates back through English common law to King Henry VIII when herbal medicines were accorded special rights.)

Essential oils have a well established track record in their action as antimicrobial agents. Alcohols, geraniol, eugenol (which has a long history in dentistry), menthol and citral all have high antibacterial activity.

In summary, aromatherapy is a recent development in alternative/complementary medicine. While aromatic substances and oils have a usage reaching into antiquity, there has been no sound system developed for their use. Until a sound scientific base is ascertained, it is believed that aromatherapy will not take its full place beside the more established complementary health care systems.

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Resources

Stevenson, C. "Aromatherapy", pp 137-148, in Fundamentals of Complementary and Alternative Medicine, Miccozi, M. ed. New York: Churchill Livingstone, 1996.

"Its zealots are intense over benefits of incense" Chicago Tribune October 28, 1998

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V. WESTERN HERBALISM

(Note: we have a separate unit on herbals. Plants have been used by humans for food, medicine, clothing, tools and in religious rites since the Middle Paleolithic 60,000 years ago. Herbalism is the study and practice of using practice materials for food, medicine, and health. While botanists define herbs as non-woody, low growing plants, herbalists use the entire plant kingdom.)

These are some common themes of herbalists: optimization of health and wellness; emphasis on the whole person; emphasis on the individual; treatment of the cause, not just the symptoms, and open exchange of knowledge. Let us introduce a definition: pharmacognosy is the study of drugs derived from plants and animals.

Plant derived drugs have long had official recognition. In 1870, the United States Pharmacopeia listed 636 herbal remedies. By 1990, only 58 were listed. Although some were dropped as ineffective, the majority were replaced by pharmaceuticals.

Biomedicine wishes to know what specific chemical is responsible for therapeutic action. In traditional herbal usage, the characteristics of a medicinal herb is emphasized without attention to its chemical basis.

Many herbalist systems believe in the Law of Signatures, which says that plants reveal their healing properties by their size, shape, color, or some other characteristic. This notion is widespread throughout worldwide. Historically, it is an ancient perception of herbals and how to identify them.

Much herbal knowledge is obtained through attentive empirical observation of a plant's effects on humans. In some traditions, intuition and sacred teachings are important. Many traditional herbalists believe in a 'life force' that is yet to be fully understood.

Read the following statement closely: Many herbalists hold that a healing energy is inherent in plants; it is primarily this energy, rather than the nutritive or chemical constituents, which promote healing. Does this sound similar to vitalism?

Herbal practitioners in the United States often rely on the plant's pharmacological actions, in some cases enhanced by specific processing and extractive solvents and techniques, or on formulating plant medicines into standardized extracts to guarantee unit doses of active ingredients. Plants may be blended together for more effectiveness.

The vast majority of herbals are much less potent than pharmaceuticals simply because they are much more dilute. Herbals contain many active ingredients, so they may have multiple effects, One anthropological observation is interesting here: humans have had many hundreds of generations of exposure to herbals; our exposure to pharmaceuticals dates back only 50 or so years. (My question: will potent pharmaceuticals that contain chemicals to which we have had no prior exposure in evolution have some unknown health consequence in the future? Just a thought.)

Dried, whole, or chopped herbs can be served as infusions (such as tea), decoctions (boiled), tinctured (dissolved in alcohol), used as suppositories, poultices and so on. Herbals are not substitutes for the pharmaceuticals. They work best as healing agents. One final note: before you get into herbals, learn from an expert.

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Resources

Mysteriously, L. "Western Hebraism," pp 111-120 in Fundamentals of Complementary and Alterative Medicine. New York: Churchill Livingstone, 1996.

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VI. ALTERNATIVE MEDICINE APPLICATIONS

Alternative medicine has quietly jumped into the mainstream. By 1993, one in three people have used at least one alternative therapy and $14 billion was spent on those therapies according to the New England Journal of Medicine. Half of all U.S. medical schools teach about mind-body connections; alternative medicine is now offered at Georgetown and Columbia University.

Why the surge in interest? Many Americans find alternative approaches to be less expensive, with fewer side effects. Some feel that modern medicine is blind to the connection between mind and body. For others, the human touch is the real appeal. According to one source, the average doctor interrupts his patient 12 to 14 seconds after the patient starts talking. It is hard to feel cared about in that kind of environment. The alternative practitioners tend to spend time with their clients and actually listen to them.

Alternatives are often sought when conventional medicine fails. What conditions, when unsuccessfully treated, lead people to seek out unconventional medicine? A study in 1990 showed that 36% go with back problems, 27% with headaches, 26% with chronic pain, and 24% with cancer. The most common treatments used were relaxation techniques, chiropractic, and messages. 89% of patients went without the advice of their allopathic physician and 72% never told them. Americans made 425 million visits to unconventional practitioners in 1990. Most users of unconventional therapies were found to be between 25 and 49 years old, but they came from all socio-demographic groups.

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VII. IS ALTERNATIVE MEDICINE VALID?

Physicians (the biomedical ones) will warn you that 'some of the practitioners worry more about their bank accounts than their medical data.' This is probably true, but physicians aren't immune to such criticism, either. To protect yourself, research your therapy of choice and keep your eyes wide open. Only a few scientific studies back up alternative medicine.

A more serious matter is cancer, and these remarks are my own. A decade or so ago, it was fashionable for patients with advanced metastatic cancer to go to border towns in Mexico and get treated with Laetril, a substance derived from fruit pits. When aggressive conventional chemotherapy and radiation failed, she sought out laetril; had hair analysis, and went on a binge diet of raw carrots to 'replace missing nutrients.' She died shortly afterward.

In the late 1940s, Dr. Andrew Ivey at Northwestern University Medical School offered Krebiozin as a cancer cure. In time he was discredited and the stuff proved to be little more than water. The debate raged in the Chicago Tribune for many months. Patients in the last stages of that terrible disease sought anything, any last straw of hope.

Here are some suggestions for evaluating a practitioner, taken from the British Medical Association. They say that a potential client should inquire about the following:

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Biomedicine is unequaled for its prowess in the care of many physical ailments, particularly those related to trauma, emergency medicine, and infectious disease. It is, however, less effective in preventing the development of disease, in altering the course of chronic physical disease, and in addressing the mental, emotional, and spiritual needs of an individual.

The biomedical model of illness used by allopathic practitioners largely concerns itself with physical disease--the more advanced, the clearer. Biomedicine finds it harder to invest time in prevention, partly because prevention is so difficult to measure. These limitations of allopathic medicine have led many individuals to seek alternative approaches.

Contemporary biomedicine does not have all of the answers. Neither does alternative medicine. Both systems have something to offer. The challenge is to seek the best from both.

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VIII. SENSE AND NONSENSE

How shall we distinguish sense from nonsense? These are my own remarks. You are free to differ with me. I encourage you to do so!

Biomedicine requires that every statement about treatment efficacy be subjected to verification or falsification. Science requires testing. Contrast this with statements that are merely based on observation. In drug therapy, the 'gold standard' is the double blind study in which a drug is compared to a placebo. In such a study, the persons administering the agent, the patients, and of persons recording the result is not aware of what is real and what is fake.

The validity even of a double blind study is a thorny and difficult problem. Most vexing to scientists is the placebo effect in which patients with the placebo achieve the same result as the therapeutic agent.

Sample size and sample choice are very important variables. Does the sample fairly represent the whole population?

My position is that any therapy or agent should be subjected to critical and ongoing testing in a rigorous, scholarly manner.

Authority should be questioned and statements about efficacy should be examined critically. In medical systems, the prudent student should question the beliefs of medical systems based on a now deceased founder and blind loyalty to those beliefs is demanded. If the profession has a scholarly journal, are its articles subject to peer review? What is the author's authority?

..... CJ '99

Resources:

Butterfield, J. and Sexton, J. "New Remedies for Old Ills' USA Weekend, Dec 30,

1994-Jan 01, 1995.

Helman, C. Culture, Health, and Illness, 3rd ed. Oxford: Butterworth Hellman, 1994.

Micozzi, M. ed Fundamentals of Complementary and Alternative Medicine. New York:Churchill Livingston, 1996.