Alternative Medicine

While conventional health care is still thought by many to be the primary option for treating an illness, particularly in the United States, many people throughout the world seek alternative medical solutions to their physical ailments. In fact, alternative medicine is now becoming a widely accepted form of health care. Much of this acceptance has been prompted by a worldwide crisis in terms of quality health care, a crisis that has taken hold of the United States as well as Third World and developing nations. Prohibitively expensive conventional medical care has prompted many people to seek alternative means to cure their ailments. Often times, this decision is motivated by more than a lack of health insurance. People suffering from chronic (long-lasting or frequently recurring) conditions or life-threatening diseases will often seek out alternative treatment when they have exhausted all the possibilities that conventional care has to offer and have found those possibilities to be inadequate.

What is interesting about the growing acceptance of alternative medicine is that practices now deemed "alternative" were for thousands of years considered standard medical practices. However, as world population continues to expand and health care concerns grow, it is likely that alternative treatments will continue to expand in popularity and acceptance by lay (non-medical) persons and medical professionals alike.

Alternative medicine includes systems of medical care such as homeopathy and naturopathy, as well as acupuncture, chiropractic, massage therapy, reflexology, and yoga, all of which are explained in the sections that follow.

HOMEOPATHY

Homeopathy is a system of natural remedies that centers around two basic laws. The first is the law of similars, which is built around the principle that "like cures like," meaning that a disease is cured by medicines that have the properties of producing in healthy persons some symptoms similar to those of the disease. For example, if an individual has a fever, is flushed, and has a high pulse rate, that person would be treated with an agent that would cause a healthy person to have similar symptoms. The second law is the law of infinitesimals, which states that medicines are more effective in smaller doses.

History of Homeopathy

Homeopathy grew out of a movement known as sectarian medicine. (Sectarian medicine can be compared to what today is called alternative medicine. That is, sectarian medicine was set apart from conventional medicine.) In the 1800s, sectarian medicine included Thomsonianism (the foundation for herbal medicine, based on the healing arts practiced by Native American women and popularized in mainstream society in the early nineteenth century by New Hampshire farmer Samuel Thompson, 1769–1843). Sectarian medicine also embraced Grahamism (named after Sylvester Graham (1794–1851), which advocated proper nutrition and hygiene to fight disease and sickness).

Alternative Medicine: Words to Know

Acupuncture:

A form of alternative medicine that involves stimulating certain points, referred to as acupoints, on a person's body to relieve pain and promote healing and overall well-being.

Allopath:

A kind of doctor who advocates the system of medical practice making use of all measures that have proved to be effective in the treatment of disease.

Alternative medicine:

Medical practices that fall outside the spectrum of conventional allopathic medicine.

Artificial:

Human-made; not found in nature.

Blood vessel:

Vessel through which blood flows.

Chiropractic:

A way of treating certain health conditions by manipulating and adjusting the spine.

Cholera:

Any of several diseases of humans and domestic animals usually marked by severe gastrointestinal symptoms.

Electromagnetic:

Magnetism developed by a current of electricity.

Genetic predisposition:

To be susceptible to something because of genes.

Holistic:

Of or relating to the whole rather than its parts; holistic medicine tries to treat both the mind and the body.

Homeopathy:

A system of natural remedies.

Hormone:

Substances formed in certain glands that control bodily functions.

Hypothesize:

To make a tentative assumption in order to draw out and test its logical or observable consequences.

Infinitesimals:

Immeasurably small quantity or variable.

Inherent:

Belonging to the essential nature of something.

Iridology:

The study of the iris of the eye in order to diagnose illness or disease.

Kinesiology:

The study of anatomy in relation to movement of the body.

Massage therapy:

The manipulation of soft tissue in the body with the aim of relieving and preventing pain, stress, and muscle spasms.

Mortality:

The number of deaths in a given time or place.

Naturopathy:

A kind of alternative medicine that focuses on the body's inherent healing powers and works with those powers to restore and maintain overall health.

Neurosis:

An emotional disorder that produces fear and anxiety.

Noninvasive:

Not involving penetration of the skin.

Physiology:

A branch of science that focuses on the functions of the body.

Plaster:

A medicated or protective dressing that consists of a film (as of cloth or plastic) usually spread with a medicated substance.

Qi (or Chi):

Life energy vital to an individual's wellbeing.

Reflexology:

A type of bodywork that involves applying pressure to certain points, referred to as reflex points, on the foot.

Sectarian medicine:

Medical practices not based on scientific experience; also known as alternative medicine.

Subatomic:

Relating to particles smaller than atoms.

Suppress:

To stop the development or growth of something.

Symptom:

Something that indicates the presence of an illness or bodily disorder.

Vertebra:

A bony piece of the spinal column fitting together with other vertebrae to allow flexible movement of the body. (The spinal cord runs through the middle of each vertebra.)

Yoga:

A form of exercise and a system of health that involves yoga postures to promote wellbeing of body and mind.

Homeopathy began its rise to popularity in America in the late 1840s, but Samuel Hahnemann (1755–1843), a German conventional physician, had created the practice in the late eighteenth century. Homeopathy grew out of Hahnemann's opposition to the medical practices of his peers, practices that were conventional but had grown from heroic medicine (see sidebar), which Hahnemann considered to be extremely crude in certain aspects.

Hahnemann's major homeopathic discovery came about while he was conducting an experiment involving cinchona, a Peruvian bark that was known to cure the disease malaria. Hahnemann had been ingesting the cinchona (he did not have malaria at the time) and found that he began to develop fevers similar to those suffered by people with malaria. When he ceased ingesting the cinchona, Hahnemann observed that the symptoms ended. This prompted Hahnemann to hypothesize (form an educated guess) that if taking a large dose of something brought on symptoms of a disease, then taking a small amount of that same substance would prompt one's body to use its defenses against that same disease. Of course, many years of experiments followed, years that led Hahnemann to form the two basic laws of homeopathy (listed above) as well as the holistic principle (emphasizing the whole of something is more important than any one of its parts) that each illness is specific to the individual.

One of Hahnemann's students, Dr. Constantine Hering, considered the father of American homeopathy, continued Hahnemann's work, bringing homeopathy to America in the early part of the nineteenth century. By 1835, Hering had opened the first homeopathic medical school in the United States. Less than ten years later, the American Institute of Homeopathy (which was the first national medical association in America) was formed.

HEROIC MEDICINE

When one thinks of going to the doctor, it is most likely a conventional, or allopathic, physician that the individual will be seeing. However, up until the late eighteenth century, most medicine could be considered sectarian, or alternative. Thereafter, however, allopathic medicine, or conventional health care, which stems from heroic medicine, began to rise in popularity.

Heroic medicine was an inexact branch of medicine practiced in the early nineteenth century, the forerunner to today's conventional medicine. Heroic medicine was called such because heroic measures were taken to cure a patient. The foundation of heroic medicine was that all diseases resulted from an excess of fluids in the body, and the cure was to relieve the body of the excesses through bloodletting (the letting of someone's blood in the [false] belief that it was a remedy for fever, inflammation, and other disorders) and purging. In heroic medical practices, doctors did not hesitate to add to a patient's pain in the name of a cure; furthermore, natural causes and treatments were completely discounted. Many people believed heroic methods worked as the treatments did provide visible and predictable effects (though not necessarily cures).

For example, Dr. Benjamin Rush (also a signer of the Declaration of Independence), a major figure in heroic medical practices, advocated the use of bloodletting on women in the throes of childbirth as he viewed childbirth as a disease. Rush also utilized techniques such as blistering the skin with camphor and tartar plasters on a patient's chest (when blisters or second-degree burns appeared, Rush concluded that the infection had been drawn out because of the appearance of pus in the blisters).

The success of homeopathy in combating several widespread epidemics helped popularize the practice. In 1849, an outbreak of cholera in Ohio proved homeopathy's validity when only 3 percent of those treated homeopathically died from the disease; compared with a mortality rate of 40 to 70 percent for those treated with conventional, or allopathic, health care methods. Similar success was seen in New Orleans, Louisiana, in 1879 when homeopaths (as practitioners of homeopathy are called) treated 1,945 people with yellow fever with a mortality rate of only 5.6 percent; conventional treatment used during the same epidemic yielded a 16 percent mortality rate.

Another factor lending itself to the popularity of homeopathy is that there long existed in the traditional medical practice community a prejudice and misunderstanding toward women and ailments particular to their bodies. Women's frustration with traditional health care, coupled with the fact that women, as the primary child-rearing force in the home, typically made the health care choices within their families, led many to seek out homeopathic solutions for their children's ailments. Thus, this too led to the surge in homeopathy.

Homeopathy soon became so popular that books on the practice appeared in several languages, some of which even offered up cures for animals' ailments. By the turn of the twentieth century, there were almost one hundred homeopathic hospitals and twenty-two homeopathic medical schools in the United States. It is also estimated that nearly 15 percent of American physicians were engaging in homeopathic practices at the time.

By the 1930s, homeopathy's popularity had begun to decline due to competition from conventional medicine and the American Medical Association (see sidebar on page 274). However, in the 1990s, homeopathy, like many other age-old alternative health care practices, enjoyed a growing resurgence in the United States and around the world.

Principles of Homeopathy

LAW OF SIMILARS. Hahnemann's law of similars actually stems from the observations and studies of another great medical mind, Hippocrates (c. 460–377 b.c.), who observed the law of similars in the fourth century b.c. The notion that "like treats like" has been proven again and again, specifically by scientific minds of the twentieth century, such as Jonas Salk (1914–1995) with his invention of the vaccine against polio. Salk and others who have developed similar vaccines use small amounts of the actual disease to help an individual's body "immunize" itself against the disease. For example, individuals who receive allergy shots today often receive small amounts of an allergen (the allergy-causing substance) to boost their bodies' tolerance to that allergen.

LAW OF INFINITESIMALS. The law of infinitessimals states that medicines are more effective in smaller doses and involves using trace amounts of a substance. A mixture is prepared by using one part of a particular substance that brings on the symptoms of a disease and mixing it with ninety-nine parts of either pure water or alcohol. This procedure is then repeated anywhere from twenty-four to thirty times to further dilute the mixture. The process also involves shaking the substance vigorously, something Hahnemann believed imbued the mixture with energy.

Critics of homeopathy have wondered how homeopathy actually works, if after twenty-four successive dilutions of a remedy are performed, there is virtually no trace of the original substance remaining in the remedy; therefore, the so-called remedy is actually only water and/or alcohol. Advocates of homeopathy have proposed theories that center on subatomic activity that takes place within the remedies themselves. Specifically, it has been suggested that structures form in the remedies that are capable of holding electromagnetic signals that may carry a message to the body, prompting the body's immune system to respond appropriately.

HOLISTIC DIAGNOSES. The holistic principle that is also employed by homeopathy centers around the fact that not all illnesses are alike even though they may fall into similar categories. For example, one person's headache should not be treated in the same manner as another person's headache as their symptoms will never be identical. In fact, according to homeopathic theory, there are more than two hundred diverse patterns of symptoms for headaches alone, with different remedies for each pattern.

THE ALLOPATHS VS. THE HOMEOPATHS

The American Institute of Homeopathy, founded in 1844, was the first formal medical association in the United States. It wasn't until 1847 that the American Medical Association (AMA) was founded, some say in large part to combat the popularity of homeopathy. In fact, by examining historical records, it appears that the primary mission of the AMA at its inception was to abolish the practice of homeopathy. The zeal with which the AMA attacked homeopathic medicine was due, in large part, to financial considerations. The homeopaths were taking business away from conventional allopathic physicians. Still, many allopathic physicians did embrace homeopathic solutions to illness.

By the early twentieth century, however, competition between medical schools, hospitals, and practitioners was on the rise. The AMA discouraged allopaths from associating professionally with homeopaths. And to compound matters, the AMA forged a bond with many major pharmaceutical companies. This bond centered on a mutually beneficial financial relationship; doctors received free samples of drugs and endorsed certain pharmaceuticals while the pharmaceutical companies purchased advertisements in the Journal of the American Medical Association. These advertisements gave the AMA the financial power it needed to improve its medical schools.

Soon, rating systems for medical colleges were created. These ratings contributed to the closing of the less financially stable homeopathic medical schools and organizations. By the 1930s, homeopathy had faded from the American medical field.

HERING'S LAWS OF CURES. Dr. Hering introduced yet another principle to the practice of homeopathy with Hering's laws of cures. These laws of cures upheld that healing begins from the deepest part of the body and then moves toward the extremities. Likewise, healing originates with emotional and mental aspects before moving to physical aspects; and finally, healing begins at the head and works its way down to the feet.

Another element of these laws includes Hering's assertion that the body will begin to heal its most recent disorder before moving to an older, preexisting condition. All of this means, then, that a homeopath will treat a condition in layers (from the inside to the outside, from the new to the old, from the top to the bottom, etc.). Yet, Hering also postulated that, as healing begins (new and old), a patient's condition might worsen before it gets better. This is what is known as the "healing crisis."

Homeopathy Helps Many Conditions

Homeopathy has been touted as being effective in treating a variety of diseases, from skin disorders to asthma to arthritis to diabetes. Practitioners believe this is so because it cures a disease at its deepest level. Many conditions, however, upon which homeopathic remedies have proven effective center around colds, influenza, or the flu, headaches, digestive disorders, and hay fever.

Other research indicates success in using homeopathic remedies to treat Parkinson's disease, bronchitis, sinusitis, pain, and rheumatoid arthritis.

Homeopathy Today

Currently, more than 500 million people in the world have received or are seeking homeopathic treatment for their illnesses. The World Health Organization has recommended that homeopathy be integrated into conventional medical practices so that health care demands worldwide will be met by the early twenty-first century.

Homeopathy is widespread in Europe, particularly in Germany, France, and Britain. Britain has a national health care system that includes homeopathic hospitals and clinics. India, too, has long advocated homeopathy; the country has more than 25,000 homeopaths. Homeopathy is also popular in Mexico and parts of South America.

In the United States, homeopathy, although its popularity is growing, still faces challenges. The Food and Drug Administration's lengthy approval process (see Chapter 9: Over-the-Counter Drugs) requires a great deal of funding. Many homeopathic remedies are extremely inexpensive (thus, unprofitable for a manufacturer) so the likelihood of homeopathic remedies appearing on pharmacy shelves is less than that of traditional over-the-counter or prescription drugs. As health care reform continues to be a topic of discussion in the United States, and individuals continue to explore and embrace alternative medicine, homeopathy may once again become an integral part of American health care practices.

NATUROPATHY

Naturopathic medicine, or naturopathy, is another alternative form of medicine that differs from allopathic medicine. Naturopathy, like most alternative medicine, has been around for thousands of years and is one of the oldest types of medical practices. In fact, naturopathy is more a combination of various healing practices than a single method; it encompasses homeopathy as well as other alternative health care practices, such as acupuncture (see section below) and therapeutic exercises, such as yoga (see section below). Naturopathy focuses on the body's inherent (natural) healing powers and works with those powers to restore and maintain overall health.

Six Principles of Naturopathy

Naturopathic doctors, or N.D.s, do not use artificial drugs or perform surgery. Rather, the practice of naturopathy is based on six main principles that take into account many different aspects of a person's body and lifestyle.

NATURE'S HEALING POWER. Naturopathic physicians believe that the body has the power to heal itself by using its own life force. The role of the naturopathic physician, however, is very important to help the body in its healing process. The naturopathic physician tries to uncover any factors preventing good health or recovery from an illness and tries to combat those factors. In addition, the physician helps a person create a lifestyle and an environment that promotes good health.

IDENTIFY AND TREAT THE CAUSE OF ILLNESS. Naturopathic physicians know that an illness does not occur without a cause. Causes, however, must not be confused with symptoms. Symptoms are signs that the body is trying to heal itself. For example, when an illness is present in the body, a symptom will appear, such as a fever, stuffed-up nose, or a cough. These symptoms are signs that the body is trying to fight the illness. The philosophy behind conventional medicine is to suppress and, therefore, relieve symptoms, but an important doctrine of naturopathic medicine is that symptoms should be left alone so that the causes of an illness can be uncovered. Causes may be rooted in physical, spiritual, or emotional problems. By identifying the cause and then treating it, proper healing and recovery can occur.

FIRST DO NO HARM. Because naturopathic physicians believe that the body will heal itself once the cause of the illness is identified and treated, trying to suppress symptoms is considered harmful. Physicians are committed to treating a person in a way that is complementary with the body's own healing process. Any practice that does not support the body's natural healing process is avoided at all times by naturopathic physicians.

TREAT THE WHOLE PERSON. Naturopathic physicians aim to treat the whole of a person, not just the part that is ailing. For this reason, healing involves the examination of many different factors in a person's life. These factors can be environmental, social, genetic, spiritual, mental, and/or physical in nature. The physician must address each of these factors to heal an illness. It is not until all these factors are working together in harmony that a person can be assured good health.

HISTORY OF NATUROPATHIC MEDICINE

Benedict Lust (1872–1945) is considered the father of naturopathic medicine. Even though the practice has been around for thousands of years, it was Lust who established the first official school of naturopathic medicine in the United States. In fact, he coined the term naturopathy in 1902.

Lust learned about naturopathic medicine by studying in Europe under Father Sebastian Kneipp. Kneipp had pioneered a philosophy of health, which was referred to as the "nature cure." This philosophy believed that good nutrition, exercise, and regular exposure to sun and air were essential to good health. These factors later became the basis of Lust's naturopathic medicine. In fact, Lust recovered from a bout of tuberculosis by following Kneipp's philosophy of hot- and cold-water treatments. When the cured Lust returned to America, he and his wife started the Yungborn Nature Cure Health Resort in New York. The resort was very successful, and three years later Lust opened the first school to teach others naturopathic medicine.

The popularity of naturopathic medicine grew in the next few years and more than twenty schools opened by 1925. The outbreak of World War II (1939–45), though, contributed to a reliance on medicine based more on science and technology. Prescription drugs, such as antibiotics, and surgical procedures became the preferred method of medical treatment in part because of their effectiveness in treating the soldiers who were wounded or fell ill during the war. Many believed at the time that medical science would soon find cures for most known diseases. As a result of these developments, naturopathic medicine suffered, and its popularity declined sharply as the American Medical Association (AMA) worked to establish itself as the main authority of medicine.

A resurgence in naturopathic medicine occurred in the late 1970s. At this time, many people became discontented by science and technology and more interested in all things natural and organic. As a result, more conventional medical schools began to offer courses in alternative medicine and naturopathy. In the 1990s, Americans spent billions of dollars on alternative health care, believing that good health involves one's diet and lifestyle and that one should take an active role in maintaining good health. Currently, there are approximately one thousand practicing naturopaths in the United States.

DOCTOR AS TEACHER. While naturopathic physicians are important in promoting good health, they have a responsibility to their patients to educate them in the practices of maintaining health. The role of the patient is equally as important in achieving good health because it is the patient who ultimately must accomplish the healing. As a result, the relationship between physician and patient must be caring, understanding, and respectful. Through education and encouragement, the naturopathic physician can give the patient the wisdom and hope he or she needs to embrace and practice good health.

PREVENTION IS THE BEST CURE. The final principle focuses on prevention (preventing illness before it strikes), which is at the root of naturopathic medicine. By promoting health through prevention, instead of working to combat disease and illness after the fact, naturopathic physicians can help their patients achieve good health. The naturopathic physician helps the patient identify any risk factors, such as genetic predisposition to disease or environmental hazards, that can be avoided. With the proper steps, a physician can help a patient avoid these risk factors and prevent illness and disease.

What Happens During a Naturopathic Doctor Visit?

Naturopathic doctors handle their patients differently from allopathic doctors. When a person makes an appointment with a naturopathic doctor, the N.D. will spend a few hours with the patient, during which time the N.D. takes a complete medical history. The N.D. will also discuss the details of the patient's symptoms and then proceed with a physical examination.

The N.D. will also conduct what is called a constitutional intake. This is a series of in-depth questions that explore the patient's lifestyle and diet. The constitutional intake will allow the N.D. to better understand the patient in order to recommend the right treatment for that person.

Once the questioning is complete and the physical examination has taken place, the N.D. will discuss treatment and a course of recovery. The patient is encouraged to take an active role in promoting good health. The N.D.'s responsibility is to make sure the patient has the information needed to heal. It is also normal for future visits to be scheduled so that the N.D. can monitor the patient's progress.

SPECIALTIES OF NATUROPATHY

Naturopathic medicine has many different specialties which include:

• Clinical nutrition: Uses food and nutritional supplements to treat illness.
• Physical medicine: Focuses on the muscles, bones, and spine, using massage, exercise, heat, water, and cold to heal.
• Homeopathy: Works to strengthen the body's immune system by giving natural medicine that produces similar symptoms to what the body is already feeling in order to treat an illness.
• Botanical medicine: Uses plants as medicines to treat illness.
• Naturopathic obstetrics: Offers natural alternatives before, during, and after childbirth that do not involve any drugs and take place outside of a hospital.
• Chinese medicine: Follows ancient beliefs that unify the body and the mind and restore balance to the body's energy force, referred to as Qi. Includes acupuncture and acupressure.
• Psychological medicine: Uses counseling and different types of therapies to achieve mental and emotional health.
• Environmental medicine: Focuses on helping people deal with the toxic elements that are part of their environment and may be causing certain illnesses.

The Benefits and Limitations of Naturopathy

Naturopathy has many different benefits, from physical and mental to financial. Sometimes, patients find that conventional medicine isn't providing them with the care they need or that conventional therapies are failing as treatment. For these patients, naturopaths can offer a different type of treatment—one that is nontoxic and noninvasive. Because naturopaths focus on prevention and a holistic approach to treatment, patients may find better results with naturopathic methods. Naturopathic treatments are less expensive than conventional treatments because natural drugs do not cost as much as prescription medicines, which are manufactured by pharmaceutical companies, and because naturopaths do not rely on high-technology medical equipment to treat their patients.

Because naturopaths must learn a great deal about their patients' lives, they tend to be more involved with their patients. Part of their training involves counseling and communications skills, which enables them to develop a strong relationship with patients and, therefore, be in a better position to help them.

Naturopaths do have their limits, however. Sometimes naturopaths must refer their patients to allopathic doctors, especially when patients need surgery. Naturopaths are not licensed or trained to perform surgery. For example, if a patient breaks a bone, an allopathic doctor has to set the bone, while the naturopath doctor can assist with the recovery process.

JOHN AND WILL KELLOGG WERE EARLY ADVOCATES OF NATUROPATHY. THE KELLOGGS, ALONG WITH C. W. POST, A FORMER EMPLOYEE, WENT ON TO START COMPANIES THAT PRODUCED BREAKFAST CEREALS THAT REFLECTED NATUROPATHIC PRINCIPLES.

ACUPUNCTURE

Acupuncture is a form of alternative medicine that involves stimulating certain points, referred to as acupoints, on a person's body to relieve pain and promote healing and overall well-being. These points are most often stimulated by thin needles and are found along twelve pathways in the body, called meridians. According to acupuncturists, these pathways have energy, called Qi (or Chi; both pronounced chee), flowing through them. For the body to be healthy, it is important for the flow of Qi to be balanced, and needling of acupoints helps to balance the flow of energy. Acupuncture also aids in balancing yin and yang, opposite forces that make up all things, including the human body.

Acupuncture has become popular in the United States in recent years. It has been found to help relieve pain and restore and maintain health. Many people use acupuncture in combination with other forms of treatment and have found it helps them recover from their conditions at a faster rate. Acupuncture has been found to help include headaches, drug addictions, asthma, tonsillitis, nausea, paralysis, stomach ailments, and even the common cold. In a few cases, it has even been used to control pain during surgeries performed in Asian countries. Mental conditions, such as depression and anxiety, have also been treated with acupuncture.

Yin and Yang

Chinese medicine has been influenced by the Chinese philosophy Taoism. In Taoism, it is believed that everything is made up of yin and yang. Yin is all things dark, negative, and feminine. Yang is all things light, positive, and masculine. One cannot exist without the other. However, one may over-power the other and create an imbalance. Acupuncturists believe if yin and yang are not balanced within a person, he or she will be more prone to illness or disease. Acupuncture helps to restore yin and yang balance.

Qi: Life Energy

As well as having balanced yin and yang, a person should be concerned with having balanced Qi, or life energy. In English, Qi has been called "life

energy," "vital life energy," "life force energy," or "life activity." This energy is invisible and is considered vital to each person. Acupuncturists believe that a balanced flow of this energy is important to a person's health. If the flow is interrupted at any point, some parts of the body are going to be affected and not function at their best. This may lead to illness or disease. In order to restore health, Qi must be rebalanced. The practice of acupuncture, then, works to rebalance the flow of Qi and allow the body to naturally heal itself.

The Ancient History of Acupuncture

Acupuncture goes as far back as five thousand years and was developed by the ancient Chinese as a form of medicine. Ancient Chinese practitioners mapped out acupoints, the places on the body to be stimulated. Researchers have found that these points have more nerve endings than other areas of the skin. These acupoints total more than 365; some say there are as many as one thousand points. Acupuncture was developed and used in China for many years before it spread to neighboring countries and eventually to Europe and the United States. The first introduction of acupuncture in the United States occurred during the 1700s, but it wasn't until the twentieth century that it became a popular form of medical treatment.

Stimulating Acupoints: Needles and Other Ways

Acupuncturists most often stimulate points on a person's body with needles that are as thin as a hair. Early needles were made of stone, bamboo, iron, silver, or even gold. Today, acupuncture needles are made of stainless steel and are typically used only once and then thrown away. Not all of the needles are straight. One type, called a staple, is round with a small needle and can be attached to the ear so the patient can wear it out of the office. This type of needle can be worn for about two weeks and is used often with patients who suffer from addictions, such asnicotine addiction.

A PRESIDENT'S SEAL OF APPROVAL

Acupuncture sharply increased in popularity in the United States following President Richard Nixon's (1913–1994) trip to China in 1970. During this trip, one of the people from the Nixon group needed to have an appendectomy, a procedure in which the appendix is removed. During the operation, pain was controlled by the use of acupuncture. After seeing the effects of acupuncture on his colleague, Nixon returned to America and made an effort to increase public awareness of acupuncture.

Other ways of stimulating the points include using pressure with hands (acupressure), electrical stimulation, lasers, magnet therapy, drug needling, and moxibustion. In electrical stimulation, a weak electric current is sent into the acupoint to stimulate it. In laser acupuncture a laser is used instead of a needle to stimulate a point. Magnet therapy has the acupuncturist placing magnets over the acupoints for stimulation. Drug needling is when herbal medicine or vitamins are injected into the acupoints, and moxibustion is when the mugwort herb is burned and placed on the head of the needle in order to send heat into the acupoint.

What Does Acupuncture Feel Like?

Surprisingly, acupuncture is not painful. Acupuncturists are trained in the proper insertion of the needles so they don't cause pain. However, patients will feel a tingling sensation and possibly some cramping or heaviness in the area of the needle. Typically, the needles are inserted about onequarter to one inch deep into the skin. The acupuncturist will usually insert only about twelve needles during one session. The placement of the needles depends upon a patient's condition. For example, if a patient is suffering from back pain, the needles may be placed in the leg. Once the needles are placed in their appropriate acupoints, the acupuncturist may twirl them to stimulate the acupoints even more. The idea of having needles inserted into a person's body may not sound appealing, but it is not as scary as it looks, and it is thought to offer great benefits to the body.

[See also Acupuncturist section in Chapter 7: Health Care Careers.]

CHIROPRACTIC

Chiropractors, practitioners of chiropractic medicine, are commonly known to help patients with back problems. While many clients of chiropractors are people with back problems, chiropractors claim to be able to ease all kinds of health conditions. They do this by manipulating and adjusting the spine. Chiropractors believe that if the spinal column is in the correct position then the nerves in the spine may function at their best, which in turn allows other bodily systems to function at their best. Therefore, chiropractors may treat a variety of conditions, including back, shoulder, and neck pain, as well as headaches, sports injuries, heart disease, allergies, and epilepsy.

What Is Chiropractic?

Chiropractic is a way of treating certain health conditions. The word chiropractic comes from Greek origins and means "done by hand." This is a good description of how chiropractors treat their patients. They use their hands to manipulate and adjust the spinal columns of their patients. According to chiropractors, vertebrae (the bones forming the spinal column) can become slightly misaligned and cause problems with nerve function since the spinal cord (which carries nerve impulses to and from the brain) runs through the vertebrae of the spinal column. Chiropractors call these misaligned vertebrae that affect the flow of nerves subluxations. It is believed that subluxations block some messages from the brain as they are routed through the nerves in the spine. This means that, depending on where the subluxation is located, certain organs are not receiving all of their vital messages from the brain. When this happens, the organs are not functioning at their best and may start to have problems. These problems can, in turn, result in illness or disease.

Chiropractors try to fix subluxations by using quick thrusts with their hands or applying pressure to the problem area on the spine. Once the spine is in the correct position, chiropractors believe nerve function will improve and the body will be able to fight illness and disease better. Thus, chiropractors do not heal the illness or disease; they work to have a person's body functioning at its best so it can naturally heal itself.

ACUPUNCTURE AND YOUR EAR

One form of acupuncture, called auricular acupuncture, focuses on stimulating the ear instead of the whole body. French neurophysiologist Paul Nogier, M.D., mapped out certain points on the ear. He founded auricular acupuncture after he noticed that by stimulating certain points on the ear different parts of the body received a benefit of increased energy flow. This increase in energy flow is thought to improve health. A similar type of therapy to auricular acupuncture is reflexology. In this practice, reflexologists stimulate certain areas on the feet in order to provide benefits to the whole body. (See the Reflexology section in this chapter.)

The History of Chiropractic

Chiropractic got its start in 1895 by Daniel David Palmer (1845–1913). A faith healer (a person who treats patients using prayer and faith in God) from Davenport, Iowa, Palmer founded chiropractic after he restored hearing in a man, Harvey Lillard, by realigning part of his spinal column. Lillard had suffered a work injury many years before that resulted in his hearing loss. When Palmer examined him, he found a painful area on Lillard's spine. By thrusting on the area with his hands, Palmer was able to adjust the spine and Lillard's hearing returned. From this experience Palmer formed his beliefs that would become the foundation for the practice of chiropractic. He even started the first chiropractic school in the United States in 1897.

Part of Palmer's chiropractic beliefs were spiritual. He believed that every human has a life force that flows through the nervous system. He called it "innate intelligence." According to Palmer, a balanced flow of this life force is important for good health. Since innate intelligence flows through the nervous system, it can be affected if the spinal column is not aligned properly. Thus Palmer believed that by realigning the spine, chiropractors would be improving nerve function as well as rebalancing the innate intelligence.

After Palmer founded chiropractic, his son, B. J. Palmer, carried on his father's beliefs and heavily promoted the practice. However, he did not work to create a relationship with practitioners of conventional medicine. Instead, he spoke out against medical doctors and their use of drugs to heal illnesses and disease. Chiropractors' rocky relationship with medical professionals was further shaken when, in the 1960s, the AMA deemed it unethical for their members to work with any chiropractors and sought to expose problems in chiropractic beliefs. A lawsuit was eventually filed by five chiropractors against the AMA and other similar associations for violating their rights. The chiropractors won the lawsuit and chiropractic has since established itself as the most popular form of alternative medicine in the United States. There are now more than 50,000 chiropractors in the United States, the third largest group of health care practitioners in the nation.

What Happens During Treatment?

Treatment by a chiropractor includes manipulation and adjustment of the spinal column and other joints and muscles as well as counseling in nutrition and other areas to promote healthy living. Chiropractors are trained to provide painless treatments. Before working on the patient's spine, a chiropractor will ask the patient about his or her medical history and perform a physical examination. A chiropractor will also create a treatment plan for each patient.

EARLY HEALING THROUGH THE SPINE

Treating health conditions by working with the spine occurred before the founding of chiropractic. It has been documented that people of ancient Egypt and ancient Greece manipulated the spine to promote healing, as did Europeans during the Middle Ages (c. 500–1450). Native Americans were also known to manipulate the spine before chiropractic practices were formalized in 1895 by Daniel David Palmer.

As well as feeling for displaced vertebrae with their hands, chiropractors often rely on X rays to locate misalignments in the spine. After locating problem areas, a chiropractor will have a patient lie on his or her stomach; the practitioner will then try to reposition the spine. Chiropractors may also use other forms of treatment in addition to manipulation with their hands. These may include massage, electrical stimulation, traction (a pulling force applied to a part of the body), ice, heat, or ultrasound.

[See also Chiropractor section in Chapter 7: Health Care Careers.]

MASSAGE THERAPY

Massage therapy is defined as the manipulation of soft tissue in the body with the aim of relieving and preventing pain, stress, and muscle spasms. In addition, massage therapy works to improve blood circulation and the body's ability to recover from illness and injury. There are many physical as well as psychological benefits to massage therapy, which will be discussed later in this section.

The practice of massage therapy has been around for thousands of years. Even ancient Greek and Roman civilizations recognized the many benefits of massage and often participated in massage after exercising or competing in athletic games. While massage therapy is considered an alternative treatment, many conventional physicians now encourage patients to seek out massage therapy for illness and injury. According to a survey in the Journal of Alternative and Complementary Medicine, there are forty-nine conventional medical schools that offer courses in massage therapy. Furthermore, conventional doctors refer patients to massage therapists for a wide variety of problems, including allergies, asthma, arthritis, carpal tunnel syndrome, headaches, insomnia, stress, bronchitis, chronic pain, and constipation.

The Different Types of Massage

There are many types of massage therapy, and each one uses a different technique to achieve a similar result. These include, but are not limited to, Swedish massage, reflexology, shiatsu and acupressure, and sports massage. Swedish massage, perhaps the most well known and popular type of massage, combines kneading

and stroking of the muscles with movement of the joints. Reflexology focuses on certain points on the hands and feet that are connected to other areas on the body. Shiatsu and acupressure are Asian techniques that apply pressure to certain points on the body that correspond with acupuncture meridians. Meridians are the channels through which the body's energy, or Qi, flows. Finally, sports massage focuses on improving an athlete's performance, preparing an athlete for a specific event, and helping the particular muscles that are used in a certain sport.

The Physical Benefits of Massage Therapy

There are many physical benefits to massage therapy. Massage therapy's rhythmic movements and applied pressure help increase one's blood circulation. It also helps blood vessels to expand, allowing more blood to pass through them. In addition to increased blood circulation, massage therapy works to increase lymph (a white substance that carries the body's toxins away) flow. Since lymph, unlike blood, does not move on its own, it must be stimulated through muscle movement, or exercise and massage. The increased flow of blood and lymph has a positive effect on the body's cells, which contribute to a person's overall health. More blood means more oxygen and more lymph means less waste and toxins.

THE INS AND OUTS OF SPORTS MASSAGE

As professional and amateur athletes strive to reach their peak performance, sports massage therapy works to keep their bodies in top shape. Massage helps athletes perform better, avoid injuries, and recover more quickly from minor injuries. The three main areas of sports massage therapy are maintenance massage, event massage, and rehabilitation massage.

Maintenance massage is used to improve an athlete's flexibility and range of motion. A trained therapist knows how to focus on the particular muscle groups that different types of athletes use most often. This allows athletes to train more effectively and prevent possible injuries.

Event massage includes two categories: Preevent massage and post-event massage. Pre-event massage helps athletes prepare for a big event by increasing their blood circulation and releasing any muscle tension that may be present before a big event. Post-event massage reduces muscle spasms that may occur and helps athletes' muscle tissues recover from the event. This allows athletes to be ready to compete in the next event. Both pre-event and postevent massage enable athletes to compete at their best while reducing the risk of injury.

Rehabilitation massage is used when athletes suffer from injuries, such as muscle tears, cramps, bruises, and aches. Even the best athletes have injuries, and it is a sports massage therapist's job to help athletes recover quickly. Massage is used simultaneously with proper medical care and helps the muscle tissue heal by removing lymph fluid (a white substance that carries the body's toxins away). Finally, rehabilitation massage can make the recovery process less painful for the athlete, which helps to restore the mental edge that athletes need in order to perform their best.

Massage can be particularly important when a person is involved in an exercise regimen or participates in a sport on a regular basis. When muscles are being used more often, there is an increase in certain acids that build up in the tissue if the muscles do not get the oxygen they need. If these acids remain in the muscle tissue, cramping, soreness, and fatigue generally follow. Massage can help to drain the muscle tissues of these acids and thus help muscles recover more quickly.

Another important aspect of overall health is good nutrition. Giving the body the proper vitamins and nutrients will help it function properly. Massage therapy can increase the benefits of good nutrition by helping the nutrients reach their destination: the cells. As mentioned, massage expands the blood vessels, which increases circulation. By having a clear and open path, nutrients have an easier time finding the cells that work to keep the body healthy.

The Psychological Benefits of Massage Therapy

In addition to physical benefits, there are many psychological, or mental, benefits to massage therapy. The most obvious benefit is stress relief. Stress affects everyone, young and old alike. Frustrations can build in many aspects of a person's life, whether it be job, family, friends, or school. Stress prompts the release of certain hormones that cause blood vessels to shrink. The shrinking of blood vessels results in poor circulation, which can greatly harm a person's overall health. Research has indicated that stress is a main cause of certain illnesses, such as migraine headaches, depression, high blood pressure, constipation, and other digestive disorders. Massage therapy can help to reduce the risk of these illnesses. Massage therapy also helps people release repressed, or built-up, emotions, which can result in an overall sense of relaxation and peace.

REFLEXOLOGY

Reflexology is a type of body therapy that involves applying pressure to certain points, referred to as reflex points, on the foot. Many people seek reflexology for relaxation and to improve their health and well-being. It is thought that by pressing points on the feet, impulses are sent through pathways to certain areas of the body, increasing energy and health in those areas. During treatments, patients may even feel tingling sensations in the parts of the body to which the impulses are being sent. Reflexology is thought to help anxiety, asthma and allergies, chronic pain, diarrhea and constipation, high blood pressure, migraine headaches, premenstrual syndrome (PMS), skin problems, and stress.

WHAT HAPPENS DURING A MASSAGE?

Massage therapists work hard to make sure their clients feel comfortable when receiving a massage. Clients usually are asked to remove most of their clothing during the massage. However, if this makes clients feel uneasy, therapists can provide a towel or sheet to cover up their clients, leaving only the body part being massaged exposed. Some clients like to have complete quiet during a massage while others enjoy music. Therapists will accommodate their clients in every way possible, providing soft music or total silence. Oils and lotions may also be used if the client wants, but these things are not necessary to a good massage. While some clients prefer not to talk during a massage, a successful session often relies on good communication between the client and the therapist. A good therapist should answer any questions a client has and lay to rest any anxiety the client may have.

Overall, the most important thing for a good massage is for the therapist to be well trained in the areas of anatomy (study of the human body), physiology (study of bodily functions and processes), and kinesiology (study of human movement). Also, the therapist should be sensitive to a client's needs and open to feedback to promote overall health for the client.

The Roots of Reflexology

Reflexology is approximately as old as acupuncture, which has been around for the past five thousand years. Like acupuncture, reflexology has its roots in China, but evidence has been found indicating that reflexology was also used in Egypt as far back as 2330 b.c. Reflexology was first developed in the United States by William Fitzgerald, M.D., in 1913. Fitzgerald had begun to realize that his patients would feel less pain when pressure was applied to certain areas of the body, such as the hands or feet, before surgery. Deciding to research this further, Fitzgerald conducted some experiments and concluded that pressing points on certain areas of the body produced beneficial effects in other areas of the body. Fitzgerald called this "zone therapy."

Physiotherapist Eunice Ingham further developed Fitzgerald's zone therapy into the practice that is known today as reflexology. During the 1930s, Ingham used zone therapy and concluded that applying pressure to the feet yields the best results to the body. She also asserted that it is better to vary the amount of pressure applied and that greater benefits than just pain relief occurred from applying pressure to the feet. Ingham then mapped out the reflex points on the feet to be pressed and the specific areas of the body that relate to the points on the feet. Thus reflexology was officially born in the United States.

THE BENEFITS OF MASSAGE FOR BABIES

Massage therapy for premature babies (babies that weigh less than five pounds at birth) is a relatively new phenomenon, pioneered by Dr. Tiffany Field, a child psychologist who founded the Touch Research Institute at the University of Miami Medical School. Its mission is to research the medical benefits of touch and further its role in the treatment of illness and disease. Field's thinking, however, has quickly caught on with both parents and the medical community. Although doctors believed for many years that premature babies were so fragile that it would be harmful to touch them at all, this belief has been challenged by the tremendous benefits massage has produced with such babies. According to the Touch Research Institute, premature babies who are massaged three times a day develop more quickly by gaining weight faster than those preemies who are not massaged. Babies who receive massage also develop better mental and motor skills just months after their births.

Massage not only benefits premature babies, but it also aids all babies by helping them sleep better and generally be more relaxed. While the benefits of massage therapy for babies seem to be evident, many hospitals still do not have programs that incorporate this therapy, and even if they do, many insurance companies won't cover the costs. As a result, many new parents are taking classes to learn how to massage their babies at home.

How Does Reflexology Work?

Students of reflexology are trained to know the correct points to press on the foot. They may refer to foot reflexology charts that show which areas of the foot should be pressed and which organs will be affected if a certain area of the foot is pressed. The reflex points on the feet are located on the bottom as well as the top and sides of the feet. Reflexologists are taught that pressing points on the right foot affects organs on the right side of the body and pressing points on the left foot affects organs on the left side of the body. They also learn that different points on a foot relate to different organs in the body. For example, if a reflexologist presses an area just below the three middle toes, the eyes and ears may be affected, and if the tips of the big toes are pressed, the head and brain are affected. Sending impulses to these areas is thought to allow the organs to perform better and thus contribute to healing or maintaining the health of the body.

OTHER MAPS TO THE BODY

Reflexology is not the only practice that sees one part of the body as a map for the entire body. In Chinese and Indian medicine, many practitioners examine the tongue as a way to determine the health of the rest of the body. In iridology, practitioners use the iris of the eye to diagnose disease in other parts of the body. The colon has also been thought to show signs if another part of the body is suffering from an illness. Auriculur acupuncture (see Acupuncture section) focuses on the ear in order to restore or maintain health in the entire body.

According to reflexologists, other benefits of reflexology include the reduction of lactic acid in the feet. Lactic acid is a waste product produced from using muscles and too much of it can cause problems, such as stiffness. Reflexologists also believe there are tiny calcium crystals that build up at the nerve endings of the feet and cause problems in energy flow. They claim reflexology helps to break up these crystals and restore healthy energy flow.

YOGA

Although many people today are embracing yoga solely as a form of exercise, yoga is actually considered to be a system of health, such as homeopathy or reflexology. In the United States, yoga has slowly grown in popularity; however, in Eastern cultures, such as India, yoga has always been a common practice.

The term yoga means "union" in the Sanskrit language, and it refers to the relationship of physical, mental, and spiritual energies that enhance all facets of an individual's well-being. Dating back to the second century b.c., when a writer named Patanjali wrote the Yoga Sutras, one of yoga's primary philosophies is that the health of the mind and the body are linked together and that one cannot function properly if the other does not. Proponents of yoga claim, then, that its practices can restore this balance between body and mind and promote overall health.

Yoga Postures

Yoga postures are known as asanas (often categorized as Hatha yoga). In Sanskrit, the word asana means "ease." Asana refers not only to postures but also to exercises that revolve around these postures to promote positive change in the body. Asanas often entail a limited amount of movement from participants, but at all times the body and the mind remain engaged, working together to achieve a state of simultaneous energy and relaxation.

When an asana is done correctly, it is designed to create a perfect balance between movement and stillness. Two types of asanas used today are meditative and therapeutic.

MEDITATIVE ASANAS. Meditative asanas are used to properly align the head and the spine. In turn, they also promote a state of relaxation that may be influenced by the improved circulation these postures elicit. This means that while the mind is at rest, the body's major organs and glands are enjoying a great deal of energy.

THERAPEUTIC ASANAS. Initially used to introduce the body into a relaxed state prior to meditation, therapeutic asanas (which include the popular shoulder stand and lotus positions) can also be used to ease pain in the back, joints, and neck. In fact, holistic practitioners often prescribe these positions to their patients as a way of alleviating such pain. Therapeutic asanas were originally referred to as cultural asanas; however, their applicability to pain reduction has contributed to the change in their name.

Breathe Easy

Controlling one's breathing in yoga is called pranayama, which refers to the control of prana, or the life force/life energy. Breath control is practiced in yoga to help yogis (experienced practitioners of yoga) regulate their autonomic

physical functions (heart rate, for example). Yoga philosophy suggests that controlling one's breathing to make it slow and steady results in having a relaxed mind. Therefore, yogis try to perfect their breathing using smooth motions that promote an evenness of breath. It is believed that this, in turn, promotes a serenity (calmness) of the mind and raises concentration and energy at the same time. This is why breath control is integral to the practice of meditation.

Meditation is Concentration

Once a yogi has mastered his or her breathing and the appropriate postures, the yogi can move on to meditation. Meditation refers to a state of heightened concentration in which many practitioners enjoy feelings of peace and awareness. Meditation creates a state in which yogis can focus fully on the balance between the mind and the body.

Expert yogis strive to achieve the final stage of yoga, known as samadhi. In this stage, the yogi is believed to realize a state of awareness (consciousness) that is above those states of dreaming, sleeping, and wakefulness. Samadhi is the fourth stage of consciousness.

Yoga's Benefits to the Body

Yoga's benefits to the body are numerous, according to proponents of the practice. Like any type of physical activity, yoga promotes a certain degree of muscle strength. Even more so, yogis enjoy a great deal of flexibility, and flexible muscles lead to improved posture. In fact, a common trait in yogis is their exceptional posture that resonates from the top of their heads down to their feet. While yoga is not considered to be an aerobic (cardiovascular) exercise, people engaging in yoga often break a sweat and, like any activity, yoga does burn calories, which further promotes fitness.

Yoga has also been credited with diminishing symptoms of and suffering from certain physical conditions. Specifically, many studies have been built around yoga's positive effects on reducing the blood pressure in those suffering from hypertension. Other physical conditions thought to be improved by yoga, according to the Yoga Biomedical Trust survey (1983–1984), include back pain, arthritis and rheumatism, migraines, menstrual disorders, premenstrual syndrome (PMS), asthma and bronchitis, hemorrhoids, cessation of smoking, and obesity.

Yoga's Benefits to the Mind

It is only natural that yoga has direct benefits to a person's mental health and well-being since the practice centers around unity between the body and the mind. Because it employs breathing techniques and meditation, yoga helps reduce people's overall stress, anxiety, and insomnia. Furthermore, advocates of yoga claim that it improves concentration as well, allowing individuals to focus clearly and easily on a thought or a task at hand.

FOR MORE INFORMATION

Books

The Burton Goldberg Group. Alternative Medicine: The Definitive Guide. Tiburon, Calif.: Future Medicine Publishing, Inc., 1997.

Cargill, Marie. Acupuncture: A Viable Medical Alternative. Westport, CT: Praeger, 1994.

Cassileth, Barrie. The Alternative Medicine Handbook: The Complete Reference Guide to Alternative and Complementary Therapies. New York: W.W. Norton, 1998.

Facklam, Howard. Alternative Medicine: Cures and Myths. New York: Twenty-First Century Books, 1996.

Kastner, Mark and Hugh Burroughs. Alternative Healing: The Complete A-Z Guide to More than 150 Alternative Therapies. New York: Henry Holt, 1996.

Murray, Michael T. and Joseph E. Pizzorno. Encyclopedia of Natural Medicine, 2nd ed. New York: Prima Publishing, 1997.

Wolfson, Evelyn. From the Earth to Beyond the Sky: Native American Medicine. New York: Houghton-Mifflin, 1993.

Web sites

American Association of Naturopathic Physicians. [Online] www.naturopathic.org (Accessed October 1, 1999).

American Massage Therapy Association. [Online] http://www.amtamassage.org (Accessed October 1, 1999).

American Yoga Association. [Online] http://users.aol.com/amyogaassn/ (Accessed October 1, 1999).

Homeopathy Online. [Online] http://www.lyghtforce.com/HomeopathyOnline/ (Accessed October 1, 1999).

Office of Alternative Medicine at the National Institutes of Medicine. [Online] http://altmed.od.nih.gov/oam (Accessed October 1, 1999).

Reflexology Association of America. [Online] http://members.xoom.com/_XOOM/reflexusa (Accessed October 1, 1999).

CHAPTER 9
ALTERNATIVE MEDICINE

The National Center for Complementary and Alternative Medicine (NCCAM), an institute of the National Institutes of Health (NIH), was created in 1992 because consumers of complementary and alternative medicine (CAM) and health care practitioners wanted to know whether available alternative medical options are safe and effective. NCCAM is "committed to the clinical study of promising CAM substances and modalities before knowledge becomes available about their active ingredients, mechanisms of action, stability, and bioavailability," and the organization uses a hierarchy of evidence to determine a method or product's effectiveness and safety. Studies indicate that data on the efficacy and safety of CAM therapies span a continuum ranging from anecdotes and case studies through encouraging information obtained from large, well-developed clinical trials. (See Figure 9.1.)

NCCAM defines alternative medicine as "a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine." Although there is some overlap between them, the NCCAM further distinguishes between "complementary," "alternative," and "integrative" medicine in the following manner:

• Alternative medicine is therapy or treatment that is used instead of conventional medical treatment. One example of alternative medicine is the treatment of depression with St. John's wort (hypericum), a botanical, herbal medicine, rather than with conventional antidepressant drugs such as Prozac.
• Complementary medicine is alternative therapy or treatment that is used along with conventional medicine, not in place of it. An example of complementary medicine is the addition of relaxation techniques or movement awareness therapies (such as the Alexander technique, Pilates, and the Feldenkrais Method) to the traditional approaches of physical and occupational therapy used to rehabilitate people who have had a stroke. Complementary medicine appears to offer health benefits, but there is generally no scientific evidence to support its utility.
• Integrative medicine is the combination of conventional medical treatment and CAM therapies that have been scientifically researched and have demonstrated that they are both safe and effective. An example of integrative medicine is teaching stress management and relaxation techniques to people with high blood pressure and heart disease along with the use of traditional approaches such as weight management, exercise, and prescription drugs to reduce the risks and complications of heart disease.

Despite the classification system outlined by the NCCAM, CAM continues to be known by a variety of names—nontraditional medicine, unorthodox medical practices, and holistic health care—and reflects a wide range of philosophies, including the need for or reliance on scientific evidence of effectiveness. Generally, alternative therapies tend to be untested and unproven, whereas complementary and integrative practices that are used in conjunction with mainstream medicine are often those with a substantial scientific basis of demonstrated safety and efficacy.

GROWING POPULARITY OF CAM

Many people have turned to CAM approaches out of frustration that mainstream medicine cannot meet all their expectations and needs. Helping this movement along is information technology, enabling easy access to sources of CAM information on the Internet and in print and electronic media, and advertising and marketing of new CAM products and methods. As many as 42 percent of Americans are using CAM approaches to satisfy their health needs, according to the NCCAM.

A survey conducted in 1997 by Harvard Medical School researcher Dr. David Eisenberg and colleagues about the use of alternative medicine in the United States found that more than four in ten Americans had used at least one alternative therapy. The survey, published in the November 1998 Journal of the American Medical Association, revealed that approximately 42 percent of Americans used alternative medicine. Further, about $27 billion was spent out of pocket (not paid by insurance) for alternative medicine, a number that was comparable to what Americans paid out of pocket for conventional treatments from physicians in the same year. The researchers reported that the highest rates of CAM use were among college graduates living in the Western United States, ages thirty-five to forty-nine, with incomes greater than $50,000 per year.

Although the majority of CAM services are provided by alternative medical practitioners, CAM also is provided by some traditionally trained physicians. In the National Ambulatory Medical Care Survey: 2001 Summary, the Centers for Disease Control and Prevention (CDC) reported that "therapeutic and preventive services" (not including medication therapy) were ordered or provided at 41.4 percent of all office visits. Visits that included counseling or education related to diet or nutrition (11.6 percent) and exercise (8.2 percent) were made most frequently. (See Table 9.1.)

Americans' Use of Alternative Medicine Is Not Just a Fad

Researchers from the Harvard Medical School and Center for Alternative Medicine Research and Education studied long-term trends in the use of CAM therapies in the United States and published their findings in the August 21, 2001, issue of the Annals of Internal Medicine. The researchers conducted more than two thousand surveys and examined historical patterns of CAM utilization dating back to the 1960s. They questioned survey respondents about twenty different CAM practices, such as acupuncture, aromatherapy, biofeedback, energy healing, massage, and yoga.

The study found that since the 1960s nearly all of the 20 CAM therapies had increased in popularity, although interest surged during the 1960s and 1970s. The researchers observed that specific CAM therapies gained acceptance during each decade. In the 1960s Americans embraced diet programs, vitamins, and self-help support groups, and in the 1970s they turned to herbal medicine, biofeedback, and energy healing. The 1980s saw growing popularity of massage and naturopathy, and during the 1990s the appeal of massage increased again along with interest in aromatherapy, energy healing, herbal medicine, and yoga.

In contrast with earlier studies, including Dr. Eisenberg's research, that found CAM users to be mostly educated adults living in Western states, the researchers found the use of alternative therapies was unrelated to education attained, gender, or ethnicity. They observed that the increases in both acceptance of CAM and its use during the past fifty years suggest that demand for CAM therapies will continue in the foreseeable future.

Why Do People Seek CAM?

People turn to CAM for many different reasons. One of the most attractive features of CAM is an emphasis on the "whole person," rather than simply the diseased organ or body part. CAM therapies and practitioners tend to consider patients as human beings rather than simply physical bodies, and nearly all emphasize the mind–body connection and pay attention to emotional wellness and spirituality.

Some patients seek alternative therapies when conventional medicine fails to relieve their symptoms or when traditional treatment produces unpleasant side effects. The 1998 study conducted by Dr. Eisenberg found that nearly half of CAM visits were to chiropractors and massage therapists for symptoms of pain associated with chronic conditions such as back and neck problems, headaches, and arthritis.

Other CAM users cite distrust of physicians, historically poor communication and interactions with physicians, the impersonality of traditional medical care, and the desire for practitioner–patient partnerships characterized by shared decision-making (rather than traditional physician–patient relationships in which physicians assume sole responsibility for decisions about patient care) for their interest in CAM.

Dr. Andrew Weil, a renowned physician and expert in CAM practices and director of the Program in Integrative Medicine at the University of Arizona School of Medicine, believes that one reason for the renewed popularity of CAM is that modern Western medicine has focused on technology and ignored simple, natural, and inexpensive ways to influence health and disease that were used by previous generations and are still used in other cultures. Dr. Weil contends:

People all over the world are increasingly concerned about the harm inflicted by modern, technological medicine, especially adverse reactions to pharmaceutical drugs that are now so common. In deciding what to put in their bodies, they are more inclined to pay attention to the wisdom of nature and be wary of all that is artificial.

TYPES OF CAM

The NCCAM has categorized CAM into five groups. The major types of CAM are as follows:

• Alternative medicine systems—These systems developed before conventional Western medicine or independent of it. Alternative medicine systems are based on different beliefs and philosophies and, as a result, approach both diagnosis and treatment of disease quite differently from traditional Western medicine. Examples of alternative medicine systems that began in Western cultures are homeopathy and naturopathic medicine. Alternative medicine systems that developed in other cultures include acupuncture, Ayurvedic medicine, and traditional Chinese medicine.
• Mind–body interventions—Mind–body medicine is a range of practices that aims to use the power of the mind to influence symptoms of disease and healing. Increasingly, this type of alternative medicine has gained acceptance among medical professionals. Mind–body therapies, such as support groups for people suffering from a variety of medical problems; relaxation techniques; and art, dance, and music therapies, are now widely used by practitioners of conventional medicine. Less widely accepted mind–body techniques include meditation, breathing, hypnosis, and prayer.
• Biologically based therapies—This type of treatment uses organic (naturally occurring) substances such as herbs, food, and vitamins to treat symptoms of disease and improve health and wellness. Examples of biologically based therapies include dietary supplements, herbal remedies, and the hotly debated use of hormones such as human growth hormone (HGH) and DHEA (dehydroepiandrosterone, the most plentiful steroid hormone in the body) to combat disease and to slow aging.
• Manipulative and body-based methods—Movement therapies, manipulative methods, and bodywork are another type of CAM. Examples of these methods are massage therapy, chiropractic, and osteopathic manipulation (also referred to as craniosacral manipulative therapy).
• Energy therapies—These techniques aim to influence energy fields that practitioners of this form of CAM believe exist in and around the body. Also called "biofield therapies," some are "touch" therapies and others do not involve direct contact with any part of the body. Reiki and Qi Gong are examples of biofield therapies. Other forms of energy therapies known as bioelectromagnetic-based therapies use magnetic energy, electromagnetic fields, pulsed fields, alternating current, or direct current fields to influence "energy flow."

ALTERNATIVE MEDICINE SYSTEMS

Practically every culture has had a medicine system; some developed more than one system, tradition, or philosophy to explain the causes of disease and suggest therapies to relieve symptoms. This section considers two alternative medicine systems that had their origins in Western culture—homeopathy and naturopathic medicine—and three that developed in non-Western cultures—acupuncture, Ayurvedic medicine, and traditional Chinese medicine.

Homeopathic Medicine

Homeopathic medicine (also called homeopathy) is based on the belief that "like cures like" and uses very diluted amounts of natural substances to encourage the body's own self-healing mechanisms. Taken in higher doses or stronger concentrations, the natural substances used by homeopathy to stimulate self-healing likely would produce the symptoms the diluted substance aimed to relieve.

Homeopathy was developed by German physician Dr. Samuel Hahnemann in the 1790s. First experimenting on healthy subjects and himself, Dr. Hahnemann discovered that he could produce symptoms of particular diseases by injecting small doses of various herbal substances. This discovery inspired him to try another experiment—giving sick people extremely diluted formulations of substances that would produce the same symptoms they suffered from in an effort to evoke natural recovery and regeneration.

Dr. Hahnemann believed that homeopathic remedies—substances that caused symptoms similar to those caused by the disease but not diluted forms of the disease-causing agents—worked by activating the "vital force," the organizing energy system that governs health in a human being. There is no comparable belief in Western medicine, but the ideas of vital force bears some resemblance to the Ayurvedic concept of prana and to qi in Chinese medicine.

Homeopathy gained a foothold in the United States during the 1830s when it appeared able to stem some epidemics, such as cholera (a devastating infectious disease that produces severe diarrhea), but by the 1900s it fell out of favor as traditional medical practice experienced greater success treating the diseases of the day. During the 1970s there was renewed interest in homeopathy in the United States, and in 2004 believers credited homeopathy with gentle, effective, and nontoxic treatment of many infections, emotional problems, and learning disorders. Although proponents assert that homeopathic medicine speeds healing, it cannot treat traumatic injuries, such as broken bones, or genetic diseases.

According to an April 2003 Research Report by the NCCAM, research studies on homeopathy have yielded contradictory findings. Some have concluded that there is no strong evidence supporting homeopathy as being effective for any clinical condition. Others have found positive effects from homeopathy, but these effects are not readily explained in scientific terms.

According to Dr. Kenneth Pelletier, a clinical professor of medicine at Stanford University School of Medicine and director of the NIH-funded Complementary and Alternative Medicine Program at Stanford, homeopathy has proved effective for a variety of ailments. In his book The Best Alternative Medicine: What Works? What Does Not? (Simon and Schuster, New York, 2000), Dr. Pelletier presents the findings of scientific research documenting the safety and efficacy of nearly every form of CAM. Dr. Pelletier reports that clinical trials of homeopathy find it effective for the treatment of disorders such as seasonal allergies, asthma, childhood diarrhea, fibromyalgia, influenza, and rheumatoid arthritis.

Naturopathic Medicine

As its name suggests, naturopathic medicine, or naturopathy, uses naturally occurring substances to prevent, diagnose, and treat disease. This alternative medicine system, one of the oldest, has its origins in Native American culture and also draws from Greek, Chinese, and Indian philosophies of health and illness.

Like homeopathy, naturopathy was introduced in the United States by a German physician, Dr. Benedict Lust, and its popularity rose, declined, and was rekindled in the same time period as homeopathy. Dr. Lust opened a school of naturopathic medicine in New York City, and with Dr. James Foster, a physician in Idaho using natural healing techniques, they christened their blend of herbal medicine, manipulative therapies, homeopathy, nutrition, and psychology, "naturopathy."

The overarching principles of modern naturopathic medicine are "first, do no harm" and "nature has the power to heal." Naturopathy seeks to treat the whole person because disease is seen as arising from many causes rather than a single cause. Naturopathic physicians are taught that "prevention is as important as cure" and to view creating and maintaining health as equally important as curing disease. They are instructed to identify and treat the causes of diseases rather than acting only to relieve symptoms. Naturopathy also requires practitioners to serve as teachers to encourage patients to assume personal responsibility for their health and actively participate in self-care.

Naturopathic physicians' treatment methods include nutritional counseling and the addition of dietary supplements, herbs, or vitamins to a patient's diet, hydrotherapy (water-based therapies, usually involving whirlpool or other baths), exercise, manipulation, massage, heat therapy, and electrical stimulation. They are trained to prescribe herbal medicines and homeopathic remedies, perform minor surgical procedures such as setting broken bones, and offer counseling services to help patients resolve emotional problems and modify their lifestyles to improve their health and wellness. Because naturopathy draws on Chinese and Indian medical techniques, naturopathic physicians often use Chinese herbs, acupuncture, and Ayurvedic medicine to treat disease.

Dr. Pelletier's research found studies demonstrating that naturopathy was effective for a variety of conditions including asthma, atherosclerosis, back pain, some cancers, depression, diabetes, eczema (a skin condition), middle ear infections, migraine headaches, natural childbirth, and osteoarthritis. Dr. Pelletier observed that licensed naturopathic physicians are among the best-trained CAM practitioners, and he predicted that research would continue to confirm the benefits and efficacy of the safe, inexpensive, and low-risk therapies provided by naturopathic physicians.

Acupuncture

Acupuncture is a Chinese practice that dates back more than 5,000 years. Although Sir William Osler called acupuncture the best available treatment for low back pain in the late 1800s, it was not widely used to treat pain in the United States until the 1970s. Chinese medicine describes acupuncture—the insertion of extremely thin, sterile needles into any of 360 specific points on the body—as a way to balance qi (also called chi), the body's vital life force that flows over the surface of the body and through internal organs. Traditional Western medicine explains the acknowledged effectiveness of acupuncture as the result of triggering the release of pain-relieving substances called endorphins, which occur naturally in the body, and neurotransmitters and neuropeptides, which influence brain chemistry.

In addition to providing lasting pain relief, acupuncture has demonstrated success in helping people with substance abuse problems, relieving nausea, heightening immunity by increasing total white blood cells and T-cell production, and assisting patients to recover from stroke and other neurologic impairments. Imaging techniques have confirmed that acupuncture acts to alter brain chemistry and function.

Ayurvedic Medicine

Ayurvedic medicine (also called Ayurveda, which means "science of life") is believed to be the oldest medical tradition and has been practiced in India and Asia for more than five thousand years. With an emphasis on preventing disease and promoting wellness, its practitioners view emotional health and spiritual balance as vital for physical health and disease prevention. Ayurveda also considers diet, hygiene, sleep, lifestyle, and healthy relationships as powerful influences on health.

Practitioners aim to balance the three doshas—fundamental human qualities that they believe reside in varying concentrations in different parts of the human body. The doshas are thought to be disturbed by improper diet, sleep deprivation, travel, coffee, alcohol, or excessive exposure to the sun and are balanced with diet, exercise, detoxification (ritual cleansing of toxins), yoga, spiritual counseling, herbal medicine, breathing exercises, and chanting.

Dr. Pelletier's research found evidence that Ayurveda was used successfully to treat many chronic diseases, including cardiovascular disease, neurologic disorders, arthritis, musculoskeletal pain, gastrointestinal disorders (such as irritable bowel syndrome), diabetes, and mental health problems. Like other CAM, Ayurveda encourages patients to assume responsibility for their health and promotes self-care.

Traditional Chinese Medicine

Traditional Chinese medicine (TCM) combines nutrition, acupuncture, massage, herbal medicine, and Qi Gong (exercises to improve the flow of vital energy through the body) to help people achieve balance and unity of their minds, bodies, and spirits. TCM has been used for more than three thousand years by about one-fourth of the world's population, and in the United States it has been embraced by naturopathic physicians, chiropractors, and other CAM practitioners.

One diagnostic technique that is noticeably different from Western medicine is the TCM approach to taking pulses. TCM practitioners take pulses at six different locations, including three points on each wrist, and pulses are described using twenty-eight distinct qualities. Reading the pulses enables practitioners to evaluate qi.

TCM views balancing qi as central to health, wellness, and disease prevention and treatment. TCM also seeks to balance the feminine and masculine qualities of yin and yang using other techniques such as "moxibustion"—stimulating acupuncture points with heat—and "cupping"—increasing circulation by putting a heated jar on the skin of a body part.

Herbal medicine is the most commonly prescribed treatment; herbal preparations may be consumed as teas made from boiled fresh herbs or dried powders or in combined formulations known as patent medicines. More than two hundred herbal preparations are used in TCM, and several, such as ginseng, ma huang, and ginger, have become popular in the United States. Ginseng is supposed to improve immunity and prevent illness; ma huang is a stimulant used to promote weight loss and relieve lung congestion; and ginger is prescribed to aid digestion, relieve nausea, reduce osteoarthritic knee pain, and improve circulation.

Many modern pharmaceutical drugs are derived from TCM herbal medicines. For example, ma huang components are used to make ephedrine and pseudoephedrine. GBE, made from ginkgo biloba, is used to treat cerebral insufficiency (lack of blood flow to the brain). During 2000, ginkgo biloba was shown to improve memory and slow the progression of dementia in some patients.

MIND-BODY INTERVENTIONS

Mind-body interventions are practices based on the belief that mind, body, and spirit are connected with one another and environmental influences. Mind-body medicine aims to improve physical, mental, and emotional well-being. According to Dr. Pelletier, the other guiding principles of mind-body medicine are as follows:

• Stress and depression contribute to the development of, and hinder recovery from, chronic diseases because they create measurable hormonal imbalances.
• Psychoneuroimmunology explains how mental functioning provokes physical and biochemical changes that weaken immunity, lowering resistance to disease.
• Overall health improves when people are optimistic and have positive outlooks on life. Health and wellness are harmed by anger, depression, and chronic stress.
• The placebo effect—improved health and favorable physical changes in response to inactive medication such as a sugar pill—confirms the importance of mind–body medicine and is a valuable intervention.
• Social support from family, friends, coworkers, classmates, or organized self-help groups boosts the effectiveness of traditional and CAM therapies.

This section looks at three types of mind-body interventions—meditation; the Alexander Technique, a movement therapy; and biofeedback. Other commonly used mind-body interventions include music and dance therapies, cognitive–behavioral therapy, hypnosis, guided imagery and visualization, and a Chinese exercise discipline called Tai Chi Chuan.

Meditation

Historically, meditation has been used in religious training and practices and to enhance spiritual growth, but it also is a powerful self-care measure that may be used to relieve stress and promote relaxation. Transcendental meditation, an Indian practice that involves sitting and silently chanting a "mantra" (a word repeated to quiet the mind), aims to produce a healthy state of relaxation.

During the 1960s, Dr. Herbert Benson studied meditation, and he and his colleagues at Harvard University Medical School showed that people who meditate could reduce heart and respiration rates, lower blood levels of the hormone cortisol, and increase alpha waves in the brain. Dr. Benson developed a relaxation technique loosely based on transcendental meditation that he dubbed the "relaxation response," and this technique quickly gained recognition in the United States and Europe.

There have been many studies performed to evaluate the physical responses to meditation, and its benefits are universally accepted in the CAM and conventional medical communities. Examples of the favorable effects of meditation include the following:

• Reduced blood pressure—meditation consistently has demonstrated the ability to lower systolic and diastolic blood pressure readings (both the top and bottom numbers of a blood pressure measurement)
• Reduced stress, anxiety, and pain
• Reduced use of health care services—patients enrolled in meditation programs tend to make fewer visits to health care practitioners
• Improved circulation and ability to exercise—studies of patients with coronary artery disease found that after 8 months of meditation, circulation and exercise tolerance increased

The Alexander Technique

The Alexander Technique is hands-on teaching to retrain the mind and body to stand, sit, lift, and move correctly. It is not an exercise program, nor is it traditional touch therapy. During lessons intended to improve posture, body mechanics, and alignment, the teacher's hands gently direct movements that are light, organic, and fluid.

Lessons involve practice performing everyday activities such as sitting at a keyboard, carrying groceries, lifting a child, and reaching the top shelf of a bookcase; they aim to change the way people think about moving. By avoiding habitual muscle tightening and poor posture, injuries may be prevented or allowed to heal. Mindful movement, correct breathing, balance, and poise result from training in the Alexander Technique.

Although the Alexander Technique encourages students to let go of unhealthy habits, the objective is release rather than relaxation. The body that has mastered the Alexander Technique is at once flexible, easy, flowing, and energized. The process of giving up old habits is gradual and respectful. It involves acknowledging and accepting responsibility for misuses and bad habits before attempting to change them.

PERFORMERS USE THE TECHNIQUE.

Although the Alexander Technique often is used as a form of treatment, its true strength lies in prevention. It is simpler to learn to move calmly and correctly than to unlearn years of bad habits. Nearly anyone can benefit from the Alexander Technique, but historically it has been favored by people who rely on physical agility and ability to perform work—actors, athletes, dancers, dentists, hairdressers, musicians, computer users, etc.

Taught at the Juilliard School of Performing Arts in New York and the Royal Academy of Dramatic Arts in London, the Alexander Technique has attracted a celebrity following. Musicians Yehudi Menuhin, James Galway, Paul McCartney, and Sting, along with actors Julie Andrews, John Cleese, James Earl Jones, John Houseman, William Hurt, Kevin Kline, Ben Kingsley, Paul Newman, Keanu Reeves, Patrick Stewart, and Joanne Woodward have publicly endorsed the Alexander Technique.

The popularity of the Alexander Technique in the entertainment industry may be because its founder, Frederick Matthias Alexander, was an actor in Australia at the end of the nineteenth century. Alexander began his career performing works by William Shakespeare, but he began to suffer from chronic laryngitis. After hours of self-observation, he determined that his problem was caused by muscular tension in his neck. He was his own first patient, successfully releasing the tension in his neck by changing the way he thought about his breathing, movements, and actions.

Frederick Alexander attributed some chronic health problems to accelerated technologic and societal changes. He believed that the pace and stress of modern life, especially mindless rushing to the market or toward a career objective, can render people virtually unconscious and unaware of their bodies. The adage he coined, "use affects functioning," affirms that the way people use their bodies affects their health and well-being. He also decried "endgaining"—rushing toward a goal without any attention to the manner of achieving it.

Biofeedback

Biofeedback training is designed to help people learn to regulate body functions such as heart rate and blood pressure. Generally, sensitive monitoring devices are attached to the individual to measure and record a variety of physical responses such as skin temperature and electrical resistance, brain-wave activity, and respiration rate. There are also devices to monitor other functions such as bladder activity and acid in the stomach. By observing their own responses and following instructions given by highly trained technicians, most people are able to exert some degree of conscious control over these body functions.

Biofeedback is especially effective for helping people learn to manage stress, and it has become mainstream medical treatment for conditions such as high blood pressure, asthma, migraine headaches, and some types of urinary and fecal incontinence (inability to control bladder or bowel functions). Although it has been used only for about thirty years, biofeedback therapy has been applied to more than 150 medical conditions.

BIOLOGICALLY BASED THERAPIES

The principal treatments in this category are herbal medicines and remedies, dietary supplements, and the use of hormones to combat disease and improve health. Because herbal medicines are used in a variety of other CAM practices, such as homeopathy, naturopathy, Ayurveda, and traditional Chinese medicine, this section will describe two greatly contested biologically based therapies—dietary supplements and the use of hormones.

Dietary Supplements

Most CAM practitioners and many conventional medical practitioners agree that food sources are the best way to obtain nutrients. They do, however, allow that it is impossible for some people to get all the nutrients they need, or sufficient quantities of specific vitamins or minerals, from their daily diets. For example, many researchers and nutritionists feel that the diets of the majority of Americans do not contain enough chromium and most women do not consume adequate amounts of iron. Further, the CAM principle of treating each patient as an individual with unique physiologic and biochemical needs suggests that some individuals may need more of specific nutrients than others.

Advocates of dietary supplements feel that the recommended dietary allowances (RDAs) are too low for some vitamins and minerals, and they observe that it is difficult to obtain higher than the RDA of certain vitamins without also consuming an excess of fat and calories. An example of this dilemma is vitamin E, an antioxidant found in high-fat vegetable and seed oils. In The Best Alternative Medicine Dr. Pelletier points out that for men to get the RDA (fifteen IU) of vitamin E, they would have to eat "248 slices of whole wheat bread, 16 dozen eggs, or 20 pounds of bacon." Several studies suggest that far higher doses—twenty to thirty times greater than the RDA—may protect against heart disease or some cancers, but to obtain such doses from diet alone is impossible.

Whether to prescribe diets supplemented with vitamin E is one of many questions about this particular issue. Another concern is the form of vitamin E available—supplements contain only alpha tocopherol instead of the variety of tocopherols available in foods. Is it better to take higher doses of one form of vitamin E at the risk of losing other perhaps equally valuable forms of vitamin E? Critics of dietary supplements use this question to support their view that people should attempt to obtain as many needed nutrients from food sources as possible, without relying on dietary supplements. Further, there is no consensus about dosages higher than the RDA, although it is known that some vitamins and minerals, such as vitamins A and E and chromium, are toxic in high doses. For example, more than four hundred IU of vitamin E taken daily may increase the risk of stroke, and high doses of vitamin E are generally not advised for people taking medications to reduce blood clotting, such as Coumadin.

Unlike drugs, dietary supplements do not need to be approved by the Federal Drug Administration (FDA) and therefore go to market with far less testing and scrutiny. This has caused debate and may lead to the ultimate FDA banning of certain supplements, as in the case of the herb ephedra, a dietary supplement used for weight loss that was taken off the market in 2004 after it was linked to 155 deaths and dozens of heart attacks and strokes.

The Hormone Debate

Our bodies would not function without hormones—they keep our bodies working as they should. They help regulate body temperature, blood pressure, and blood sugar levels. In childhood, they help us "grow up," and in the teen years, they stimulate puberty. As we age, some hormones increase (such as parathyroid hormone, which helps regulate the amount of calcium in our blood and bones), and others decrease (such as estrogen in women and testosterone in men). Some diseases cause our bodies to produce fewer hormones, in which case they may need to be supplemented. Conventional medical practice does not recommend taking additional hormones unless an individual has a documented deficiency of a necessary hormone, such as thyroid hormone deficiency.

Although there are many advertisements and products claiming that taking certain hormones can help prevent effects of aging, this has not been proved and may be harmful. It is now understood that unsupervised, off-label (use for purposes other than those approved by the U.S. Food and Drug Administration), or even physician-prescribed use of hormones may be dangerous. In fact, in July 2002, a Women's Health Initiative (WHI) study conducted by the U.S. National Institutes of Health (NIH) concluded that the risks associated with hormone replacement therapy (HRT), which included the hormones estrogen and progestin and was routinely prescribed for postmenopausal women (those who no longer ovulate or have menstrual periods) to prevent osteoporosis and heart disease, were found to be greater than the benefits. Though there were some benefits of estrogen plus progestin, including fewer cases of hip fractures and colon cancer, in healthy menopausal women HRT was no longer recommended due to an increased risk of invasive breast cancer. According to the NIH, the trial also found increases in coronary heart disease, stroke, and pulmonary embolism. The study was scheduled to run until 2005, but was stopped after an average follow-up of 5.2 years. Most physicians and other health care practitioners advised patients to stop taking HRT.

In March 2004 the NIH halted the estrogen-only portion of the WHI study because it found that after seven years of follow-up, estrogen alone does not appear to affect the risk of heart disease, yet it does appear to increase the risk of stroke. The researchers announced that one more year of study, as had been planned, likely would not change the results, and they had enough data to assess the overall risks and benefits of the use of estrogen; thus they stopped the study so as not to increase the risk of stroke in otherwise-healthy women. The increased risk of stroke in the estrogen-alone study is similar to what was found in the WHI study of estrogen plus progestin when that trial was stopped two years earlier. On the positive side, estrogen-only therapy has not increased the risk of breast cancer during the time period of the study, and it has been found to decrease the risk of hip fracture.

DOES DHEA SLOW OR REVERSE AGING?

Dehydroepiandrosterone (DHEA) is the most plentiful steroid hormone in the body. It is produced in the adrenal glands, brain, and skin; in the body it is converted into other hormones such as estrogen and testosterone (the primary female and male sex hormones, respectively) and other steroid hormones. DHEA levels may be measured using a blood test. The amount of DHEA in the body starts to decline gradually at about age thirty years; it is also reduced during periods of illness. Laboratory research (as opposed to research conducted on human subjects) reveals that low DHEA levels are linked to heart disease and certain cancers.

In view of these findings, some CAM practitioners favor supplementing DHEA for people who no longer have peak levels of the hormone. They claim that studies support the findings that DHEA replacement increases physical stamina, muscle mass, immune functions, and emotional well-being while simultaneously promoting weight loss and reducing bone loss from osteoporosis. Skeptics cite other studies showing that taking DHEA may cause excessive, unwanted hair growth; a reduction in high-density lipoprotein (HDL), the lipid that protects against heart disease; and resistance to insulin, the hormone involved in glucose metabolism. They caution that replacing any hormone that normally declines with advancing age is perilous, especially because some cancers, such as breast and prostate cancers, thrive in the presence of hormones.

MANIPULATIVE AND BODY-BASED METHODS

Manipulative therapies, such as osteopathic manipulation and chiropractic, and body-based methods (also known as bodywork), such as therapeutic massage, are CAM practices that have been tremendously popular during the last two decades. Some observers feel that enthusiasm for these CAM practices is because of their demonstrated ability to relieve aches and pains associated with musculoskeletal injuries and stress more effectively than treatment prescribed by conventional medical practitioners. This section describes chiropractic, a relatively well-known manipulative therapy, and zero balancing, a lesser-known gentle form of bodywork.

Chiropractic

The American Chiropractic Association (ACA) defines chiropractic as "a branch of the healing arts which is concerned with human health and disease processes. Doctors of Chiropractic are physicians who consider man as an integrated being and give special attention to the physiological and biochemical aspects including structural, spinal, musculoskeletal, neurological, vascular, nutritional, emotional, and environmental relationships." Doctors of chiropractic (also known as chiropractors or DCs) do not use or prescribe pharmaceutical drugs or perform surgery. Instead they rely on adjustment and manipulation of the musculoskeletal system, particularly the spinal column.

Many chiropractors use nutritional therapy and prescribe dietary supplements, and some use a technique known as applied kinesiology to diagnose and treat disease. Applied kinesiology is based on the belief that every organ problem is associated with weakness of a specific muscle. Chiropractors who use this technique claim they can accurately identify organ system dysfunction without any laboratory or other diagnostic tests.

In addition to manipulation, chiropractors also use a variety of other therapies to support healing and relax muscles before they make manual adjustments. These treatments include the following:

• Heat and cold therapy to relieve pain, speed healing, and reduce swelling
• Hydrotherapy to relax muscles and stimulate blood circulation
• Immobilization such as casts, wraps, traction, and splints to protect injured areas
• Electrotherapy to deliver deep-tissue massage and boost circulation
• Ultrasound to relieve muscle spasms and reduce swelling

According to the ACA, chiropractic is the third-largest specialty group of health care professionals after medicine and dentistry. The ACA predicts that there will be nearly twice as many practicing doctors of chiropractic by 2010 as there were in 1997, when approximately thirty million patients sought care from slightly more than fifty thousand chiropractors. Visits to chiropractors are most often for treatment of low back pain, neck pain, and headaches. The U.S. Agency for Healthcare Research and Quality reports that chiropractors are seen for low back pain one-third more often than are primary care physicians. In fact, after one hundred years of practice, chiropractic often is referred to as "mainstream medicine," and many health insurance companies will cover their care.

Critics of chiropractic are concerned about injuries resulting from powerful manual adjustments, and some physicians question chiropractors' abilities to establish medical diagnoses. Others worry that people seeking chiropractic care instead of traditional allopathic medical care may be foregoing lifesaving diagnoses and treatment.

Zero Balancing

Zero balancing (ZB) is diagnostic and therapeutic bodywork that traces and aligns energy in the skeletal system. Grounded in anatomy, physics, mechanics, and psychology, ZB integrates Eastern philosophy, meditation, and the realignment of vibratory energy fields with practical, hands-on bodywork. Along with relief of physical stress, pain, and dysfunction, ZB aims to enhance emotional equilibrium, concentration, and objectivity.

Developed more than twenty years ago by Frederick (Fritz) Smith, an osteopathic physician, this treatment modality was the culmination of studies Smith completed to earn his master of acupuncture certification. ZB practitioners touch bones to facilitate the flow of skeletal energy (called chi) through three vertical pathways. In the first pathway, energy flows from the skull to spine, pelvis, legs, and feet. In the second pathway, energy flows from the shoulders and vertebral transverse processes to rejoin the central flow at the pelvis. The third pathway travels from the shoulders out through the arms and hands.

Working directly with energy they feel is located in the bones, the densest structures in the body, practitioners assess, balance, and reassess energy flow. Performed on fully clothed people, ZB is relaxing as joints and fulcrums—meeting points of energy and structure—of the musculoskeletal system are gently palpated (touched). Gentle pressure, manipulation, and support of the joints are applied to release tension and ease movement and energy flow. ZB practitioners attend closely to observe responses to treatment. During a ZB session, subjects are said to enter a "working state" with observable signs that energy is shifting, balancing, reorganizing, or integrating. These signs may include a trance state, rapid eyelid fluttering, shallow breathing, bowel sounds, swallowing, and involuntary muscle movements.

Who Practices Zero Balancing?

Practitioners from a variety of disciplines, including traditional allopathic and osteopathic medicine, psychotherapy, chiropractic, acupuncture, massage, and physical therapy, use ZB to locate, isolate, and relieve stress patterns, sources of physical pain, and skeletal imbalance. Many practitioners use ZB in combination with other forms of therapy. Performed before a massage, physical therapy session, or other healing therapy, it relaxes subjects, enabling them to make greater progress in treatment. Used following treatment, it helps to sustain and prolong the benefits of chiropractic, acupuncture, physical, or massage therapy.

ENERGY THERAPIES

Energy therapies that purport to influence energy fields in and around the body are among the CAM practices that arouse the most suspicion from the conventional medical community. Some skeptics attribute the health benefits reported by patients who have received energy therapies to the placebo effect (a perceived beneficial result that occurs from the therapy because of the patient's expectation that the therapy will help). Despite widespread lack of understanding and acceptance from traditional health care practitioners, some hospitals and pioneering practitioners are incorporating energy therapies into their treatment programs.

Reiki

An ancient Japanese technique, Reiki is bioenergetic healing intended to restore physical, emotional, mental, and spiritual balance. The unique therapy takes its name from two Japanese words. Rei means higher power, wisdom, and all that exists, and ki is energy—the life force that emanates from rei.

Based on the teachings of Dr. Makao Usui (1865–1926), Reiki is a universal healing vibration that flows from practitioner to client. The practitioner acts as a channel for Reiki energy, and as it passes through practitioners, it acts to strengthen and harmonize them simultaneously as it heals their clients.

There are more than a dozen styles of Reiki, each with its own subtle variations. Students studying with Usui Reiki masters receive a series of "attunements" and may progress through three levels or degrees of training. Level I connects the practitioner to the Reiki channel and initiates the flow of healing energy. Level II teaches distance or remote healing. Level III initiates the practitioner to the role of master and teacher.

Some practitioners use a variety of other therapies, including meditation, prayer, chanting, breathing, and movement education. Most often performed as hands-on body-work, Reiki is believed by its therapists to convey energy to calm nerves, relax muscles, and ease pain without any physical touch. During the second level of training, practitioners learn to deliver Reiki energy remotely, over long distances.

COMPLEMENTING TRADITIONAL MEDICINE.

Increasingly, clinics and hospitals across the United States offer Reiki to women in labor, surgical patients, and those suffering from pain, anxiety, sleep disorders, headaches, asthma, and eating disorders. The Tucson Medical Center in Arizona has been the home of a Reiki clinic since 1995. Initially, the clinic focused exclusively on cancer patients. By 1999 it offered Reiki to patients throughout the hospital.

In conventional medical settings, Reiki usually is presented as "a technique to reduce stress and promote relaxation, thereby enhancing the body's natural ability to heal itself." To gain credibility with traditional physicians and other mainstream professionals, Reiki therapists often downplay the spiritual benefits of the practice and judiciously avoid mentioning other CAM practices.

Although its effectiveness has not been documented in scientific studies, Reiki has gained acceptance because it is viewed as a complement, rather than an alternative, to traditional Western medicine. Considered safe by many health care practitioners, it is well-received by patients who seem to respond favorably to the time and attention, as well as the healing energy, offered by Reiki therapists.

WHITE HOUSE COMMISSION ON COMPLEMENTARY AND ALTERNATIVE MEDICINE POLICY

In March 2000 an executive order established the White House Commission on Complementary and Alternative Medicine Policy (WHCCAMP) to study and prepare a report and recommendations about public policy measures governing CAM. U.S. President Bill Clinton appointed twenty people representing traditional and CAM interests to serve on WHCCAMP. The commission heard testimony from clinicians, researchers, medical educators, health insurance company and managed care plan representatives, and regulators to learn about CAM use, practices, and integration in traditional health care settings.

In March 2002 WHCCAMP issued its final report, which included the following ten guiding principles:

• Quality health care should support and address the whole person with attention to mind, body, spirit, and environment.
• WHCCAMP endorses the use of rigorous scientific methods to evaluate the safety and efficacy of CAM practices and products.
• Health care should support individuals' innate abilities for self-healing.
• All people are entitled to responsive, personalized health care that is consistent with preferences and respects their individuality.
• Health care consumers must be free to choose from an assortment of safe, effective treatments and a variety of qualified, accountable health care practitioners.
• Quality health care emphasizes prevention, health promotion, and self-care programs.
• Patients, practitioners, and researchers must work together to create quality health care delivery and respect the diversity of all health care traditions.
• Health care professionals and consumers should be taught about prevention, healthy lifestyles, and self-healing.
• Evidence-based recommendations about CAM products and services must be effectively communicated in a timely manner.
• Informed consumers and other stakeholders in the community must be involved in the process of establishing priorities for health care research and policy.

Alternative Medicine

Naturopathy

Lifestyle changes

Relaxation

Chiropractic medicine

Acupuncture

Homeopathy

Resources

Alternative medicine is defined as the medical and therapeutic techniques, practices, and beliefs that are generally not accepted by most mainstream Western health care practitioners and organizations. The National Institutes of Health classifies alternative medicine as an unrelated group of non-orthodox therapeutic practices, often with explanatory systems that do not follow conventional biomedical explanations or more seriously, based on pseudoscience. Overall, it covers a broad range of philosophies, approaches, and therapies for healing. It is usually defined as treatments and practices outside of traditional Western medicine that are not taught widely in medical schools, not used in hospitals, and not usually reimbursed by insurance companies. Alternative medicine is used to treat conditions ranging from colds to skin cancer.

Alternative medicine considers health a balancing of mind, body, and spirit. This holistic approach takes into consideration the whole person including his or her physical, mental, emotional, and spiritual aspects. Many alternative practices are designed to prevent health problems rather than attempting to treat symptoms later. Some alternative medicine approaches are consistent with Western medical principals and some are not. Some are far outside of accepted Western medical practice and theory, while others are becoming part of mainstream medicine.

Alternative therapies include, but are not limited to the following disciplines: folk medicine, herbal medicine, diet fads, homeopathy, faith healing, new age healing, chiropractic, acupuncture, naturopathy, massage, and music therapy. Studies suggest these therapies are sought out by individuals who suffer a variety of medical problems. In general, alternative medical practice that fits three criteria: it is not taught in the standard medical school curriculum; there is not sufficient scientific evidence that the treatment is safe and effective against a specific disease; and insurance companies do not reimburse the patient for its cost.

Such descriptions could include nearly all unproven but ineffective practices that offer little in benefit but draw billions of health care dollars from desperate patients. The use of laetrile (a derivative of apricot pits) to treat cancer and chelation therapy to remove cholesterol deposits from severely affected arteries are cases in point. Both are highly touted by their practitioners, both have been tested under rigid scientific research standards, and both have been found ineffective and useless. The primary harm of such treatments lies in the fact that patients who utilize them often do not seek more effective, mainstream medical care.

The first known example of alternative medicine in the United States was the introduction and patenting in 1797 of a ‘mechanical tractor’ to pull bad electricity, alleged to be the source of all illnesses, from the body. A chief justice of the Supreme Court, several members of Congress, and retired president George Washington, all used this device.

Although some alternative medical practices are clearly ineffective and sometimes dangerous, others have achieved a degree of acceptability in the eyes of organized medicine. Among these are naturopathy, yoga, biofeedback, hypnotism, acupuncture, chiropractic medicine, homeopathy, and relaxation techniques.

Worldwide, only about 10 to 30% of all health care is delivered by conventional medical practitioners. The remainder use alternative medicine. According to the World Health Organization, interest in traditional and alternative systems of medicine has grown in many developed countries during the last decade of the twentieth century and into the twenty-first century. One-third of American adults have used an alternative treatment. As Americans take more control over their own health care, and seek to avoid drugs and surgery, or supplement conventional medical treatments, interest continues to grow. Disenchantment with the cost, complexity, and perceived limitations of modern medicine has also contributed to the rise of alternative medicine. Medical doctors are also becoming more interested in alternative medicine and some have incorporated alternative therapies into their practices. Health insurance companies are now beginning to cover some alternative methods.

With its growing popularity among consumers and professionals worldwide, alternative medicine is becoming less “alternative” with each passing year. In the 1990s, an increasing number of medical schools began offering courses in alternative medicine, and some hospitals began creating departments of alternative medicine. According to a report published in the New England Journal of Medicine in 1993, the estimated number of annual visits to providers of alternative medicine (425 million) in the United States in 1990 exceeded the number of visits to all primary care physicians (388 million). From 1990 to 2005, the number of visits to providers of alternative medicine continued to grow faster than visits to primary care physicians. This trend is expected to continue in the near future.

Naturopathy

The practitioner of naturopathic medicine considers the person as a whole, treats symptoms such as fever as a natural manifestation of the body’s defense mechanism that should not be interrupted, and works to heal disease by altering the patient’s diet, lifestyle, or work habits. The basis of naturopathy can be traced back through Native American practices, to India, China, and ancient Greece.

In naturopathy, the body’s power to heal is acknowledged to be a powerful process that the practitioner should enhance using natural remedies. Fever, inflammation, and other symptoms are not the underlying cause of disease, but are reflections of the body’s attempt to rid itself of the underlying cause. The disease itself originates from spiritual, physical, or emotional roots, and the cause must be identified in order that effective therapy may be applied. The patient is viewed holistically and not as a collection of symptoms; the cure is gauged to be safe and not harmful to the patient. The practitioner is a teacher who is trained to recognize the underlying problems and teach the patient to adopt a healthier lifestyle, diet, or attitude to forestall disease. The naturopathic practitioner is a specialist in preventive medicine who believes prevention can best be achieved by teaching patients to live in ways that maintain good health.

In addition to advising the patient on lifestyle changes to prevent disease, the naturopathic practitioner may also call upon acupuncture, homeopathy, physical therapy, and other means to strengthen the patient’s ability to fight disease. Herbal preparations as well as vitamin and mineral supplements may be used to strengthen weakened immune systems. Stressful situations must be eased so that the digestive system can function properly, and any spiritual disharmony is identified and corrected.

Naturopaths are trained in herbal medicine, clinical dietetics, hydrotherapy, acupuncture, and other noninvasive means to treat disease. They provide therapy for chronic as well as acute conditions, and may work beside physicians to help patients recover from major surgery. The naturopath does only minor surgery and depends upon natural remedies for the bulk of patient therapy. Naturopathy is not widely accepted by physicians, although some practitioners are also doctors of medicine (M.D.).

Lifestyle changes

Lifestyle changes can be as simple as getting more exercise or as complex as completely redesigning the diet. Exercise in moderation is a preventive measure against heart disease, stroke, and other serious conditions. It is only when such exercise programs become excessive or all consuming that they may be harmful. Some people use very high daily doses of vitamins in an attempt to forestall the aging process or to assist the body in ridding itself of cancer or HIV (human immunodeficiency virus). Huge dosages (what is called megadoses) of vitamins have not been proven effective for these purposes. Vitamins play a specific role in the metabolism and excess vitamins simply are stored in the fat or are eliminated from the body through the kidneys.

Changes to achieve a more balanced intake of nutrients or to reduce the amount of fat in the diet are beneficial, but dietary programs that add herbal supplements to the diet may be ineffective or even harmful. Chinese and Far Eastern cultures use herbal therapy to achieve weight loss, delay aging, or increase strength. Dietary supplements of Chinese herbs have become increasingly popular among Westerners, although most Americans do not know specifically what herbs they are consuming. Laboratory tests have raised questions about the effectiveness of many of these herbs; some may have high lead content and therefore are potentially toxic.

Relaxation

Many practices are included under the general term of relaxation. Relaxation techniques are generally accepted as beneficial to individuals who are otherwise unable to sleep, in pain, under ongoing job-related stress, or recovering from surgery. Various relaxation techniques frequently are used in hospitals to help patients deal with pain or to help them sleep.

In the simplest form of relaxation therapy, the individual is taught to lie quietly and to consciously relax each part of the body. Beginning with the feet and progressing through the ankles, calves, thighs, abdomen, and so forth up to the neck and forehead, each part of the body is told to relax and the individual focuses his thoughts on the body part that is being told to relax. It is possible to feel the muscles of the leg or the arm relaxing under this focused attention.

The ancient practice of yoga is also considered a relaxation technique. The practice of assuming a specified position (the lotus position, for example), clearing the mind of the sources of stress, and concentrating on one’s inner being for a short time can be beneficial. Following a yoga session, the individual often is less stressed and can order his thoughts in a more organized manner. Transcendental meditation is a variation of yoga that consists of assuming specific body positions and chanting a mantra, a word or two that is repeated and serves to concentrate the mind. This practice is claimed to clear the mind of stressful thoughts and anxiety, and enables the practitioner to reorder his priorities in a more relaxed manner.

Yet another variation on relaxation came into widespread use in the late 1960s. Biofeedback became a popular practice that initiated an industry devoted to manufacturing the devices needed to practice it effectively. Biofeedback is a process by which an individual consciously controls certain physiologic processes. These can be processes that normally are subject to thought control, such as muscle tension, or those that are not, such as heart rate. To effect such control, the person is connected to a gauge or signal device that changes tone with changes in the organ being controlled. This visual or auditory signal provides evidence of the effectiveness of the person’s effort. The heart rate can be monitored by the scale of a tone or a blip on a small screen. The tone lowers in pitch or the blip appears with decreasing frequency as the heart rate slows. The goal is for the individual to learn to influence the signal in front of him and, having acquired this proficiency, to be able to accomplish the same physiologic changes without the visual or auditory signal. Biofeedback has been used successfully to reduce stress, eliminate headaches, control asthma attacks, and relieve pain.

Hypnotism, despite its use for entertainment purposes, also has a place in medical practice. Hypnotism was first introduced to the medical community in the late eighteenth century by German physician Franz Anton Mesmer (1734–1815), and was first called mesmerism. Mesmerism fell out of favor in France when a scientific committee failed to verify Mesmer’s claims for the practice. The name was later changed to hypnotism (from the Greek word hypnos for sleep) by James Braid (1795–1860), an English ophthalmologist. Although technically hypnotism is not sleep, the name stuck.

Austrian physiologist, medical doctor, psychologist Sigmund Freud (1856–1939) adopted hypnotism into his practice in the nineteenth century. Early in his use of the practice he praised its benefits, writing two scientific papers on hypnotism and employing it to treat his patients. By the early 1890s, however, Freud abandoned hypnotism in favor of his own methods of analysis. It was not until the 1950s that the British and American medical societies approved the use of hypnosis as an adjunct to pain treatment. In clinical use, hypnotism is called hypnotherapy, and it is used to treat both physical and psychological disorders. The patient is placed in a trance-like state so that the physician may delve into the deepest levels of the mind to relieve such conditions as migraine headaches, muscle aches, chronic headaches, and postoperative pain. This trance-like condition can be induced by the practitioner or by the patient. It is achieved by first relaxing the body and then by concentrating the patient’s attention on a single object or idea, shifting his thoughts away from the immediate environment. In the lightest form of hypnosis, the superficial level, the patient may accept suggestions but will not always take steps to carry them out. Therapists try to reach the deeper state of hypnosis, the somnambulistic stage, in which the patient is readily susceptible to suggestion and carries out instructions while hypnotized as well as after he has come out of the trance (post-hypnotic suggestion).

While in the trance the patient can be induced to ignore pain, to fully relax, or to carry out other beneficial suggestions by the therapist. Also the therapist may suggest that the patient can hypnotize himself when he/she needs relief from pain or needs to blunt his appetite. The patient is given a simple ritual to follow including specific words to say to place himself/herself in a hypnotic trance. The patient will then convince himself/herself that the pain has been relieved or that he/she has eaten a sufficient amount. Upon recovering to a normal level of consciousness the patient will find that the pain is less or that he/she has no need for additional food.

Unlike portrayals of hypnotists in films, a therapist cannot hypnotize anyone who does not want to be hypnotized. It is essential that the patient and therapist have a close rapport; along with the patient fully believing that the practice will be of benefit to him and the surroundings being devoid of any distracting stimuli. Even when in a trance, the patient will not carry out any act he/she would find morally unacceptable in the waking state. The hypnotist cannot place someone in a trance, for example, and direct him/her to steal a car or rob a bank. The subject will awaken with the shock of the suggestion.

Chiropractic medicine

Chiropractic medicine is founded on the hypothesis that many human diseases and disorders stem from deviations or subluxations of the spine, which impinge on the spinal nerves, causing pain or disfunction of the affected organs. Treatment consists of determining which of the vertebrae have shifted and then realigning them properly. This may be accomplished in a single treatment or may require a series of treatments over time.

Chiropractic, derived from the Greek words for ‘practice by the hands,’ was developed by Canadian-born American grocer Daniel David Palmer (1845–1913), in 1895, in Iowa. Palmer believed that the source of illness was the misalignment, or subluxation, of the spinal column in such a way that the vertebrae impinged upon the spinal nerves that passed from the spinal cord, between the vertebrae, to the various organs and muscles of the body. This constriction of the spinal nerve prevented the neural impulses from flowing properly, thus making it impossible for the brain to regulate body functions and leaving tissues susceptible to diseases. Correcting the subluxation would, therefore, restore the neural impulses and strengthen the body.

In 1898, Palmer established the Palmer College of Chiropractic in Davenport, Iowa. In 1910 he published a textbook on chiropractic, which outlined his theories. Since then, the number of chiropractic schools has increased to 16 with a total enrollment of approximately 10, 000. To practice as a doctor of chiropractic (D.C.) an individual must complete the four years of chiropractic school and pass a licensing test. Some states specify that entry into a chiropractic college requires only a high school diploma and others require two years of college prior to entry.

Chiropractors themselves differ in the definition of their specialty—this has led to the formation of two separate professional organizations. The International Chiropractors Association advocates chiropractic therapy limited to spinal manipulation only, while members of the American Chiropractors Association endorse a wider range of therapeutics including physical therapy, diathermy (heating of body tissues with electromagnetic radiation, electric current, and ultrasonic waves), and dietary counseling in addition to the basic spinal manipulation.

Chiropractors do not prescribe medication or perform surgery. Only with great reluctance did the American Medical Association recognize chiropractic as a legitimate specialty. The practice is still approached with skepticism by many in the mainstream medical community because no chiropractic school is recognized by any accrediting body and because the practice itself is based on unsound, unscientific principles. Still, many physicians refer patients with back pain to chiropractors who are more skilled at manipulating misaligned vertebrae.

Acupuncture

Acupuncture is a form of therapy developed by the ancient Chinese and subsequently refined by Chinese practitioners. It consists of inserting needles through the skin in very specific places to alleviate pain, cure disease, or provide anesthesia for surgery. Acupuncture as a palliative is accepted among the medical community. Its use as a cure for serious disease or for anesthesia is not endorsed by many physicians.

For the practitioner of acupuncture, the human body is a collection of thousands of acupuncture points that lie along specific lines or meridians. Twelve

KEY TERMS

Acupuncture— A form of therapy developed by the ancient Chinese in which needles are inserted through the skin in very specific places to alleviate pain, cure disease, or provide anesthesia for surgery.

Chiropractic— The theory that many human diseases and disorders stem from deviations or subluxations of the spine, which impinge on the spinal nerves, causing pain or disfunction of the affected organs.

Homeopathy— A system in which diluted plant, mineral, or animal substances are given to stimulate the body’s natural healing powers. Homeopathy is based upon three principles: the law of similars, the law of infinitesimal dose, and the holistic medical model.

Hypnotherapy— The clinical use of hypnotism to treat both physical and psychological disorders, whereby the patient is placed in a trance-like state by the practitioner or by the patient and the patient’s attention focuses on a single object or idea in order to relax.

Naturopathy— Form of alternative medicine that focuses on the patient holistically and views symptoms such as fever as a natural manifestation of the body’s defense mechanism that should not be interrupted. Patients are taught to adopt a healthier lifestyle, diet, or attitude to forestall disease development.

pairs of meridians are plotted on the body, one of each pair on each side. An additional meridian, the Conception Vessel, courses along the midline of the front of the body and another, the Governor Vessel, along the spine. The meridians are connected by extra-meridians. Additional acupuncture points lie outside the meridians on areas such as the ear lobes, fingers, toes, and so forth.

Each meridian is a course for the perceived flow of energy through the body and that flow may be connected to an organ removed from the actual location of the meridian. Needles are inserted at points along the meridian that are specific for a given organ. For example, although the liver lies in the right side of the abdomen, the acupuncture points for liver disease may include areas on the opposite side of the body as well as one of the earlobes.

Acupuncture therapy consists of first locating the source of pain, then deciding upon the appropriate meridian and acupuncture points. Needles used in acupuncture may be short, for use in less-fleshy areas, or long for use in areas with copious flesh or muscle. The needle is simply inserted into the proper acupuncture point and rotated. The needles are left in place for a given time and rotated periodically while they are in place. Some patients find dramatic relief from pain with acupuncture and a number of physicians have incorporated the procedure into their practices.

In the Far East, acupuncture is a recognized form of therapy, and it is combined with herbal medicine, diet restrictions, and exercise. Not only is it used for pain relief, but it is also used frequently as anesthesia during surgery and for the treatment of serious diseases such as cancer. No scientific proof has been offered that it is effective against serious diseases, though its anesthetic and analgesic properties have been demonstrated.

Homeopathy

Homeopathy is a term derived from the Greek words meaning ‘similar suffering.’ It is a system in which diluted plant, mineral, or animal substances are given to stimulate the body’s natural healing powers. Homeopathy was developed in the late eighteenth century by Samuel Hahnemann (17551–1843), a German physician. Hahnemann conducted experiments to improve standard therapy, which then consisted of bloodletting and administering purgatives made with mercury, which were highly toxic. In one of his experiments he ingested an extract of cinchona, the bark from a Peruvian tree used by the natives to treat malaria. Hahnemann consumed large doses of the bark and developed the symptoms of malaria. From this he concluded that if large doses resulted in symptoms of the disease, small doses should stimulate the body’s own disease-fighting mechanism.

Homeopathy is based upon three principles formulated by Hahnemann. The first is the law of similars, stating that like cures like. The second is the law of infinitesimal dose, stating that the potency of a remedy is a reflection of how much it is diluted. Third is the holistic medical model, stating that any illness is specific to the individual who has it.

The law of similars is seen in more traditional medical practice in the use of immunizations. Inoculations of attenuated or dead viruses or bacteria are given to stimulate the production of antibodies to resist a full-scale invasion of the same virus or bacterium. Thus, immunizing a child against poliomyelitis consists of administering a solution containing the dead polio virus; this results in the formation of antibodies that are available to repel the living polio virus if the child is exposed to it.

Homeopathy is much more accepted in Europe, Latin America, and India than it is in the United States. It is touted as a low-cost, nontoxic, effective means of delivering medication that can cure even chronic diseases, including those that conventional medications fail to cure. In France, pharmacies are required to stock homeopathic remedies in addition to regular pharmaceutical drugs. Hospital and outpatient clinics specializing in homeopathy are part of the British health care system and the practice of homeopathy is a recognized postgraduate medical specialty.

In the United States homeopathy has only begun to be accepted by the mainstream medical community. Approximately 3, 000 physicians or other health care providers endorse the practice. Though it excites little enthusiasm among practicing physicians in North America, homeopathy is an ongoing specialty, and the production of homeopathic remedies is regulated by the U.S. Food and Drug Administration to assure their purity, and proper labeling and dispensing.

See also Acupressure.

Resources

BOOKS

Foster, Steven. Desk Reference to Nature’s Medicine. Washington, DC: National Geographic Society, 2006.

Goldberg, Burton, John W. Anderson, and Larry Trivieri. Alternative Medicine: The Definitive Guide. 2nd ed. Berkeley, CA: Ten Speed Press, 2002.

Micozzi, Marc S., ed. Fundamentals of Complementary and Integrative Medicine. St. Louis, MO: Saunders Elsevier, 2006.

Pierce, Andrea, and John A. Gans. The American Pharmaceutical Association Practical Guide to Natural Medicines New York: William Morrow & Co., 1999.

Rakel, David, ed., and Charles Dickens. Integrative Medicine Philadelphia, PA: W.B. Saunders, 2002.

Yuan, Chun-Su, Eric J. Bieber, and Brent A. Bauer, eds. Textbook of Complementary and Alternative Medicine. London, UK: Taylor & Francis, 2006.

OTHER

National Institutes of Health. “National Center for Complementary and Alternative Medicine” <http://nccam.nih.gov/> (accessed November 27, 2006).

Larry Blaser

Alternative medicine

National Institutes of Health classifies alternative medicine as an unrelated group of non-orthodox therapeutic practices, often with explanatory systems that do not follow conventional biomedical explanations or more seriously, based on pseudoscience. Others more generally define it as medical interventions not taught at United States medical schools or not available at United States hospitals.

Alternative therapies include, but are not limited to the following disciplines: folk medicine, herbal medicine , diet fads, homeopathy, faith healing, new age healing, chiropractic, acupuncture , naturopathy, massage, and music therapy. Studies suggest these therapies are sought out by individuals who suffer a variety of medical problems. In general, alternative medical practice that fits three criteria: it is not taught in the standard medical school curriculum; there is not sufficient scientific evidence that the treatment is safe and effective against a specific disease ; and insurance companies do not reimburse the patient for its cost.

Such a definition could include nearly all unproven but ineffective practices that offer little in benefit but draw billions of health care dollars from desperate patients. The use of laetrile (a derivative of apricot pits) to treat cancer and chelation therapy to remove cholesterol deposits from severely affected arteries are cases in point. Both are highly touted by their practitioners, both have been tested under rigid scientific research standards, and both have been found ineffective and useless. The primary harm of such treatments lies in the fact that patients who utilize them often do not seek more effective, mainstream medical care.

The first known example of alternative medicine in the United States was the introduction and patenting in 1797 of a "mechanical tractor" to pull bad electricity , alleged to be the source of all illnesses, from the body. A chief justice of the Supreme Court, several members of Congress, and the retired president, George Washington, all used this device.

Although some alternative medical practices are clearly ineffective and sometimes dangerous, others have achieved a degree of acceptability in the eyes of organized medicine. Among these are naturopathy, yoga, biofeedback , hypnotism, acupuncture, chiropractic medicine, homeopathy, and relaxation techniques.

Naturopathy

The practitioner of naturopathic medicine considers the person as a whole, treats symptoms such as fever as a natural manifestation of the body's defense mechanism that should not be interrupted, and works to heal disease by altering the patient's diet, lifestyle, or work habits. The basis of naturopathy can be traced back through Native American practices, to India, China, and ancient Greece.

In naturopathy, the body's power to heal is acknowledged to be a powerful process that the practitioner should enhance using natural remedies. Fever, inflammation , and other symptoms are not the underlying cause of disease, but are reflections of the body's attempt to rid itself of the underlying cause. The disease itself originates from spiritual, physical, or emotional roots, and the cause must be identified in order that effective therapy may be applied. The patient is viewed holistically and not as a collection of symptoms; the cure is gauged to be safe and not harmful to the patient. The practitioner is a teacher who is trained to recognize the underlying problems and teach the patient to adopt a healthier lifestyle, diet, or attitude to forestall disease. The naturopathic practitioner is a specialist in preventive medicine who believes prevention can best be achieved by teaching patients to live in ways that maintain good health.

In addition to advising the patient on lifestyle changes to prevent disease, the naturopathic practitioner may also call upon acupuncture, homeopathy, physical therapy , and other means to strengthen the patient's ability to fight disease. Herbal preparations as well as vitamin and mineral supplements may be used to strengthen weakened immune systems. Stressful situations must be eased so that the digestive system can function properly, and any spiritual disharmony is identified and corrected.

Naturopaths are trained in herbal medicine, clinical dietetics, hydrotherapy, acupuncture, and other noninvasive means to treat disease. They provide therapy for chronic as well as acute conditions, and may work beside physicians to help patients recover from major surgery . The naturopath does only minor surgery and depends upon natural remedies for the bulk of patient therapy. Naturopathy is not widely accepted by physicians, although some practitioners are also doctors of medicine (M.D.).

Lifestyle changes

Lifestyle changes can be as simple as getting more exercise or as complex as completely redesigning the diet. Exercise in moderation is a preventive measure against heart disease, stroke , and other serious conditions. It is only when such exercise programs become excessive or all consuming that they may be harmful. Some people use very high daily doses of vitamins in an attempt to forestall the aging process or to assist the body in ridding itself of cancer or the HIV virus . Megadoses of vitamins have not been proven effective for these purposes. Vitamins play a specific role in the metabolism and excess vitamins simply are stored in the fat or are eliminated from the body through the kidneys.

Changes to achieve a more balanced intake of nutrients or to reduce the amount of fat in the diet are beneficial, but dietary programs that add herbal supplements to the diet may be ineffective or even harmful. Chinese and Far Eastern cultures use herbal therapy to achieve weight loss, delay aging, or increase strength. Dietary supplements of Chinese herbs have become increasingly popular among Westerners, although most Americans do not know specifically what herbs they are consuming. Laboratory tests have raised questions about the effectiveness of many of these herbs; some may have high lead content and therefore are potentially toxic.

Relaxation

Many practices are included under the general term of relaxation. Relaxation techniques are generally accepted as beneficial to individuals who are otherwise unable to sleep , in pain , under ongoing job-related stress , or recovering from surgery. Various relaxation techniques frequently are used in hospitals to help patients deal with pain or to help them sleep.

In the simplest form of relaxation therapy, the individual is taught to lie quietly and to consciously relax each part of the body. Beginning with the feet and progressing through the ankles, calves, thighs, abdomen, and so forth up to the neck and forehead, each part of the body is told to relax and the individual focuses his thoughts on the body part that is being told to relax. It is possible to feel the muscles of the leg or the arm relaxing under this focused attention.

The ancient practice of yoga is also considered a relaxation technique. The practice of assuming a specified position (the lotus position, for example), clearing the mind of the sources of stress, and concentrating on one's inner being for a short time can be beneficial. Following a yoga session, the individual often is less stressed and can order his thoughts in a more organized manner. Transcendental meditation is a variation of yoga that consists of assuming specific body positions and chanting a mantra, a word or two that is repeated and serves to concentrate the mind. This practice is claimed to clear the mind of stressful thoughts and anxiety , and enables the practitioner to reorder his priorities in a more relaxed manner.

Yet another variation on relaxation came into widespread use in the late 1960s. Biofeedback became a popular practice that initiated an industry devoted to manufacturing the devices needed to practice it effectively. Biofeedback is a process by which an individual consciously controls certain physiologic processes. These can be processes that normally are subject to thought control, such as muscle tension, or those that are not, such as heart rate . To effect such control, the person is connected to a gauge or signal device that changes tone with changes in the organ being controlled. This visual or auditory signal provides evidence of the effectiveness of the person's effort. The heart rate can be monitored by the scale of a tone or a blip on a small screen. The tone lowers in pitch or the blip appears with decreasing frequency as the heart rate slows. The goal is for the individual to learn to influence the signal in front of him and, having acquired this proficiency, to be able to accomplish the same physiologic changes without the visual or auditory signal. Biofeedback has been used successfully to reduce stress, eliminate headaches, control asthma attacks, and relieve pain.

Hypnotism, despite its use for entertainment purposes, also has a place in medical practice. Hypnotism was first introduced to the medical community in the late eighteenth century by a German physician, Franz Anton Mesmer (1734–1815), and was first called mesmerism. Mesmerism fell out of favor in France when a scientific committee failed to verify Mesmer's claims for the practice. The name was later changed to hypnotism (from the Greek word hypnos for sleep) by James Braid (1795–1860), an English ophthalmologist. Although technically hypnotism is not sleep, the name stuck.

Sigmund Freud (1856–1939) adopted hypnotism into his practice in the nineteenth century. Early in his use of the practice he praised its benefits, writing two scientific papers on hypnotism and employing it to treat his patients. By the early 1890s, however, Freud abandoned hypnotism in favor of his own methods of analysis. It was not until the 1950s that the British and American medical societies approved the use of hypnosis as an adjunct to pain treatment. In clinical use, hypnotism is called hypnotherapy, and it is used to treat both physical and psychological disorders. The patient is placed in a trance-like state so that the physician may delve into the deepest levels of the mind to relieve such conditions as migraine headaches, muscle aches, chronic headaches, and postoperative pain. This trance-like condition can be induced by the practitioner or by the patient. It is achieved by first relaxing the body and then by concentrating the patient's attention on a single object or idea, shifting his thoughts away from the immediate environment. In the lightest form of hypnosis, the superficial level, the patient may accept suggestions but will not always take steps to carry them out. Therapists try to reach the deeper state of hypnosis, the somnambulistic stage, in which the patient is readily susceptible to suggestion and carries out instructions while hypnotized as well as after he has come out of the trance (post-hypnotic suggestion).

While in the trance the patient can be induced to ignore pain, to fully relax, or to carry out other beneficial suggestions by the therapist. Also the therapist may suggest that the patient can hypnotize himself when he needs relief from pain or needs to blunt his appetite. The patient is given a simple ritual to follow including specific words to say to place himself in a hypnotic trance. He will then convince himself that his pain has been relieved or that he has eaten a sufficient amount. Upon recovering his normal level of consciousness he will find that his pain is less or that he has no need for additional food.

Unlike portrayals of hypnotists in films, a therapist cannot hypnotize anyone who does not want to be hypnotized. It is essential that the patient and therapist have a close rapport, that the patient fully believes the practice will be of benefit to him, and that the surroundings are devoid of distracting stimuli. Even when in a trance, the patient will not carry out any act he would find morally unacceptable in his waking state. The hypnotist cannot place someone in a trance, for example, and direct him to steal a car or rob a bank. The subject will awaken with the shock of the suggestion.

Chiropractic medicine

Chiropractic medicine is founded on the hypothesis that many human diseases and disorders stem from deviations or subluxations of the spine, which impinge on the spinal nerves, causing pain or disfunction of the affected organs. Treatment consists of determining which of the vertebrae have shifted and then realigning them properly. This may be accomplished in a single treatment or may require a series of treatments over time.

Chiropractic, derived from the Greek words for "practice by the hands," was developed by a Canadian-born Iowa grocer, Daniel David Palmer (1845–1913), in 1895. Palmer believed that the source of illness was the misalignment, or subluxation, of the spinal column in such a way that the vertebrae impinged upon the spinal nerves that passed from the spinal cord, between the vertebrae, to the various organs and muscles of the body. This constriction of the spinal nerve prevented the neural impulses from flowing properly, thus making it impossible for the brain to regulate body functions and leaving tissues susceptible to diseases. Correcting the subluxation would, therefore, restore the neural impulses and strengthen the body.

In 1898, Palmer established the Palmer College of Chiropractic in Davenport, Iowa. In 1910 he published a textbook on chiropractic, which outlined his theories. Since then, the number of chiropractic schools has increased to 16 with a total enrollment of approximately 10,000. To practice as a doctor of chiropractic (D.C.) an individual must complete the four years of chiropractic school and pass a licensing test. Some states specify that entry into a chiropractic college requires only a high school diploma and others require two years of college prior to entry.

Chiropractors themselves differ in the definition of their specialty—this has led to the formation of two separate professional organizations. The International Chiropractors Association advocates chiropractic therapy limited to spinal manipulation only, while members of the American Chiropractors Association endorse a wider range of therapeutics including physical therapy, diathermy (heating of body tissues with electromagnetic radiation , electric current , and ultrasonic waves), and dietary counseling in addition to the basic spinal manipulation.

Chiropractors do not prescribe medication or perform surgery. Only with great reluctance did the American Medical Association recognize chiropractic as a legitimate specialty. The practice is still approached with skepticism by many in the mainstream medical community because no chiropractic school is recognized by any accrediting body and because the practice itself is based on unsound, unscientific principles. Still, many physicians refer patients with back pain to chiropractors who are more skilled at manipulating misaligned vertebrae.

Acupuncture

Acupuncture is a form of therapy developed by the ancient Chinese and subsequently refined by Chinese practitioners. It consists of inserting needles through the skin in very specific places to alleviate pain, cure disease, or provide anesthesia for surgery. Acupuncture as a palliative is accepted among the medical community. Its use as a cure for serious disease or for anesthesia is not endorsed by many physicians.

For the practitioner of acupuncture, the human body is a collection of thousands of acupuncture points that lie along specific lines or meridians. Twelve pairs of meridians are plotted on the body, one of each pair on each side. An additional meridian, the Conception Vessel, courses along the midline of the front of the body and another, the Governor Vessel, along the spine. The meridians are connected by extrameridians. Additional acupuncture points lie outside the meridians on areas such as the ear lobes, fingers, toes, and so forth.

Each meridian is a course for the perceived flow of energy through the body and that flow may be connected to an organ removed from the actual location of the meridian. Needles are inserted at points along the meridian that are specific for a given organ. For example, although the liver lies in the right side of the abdomen, the acupuncture points for liver disease may include areas on the opposite side of the body as well as one of the earlobes.

Acupuncture therapy consists of first locating the source of pain, then deciding upon the appropriate meridian and acupuncture points. Needles used in acupuncture may be short, for use in less-fleshy areas, or long for use in areas with copious flesh or muscle. The needle is simply inserted into the proper acupuncture point and rotated. The needles are left in place for a given time and rotated periodically while they are in place. Some patients find dramatic relief from pain with acupuncture and a number of physicians have incorporated the procedure into their practices.

In the Far East, acupuncture is a recognized form of therapy, and it is combined with herbal medicine, diet restrictions, and exercise. Not only is it used for pain relief, but it is also used frequently as anesthesia during surgery and for the treatment of serious diseases such as cancer. No scientific proof has been offered that it is effective against serious diseases, though its anesthetic and analgesic properties have been demonstrated.

Homeopathy

Homeopathy is a term derived from the Greek words meaning "similar suffering." It is a system in which diluted plant , mineral, or animal substances are given to stimulate the body's natural healing powers. Homeopathy was developed in the late eighteenth century by Samuel Hahnemann (17551–1843), a German physician. Hahnemann conducted experiments to improve standard therapy, which then consisted of bloodletting and administering purgatives made with mercury, which were highly toxic. In one of his experiments he ingested an extract of cinchona, the bark from a Peruvian tree used by the natives to treat malaria . Hahnemann consumed large doses of the bark and developed the symptoms of malaria. From this he concluded that if large doses resulted in symptoms of the disease, small doses should stimulate the body's own disease-fighting mechanism.

Homeopathy is based upon three principles formulated by Hahnemann. The first is the law of similars, stating that like cures like. The second is the law of infinitesimal dose, stating that the potency of a remedy is a reflection of how much it is diluted. Third is the holistic medical model, stating that any illness is specific to the individual who has it.

The law of similars is seen in more traditional medical practice in the use of immunizations. Inoculations of attenuated or dead viruses or bacteria are given to stimulate the production of antibodies to resist a full-scale invasion of the same virus or bacterium. Thus, immunizing a child against poliomyelitis consists of administering a solution containing the dead polio virus; this results in the formation of antibodies that are available to repel the living polio virus if the child is exposed to it.

Homeopathy is much more accepted in Europe , Latin America, and India than it is in the United States. It is touted as a low-cost, nontoxic, effective means of delivering medication that can cure even chronic diseases, including those that conventional medications fail to cure. In France, pharmacies are required to stock homeopathic remedies in addition to regular pharmaceutical drugs. Hospital and outpatient clinics specializing in homeopathy are part of the British health care system and the practice of homeopathy is a recognized postgraduate medical specialty.

In the United States homeopathy has only begun to be accepted by the mainstream medical community. Approximately 3,000 physicians or other health care providers endorse the practice. Though it excites little enthusiasm among practicing physicians in America, homeopathy is an ongoing specialty, and the production of homeopathic remedies is regulated by the Food and Drug Administration to assure their purity, and proper labeling and dispensing.

See also Acupressure.

Resources

books

Cohen, Michael. Complementary Medicine: Legal Boundaries and Regulatory Perspectives Baltimore: Johns Hopkins University Press, 1999.

Goldberg, Burton, John W. Anderson, and Larry Trivieri. Alternative Medicine: The Definitive Guide. 2nd. ed. Ten Speed Press, 2002.

Pierce, Andrea, and John A. Gans. The American Pharmaceutical Association Practical Guide to Natural Medicines New York: William Morrow & Co., 1999.

Rakel, David, ed., and Charles Dickens. Integrative Medicine Philadelphia: W.B. Saunders, 2002.

organizations

National Institutes of Health. "National Center for Complementary and Alternative Medicine" <nccam.nih.gov> (February 4, 2003).

Larry Blaser

KEY TERMS

Acupuncture

—A form of therapy developed by the ancient Chinese in which needles are inserted through the skin in very specific places to alleviate pain, cure disease, or provide anesthesia for surgery.

Chiropractic

—The theory that many human diseases and disorders stem from deviations or subluxations of the spine, which impinge on the spinal nerves, causing pain or disfunction of the affected organs.

Homeopathy

—A system in which diluted plant, mineral, or animal substances are given to stimulate the body's natural healing powers. Homeopathy is based upon three principles: the law of similars, the law of infinitesimal dose, and the holistic medical model.

Hypnotherapy

—The clinical use of hypnotism to treat both physical and psychological disorders, whereby the patient is placed in a trance-like state by the practitioner or by the patient and the patient's attention focuses on a single object or idea in order to relax.

Naturopathy

—Form of alternative medicine that focuses on the patient holistically and views symptoms such as fever as a natural manifestation of the body's defense mechanism that should not be interrupted. Patients are taught to adopt a healthier lifestyle, diet, or attitude to forestall disease development.

Alternative Medicine

Scientific medicine made enormous progress throughout the twentieth century. The steady improvement of pharmaceutics, surgical techniques, and biotechnology has given humans control over diseases that would have led to untimely death just a generation or two before. Yet for all the progress that scientific medicine has made, millions of twenty-first-century Americans are still enthusiastic adherents of alternative medicine. Some persons are motivated to explore alternative medicine out of sheer desperation. After all, alternative medicine provides hope for those whose pains (e.g., lingering back pain) do not fall under the purview of conventional medicine or who have a terminal illness and have already exhausted all conventional treatment options. Alternative medicine is, furthermore, less likely to be as invasive or to assault the body with heavy doses of drugs as scientific medicine often does. Alternative medicine is usually less expensive and also tends to establish warm personal relationships between healers and patients, thus appealing to those who are turned off by the bureaucratic impersonality of modern hospitals. Furthermore, alternative medicine is especially prevalent among recent immigrants or ethnic groups who have preserved cultural traditions that do not understand issues of health and illness in the same way as scientific medicine does.

What is striking, however, is the great extent to which Americans have become interested in alternative medicine for spiritual reasons. Beginning in the nineteenth century with unorthodox medical systems such as mesmerism, hydropathy, homeopathy, and mind cure, Americans have found alternative medicine to have spiritually edifying interpretations of mind-body-spirit interaction. After all, most alternative medicine is embedded in belief systems that affirm the existence of energies or forces not recognized by scientific medicine. Health is typically understood to be the result of achieving harmony with these more-than-physical energies. In short, unorthodox healing systems are not only purveying alternative medical treatments, but alternative spiritual philosophies as well. The religious and cultural significance of these "alternative" interpretations of body-mind-spirit interaction often has as much to do with the popularity of alternative medicine as with its ability to heal.

The sheer diversity of healing systems that are lumped together under the category of alternative medicine makes it somewhat difficult to make tidy generalizations about their connection with American religious life. We might begin, however, by suggesting that alternative medicine systems can be arranged along a philosophical or religious continuum. On one end of the continuum are those healing systems that have no overtly supernatural or metaphysical elements. Many dietary, exercise, and botanical healing systems fall into this category. They are considered alternative simply because their therapies have not yet been validated as efficacious by scientific researchers. Yet even though these therapies do not propound belief in more-than-physical energies, they nonetheless frequently invoke attitudes and outlooks that can be classified as belonging to American "nature religion"—that is, alternative medicine systems characteristically profess belief in the recuperative and progressive forces inherent in nature. Believing nature to be the handiwork of God, many alternative therapies suggest that nature, not a credentialed doctor, is the source of all healing. Thus even nonmetaphysical healing systems often articulate a form of moral and religious piety based on belief in the sanctity of nature's own restorative powers.

The other end of the philosophical continuum along which alternative medicine systems might be arranged is more frankly supernatural or metaphysical. These healing groups overtly profess belief in the existence of some invisible, spiritual power capable of promoting healing within the human body. Since the Transcendentalists of the mid-nineteenth century, American nature religion has also tended to foster the belief that, under special conditions, energies from higher spiritual dimensions can flow into—and exert influences on—our natural universe. The majority of alternative healing systems incorporate some degree of this metaphysical belief. This is especially true of "manipulative" therapies such as traditional chiropractic medicine, acupuncture, Therapeutic Touch, and shiatsu. Many "mind over matter" healing systems such as meditational practices, twelve-step programs, and power-of-positive-thinking therapies also rely heavily on metaphysical beliefs. So, too, do most New Age healing practices, such as those that draw on Eastern religious beliefs in "subtle energies" and those that claim to awaken our dormant psychic abilities to draw on the energies from our astral bodies.

The early history of chiropractic medicine provides an excellent example of how alternative medicine systems provide patients with a spiritually significant way of viewing the world. Daniel David Palmer was a grocer and fish peddler in Iowa before he began the study of the nineteenth-century metaphysical healing system known as mesmerism. Palmer soon learned that he could heal persons by using his hands to apply pressure to their spinal vertebrae. However physical his methods were, Palmer's philosophical explanation was entirely metaphysical. He reasoned that there is an intelligent spiritual force that pervades the entire universe and which he chose to call Innate Intelligence. Disease develops whenever Innate Intelligence is blocked from flowing freely through the human nervous system. The manipulative therapy that Palmer designed was thus understood to be a means of aligning people to make them more receptive to the working of a higher spiritual power. Over the years, the majority of chiropractic physicians downplayed their metaphysical origins to gain both scientific respectability and access to both governmentand insurance-sponsored programs. Thus while some chiropractic physicians continue to champion a decidedly metaphysical understanding of the healing process, others have muted the supernatural elements in favor of the more restrained form of nature religion that reverences the revitalizing powers inherent in the natural order. Today more than nine million persons visit chiropractic physicians each year. And while some of these persons go for reasons wholly unrelated to chiropractic's spiritual underpinnings, others are eager to be introduced to a spiritually charged philosophy concerning every person's inner connection with the spiritual power that radiates life and health throughout the entire universe.

What is commonly referred to as the New Age movement has also encouraged Americans to explore alternative medical systems. The various philosophies and practices that make up the New Age movement all endorse an approach to health and medicine that is said to be holistic and that envisions every human being as a unique, interdependent relationship of body, mind, emotions, and spirit. New Agers are for this reason critical of the Western scientific heritage and instead drawn to those Eastern religious and medical systems that teach that humans can potentially open the inner recesses of their psyches to the inflow of a higher spiritual energy (variously referred to as ch'i, prana, kundalini, or pure white light). Americans have embraced yoga, t'ai chi, ch'uan, Ayurvedic medicine, shiatsu, acupuncture, and various Oriental massage systems for their advocacy of attitudes and lifestyles geared to bringing persons into harmony with a metaphysical healing energy.

New Age crystal healing serves as an additional example of Americans' fascination with the metaphysical dimensions of alternative medicine. New Age philosophies tend to view God as a "pure white light" or "divine spirit" rather than in the traditional biblical categories of father or king. They further explain that this pure white light continuously flows into, or infuses, each plane of existence—mineral, vegetable, animal, human or mental, and astral. Pure white light is thought to enter into each person's consciousness by passing through his or her spiritual aura, where it is diffused into the seven interior centers or chakras that supply the body with power and vitality. Any technique (e.g., massage, color healing, visualization exercises, meditation) that can help persons increase their receptivity to this white light and promote its proper flow through the various chakras can thus have medical value. The most popular of these techniques is the use of rock crystals. It is claimed that crystals, because they are almost entirely devoid of color, are almost perfect capacitators of divine white light. They can be placed over a chakra believed to be "blocked," or held by a healer who moves them back and forth along the patient's nervous system. Over and beyond their healing power, crystals are thought to be capable of enhancing our spiritual awareness and aligning us more fully to the "Higher Guidance" that is believed to permeate our universe.

These examples draw attention to the fact that alternative medicine systems have become important vehicles of an unchurched American spirituality. The healing practices advocated by alternative medicine systems typically stress the importance of finding personal harmony with nature, becoming receptive to spiritual power, and establishing more emphatic relationships with one's fellow human beings. Spiritual themes such as these are especially attractive to individuals who are sensitive to the excesses of the hierarchical, exploitative, and overly male institutions that have historically dominated Western culture. Those who are attracted to alternative medicines are thus seeking to create a counterculture that provides a remedy for the increasing mechanization, secularization, and depersonalization of modern life (including modern medicine). Adherents of these groups are characteristically white, middleor upper-middleclass, well educated, and either urban or suburban (except, of course, those who subscribe to medical folk traditions owing to their participation in ethnic or immigrant communities). The ideas advocated by alternative medicine can be found in bookstores in almost every shopping mall in the country, in displays at health-food stores, and in advertisements placed in various "human potential" magazines. Thus, although only a small percentage of Americans rely on alternative healing practices to the exclusion of scientific medicine, a good many others drawn from all regions of the country and all religious denominations have been influenced by their alternative philosophies of body-mind-spirit interaction.

See alsoChakra; Health; Holistic Health; Human Potential Movement; Macrobiotics; Nature Religion; New Age Spirituality; Peale, Norman Vincent; Quantum Healing; Twelve-Step Program.

Bibliography

Albanese, Catherine. Nature Religion in America. 1990.

Fuller, Robert C. "Alternative Medicine." In Encyclopedia of American Social History, edited by Cayton, Gorn, and Williams. 1993.

Fuller, Robert C. Alternative Medicine and American Religious Life. 1989.

Gevitz, Norman, ed. The Other Healers. 1988.

McGuire, Meredith. Ritual Healing in Suburban America. 1988.

Robert C. Fuller