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- Alternative Systems of
Medical Practice
- Overview
Worldwide, only an estimated 10 to 30
percent of human healthcare is delivered by conventional, biomedically oriented
practitioners. The remaining 70 to 90 percent ranges from self-care, according
to folk principles, to care given in an organized healthcare system based on an
alternative tradition or practice.
Popular healthcare is the kind most
people practice and receive at home, such as giving herbal tea to someone who
has a cold. Community-based healthcare, which reflects the health needs,
beliefs, and natural environments of those who use it, refers to the
nonprofessionalized but specialized healthcare practices of many rural and urban
people. Professionalized healthcare is more formalized; practitioners
undergo more standardized training and work in established locations.
Professionalized Healthcare Systems
The professionalized healthcare
practitioners often have conducted scientific studies about the causes of
illness and explanations and results of treatment. Each of the major
professionalized systems has certain characteristics: a theory of health and
disease; an educational scheme to teach its concepts; a delivery system
involving practitioners; a material support system to produce medicines and
therapeutic devices; a legal and economic mandate to regulate its practice;
cultural expectations about the medical system’s role; and a means to confer
professional status on approved providers. These professionalized medical
systems include traditional oriental medicine, acupuncture, ayurvedic
medicine, homeopathy, anthroposophy, naturopathy, and environmental medicine.
Traditional Oriental Medicine
Traditional oriental medicine is a
sophisticated set of many systematic techniques and methods, including
acupuncture, herbal medicine, acupressure, qi gong, and oriental massage. The
most striking characteristic of oriental medicine is its emphasis on
diagnosing disturbances of qi, or vital energy, in health and disease.
Diagnosis in oriental medicine involves the classical procedures of
observation, listening, questioning, and palpation, including feeling pulse
quality and sensitivity of body parts.
The professionalization of oriental
medicine has taken diverse paths in both East Asia and the United States.
Currently, the model in the People’s Republic of China, which was
established after the 1949 revolution, involves the organized training of
practitioners in schools of traditional Chinese medicine. The curriculum of
these schools includes acupuncture, oriental massage, herbal medicine, and
pharmacology, though the clinical style of making a diagnosis and then
designing a treatment plan is the one traditionally associated with herbal
medicine. The graduates of these colleges are generally certified in one of
the four specialty areas at a training level roughly equivalent to that of a
Western country’s bachelor’s degree.
In the United States, the professional
practitioner base for oriental medicine is organized around acupuncture and
oriental massage. There are about 6,500 acupuncturist practitioners in the
United States. The American Oriental Body Work Therapy Association has
approximately 1,600 members representing practitioners of tuina, shiatsu, and
related techniques. Many American schools of acupuncture are evolving into
"colleges of oriental medicine" by adding courses in oriental
massage, herbal medicine, and dietary interventions. They also are offering
diplomas, master’s degrees, and doctor’s degrees in oriental medicine. The
legal sanctioning of oriental medical practice is most extensive in New
Mexico, where the acupuncture community has established an exclusive
profession of oriental medicine. Their legal scope of practice is currently
similar to that of primary care M.D.s and D.O.s (doctors of osteopathy), and
their State statute restricts other licensed New Mexico health professionals’
ability to advertise or bill for oriental medicine or acupuncture services.
Extensive research has been done in China through the institutions of
traditional Chinese medicine, but only in the past quarter century have
biomedical scientists in China characterized and identified active agents in
much of traditional medical formulary. The use of traditional oriental herbal
medicines and formulas in China and Japan has been studied for therapeutic
value in the following areas: chronic hepatitis; rheumatoid arthritis;
hypertension; atopic eczema; various immunologic disorders, including acquired
immunodefiency syndrome (AIDS); and certain cancers. It would be useful to
repeat these studies in the United States, assessing U.S. clinical populations
according to high-quality research criteria.
Acupuncture
Acupuncture involves stimulating
specific anatomic points in the body for therapeutic purposes. Puncturing the
skin with a needle is the usual method, but practitioners also use heat,
pressure, friction, suction, or impulses of electromagnetic energy to
stimulate the points. In the past 40 years, acupuncture has become a
well-known, reasonably-available treatment in developed and developing
countries. Acupuncture is used to regulate or correct the flow of qi to
restore health.
Modern theories of acupuncture are based
on laboratory research conducted in the past 40 years. Acupuncture points have
certain electrical properties, and stimulating these points alters chemical
neurotransmitters in the body. The physiological effects of acupuncture
stimulation in experimental animals have been well documented, and in the past
20 years acupuncture has become an increasingly established healthcare
practice. An estimated 3,000 conventionally trained U.S. physicians have taken
courses to incorporate acupuncture in their medical practices.
Acupuncture is one of the most
thoroughly researched and documented of the so-called alternative medical
practices. A series of controlled studies has shown evidence for the efficacy
of acupuncture in the treatment of a variety of conditions, including
osteoarthritis, chemotherapy-induced nausea, asthma, back pain, painful
menstrual cycles, bladder instability, and migraine headaches. Studies on
acupuncture also have shown positive results in the areas of chronic pain
management and in the management of drug addition, two areas where
conventional Western medicine has had only a modicum of success.
Ayurveda
Ayurveda is India’s traditional,
natural system of medicine that has been practiced for more than 5,000 years.
Ayurveda provides an integrated approach to preventing and treating illness
through lifestyle interventions and natural therapies. Ayurvedic theory states
that all disease begins with an imbalance or stress in the individual’s
consciousness. Lifestyle interventions are a major ayurvedic preventive and
therapeutic approach. There are ten ayurveda clinics in North America,
including one hospital-based clinic that has served 25,000 patients since
1985.
In India, ayurvedic practitioners
receive state-recognized, institutionalized training in parallel to their
physician counterparts in India’s state-supported systems for conventional
Western biomedicine and homeopathic medicine. The research base is growing
concerning the physiological effects of meditative techniques and yoga
postures in Indian medical literature and Western psychological literature.
Published studies have documented reductions in cardiovascular disease risk
factors, including blood pressure, cholesterol, and reaction to stress, in
individuals who practice Ayurvedic methods.
Laboratory and clinical studies on
ayurvedic herbal preparations and other therapies have shown them to have a
range of potentially beneficial effects for preventing and treating certain
cancers, treating infectious disease, promoting health, and treating aging.
Mechanisms underlying these effects may include free-radical scavenging
effects, immune system modulation, brain neurotransmitter modulation, and
hormonal effects.
Homeopathic Medicine
Homeopathic medicine is practiced
worldwide, especially in Europe, Latin America, and Asia. However, even in the
United States the homeopathic drug market is a multimillion-dollar industry.
Homeopathic remedies, which are made from naturally occurring plant, animal,
or mineral substances, are recognized and regulated by the Food and Drug
Administration (FDA) and are manufactured by established pharmaceutical
companies under strict guidelines. Homeopathy is used to treat acute and
chronic health problems as well as for disease prevention and health
promotion. Recent clinical trials suggest that homeopathic medicines have a
positive effect on allergic rhinitis, fibrositis, and influenza.
Basic research in homeopathy has
involved investigations into the chemical and biological activity of highly
diluted substances. Some homeopathic medicines are diluted to concentrations
as low as 10-30 to 10-20,000. This particular aspect of homeopathic theory and
practice has caused many modern scientists to reject homeopathic medicine.
Critics of homeopathy contend that such extreme dilutions of the medicines are
beyond the point at which any active molecules of the medicine can
theoretically still be found in the solution. On the other hand, scientists
who accept the potential benefits of homeopathic theory suggest several
theories to explain how highly diluted homeopathic medicines may act. Using
recent developments in quantum physics, they have proposed that
electromagnetic energy in the medicines may interact with the body on some
level. Researchers in physical chemistry have proposed the "memory of
water" theory, whereby the structure of the water-alcohol solution is
altered by the medicine during the process of dilution and retains this
structure even after none of the actual substance remains.
Anthroposophically Extended
Medicine
Anthroposophically extended medicine is
an extension of Western biomedicine and also incorporates approaches and
therapeutics from two alternative medicine movements: naturopathy and
homeopathy. Anthroposophically extended medicine is most prominent in Europe,
but there are an estimated 30 to 100 M.D.s in the United States who practice
it also. Hundreds of uniquely formulated medications are used in
anthroposophical practice, each seeking to match the key dynamic forces in
plants, animals, and minerals with disease processes in humans to stimulate
healing. Much research in anthroposophically extended medicine has been
connected with attempts to understand the nature of disease, assess treatments
qualitatively, and understand how the essential properties of the objects
under investigation could be applied in therapy.
Naturopathic Medicine
Naturopathic medicine, as a distinct
American healthcare profession, is almost 100 years old. It was founded as a
formal healthcare system at the turn of the century by medical practitioners
from various natural therapeutic disciplines. By the early 1900s, more than 20
naturopathic medical schools existed, and naturopathic physicians were
licensed in most States. Today there are more than 1,000 licensed naturopathic
doctors in the United States.
As practiced today, naturopathic
medicine integrates traditional natural therapeutics — including botanical
medicine, clinical nutrition, homeopathy, acupuncture, traditional oriental
medicine, hydrotherapy, and naturopathic manipulative therapy — with modern
scientific medical diagnostic science and standards of care. The medical
research base of naturopathic practice consists of empirical documentation of
treatments using case history observations, medical records, and summaries of
practitioners’ clinical experiences.
At present, the two accredited
naturopathic medical schools in the United States have active research
departments. Naturopathic researchers have investigated the pharmacology and
physiological effects of nutritional and natural therapeutic agents, and
naturopathic physicians have been active in the investigation of new
homeopathic remedies and in the natural treatment of women’s health
problems. The most recently completed naturopathic study in women’s health
tested the clinical and endocrine effects of a botanical formula as an
alternative to estrogen replacement therapy.
Environmental Medicine
Environmental medicine, like
anthroposophically extended medicine, also can be viewed as an extension of
modern biomedicine. Environmental medicine traces its roots to the practice of
allergy treatment and the work of Dr. Theron Randolph, in the 1940s, who
identified a variety of common foods and chemicals that were able to trigger
the onset of acute and chronic illness even when exposure was at relatively
low levels.
Environmental medicine recognizes that
illness in individuals can be caused by a broad range of incitant substances,
including foods, chemicals found at home and in the workplace, and chemicals
in the air, water, and food. Today there are 3,000 physicians worldwide
practicing environmental medicine, and there are several environmental control
units in the United States and one in Canada, where patients’ sensitivities
are unmasked through fasting and complete avoidance of potentially incitant
chemicals.
Research, in this field, has been
directed at clinical treatment of patients and at evaluation of the diagnostic
and treatment techniques used by practitioners. Other studies have supported
the use of the approaches of environmental medicine in treating arthritis,
asthma, chemical sensitivity, colitis, depression, eczema, fatigue, and
hyperactivity.
The belief that humans can get sick from
cumulative low-level environmental exposure to certain incitants is not well
accepted by the conventional medical community. However, because "sick
building syndrome" and other chronic conditions that cannot be explained
by other phenomena are being seen with greater frequency, environmental
medicine offers a theoretical groundwork for dealing with such phenomena.
Indeed, environmental medicine is in a position to be a leading force in the
investigation of ways to reduce the incidence of these and other disorders.
Community-Based Healthcare Practices
Community-based healthcare practices are
varied and are found throughout the United States. Like other healthcare
specialists, community-based healers may emphasize naturalistic, personalistic,
energetic explanatory models or a combination. Traditional midwives and
herbalists and, at the present time, pragmatic weight loss specialists are
probably the best known of community-based practitioners who follow the
naturalistic model. In addition, the Native American medicine man or medicine
woman is a community-based traditional healer with primarily naturalistic
skills, that is, the skills of an herbalist in particular. Some medicine
people are also shamans, in which case they are often distinguished as holy
men and women.
In contrast to professionalized
practitioners, community-based healers often do not have set locations such as
offices or clinics for delivering care but do so in homes, at ceremonial
sites, or even right where they stand. Community-based healing of the
personalistic variety can also be "distant," that is, it does not
require that practitioner and patient be in each other’s presence. Prayers
or shamanic journeys, for example, can be requested and
"administered" at any time, and charm cures are sometimes delivered
by telephone.
Meanwhile, community-based systems also
thrive in urban areas. These systems include the popular weight loss programs
and other 12-step programs. Often the practitioners rent office space and
emphasize contact between client and practitioner, and they may charge
considerable fees. Since these practitioners depend on their healing practice
for their livelihood, they advertise and so may be easier to identify and
contact for study purposes.
Native American
Native American Indian community-based
medical systems have a number of rituals and practices: sweating and purging,
usually done in a "sweat lodge"; the use of herbal remedies gathered
from the surrounding environment and sometimes traded over long distances; and
shamanic healing involving naturalistic or personalistic healing. Tribes such
as the Lakota and Dineh (Navajo) also use practices such as the medicine
wheel, sacred hoop, and the "sing," which is a healing ceremony rite
that lasts from two to nine days and nights and is guided by a highly skilled
specialist called a "singer."
Formal research into the healing
ceremonies and herbal medicines conducted and used by bona fide Native
American Indian healers or holy people is almost nonexistent, even though
Native American Indians believe they positively cure both the mind and body.
Ailments and diseases such as heart disease, diabetes, thyroid conditions,
cancer, skin rashes, and asthma reportedly have been cured by Native American
Indian doctors who are knowledgeable about the complex ceremonies.
Latin American
Latin American community-based practices
include curanderismo, which is a folk system of medicine that includes two
distinct components: a humoral model for classifying activity, food, drugs,
and illness; and a series of folk illnesses.
In the humoral component of curanderismo,
things could be classified as having qualitative (not literal) characteristics
of hot or cold, dry or moist. According to this theory, good health is
preserved by maintaining a balance of hot and cold. Thus, a good meal will
contain both hot and cold foods, and a person with a hot disease must be given
cold remedies and vice versa. Again, a person who is exposed to cold when
excessively hot may "take cold" and become ill.
The second component, the folk
illnesses, is actively in use in much of Mexico and among less educated
Hispanic U.S. citizens. Studies have found that as many as 96 percent of
Mexican-American households (more frequent in the less Americanized
communities) treated members for Hispanic folk illnesses. Similarly, high use
patterns among Mexican migrant workers have been found in Florida and Mexico.
Although no formal effectiveness studies
seem to have been done on this system, its wide popularity and the research
suggesting the relevance of the folk diagnoses, for biomedical practice,
indicate the need for further demographic and effectiveness studies.
Alcoholics Anonymous
Alcoholics Anonymous (AA) is an example
of an urban community-based healing system for helping people, whose lives are
damaged by the consumption of alcohol, to stop drinking. Founded in 1935 by
Bob Smith, M.D. and Bill Wilson, two alcoholics, it is a patient-centered
self-help fellowship of men and women. AA has burgeoned and today is widely
considered the most successful existing method for supporting sobriety.
In contrast to most community-based
systems, a very large literature exists analyzing AA. Several models attempt
to explain its success. One popular psychometric model interprets AA as a
"cult" and the achievement of sobriety as a "conversion
experience." Another model, however, asserts that members recover by
integrating their own experiences with alcohol with those of others in the
group and by learning and practicing some new ways to behave. Through these
new ways, AA members feel as if they are living apart from the urban
materialist norm; that the cause of alcoholism is not at issue; that people
should share, not compete; and that the individual need not rise above the
rest (spiritual anonymity).
Studies have concluded that active AA
membership allows up to 68 percent of alcoholics to drink less or not at all
for up to a year, and 40 to 50 percent to achieve sobriety for many years.
More active or dedicated members (those who attend meetings more often) remain
sober longer.
National Institutes of Health
Adapted from Alternative Medicine:
Expanding Medical Horizons, a report prepared under the auspices of the
Workshop on Alternative Medicine, held in Chantilly, VA on September 14-16,
1992.
Disclaimer: The NIH cautions users
not to seek the therapies described on these pages without the consultation of a
licensed healthcare provider. Inclusion of a treatment or resource on the NCCAM
Web site does not imply endorsement by the NCCAM, the NIH, or the Department of
Health and Human Services (DHHS).
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