COMPLEMENTARY MODALITIES
For reference purposes, 917,940 licensed MD’s in the US in 2020 (and there were 789,788 in 2010)
In 2020, 783,639 were US and Canadian medical school graduates; 233,177 were International Medical Graduates
In 2010, 649,736 were US and Canadian medical school graduates; 188,598 were International Medical Graduates
Acupressure
Descriptive definition:
Finger pressure is applied to meridians, to stimulate the flow of qi.
This is similar to acupuncture, but pressure is used instead of needles.
History - 5,000 years old.
Uses – similar to acupuncture. A meta-analysis of 33 trials examining acustimulations for postoperative nausea and emesis in adults found that acupressure is just as effective as acupuncture or electrical stimulation of acupuncture points (Explore. 2006. 2. 202-215).
Contra-indication - pregnancy
Acupressure Institute
1533 Shattuck Ave.
Berkeley, CA 94709
510-845-1059
Acupuncture [see also ‘Traditional Chinese Medicine’ section below in this outline]
Descriptive definition - Needles are inserted into the skin along life-force pathways in order to treat health problems. \
Acupuncture points on the skin connect with pathways called meridians, which conduct energy which is called Qi.
There are approximately 360 acupuncture points and 14 meridians.
Acupuncture points and meridians can be conceptualized as a depiction of the energetic body, as viewed externally (in contrast with chakras [reiki, qi gong, and tai chi] which are a depiction of the energetic body, as viewed internally).
History - Four thousand of years old.
1973 - FDA declared acupuncture needles "experimental devices."
1996 - FDA declared acupuncture needles were no longer experimental devices.
1997 – NIH Consensus conference concluded that acupuncture is effective in certain circumstances (see below – ‘Uses’).
Education
Medical school in China.
More than 50 accredited acupuncture/Traditional Chinese Medicine schools in 2015.
Licensure:
First licensed in Nevada, Oregon, and Maryland in 1973; licensed in 47 states in 2023.
Criteria for licensure vary from state to state; historically NY had stringent criteria for licensure.
Non-MD acupuncturists licensed in 42 states and D.C. in 2001, licensed in 45 states in 2015.
MD acupuncturists in 2001: 31 states expressly include acupuncture in MD or DO licensure, 11 states require additional training or an exam, 4 states do not have any ruling, 2 states do not permit.
Only 14 states have an independent board of acupuncture or Oriental medicine.
Popularity:
6% of Americans in a 1990 survey had tried acupuncture at least once.
A 2007 national survey found that 3.1 million Americans had used acupuncture in the past year.
72 schools in the United States in 2001, but only 37 accredited by the National Accreditation Commission for Schools and Colleges of Acupuncture and Oriental Medicine.
Performed in 2001 by an estimated 3000 physicians and 14,000 licensed non-physician acupuncturists, but a minority have taken the exam administered by the National Commission for Certification in Acupuncture. In 2015, 27,800 licensed acupuncturists.
Safety:
Very safe if used by certified acupuncturists with disposable needles, which is the standard of care.
A review of all adverse events reported worldwide as of 1998 noted just 11 serious complications (BMJ. 2000. 320. 513-514).
A comprehensive systematic review of prospective studies of acupuncture found the following rates of adverse events (Am J Med. 2001. 110. 481-485):
Needle pain 1-45%
Tiredness 2-41%
Bleeding 0.3-38%
Feeling faint 0-0.3%
Pneumothorax rare
Cardiac tamponade rare
Contraindicated in pregnancy because it may stimulate uterine contractions.
Mechanism of action
Research in rabbits in the 1960's by Professor Kim Bong Han in Korea demonstrated by the use of microautoradiography that radioactive P32 injected into acupoints was taken up by a fine duct-like tubule system which followed classical acupuncture meridians.
Studies by Pierre de Vernejoul in France using radioactive technetium 99m in humans shows that if injected at classical acupuncture points, it travels up to 30 cm in 4 - 6 minutes, whereas if injected at random points on the skin, it travels a much shorter distance.
Quantitative measurements by researchers demonstrate a nearly 20-fold drop in electrical resistance at acupoints.
Neuroscience research suggests distinct mechanisms for true versus sham acupuncture (Kaptchuk, Ted. Herbal Crossroads Newsletter distributed by Kan Herb Company. March 2010).
Examination of neuroanatomical correlates of sham (nonpenetrating) acupuncture versus true (needle) acupuncture in healthy volunteers, using functional MRI, showed that needle stimulation inhibited noxious stimuli via a peripheral to central modulation whereas sham acupuncture activated a central to peripheral modulation (NeuroImage. 2009. 47. 1066-1076).
A study using a radioactive tracer and PET scanning in patients with fibromyalgia found equal relief from true versus sham acupuncture; true acupuncture seemed to increase endogenous opioid receptor availability while sham acupuncture seemed to seemed to increase endorphin release (NeuroImage. 2009. 47. 1077-1085).
Uses: More than 500 RCTs since the 1970s, but many small and/or of poor methodological quality
At a NIH Consensus Development Conference on November 3-5, 1997, the 15 member panel concluded that acupuncture was clearly effective for post operative dental pain and for nausea from chemotherapy, pregnancy, and anesthesia. The panel concluded based on current evidence that acupuncture may also be effective for migraine headaches, arthritis, menstrual cramps, low back pain, and tennis elbow.
Sham acupuncture as a control – issues
Some acupuncturists assert that there is no such entity as a sham acupuncture point.
PET scan research suggests that sham acupuncture may stimulate areas of the brain associated with natural opiate production.
Back pain:
A meta-analysis of all randomized, controlled studies suitable for meta-analysis (9 studies) showed acupuncture superior to various control measures (Arch Intern Med. 1998. 158. 2235-2241).
A RCT of 33 women and 17 men with uncomplicated chronic low back pain showed that 44% of patients receiving acupuncture had pain relief at 3 months compared to 12.5% in the placebo group; results were similar at 9 months of follow up (Clin J Pain. 2001. 17. 296-305).
A review finds that “An abundant amount of conflicting information exists on the efficacy of acupuncture for treating back pain” (Alternative Medicine Alert. 2004. 7. 72-78).
A meta-analysis of 33 RCTs found that acupuncture effectively relieves chronic low back pain (Ann Intern Med. 2005. 142. 651-663).
Chronic pain – see pain
Constipation ( chronic severe functional ) based on the results of a randomized, parallel, sham-controlled 8-week trial of electroacupuncture, 28 sessions, in 1075 patients enrolled at 15 hospitals (Ann Intern Med. 2016. 165. 761-769).
Infertility: Negative RCT. A single-blind, parallel-group RCT of 848 females in which acupuncture was compared with sham acupuncture at 16 IVF centers failed to show benefit (JAMA. 2018. 319. 1990-1998).
Headache: A RCT in England and Wales of 255 patients with chronic headaches (at least two headaches per month) in which 136 patients had 12 acupuncture treatments over 3 months and 119 patients had usual care found that acupuncture was cost effective, with a cost of $16,300 per QALY (BMJ. 2004. 328. 747-749). Previous studies have shown acupuncture beneficial for headache (Headache. 1983. 23. 66-69; Cephalagia. 1985. 5. 137-142).
Irritable bowel syndrome - a multicenter 6 week RCT in China of 531 patients who were randomized in a 2:1 ratio to receive either 18 sessions of acupuncture versus medical therapy with PEG for IBS-C/pinaverium for IBS-D reported that the IBS-Symptom Severity score decreased statistically significantly more in the acupuncture group (p < 0.001) and that the difference was maintained through 12 weeks of follow up after the intervention (Mayo Clin Proceed. 2020. 95. 1671-1683).
Migraine - a Cochrane review identified 22 RCTs (n=4985) and concluded that acupuncture reduces migraine frequency more than usual care, sham acupuncture, or prophylactic medications (Linde K et al. Acupuncture for prevention of episodic migraine. Cochrane Database Syst Rev. 2016; 6:CD001218).
Neck pain: In a randomized, single-blind, placebo-controlled, parallel-arm trial in 135 patients with mechanical neck pain, acupuncture reduced neck pain and produced a statistically significant, but not clinically significant effect compared to placebo (mock transcutaneous electrical stimulation of acupuncture points using a decommissioned electroacupuncturestimulation unit). Both the acupuncture and placebo groups improved significantly from baseline, and this improvement was maintained at 6 and 12 months, so the main conclusion of this study is that most of the benefit of acupuncture for neck pain is a ‘nonspecific’ effect (Ann Intern Med. 2004. 141. 911-919). Previous studies also reported a benefit of acupuncture for neck pain (Clin J Pain. 1998. 14. 248-255; Am J Chin Med. 1982. 9. 326-332).
Nausea and vomiting:
A meta-analysis of 33 trials examining acustimulation for postoperative nausea and emesis in adults found that acustimulation is just as effective as medications for postoperative nausea and emesis in adults. The meta-analysis pooled 24 trials for nausea, 29 trials for vomiting, and 19 trials for rescue antiemetics. Acupuncture, acupressure, and electrical stimulation of acupuncture points appeared equally effective. Furthermore, the data suggested that Korean hand acupressure stimulations at K-K9 and K-D2 (two trials) were more effective than P6 stimulation (Explore. 2006. 2. 202-215).
A meta-analysis of 12 trials examining acustimulation for postoperative nausea and emesis in children found that acustimulation is just as effective as medications for postoperative nausea and emesis in adults (Explore. 2006. 2 314-320).
A meta-analysis of 14 trials of acustimulation (n=1655) for nausea and vomiting of pregnancy shows that efficacy is best for acupressure, equivocal for acupuncture (Explore. 2006. 2. 412-421).
A Cochrane review of 11 trials (n=1247) of acustimulation for chemotherapy-induced nausea and vomiting showed benefit (Cochrane Database Syst Rev. 2006. CD002285).
Osteoarthritis (symptomatic) of the knee:
Historically, a systematic review of 7 trials representing 393 patients found strong evidence that acupuncture is effective for the pain of knee osteoarthritis but little evidence that it improves function (Arthritis Rheum. 2001. 44. 819-825).
Landmark study -in a 26 week RCT in 570 patients, those who received true acupuncture experienced greater improvement in WOMAC function scores at 8 weeks, and significantly greater improvement in WOMAC function scores, WOMAC pain score, and patient global assessment score at 26 weeks, compared to a sham acupuncture group. At 8 and 26 weeks, the sham acupuncture group experienced significantly greater improvement in WOMAC function and pain scores, but not patient global assessment score, compared to an education control group (Ann Intern Med. 2004. 141. 920-928).
There have been a number of negative published studies too.
A meta-analysis of 9 RCTs longer than 6 weeks in duration and examining acupuncture for knee OA found that sham-controlled trials had heterogeneous results, but in aggregate showed “clinically irrelevant short-term benefits,” whereas “waiting-list controlled trials suggest clinically relevant benefits, some of which may be due to placebo or expectation effects” (Ann Intern Med. 2007. 146. 868-877).
Benefit seen in an “individual patient data meta-analysis” – see details in ‘Acupuncture – Pain section just below.
Pain
A review of 58 systematic reviews concluded that “high-quality reviews show mixed effectiveness of acupuncture for pain.” (Pain. 2011. 152. 755-764 and ACP Journal Club. 2011. 155. JC2-6).
Goal – determine effect size of acupuncture of 4 chronic pain conditions – back and neck pain, osteoarthritis, chronic headache, and shoulder pain. An individual patient data meta-analysis conducted using data from 29 of 31 eligible RCTs, with a total of 17,922 patients analyzed reported effect sizes of 0.23 for chronic back and neck pain, 0.16 for osteoarthritis, and 0.15 for chronic headaches, when acupuncture was compared with sham acupuncture. Effect sizes were slightly larger, and considered clinically significant when acupuncture was compared with no-acupuncture controls – 0.55 for chronic neck and back pain, 0.57 for osteoarthritis, and 0.42 for chronic headache (Arch Intern Med. 2012. 172. 1444-1453)
Sepsis - benefit reported in a systematic review and meta-analysis (Acupunct Med. 2023. 41. 3-15).
Smoking cessation: A single blind randomized trial using true versus sham acupuncture in 46 adults smoking approximately 1 ppd and stating a desire to quit found benefit for acupuncture (Prev Med. 2001. 33. 364-372). HOWEVER, a Cochrane review of acupuncture for smoking cessation failed to find convincing evidence for benefit (Cochrane Database Syst Rev. 2002, Issue 4).
Stroke rehabilitation – conflicting evidence on effectiveness. A RCT in 116 patients comparing acupuncture with sham acupuncture found no benefit for acupuncture (Arch Intern Med. 2005, 165. 2026-2031).
Urine incontinence
Electroacupuncture beneficial for stress incontinence based on results of a RCT of 504 women (JAMA. 2017. 317. 2493-2501 and editorial 2489-2490).
Electroacupuncture beneficial for mixed incontinence based on a RCT of 500 women in China - 36 sessions over 12 weeks was not inferior to pelvic floor muscle training + solifenacin (Vesicare) in women with moderate to severe mixed urinary incontinence (Mayo Clin Proc. 2019. 94. 54-65).
Urticaria (chronic spontaneous) - borderline RCT. A multi-center sham-controlled RCT of 330 participants showed a statistically greater improvement in UAS7 in the treatment group, but the difference from control was not clinically significant. Adverse events were mild or transient. The acupuncture intervention in this trial was intensive, with 16 sessions over 4 weeks, starting with daily treatment on weekdays for the first 2 weeks (Ann Intern Med. 2023. 176. 1617-1624 and editorial 1674-1675).
UTI (recurrent) in women: Women who received acupuncture twice a week for one month were half as likely to have another UTI (American Journal of Public Health, October 2002).
Xerostomia (radiation induced): An uncontrolled trial using a validated xerostomia inventory showed that 70% of the 50 patients in the study responded. The number of acupuncture visits was highly correlated with improved response (Cancer. 2002. 94. 1151-1156).
Many authorities and acupuncturists consider acupuncture helpful for addictions (Arch Intern Med. 2000. 160. 2305-2312), AIDS, alcohol abuse, asthma, depression, fibromyalgia (BMJ. 1992. 305. 1249-1252; J Fam Pract. 1999. 48. 213-218), irritable bowel syndrome, and migraine (Clin J Pain. 1989. 5. 305-312; Headache. 2002. 42. 855-861).
The experience - Most people state that acupuncture needles hurt less than the needle associated with a blood draw. Acupuncture needles are thinner than needles used for drawing blood, and acupuncture needles are solid whereas needles used to draw blood have a hollow tip, so insertion of acupuncture needles causes less skin trauma than insertion of a needle to draw blood.
Cost (in 1995) - Usually $60 - $80 for the initial visit and $30 - $50 for follow up visits.
Reference: Invited Commentary. Avins AL. Needling the Status Quo. Arch Intern Med. 2012. 172. 1454-1455
National Certification Commission for Acupuncture and Oriental Medicine
703-548-9004
www.nccaom.org
American Academy of Medical Acupuncture
800-521-2262
www.medicalacupuncture.org
Alexander Technique
Descriptive Definition - A set of bodywork exercises in which patients are trained to improve posture by reducing habitual muscle tension, and increasing moment-by-moment postural awareness.
The practitioner begins by observing how the client sits, stands, and walks.
The practitioner next helps the client recognize how unconscious patterns of movement may be contributing to symptoms.
Finally, the practitioner coaches the client through movements, making adjustments to the alignment of the head, neck, shoulders, and back.
History - Developed by actor F. Matthias Alexander (1865-1955).
Education - 1600 hours over 3 years.
Uses - Parkinson's disease (Clinical Rehabilitation 2/97), seniors to improve balance (Journal of Gerontology 1/99), asthma, chronic pain.
Cost (in 1995) - $40 - $90 for a 30-60 minute session.
American Society for the Alexander Technique
800-473-0620
www.alexandertech.org
Alpha-Stim
Descriptive definition - this is a medical device regulated in the US by the FDA (and approved for use in many other countries). Two protocols:
Cranial electrotherapy Stimulation (CES) - 1/2 milliamp of microcurrent is delivered directly to the brain via earclip electrodes for 20-60 min sessions
Microcurrent Electrical Therapy (MET) - microcurrent of less than 1 milliamp per channel is administered via a probe for a 2-5 min session
Mechanism of action for CES - the waveform activates particular groups of nerve cells located in the brainstem.
Safety - in 2019, several decades of use and studies including approximately 8800 participants, and safety is excellent, with the most common side effects of headache in 0.1% of individuals and skin irritation in 0.07% of individuals
Uses:
CES: anxiety, depression, insomnia
MET - pain
Anthroposophical Medicine
Descriptive definition:
An extension of medical practice on the basis of the comprehensive view of the human being provided by spiritual science.
A mix of conventional medicine, naturopathy, and homeopathy – blends spiritual and scientific principles and applies them to healing practices.
A central concept is that humans are composed of interactions of the physical body (material), inner life body (forma), soul (anima), and spiritual ego (geist). Illness is a result of disharmony and imbalance amongst these systems.
Diagnosis is based on allopathic medicine.
Treatment includes dietary changes, homeopathic medicines, art and movement therapies, spiritual and psychological counseling and a supportive relationship between the physician and patient.
385 of the homeopathic preparations are cataloged by the US Homeopathic Pharmacopoeia, but 275 preparations crucial to the practice are unique to the anthroposophical materiamedica.
Many homeopathic preparations are derived from minerals.
The goal of treatment is an overall state of wellness for the whole of the being, including physical, emotional, and spiritual.
History:
Founded by Steiner (1861-1925) in 1921 as guidelines for the application of anthroposophy to medicine.
Anthroposophy may be defined as the science of the innate wisdom of humanity.
The theory is that humanity holds within itself the clue to all the secrets of the universe, and those secrets can be discovered through rational clairvoyance.
Anthroposophy is also the basis of biodynamic agriculture and Waldorf education.
Education - 6 weekend intensive course for M.D.’s or D.O’s followed by self study.
Licensure - Certificate of course completion. Board certification.
Popularity:
Several dozen certified practitioners in the U.S.
Over 1000 physicians in Europe formally practice anthroposophical medicine.
Uses - Variable. In a prospective observational study in 717 outpatients with chronic disease, those using anthroposophic therapy had fewer symptoms, an improved quality of life, and cost reductions in total health costs, starting in year two, primarily due to reductions in inpatient care (BMC Health Services Research. 2006. 6. 65).
Physicians Association of Anthroposophical Medicine
7953 California Ave.
Fair Oaks, CA 95628
Aromatherapy
Descriptive definition
The essential oils from plants or flowers are inhaled or massaged into the skin to treat ailments.
Essential oils are volatile and fragrant substances produced during the process of photosynthesis.
By definition, essential oils are less than 350 atomic mass units in weight, which means that they are readily absorbed through the skin and in the lung alveoli.
The purpose of essential oils in nature is to attract beneficial insects, repulse or kill pathogenic agents, and block germination of other plants with which they are competing.
History
The earliest recorded use of aromatic plant formulations in France dates to the 14th Century.
The more formalized science of essential oil pharmacology became established in the 17th Century.
Modern essential oil therapy was founded in by Maurice Gattefosse, a French chemist, who published his research in 1931. These oils are at least 20% concentrated, sometimes even undiluted.
Pierre Franchomme introduced the concept of biochemical specificity, also called chemotype, based on the recognition that the same aromatic plant (i.e. genus and species) may produce a somewhat different aromatic components base on the climate and season in which the oil is harvested. This can be quantified with gas chromatography and mass spectroscopy.
The English tradition of aromatherapy, pioneered by Marguerite Maury, is based on external use of vegetable oils blended with 2-3% essential aromatic oils.
Education - Correspondence courses or seminars.
Licensure - None. Numerous certifying organizations.
Popularity - Unknown.
Uses – Multiple, especially if pure essential oils are utilized (French tradition).
Antimicrobial – direct effects on microbes (especially thyme and oregano, also Eucalyptus and Ravensare), direct action on the ‘terrain’ by lowering the pH, indirect action on the terrain.
Anti-anxiety – especially lavender
Migraine – peppermint.
Safety - Very safe if high quality oils are utilized.
BEWARE though that essential oils are extremely concentrated – on average, 125 pounds of plant material are utilized to make one pound of essential oil.
Case reports of prepubertal gynecomastia linked to lavender and tea tree oils. In addition, studies in human cell lines indicated that the two oils had estrogenic and antiandrogenicactivities (N Engl J Med. 2007. 356. 479-485).
Quality issues
If plants are not grown organically, pesticides and herbicides may be present in the essential oils.
If the oils are extracted using chemical solvents, there may be residual solvent in the final product - ideally oils are extracted using steam distillation. Another option is cold-pressed oils.
Label should include full botanical identification, including genus, species, and chemotype.
Oils may be contaminated with bacteria which can cause infection - melioidosis is an uncommon infection typically associated with exposure to soil and water in tropical and subtropical environments. A cluster of four cases of non-travel associated melioidosis in 4 distinct states (Georgia, Kansas, Minnesota and Texas) were caused by the same strain of bacteria as was linked to an aromatherapy spray product (Better Homes and Gardens brand, labeled as containing lavender and chamomile) imported from a melioidosis-endemic area. In these four cases, two patients died and the other two experienced longstanding debilitation from the infection (Brief Report. Gee JE et al. New Engl J Med. 2022. 386. 861-868).
Sources touted to have high quality aromatic oils: www.florihana.com, www.ancientlegacy.com, www.juliarosebotanicals.com, www.aromapediatric.com, www.elizabethvanburen.com, www.floracopeia.com, www.originalswissaromatics.com and www.omnessence.net.
National Association for Holistic Aromatherapy
3327 W. Indian Trail Road PMB 144
Spokane, WA 99208
509-325-3419
Ayurvedic Medicine
Descriptive definition - Comprehensive system based on the belief that illness is influenced by the way one experiences life, and that all disease begins with imbalance in the consciousness of the individual. The focus is on maintaining balance to prevent illness. Ayurveda literally means knowledge and wisdom of life.
Ones individual constitution (prakruti) is made up of a combination of three doshas, or energy types - vata, pitta, and kapha.
Diagnosis involves a thorough personal and family history, along with exam of the tongue, nails, and pulse in 6 places on each wrist.
Treatment includes massage, Ayurvedic physical therapy, yogic postures, meditation, herbs, diets, and aromatic scents in combination, based on body type, to bring the doshas into balance. Results are often not seen for weeks to months.
History - 5,000 years old; traditional healing system of India.
Education - 8 month - 2 year course in United States. Six years of study in India.
Licensure – in 2011, the National Ayurvedic Medical Association is moving toward standardized credentialing.
Popularity – in 2011, 30 Ayurvedic training programs in the US, with several thousand practitioners.
Cost (in 1995) - Average cost of initial visit is $100 - $150, for a 30 -60 minute visit.
Ayurvedic Institute
11311 Menaul NE, Suite A
Albuquerque, NM 87112
505-291-9698
American Ayurvedic Association
877-598-8830
National Ayurvedic Medical Association (NAMA, founded in 2000)
Bach Flower Essences
Descriptive definition:
Use of dilute preparations of spring water energized by flower petals floating in a vessel and exposed to sunlight. Typically brandy is added to the water before it is diluted.
An alternate method of preparation is to boil the flowers and stems in spring water and then to add brandy and dilute.
The rationale is that all emotions and all flower essences are associated with a specific frequency of vibration.
Through a process of synchronization, the proper flower essence can produce the emotion which vibrates at the same frequency.
There are 38 remedies, and Rescue Remedy, widely available, is a combination of 5 remedies.
History:
Developed by Edward Bach, M.D. in England in 1930's.
Through observation he classified common negative states of mind.
Bach discovered for each negative state of mind the corresponding flower which helped to eliminate the negative mood.
The experience - The consumer can use a self-help questionnaire to assist in the selection of remedies.
Safety - Very safe.
Flower Essence Society
P.O. Box 459
Nevada City, CA 95959
800-736-9222
Bee Venom Therapy (Lobay, Douglas ND. Townsend Letter. July 2020. 54-56)
Descriptive definition - the venom of honeybees is collected, purified, and sterilized; and then administered as intracutaneous or subcutaneous injections.
History - Charles Mraz in the late 1990’s was the pioneer beekeeper who championed the use of bee venom therapy.
Proposed mechanism of action - bee venom is a potent anti-inflammatory and analgesic
Scientific database - a Pub Med Search in 2020 yielded 1600 articles, with research conducted in China, Russia, Korea, Eastern Europe, and more recently in France, Germany and Switzerland.
Safety - risk of anaphylactic reactions is low. Practitioner should be trained in administration of epinephrine, corticosteroids, and antihistamines in the event an anaphylactic reaction occurs. Single, small test injection is recommended, prior to proceeding with multiple injections.
Potential uses
Bursitis - typically involves one session of one to four stings
Multiple sclerosis - typically involves 10 - 40 stings per session and sessions 2 - 3 times per week
Osteoarthritis - typically involves 2 - 6 weeks of bee venom therapy
Rheumatoid arthritis - typically involves 4 - 12 weeks of bee venom therapy
Tendinitis - typically involves one session of one to four stings
Biofeedback
Descriptive definition - A dynamic combination of learning processes and procedures in which the patient and the therapist receive objective information about the immediate status of a physiologic parameter (i.e. bodily process).
History:
Pioneered by O. Hobart Mowrer in 1938.
Initially used for bedwetting in children.
Popularized in the late 1960's in the U.S. at the Menninger Foundation.
Education - Bachelors degree or Associate degree in nursing is a prerequisite, then 60 didactic hours, 140 clinical hours.
Licensure - Certification based on written plus practical examination.
Popularity - Approximately 1700 certified practitioners.
Uses - Insomnia, chronic pain, and tension headache pain, based on the 1995 recommendations of a 12 member NIH Consensus conference.
Breath biofeedback for asthma, anxiety, and hyperventilation.
EEG biofeedback – ADHD, seizures
Electrodermal (also called galvanic skin response or GSR, measures sweat activity) biofeedback for anxiety, hyperhidrosis, phobias, panic attacks, stuttering.
EMG (muscle activity) biofeedback for asthma, diabetes, headache (tension), incontinence, muscle injury, pain (chronic), and general relaxation.
Finger pulse biofeedback for hypertension, anxiety, and arrhythmias.
Heart rate variability biofeedback – anxiety
Thermal (peripheral temperature) biofeedback for anxiety, hypertension, migraines, Raynauds, and general relaxation.
Safety - Very safe.
The experience:
Subject sits in front of a machine with wires running from the machine to the body, to allow for monitoring muscle tension, heart rate, and blood flow.
The machine provides feedback in the form of beeps, pictures, or lines to let one know how well one is relaxing, or controlling body temperature.
Cost (in 1995) - $75 - $150/hour with sessions usually in increments of 15 minutes. Typically, 6 - 20 sessions are necessary.
Supplies:
Order temperature bands and Biodots from www.stens-biofeedback.com or 1-800-366-2084.
Biodots also available at 800-272-2340.
Order thermometers from 1-937-322-4972.
Order Freeze Framer Interactive Learning System from HeartMath Institute, www.freezeframer.com for $295 for home use, especially to improve heart rate variability. Consumer Reports on Health reports that maintaining required scores produced anxiety in some staff volunteers who tried the program.
Order a biofeedback-based computer game called The Journey to the Wild Divine from www.wilddivine.com for $160. Consumer Reports on Health reports that the slow pace frustrated some staff volunteers who tried the program.
Order StressEraser from www.stresseraser.com for $299 – does not require a computer for use.
Biofeedback Certification Institute of America
10200 West 44th Ave., Suite 310
Wheat Ridge, CO 80033
303-420-2902
www.bcia.org
Chelation Therapy (Marcolina ST. Chelation Therapy for Treatment of Atherosclerosis: A Medical Bypass? Alt Med Alert. 2005. 8. 73-84)
Descriptive definition - Intravenous or oral administration of a synthetic amino acid such as EDTA or DMSA or DMPS to rid the body of unnecessary toxic metals, such as aluminum, iron, and lead; or to reverse the process of atherosclerosis via a variety of theoretical but unproven mechanisms (i.e. remove calcium in fatty plaques, stimulate the release of a hormone that causes calcium to be removed from plaques or a lowering of cholesterol levels, reduce oxidative stress and thus inflammation). The chelating substance binds to molecules and holds them tightly so they can be removed from the body via the kidneys. Other vitamins or minerals may be added to the intravenous solution, to theoretically make the solution more effective, or to make the infusion safer.
Mechanism of action: uncertain.
Hypothesized that benefit is secondary to chelation of excess iron, copper, and heavy metals (lead, mercury, cadmium) leading to less free radical generation and less lipid peroxidation, and thus less endothelial dysfunction.
In practice, chelation therapy is administered in conjunction with a variety of intravenous and oral vitamins and minerals.
History:
By 1948, EDTA was used successfully and safely to treat lead poisoning. It was approved for this purpose by the FDA in 1953. One of the earliest reports of success was published in the Medical Annals, District of Columbia, in 1952.
The historical basis of use for atherosclerosis is observations in the 1950s that individuals with angina who were treated for lead poisoning experienced relief of angina. The initial reports describing benefit of chelation for cardiac symptoms were written by a Detroit cardiologist, Norman E. Clarke, MD in 1955.
EDTA was listed in the late 1950’s editions of the Physician’s Desk Reference as ‘indicated’ for the treatment of peripheral vascular disease; this indication was removed based on stricter criteria for approval of drugs after the introduction of the 1962 Kefuaver-Harris Amendment to the Federal Food, Drug and Cosmetic Act.
In 1989, the American College for Advancement of Medicine (ACAM) established a protocol for use of EDTA for chelation therapy. This protocol was updated in 1996.
EDTA is approved today by the FDA as a food additive which is generally recognized as safe (GRAS).
Education - Workshops for physicians.
Licensure - Certification by the American Board of Chelation Therapy based upon written and oral examination.
Popularity - 160 certified physicians in the U.S. in 2005. Estimated in 1993 that 500,000 Americans per year undergo chelation therapy.
Uses (Note oral EDTA poorly absorbed from GI tract; approximately 5% absorption): Most indications are based on anecdotes, small uncontrolled case series, and theoretical rationale
Coronary artery disease
Peripheral vascular disease
Atrial fibrillation – anecdotes of return to and maintenance of sinus rhythm
Macular degeneration – anecdotes of reversal of legal blindness
Scleroderma
The evidence
Ernst in a literature review identified 22 studies of chelation and CAD, but none had control groups (Am Heart J. 2000. 140. 139-141).
A Cochrane review found no evidence of efficacy in atherosclerosis (Cochrane Databses Syst Rev. 2004. CD002785).
Consumer Reports on Health, 8/02, page 7 concludes that the potential risks outweigh the benefits based on current data.
The few, small, randomized, controlled trials have been negative.
Randomized, controlled trial of 159 patients with peripheral vascular disease (J Intern Med. 1992. 231. 261-267).
Randomized, controlled trial of 32 patients with peripheral vascular disease (Circulation. 1994. 90. 1194-1199).
Randomized, controlled trial of 78 patients with documented stable coronary artery disease (JAMA. 2002. 287. 481-486).
TACT - $30 million, NIH-funded, 5-year, randomized, double-blind, placebo-controlled 2 x 2 factorial trial, with an oral and intravenous vitamin regimen, along with intravenous chelation and placebo, in post MI patients over age 50, conducted at 134 clinical sites. In 1708 stable patients, intravenous chelation modestly reduced the risk of adverse cardiovascular outcomes. Treatment groups received a total of 40 chelation treatments (JAMA. 2013. 309. 1241-1250).
Safety:
Most common side effect is burning at infusion site.
Other side effects included infusion site phlebitis, prolongation of clotting times, hypotension, hypocalcemia, bone marrow depression, malaise, fever, headache, nausea, and emesis. These are uncommon if ACAM protocol is followed.
Occasionally, patients appear to have an “allergic” reaction; anecdotally supplementation with molybdenum may blunt future ‘allergic” reactions.
Renal toxicity was seen historically with 5 gram doses but is uncommon with 3 gram dosage currently specified by ACAM protocols.
The experience:
The patient reclines and an intravenous solution is administered over approximately three hours.
One to three treatments/week, with each lasting 3.5 – 4 hours.
Cost (in 1995):
$75 - $125 per session.
Number of treatments required to achieve optimal benefit is generally considered to range from 20 – 40.
The American Board of Chelation Therapy
1407-B North Wells Street
Chicago, IL 60610
312-266-7246
800-356-2228
Website not found 12/2015
American College of Advancement in Medicine
24411 Ridge Route, Suite #115
Laguna Hills, CA 92653
800-532-3688
American Board of Clinical Metal Toxicology
1407½ North Wells Street
Chicago, Illinois 60610
312-266-3688
800-356-2228
Chiropractic (D.C.) (Altern Med Alert. 2005. 8. 133-138)
Descriptive definition - All diseases result from vertebral misalignments and can be cured by vertebral adjustments, using high velocity movements. Theory is that removing subluxations allows for optimal nervous system function and thus allows the body’s self-healing mechanisms to operate optimally.
Philosophical split into two factions early in the history of the profession – “straight” chiropractors who adhere to the above theory that all disease is due to joint dysfunction versus “mixers” who incorporate other theories of health and disease.
Proposed new definition by “mixers” - specialized health science which focuses on the differential diagnosis and treatment of functional disorders of the nervous system.
History:
Spinal manipulation has been used in medical practice since at least the time of Hippocrates.
Chiropractic as a modality was founded by Daniel David Palmer, a magnetic healer, in 1895, when a spinal adjustment on a deaf man reportedly restored his hearing.
Guided by Palmer's son, B.J. Palmer, until 1960, with an emphasis on advertising gimmicks and mail-order diplomas.
Guided by Palmer's grandson, David Daniel Palmer, after 1960, with re-organization on a more professional basis. In 1997, a research center was established at the Palmer College of Chiropractic in Davenport, Iowa.
Treatment first covered by Medicare in 1972.
In 1987, a U.S. District Court judge ruled that the AMA was in violation of the Sherman Antitrust Act in terms of the efforts by the AMA to prevent physicians from associating with chiropractors.
Education:
Two years of college is required for admission
In 2005, 5 years of chiropractic school, including 4000 hours of basic science instruction and 1000 hours of clinical internship
Older chiropractors with less education may have been "grandfathered".
Licensure
State and National board exams, with the national exam a three part exam given under the auspices of the National Board of Chiropractic Examiners.
First licensed in 1904 in Illinois, now licensed in all 50 states and D.C. Scope of practice varies from state to state.
All 50 states also have continuing education criteria for license renewal.
Popularity:
81,000 chiropractors in 2015 – third largest group of health providers in the U.S. (there a more M.D.’s and LMT’s).
17 accredited schools of chiropractic in 2015, with a total of 2000 graduates per year.
19 million Americans visited chiropractors in 1990. In 2015, estimated that chiropractors see 14% of the adult population annually.
160 million visits were made to chiropractors in 1992. 190 million visits estimated in 2005.
31% of Americans have seen a chiropractor at least once (1990 data).
In a 2002 National Health Interview Survey of 31,044 adults, 7.5% saw a chiropractor in the previous 12 months.
Safety:
Severe adverse effects (vertebrobasilar stroke) for cervical spine manipulation estimated at 6.39 per 10,000,000 manipulations (Principles and Practice of Chiropractic. 1991; Ann Intern Med. 1998. 1. 61-66; Stroke. 2001. 32. 1054-1060).
Severe adverse effects (cauda equina syndrome) for lumbar spine manipulation estimated at 1 per 100,000,000 manipulations (Spine. 1992. 17. 1469-1473; Ann Intern Med. 1998. 1. 61-66).
For comparison purposes, the rate of serious adverse effects for spinal surgery is 15.6 per 1000 surgeries; the rate of serious adverse effects for NSAIDs is 3.2 per 1000 subjects (Ann Intern Med. 1998. 1. 61-66).
Contraindications: rheumatoid arthritis with ligamentous laxity, bleeding disorders or anticoagulation therapy, acute fractures, bone tumors, severe osteoporosis.
Uses:
Back pain:
A RAND Corporation review published in 1992 concluded that although several of the studies had poor research design, spinal manipulation hastens recovery and decreases lost work time for acute, uncomplicated low back pain.
The U.S. Agency for Health Care Policy and Research concluded in 1994 that spinal manipulation is effective for treatment of acute low back pain (Clinical Practice Guideline No. 14. Publication # 95-0642). The British Clinical Standards Advisory Group came to a similar conclusion in 1994.
Another review concluded there was limited evidence to suggest that spinal manipulation is more effective than placebo, physical therapy, and exercise in the treatment of acute low back pain (Spine. 1997. 22. 2128-2156).
A review of the English language literature found 73 randomized clinical trials, 43 of them focusing on back pain, of which 30 were positive, with the magnitude of the benefit characterized as clinically and statistically significant, but not dramatic (Ann Intern Med. 2002. 136. 216-227).
In a large RCT in 672 patients done at UCLA, satisfaction was significantly higher (p <0.001) in those randomized to receive chiropractic care (Am J Public Health. 2002. 92. 1628-1633).
A meta-analysis of 39 RCTs (n=5486) found spinal manipulation therapy effective for acute and chronic low back pain (Ann Intern Med. 2003. 138. 871-881).
A systematic review of 43 RCTs concluded that there is limited to moderate evidence that spinal manipulation is better than physical therapy and home back exercises for chronic low back pain (Spine J. 2004. 4. 335-356).
The U.K. BEAM trial, a multicenter RCT (n=1334) with rigorous methodology found that patients randomized to spinal manipulation with and without exercise experienced the most benefit at 3 and 12 months of follow-up, and that spinal manipulation was the most cost effective therapy (BMJ. 2004. 329. 1381).
A clinical prediction rule has been developed to predict those patients most likely to benefit from spinal manipulation for back pain – the five criteria which predict a positive response include (1) duration of current episode of low back pain < 16 days, (2) no symptoms distal to the knee, (3) FABQ work subscale score (a fear-avoidance measure) < 19 points, (4) at least one hypomobile segments in the lumbar spine, and (5) at least one hip with > 35 degrees of internal rotation range of motion (Spine. 2002. 27. 2835-2843).
A multi-center RCT in 131 consecutive patients with low back pain evaluated in physical therapy clinics validated the above prediction rule (Ann Intern Med. 2004. 141. 920-928).
Consider for arthritis, asthma, carpal tunnel syndrome, headaches, irritable bowel syndrome, and vertigo, based on uncontrolled data.
The experience:
Lie on a padded table.
Adjustment involves quick, smooth hand movements by the practitioner, is usually painless, and may be accompanied by a popping sound.
Cost (in 1995) - Usually about $50-$60 for an initial visit and $30 for a follow-up.
American Chiropractic Association
1701 Clarendon Blvd.
Arlington, VA 22209
703-276-8800
Cranial Therapy (Craniosacral Therapy)
Descriptive definition - manipulation of the joints of the skull and the sacrum (tailbone) improve health, based on the premise that the central nervous system is in constant, rhythmic motion, manifested in part by motion of the joints linking the bones of the skull and motion of the sacrum.
History - Developed by William Sutherland, D.O. in the early 1900's. Now characterized by several different styles, and also practiced by physical therapists, body workers, as well as osteopathic physicians.
Uses - Variable, but especially useful in serous otitis media in children.
The Cranial Academy
8202 Clearvista Pkwy #9-D
Indianapolis, IN 46256
317-879-1881
Cupping [see also ‘Traditional Chinese Medicine’ section below in this outline]
Descriptive definition - placement of special cups over areas of pain or restriction, with creation of negative pressure (vacuum) to disrupt stagnation
History
This practice was used millennia ago in China, Egypt, Europe, and Greece, amongst other places.
There is a reference to cupping and an ejection medical text dating back to 1500 BC.
Historically the cups were made of bamboo, ceramics, horn, glass, metal; in modern times cups are made of plastic or silicone
Uses - anorexia, constipation, irregular menses, pain, pulmonary issues, vertigo
Techniques
Wet cupping involves breaking of the skin with pinpricks or a scalpel, placing a cup over the area, and creating suction.
Dry cupping involves creation of a vacuum with a cup, without breaking of the skin.
Static technique involves placing the cup in one spot and leaving it there for 3-15 minutes.
Gliding technique involves application of some type of lubrication such as massage or coconut oil, creation of a vacuum seal, then lifting of the cup and a gliding movement along areas of tension, theorized to trigger release of fascial constrictions
Reference: Cupping Therapy. Holistic Primary Care. Winter 2022. Page 8
EMDR (eye movement desensitization and reprocessing)
Descriptive definition – a method of psychotherapy; a set of standardized protocols that incorporates elements from many different treatment approaches. It is based upon the observation that by moving the eyes in a certain way, negative feelings associated with particularly disturbing memories diminish. Mechanism of action is not understood.
History – Discovered ‘accidentally’ in the late 1980’s by Francine Shapiro, MD
Certification
Basic EMDR training is available only to students enrolled in a Master’s or Doctorate level program in the mental health field or psychiatric nursing, licensed medical doctors with specialty training in psychiatry, licensed registered nurses with a Master’s Level psychiatric nursing degree, licensed mental health clinicians who have completed a Master’s level or Doctorate level Graduate Program with a focus in the mental health field. All eligible students and licensed health care professionals must then submit to EMDRIA detailed information which is carefully reviewed and verified as a condition of acceptance into a training program. The specific criteria for entry into a basic level training program are outlined at www.emdria.org under the heading of ‘Training & Certification’ and the topic ‘Basic EMDR Training – Eligibility Requirements.’
Certification requires evidence of completion of EMDRIA approved training, evidence of a license/certification/registration as a mental health professional, and then notarized proof of various specific types of experience in the field, with all details listed at www.emdria.org under the heading of ‘Training & Certification’ and the topic ‘Certification in EMDR.’
Popularity – it is estimated by the EMDR International Association that more than 2 million individuals have experienced EMDR as of 2006.
Uses – PTSD, unresolved grief, eating disorders, addictions, body image disorders, generalized anxiety, based on anecdotes.
The experience – patients are asked to recall a painful memory, or pay attention to a powerful emotion they are experiencing not necessarily attached to a memory, while following the therapists fingers back and forth, or listening to alternating tones in headphones. The patient engages in mindfulness, observing and feeling ‘whatever comes up’ without reacting to it. During short breaks, the patient tells the therapist what they are feeling.
EMDR Institute
831-761-1040
EMDR International Association (EMDRIA)
866-451-5200
Emotional Freedom Technique (EFT)
Descriptive definition – stimulation of well established energy meridian points on the body by tapping on them with the fingertips. This may be thought of as acupuncture without the needles.
History – founded by Gary Craig, a Stanford engineering graduate and an ordained minister.
Education – manuals, DVDs, workshops
Uses – pain, anorexia, anxiety, depression, OCD, PTSD
Training
EFTonline.org ACEP’s (see Energy Psychology just below) online EFT training program w/live small group practice session
Eftonline.org/free Free Masterclass on EFT
EFT
PO Box 269
Coulterville, CA 95311
Energy Psychology
Defined as “a family of focused and brief approaches to shifting dysfunctional flows of energy and information in the mind-body system that usually is the result of unresolved small “t” or big “T” trauma” (Robert Schwarz, PsyD, AIHM conference presentation October 30, 2021).
“Energy psychology theory suggests that psychological problems are a reflection of disturbed bio-energetic patterns within the mind-body system—a system that involves complex communication between a person’s neurobiology and their cognitive-behavioral-emotional patterns.”
“Energy psychology practitioners combine cognitive interventions (including focused awareness, imaginal exposure to traumatic memories) with the simultaneous stimulation of one or more of the human bio-energy systems such as meridians, chakras and biofields.”
Evidence base (2021): 75 RCTs, 50 outcomes studies, 5 meta-analyses (4 show large effect size and 1 shows medium effect size) - Robert Schwarz, PsyD, AIHM conference presentation October 30, 2021.
Top 5 Energy Psychology Approaches
Emotional Freedom Technique (EFT) - see just above for a bit more detail
Thought Field Therapy (TFT)
Tapas Acupressure Technique (TAT)
Advanced Integrative Therapy (AIT)
Comprehensive Energy Psychology (CEP)
Association for Comprehensive Energy Psychology (ACEP)
Environmental Medicine
Descriptive Definition:
Study of the interface among food, chemicals, inhalants, and the biologic function of the individual.
An approach to medical care dedicated to the evaluation, management, and prevention of adverse consequences resulting from environmentally triggered illnesses.
History:
Founded by Theron Randolph in the 1940's.
Knowledge now disseminated in a peer-reviewed journal, Environmental Medicine.
Education - M.D. or D.O.
Popularity:
Practiced by 3000 physicians world wide in the 1990's.
Several environmental control units in the United States and Canada.
Uses - Multiple chemical sensitivities.
American Academy of Environmental Medicine
7701 E Kellogg Dr Suite 625
Wichita KS 67207
316-684-5500
Feldenkrais
Descriptive definition - The practitioner actively directs the clients body through movements individualized to ones particular needs, teaching the client how to improve breathing and posture.
History - Developed by Moshe Feldenkrais, a physicist.
Education - 200 hours per year for 4 years (800 hours total).
Licensure - Trade name certified by Feldenkrais Guild.
Popularity - Approximately 1200 certified practitioners in the United States.
Safety - Very safe.
Uses - Cerebral palsy, stroke, fibromyalgia, improvement in balance in elderly community dwelling subjects (pilot study in 26 subjects reported in Evid Based Complement Alternat Med. Epub 6/24/09).
Feldenkrais Guild
3611 SW Hood Ave., Suite 100
Portland, OR 97239
866-333-6248
Guided Imagery
Descriptive definition:
A trained practitioner (or an audiotape) helps a person to achieve a state of deep relaxation characterized by physiologic changes opposite to those invoked by the fight-or-flight response; and in this state to visualize healing images. This is a kind of directed daydreaming.
The physiologic changes include decreased oxygen consumption, decreased metabolic rate, alpha waves on EEG tracings, decreased blood lactate levels, decreased heart rate, decreased respiratory rate, and possibly decreased blood pressure.
These are the same physiologic changes which are associated with meditation.
Interactive guided imagery is a term coined by the Academy for Guided Imagery, and designates a process in which imagery is used in a highly interactive format to evoke patient autonomy. This gives patients tools for drawing on their own inner resources to support healing, to make appropriate adaptations to their changes in health, and to better understand what their symptoms may be signaling.
History – developed and refined by Roberto Assagioli in a popular book (The Act of Will) published in 1980.
Education – 150 hour certification program available to licensed health professionals who wish to practice interactive guided imagery.
Safety – very safe, but relatively contra-indicated in those with psychosis, dissociative disorders, and borderline personality disorder.
Uses
Stress reduction, pain relief, management of chronic illness, preparation for surgery, end of life care, infertility, grief therapy, PTSD, anxiety, depression.
A review of ‘Guided Imagery for Treating Pain’ can be found in Alternative Medicine Alert. 2005. 8. 103-106.
Academy for Guided Imagery
1-800-726-2070
Herbalism
Descriptive definition - Use of natural plant substances including flowers, fruit, leaves, roots, seeds, and stems to treat illness.
History - As old as civilization
Education - No formal criteria.
Licensure - No formal criteria.
Popularity – return to Home Page and click on ‘Herbal Medicine” for specifics.
Uses - Variable.
Safety - Unknown.
The American Herbalist Guild
P.O. Box 1863
Sequel, CA 95073
www.americanherbalistsguild.com
American Botanical Council
Box 201160
Austin, TX 78720
512-926-4900
www.herbalgram.org
Homeopathy
Descriptive definition:
Symptoms can be eliminated and disease cured if the patient takes infinitesimal amounts of substances that, in larger amounts, would produce the same symptoms.
The substances are derived from plants, animals, and minerals, then serially diluted using a method of vigorous shaking and tapping called succussion.
Homeopathy works by bringing about changes at an energetic level.
The fundamental principle is that the body's symptoms represent the body's effort to heal itself; the infinitesimal dose of homeopathic remedy stimulates the body to heal itself.
A homeopathic nosode is a diluted remedy that takes an energy imprint from a disease such as tuberculosis.
A homeopathic miasm is the energy residue from a previous disease
Basic tenets of homeopathy:
“Principle of similars”
“Like cures like" (similar to the principle of vaccinations and allergy desensitization).
"Large doses of a poisonous substance may prove lethal, small doses of the same poison can actually stimulate vital cellular activity"
"Whatever symptoms a substance causes in a healthy person, a disease with a similar symptom configuration can be cured by small amounts of the same substance"
“Law of infinitesimals”
The more dilute the remedy, the more potent it is.
Most remedies are more dilute than Avogadro's Limit of 6.02 x 1023.
Classic laws of chemistry say nothing is left but water.
Homeopaths say the water has an energy pattern which is the basis of treatment, that the water is biophysically different.
Theoretic proof for this law comes from Bell's Theorem, postulated in 1964.
Related to the “Law of infinitesimals” is the principle of “Minimal dose” – practitioners employ as few doses of the remedy as necessary to produce a healing response.
“Law of chronic disease” - Many homeopaths do not subscribe to this belief.
When homeopathy fails, it is because allopathic treatment has driven the disease too deeply into the body.
Alternative description - the principle that remedies are most effective when they are selected based on the total characteristic set of symptoms, not just those of the disease (Homeopathic Physician. 1885. 5. 346-351).
History:
Thousands of years old
Systematized by Samuel Hahnemann, who obtained his M.D. degree in 1779, and became recognized by 1790 as one of the most distinguished physicians of Germany, before becoming dissatisfied with the current mode of treatment.
Hahnemann’s method of gathering data was observation - identifying the medicinal characteristics of various substances by administering the substances in potent amounts to healthy volunteers and observing the symptom complex created. Hahnemann was his first subject in this process. “Provings” is the label applied to the potent strengths of plant, animal, or mineral substances which are administered to healthy volunteers as part of the data-gathering process.
Historically, Hahnemann for the first 20 years used mostly 1:10 dilutions, but as he experimented with greater dilutions in individuals who experienced adverse effects with 1:10 dilutions, he observed that not only were adverse effects less common, but the greater dilutions were more potent.
In 1796, Hahnemann published his initial findings in a paper entitled "Essay on a New Principle for Ascertaining the Curative Power of Drugs."
Organon, the basic text, was published in 1810 by Hahnemann.
More successful than allopathy for treatment of cholera - during the epidemic of 1853, homeopathic hospitals had dramatically lower mortality rates than allopathic institutions (British Homeopathic Journal. 1994. 83. 117-121).
22 colleges in the U.S. in 1900, and 15,000 practitioners - a sixth of the U.S. medical profession
In 1903, after a long antagonism, the AMA invited homeopaths to join.
In the US, decline in popularity followed the release of the Flexner Report in 2010. There were only 2 colleges still in existence in 1923 (Time. 9/25/95. 47-48), and then none for years.
Resurgence of popularity in the U.S. in the 1990's, but with most use of homeopathy involving self treatment with over the counter remedies, rather than a visit to a homeopathic practitioner. Those in the U.S. who do go to a practitioner tend to be young, white, and affluent, with a multitude of subjective symptoms (Arch Fam Med. 1998. 7. 537-540).
History lesson - good evidence from randomized, controlled trials does not imply acceptance by physicians. For many physicians, the belief that homeopathy cannot work because it is not consistent with the laws of science overrules the evidence that homeopathy in some circumstances does work.
Education - Tremendously variable. 14 schools in the U.S. in 2001, but only 4 accredited.
Licensure/Regulation
Licensure of practitioners
Only 4 states in 2005 licensed homeopathic practitioners.
The American Board of Homeotherapeutics does provide board certification for licensed medical doctors.
There are several boards for certification of health care professionals who do not have a M.D. or D.O. degree.
Regulation of homeopathic remedies - remedies in the U.S. are regulated by the Food and Drug Administration as OTC medications, based on the Food, Drug, and Cosmetic Act of 1938. The chief architect of this bill in the Senate was Dr. Royal Copeland, who was a homeopathically trained physician, and by defining drugs in this Act as “articles” recognized in “official compendia,” which included the Homeopathic Pharmacopeia of the United States, homeopathic remedies were placed into the same regulatory category as prescription and OTC drugs (Robins, Natalie. Copeland’s Cure: Homeopathy and the War Between Conventional and Alternative Medicine. Knopf. 2005).
A spokeswoman for the FDA told Consumer Reports that the FDA in fact does not devote any resources to regulation of homeopathic remedies (Consumer Reports on Health. 4/08. 7).
Look for remedies with “HPUS” on their labels – this indicates that the remedies conform to the standards of Homeopathic Pharmacopoeia Convention of the U.S. (Consumer Reports on Health. 4/08. 7).
Popularity:
3000 practitioners in the U.S. in 1996, 6000 in 2001, including 500 physicians.
In 2005, more than 2500 remedies available.
Annual sales in the U.S. in 1995 were $165 million (Time. 9/25/95. 47-48).
Used by an estimated 500 million people worldwide.
India - dozens of homeopathic colleges, over 200,000 registered homeopathic physicians in 2022, with an additional 12,000 each year
In the 1990's, approximately 32% French family practitioners, 20% of German family practitioners prescribed homeopathic remedies.
Evidence for effectiveness:
Systematic reviews and meta-analyses which have found homeopathy more effective than placebo in RCT's.
A review of 107 published, controlled trials of homeopathy found that of the 105 trials that could be interpreted, 81 trials showed a positive effect. Most trials were of low quality, but there were exceptions (Br J Med. 1991. 302. 316-323).
A meta-analysis of 89 RCT's with adequate data for meta-analysis (out of 186 placebo-controlled trials published in the scientific literature) found that 73% of these trials found a greater-than-placebo action from homeopathy. The odds ratio was 2.45 (95% confidence interval of 2.05-2.93) in favor of homeopathy. The odds ratio for the 26 good quality studies was 1.66 (1.33-2.08). [Lancet. 1997. 350. 834- 843].
An independent review conducted by the Homeopathic Medicine Research Group at the request of the European Parliament found that the balance of evidence is in favor of homeopathy exerting a greater effect than placebo. A meta-analysis of 17 RCTs (2001 patients) deemed suitable for pooled analysis found a P value of 0.0003 in comparing homeopathy to placebo (Eur J Clin Pharmacol. 2000. 26. 27-33).
A review of studies and systematic analyses to date found that there is positive evidence for an effect of homeopathy beyond that of placebo (Jonas WB et al. A critical overview of homeopathy. Ann Intern Med. 2003. 138. 393-399).
Published studies of effectiveness in given conditions (see "Uses" below).
Laboratory investigation of ultra high dilutions of histamine on mast cell degranulation – results have been mixed, perhaps because minor variables influence outcomes.
Jacques Benveniste published in Nature in 1988 a paper reporting positive results – this paper was criticized when results could not be replicated.
Positive results were reported by Belon et al (Inflamm Res. 2004. 53. 181-188).
Negative results were reported by Guggisberg et al (Complementary Ther Med. 2005. 13. 91-100)
Uses: Remedies are usually recommended at a dose of 3-5 pellets three times a day. There are more than 8000 unique remedies in 2022.
Allergic asthma symptoms -
Effective based on the results of three independent, randomized, controlled trials including a total of 202 patients (Lancet. 1994. 344. 1601-1606; Lancet. 1986. II. 881-886; Br Homeopathic J. 1985. 74. 65-75).
Evidence inconclusive (Cochrane Database Syst Rev. 2000. CD000353).
Arthritis- evidence is inconclusive (Rheum Dis Clinics North Am. 2000. 26. 117-123).
Influenza
Effective for treatment based on a randomized, controlled trial with 237 experimental patients who received Oscillococcinum, a combined homeopathic remedy, and 241 controls, 17% of experimental patients recovered in 48 hours versus 10% of controls, based on recording of symptoms twice a day for a week (Br J Clin Pharmocol. 1989).
Cochrane review found evidence for effectiveness in treatment, but not prevention (Cochrane Database Syst Rev. 2000. CD001957).
Lung cancer (non-small cell, late-stage) - homeopathic treatment improved quality of life and mean survival in a 3-arm RCT in Australia of 150 patients. NOTE this study was done prior to the introduction of immune-oncologic conventional treatment (The Oncologist. 2020. 25. e1930-e1935).
Minimal brain damage - combination remedies are effective
Otitis media (acute) - individual remedies are effective
Pediatric diarrhea (acute) - effective based on a study in Nicaragua (Pediatrics. 1994. 93. 719-725), and a subsequent study was conducted in Nepal (J Altern Complement Med. 2000. 6. 131-139). A third trial was also positive (Pediatr Infect Dis J. 2003. 22. 229-234), and when combined with the two above positive trials (n=230) showed the duration of diarrhea to be 3.3 days in the treatment group and 4.1 days in the placebo group (p=0.008).
Postoperative ileus - evidence is inconclusive (J Clin Gastroenterol. 1997. 25. 628-633). a
NOTE that classic homeopathy does not prevent migraine (J Pain Symptom Management. 1999. 18. 353-357).
NOTE homeopathic Arnica montana does not alleviate delayed-onset muscle soreness after exercise (Perfusion. 1997. 11. 29-35).
Safety
Probably very safe because remedies are very dilute, but adverse effects have been reported.
Note homeopathic remedies do not have expiration dates, as the remedies are believed to maintain potency for decades
The experience - Remedies are packaged as tablets or liquid tinctures, and are taken by mouth.
Cost (in 1995) - Average of $137 for an initial visit of 60 - 120 minutes, $55 for a follow up, and $6 for a remedy.
References:
Bell IR. All evidence is equal, but some evidence is more equal than others: Can logic prevail over emotion in the homeopathy debate? J Altern Complement Med. 2005. 11. 763-769.
Eskinazi D. Homeopathy re-revisited: Is homeopathy compatible with biomedical observations. Arch Intern Med. 1999. 159. 1981-1987.
Reichenberg-Ullman, Judyth. Is Homeopathy Too Good to Be True? Townsend Letter. April 2022. 68-69
Reilly D. Homeopathy: increasing scientific validation. Altern Ther Health Med. 2005. 11. 28-31.
Shalts E. Homeopathy: A brief overview with examples. Altern Med Alert. 2006. 9. 17-24.
Film entitled Just One Drop: The Story Behind the Homeopathy Controversy at here
National Center for Homeopathy
801 North Fairfax, Suite 306
Alexandria, VA 22314
703-548-7790
American Institute of Homeopathy
888-445-9988
Hypnotherapy (Stewart JH. Hypnosis in contemporary medicine. Mayo Clin Proc. 2005. 80. 511-524)
Descriptive definition - Artificial induction (with the cooperation of the patient) of an altered level of consciousness in which an individual is extremely responsive to suggestion. Defined by Kohen and Olness in 1993 as “An alternative state of awareness, usually but not always or necessarily involving relaxation, in which the individual develops heightened concentration on a particular image or idea for the purpose of maximizing potential or achieving some specific goal.”
History - Thousands of years old
The era of modern hypnotism began with the Austrian physician Franz Mesmer, in the 1770s – the term at this time was mesmerism.
Approved by the AMA in 1958 as a valid treatment.
In 1996, a NIH Panel concluded hypnotherapy effective for alleviation of cancer pain (See ‘Uses’ below).
Education - Variable, generally a course less than 50 hours.
Licensure - None. Multiple organizations which certify based on a course, including American Society of Clinical Hypnosis (ASCH) and Society for Clinical and Experimental Hypnosis (SCEH).
Popularity - Approximately 15,000 physicians combine hypnotherapy with conventional treatment.
Mechanism of action – perception is altered, based on data obtained from studies using functional MRI and PET scanning. Hypnosis does not act as a placebo based on this data, and hypnosis is not a state of sleep. Research in 2021 is funded by the National Center for Complementary and Integrative Health (NCCIH).
Uses - Multiple, including dentistry. Note only approximately 85% of people are hypnotizable.
Allergy – suppression of immediate-type hypersensitivity reactions seen in 8 of 12 patients in one trial (Br Med J. 1963. 1. 925-929).
Analgesia – numerous studies – See Table 2 in article cited above.
Anesthesia for surgery or procedures – a review of more than 1650 surgical cases using hypnosis combined with other methods for conscious sedation found good evidence of safety and benefit (Acta Chir Belg. 1999. 99. 141-146). In one study in those undergoing upper endoscopy, only 2 of over 200 patients hypnotized were unable to complete the exam without intravenous sedation (Amer J Clin Hypn. 1998. 40. 284-287). In another study, a randomized, nonblinded, controlled trial of 241 subjects undergoing diagnostic percutaneous peripheral vascular procedures, pain increased linearly in the with the procedure time in the standard treatment group and the structured attention control group, but remained flat in the self-hypnotic relaxation treatment group (Lancet. 2000. 355. 1486-1490).
Anxiety - benefit reported in a meta-analysis (Int J Clin Exp Hypn. 2019. 67. 336-363).
Cancer pain – NIH Technology Assessment Panel concluded that there was “strong evidence for the use of hypnosis in alleviating pain associated with cancer” (JAMA. 1996. 276. 313-318).
Fractures - in a pilot study of 12 healthy subjects, those randomized to a series of 6 hypnotherapy sessions showed trends toward faster healing of bone fractures through 9 weeks after injury (Altern Ther Health Med. 1999. 5. 67-75).
Functional dyspepsia - in a study with 126 patients who received hypnotherapy, counseling, or Zantac for 16 weeks, 40 weeks after treatment ended the hypnotherapy group still had fewer symptoms than the other two groups (Gastroenterology. 2002. 123. 1778-1785).
Irritable bowel syndrome
A chart audit of 250 patients (200 female and 50 male) with IBS refractory to other treatment for 2 years showed that those who underwent 12 weekly hypnotherapy sessions over 3 months showed that other than the subgroup of males with diarrhea-predominant IBS, there was marked improvement in the patients in terms of IBS symptoms, quality of life, and degree of depression and anxiety (Am J Gastroenterol. 2002. 97. 954-961).
Other published reports showing benefit of hypnotherapy in IBS include (Curr Treat Options Gastroenterol. 2001. 4. 323-331 and Lancet. 1984. 2. 1232-1234). See also Table 5 in the article cited above.
Benefit reported in a systematic review (Int J Clin Exp Hypn. 2018. 66. 343-352).
Migraines - benefit reported in a systematic review (Int J Clin Exp Hypn. 2018. 66. 343-352).
Osteoarthritis pain - in a trial of 36 adults with osteoarthritic pain for an average of 13.7 years, hypnosis resulted in a 50% pain reduction at 4 weeks, compared to 15% in a wait list control group. This effect persisted for 6 months, and was associated with a reduced intake of pain medication after 8 weeks. In this same study, relaxation training also had a positive effect, but it was only 31% pain reduction at 8 weeks, compared to -4% in controls (Eur J Pain. 2002. 6. 1-16).
Safety - Can be very dangerous and subject to abuses by the practitioner. WHO states contraindicated in psychosis, organic psychiatric conditions, and antisocial personality disorders.
The experience - Typically weekly sessions of 60 to 90 minutes for 6-12 weeks.
Myths (Self Healing. 10/06. Pg 8)
You lose control or surrender your will – the person in a hypnotic trance is always in control.
You will lose consciousness or have amnesia – amnesia is rare.
Anyone who can be hypnotized is weak-minded or gullible – greater intelligence is associated with a greater likelihood of being hypnotized.
You may get stuck in a trance – the therapist at the end of the session offers suggestions to come out of the trance.
The American Institute of Hypnotherapy
2002 E Mcfadden Ave
Santa Ana, California 92705-4706
714-261-6400
Website not found 12/2015
American Society of Clinical Hypnosis
630-980-4740
The Society for Clinical and Experimental Hypnosis
Iridology
Descriptive definition:
Identification of potential diseases and internal imbalances by looking for distinct marks appearing on the iris of the eyes.
Iris maps correlate changes in the iris with abnormalities in different internal organs.
Rationale - The iris is mostly muscle, and the state of our nervous system is revealed in the state of our muscles.
History - Founded in 1881 by Hungarian physician, Ignatz von Peczely, M.D.
Education - Variable.
Licensure - No certification requirements. Skill of practitioners is variable.
Uses – Variable; with several published studies negative
Diagnosis of kidney disease – in a study in 143 patients, 48 of whom had medically diagnosed kidney disease, neither the 3 ophthalmologists nor the 3 iridologists were not reliably able to detect this condition by examination of the iris (JAMA. 1979. 242. 1385).
Diagnosis of gallbladder disease – 5 Dutch iridologists were unable to accurately diagnose this condition based on color slides of the right iris in 78 patients with the condition (Br Med J. 1988. 297. 1578-1581).
Diagnosis of breast, ovary, uterus, prostate, or colorectal cancer – in a prospective case-control study with 68 patients with histologically proven cancer and 42 controls, an experienced iridologist was able to accurately diagnose only 3 cases of cancer accurately (J Altern Compl Med. 2005. 11. 515-519).
LITERATURE REVIEW found that iridologists did not perform significantly better than chance (Ernst E. Iridology: not useful and potentially harmful. Arch Ophthalmol. 2000.118. 120-121).
Safety - Herbs used for treatment may be toxic.
The experience - The practitioner looks very closely at the subject's iris of the eye, using a magnifying glass and a flashlight.
National Iridology Research Association (iridologists’ service organization)
P.O. Box 31013
Seattle, WA 98103
206-282-6604
Website not found 12/2015
International Iridology Practitioners Association
PO Box 339
Pinehurst, TX
888-682-2208
Laser Therapy (low level) - see also ‘Photobiomodulation’ below
Descriptive definition
A light-based noninvasive therapeutic technique in which exposure to low levels of coherent red to near-infrared (NIR) light. Low-level laser radiation is a nonionizing form of radiation with no mutagenic effects which triggers intracellular pathways, modulating cytokine levels, growth factors, and inflammatory mediators. increased blood flow and lymphatic drainage are indirect effects (Review article. Altern Ther Health Med. 2016. 22 (6). 24-31).
Photons in these wavelengths are absorbed by cytochromes and porphyrins in the mitochondria, triggering the transient release of nitric oxide and increased ATP synthesis.
Photons in these wavelengths have been shown to have a variety of effects on the physiology of dysfunctional neurons.
Note laser is coherent light energy, which is very high frequency, in contrast to pulsed electromagnetic frequency (pEMF) treatments (see below in this outline) which are low frequency.
Laser energy is absorbed, with a shallow depth of penetration (and heats the tissue which absorbs the energy).
Uses
Burning mouth syndrome
Canker sore treatment
Herpes labialis prevention and treatment
Oral lichen planus
Oral mucositis
Magnets
Descriptive definition – externally applied static magnets are used to treat health ailments. It is hypothesized that these act either via induction of an electric current in soft tissue related to the ions associated with blood flow, and/or by desensitizing sensory neurons or modifying cell membrane potentials.
History – used for hundreds of years.
Education – variable.
Licensure – none.
Uses: Overall very little controlled data to support efficacy (Alt Med Alert. 2005. 8. 53-55)
Diabetic neuropathy
Fibromyalgia – mattress pads not shown to be more effective than sham pads in a study with 119 subjects (J Altern Complement Med. 2001. 7. 53-64).
Foot pain – magnetized insoles not found effective in an 8 week RCT in 101 adults in which the insoles were worn 4 hours per day, 4 days per week (JAMA. 2003. 290. 1474-1478 with a published correction in JAMA. 2004. 291. 46). Magnetic insoles not found effective in a second 8 week RCT in 89 adults in which the insoles were worn at least 4 hours daily, 4 days per week (Mayo Clinic Proc. 2005. 80. 1138-1145).
Knee pain – effective in a 2 week RCT in 43 subjects who wore pads containing either magnets or placebo (Altern Ther Health Med. 2002. 8. 50-55).
Knee osteoarthritis – found effective in the short term in a 6 week RCT in 26 subjects who wore a knee sleeve for 7-10 hours per day, with blinding successfully achieved by survey based on the use of a sham sleeve that radiated the magnetic field away from the joint (Altern Ther Health Med. 2004. 10. 36-43).
Low back pain – not found effective in a RCT with 24 subjects (JAMA. 2000. 283. 1322-1325).
Osteoarthritis – less pain in the treatment group wearing a magnetic bracelet for 12 weeks, but a survey done as part of the study showed that 1/3 of patients in each group could identify if they were wearing a standard or dummy bracelet, and effect of unblinding not calculated in report of benefit (BMJ. 2004. 329. 1450-1454).
Post-polio syndrome
Safety – probably safe based on low strength of magnetic field.
Cost (in 1995) - $10 for a bracelet to $500 for a mattress pad; available through web sites and independent distributors.
Massage Therapy (LMT)
Descriptive definition - Manipulation of soft tissues for therapeutic purposes. Stroking, kneading, tapping, friction, and range of motion stretches are designed to improve blood circulation and lymphatic flow, flush out metabolic toxins, improve muscle, connective tissue, and joint flexibility, and soothe the nervous system. Theory is to help the body heal itself by supporting systems that control circulation, immune response, muscle function, and nerve activity.
Styles of massage
Craniosacral - see separate section of this outline above
Myofascial release
Shiatsu - see separate section of this outline below
Swedish
Thai yoga Stacy Collier, LMT. Holistic Primary Care. Summer 2023. Page 13)
Administered on a matt on the floor, with the patient fully clothed
Incorporates energy work, acupressure, stretching, compression, and movements focused on increasing joint range of motion
Focus is compressing, pulling, stretching, and rocking the muscle
Practitioners typically do not apply oils or lotions
Theoretical mechanism of action - practitioner utilizes energy channels (meridians) and then uses acupuncture and other techniques such as "thumb chasing thumb"
This massage modality is suited for those who are healthy and/or athletic, and for those to desire to increase range of motion following an injury, surgery, or overuse
Certification in Thai yoga massage is available
This tyle of massage is typically not relaxing
Patient should wear light, loose clothing that can sustain movement
Typical sessions are 1-3 hours for a full body treatment
History:
Centuries old.
Abundant published research, especially at the Touch Research Institute in Miami, Florida.
Education - 7-8 months of full time courses. Most states specify a minimum of 500 hours. Schools are accredited by the Commission on Massage Therapy Accreditation (COMTA), which is part of the American Massage Therapy Association (AMTA). Approximately 1000 schools, only 42 accredited by COMTA in 2001. On line courses are available - information here
Licensure
Licensed in 33 states in 2006, 43 states in 2023.
16 states require passage of the National Certification Exam for Therapeutic Massage and Bodywork (NCETMB); 7 states have their own exam.
Numerous accrediting organizations exist; approximately half of massage therapists do not belong to any organization.
In states that don’t license massage therapists, credentials for the consumer to look for are either “professional level
membership in AMTA or national certification ,indicated by NCTMB.
Popularity
Approximately 75,000 LMT's in 1995, 250,000 in 2002.
In a 2002 National Health Interview Survey of 31,044 adults, 5.1% saw a massage therapist in the previous 12 months.
Safety - May be contra-indicated in people with psychological "boundary issues".
Uses: Back pain, cancer, fibromyalgia, headaches, post exercise muscle fatigue, premature babies, stress reduction, TMJ dysfunction, wellness.
Back pain
A study of 262 patients with chronic back pain randomized to receive Traditional Chinese Medicine acupuncture, therapeutic massage, or self-care educational materials showed that at 10 weeks, massage was superior to self care on the symptom scale (p=.01) and the disability scale (p<.001) [Arch Intern Med. 2001. 161. 1081-1088].
A parallel group, 10 week RCT in which 132 patients received structural massage, 136 received relaxation massage, and 133 received usual care showed that both massage groups had similar functional outcomes, which were better than functional outcomes in the usual care group, and also improvement in symptom scores as compared with the usual care group (Ann Intern Med. 2011. 155. 1-9).
Cancer – improves psychological well-being, coping styles, and anxiety, based on a 2005 Cochrane Collaboration review.
Premature babies - a study of 40 babies with low birth weight found that the 20 babies treated with daily massage had a 47% greater weight gain per day and stayed in the hospital 6 fewer days on average than the 20 control babies (Pediatrics. 1986. 77. 654-658).
Wellness
A study comparing 52 children and adolescents treated with massage therapy to a control group that watched relaxation videotapes found that the massage therapy subjects showed less depression and anxiety and had lower salivary cortisol levels (J Am Acad Child Adolesc Psychiatry. 1992. 31. 125-131).
A study of massage therapy in 18 elderly subjects found that treatment was correlated with physiologic signs of relaxation such as decreased blood pressure and heart rate and increased skin temperature (J Gerontol Nursing. 1987. 13. 32-35).
The experience - Relaxing experience which produces a state of bliss and a sensation of super-health or partial weightlessness after the session.
Cost (in 1995) - Usually $55-$70 for a one hour session.
American Massage Therapy Association
820 Davis St., Suite 100
Evanston, IL 60201-4444
877-905-2700
National Certification Board for Therapeutic Massage and Bodywork
Meditation - see the web page entitled Mind Body Spirit Medicine
Music Therapy
Descriptive definition: A systematic process of intervention wherein the therapist helps the client to promote health, using musical experiences and the relationships that develop through them" (J Music Ther. 1998. 35. 176-200).
Naturopathy
Descriptive definition:
The use of nature-based, noninvasive treatments such as massage, herbs, diet, exercise, hydrotherapy (water therapy) and homeopathy to help the body heal itself.
This is an eclectic approach - unifying principle is the healing power of nature, Vis medicatrix naturae
Core tenets (as specified in the Executive Summary of the White Paper published in 2021 by the Institute for Natural Medicine)
Comprehensive in its approach to whole health, whole person primary care.
Focused on addressing underlying causes of acute and chronic diseases.
Dedicated to health promotion, minimally invasive therapies, and reducing healthcare costs.
Individualized to engage patients and to support health-related lifestyle and behavioral change.
Six naturopathic principles of practice - guide the application of clinical theory to individual patients (White Paper published in 2021 by the Institute for Natural Medicine)
The Healing Power of Nature (Vis Medicatrix Naturae)
Identify and Treat the Causes
First Do No Harm
Doctor as Teacher (Docere) - this is the primary principle which guides naturopathic physicians’ interaction with patients
Treat the Whole Person
Prevention
Additional governing principle - Unity of Disease and Unity of Cure (UDUC) - Integr Med. 2023. 22[3]. 38-43
Treatment is offered at one or more of the following levels, based on the individual’s needs (White Paper published in 2021 by the Institute for Natural Medicine)
Foundational support: healthy diet, encourage movement and exercise, stress management, optimize emotional and spiritual health, toxin exposure management, address social and environmental determinants of health
Therapeutic diets and nutrition therapy
Botanical medicines and dietary supplements
Restorative therapies: hydrotherapy, manual medicine, homeopathy
Evidence-based, disease-targeted therapy: therapeutic use of nutrients, vitamins, herbs, and (in states in which regulations include it in the profession’s scope of practice) pharmaceuticals
Physical medicine modalities: massage, acupuncture, physical therapy, regenerative injection therapy (trigger point therapy, prolotherapy, platelet therapy
Mind-body techniques: mindfulness meditation, yoga, relaxation modalities, sensory-based therapies, behavioral modification, biofeedback
History:
Many consider Hippocrates to be the father of naturopathy.
Formalized by Benedict Lust, M.D., who coined the term in 1895 and in 1900 established the first naturopathic college.
By the early 1920’s there were approximately 20 naturopathic colleges and naturopaths were licensed in most states.
Naturopathic medicine began a decline around 1940.
In 1970 there was only one naturopathic school in the U.S. (Portland. OR) with a total enrollment of only 15 students.
Bastyr University opened in 1978.
Textbook of Naturopathic Medicine (1993) by naturopathic leaders Drs. Michael Murray and Joseph Pizzorno had over 10,000 citations from peer-reviewed scientific literature.
Education (2021):
8 naturopathic medical schools in the US and Canada accredited by the US Department of Education
4-year doctoral program (these four year programs require all premedical courses as prerequisites), with 2 years biomedical sciences, 2 years clinical sciences
4100 total hours, 1200 clinical hours (700 patient visits required to graduate)
Postdoctoral licensing examination by the North American Board of Naturopathic Examiners
4 board specialties & a dozen or more certifications currently available4 year degree program offered at 6 accredited schools of naturopathy.
BEWARE there are also mail-order diplomas available in naturopathy.
Licensure:
Naturopathic physicians currently are licensed or regulated in 25 jurisdictions, including 22 states and three US territories in 2021
Beware of practitioners with mail-order diplomas only, especially in states without licensure.
Popularity
1000 licensed N.D.'s in 1993, 1400 in 2001, 4400 in 2015. Approximately 400 graduates, annually (2021)
Safety - Very safe.
Uses - Variable.
Cost (in 1995) - $125 - $300 for initial visit of 60 -90 minutes.
References
Pizzorno J. Naturopathic medicine – a 10-year perspective (from a 35-year view). Altern Ther Health Med. 2005. 11. 24-26.
Naturopathic Physicians as Whole Health Specialists - White Paper published in 2021 by the Institute for Natural Medicine
American Association of Naturopathic Physicians
300 New Jersey Ave NW, Suite 900
Washington, DC 20001
866-538-2267
Institute for Natural Medicine
4500 Ninth Ave NE, Suite 300
Seattle, WA 98105
Neural Therapy
Descriptive definition - injection of local anesthetic into autonomic ganglia, peripheral nerves, scars, glands, trigger points and acupuncture points with the goal of balancing the autonomic nervous system.
History - developed by the Huneke brothers in Germany in the early 1900’s.
Theorized mechanism of action
Procaine is a local anesthetic and it may restore a normal electrical resting potential of injured tissue, which might restore communication (via peripheral nerves) between injured tissue and the central nervous system, thus reducing or eliminating pain.
Injured or scar tissue can set up an electrical “interference field” which impedes electrical flow in the body (via the nerves), and subcutaneous injections of procaine into scar tissue can eliminate this interference field.
Emotions can set up powerful interference fields, especially in those with PTSD
Klinghardt DK, Neural Therapy. J Neural Orthop Med Surg. 1993. 14. 109-114
Gurevich M. Innovative Approach to Psychiatry: Treating Incurable Psychiatric Patients with Neural Therapy. Townsend Letter. October 2017. 51-54 (www.townsendletter.com)
Osteopathy (D.O.)
Descriptive definition - Healing can be promoted by manipulation of bones to allow free circulation of blood and balanced functioning of the nervous system. Theory is that re-establishment of a normal relationship between anatomic and physiologic components removes barriers to healing.
History - Founded by Andrew Taylor Still, MD, who opened the first osteopathic medical school in Kirksfille, Missouri in 1892. Has become mainstream.
Education:
Four years of osteopathy school after Bachelors degree. Twenty DO schools in 2002; 33 schools in 2016.
Curriculum very similar to medical school, plus includes manipulation.
Rotating internship after four years of school.
Osteopathic family practice residencies.
Licensure - National Board Exam. Licensed in all 50 states.
Popularity
38,240 practitioners in 1995, 58,329 practitioners in 2010, > 141,000 practitioners in 2023
First year enrollment in DO schools 2968 in 2002; 7219 in 2016.
38 osteopathic medical schools in 2023.
Uses – many.
The experience
Lie on a padded table.
Adjustment involves hand movements by the practitioner and is usually painless.
Cost (in 1995) - $100-$200 for a 30-60 minute visit.
American Osteopathic Association
142 East Ontario St.
Chicago, IL 60611
312-280-5800
Photobiomodulation (PBM)
Devices which emit infrared or near infrared ligtht, and are used to treat a variety of conditions.
FDA approved uses include treatment of arthritis, hair loss, joint pain, muscle pain
Additional uses based on anecdotes (in 2021) include treatment of Alzheimer’s, multiple sclerosis, Parkinson’s, stroke, and traumatic brain injury
Pilates
Descriptive definition – movement therapy which uses a method of physical exercise to strengthen and build control of muscles, especially those used for posture
Uses – pain
Polarity Therapy
Descriptive definition - Both hands are used to release energy blockages in the body and help to restore a more natural flow of energy.
History - Developed by Randolph Stone, D.C., D.O., N.D.
Education - 125 hours for associate practitioner, 650 hours for registered polarity therapist.
Licensure - Theoretically monitored by American Massage Therapy Association.
Popularity - 600 certified practitioners.
Safety - Potential risk is that emotional releases may be pronounced.
Uses - Variable.
The experience - Mostly light tough, similar to massage.
Cost (in 1995) - Approximately $60/session.
Polarity Wellness Center
10 Leonard St. Suite A
New York, NY 10013
212-334-8392
Pulsed electromagnetic frequency (pEMF)
Descriptive definition - low frequency (3 - 100 Hz), low intensity EMF which passes through the body, rather than absorbed, and exerts its therapeutic effects as it passes though the body. There are many devices which may be used for self-care or administered in the office of a health care practitioner.
On consumer devices, intensity ranges from 0.1 mT to 800 mT (repetitive transcutaneous magnetic stimulation devices are typically 800 mT)
For comparison, the intensity of standard MRI machines is 1000 - 2000 mT.
Most devices are marketed for wellness and do not require FDA approval.
Uses
Carpal tunnel syndrome
Depression
Diabetic neuropathy
Fibromyalgia
Fractures
Insomnia
Memory loss
Migraines
Musculoskeletal pain conditions
Osteoarthritis
Reflex sympathetic dystrophy
Stroke
Traumatic brain injury
Wound healing
William Pawluk, MD, PC and his book entitled Power Tools for Health
866-455-7688
Qigong
Descriptive definition – ancient Chinese discipline which combines the use of gentle physical movements, mental focus, and deep breathing directed toward specific parts of the body.
It is typically performed at least twice a week for 30 minutes.
Qigong can be conceptualized as a method for drawing energy into the body through the navel center.
Tai chi can be conceptualized as a variation of Qigong.
Uses - pain
Reflexology
Descriptive definition:
Precise pressure applied to reflex points in the hands and feet releases energy blockages, and by promoting balanced flow of energy, facilitates circulation and elimination of toxins.
Foot reflexology charts correlate spots on the feet with each internal organ.
History
Ancient Chinese and Egyptian diagrams are believed to depict early forms of reflexology
Formalized by William Fitzgerald, M.D. in 1913, who divided the body into 10 longitudinal zones, each of which ends in the feet.
Further developed in the 1930’s by Eunice Ingham, a massage therapist.
Education - 200 hours including self study; two one day regular workshops; one two day advanced workshop.
Licensure - Variable. Certification by an International Institute is available.
Popularity:
25,000 certified practitioners worldwide.
Since 1950, 50,000 people have taken reflexology seminars.
Safety - Very safe, but can cause transient foot pain during a session.
Uses - Relieve stress and tension, relieve pain.
In a RCT with 40 adults with bronchial asthma, no significant difference was found between active and simulated reflexology (Respire Med. 2001. 95[3]. 173-179).
In a RCT with 243 patients with low back pain, there were no statistically significant differences in pain or functioning after 6 months, compared to either a relaxation treatment group or a usual care group (poster session at conference on complementary medicine in Exeter, England in December, 2001)
In a pilot randomized study with 17 patients with advanced cancer, reflexology had no objectively demonstrated benefits, as compared with foot massage (Palliat Med. 2002. 16. 544-545).
Several pilot studies do show transient improvements in pain and/or anxiety in cancer patients with foot reflexology, with a brief description of these studies and citations available in a review article (Mathuna DP. Reflexology for Pain and Anxiety in Cancer Patients. Alt Med Alert. 2008. 11. 140-143).
International Institute of Reflexology
P.O. Box 12462
St. Petersburg, FL 33733
727-343-4811
Reiki
Descriptive definition:
This is a vibrational or energetic healing practice which focuses on the chakras, which are energy centers, and can be conceptualized as a depiction of the energy body, as viewed internally (in contrast with acupuncture points and meridians, which can be conceptualized as a depiction of the energy body, as viewed externally)
The practitioner uses light touch to make universal energy available to the recipient, who can then balance the energy his or her own energy body.
The practitioner acts as a conduit to channel universal energy to the recipient.
Chakras
Root color is red associated with spinal column and kidneys
Sacral color is orange associated with reproductive system
Solar plexus color is yellow associated with adrenal glands, digestive organs, and nervous system
Heart color is green associated with thymus and circulatory system
Throat color is sky blue associated with thyroid, vocal cords and respiratory system
Head color is indigo associated with pituitary, left eye, ears, and autonomic nervous system
Crown color is violet/white associated with central nervous system and right eye
History - Formulated in Tibet 2500 years ago; developed in the mid 1800's by Miko Usui, a Japanese educator, and brought to the U.S. in the 1930's by Hawayo Takata.
Education - Practitioners are taught by Masters (Level III), 8-20 hours for levels I, II.
Licensure - None, but certification by several different national organizations.
Popularity - Unknown.
Uses - Variable, including veterinary medicine.
Cancer – better pain control and quality of life (J Pain Sympt Management. 11/03).
Chronic pain - a study looking at 4 groups of 12 men and 18 women, with all subjects experiencing pain as well as other symptoms, found significant improvements in pain scores, depression scores, and anxiety scores in the reiki group, compared with the "false reiki" or placebo control group, the progressive muscle relaxation control group, and the no treatment control group (Subtle Energies Energy Med. 1998. 9. 51-82).
Depression – reduces symptoms (Alt Ther Health Med. May/June 2004).
HIV – reduced pain and anxiety seen (Altern Ther Health Med. 2003. 9. 36).
Stress relief (J Adv Nurs. 2001. 33. 439-445).
Safety - Very safe.
The experience - The client remains fully clothed and often lies on a padded table. The practitioner gently places both hands, palms down, on a sequence of approximately 12 standard sites throughout the body, in order to channel energy to those areas. Each hand position is maintained for 3-5 minutes. The client may experience the energy transfer as heat, cold, vibration, or unusual heaviness (description as per Dr. Andrew Weil, Self Healing, 10/00 and 4/06).
Cost (in 1995) - $45 - $100 for a 60 -90 minute session.
The Reiki Alliance
204 N. Chestnut Street
Kellogg, ID 83837
208-783-3535
International Association of Reiki Professionals
781-729-3530
Rolfing
Descriptive definition - Stretching, lengthening, and reshaping the fascia via application of manual pressure allows muscles and bones to naturally re-align in a way that balances the body in a relation to gravity, allowing the body to regain normal function.
History - Founded/formulated by Ida Rolf in 1970, a Ph.D. biochemist.
Education - Some science courses, some bodywork experience, then an 18 week course.
Licensure - Trade name certified by the International Rolf Institute.
Popularity - Approximately 800 practitioners.
Safety - A potential risk is that emotional releases may be pronounced.
Uses - Poor posture, pain and stiffness related to mechanical imbalances, constriction of the fascia secondary to sports.
The experience:
Series of 10 sessions is recommended.
Moderately painful and unpleasant during the session, but pain does not persist.
Active process which includes deep breathing, moving a body part in a specified manner, and providing verbal feedback regarding the intensity of the pain or discomfort.
End result is a sense of lightness of the body part which has been rolfed.
Cost (in 1995) - Approximately $60/session.
Rolf Institute of Structural Integration
205 Canyon Blvd
Boulder, CO 80302
800-530-8875
Shiatsu
Descriptive definition - A firm sequence of rhythmic pressure is applied at acupuncture meridians, allowing the patient to attain homeostasis.
History - Centuries old Japanese adaptation of Chinese medicine.
Education:
90 hours as part of massage therapy education.
278 hours to be an ohashiatsu practitioner.
Licensure:
Theoretically monitored by American Massage Therapy Association.
Ohashiatsu is a trade name certified by the Ohashi Institute.
Popularity - Unknown. 2000 international students per year take some courses through the Ohashi Institute, which has been in existence since the 1970's.
Safety - Very safe.
Uses - Variable.
The experience - Moderate pressure applied by the practitioner, using hands, elbows, and knees, with the amount of pressure adjusted to minimize pain.
Cost (in 1995) - Approximately $60/session.
Ohashi Institute
12 West 27th St.
New York, NY 10001
212-684-4190
800-810-4190
American Organization for Bodywork Therapies of Asia
856-782-1616
Tai Chi (see also information at the bottom of the web page ‘Exercise’)
Descriptive definition – Chinese martial art that combines deep breathing and relaxation with slow, gentle, graceful movements. Tai Chi is designed to develop and balance Qi or biofield energy (Alt Med Alert. 2008. 11. 53-56). Tia chi is a varient of Qigong.
History – founded in the 12th Century by Chang San Fang, who described the physical techniques of Tai Chi in the Tai Chi Classics.
Education – variable; an individual can begin practicing after watching a video or attending a class
Licensure – non-existent
Popularity – very popular for centuries in China; growing popularity in the U.S.
Benefits (Alt Med Alert. 2008. 11. 53-56)
Chronic Illness Management - an umbrella review of systematic reviews and meta-analyses of RCTs identified 45 meta-analyses of RCTs and calculated 142 summary estimates of outcomes among adults living with 16 types of chronic illnesses, and found that statistically significant results were found for 81 of the 142 outcomes, and 45 of these 81 beneficial outcomes were supported by high or moderate evidence. The conclusion is “Moderate evidence suggests that Tai Chi intervention improved physical function and disease-specific outcomes compared with nonactive controls and improved cardiorespiratory fitness compared with active controls among adults with diverse chronic illnesses” (Am J Med. 2021. 134. 194-205).
Breast cancer - systematic review article of 3 RCTs and 1 controlled clinical trial reports significant improvement in psychological and physiological symptoms, compared to the psychosocial support control group.
Depression – in a study in which a weekly Tai Chi exercise class was combined with standard treatment, those in the Tai Chi group showed greater improvement in level of depression, quality of life, memory, and cognition (Am J Geriatr Psychiatry. 2011. 19. 839-850).
Diabetes – systematic review article concludes that clinical trial data is scarce and not convincing with regard to showing benefit (Diabetes Med. 2008. 25. 240-241).
Falls Prevention
Reduces the risk of falling in the elderly by 47.5%, based on a RCT in 200 subjects over age 70, in which treatment subjects met with an instructor twice a week for 20 minutes, and were encouraged to practice on their own for 15 minutes twice a day (J Am Geriatr Soc. 1996. 44. 489). This study in 2003 was named by the American Geriatric Society as the best research paper from the 1990’s, and was republished (J Am Geriatr Soc. 2003. 51. 1794-1803).
Reduces the risk of falling in the elderly, based on a RCT in 256 physically inactive subjects over age 70. The treatment group attended one hour classes 3 times a week for 6 months, and those in the tai chi group had 55% fewer falls (p=0.007). Repeat assessment 6 months after completion of the study showed that group differences with regard to falls persisted (p<0.001) [J Gerontol A Biol Sci Med Sci. 2005. 60. 187-194].
Reduces the number of falls among healthy elderly, based on aggregate data from 5 RCTs (Altern Ther Health Med. 2011. 17[1]. 40-48).
Fibromyalgia - in a 52 week RCT of 226 adults, high-intensity and frequent tai chi reduced symptom severity at 24 weeks compared with aerobic exercise (BMJ. 2018. 360. K581).
Heart disease prevention - in a 1 year RCT of individuals at high risk for heart disease, tai chi significantly boosted exercise capacity, lowered blood pressure, and improved levels of cholesterol, triglycerides, insulin and CRP (J Altern Complement Med. 2008. 14. 813-819).
Heart failure – a study of 100 patients showed improvements in mood, quality of life, and exercise capacity (Arch Intern Med. 2011. 171. 750-757).
Hypertension - systematic review article of 9 RCTs concludes that there is evidence suggesting BP reduction in patients with hypertension (J Hypertens. 2007. 25. 1974-1975). A review of 26 studies reported a lowering of BP in 85% of the trials, with improvements of 3-32 mm Hg in SBP and 2-18 mm Hg in DBP (Prev Cardiol. 2008. 11. 82-89).
Insomnia – effective in a 16 week study of 112 healthy older adults (Sleep. 2008. 31. 1001-1008).
Osteoarthritis – systematic review article of 5 RCTs and 7 controlled clinical trials concludes that Tai Chi may be effective for pain control in patients with knee osteoarthritis, but the evidence is not convincing for improvement in physical function (Clin Rheumatol. 2007. 19. 139-146).
Osteoporosis prevention – a review of controlled studies concludes that tai chi may be a method of maintaining bone density in postmenopausal women (Arch Phys Med Rehab. 2007. 88. 673-680), but a systematic review article of 5 RCTs and 2 controlled clinical trials concludes that clinical trial data is not convincing with regard to showing benefit (Osteoporosis Int. 2008. 19. 139-146).
Parkinson’s disease – reduces balance impairments in those with mild to moderate Parkinson’s, and also improves functional capacity and reduces falls, based on a RCT of 195 patients who were randomized to tai chi, resistance training, or stretching (N Engl J Med. 2012. 366. 511-519). A systematic review reports reduction in symptoms, improved mobility, gait, balance, and quality of life (J Rev Neurosci. 2013. 24. 149-152).
Rheumatoid arthritis – systematic review article of 2 RCTs and 3 controlled clinical trials concludes that clinical trial data is not convincing with regard to showing benefit (Rheumatology [Oxford]. 2007. 46. 1648-1651). However, a Cochrane database review concludes that Tai Chi also does not exacerbate the symptoms of rheumatoid arthritis (Cochrane Database Syst Rev. 2004. CD004849).
Stroke – in a study of 136 patients with a prior stroke (at least 6 months ago), 12 weeks of tai chi improved standing balance more than a general exercise program (Neurorehabil Neural Repair. 2009. 23. 515-522).
Weight loss - in a RCT of 543 participants with central obesity, tai chi was more effective than in the control group and equally effective to aerobic exercise and strength training (Ann Intern Med. 2021. 174. 1050-1057).
Therapeutic Touch
Descriptive definition:
The healing force of the therapist affects the patient’s recovery and cure; physical touch is not necessary.
This is based on the principle that humans are a four dimensional energy system that extends beyond skin boundaries, and that disease is due to a disturbance in energy flow.
The act of therapeutic touch involves (1) centering, a conscious meditative act, (2) assessment using the hands as sensors, and (3) energy transfer using the hands to re-establish wholeness.
Therapeutic touch begins with compassion and requires intentionality.
History - Developed by Dolores Krieger, Ph.D., R.N., in 1972, and now taught in more than 80 American colleges, and used by nurses in particular at many hospitals.
Education - Variable, as little as a few hours.
Licensure - Variable, often non-existent.
Popularity - 37,000 health practitioners have learned the technique as of the early 1990's.
Uses - Variable.
In a randomized, controlled trial, statistically significant reduction in anxiety in patients on a cardiovascular unit (p<0.001) with therapeutic touch (Nurs Res. 1981. 30. 32-37).
In a randomized, controlled trial, statistically significant reduction in anxiety in oncology patients receiving chemotherapy (p<0.05) with therapeutic touch (Masters Abstr Int. 1985. 42. 24).
In a randomized, controlled trial, statistically significant reduction in the severity of tension headache pain (p<0.0001), based on a randomized, controlled trial with 60 volunteers (Nurs Res. 1986. 35. 101-106).
In a randomized, controlled trial, statistically more rapid healing of wounds from a full thickness dermal punch biopsy in healthy male volunteers. Wounds on day 16 were completely healed in 12 of 23 subjects, but none of the 21 controls (Subtle Energies. 1992. 1. 1-20).
Safety - Probably safe, but considered invasive by some because the energy field is entered by the practitioner.
The experience - The client sits in a chair or lies down, fully clothed. The practitioner(s) stand near the person and move their hands in a pattern around the body twice; first to accomplish assessment and second to accomplish energy transfer.
Cost (in 1995) - $25 - $75 for a 15 -30 minute session.
Nurse Healers-Professional Associates, Inc. (NHPAI)
P.O. Box 158
Warnerville, NY 12187-0158
518-325-1185
877-32NHPAI
Therapeutic Touch: Science or Scam (Submitted to JAMA as a letter to the editor, but not accepted for publication)
I feel that "A Close Look at Therapeutic Touch" published April 1, 1998 in JAMA is fundamentally flawed, because a modality which is theorized to have benefit based upon an energetic model of disease has been tested only in a Newtonian paradigm. Determination of whether therapeutic touch is scientific and/or whether the above published study of therapeutic touchis scientific requires a definition of science. Marc Micozzi, M. D., Ph.D., in the introductory chapter of his textbook on alternative and complementary medicine, elegantly states that "...science simply requires empiricism - making and testing models of reality by what can be observed, guided by certain values and based upon certain metaphysical assumptions." He further states that contemporary biomedicine, which many physicians inappropriately consider synonymous with science is merely "...a scientific paradigm with a particular history, as much influenced by social history as it is by scientific laws ." The bioscientific paradigm is characterized by objectivism, reductionism, positivism, and determinism.1
The act of therapeutic touch, as it is formulated, is a dynamic process which involves as step two a holistic assessment of the total energy field around a living being. The endpoint in the study published in JAMA, namely whether a practitioner of therapeutic touch could accurately determine which hand, left or right, was closer to the investigator's hand, is a static physical endpoint. I question whether this physical endpoint, presumably chosen based on a reductionist bioscientific paradigm, is in any way related to an accurate determination of the validity of therapeutic touch. I assert that the theoretical basis of therapeutic touch is plausible, based upon Micozzi's definition of science, and I believe that the best way to test this hypothesis is by controlled clinical trials. A number of trials have been done, and several with positive results have been published.2,3The design of the clinical trials is novel - practitioners in the control group go through the motions of assessment of the energy field, then transfer of energy, without centering, the conscious meditative act whichis step one in the practice of therapeutic touch.
In consideration of all the above, I am extremely disappointed that the editors of JAMA did not request modification of the inflammatory wording in the abstract, namely "Therapeutic touch (TT) is a widely used nursing practice rooted in mysticism but alleged to have a scientific basis." and "Their failure to substantiate TT's most fundamental claim is unrefuted evidence that the claims of TT are groundless and that further professional use is unjustified."4 I would suggest that JAMA proceed by soliciting an editorial on this paper from an authority in the field of energy medicine.
1. Micozzi MS. Characteristics of complementary and alternative medicine. In Micozzi MS, ed. Fundamentals of Complementary and Alternative Medicine. New York, NY: Churchill Livingston; 1996: 3.
2. Keller E, Bzdek VM. Effects of therapeutic touch on tension headache pain. Nurs Res. 1986; 35: 101-106.
3. Wirth DP. The effect of non-contact therapeutic touch on the healing rate of full thickness dermal wounds. Subtle Energies. 1992; 1: 1-20.
4. Rosa L, Rosa E, Sarner L, Barrett S. A close look at therapeutic touch. JAMA. 1998; 279. 1005-1010.
Traditional Chinese Medicine (TCM) [see also ‘Acupuncture and ‘Cupping’ sections above in this outline]
Descriptive definition - comprehensive system rooted in ideas and conceptions different from and irreconcilable with Western medicine (different world view). The focus is on keeping the body in balance with nature, to ward off agents of disease.
Disease is caused by energy imbalance. Nutrition, stress, and external factors all contribute.
Diagnosis is based on identifying the location and nature of energy imbalances.
Observation is very important. Pulse diagnosis is a highly refined art.
Twelve organs are identified. Each organ is associated with a meridian and represents a whole sphere of human functioning – mind, body, and energy
Treatment is based upon correcting energy imbalances.
Qi is vital energy.
Acupuncture, cupping, herbal therapy, massage and moxibustion (burning herbs at an acupuncture point) are modalities of TCM treatment.
History - 2000-3000 years old.
Education – 3-4 year program or 200 hours of study for M.D.'s, D.O.'s, D.C.'s. Approximately 30 TCM colleges.
Licensure - 36 states in 1999.
Popularity - Approximately 10,000 practitioners in the United States in 1999.
Safety - There are reports of contamination of Chinese herbs with heavy metals.
Cost (in 1995) - $40 - $100 for a 60 -90 minute visit.
American Association of Oriental Medicine
610-266-1433
www.aaom.org
National Certification Commission for Acupuncture and Oriental Medicine
703-548-9004
www.nccaom.org
Trager Approach
Descriptive Definition - technique includes compressions, elongations, light bounces, and gentle rhythmic rocking motions. The intent is to release physical tension and increase range of motion
History - Developed by a Hawaiian physician, Milton Trager, MD.
Uses - Musculoskeletal problems.
Cost (in 1995) - $50 - $120 for a 60-90 minute session.
The Trager Institute
216-897-9383
Yoga
Descriptive definition
A series of stretches designed to balance the body and quiet the mind.
Yoga is the spiritual side of Ayurveda; Ayurveda is the healing side of yoga.
Described as an eight-limbed system in Pantanjali’s Yoga Sutras: restraints, positive habit patterns, posture, voluntary control of breathing, relaxation and a sense of withdrawal, concentration, meditation, and enlightenment
Styles of yoga- approximately 20 different styles in all.
Ashtanga – fast-paced series of postures done in a continual flow, similar to tai chi.
Bikram – vigorous series of 26 poses that are performed in a room heated to 85 to 100 degrees Fahrenheit.
Hatha – uses body postures or poses (asanas) and mindful breathing to develop muscular control, relaxation, and a feeling of wellness. Integral – control of breath, sound vibration, and meditation are emphasized along with the postures; used as a lifestyle intervention by Dean Ornish.
Integral – control of breath, sound vibration, and meditation are emphasized along with the postures; used as a lifestyle intervention by Dean Ornish.
Iyengar – uses props to help less flexible students attain the postures and properly flex the spine.
Laughter - developed in 1994; combines real and simulated laughter and often results in yogic breathing
Viniyoga – flows from pose to pose like ashtanga but is performed at a slower pace.
History –ancient Vedic science believed to have originated in India around 5000 B.C.; associated with Hinduism.
Education – variable; as little as a weekend seminar or as much as 3 years of practice and extensive training for Iyengar yoga.
Licensure – non-existent
Popularity
An estimated 14 million Americans practiced yoga in 2002 (Adv Data. 2004. 1-19).
In the US the 12 month prevalence of the percentage of the population doing yoga increased from 3.8% in 2004 to 8.9% in 2016 (Am J Prev Med. 2016. 50. 230-235).
Safety - editorial with multiple citations (Mayo Clin Proc. 2019. 94. 385-387)
Specific poses carry the risk of injury if performed incorrectly - hyperflexion and hyperextension of the spine are the poses most commonly associated with injury.
Three categories of injury based on a retrospective chart review of 89 patients with injuries (Mayo Clin Proc. 2019. 94. 424-431).
Soft tissue injury
Axial nonbony injury
Bony injury including vertebral compression fractures
In a large national survey of Australian yoga participants, 20% reported injuries attributed to yoga, mostly minor (Int J Yoga. 2012. 5. 92-101)
Uses
Inflammatory conditions - a systematic review of 15 RCTs identified a pattern of downregulation of inflammation by yoga, including lower IL-1beta, TNF-alpha and IL-6 (J Behav Med. 2018. 41. 467-482).
Anxiety – yoga significantly reduced symptoms of anxiety in 6 of 6 RCTs (Br J Sports Med. 2005. 39. 884-891).
Depression – yoga significantly reduced symptoms of depression in 4 of 5 RCTs (J Affective Disord. 2005. 89. 13-24).
Endothelial dysfunction - a systematic review of 18 studies including 1043 participants reported that yoga training improved endothelial function in 12 studies, whereas 6 studies did not find any statistically robust effect (< 0.05). There was moderate heterogeneity of studies, the risk of bias in studies was deemed low to moderate, and there were no adverse effects of yoga (Patil SG et al. Journal of Integrative and Complementary Medicine. ePub 10/25/23).
Frailty
Defined as a geriatric syndrome of decreased functioning across several physiological systems, accompanied by increased vulnerability to stressors and increased morbidity and mortality. Up to 50% of US adults over age 80 are estimated to be frail.
A systematic review of 33 studies (n = 2384) concluded “yoga may affect frailty markers that are associated with clinically meaningful outcomes in older adult populations but may not offer benefit over active interventions (for examples, exercise).” (Ann Intern Med. 2023. 176. 524-535).
Hypertension - effective based on a systematic review and meta-analysis of 49 trials (n = 3517) which showed significant decreases in SBP and DBP; reductions augmented when yoga is practiced in conjunction with breathing exercises and meditation (Mayo Clin Proc. 2019. 94. 432-446).
Insomnia – in a waiting list controlled trial, yoga twice per week for 12 weeks improved sleep and quality of life in older adults with insomnia (Altern Ther Health Med. 2014. 20[3]. 37-46).
Low back pain
A systematic review and meta-analysis of 10 RCTs (n=967) found that yoga reduces short term (12 weeks) and long term (12 months) pain and back specific disability (Clin J Pain. 2013. 29. 450-460).
Effective, with a moderate strength of evidence (based on a systematic review for an ACP Clinical Practice Guideline – Ann Intern Med. 2017. 166. 493-505).
A Cochrane review found evidence of benefit (Cochrane Database Syst Rev. 2017. CD010671).
Stress management – a systematic review of 4 RCTs and 4 additional controlled clinical trials (number of participants ranging from 11 to 68) found a positive effect of yoga in reducing stress levels or stress symptoms. Limitations of the trials included small size, limited follow up, and methodologic problems (Altern Ther Health Med. 2011. 17[1]. 32-38).
Other uses include carpal tunnel syndrome, fitness, multiple sclerosis, recovery from sports-related injuries.
Cost (in 1995) - $8 per class.
Yoga Alliance
877-964-2255
Reference: Eisenberg DM et al. Credentialing Complementary and Alternative Medical Providers. Ann Intern Med. 2002. 137. 965-973.
Unlicensed CAM therapies
There are many, and these are dealt with differently by different states.
Health Freedom States (law protects health care practitioners who use CAM therapies) – Alaska, Colorado, Georgia, Indiana, Massachusetts, New York, North Carolina, Ohio, Oklahoma, Oregon, Texas, Washington.
CAM Health Freedom Access States – Minnesota, Rhode Island, California
Exempt traditional healers from regulation/licensure – Alabama, Arizona, Hawaii
Page Updated February 2, 2024