Alternative Therapies: Growing Options in Nursing Practice #9017

The goal of this course is for you to learn about the many options that complementary and alternative therapies have to offer. Much interest has stemmed from "preventive" care measures as one way to reduce health care costs. Vitamin, nutrition, and diet therapies abound. You will learn about the use of massage and other relaxation therapies for stress prevention and treatment. The established role of the nurse in seeing clients holistically, and intervening in all the dimensions - physical, psychological, intellectual, social, and spiritual - places the nurse in a unique position to give information and advice concerning these various new therapies.

Instructional Objectives

Introduction

Traditional Western medicine (allopathic medicine), especially since the late nineteenth century, has been successful in treating and/or eradicating many diseases that had meant certain death. Much of the success comes from the use of scientific methodology in dealing with disease. Because of these scientific methods, surgical procedures and pharmacologic treatments were developed for illnesses affecting people of all ages. For example, antibiotics have severely limited the threat of many childhood illnesses while surgery, radiation, and chemotherapy are used for treating many types of cancer, and open-heart surgery has saved the lives of many with crippling heart disease. After the discoveries by Pasteur and Koch, the belief that disease could be eliminated through the studying, identifying, and conquering of germs became dominant in Western culture.

The increasing use of surgery and pharmacology today to treat diseases, along with the increase in life expectancy because of these procedures, has dramatically increased health care costs. Some experts have postulated that the economics of health care has played a vital role in maintaining the "disease" mentality rather than encouraging consumer participation in one's own health care because powerful drug companies make money off diseases rather than off wellness. As the cost of American health care skyrockets, many health care practitioners are looking for ways to decrease the cost of delivering good care.

For the past thirty years or so health educators have emphasized the importance of preventive care (concentrating on "wellness" as opposed to "illnesses") as one way to reduce health care costs, since preventive measures are cheap in comparison with the cost of treating disease once it has already developed.

In recent years this interest in prevention has deepened, and new therapies, referred to as "alternative" or "complementary" medicine, are now on the market. For example, many new and varied vitamin, nutrition, and diet therapies abound. The use of massage in stress prevention is widespread. Support groups are a less expensive, and sometimes more effective, way to provide mental health care than the traditional use of individual psychotherapy. Others of these "new" therapies are really not new, but instead are part of traditional medicine in other parts of the world. Acupuncture, herbal medicine, yoga and tai chi fall into this last category. Many traditionally trained Western health care practitioners are turning to these adjunct therapies as valuable sources of information and healing, especially when Western methods fail. Thus, a spirit of collaboration is forged between practitioners of both Western and Eastern medicine.

A recent survey of 461 general practice physicians, designed to determine the general attitude of practitioners of traditional Western medicine toward complementary approaches to health care, found that 47% had been involved in complementary medicine in some form during the previous week. Of these 16% had actually used it themselves in the clinical setting while the rest had referred patients to other practitioners. They rated chiropractic, acupuncture, and osteopathy as the most effective therapies. Some HMOs are developing alternative medicine departments to include these new methods in the health care packages they offer their customers. This trend toward legitimizing alternative methods has been apparent in Europe for some time. For example, a hospital in Switzerland reserves two nursing units for the treatment of patients using Chinese herbal medicine and homeopathy; a department of complementary medicine is now available in a Swiss medical school; Finland has included acupuncture in its medical school curriculum for several years; and a complementary medicine section has been added to the curriculum of the Royal College of Nursing in the United Kingdom.

Statistics show that in 1996 thirty-four percent of the US population used some form of alternative medicine to augment their health care. New NCCAM statistics show that number has increased to around 42%. Most of these people ranged in age from 25-49 years, and were highly educated with high-income levels; many paid for this care out of their own pocket. Those with poorer health were more likely to use alternative medicine than were those with better health. In six studies done on the use of alternative therapies in AIDS patients, researchers found that 30-50% of those with HIV sought some form of alternative care, not because they were dissatisfied with the traditional approach of allopathic medicine, but because they were seeking to improve immune functioning and overall health as an adjunct to conventional methods. The majority seeking alternative therapies, no matter what their diagnosis, gravitated to relaxation techniques, chiropractics, massage, guided imagery, and spiritual healing more frequently than they did to interventions that required the intake of any substance (although those with HIV did use vitamin therapies rather often). Most consumers of alternative therapies for serious diseases did not report this care to their allopathic physician. Because of this trend in the use of alternative care by the public, and the growing respect that many of these practitioners are receiving from traditional medical practitioners as well, the number of alternative practitioners is expected to increase by 88% by the year 2010.

As the role of nurses in the health care delivery process shifts from the traditional hospital setting to private practices, community and business organizations, and home health care, nurses will be in a position to educate the public about these complementary approaches to modern medicine. The established role of the nurse in seeing clients holistically, and intervening in all the dimensions of human existence - physical, psychological, intellectual, social, and spiritual - places the nurse in a unique position to give information and advice concerning these various new therapies, many of which stress the importance of the holistic approach to health care.

Traditional Chinese Medicine

Development

Most practices of traditional Chinese medicine trace their roots to the Han Dynasty of about two thousand years ago. This was an age of philosophical, cultural, and medical importance in Chinese history. At that time there were attempts made to unify the various practices into one cohesive body of medicine. Over the centuries Chinese medicine has been influenced by other Asian cultures so that today's practices have a combination of Japanese, Korean, and Southeast Asian influence.

While Chinese medicine has had a following in the United States since the 1700's, the unifying of various practices into a single body of medicine in the mid-twentieth century has made it easier to mainstream its use in the United States. There are now approximately seventy schools of Chinese medicine in the US. They train non- physician practitioners in three to four-year programs.

Diagnosis

Chinese medicine focuses on identifying patterns of symptoms that reflect energy blockages within the body. The practitioner examines the skin, bones, body odors, body sounds, body build, pulse, the tongue, the patient's mental state, and the patient's demeanor. This examination of the exterior provides clues to the interior state of health. The pulse, as one example, provides information on body energy flow and blockage through assessment at various positions in the body such as the wrist, neck, and leg. The practitioner assesses pulse strength, length, its trailing characteristics, and what happens between pulse beats. These findings can be documented scientifically, with an oscilloscope. The practitioner assesses many seemingly unrelated areas such as sleep and elimination patterns, digestion, emotional makeup, sex drive, and menstrual patterns.

These observations are recorded and reassessed at future appointments to determine the effectiveness of the treatment regimen. Areas of treatment that need to be amended to meet the needs of the individual patient are also determined.

Nursing diagnoses which might lead a nurse to suggest a patient try a Chinese medicine practitioner (especially if the patient has already undergone treatment by a Western trained physician and had limited results) include:

Acupuncture

Acupuncture is part of the Chinese system of medicine - a philosophy of healing - developed over thousands of years.

Acupuncture is defined by the California Business and Professions Code, Section 4927, as: "The stimulation of points on or near the surface of the body by the insertion of needles to prevent or modify the perception of pain or to normalize physiological functions, including pain control, for the treatment of certain diseases or dysfunctions of the body." There are four types of acupuncture currently used in the U.S, known as medical, ethnic Chinese, Japanese and Auricular.

The needles inserted are thin, sterile, and usually disposable; the insertion usually takes place while the patient rests in a reclining position. The insertion goes to a point just below the surface of the skin in the epidural layer and may last anywhere from a few seconds to forty minutes. It may cause some tingling, aching, numbness, and/or a feeling of warmth and heaviness. The locations of the insertion are determined by the diagnosis and treatment goals, but usually involve several different spots on the body at a time. Sometimes, the needles are moved to other spots during a session, depending on feedback from the continuous pulse readings. Some practitioners remain with the patient throughout the process while others leave them to rest while the needles are working.

Scientific support for the effectiveness of acupuncture comes from understanding its physiological effects. It appears to activate several of the body's systems, such as the electromagnetic system (acupuncture points are more conductive than the surrounding tissue), and the chemical responses of the nervous system, the vascular system, and the lymph system. Acupuncture causes the release of neurotransmitters such as endorphins, serotonin, and enkephalins (which recently have been documented as natural painkillers) as well as anti-inflammatory agents such as cortisol. Beyond this, little is understood about how or why acupuncture works. Many studies report relief from symptoms after acupuncture treatments, but none of the studies have been done under conditions applying the strict Western principles of research design; therefore, many Western trained physicians and researchers remain skeptical about the results of these studies. Some say that the relief from symptoms may be nothing more than a placebo effect.

Nevertheless, the magnitude of the above cited reports suggests that acupuncture may be effective for the treatment of low back pain, tooth extractions, nausea, angina, migraine and tension headaches, dysmenorrhea, and substance abuse. One study in the US, in a managed care setting, showed those receiving acupuncture had a decrease in the number of times they accessed the system. There were fewer clinic visits, phone consultations, and laboratory uses, as well as fewer hospitalizations, and a decrease in the use of prescription drugs.

Other studies have shown acupuncture to be beneficial for GI disturbances, such as nausea and vomiting. It has been tested as an option for drug addiction recovery treatment decreasing drug cravings and withdrawal symptoms.

Conditions Often Treated by Acupuncture
Allergies/Asthma Arthritis Low back pain Nausea and vomiting Constipation/Diarrhea Urinary tract disorders Colds, flu, coughing Dizziness/motion sickness Fatigue PMS	Anxiety/Depression Substance Abuse Headaches Neck pain or stiffness Knee pain Shoulder pain Sciatica Stress Sexual dysfunction
Figure 1

The number of sessions depends on the illness treated, as well as on the needs of the individual. On the average, treatments are once or twice a week for several weeks, with appointments spaced further apart as the treatment progresses.

For more information about the use of acupuncture and how to find certified acupuncturists in your area, contact:

Chinese Herbal Medicine

Many of our modern Western medicines have their origins in some kind of plant or herb. Some examples: morphine comes from the opium poppy seed, aspirin comes from the bark of the willow tree, and digitalis comes from the foxglove plant. These substances have been scientifically tested, and their use strictly controlled, safe dosages were determined, adverse reactions assessed, and guidelines for their use developed and approved by the FDA. Chinese herbs easily lend themselves to such Western-style research methods, similar to other pharmaceuticals, and their effectiveness can be readily demonstrated to the skeptical Western mind. Their potential for use in the treatment of certain cancers and heart disease is certainly promising and merits further research. Currently many of these herbal preparations are not classified as drugs, and so are not regulated by the FDA.

Because they are not regulated, there are many popular preparations that have not undergone the rigorous testing required for FDA approval. These preparations are not necessarily prescribed by certified herbal practitioners, so the consumer is often unaware of possible adverse reactions from the indiscriminate use of these herbs.

Find out if a certified practitioner has prescribed them. If not, encourage the patient to consult with a certified experienced herbologist or a pharmacist to insure the safety of the dosage and the purpose for taking the preparation.

If you have a patient who is using herbal remedies, make sure you inform him (or her) of the following:

Commmercial preparations may vary significantly in dosages from different brands making it risky to change brands, since the new brand may cause adverse reactions if the dosage is significantly higher than that of the previous brand.
Herbal extracts are much stronger than whole herbs, so your patient should know which form he is using.
Excessive dosages can lead to toxicity, resulting in rashes, urticaria, diarrhea and/or other gastrointestinal problems.

Figure 2

It is also important to stress that the patient should inform the primary caregiver that he is taking the herbal remedy in case there are potential adverse reactions between the herbal preparation and any conventional medicines the patient may be taking. If your patient is pregnant, the use of herbal remedies should be discouraged until she has consulted a physician because many of these preparations are uterine stimulants and/or diuretics.

Mind/Body Medicine

The practice of mind/body medicine crosses all health care disciplines. Many healthcare professionals practice it. The interventions used in mind/body medicine are taught one-on-one as well as in groups, and as part of both inpatient and outpatient programs. They may be used as preventive measures for major illness(es) in those indicating tendencies towards such illness(es). They may also be part of the treatment plan for those already suffering from major illnesses; for example, to decrease the side effects of chemotherapy, or to increase the chance of successful surgery intervention.

Nursing Diagnosis

The importance of the nursing diagnosis involving mind/body medicine is the impact natural treatment has on the nurse's role in providing health care. Nurses may use independently many "natural" therapies (those not requiring pharmaceuticals or surgery) to promote healing. This is gradually changing the role of the nurse from that of a caregiver to a healer.

Nursing diagnoses for which mind/body interventions may prove useful include, but are not limited to:

Mind/Body Interventions

In the broadest sense, mind/body medicine means changing one's lifestyle to promote health and prevent illness. Practitioners encourage their clients to incorporate various interventions into their daily lives to promote optimal health. This can include changing exercise patterns, and finding a social support system that can help relieve the stress inherent in modern living. Few techniques are used individually. Depending on the specific needs of the individual client, they may be used in conjunction with each other.

Meditation is one of the most widespread interventions in the mind/body repertoire. It is useful in helping patients to deal with a variety of stress-producing psychological problems associated with illnesses, such as decreased independence caused by hospitalization, feelings of isolation, anxiety, depression, and changes in body image. When combined with guided imagery and/or therapeutic touch, it can be a powerful nursing intervention in a wide variety of nursing settings such as nursing homes, hospices, and hospitals; and for a wide variety of illnesses such as the side-effects of chemotherapy and radiation in treating cancer patients, AIDS related problems, heart disease, postpartum depression, and anxiety of new mothers.

Evidence shows that brain waves are different during a state of relaxation than they are during tension or anxiety. When relaxed, the brain is in a more receptive state and, therefore, more open to new ideas.

Mental imagery uses this suggestible state by creating symbols to imagine specific positive changes occurring in the body, such as the cancer cells attacked by cells of the immune system.

Studies show the technique of mental imagery creates positive physiological changes to boost the immune system functioning. Research indicates that depression, the stress of losing a sense of control over life situations, and an emotionally repressive life-style, can contribute to immune system dysfunction. Positive emotions have positive effects on S-IgA levels. This reduces the size of tumors, increases the number of lymphocytes fighting the tumor, and increases NK (natural killer) cell activity.

Guided imagery is closely related to mental imagery except it is usually performed by a health care professional rather than auto-induced. It is often used in support group settings where everyone is in the process simultaneously, and can share their responses. It can be fascinating to see how differently individuals internalize the same words spoken by the facilitator. Such experiences of individuality can provide great insight into one's own psychological makeup. As a result, individuals often become kinder to themselves, which in turn reduces their stress level, thus improving immune function and overall health.

Practitioners of meditation caution that it may take awhile before tangible health benefits are seen. Patients should be encouraged to continue the practices even if they get impatient for results and want to stop.

A relatively new technique in mind/body medicine is called "thought-field therapy," developed by Dr. Roger Callahan, a psychologist interested in applying eastern and western medical practices in a variety of hybrid approaches. It is believed to work on the energy patterns surrounding a specific thought and its related feelings. Thought-field therapy intervenes between the thought and the negative emotional content of the thought, to either neutralize or completely remove it before the negative energy has a chance to damage the body. Afterward, the person can think in a more positive, clear, and hopeful manner, leading to better overall health and functioning.

Thought-field therapy is used in the treatment of negative or upsetting emotions and has been found to be especially useful in the relief of chronic worrying, anxiety, panic disorders, phobias, and memories surrounding traumatic events. The therapy is done by having the client concentrate on the specific problematic thoughts and feelings.

Biofeedback is a technique that uses special instruments attached to the body to provide the person information about what is occurring in the body at a given moment. The testing instruments pick up very subtle signals within the body (signals of which the person may be completely unaware); these signals then help the person see where impediments to relaxation may be occurring. An EMG (electromyograph) is often the instrument used in biofeedback sessions. Sensors that measure electrical activity in the muscles are attached to the skin. These readings help determine the amount of tension existing in the muscles by emitting small sounds or by visual indications; the client may then attempt to relax the muscle further until a state of complete relaxation has been achieved.

Therapeutic Touch is a healing method developed by Dolores Krieger, PhD, RN in the 1970s. It is based on the principle that the human energy system extends above the skin, and the practitioner can use the hands as sensors to locate problems within the body.

Disease is seen as a condition of energy imbalance or flow blockage which can be assessed by moving the hands over the body at a distance of about two to four inches above the body surface. The practitioner serves as a conduit through which the blocked energy flow is corrected. This method can be used without ever touching the body so it is good for physical conditions in which the body cannot tolerate contact, as for post-surgery or burn patients. Sessions typically last about 30 minutes and are performed with the patient fully clothed. Therapeutic Touch is taught in over eighty universities and practiced by approximately thirty thousand health care professionals throughout the world.

Breath therapy is another technique that is often used in trying to induce a state of relaxation. It helps release tension, anxiety and pain, and is often used along with mental imagery and/or autosuggestion. Sometimes breath therapy is not used to induce immediate relaxation, but rather to evoke strong emotions so that these emotions, which are often blocks to relaxation, can be released. Once these strong emotions are released, the client may be more successful in inducing the relaxation response.

Over the last few decades the medical establishment has attempted to ease this problem by developing support groups for those afflicted with major illnesses of our modern age. When used in conjunction with other therapies, this approach is valuable in treating many diseases. Being with others who are suffering in similar ways reduces the sense of isolation and loneliness that accompanies many of these diagnoses. It provides a regular format (usually weekly meetings) for teaching new coping methods, training in guided imagery, breath therapy, and other forms of stress release. It also provides a safe environment for learning how to express emotions in a healthy way, and teaching new nutrition and exercise regimes.

As stated earlier, most practitioners of mind/body medicine do not rely on just one of these techniques or interventions, but use them in conjunction with one another to provide an individualized approach to health care promotion.

Multi-strategy regimens have been developed for other illnesses as well. Heart attack survivors have been able to reduce their death rate by half using mind/body techniques such as stress management and support group therapy; coronary artery blockage is almost always reduced by changing diet, exercise patterns, practicing yoga, and attending support group meetings. Cancer patients receiving lessons in guided imagery, relaxation training, breath therapy, training in problem-solving techniques, and support group time showed evidence of increased psychological well-being as measured by increased emotional expressiveness, higher levels of positive coping, and increased survival times.

One of the oldest forms of mind/body medicine is yoga. This practice has had a profound impact on the fields of stress reduction, mind/body interventions, and energy medicine. The word itself means a union between the physical, mental, and spiritual dimensions of life and is therefore philosophically compatible with the concept of holistic health. Many physical postures, breathing exercises, and meditation practices are similar to those previously mentioned in this section. Classes are usually available through the local YMCA and YWCA, and in many towns. It is a good place to start for a comprehensive approach to holistic health practices.

The Stress Factor

Stress Stress Stress Stress . . . It goes on and on. You can hardly pick up a newspaper or magazine or watch TV without seeing or hearing some reference to stress. Why all of a sudden focus and fascination? After all, stress has been around since Adam and Eve were evicted from the Garden of Eden. Is it because there is more stress today? Is it because the nature of contemporary stress is somehow different and more dangerous? Or is it because scientific research has increasingly confirmed the crucial role stress can play in causing and aggravating different disorders and the diverse mechanisms of actions responsible for mediating its countless effects? Yes. Yes. Yes . . .

The word stress comes from the Latin term, strictus, which means to be drawn tight. This concept from physics has to do with the measurement of strain on metal materials and its ability to withstand pressure.

The stress response of the body is somewhat like an Indy car revving at the starting line. Virtually all systems (the heart and blood vessels, the lungs, the digestive system, the sensory organs, the immune system, and brain) are geared up to meet the perceived danger.

Stress is an unavoidable consequence of life. According to Hans Selye, the most widely recognized authority on stress, "Without stress, there would be no life". However, just as distress can cause disease, it seems reasonable that there are good stresses that promote wellness. Stress is not always necessarily harmful. Winning a race or contest can be just as stressful as losing, or more so, but may trigger different biological responses. Increased stress results in increased productivity - up to a point. However, this level differs for each of us. It's much like the stress on a violin string. Not enough produces a dull, raspy sound. Too much tension makes a shrill, annoying noise or snaps the string. However, just the right degree can create a magnificent tone. Similarly, we all need to find the proper level of stress that allows us to perform optimally and make melodious music as we go through life.

According to Time magazine stress was considered "The Epidemic of the Eighties", and our leading health problem as a nation at that time. It is without a doubt that the situation has progressively worsened since then. Numerous surveys confirm that adult Americans perceive they are under much more stress than a decade or two ago. It has been estimated that 75 -90 percent of all visits to primary care physicians are for stress related problems. Job stress is the leading source of stress for adults. Stress levels have also escalated in children, teenagers, college students and the elderly for other reasons, including: increased crime, violence and other threats to personal safety; destructive peer pressures that lead to substance abuse and other unhealthy lifestyle habits; social isolation and loneliness; the erosion of family and religious values and ties; the loss of other strong sources of social support that are powerful stress busters.

Alterations in Body Metabolism During Stress

Carbohydrate Metabolism	Glucose is mobilized by increased glycogenesis and glucogenesis. Glucogenic amino acids and glycerol are used for energy. Vitamin B1, B2, B3, B6, B12, Biotin, K, Mg, Inositol metabolism affected.
Protein Metabolism	Protein breakdown occurs in peripheral tissues. Amino acids then converted into glucose in the liver. Urinary excretion of nitrogen and creatinine. Vitamin B3, B6, Folate, K, Mg, Zn, Biotin metabolism affected.
Fat Metabolism	Fat stores mobilized to produce energy. Circulatory fatty acids and cholesterol Fats in liver Oxidation free radicals Vitamin B1, B2, B3, Biotin, Mg, Fe, Phosphorous.
Steroid Production	Gluco and mineral corticoids affecting metabolism of cholesterol, B2, B3, and pantothenic acid.
Catecholamine Production	Epinephrine and norepinephrine production affecting metabolism of tyrosine, Fe, B6, Mg, Vitamin C.
Figure 3

How Has Stress Changed and Become More Dangerous?

Contemporary stress tends to be more pervasive, persistent and insidious because it stems primarily from psychological than physical threats. It is associated with ingrained and immediate reactions over which we have little control that were originally designed to be beneficial such as:

These and a myriad of other immediate and autonomic responses, have been exquisitely honed over time as life saving measures to facilitate the ability to deal with physical challenges. However, the nature of stress for modern man is not an occasional confrontation with a saber-toothed tiger or a hostile warrior but rather a host of emotional threats like getting stuck in traffic and fights with customers, co-workers, or family members, that often occur several times a day. Unfortunately, our bodies still react with these same, ancient fight or flight responses that are now potentially damaging and deadly. Repeatedly invoked, it is not hard to see how they can contribute to hypertension, strokes, heart attacks, diabetes, ulcers, neck or low back pain.

However, the body may contain it's own best pharmacy. There is vast innate potential that resides in each of us for preventing disease and promoting health. Good health is more than just the absence of illness. Rather, it is a positive state of physical and emotional well being, that acknowledges the importance and inseparability of mind/body relationships. Our goal should be to learn how to harness stress, so that it can work in a positive, more productive, rather than self-destructive manner. Highly conditioned athletes display a stress response that rises quickly in a competition then falls quickly back down. We should aim for that same condition - through diet, exercise and a resolution to stop hitting the refrigerator or the bar when things get tense. A lot of it depends on attitude.

There are five specific nursing interventions related to the spiritual dimension:

Prayer
The use of Scripture
Providing a centered presence
Active listening
Referral

Figure 4

Although the exact physiological mechanism by which spirituality to heal illness has not been determined, prayer has been demonstrated to stimulate healing. It is thought that prayer stimulates the relaxation response and enhances the immune system. Nurses in holistic practices concede that there is an element of mystery in the use of prayer for healing. Many attribute this mysterious component to the assistance of a "higher power" in the healing process. This "higher power" is often referred to as God.

Holistic nurses report that intervention in the healing process with prayer helps clients cope with anxieties surrounding their diagnoses and their loved ones. Prayer is also seen as an important tool to deepen the nurse/client bond that is often so crucial in healing.

Interventions that Manipulate Body Parts

Massage Therapy

Healers from most cultures throughout history have used hands-on manipulation as a significant part of their healing traditions. Despite the wide variety of massage techniques they all tend to hold certain key physiological principles in common. These principles are:

Scientific support through controlled studies demonstrates the effectiveness of massage as part of an overall health care plan. Studies show its effectiveness for a wide variety of ailments. Studies are currently being conducted to determine the effectiveness of massage in a variety of other ailments as well. Some of these include addicted infants, colic, infants whose mothers are depressed, abused and/or autistic children, post traumatic stress, eating disorders, and fibromyalgia.

A major advantage of massage therapy is its usefulness to combat the symptoms in a wide variety of stress-related diseases and ailments. While it has few contraindications, there is concern that it might spread cancer cells, spread communicable skin diseases, or cause the dislodging of a blood clot. In such cases, massage is not recommended unless affected areas of the body can be worked around.

Structural/Functional Movement methods of massage are used to reinstate balance within the body as well as to improve the ease of movement and are often used in conjunction with deep tissue massage. There are several variations of structural/functional methods. Some are:

Oriental massage methods are based on the principles of Chinese medicine and the changes of energy flow within the body. The most common in this country are Acupressure and Shiatsu (Shiatsu was actually developed in Japan). These methods are based on applying finger and palm pressure to specific points to improve the efficiency and balance of energy in the body. It is believed that impeding of energy flow is caused by tension within the body's muscles which must be released before it causes muscle and organ damage.

Reflexology is becoming increasingly popular and involves the stimulation of specific points on the ears, hands, and feet that are believed to correspond, or "reflex", through a complex neurological system to specific areas and organs of the body. Pressure applied to these reflex points releases tension, improves circulation, and restores the balance of the body's energy flow.

Chiropractic Medicine

Chiropractic medicine is a non-pharmaceutical and nonsurgical approach that involves hands-on manipulation of the musculoskeletal system as a means of primary treatment. Chiropractors are the second largest group of primary care providers in the US. They are second only to physicians, and they receive roughly 2/3 of all health care visits for back pain. Roughly ten percent of the population use chiropractic medicine.

There are several key principles underlying the practice of chiropractic medicine. The first one, the vitalistic principle, states that the body can heal itself from within through the flow of energy in the body's nervous system. By manipulating the spine and joints through which the flow occurs, chiropractors believe that they remove barriers to the body's natural healing power. Chiropractors also believe in the holistic principle, but see the nervous system as the master of all other body systems, and thus the nervous system is the key to making the entire network of systems function at their highest level.

For chiropractors, the musculoskeletal system plays a key role in understanding how the body functions. They see biological functioning as a by-product of biological structure. Since the musculoskeletal system provides the body's structure, it plays a critical role in maintaining a healthy body function. Illness is the result of flaws in musculoskeletal structure that impact the nervous system and cause disease in corresponding parts of the body. Subluxations (a state in which a joint is only partially dislocated) occurring in the spinal column account for much of the body's poor functioning, and are from a modern lifestyle which is inconsistent with the way the body was designed. Subluxations are common and often the result of a sedentary life-style, such as sitting for prolonged periods of time which is hard on the spine, and lack of exercise.

There are variations in the practice of chiropractic medicine. Some limit their practice solely to subluxations of the spine and its immediate connections to the nervous system. Most practitioners bring in concepts from diverse health care disciplines and have a broader scope of practice. They use nutritional supplementation, Chinese medicine, naturopathy, homeopathy, massage, and mind/body medicine. Each uses a unique combination, which allows flexibility in meeting the needs of their clients. Other practitioners take a more allopathic approach to healing, such as the diagnosis of disease followed by referral for treatment, if warranted, or followed by chiropractic treatment of the disease.

Preliminary studies revealed an increase in monocyte functioning after chiropractic adjustment, suggesting a possible link between spinal manipulation and immune functioning.

Treatment usually begins with a medical history questionnaire that is filled out prior to the first visit. This is followed by a physical exam, much like that given by a physician, which assesses whether the client is a good candidate for chiropractic treatment by measuring leg length, muscle tone, heel tension, and other musculoskeletal features. Once a diagnosis is made, then treatment follows using a variety of therapies such as: physiotherapy, adjustments to problem areas to reduce subluxations and to restore normal joint function, and manipulations such as stretching or traction to relieve adhesions that may have built up from an old injury and which may be impeding flexibility.

Chiropractic medicine's greatest strength lies in its treatment of musculoskeletal problems such as sprains, low back problems, headaches, neck stiffness, and joint conditions. Chiropractors do not treat fractures or acute infections, perform surgery or trauma care, or prescribe pharmaceutical medication.

The chiropractor/client relationship is another strength of this approach to health care. The need for constant communication between the practitioner and the client during treatment sessions usually makes for a warm and empathic relationship.

For more information on chiropractics, you can contact one of the several professional organizations for this discipline. The American Chiropractic Association publishes the Journal of the American Chiropractic Association, emphasizes ethical and professional conduct, conducts research, and is involved in lobbying for laws that support the profession. Phone 800/986-4636, Website: www.amerchiro.com

Osteopathic Medicine

An American Civil War surgeon named Andrew Still founded osteopathic medicine. Like Chiropractics, the theory he developed emphasizes the importance of viewing the body's health holistically by integrating its inherent healing powers, its communication and regulatory feedback mechanisms, and the pivotal role of the musculoskeletal system into a system of thought to promote health maintenance and fight disease. While this doesn't sound particularly innovative by today's standards, it was innovative for the time in which Dr. Still lived. During the Civil War and the post-war period, American medicine was not particularly scientific in nature, and considered unorganized.

Still founded the first school of osteopathic medicine in 1892. Its curriculum contained courses similar to those taught in allopathic schools, but stressed the importance of the relationship between structure and function, and focused on the importance of the structure of the musculoskeletal system in overall body function. He saw interplay between the mechanics of joint function and the performance of muscles and ligaments, which impacts vascular flow and the function of the nervous system. He believed improving the circulation, and maintaining the body's highly tuned regulatory system (which involves the vascular and nervous system communication and feedback loops) was the best way to insure optimum health.

Dr. Still taught that manipulative therapies, performed on parts of the musculoskeletal system, would improve the blood supply throughout the body. Improved blood supply would improve the nervous system function. This emphasis on the musculoskeletal system is what lends the name "osteopathy."

Like chiropractors, osteopaths view disease as caused by disturbances in the particular location on the spinal column, which supplies the nerves to the particular organ that is malfunctioning.

Like Chiropractics, Doctors of Osteopathy (DOs) were not accepted as part of mainstream medicine until the emphasis on holistic health began to surface in the last few decades. It wasn't until 1972 that all states allowed DOs to apply for licensure, and later they were allowed to practice in allopathic hospitals. Currently there are approximately 50,000 DOs and seventeen osteopathic medical schools in the United States. DOs are now eligible for AMA membership, and they have their own professional organization, the American Osteopathic Association. Many allopathic physicians recognize that the emphasis on musculoskeletal functioning has an impact on many disease processes and train themselves in that aspect of osteopathic medicine. Osteopaths see themselves as a separate, but equal profession to MDs. However, they do not want to lose what makes them unique by abandoning their own organizations in favor of admission into the AMA. DO training is similar to allopathic physicians, although there is a greater emphasis on preventive medicine, and more training in musculoskeletal physiology and manipulative interventions. Studies confirm that the quality of medical knowledge of MDs and DOs is comparable.

There are some differences in the ways that DOs actually practice their art. Some are loyal to the idea that manipulation is central to the practice of osteopathy, but the majority of DOs use many allopathic approaches in their work with patients. DOs easily integrate homeopathy, naturopathy, Chinese medicine, and mind/body medicine into their practices. Osteopaths are able to specialize in the same fields in which allopaths specialize, but approximately half of them go into primary care medicine instead.

A survey of 100 practicing DOs showed that 71% of them used manipulative therapies with only 5% of their patients, and only 14% used manipulation with over half of their patients. Some predictors for using manipulation therapy:

Specialty, emphasis in school, and era of training were not significant in this study.

Other studies show that DOs entering the primary care fields, especially those entering family practice, are more likely to use manipulative techniques in their practice than those entering more specialized fields. The authors of one study suggest that this difference in practice styles starts in medical school. With this in mind, they encourage DO medical schools to provide greater emphasis on manipulative medicine. The American Osteopath Association has developed a medical school program with primary care specialization beyond the basic medical school requirements.

A common theme throughout many professional osteopathic journals is the concern that osteopaths, in moving away from manipulative techniques, are losing much of what makes them unique in comparison to other health care providers. There seems to be widespread concern that as DOs become accepted by allopathic providers, they will be absorbed by the more traditional approaches and eventually cease to exist as a group with their own unique approaches and philosophical underpinnings. Concerned osteopaths emphasize the importance of maintaining an emphasis on manipulative techniques and prevention-oriented holistic care if the profession is to survive as a separate entity from allopathic medicine.

Scientific support for the theory behind osteopathic medicine comes from research conducted over the past few decades and is, at times, indistinguishable from allopathic theory. There are a few studies that have been conducted to test theory that is unique to osteopathic medicine.

A study compared the musculoskeletal differences between psychotic patients and those with affective disorders. This study concluded that there were, indeed, significant differences. The psychotic patients had more structural problems in the midcervical regions of the spine and the lower extremities, while those with affective disorders had more problems associated with the thoracic region of the spine.

Recent studies demonstrate the usefulness of osteopathic medicine in treating low back pain, muscle contraction headaches, herniated discs, peripheral nerve problems, chronic shoulder pain, decreased range of motion associated with old age, and fibromyalgias. Osteopathic manipulations have proven particularly helpful in these cases when combined with self-help training. DOs treat hypertension, generalized muscle pain, fatigue, sleep problems, children infected with measles, and childhood respiratory disorders.

Manipulative therapies have proven useful in reducing the length of the course of antibiotics needed in the treatment of pneumonia in elderly individuals in reducing the number of attacks and medication needed in the treatment of asthma sufferers, and in relieving the symptoms and reducing the length of acute episodes in those with COPD.

Osteopathic diagnosis is made using the standard approaches of allopathic medicine, but DOs also employ palpation and other touch techniques to assess skin temperature, range of motion, and pain. In addition to the standard physical exam and history taken by the allopathic physician, the osteopath assesses body alignment, posture, and muscle movement to obtain further information, which might suggest particular treatment methods.

Treatment often involves a combination of allopathic pharmaceutical interventions with osteopathic manipulation. All interventions are made with the importance of blood circulation in mind. Some of these interventions include:

The biggest strength of osteopathic medicine is its ability to incorporate the theories and techniques of many other types of treatment into its practice. The osteopath will use theory and drugs from allopathic medicine along with techniques from mind/body medicine and/or Chinese herbs. The hands-on techniques of manipulation are beneficial because they bring an intimate atmosphere into the treatment setting. Osteopathic patients are more likely to report feelings of caring and compassion from their practitioner than patients of allopathic practitioners.

While an interpersonal relationship between practitioner and patient is vital to the success of osteopathic treatment, some osteopathic practitioners align themselves closely with allopathic practices. A potential patient should evaluate whether an individual osteopath is able to meet their particular needs. For example, an osteopath that follows the typical structure of the 15-minute office visit might be unable to respond to questions that might come up during the course of treatment. Those who space their appointments further apart can be flexible should additional time be needed.

Costs for osteopathic office visits are similar to those of allopathic physicians, but overall cost for osteopathic treatments may be less than for allopathic treatments. Costs in rural areas are lower than those in urban centers.

The best way to evaluate the results of osteopathic care is by a subjective response - the patient feels better. However, there are some objective criteria such as increased range of motion, lab tests, spinal palpation, and changes in craniosacral motion and pulse.

For more information on osteopathy, and a list of board certified practitioners, contact:

Therapies Involving Nature

To some extent, the alternative therapies covered so far fall into the broad category of "naturopathic" medicine because they are aimed at helping the body to heal itself using natural substances and processes.

Naturopathic Medicine

There are two broad categories of naturopathic medicine. The first is the vitalistic approach, which emphasizes the body's natural healing powers, insists on lifestyle changes, hydrotherapy, and stress reduction techniques to prevent and treat illnesses. Only if these methods fail are herbs and other chemical interventions tried.

The second category, the biochemical approach, uses herbs and nutritional substances, such as vitamins, as the first line of treatment. This approach is more symptom-oriented than the vitalistic approach. This second category is more in line with the views of allopathic medicine, and more easily studied using Western scientific research methods. It is more commonly practiced in this culture than the vitalistic method.

Naturopaths are trained as primary care providers in a variety of intervention techniques, and may specialize in any of them, or choose to specialize in specific problem areas, such as allergy or arthritis.

There is more support in some cases for the use of naturopathic interventions than for some pharmaceutical and surgical interventions we now take for granted. In some cases "new" remedies in allopathic medicine have been used for years by naturopaths. For example, naturopaths have been using vitamin E for its antioxidant properties for over thirty years. As the demand for nontoxic remedies for serious illnesses increases, naturopathic research is receiving more attention from mainstream medicine; allopathic researchers are beginning to research naturopathic remedies, thus providing the scientific data necessary to legitimize naturopathic medicine in the minds of those trained in Western medical thought.

The strength of naturopathic medicine lies in its ability to prevent illness and to treat illnesses that haven't responded well to conventional medical therapies. Naturopaths excel in the clinical use of nutrition regimens because of their vast knowledge of the latest research in nutritional medicine. They see themselves as part of a comprehensive system of health care that includes many other traditions with valid intervention that can be used alongside naturopathy. They evaluate their results by the subjective responses of the patient, their own observations, the reduction of symptoms, and the results of any lab tests administered.

Appropriate nursing diagnoses for referral to a naturopath include the following because they are often responsive to nutritional remedies:

Many studies on the development and treatment of various cancers are supporting the importance of diet, and other lifestyle issues.

Garlic has been shown, in some animal studies, to have cancer-suppressing potential by inhibiting the metabolism of carcinogens in the body, and by stopping them from binding to genetic material. This is true not just for breast cancer, but for other forms of cancer as well, such as liver, lung, and colon cancers. Other researchers say that it is difficult to study the effects of garlic because the same properties that are suspected of producing anti-carcinogenic effects are also the properties that cause its distinctive odor. There are no adequate odorless stand-ins for fresh cloves, and the amount of garlic needed to provide definitive answers (often as much as 7-28 cloves a day) is prohibitive, given the odor problems associated with it. More research is needed before definitive dietary conclusions can be made.

Scientists are also starting to realize the anti-carcinogenic properties of compounds called polyphenols. They are found in fresh fruits and vegetables, and in many grains. Anyone eating a standard healthy diet is exposed to them regularly. They generally come from plant foods, and are manufactured by the plant to protect itself against ultraviolet light, oxidation, and insects.

It is believed that these anti-carcinogenic properties may be transferred to humans when they consume these plants. The major antioxidant vitamins are A (beta-carotene found in a wide variety of fruits and vegetables), C (ascorbic acid), and E (tocopherol). They have the distinct advantage of having few side effects when taken in a wide range of supplemental doses and are ideal for use as preventive agents in healthy populations.

Recent studies have shown that antioxidants may play a role in reducing the risk of cataracts, age-related macular degeneration, certain neurological disturbances, bladder cancer recurrence, and infectious diseases. However, despite the number of studies showing the benefits of antioxidant supplementation, consensus about these benefits still does not exist. Researchers are calling for longer and more substantial clinical trials before definitive results can be obtained.

For years scientists have suspected that fish oils provide protection against certain types of cancers such as breast and prostate. The omega-3 fatty acids found in fish oils have been a prime target of cancer research in recent years because researchers have observed that the same parts of the world where breast cancer rates are high are where prostate cancer rates are high. Parallels in terms of diet (diets in these countries are high in fat), hormonal dependence, and biological behavior have been found. Because research has shown a correlation between the development of breast cancer and the intake of omega-6 fatty acids (found mostly in polyunsaturated oils), current research is looking for a correlation between omega-6 fatty acids and prostate cancer.

Soy products such as soy flour, soy milk, and tofu contain phytoestrogen compounds that appear to not only aid in symptoms of menopause, but may also prevent certain types of cancer such as breast and prostate. It appears, however, that it is difficult to get all that is needed for cancer prevention simply from diet. Therefore, many researchers are excited by a new supplementation product known as genistein, an isoflavone phytoestrogen found naturally in soybeans. Because its chemical structure is similar to estrogen, but its hormonal action is considerably less than that of the body's naturally produced estrogens, it is theorized that genistein may be useful in preventing cancers of several different organs by binding with estrogen receptor sites and preventing the stronger estrogens from binding, thus reducing overall hormonal activity. Genistein may also cause cancer cells to mature, differentiate, and die as normal cells do, which kills the cancer cells. Soy isoflavones may encourage bone density in postmenopausal women by binding to an estrogen receptor found in bones, thereby preventing osteoporosis. More studies are called for to reproduce these findings.

The complexity of factors which lead to cardiovascular risk, make cardiovascular wellness and prevention a good candidate for holistic interventions. The use of antioxidants to prevent and treat heart disease has been an important part of research from earlier findings suggesting that the oxidation of low-density lipoprotein cholesterol is critical in the development of arteriosclerosis.

The mechanism by which antioxidants may prevent the development of cardiovascular disease is not fully understood. They may work on the LDL/HDL ratio; affect the blood coagulation system, making thrombosis unlikely; or prevent the oxidation of the arterial walls. To complicate matters further, it may be that each of these possible mechanisms is linked to a specific antioxidant.

Not surprisingly, it appears that fats play a role in the development of cardiovascular disease as well as cancer. A Norwegian study demonstrated that fish oils lower both diastolic and systolic blood pressures, decrease serum triglyceride levels, and decrease serum lipid levels in persons with untreated hypertension. Another study found that when fish-oil supplementation is combined with garlic supplementation, serum cholesterol levels drop and the LDL/HDL ratio is improved.

Often powerful drugs with unpleasant side-effects are the allopathic means of treating hypercholesterolemia. Those who think in holistic terms believe these drugs should not be the first choice in the treatment of high cholesterol, but should be used only after efforts at lifestyle and dietary changes have failed. Such changes entail regular exercise, a reduction of dietary saturated fatty acids and cholesterol, and possibly moderate alcohol intake (to change LDL/HDL ratio). Often dietary supplements with lipid-lowering effects are given as well. Soy proteins are one such supplement shown to be as effective as pharmacological treatments, without the troubling side effects.

Another advantage to soy is that the higher the beginning cholesterol level, the greater the lipid-reducing effect it has, which suggests that it should, at least, be used in conjunction with allopathic drugs when a patient has dangerously high cholesterol levels. The mechanism by which these supplements work is believed to be connected to the isoflavone component of the soy protein. Isoflavones are an example of a group of compounds called phytoestrogens, which exert mild hormonal effects on the body. It is theorized that the isoflavones found in soy proteins affect the body in a metabolically and hormonally complex way to lower cholesterol levels, and may reduce the rates of some cancers by slowing cell replication.

Soy supplements are an important part of a holistic approach to heart disease. The dietary changes needed to lower cholesterol are often difficult for patients to maintain because they require a vigilance that some don't think they have the time for, find too expensive, or deem inconvenient. Whatever the reason, if one is unable to comply with the rigid diet recommended, it does little to improve their overall health. Soy supplementation may be an answer for many because it lowers overall cholesterol levels, even in the patient who is not maintaining the strict dietary regimen prescribed.

Orthomolecular medicine (often known as megavitamin therapy) is another complementary regimen based on nutrition. The main principle underlying this form of medicine is that people are biochemical individuals with their own special bodily needs and, therefore, RDA vitamin and supplement requirements make little sense as nutrient guides. Instead, the patient's progress is monitored through regular blood work and urinalysis. This system eliminates junk food, refined sugar, and food additives from the diet while prescribing large doses of specific vitamins. Most practitioners are aware of the danger of toxicity with some vitamins and carefully watch for symptoms. This form of complementary care is used in cancer prevention; prevention of neural tube defects (by folic acid supplementation); and the treatment of diabetes, hypoglycemia, and arthritis.

A cure for the common cold has eluded researchers for decades and, while zinc does not technically qualify as a cure, there is some evidence to support the claim that zinc lozenges can reduce the aggravating symptoms of the common cold, and reduce the duration of symptoms.

A study showed those taking zinc lozenges had symptoms for 4.4 days, while those who took placebos had symptoms for 7.6 days. The patients who took the lozenges reported significantly less coughing, headache, hoarseness, nasal congestion, and drainage than did the placebo group. However, no difference was found in fevers, muscle aches, or sneezing.

Chronic Fatigue Syndrome (CFS) is a fairly new phenomenon that has not been amenable to allopathic treatment methods.

The Center for Disease Control (CDC) defines chronic fatigue syndrome as unexplained fatigue lasting for six months resulting in substantial reduction of activities, plus at least four of the following symptoms: impaired short-term memory, difficulty concentrating, sore throat, tender lymph nodes, muscle pains, joint pains without swelling or redness, headaches of a type or severity not previously experienced, lack of sleep, and malaise of more than one day following exercise.

CFS strikes primarily women between the ages of 25 and 45, and usually occurs suddenly. It can last for years, but sufferers often do not look sick, and may be labeled as lazy or mentally unstable. There is no known cause or lab test to diagnose CFS, but researchers are looking into the possibility that stress causes the immune system dysfunction, viral infection, environmental assault, and neuroendocrine imbalances associated with CFS. The latest thinking is that the cluster of symptoms is caused by a combination of these factors.

Pharmaceutical intervention is mildly helpful in treating CFS, and includes the nonsteroidal anti-inflammatory agents for joint pain and low doses of antidepressants to reset disturbed sleep patterns. Some herbs that may help are:

Homeopathic remedies may help CFS, but because everyone is different, and there is a wide array of symptoms associated with the syndrome, it is strongly suggested that one should consult a trained homeopathic practitioner rather than attempt to self-medicate with homeopathic agents.

Cognitive therapy and/or support group therapy may help, as long as the practitioner and/or group members maintain a positive attitude. These can be sources for information, and to learn to cope with distressing thoughts and feelings. Relaxation techniques can be taught in these settings.

Health food stores and alternative medicine literature contain many newer supplementation materials and information that is impossible to cover in an overview course such as this one. However, a few of the more common ones, many of which are actually hormones, will be highlighted.

DHEA, a hormone produced by the adrenal gland that reaches its peak at about the age of 30 and drops significantly by age 60, has been reported to cure aging, promote weight loss, prevent heart disease and Alzheimer's disease, combat AIDS, cure lupus, and even serve as a remedy for some cancers. There is not enough clinical evidence to support these claims, but there is much scientific interest in DHEA because of the way it naturally functions in the body. Since it is associated with youth and vitality, it is natural to wonder if replacing it as one gets older would retard the aging process. Most claims are based on animal and lab studies, and the few that have been conducted on humans have been inconclusive.

Other hormones that decrease as aging occurs include human growth hormone, estrogen, testosterone, and melatonin. Human growth hormone declines gradually after middle age. When replaced, it can have dramatic effects on the body's metabolic rates and change the muscle/fat ratio, accelerate the healing process in surgical patients, and help people sleep better.

Estrogen begins its decline in women around age 40 and sharply drops off about age 50. Replacement can reduce or eliminate hot flashes and insomnia, two of the major annoyances women going through menopause complain about. It is believed to reduce the risk of heart disease and osteoporosis in postmenopausal women. This is extremely important because studies have shown that although women are, for the most part, protected against heart disease until menopause occurs, once estrogen levels drop dramatically, women have the same risk as men for developing heart disease. The major difference is that when women have MIs after menopause, they are usually more severe than the first heart attacks of men, and women are more likely to die from the first attack than men are. Men may get a warning, but women often do not.

Melatonin is a hormone produced in the pineal gland from serotonin (5-HT) levels. It has serum levels that change on a circadian rhythm pattern, with higher levels present at night, and lower levels present during the day. Its overall body levels decrease sharply at adolescence, and again at age 40. The elderly produce about half of that produced by children. Replacement may ease insomnia, relieve symptoms of jet lag, strengthen the immune system, fight certain cancers, act as an antioxidant, relieve some symptoms of seasonal affective disorder, and prevent ovulation. It can have a side effect of daytime grogginess and exacerbate any tendencies toward depression. The FDA does not approve it because it is classified as a dietary supplement instead of a drug, so it cannot be obtained by prescription, but may be commercially available in health food stores. It is found in both a synthetic and non-synthetic form, but use of the non-synthetic form is discouraged because of the risk of contamination or viral transmission. It is suggested that patients seek medical advice before taking melatonin.

There are many herbal remedies that are used by a variety of alternative practitioners.

Garlic is probably the most recognized medicinal herb among researchers. Its chemistry and pharmacology are well studied. It is well known for its antibiotic, antifungal, antiviral, and anti-carcinogenic properties. It also clears congestion, kills intestinal worms, improves immune system functioning, and lowers blood pressure.

Ginger is known for its aid in digestion, its anti-nausea, and its anti-motion sickness properties. It is currently being studied as a source of migraine relief.

Feverfew is an herb that has been researched and proven effective against migraines, and prevents the onset of future episodes.

Ginkgo biloba is an extract from the leaves of the ginkgo tree and is popular in Europe where it is usually sold in 40mg tablets. Evidence suggests that in large doses, it dilates blood vessels, increasing circulation throughout the body and improving memory and concentration. It may act as an antioxidant, useful in treating chronic hypertension, and aid in the reduction of serum cholesterol. In Germany it is used for tinnitus, headaches, and emotional instability. Its major side effects, which occur at very high doses, include nausea, vomiting, and diarrhea.

Echinacea is sold in liquid and capsule form, and is taken orally. Several studies have demonstrated its multiple effects on the immune system. It elevates WBC, improves the efficiency of macrophages and proteins designed to regulate disease-fighting cells, and may alleviate cold and flu symptoms. It has few side effects, except for those who are allergic to it.

Ginseng is from an Asian class of drugs that interact with neurotransmitters and can alleviate stress. It is used to reduce hot flashes in menopausal women, but has been found to be more effective if taken with vitamin E. Recent studies suggest that it may be useful as adjunct therapy in treating newly diagnosed non-insulin dependent diabetes, and as an antioxidant. Side effects, such as nausea and insomnia, are few and usually occur at very high doses. However, there is some evidence that ginseng may interfere with other pharmacologic agents such as digoxin. Health professionals should be aware of this danger. When obtaining a patient's history, to be alert for medications the patient is taking, including herbal remedies. Claims that ginseng acts as an aphrodisiac do not have supporting evidence.

Dong quai is used to relieve menstrual cramps, symptoms of menopause, and other gynecological problems. It appears to work by dilating the blood vessels and preventing vessel spasms. There is no clinical evidence to support these claims. Dong quai's main side effect is to increase the skin's sensitivity to the sun, and it should never be taken in high doses.

Black cohosh is a powder usually sold in capsule form, or as an herbal tea, and derived from a plant commonly known as rattleweed. It dilates blood vessels, and lab studies have revealed that it contains several compounds that bind to estrogen receptors. It is widely used in Europe to relieve the symptoms of PMS and menopause. An overdose can cause dizziness and headaches. Safety during pregnancy has not been established.

Other herbs that may have estrogenic properties and help reduce hot flashes are blue cohosh, fennel, false unicorn root, red clover, sarsaparilla, unicorn root, wild yam root, and oil of primrose. It is important to remember that herbs with estrogenic properties may be dangerous for women who have been advised against taking estrogen, either as a hormone replacement in menopause, or in birth control pills. The nurse should provide this information to a client inquiring about the use of these herbs.

It is true that some herbs with estrogenic properties also have anti-estrogenic properties. Some theorize that these herbs can protect against certain estrogen-related cancers as they provide relief for the estrogen-dependent symptoms of menopause. This has not been proven, however, and one taking these herbs should know of the potential dangers, as well as their benefits. Together, the client and doctor can make the best choice for individual symptoms and risk factors.

Tea-tree oil is pressed from the leaves of a tropical tree and has been used for centuries as a topical antiseptic by those living in the South Sea Islands. Its principle active ingredient is terpinen-4-ol, which acts as a bactericidal substance. Some clinical studies have indicated that it may be effective in treating acne and other skin infections, as well as vaginal infections. There seem to be few side effects.

Herbs and teas that may produce a calming effect on the nervous system and help reduce anxiety, irritability, and insomnia are chamomile, catnip, hops, valerian root, peppermint, and passionflower.

Other herbs that may target specific problems include milk thistle used to treat liver conditions, such as cirrhosis and jaundice; saw palmetto used to treat prostate enlargement; and valerian used as a minor tranquilizer and sleep aid. Valerian does not seem to interact with alcohol or have a side effect of morning grogginess as other sedatives do. Cayenne pepper can stimulate blood flow, strengthen the heart and metabolic rate, and aid in digestion. Chasteberry can restore a normal estrogen/progesterone balance within the body. Goldenseal has antimicrobial and antibacterial effects. Licorice is used for gastritis and bronchitis, nettle for arthritis and rheumatism and its possible effects against hay fever, senna for constipation, and witch hazel to soothe hemorrhoids and to stop diarrhea.

St. John's Wort is a remedy used for nearly two thousand years for its anti-inflammatory effects, and sedative and pain reducing properties. It is also good for anxiety, tension, neuralgia, and the irritability symptoms of menopause. It is also used as an antidepressant, and an antiviral in conditions ranging from the common cold to HIV.

It is important for nurses to remember that allopathic medicine does not have all the answers to important health questions, and much can be learned from the wide variety of complementary approaches described in this course. Unfortunately, there are people who will take advantage of the lack of controls over many of these alternative substances, and use them in harmful ways to make a quick buck or use them in excess; more is not always better.

Commercially available preparations vary as to dosages, so patients should be warned about the possibility of problems if they change brands. Exceeding the recommended dosage can lead to toxicity, just as it can with allopathic medicines. Patients should be counseled to report symptoms such as diarrhea, rash, urticaria, or gastrointestinal upset to their healthcare provider.

The role of the nurse is to be informed about alternative and complementary approaches, and to help patients weed through the vast amount of information about these substances so that optimum health care can be achieved, with as little risk as possible. Therefore, nurses should ask why the patient is taking the herb, how much, what brand, and who suggested its use. If the patient is pregnant, the nurse should discourage further use until the patient has consulted with her allopathic primary caregiver, just as one should with any drug.

The public perception of the FDA as a slow-moving bureaucracy that prevents the latest "cures" from being marketed may have some truth to it. Some suggest that the FDA has biases against dietary supplements because of its relationship with large pharmaceutical companies, implying an element of corruption within the FDA itself. Patients must be reminded that the regulatory benefits of an agency such as the FDA can prevent disasters like the thalidomide tragedy of the 1950's from occurring. On a less dramatic note, the FDA's requirements of consistent dosages protect people from suffering unnecessary side effects when they switch brands of a product. In an age of rapidly expanding knowledge about health care and the ability to disseminate that information quickly and widely, a regulatory agency such as the FDA definitely has its positive and negative qualities.

Homeopathy

Homeopathy is a system of medicine based on the use of natural substances to stimulate the body's own healing powers in curing disease. Because homeopathy uses natural substances, it is considered to be a subspecialty of naturopathic medicine. However, the theory behind it is different.

Homeopathy made its debut in this country around the turn of the century and was popular for many years but, like many other fields of complementary medicine, it began to decline as the interest in allopathic medicine rose. Interestingly, it was a homeopathic physician who was instrumental in the formation of the FDA. In recent years, as the limitations of allopathic medicine have become more apparent to the public, interest in homeopathic remedies has skyrocketed.

Homeopathic roots go back as far as Hippocrates' "law of the similars" which in medical terms can be stated as "like cures like." In practical terms, this means that often a substance that causes a set of symptoms in a healthy individual will have the opposite effect (a cure) on an ill person with similar symptoms. Vaccinations and allergy treatments of allopathic medicine share much the same principle. Unlike homeopathy, however, a standard treatment and dosage is given to all patients, whereas homeopathy strives to find the perfect dose and combination of remedies for each individual.

Like many complementary practices, this one believes that human beings are enlivened by a "vital force" or energy that can be an indicator of the presence of illness. Homeopaths use the energy of one substance (the remedy) to heal the energy field of another substance (the ill person) by arousing this energy field so that it actually heals itself. The remedies are not chosen to support the body's nutritional or metabolic needs, or to attack viruses and other pathogens that may be attacking the body as occurs in allopathic medicine but, instead, to subtly urge the body's vital force into a higher level of functioning to eliminate symptoms and their cause.

Homeopathy views symptoms as defense mechanisms by which the body tries to rid itself of harmful stresses. These symptoms, and their remedies, are studied in different ways from other forms of medicine. They are not described pharmacologically, or in terms of action, but rather the effects of the remedies are derived from three sources:

Homeopathy treats the unique compilation of symptoms of an individual by paying attention to those symptoms, which may differ from someone else with the same diagnosis. To illustrate this point, several patients with migraine headaches would be given several different treatment regimens to follow, depending on whether the pain is localized on the right side of the head, or the left, whether the migraines are associated with hormonal changes of the menstrual cycle or menopause, or whether they are triggered by certain foods and/or emotions. The diagnosis of migraine headache is not what leads to the remedy, but rather the unique way that the migraines are expressed from one individual to another is what determines treatment choices.

The nearly three thousand homeopathic remedies (of which 200-300 are used frequently) come from nature in the form of herbs, minerals, and are some animal products, and are regulated by the FDA and sold as over-the-counter medications. They take the form of small sublingual tablets and are prepared by a process known as "potentization" in which they are constantly diluted until only a very small amount remains. The theory behind this practice states that the more diluted a remedy is, the longer it will act, the more effective it will be, and the fewer the side effects it will produce. The mechanism of action of these extremely dilute substances is not well understood.

Homeopathic remedies are divided into three categories - acute, chronic, and constitutional. Acute remedies are given for short- term illness, such as the flu or the common cold, while chronic remedies are given for long - term conditions. Chronic remedies may take a few months to a couple of years to be effective in reducing symptoms. Once the person has recovered from the precipitating symptoms, a constitutional remedy may be given to increase the body's resistance to developing future symptoms. Constitutional remedies work slowly over time to strengthen the body against further disease.

An ideal remedy is matched to this set of symptoms, which would create the same symptoms if given to a healthy person. The result is a total body response which causes the person to function better. The symptoms are viewed as the body's attempt to restore homeostasis to a body in distress; the treatment is designed to promote the power of the total body to heal itself. Symptoms that, at first glance, may appear to be unrelated are treated together as though they are related, so the patient can heal on all levels - physically, emotionally and spiritually.

As stated before concerning migraine headaches, treatments selected are unique to the individual so that two people with the same disease may be manifesting symptoms in different ways. The homeopath treats the symptoms rather than the disease itself, and believes that the whole person is healed in a way that is foreign to the thinking of allopathic medicine. Unlike the allopathic physician, the homeopath does not need to diagnose a particular disease to treat the patient. Some homeopaths suggest that modern pharmaceutical preparations can impede the body's own healing mechanism by masking symptoms instead of curing the underlying disease. Homeopaths believe modern allopathic treatment methods can weaken the body's vital force. They stress the importance of focusing on strengthening the vital force instead of searching for offending pathogens.

In homeopathic theory it is believed that faster the onset of symptoms, the faster the cure; therefore, acute illnesses are easier to treat than chronic ones. When several symptoms are involved, the minor ones disappear before the major ones do. Often, a short time after administering the remedy, the patient's symptoms may worsen for a time. This is considered normal in homeopathic practice and is a sign that the body is being spurred on to greater levels of healing. Frequently, emotional healing occurs before the abatement of physical symptoms.

Homeopathy is most effective in the early stages of acute and long-term illnesses before enough time has passed to cause tissue damage. It is good in treating headaches (including migraines), immune system conditions, auto-immune disorders, viral and bacterial infections, childhood health problems such as chronic ear infections, croup, bladder infections, emotional and behavioral problems, and even learning disabilities. Some researchers are less impressed with the success of homeopathy against these childhood diseases than are other researchers, so exercise caution in referring these patients to a homeopathic practitioner. Homeopathy has shown effectiveness against the herpes virus. A major advantage homeopathy has over conventional medicine is it uses substances in such small amounts to effect a cure, that there are virtually no side effects.

Nursing diagnoses for referral to a homeopath might be an appropriate intervention include: activity intolerance or high risk for activity intolerance, constipation, diarrhea, fatigue, altered health maintenance, high risk for infection, altered nutrition patterns - less than or more than body requirement, and altered urinary elimination patterns.

Like most alternative therapies, there is a long initial interview in which the practitioner/patient relationship is established. Unlike most alternative traditions, practitioners of homeopathy do not consider the relationship the most important part of the healing process but, instead, attribute most of the effectiveness of the approach to the remedies themselves and the diagnostic skills of the practitioners. The patient's subjective report of symptom reduction is the major criterion upon which this approach is evaluated.

Homeopathic practitioners tend to be less concerned with the other alternative therapies covered in this course because they administer physical remedies similar to the medications of allopathic medicine and, therefore, believe that relief of symptoms comes from their choice of the right remedy. They have little interest in bodywork, herbal and nutritional medicine, or mind/body techniques.

Patients should be encouraged to look into the training background of a homeopath they are considering. The Council on Homeopathic Education has a list of several accredited programs. Their website is www.chedu.org. Naturopathic homeopaths are believed to be better equipped than some MDs for the practice of homeopathy because they have often undergone specialization in homeopathy as part of their elective training. Such a specialization is not readily available in most Western medical schools.

Other Forms of Alternative Medicine

It is not feasible to provide detailed information on every alternative approach available, but it is important to briefly cover some of them.

Essential Oils and Aromatherapy

The term "aromatherapy" was coined in 1928 by French chemist Rene-Maurice Gattefoss,. His interest in using essential oils therapeutically was stimulated by a laboratory explosion in his family's perfumery business, in which his hand was severely burned. He plunged the injured hand into a container of lavender oil and was amazed at how quickly it healed. By the 1960s, a few people, including the French doctor Jean Valnet and the Austrian-born biochemist Madame Marguerite Maury, were inspired by Gattefoss,'s work. As an army surgeon in World War II, Dr. Valnet used essential oils such as thyme, clove, lemon and chamomile on wounds and burns, and later found fragrances successful in treating psychiatric problems. But while Valnet helped inspire a modern aromatherapy movement when his book Aromatherapie was translated into English as The Practice of Aromatherapy, it was the appearance in 1977 of masseur Robert Tisserand's book The Art of Aromatherapy, strongly influenced by the work of Valnet and Gattefoss, that was successful in capturing American interest. At present, there are many books available on aromatherapy.

Most important, the efforts of pioneers like Valnet, Maury and Tisserand have turned aromatherapy into a disciplined healing art, rediscovering the uses of fragrance from ancient times and sparking a revival of aromatherapy that has swept throughout the world.

Aromatherapy uses the essential oils extracted from plants and herbs to treat bacterial and viral infections, skin disorders, stress, herpes simplex, herpes zoster and immune deficiencies. The oils are believed to act on the adrenal glands, ovaries, and the thyroid by traveling from the nose to the limbic system, which controls heart rate, blood pressure, breathing patterns, memory, stress levels, and hormone balance. They work by invoking pleasant emotional reactions stored in the brain from previous experiences with a particular aroma. The main oils used are:

Some of these essential oils are applied topically, and others breathed in. It is extremely important for patients to know that the method of application is essential for maximum benefit from the oil, and to prevent toxic reactions that can occur with some substances if they are not applied properly. For more information on aromatherapy, contact the National Association for Holistic Aromatherapy in Seattle, Washington (888-ASK-NAHA or visit www.naha.org ) or Health World Online at www.healthy.net .

Detoxification Therapy

Detoxification therapy is rapidly becoming popular as more people recognize that they may not feel their best because of their body's exposure to toxic substances as a result of our modern lifestyle. Detoxification therapy rids the body of these toxins to improve the immune function, reduce neurotoxicity and hormonal dysfunction, decrease psychological problems, and even eliminate cancer cells. Detoxification usually takes the form of fasting or strict diet regimens, colonic irrigation, and/or hyperthermia. These processes can be hard on the body and are not recommended for recovering drug addicts, alcoholics, diabetics, or those with eating disorders without strict medical supervision. It is also not recommended for the physically weak, the underweight, or for those with hypothyroid or hypoglycemic conditions. For more information, contact the American Association of Naturopathic Physicians in Seattle, Washington at 866-538-2267 or www.naturopathic.org.

Environmental Medicine

Environmental medicine explores the role of dietary and environmental allergens such as dust, mold, chemicals, and foods in promoting health and illness. These environmental substances, including food, may affect any of the body's many systems, thus contributing to many forms of illness.

A variety of tests are used to determine particular problem substances for an individual. Examples are elimination diet, skin testing, blood tests, electroacupuncture, biofeedback, and thyroid functioning. It is useful in treating mold, pollen, and food allergies, and rheumatoid arthritis.

For more information, contact the American Academy of Environmental Medicine in Wichita, Kansas at 316-684-5500 or www.aaem.com.

Enzyme Therapy

Enzyme therapy is used to treat digestive problems from an individual's lack of an enzyme or the proper amount of the enzyme needed for healthy digestion to occur. Enzyme supplementation, along with a diet consisting of whole, and whenever possible, raw foods, helps ensure that the proper nutrients are absorbed to restore the body to a fully functioning capacity. Cooking kills many of the plant enzymes needed for proper stomach digestion. Pancreatic enzymes, derived from animals, are used to aid intestinal digestion. Enzyme therapy is useful in treating inflammation, viruses, multiple sclerosis, and cancers.

Oxygen Therapies

Oxygen therapies alter the body's chemistry to help overcome disease, promote healing, and improve overall body function. They are effective against viral, fungal, parasitic, and bacterial infections, as well as circulatory irregularities, chronic fatigue syndrome, arthritis, allergies, cancer, and multiple sclerosis. They include:

There is a variety of complementary and alternative health care practices and traditions that are quickly assimilated into modern Western medical tradition as more Western-trained health care professionals recognize the benefits of these methods, and become trained in them. As the cost of health care skyrockets, the less expensive complementary methods are looking increasingly attractive to both the public and to health care professionals.

The role of the nurse is rapidly changing as the emphasis on holistic health increases, because nurses have traditionally been taught to look at the whole patient and to care for the spiritual, psychosocial, physical and emotional aspects of their patients. The holistic approach of most of the complementary practices naturally lends itself to nursing functions.

Naturopathic medicine, with its emphasis on diet and supplements, is naturally attractive to most nurses. Nurses have an important role to play in educating the public about the role of diet and supplementation to maintain optimal health, and to fight the disease process once it has started. Because of the holistic approach to health, nurses are becoming increasingly involved in mind/body medicine in a variety of ways by making appropriate nursing diagnoses, and intervening with appropriate nursing interventions. These interventions include teaching relaxation and meditation techniques to reduce stress, facilitating support groups to encourage psychosocial development, and using therapeutic touch and prayer, when requested, to meet the spiritual needs of their patient. Some nurses are trained in massage therapy to better serve their clients' holistic health care needs for comforting touch.

In other areas of complementary medicine the role of the nurse is to be informed on the subject to better serve patients by providing information about the advantages and disadvantages of these approaches, and to make referrals to the appropriate practitioners. These areas include Traditional Chinese Medicine (both herbal and acupuncture), other popular forms of herbal medicine distributed by naturopaths, chiropractic medicine, osteopathic medicine, and homeopathic medicine.

As we move further into the twenty-first century, it is an exciting time to be a nurse because of the new techniques and theories of medicine. Nurses can play a key role in disseminating this information to an increasingly sophisticated public. As hospital census numbers decrease throughout the country, more nurses are finding employment in other environments such as home health, industries, and entrepreneurial ventures of their own. This helps to place the nurse in a position to teach not just sick people, but the healthy, too, by providing important preventive information to obtain an optimum state of health. This not only improves quality of life, but also helps to reduce the astronomical costs of health care. Today's nurse is an integral part of the modern health care delivery system, and provides a positive influence.

References & Suggested Readings

Bascom, A; "Complementary and alternative therapies in occupational health. Part II - Specific therapies." AAOHN J, 2002 Oct; 50(10): p468-77; quiz 478-9.

Bascom, A; "Complementary and alternative therapies in occupational health. Part One." AAOHN J, 2002 Sep; 50(9): p418-25; quiz 426-7.

Burman, ME; "Complementary and alternative medicine: core competencies for family nurse practitioners." J Nurs Educ, 2003 Jan; 42(1): p28-34.

Downey, RP; "Healing with flower essences." Beginnings, 2002 Jul-Aug; 22(4): p11-2.

Lengacher, CA; Bennett, MP; Kip, KE; Keller, R; La Vance, MS; Smith, LS; Cox, CE; "Frequency of use of complementary and alternative medicine in women with breast cancer." Oncol Nurs Forum, 2002 Nov-Dec; 29(10): p1445-52.

Lusby, PE; Coombes, A; Wilkinson, JM; "Honey: a potent agent for wound healing?" J Wound Ostomy Continence Nurs, 2002

Purpose and Goals