Alternative Medicines

Alternative Medicine

2009-04-20T20:10:00.001-07:00

The term alternative medicine, as used in the modern Western world, encompasses any healing practice "that does not fall within the realm of conventional medicine".^[1] Commonly cited examples include naturopathy, chiropractic, herbalism, traditional Chinese medicine, Unani, Ayurveda, meditation, yoga, biofeedback, hypnosis, homeopathy, acupuncture, and diet-based therapies, in addition to a range of other practices.^[2] It is frequently grouped with complementary medicine, which generally refers to the same interventions when used in conjunction with mainstream techniques,^[3]^[4]^[5] under the umbrella term complementary and alternative medicine, or CAM. Some significant researchers in alternative medicine oppose this grouping, preferring to emphasize differences of approach, but nevertheless use the term CAM, which has become standard.^[6]^[7]

Alternative medicine practices are as diverse in their foundations as in their methodologies. Practices may incorporate or base themselves on traditional medicine, folk knowledge, spiritual beliefs, or newly conceived approaches to healing.^[8] Jurisdictions where alternative medical practices are sufficiently widespread may license and regulate them. The claims made by alternative medicine practitioners are generally not accepted by the medical community because evidence-based assessment of safety and efficacy is either not available or has not been performed for many of these practices. If scientific investigation establishes the safety and effectiveness of an alternative medical practice, it may be adopted by conventional practitioners.^[9]^[10] Because alternative techniques tend to lack evidence, some have advocated defining it as non-evidence based medicine, or not medicine at all. Some researchers state that the evidence-based approach to defining CAM is problematic because some CAM is tested, and research suggests that many mainstream medical techniques lack solid evidence.^[11]

A 1998 systematic review of studies assessing its prevalence in 13 countries concluded that about 31% of cancer patients use some form of complementary and alternative medicine.^[12] Alternative medicine varies from country to country. Dr. Edzard Ernst believes that in Austria and Germany CAM is mainly in the hands of physicians,^[7] while some estimates suggest that at least half of American alternative practitioners are physicians.^[13] In Germany, herbs are tightly regulated, with half prescribed by doctors and covered by health insurance based on their Commission E legislation.^[14]

Music therapy

2009-04-20T19:43:00.000-07:00

From Wikipedia, the free encyclopedia

"Music and song embrace can sustain us throughout our journey in life, present in our celebrations, marking passages and milestones, strengthening us with courage when we are fearful and despairing. Music helps to answer questions of who we are, what we stand for and value, comforting us individually and bringing us together collectively. Music helps us to wordlessly understand ourselves and others, to console when there are no words and to create ways to communicate when through disability or other barriers, language alone is not possible. And although you may be “at a loss for words”, not know what to say or when “words just can’t express” your true feelings, music is always there to communicate the inexpressible and to free the mind from the boundaries of speech and ordinary thought to expand to an alternate place of emotion, rhythm and imagery. Words may desert us, but music is always present – like a heartbeat, linking us to our world and providing a pathway back “home” ."Music therapy is an interpersonal process in which the therapist uses music and all of its facets—physical, emotional, mental, social, aesthetic, and spiritual—to help clients to improve or maintain their health. In some instances, the client's needs are addressed directly through music; in others they are addressed through the relationships that develop between the client and therapist. Music therapy is used with individuals of all ages and with a variety of conditions, including: psychiatric disorders, medical problems, physical handicaps, sensory impairments, developmental disabilities, substance abuse, communication disorders, interpersonal problems, and aging. It is also used to: improve learning, build self-esteem, reduce stress, support physical exercise, and facilitate a host of other health-related activities.

Music therapists are found in nearly every area of the helping professions. Some commonly found practices include developmental work (communication, motor skills, etc.) with individuals with special needs, songwriting and listening in reminiscence/orientation work with the elderly, processing and relaxation work, and rhythmic entrainment for physical rehabilitation in stroke victims.

The Turco-Persian psychologist and music theorist al-Farabi (872–950), known as "Alpharabius" in Europe, dealt with music therapy in his treatise Meanings of the Intellect, where he discussed the therapeutic effects of music on the soul.^[1] Robert Burton wrote in the 17th century in his classic work, The Anatomy of Melancholy, that music and dance were critical in treating mental illness, especially melancholia.^[2] ^[3] ^[4]

Music therapy in the United States

Music therapy has existed in its common current form in the United States since around 1944, when the first undergraduate degree program in the world was founded at Michigan State University and the first graduate degree program at the University of Kansas. The American Music Therapy Association (AMTA) was founded in 1998 as a merger between the National Association for Music Therapy (NAMT, founded in 1950) and the American Association for Music Therapy (AAMT, founded in 1971). Numerous other national organizations exist, such as the Institute for Music and Neurologic Function, Nordoff-Robbins Center For Music Therapy and The Bonny Foundation. In the United States, a music therapist is most commonly designated by MT-BC (Music Therapist-Board Certified). A music therapist may use ideas or concepts from different disciplines such as social work, speech/language, physical therapy, medicine, nursing, education, and so forth. A music therapist may have different credentials or professional licenses and may also have a master's degree in music therapy or in another clinical field (social work, mental health counseling, or the like). New York State requires that people holding the title music therapist be licensed as a creative arts therapist by holding a master's degree or higher in the field. Other masters degree holders may also take a test administered by the state of New York. Some practicing music therapists have held Ph.D.s in non-music-therapy (but related) areas, but more recently Temple University and Lesley University have founded a true music therapy Ph.D. program. A music therapist will typically practice in a manner that incorporates music therapy techniques with broader clinical practices such as assessment, diagnosis, psychotherapy, rehabilitation, and other practices depending on population. Music therapy services rendered within the context of a social service, educational, or health care agency are reimbursable by insurance and sources of funding for individuals with certain needs, under the title of Activity Therapy. Music therapy services have been identified as reimbursable under Medicaid, Medicare, Private insurance plans and other services such as state departments and government programs.

A U.S. music therapist may also hold the designation of CMT, ACMT, or RMT--initials which were previously conferred by the now-defunct AAMT and NAMT. More current music therapists hold the designation, MT-BC, music therapist-board certified, given by the Certification Board of Music Therapists.

A degree in music therapy requires proficiency in guitar, piano, voice, music theory, music history, reading music, improvisation, as well as varying levels of skill in assessment, documentation, and other counseling and health care skills depending on the focus of the particular university's program.

To become board-certified in the United States, a music therapist must complete course work at an accredited ATMA program at a college or university, successfully complete a 1040 hour Music Therapy internship, and pass the Certifying Board examination.

Board Certified Music Therapists are required to maintain their education through continuing education courses, called Continuing Music Therapy Education courses, or CMTEs. These classes fall under the purview of the Certification Board for Music Therapists to assure quality and applicability. They are offered at the state, regional, and national level.

Music therapy in the United Kingdom

Live music was used in hospitals after both of the World Wars, as part of the regime for some recovering soldiers. Clinical Music therapy in Britain as it is understood today was pioneered in the 60s and 70s by French cellist Juliette Alvin, whose influence on the current generation of British music therapy lecturers remains strong. Mary Priestley, one of Juliette Alvin's students came to discover/create Analytical Music Therapy. Analytical Music Therapy is a form of Music Therapy which together with the Nordoff-Robbins school of Music Therapy, form the two central forms of Music Therapy used today. Mary Priestley's books: Music Therapy in Action, first published by Constable and company 1975 (ISBN 0 09 459900 9) and Essays on Analytical Music Therapy, Barcelona Publishers ©1994.(ISBN 0-9624080-2-6) Form part of the core course work for students of Analytical Music Therapy all over the world.

The Nordoff-Robbins approach to music therapy developed from the work of Paul Nordoff and Clive Robbins in the 1950/60s. It is grounded in the belief that everyone can respond to music, no matter how ill or disabled. The unique qualities of music as therapy can enhance communication, support change, and enable people to live more resourcefully and creatively. Nordoff-Robbins now run music therapy sessions throughout the UK, US, South Africa, Australia and Germany. Its head quarters are in London where it also provides training and further education programmes, including the only PHD course in music therapy available in the UK. Music therapists, many of whom work with an improvisatory model (see clinical improvisation), are active particularly in the fields of child and adult learning disability, but also in psychiatry and forensic psychiatry, geriatrics, palliative care and other areas. Practitioners are registered with the Health Professions Council [3] and from 2007 new regisrants must normally hold a masters degree in music therapy. There are masters level programmes in music therapy in Bristol, Cambridge, Cardiff, Edinburgh and London, and there are therapists throughout the United Kingdom. The professional body in the UK is the Association of Professional Music Therapists [4] while the British Society for Music Therapy [5] is a charity providing information about music therapy. roya a stink

In 2002, the World Congress of Music Therapy was held in Oxford, on the theme of Dialogue and Debate. ^[5]

In November 2006, Dr. Michael J. Crawford ^[6] and his colleagues again found that music therapy helped the outcomes of Schizophrenic patients. ^[7]^[8] In 2009, he and his team were researching the usefulness of improvisational music in helping patients with agitation and also those with Dementia.

Music Therapy as Stroke Therapy

Music has been shown to affect portions of the brain. Part of this therapy is the ability of music to affect emotions and social interactions. Research by Nayak et al showed that music therapy is associated with a decrease in depression, improved mood, and a reduction in state anxiety^[9]. Both descriptive and experimental studies have documented effects of music on quality of life, involvement with the environment, expression of feelings, awareness and responsiveness, positive associations, and socialization ^[10]. Additionally, Nayak et al. found that music therapy had a positive effect on social and behavioral outcomes and showed some encouraging trends with respect to mood.^[9]

More recent research suggests that music can increase patient’s motivation and positive emotions. ^[11]^[9]^[12] Current research also suggests that when music therapy is used in conjunction with traditional therapy it improves success rates significantly.^[13]^[14]^[15] Therefore, it is hypothesized that music therapy helps stroke victims recover faster and with more success by increasing the patient’s positive emotions and motivation, allowing them to be more successful and driven to participate in traditional therapies.

Research has shown the ability of music therapy to increase positive social interactions, positive emotions, and motivation in stroke patients. Wheeler et al. found that group music therapy sessions increased the ease at which stroke patients responded to social interaction and increased positive attitude reports from patient families, while individual sessions helped to motivate patients for treatment^[12]. Another study examined the effect of music therapy on mood of stroke patients and found similar results that showed decreased anxiety, fatigue, and hostile mood states ^[11]. Additionally, Nayak et al. found improved social interaction (more actively involved and cooperative) when music therapy was used in stroke recovery programs^[9].

Recent studies have examined the effect of music therapy on stroke patients, when combined with traditional therapy. One study found the incorporation of music with therapeutic upper extremity exercises gave patients more positive emotional effects than exercise alone.^[13] In another study, Nayak et al. discovered found that rehabilitation staff rated participants in the music therapy group as more actively involved and cooperative in therapy than those in the control group.^[9] Their findings gave preliminary support to the efficacy of music therapy as a complementary therapy for social functioning and participation in rehabilitation with a trend toward improvement in mood during acute rehabilitation.

Although positive changes have been associated with music therapy, some considerations must be taken into account. While scientists have determined that a variety of physiological and psychological changes occur when listening to music, broad conclusions cannot yet be made concerning the relationship and the direction of the relationship between music and emotion.^[16] Additionally, there may be mediating factors which affect the success of music therapy. For example, Nayak et al. found the more impaired an individual’s social behavior was at the outset of treatment, the more likely he or she was to benefit from music therapy.^[9] Additionally, they noted the effectiveness of music therapy may be moderated by the time frame of the treatment. It is possible that music therapy has a more pronounced effect on mood the closer to injury it is applied.

Current research shows that when music therapy is used in conjunction with traditional therapy, it improves rates of recovery, and emotional and social deficits resulting from stroke. ^[17]^[14]^[15]^[18]^[13]^[9] A study by Jeong & Kim examined the impact of music therapy when combined with traditional stroke therapy in a community-based rehabilitation program. ^[17]Thirty-three stroke survivors were randomized into one of two groups: the experimental group, which combined rhythmic music and specialized rehabilitation movement for eight weeks; and a control group, that received referral information for traditional therapy (and were assumed to have sought traditional therapy). The results of this study showed that participants in the experimental group gained more flexibility, wider range of motion, more positive moods, and increased frequency and quality of social interactions.^[17]

Music has also been used in recovery of motor skills. Rhythmical auditory stimulation in a musical context in combination with traditional gait therapy improved the ability of stroke patients to walk.^[14] The study consisted of two treatment conditions, one which received traditional gait therapy and another which received the gait therapy in combination with the rhythmical auditory stimulation. During the rhythmical auditory stimulation, stimulation was played back measure by measure, and was initiated by the patient’s heal-strikes. Each condition received fifteen sessions of therapy. The results revealed that the rhythmical auditory stimulation group showed more improvement in stride length, symmetry deviation, walking speed and rollover path length (all indicators for improved walking gait) than the group that received traditional therapy alone.^[14]

Schneider et al. also studied the effects of combining music therapy with standard motor rehabilitation methods^[15]. In this experiment, researchers recruited stroke patients without prior musical experience and trained half of them in an intensive step by step training program that occurred fifteen times over three weeks, in addition to traditional treatment. These participants were trained to use fine both fine and gross motor movements by learning how to use the piano and drums. The other half of the patients received only traditional treatment over the course of the three weeks. Three-dimensional movement analysis and clinical motor tests showed participants who received the additional music therapy had significantly better speed, precision, and smoothness of movements as compared to the control subjects. Participants who received music therapy also showed a significant improvement in every-day motor activities as compared to the control group ^[15]. Wilson, Parsons, & Reutens looked at the effect of melodic intonation therapy (MIT) on speech production in a male singer with severe Broca’s aphasia^[18]. In this study, thirty novel phrases were taught in three conditions: unrehearsed, rehearsed verbal production (repetition), or rehearsed verbal production with melody (MIT). Results showed that phrases taught in the MIT condition had superior production, and that compared to rehearsal, effects of MIT lasted longer.

Another study examined the incorporation of music with therapeutic upper extremity exercises on pain perception in stroke victims ^[13]. Over the course of eight weeks, stroke victims participated in upper extremity exercises (of the hand, wrist, and shoulder joints) in conjunction with one of the three conditions: song, karaoke accompaniment, and no music. Patients participated in each condition once, according to a randomized order, and rated their perceived pain immediately after the session. Results showed that although there was no significant difference in pain rating across the conditions, video observations revealed more positive affect and verbal responses while performing upper extremity exercises with both music and karaoke accompaniment ^[13]. Nayak et al. ^[9] examined the combination of music therapy with traditional stroke rehabilitation and also found the addition of music therapy improved mood and social interaction. Participants who had suffered traumatic brain injury or stroke were placed in one of two conditions: standard rehabilitation or standard rehabilitation along with music therapy. Participants received three treatments per week for up to ten treatments. Therapists found that participants who received music therapy in conjunction with traditional methods had improved social interaction and mood.

Music Therapy in Heart Disease

Some music may reduce heart rate, respiratory rate, and blood pressure in patients with coronary heart disease, according to a 2009 Cochrane review of 23 clinical trails [[6]]. Benefits included a decrease in blood pressure, heart rate, and levels of anxiety in heart patients. However, the effect was not consistent across studies, according to Joke Bradt, Ph.D., and Cheryl Dileo, Ph.D., both of Temple University in Philadelphia. Music did not appear to have much effect on patients' psychological distress. "The quality of the evidence is not strong and the clinical significance unclear," the reviewers cautioned. In 11 studies patients were having cardiac surgery and procedures, in nine they were MI patients, and in three cardiac rehabilitation patients. The 1,461 participants were largely white (average 85%) and male (67%). In most studies, patients listened to one 30-minute music session. Only two used a trained music therapist instead of prerecorded music.

Important music therapists and writers on music therapy

Linda Toll
Juliette Alvin
Helen Bonny
Kaithapram Damodaran Namboothiri
John Carmichael
E. Thayer Gaston
Pandit Chandrakant Sardeshmukh
Rajasree Mukherjee
Paul Nordoff and Clive Robbins of Nordoff-Robbins
Oliver Sacks
Concetta M. Tomaino
Al-Farabi
Dr.Bhaskar Khandekar India's First Music Therapist, www.indiasfirst.com

Alternative medicine

2009-04-20T19:31:00.000-07:00

Traditional Tibetan medicine

2009-04-20T19:03:00.001-07:00

From Wikipedia, the free encyclopedia

Tibetan medicine is a centuries-old traditional medical system that employs a complex approach to diagnosis, incorporating techniques such as pulse analysis and urinalysis, and utilizes behavior and dietary modification, medicines composed of natural materials (e.g., herbs and minerals) and physical therapies (e.g. Tibetan acupuncture, moxabustion, etc.) to treat illness.

The Tibetan medical system is based upon a synthesis of the Indian (Ayurveda), Persian (Unani), Greek, indigenous Tibetan, and Chinese medical systems, and it continues to be practiced in Tibet, India, Nepal, Bhutan, Ladakh, Siberia, China and Mongolia, as well as more recently in parts of Europe and North America. It embraces the traditional Buddhist belief that all illness ultimately results from the "three poisons" of the mind: ignorance, attachment and aversion.

Like other systems of traditional Asian medicine, and in contrast to biomedicine, Tibetan medicine first puts forth a specific definition of health in its theoretical texts. To have good health, Tibetan medical theory states that it is necessary to maintain balance in the body's three principles of function [often mistranslated as humors]: rLüng (pron. Loong), mKhris-pa (pron. Tree-pa) [often mistranslated as bile], and Bad-kan (pron. Pay-gen) [often mistranslated as phlegm].

• Lung is the source of the body's ability to circulate physical substances (e.g. blood), energy (e.g. nervous system impulses), and the non-physical (e.g. thoughts). In embryological development, the mind's expression of materialism is manifested as the system of rLüng. There are five distinct subcategories of rLung each with specific locations and functions: Srog-'Dzin rLung, Gyen-rGyu rLung, Khyab-Byed rLung, Me-mNyam rLung, Thur-Sel rLung.

• mKhris-pa is characterized by the quantitative and qualitative characteristics of heat, and is the source of many functions such as thermoregulation, metabolism, liver function and discriminating intellect. In embryological development, the mind's expression of aggression is manifested as the system of mKhris-pa. There are five distinct subcategories of mKhris-pa each with specific locations and functions: 'Ju-Byed mKhris-pa, sGrub-Byed mKhris-pa, mDangs-sGyur mKhris-pa, mThong-Byed mKhris-pa, mDog-Sel mKhris-pa.

• Bad-kan is characterized by the quantitative and qualitative characteristics of cold, and is the source of many functions such as aspects of digestion, the maintenance of our physical structure, joint health and mental stability. In embryological development, the mind's expression of ignorance is manifested as the system of Bad-kan. There are five distinct subcategories of Bad-kan each with specific locations and functions: rTen-Byed Bad-kan, Myag-byed Bad-kan, Myong-Byed Bad-kan, Tsim-Byed Bad-kan, 'Byor-Byed Bad-kan.

Traditional Chinese medicine

2009-04-20T18:50:00.000-07:00

From Wikipedia, the free encyclopedia

Traditional Chinese medicine/dried goods shop in Tsim Sha Tsui, Hong Kong

Traditional Chinese medicine, also known as TCM (simplified Chinese: 中医; traditional Chinese: 中醫; pinyin: zhōngyī), includes a range of traditional medical practices originating in China. Although well accepted in the mainstream of medical care throughout East Asia, it is considered an alternative medical system in much of the western world.

TCM practices include such treatments as herbal medicine (中药), acupuncture, dietary therapy, and both Tui na and Shiatsu massage. Qigong and Taijiquan are also closely associated with TCM.

TCM theory originated thousands of years ago through meticulous observation of nature, the cosmos, and the human body. Major theories include those of Yin-yang, the Five Phases, the human body Channel system, Zang Fu organ theory, six confirmations, four layers, etc.

History

Ancient (classical) TCM history

Taijitu

Much of the philosophy of traditional Chinese medicine derives from the same philosophy that inform Taoist and Buddhist thought, and reflects the classical Chinese belief that the life and activity of individual human beings have an intimate relationship with the environment on all levels.^[1]

In legend, as a result of a dialogue with his minister Qibo (岐伯), the Yellow Emperor (2698 - 2596 BCE) is supposed by Chinese tradition to have composed his Neijing Suwen (《内经·素问》) or Inner Canon: Basic Questions, also known as the Huangdi Neijing (Yellow Emperor's Inner Canon). The book's title is often mistranslated as Yellow Emperor's Classic of Internal Medicine. Modern scholarly opinion holds that the extant text of this title was compiled by an anonymous scholar no earlier than the Han dynasty just over two-thousand years ago.

During the Han Dynasty (202 BC –220 AD), Zhang Zhongjing (张仲景/張仲景), the Hippocrates of China, who was mayor of Chang-sha toward the end of the 2nd century AD, wrote a Treatise on Cold Damage, which contains the earliest known reference to Neijing Suwen. Another prominent Eastern Han physician was Hua Tuo (c. 140 – c. 208 AD), who anesthetized patients during surgery with a formula of wine and powdered hemp. Hua's physical, surgical, and herbal treatments were also used to cure headaches, dizziness, internal worms, fevers, coughing, blocked throat, and even a diagnosis for one lady that she had a dead fetus within her that needed to be taken out. The Jin dynasty practitioner and advocate of acupuncture and moxibustion, Huang-fu Mi (215 - 282 AD), also quoted the Yellow Emperor in his Jia Yi Jing (甲乙经/甲乙經), ca. 265 AD. During the Tang dynasty, Wang Bing claimed to have located a copy of the originals of the Neijing Suwen, which he expanded and edited substantially. This work was revisited by an imperial commission during the 11th century AD.

There were noted advances in Chinese medicine during the Middle Ages. Emperor Gaozong (r. 649–683) of the Tang Dynasty (618–907) commissioned the scholarly compilation of a materia medica in 657 that documented 833 medicinal substances taken from stones, minerals, metals, plants, herbs, animals, vegetables, fruits, and cereal crops.^[2] In his Bencao Tujing ('Illustrated Pharmacopoeia'), the scholar-official Su Song (1020–1101) not only systematically categorized herbs and minerals according to their pharmaceutical uses, but he also took an interest in zoology.^[3]^[4]^[5]^[6] For example, Su made systematic descriptions of animal species and the environmental regions they could be found, such as the freshwater crab Eriocher sinensis found in the Huai River running through Anhui, in waterways near the capital city, as well as reservoirs and marshes of Hebei.^[7]

Contact with Western culture and medicine has not displaced TCM. While there may be traditional factors involved in the persistent practice, two reasons are most obvious in the westward spread of TCM in recent decades. Firstly, TCM practices are believed by many to be very effective, sometimes offering palliative efficacy where the practices of Western medicine fail or unable to provide treatment, especially for routine ailments such as flu and allergies, or when Western medicine fails to relieve patients suffering from chronic ailments. TCM has been shown to be effective^{[citation needed]} in the treatment of chronic, functional disorders, such as migraines and osteoarthritis, and is traditionally used for a wide range of functional disorders. Secondly, TCM provides an alternative to otherwise costly procedures whom many can not afford, or which is not covered by insurance. There are also many who turn to TCM to avoid the toxic side effects of pharmaceuticals.

TCM of the last few centuries is seen by at least some sinologists as part of the evolution of a culture, from shamans blaming illnesses on evil spirits to "proto-scientific" systems of correspondence;^[8] any reference to supernatural forces is usually the result of romantic translations or poor understanding and will not be found in the Taoist-inspired classics of acupuncture such as the Huang Di Nei Jing. The system's development has, over its history, been analysed both skeptically and extensively, and the practice and development of it has waxed and waned over the centuries and cultures through which it has travelled^[9] - yet the system has still survived thus far. It is true that the focus from the beginning has been on pragmatism, not necessarily understanding of the mechanisms of the actions - and that this has hindered its modern acceptance in the West. This, despite that there were times such as the early 18th century when "acupuncture and moxa were a matter of course in polite European society"^[10]

The term "TCM" describes the modern practice of Chinese medicine as a result of sweeping reforms that took place after 1950 in the People's Republic of China. The term "Classical Chinese medicine" (CCM) often refers to medical practices that rely on theories and methods dating from before the fall of the Qing Dynasty (1911). Advocates of CCM portray it as less influenced by Western and political agendas than TCM.

Timeline

Macerated medicinal liquor with wolfberry, tokay gecko, and ginseng, for sale at a traditional medicine market in Xi'an.

The history of TCM can be summarized by a list of important doctors and books.

Unknown, Huángdì nèijīng (黃帝內經/黄帝内经) (Yellow Emperor's Inner Canon) - Sùwèn (素问/素問) and Língshū (灵枢/靈樞). The earliest classic of TCM passed on to the present.

Warring States Period (5th century BC to 221 BC): Silk manuscripts recording channels and collaterals, Zubi shiyi mai jiu jing (足臂十一脉灸经/足臂十一脈灸經) (Moxibustion Classic of the Eleven Channels of Legs and Arms), and Yinyang shiyi mai jiu jing (阴阳十一脉灸经/陰陽十一脈灸經) (Moxibustion Classic on the Eleven Yin and Yang Channels). The latter was part of a cache of texts found in Mawangdui in the 1970s.

Han Dynasty (206 BC–AD 220) to Three Kingdoms Period (220 - 280 AD):
- Zhenjiu zhenzhong jing (针灸枕中经/鍼灸枕中經) (Classic of Moxibustion and Acupuncture Preserved in a Pillow) by Huà Tuó (华佗/華佗).
- Shanghan zabing lun (伤寒杂病论/傷寒雜病論), which has since been split into two texts: the Shānghán lùn (伤寒论/傷寒論) ("Treatise on Cold Damage [Disorders]" - focusing on febrile conditions attributed to "Cold") and the Jingui yaolue (金匱要略) ("Essentials of the Golden Cabinet" - focusing on "miscellaneous illnesses") by Zhāng Zhòngjǐng (张仲景/張仲景).

Jìn Dynasty (265-420): Zhēnjiǔ jiǎyǐ jīng (针灸甲乙经/鍼灸甲乙經) (Systematic Classic of Acupuncture and Moxibustion) by Huángfǔ Mì (皇甫谧/皇甫謐).

Tang Dynasty (618–907)
- Beiji qianjin yaofang (备急千金要方/備急千金要方) (Emergency Formulas Worth a Thousand in Gold) and Qianjin yifang (千金翼方) (Supplement to the Formulas Worth a Thousand in Gold) by Sūn Sīmiǎo (孙思邈/孫思邈).
- Waitai miyao (外台秘要/外臺秘要) (Arcane Essentials from the Imperial Library) by Wang Tao (王焘/王燾).

Song Dynasty (960 – 1279):
- Tóngrén shūxué zhēnjiǔ tújīng (铜人腧穴针灸图经/銅人腧穴鍼灸圖經) (Illustrated Manual of the Practice of Acupuncture and Moxibustion at (the Transmission) (and other) Acu-points, for use with the Bronze Figure) by Wáng Wéiyī (王惟一).

Yuan Dynasty (1271 to 1368): Shísì jīng fāhuī (十四经发挥/十四經發揮) (Exposition of the Fourteen Channels) by Huá Shòu (滑寿/滑壽).

Ming Dynasty (1368 to 1644): golden age of acupuncture and moxibustion. Many famous doctors and books. To name only a few:
- Zhēnjiǔ dàquan (针灸大全/鍼灸大全) (A Complete Collection of Acupuncture and Moxibustion) by Xu Feng (徐凤/徐鳳).
- Zhēnjiǔ jùyīng fāhuī (针灸聚英发挥/鍼灸聚英發揮) (An Exemplary Collection of Acupuncture and Moxibustion and their Essentials) by Gāo Wǔ (高武).
- Zhēnjiǔ dàchéng (针灸大成/鍼灸大成) (Compendium of Acupuncture and Moxibustion) by Yáng Jìzhōu (杨继洲/楊繼洲), completed in 1601.
- Běncǎo gāngmù (本草冈目/本草綱目) (Compendium of Materia Medica) by Lǐ Shízhēn (李时珍/李時珍), the most complete and comprehensive pre-modern herbal book (completed in 1578).
- Wenyi lun (温疫论/溫疫論), by Wu Youxing 吴有性 (1642).

Qing Dynasty (1644-1912):
- Yizong jinjian (医宗金鉴/醫宗金鑒) (Golden Mirror of the Medical Tradition) compiled by Wu Quan (吴谦/吴謙) under imperial commission.
- Zhenjiu fengyuan (针灸逢源/鍼灸逢源) (The Source of Acupuncture and Moxibustion) by Li Xuechuan (李学川/李學川).
- Wenre lun (温热论/溫熱論), by Ye Tianshi (叶天士/業天士).
- Wenbing tiaobian (温病条辨/溫病條辨) (Systematized Identification of Warm-factor disorders) compiled by Wu Jutong (吴鞠通) in 1798.^[11]

Theory

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Dried plants and animals parts are used in traditional Chinese medicines. In the image are dried lingzhi, snake, turtle plastron, Luo Han Guo, and species of ginseng.

The foundation principles of Chinese medicine are not necessarily uniform, and are based on several schools of thought. Received TCM can be shown to be influenced by Taoism, Buddhism, and Neo-Confucianism.^[12]

Since 1200 BC, Chinese academics of various schools have focused on the observable natural laws of the universe and their implications for the practical characterisation of humanity's place in the universe. In the I Ching and other Chinese literary and philosophical classics, Chinese writers described general principles and their applications to health and healing.

Porkert, a Western medical doctor, placed Chinese medical theory in context as:

Chinese medicine, like many other Chinese sciences, defines data on the basis of the inductive and synthetic mode of cognition. Inductivity corresponds to a logical link between two effective positions existing at the same time in different places in space. (Conversely, causality is the logical link between two effective positions given at different times at the same place in space.) In other words, effects based on positions that are separate in space yet simultaneous in time are mutually inductive and thus are called inductive effects. In Western science prior to the development of electrodynamics and nuclear physics (which are founded essentially on inductivity), the inductive nexus was limited to subordinate uses in protosciences such as astrology. Now Western man, as a consequence of two thousand years of intellectual tradition, persists in the habit of making causal connections first and inductive links, if at all, only as an afterthought. This habit must still be considered the biggest obstacle to an adequate appreciation of Chinese science in general and Chinese medicine in particular. Given such different cognitive bases, many of the apparent similarities between traditional Chinese and European science which attract the attention of positivists turn out to be spurious.^[13]

The Shen Nong's Herbal Classic, a 2000-year old medicinal Chinese book considered today as the oldest book on oriental herbal medicine, classifies 365 species of roots, grass, woods, furs, animals and stones into three categories of herbal medicine:

The first category, called "superior", includes herbs effective for multiple diseases and are mostly responsible for maintaining and restoring the body balance. They have almost no unfavorable side-effects.
The second category comprises tonics and boosters, for which their consumption must not be prolonged.
The third category must be taken, usually in small doses, and for the treatment of specific ailments only.

Lingzhi ranked number one of the superior medicines, and was therefore the most exalted medicine in ancient times.^[14] The ancient Chinese use of mushrooms for medicine, has inspired modern day research into mushrooms like shiitake, Agaricus blazei, Trametes versicolor, the table mushroom and of course lingzhi.^[15] Although a 2008 Review, by UC Davis, concluded that there is not enough evidence yet to promote the use of mushrooms or mushroom extracts in the treatment of disease, it stressed the urgency of further research and future clinical trials due to large numbers of promising in vivo and in vitro experiments.^[16]

Basic theory and model of the body

An old Chinese medical chart on acupuncture meridians

Interactions of Wu Xing.

Main article: TCM model of the body

The following text needs to be harmonized with text in TCM model of the body.

Traditional Chinese medicine is largely based on the philosophical concept that the human body is a small universe with a set of complete and sophisticated interconnected systems, and that those systems usually work in balance to maintain the healthy function of the human body. The balance of yin and yang is considered with respect to qi ("breath", "life force", or "spiritual energy"), blood, jing ("kidney essence", including "semen"), other bodily fluids, the Wu Xing, emotions, and the soul or spirit (shen). TCM has a unique model of the body, notably concerned with the meridian system. Unlike the Western anatomical model which divides the physical body into parts, the Chinese model is more concerned with function. Thus, the TCM spleen is not a specific piece of flesh, but an aspect of function related to transformation and transportation within the body, and of the mental functions of thinking and studying.

There are significant regional and philosophical differences between practitioners and schools which in turn can lead to differences in practice and theory.

Theories invoked to describe the human body in TCM include:

Channels, also known as "meridians"
Wu Xing
Qi
Three jiaos also known as the Triple Burner, the Triple Warmer or the Triple Energiser
Yin and Yang
Zang and Fu

The Yin/Yang and five element theories may be applied to a variety of systems other than the human body, whereas Zang Fu theory, meridian theory and three-jiao (Triple warmer) theories are more specific.

There are also separate models that apply to specific pathological influences, such as the Four stages theory of the progression of warm diseases, the Six levels theory of the penetration of cold diseases, and the Eight principles system of disease classification.

Diagnostics

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Following a macro philosophy of disease, traditional Chinese diagnostics are based on overall observation of human symptoms rather than "micro" level laboratory tests. There are four types of TCM diagnostic methods: observe (望 wàng), hear and smell (闻/聞 wén), ask about background (问/問 wèn) and touching (切 qiè).^[17] The pulse-reading component of the touching examination is so important that Chinese patients may refer to going to the doctor as "Going to have my pulse felt."^[18]

Traditional Chinese medicine is considered to require considerable diagnostic skill. A training period of years or decades is said to be necessary for TCM practitioners to understand the full complexity of symptoms and dynamic balances. According to one Chinese saying, A good (TCM) doctor is also qualified to be a good prime minister in a country.^{[citation needed]}^{[dubious – discuss]} Modern practitioners in China often use a traditional system in combination with Western methods.^{[citation needed]}

Techniques

Palpation of the patient's radial artery pulse (pulse diagnosis) in six positions
Observations of patient's tongue, voice, hair, face, posture, gait, eyes, ears, vein on index finger of small children
Palpation of the patient's body (especially the abdomen, chest, back, and lumbar areas) for tenderness or comparison of relative warmth or coolness of different parts of the body
Observation of the patient's various odors
Asking the patient about the effects of their problem.
Anything else that can be observed without instruments and without harming the patient
Asking detailed questions about their family, living environment, personal habits, food diet, emotions, menstrual cycle for women, child bearing history, sleep, exercise, and anything that may give insight into the balance or imbalance of an individual.

Methods of treatment

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The following methods are considered to be part of Chinese medicine:

Acupuncture(针灸/針灸) (from the Latin word acus, "needle", and pungere, meaning "prick") is a technique in which the practitioner inserts fine needles into specific points on the patient's body. Usually about a dozen acupoints are needled in one session, although the number of needles used may range anywhere from just one or two to 20 or more. The intended effect is to increase circulation and balance energy (Qi) within the body.
Auriculotherapy (耳灼疗法/耳燭療法), which comes under the heading of Acupuncture and Moxibustion.
Chinese food therapy (食疗/食療): Dietary recommendations are usually made according to the patient's individual condition in relation to TCM theory. The "five flavors" (an important aspect of Chinese herbalism as well) indicate what function various types of food play in the body. A balanced diet, which leads to health, is when the five functional flavors are in balance. When one is diseased (and therefore unbalanced), certain foods and herbs are prescribed to restore balance to the body.
Chinese herbal medicine (中草药/中药/中藥): In China, herbal medicine is considered as the primary therapeutic modality of internal medicine. Of the approximately 500 Chinese herbs that are in use today, 250 or so are very commonly used.^{[citation needed]} Rather than being prescribed individually, single herbs are combined into formulas that are designed to adapt to the specific needs of individual patients. A herbal formula can contain anywhere from 3 to 25 herbs. As with diet therapy, each herb has one or more of the five flavors/functions and one of five "temperatures" ("Qi") (hot, warm, neutral, cool, cold). After the herbalist determines the energetic temperature and functional state of the patient's body, he or she prescribes a mixture of herbs tailored to balance disharmony. One classic example of Chinese herbal medicine is the use of various mushrooms, like reishi and shiitake, which are currently under intense study by ethnobotanists and medical researchers for immune system enhancement.
Cupping (拔罐): A type of Chinese massage, cupping consists of placing several glass "cups" (open spheres) on the body. A match is lit and placed inside the cup and then removed before placing the cup against the skin. As the air in the cup is heated, it expands, and after placing in the skin, cools down, creating a lower pressure inside the cup that allows the cup to stick to the skin via suction. When combined with massage oil, the cups can be slid around the back, offering what some practitioners think of as a reverse-pressure massage.
Die-da or Tieh Ta (跌打) is usually practiced by martial artists who know aspects of Chinese medicine that apply to the treatment of trauma and injuries such as bone fractures, sprains, and bruises. Some of these specialists may also use or recommend other disciplines of Chinese medical therapies (or Western medicine in modern times) if serious injury is involved. Such practice of bone-setting (整骨) is not common in the West.
Gua Sha (刮痧)
Moxibustion: "Moxa," often used in conjunction with acupuncture, consists in burning of dried Chinese mugwort (Artemisia vulgaris) on acupoints. "Direct Moxa" involves the pinching of clumps of the herb into cones that are placed on acupoints and lit until warm. Typically the burning cone is removed before burning the skin and is thought, after repeated use, to warm the body and increase circulation. Moxa can also be rolled into a cigar-shaped tube, lit, and held over an acupuncture point, or rolled into a ball and stuck onto the back end of an inserted needle for warming effect.
Physical Qigong exercises such as Tai chi chuan (Taijiquan 太极拳/太極拳), Standing Meditation (站樁功), Yoga, Brocade BaDuanJin exercises (八段锦/八段錦) and other Chinese martial arts.
Qigong (气功/氣功) and related breathing and meditation exercise.
Tui na (推拿) massage: a form of massage akin to acupressure (from which shiatsu evolved). Oriental massage is typically administered with the patient fully clothed, without the application of grease or oils. Choreography often involves thumb presses, rubbing, percussion, and stretches.
Some TCM doctors may also utilize esoteric methods that incorporate or reflect personal beliefs or specializations such as Fengshui (风水/風水) or Bazi (八字).

Branches

Traditional Chinese medicine has many branches, the most prominent of which are the Jingfang (经方学派) and Wenbing (温病学派) schools. The Jingfang school relies on the principles contained in the Chinese medicine classics of the Han and Tang dynasty, such as Huangdi Neijing and Shennong Bencaojing. The more recent Wenbing school's practise is largely based on more recent books including Compendium of Materia Medica from Ming and Qing Dynasty, although in theory the school follows the teachings of the earlier classics as well. Intense debates between these two schools lasted until the Cultural Revolution in mainland China, when Wenbing school used political power to suppress the opposing school.^{[citations needed]}

Scientific view

Efficacy

Much of the scientific research on TCM has focused on acupuncture. The effectiveness of acupuncture remains controversial in the scientific community, and a review by Edzard Ernst and colleagues in 2007 found that the body of evidence was growing, research is active, and that the "emerging clinical evidence seems to imply that acupuncture is effective for some but not all conditions".^[19] Researchers using the protocols of evidence-based medicine have found good evidence that acupuncture is moderately effective in preventing nausea.^[20]^[21] A 2008 study suggest that combining acupuncture with conventional infertility treatments such as IVF greatly improves the success rates of such medical interventions.^[22] There is conflicting evidence that it can treat chronic low back pain,^[23]^[24] and moderate evidence of efficacy for neck pain^[25]^[26] and headache.^[27] For most other conditions^[28] reviewers have found either a lack of efficacy (e.g., help in quitting smoking^[29]) or have concluded that there is insufficient evidence to determine if acupuncture is effective (e.g., treating shoulder pain^[30]). While little is known about the mechanisms by which acupuncture may act, a review of neuroimaging research suggests that specific acupuncture points have distinct effects on cerebral activity in specific areas that are not otherwise predictable anatomically.^[31]

The World Health Organisation (WHO), the National Institutes of Health (NIH), and the American Medical Association (AMA) have also commented on acupuncture^[32]^[33]. Though these groups disagree on the standards and interpretation of the evidence for acupuncture, there is general agreement that it is relatively safe, and that further investigation is warranted. The 1997 NIH Consensus Development Conference Statement on acupuncture concluded:

...promising results have emerged, for example, showing efficacy of acupuncture in adult postoperative and chemotherapy nausea and vomiting and in postoperative dental pain. There are other situations such as addiction, stroke rehabilitation, headache, menstrual cramps, tennis elbow, fibromyalgia, myofascial pain, osteoarthritis, low back pain, carpal tunnel syndrome, and asthma, in which acupuncture may be useful as an adjunct treatment or an acceptable alternative or be included in a comprehensive management program. Further research is likely to uncover additional areas where acupuncture interventions will be useful.

Much less scientific research has been done on Chinese herbal medicines, which comprise much of TCM. Some doubts about the efficacy of many TCM treatments are based on their apparent basis in (causation due to analogy or similarity) — for example, that plants with heart-shaped leaves will help the heart. While the doctrine of signatures does underlie the selection of many of the ingredients of herbal medicines, this does not necessarily mean that some substances may not (perhaps by coincidence) possess attributed medicinal properties. For example, it is possible that while herbs may have been originally selected on erroneous grounds, only those that were deemed effective have remained in use. Potential barriers to scientific research include the substantial cost and expertise required to conduct double-blind clinical trials^{[citation needed]}, and the lack of financial incentive from the ability to obtain patents. Traditional practitioners usually have no philosophical objections to scientific studies on the effectiveness of treatments.^{[citation needed]}

Pharmacological compounds have been isolated from some Chinese herbal medicines; Chinese wormwood (qinghao) was the source for the discovery of artemisinin, which is now used worldwide to treat multi-drug resistant strains of falciparum malaria, and is also under investigation as an anti-cancer agent.^{[citation needed]} It was one of many candidates then tested by Chinese scientists from a list of nearly 200 traditional Chinese medicines for treating malaria^{[citation needed]}. It was the only one that was effective^{[citation needed]}. Many Chinese herbal medicines are marketed as dietary supplements in the West, and there is considerable controversy over their effectiveness.^[34]

Safety

In Practice

Acupressure and acupuncture are largely accepted to be safe from results gained through medical studies. Several cases of pneumothorax, nerve damage^{[citation needed]} and infection^{[citation needed]} have been reported as resulting from acupuncture treatments. These adverse events are extremely rare especially when compared to other medical interventions, and were found to be due to practitioner negligence.^{[citation needed]} Dizziness and bruising will sometimes result from acupuncture treatment.

Some governments have decided that Chinese acupuncture and herbal treatments should be administered by persons who have been educated to apply them safely. One Australian report said in 2006, "A key finding is that the risk of adverse events is linked to the length of education of the practitioner, with practitioners graduating from extended traditional Chinese medicine education programs experiencing about half the adverse event rate of those practitioners who have graduated from short training programs."^[35]

Allergy

Certain Chinese herbal medicines involve a risk of allergic reaction and in rare cases involve a risk of poisoning. Cases of acute and chronic poisoning due to treatment through ingested Chinese medicines are found in China, Hong Kong, and Taiwan, with a few deaths occurring each year.^{[citation needed]} Many of these deaths do occur however, when patients self prescribe herbs or take unprocessed versions of toxic herbs.^{[citation needed]} The raw and unprocessed form of aconite, or fuzi is the most common cause of poisoning. The use of aconite in Chinese herbal medicine is usually limited to processed aconite, in which the toxicity is denatured by heat treatment.

Toxins and contaminants

Potentially toxic and carcinogenic compounds such as arsenic trioxide (三氧化二砷) and cinnabar (called zhūshā, 朱砂) are sometimes prescribed as part of a medicinal mixture, in a sense "using poison to cure poison". Unprocessed herbals are sometimes adulterated with chemicals that may alter the intended effect of a herbal preparation or prescription. As with the 2008 Chinese milk scandal, tampering with food and medicine to boost profit is rampant despite knowledge of the dangers and strict regulations in place that are circumvented often due to corruption and profit motive. However, knowledge of processing is being improved with more empirical studies of Chinese herbals and tighter regulations are being put in place, whether heeded to or not, regarding the growing, processing, and prescription of various herbals.

A medicine called Fufang Luhui Jiaonang (复方芦荟胶囊) was taken off shelves in UK in July 2004 when it found to contain 11-13% mercury.^[36]

In the United States, the Chinese herb má huáng (麻黄; lit. "hemp yellow") — known commonly in the West by its Latin name Ephedra — was banned in 2004 by the FDA, although the FDA's final ruling exempted traditional Asian preparations of Ephedra from the ban. The Ephedra ban was meant to combat the use of this herb in Western weight loss products, a highly modern phenomenon and well removed from traditional Asian uses of the herb. There were no cases of Ephedra based fatalities with patients using traditional Asian preparations of the herb for its traditionally intended uses. This ban was ordered lifted in April 2005 by a Utah federal court judge. However, the ruling was appealed and on August 17, 2006, the Appeals Court upheld the FDA's ban of ephedra, finding that the 133,000-page administrative record compiled by the FDA supported the agency's finding that ephedra posed an unreasonable risk to consumers.

Lack of standardization

Chinese herbals are often not standardized from one pill to the next, or from one brand to the next, and can be reformulated, remixed, or otherwise altered by any company. To avoid such issues, standardized Japanese Kampo medicine for sale worldwide is a safer alternative based on classical Chinese traditional medicine and strict enforced regulations and is regulated as pharmaceuticals coupled with extensive after-market testing and monitoring.

Vague naming

Many Chinese medicines have different names for the same ingredient depending on location and time, ingredients with different medical properties have shared similar names. For example, there was a report that mirabilite/sodium sulphate decahydrate (芒硝) was misrecognized as sodium nitrite (牙硝)^[37], resulting in a poisoned victim^[38]^[39]. In some Chinese medical texts, both names are interchangeable^[40]. The Chinese Medicine Registration Board of the Australian state of Victoria issued a report in 2004 which noted this was a problem that needed to be addressed.^[41]

Relationship with Western medicine

Within China, there has been a great deal of cooperation between TCM practitioners and Western medicine, especially in the field of ethnomedicine. Chinese herbal medicine includes many compounds which are unused by Western medicine, and there is great interest in those compounds as well as the theories which TCM practitioners use to determine which compound to prescribe. For their part, advanced TCM practitioners in China are interested in statistical and experimental techniques which can better distinguish medicines that work from those that do not. One result of this collaboration has been the creation of peer reviewed scientific journals and medical databases on traditional Chinese medicine.^{[citation needed]}

Outside of China, the relationship between TCM and Western medicine is more contentious. While more and more medical schools are including classes on alternative medicine in their curricula, older Western doctors and scientists are more likely than their Chinese counterparts to skeptically view TCM as archaic pseudoscience and superstition. This skepticism can come from a number of sources. For one, TCM in the West tends to be advocated either by Chinese immigrants or by those that have lost faith in conventional medicine. Many people in the West have a stereotype of the East as mystical and unscientific^{[citation needed]}which attracts those in the West who have lost hope in science and repels those who believe in scientific explanations.

As an example of the different roles of TCM in China and the West, a person with a broken bone in the West (i.e. a routine, "straightforward" condition) would almost never see a Chinese medicine practitioner, whereas this is routine in China.

Most Chinese in China do not see traditional Chinese medicine and Western medicine as being in conflict. In cases of emergency and crisis situations, there is generally no reluctance in using conventional Western medicine. At the same time, belief in Chinese medicine remains strong in the area of maintaining health. As a simple example, you see a Western doctor if you have acute appendicitis, but you exercise or take Chinese herbs to keep your body healthy enough to prevent appendicitis, or to recover more quickly from the surgery. Very few practitioners of Western medicine in China reject traditional Chinese medicine, and most doctors in China will use some elements of Chinese medicine in their own practice.

A degree of integration between Chinese and Western medicine also exists in China. For instance, at the Shanghai cancer hospital, a patient may be seen by a multidisciplinary team and be treated concurrently with radiation surgery, Western drugs and a traditional herbal formula. A report by the Victorian state government in Australia on TCM education in China noted:

Graduates from TCM university courses are able to diagnose in Western medical terms, prescribe Western pharmaceuticals, and undertake minor surgical procedures. In effect, they practise TCM as a specialty within the broader organisation of Chinese health care.^[42]

In other countries it is not necessarily the case that traditional Chinese and Western medicine are practiced concurrently by the same practitioner. TCM education in Australia, for example, does not qualify a practitioner to provide diagnosis in Western medical terms, prescribe scheduled pharmaceuticals, nor perform surgical procedures.^[43] While that jurisdiction notes that TCM education does not qualify practitioners to prescribe Western drugs, a separate legislative framework is being constructed to allow registered practitioners to prescribe Chinese herbs that would otherwise be classified as poisons.^[41]

It is worth noting that the practice of Western medicine in China is somewhat different from that in the West. In contrast to the West, there are relatively few allied health professionals to perform routine medical procedures or to undertake procedures such as massage or physical therapy.

In addition, Chinese practitioners of Western medicine have been less affected by trends in the West that encourage patient empowerment, to see the patient as an individual rather than a collection of parts, and to do nothing when medically appropriate. Chinese practitioners of Western medicine have been widely criticized for over-prescribing drugs such as corticosteroids or antibiotics for common viral infections. It is likely that these medicines, which are generally known to be useless against viral infections, would provide less relief to the patient than traditional Chinese herbal remedies. A more popular and reliable explanation is the financial benefits doctors receive from pharmaceutical companies for prescribing medication that may not be necessary.^[44]

Traditional Chinese diagnostics and treatments are often much cheaper than Western methods which require high-tech equipment or extensive chemical manipulation.

TCM doctors often criticize Western doctors for paying too much attention to laboratory tests and showing insufficient concern for the overall feelings of patients.^{[citation needed]}

Modern TCM practitioners will refer patients to Western medical facilities if a medical condition is deemed to have put the body too far out of "balance for traditional methods to remedy.

Animal products

Dried seahorses like these are extensively used in traditional medicine in China and elsewhere

Animal products are used in certain Chinese formulae, which may present a problem for vegans and vegetarians. If informed of such restrictions, practitioners can often use alternative substances.

The practice of using endangered species is controversial within TCM. Many substances fall into this category, with modern Materia Medicas such as Bensky, Clavey and Stoger's comprehensive Chinese herbal text dealing with substances derived from endangered species in an appendix, with an emphasis on recommending alternatives.^[45] Some claimed uses of certain animal derived ingredients, such as use of the tiger's penis for impotence, cannot be considered true, because the substances in question do not appear in the ingredients lists of the pharmacopoeia^{[citation needed]}. Use of rhinoceros horn (xī jiǎo / 犀角) for "cooling the blood" was replaced with buffalo horn (shuǐ niú jiǎo / 水牛角) starting from perhaps 5CE, and cow (bovine) bile (niú dǎn / 牛膽 / 牛胆) is a modern replacement for bear (ursine) bile (xíong dǎn / 熊膽 / 熊胆). An ingredient like "horny goat weed" (yín yáng hoù / 淫羊藿) is obviously a plant (Epimedium).

Medicinal use is having a major impact on the populations of seahorses, which are considered a fundamental ingredient, and used to treat a variety of disorders, including asthma, arteriosclerosis, incontinence, impotence, thyroid disorders, skin ailments, broken bones, heart disease, as well as to facilitate childbirth and even as an aphrodisiac.^[46]

Shark fin soup is traditionally regarded as beneficial for health in East Asia, and its status as an "elite" dish has led to huge demand with the increase of affluence in China, but it is surely having a devastating effect on shark populations^[47].

The animal rights movement notes that a few traditional Chinese medicinal solutions still use bear bile (xíong dǎn). Since 1988, the Chinese Ministry of Health started controlling production of this, which previously used bears killed before winter. The bears are often fitted with a sort of permanent catheter, which was more profitable than killing the bears^[48]. The treatment itself and especially the extraction of the bile is very painful for bears, and causes damage to their stomach and intestines, often resulting in their eventual death. However, due to international attention on the issues surrounding its harvesting, bile is now rarely used by practitioners outside of China; gallbladders from butchered cattle (cow bile / niú dǎn) are recommended as a substitute for this ingredient.

Opposition

Starting from the late 19th century, some politicians and Chinese scholars with background in Western medicine have been trying to phase out TCM totally in China.^{[citation needed]}

The attempts to curtail TCM in China always provoke large scale debates but have never completely succeeded. Still, many researchers and practitioners of TCM in China and the United States argue the need to document TCM's efficacy with controlled, double blind experiments. These efforts remain hampered by the difficulty of creating effective placebos for acupuncture studies.^{[citations needed]}

The attempt to phase out TCM in Japan partially succeeded after Meiji Restoration. However, in the 1920s a movement emerged that attempted to restore traditional medical practice, especially acupuncture. This movement, known as the Meridian Therapy movement (Keiraku Chiryo in Japanese) persists to this day. Furthermore, many Japanese physicians continue to practice Kampo, a form of traditional medicine based on the Shang Han Lun tradition of Chinese herbal medicine.^{[citations needed]} However, there are many differences such as standardization and strong enforced regulations in Kampo that are absent in TCM. The most scientific derivative of TCM practiced in Japan is ryodoraku (良導絡), which was developed by Yosio Nakatani in 1950. It utilizes objective electricity test instruments and direct current stimulation of acuーpoints instead of subjective interpretation of symptoms and treatment. 　Ryodoraku research is centered at Osaka Medical College, Japan.

The use of parts of endangered species (such as seahorses, rhinoceros horns, and tiger bones and claws) has created controversy and resulted in a black market of poachers who hunt restricted animals. ^[49]^[50] Deep-seated cultural beliefs in the potency of tiger parts are so prevalent across Asia that laws protecting even critically endangered species such as the Sumatran Tiger fail to stop the display and sale of these items in open markets, according to a 2008 report from TRAFFIC Popular "medicinal" tiger parts from poached animals include tiger penis, believed to improve virility,^[51] and tiger eyes. In Black Market, photographer Patrick Brown took a deep look at the illegal wildlife trade in Asia.

Modernization

Traditional Chinese medicine has been to some degree modernized by transforming the plants and ingredients to soluble granules and tablets. Modern formulations in pills and sachets used 675 plant and fungi ingredients and about 25 from non-plant sources such as snakes, geckos, toads, frogs, bees, and earthworms.

Investigation of the active ingredients in TCM has produced western style drugs, for example Artemisinin now widely used in the treatment of malaria.

Osteopathy

2009-04-20T18:43:00.000-07:00

From Wikipedia, the free encyclopedia

Osteopathy is an approach to healthcare that emphasizes the role of the musculoskeletal system in health and disease. It is practised in the United Kingdom, the rest of the European Union, Israel, Canada, and Australia. Osteopathy is not to be confused with the historically related but now distinct field, osteopathic medicine in the United States.^[1]

In most countries, osteopathy is a form of complementary medicine, emphasizing a holistic approach and the skilled use of a range of manual and physical treatment interventions in the prevention and treatment of disease. In practice, this most commonly relates to musculoskeletal problems such as back and neck pain. Osteopathic principles teach that treatment of the musculoskeletal system (bones, muscles and joints) facilitates the recuperative powers of the body.

History

The practice of osteopathy began in the United States in 1874. The term "osteopathy" was coined by Andrew Taylor Still. Still was a free state leader who lived near Baldwin City, Kansas at the time of the American Civil War, and it was here he developed the practice of osteopathy.^[2]

Still named his new school of medicine "osteopathy," reasoning that "the bone, osteon, was the starting point from which [he] was to ascertain the cause of pathological conditions."^[3] Still founded the American School of Osteopathy (now A.T. Still University) in Kirksville, Missouri, for the teaching of osteopathy on May 10, 1892. While the state of Missouri, recognizing the equivalency of the curriculum, was willing to grant him a charter for awarding the MD degree, he remained dissatisfied with the limitations of conventional medicine and instead chose to retain the distinction of the DO degree.^[4]

Osteopathic principles

These are the eight major principles of osteopathy and are widely taught throughout the international osteopathic community. ^[5]

The body is a unit.
Structure and function are reciprocally inter-related.
The body possesses self-regulatory mechanisms.
The body has the inherent capacity to defend and repair itself.
When the normal adaptability is disrupted, or when environmental changes overcome the body’s capacity for self maintenance, disease may ensue.
The movement of body fluids is essential to the maintenance of health.
The nerves play a crucial part in controlling the fluids of the body.
There are somatic components to disease that are not only manifestations of disease, but also are factors that contribute to maintenance of the disease state.

These principles are not held by osteopathic physicians to be empirical laws; they are thought to be the underpinnings of the osteopathic philosophy on health and disease.

Techniques of Osteopathic Treatment

Main article: Osteopathic manipulative medicine

The goal of OMM is the resolution of what many osteopaths call somatic dysfunction in an attempt to aid the body's own recuperative faculties. Osteopathic manual treatment of the musculoskeletal system employs a diverse array of techniques. These are normally employed together with dietary, postural, and occupational advice, as well as counseling in an attempt to help patients recover from illness and injury, in an attempt to minimise or manage pain and disease.

Scope of manual therapies

Osteopathy employs manual therapies for the treatment of many neuromusculoskeletal pain syndromes, such as lower back pain and tension headache, alongside exercise and other rehabilitative techniques. Many osteopaths also attempt to manage (or, more often, co-manage) organic or Type-O disorders conditions, such as asthma and middle ear infections in children,^[6] menstrual pain, and pulmonary infection.

Cranial osteopathy

It has been suggested that this section be split into a new article entitled Cranial osteopathy. (Discuss)

Cranial osteopathy is a set of theory and techniques that have been developed from the observations of Dr William Sutherland that the plates of the cranium, although fused, do permit microscopic movement or force dissipation and that there is a 'force' or rhythm that is operating in moving the plates of the skull.^[7] Cranial osteopathy is said to be based on a primary respiratory mechanism, a rhythm that can be felt with a very finely developed sense of touch. Some osteopaths believe that improving dysfunctional cranial rhythmic impulses enhances cerebral spinal fluid flow to peripheral nerves, thereby enhancing metabolic outflow and nutrition inflow. It has gained particular popularity in the treatment of babies and children.

The primary respiratory mechanism is not acknowledged as existing in standard medical texts, and at least one study has failed to show inter-rater reliability between craniosacral therapists attempting to detect this rhythm.^[8] While other studies have reported evidence of the existence of such a rhythm, the link between any such mechanism and states of health or disease has also been contested. One meta-analysis from the British Columbia Office of Health Technology Assessment (BCOHTA) concluded that "there is evidence for a craniosacral rhythm, impulse or 'primary respiration' independent of other measurable body rhythms", however it was noted that "these and other studies do not provide any valid evidence that such a craniosacral 'rhythm' or 'pulse' can be reliably perceived by an examiner" and that "The influence of this craniosacral rhythm on health or disease states is completely unknown."^[9]

Craniosacral therapy is based on the same principles as cranial osteopathy, but the practitioners are not qualified osteopaths. The theory and techniques of cranial osteopathy have also had a major influence in alternative medicine in general.^[10]

Visceral osteopathy

Proponents of visceral osteopathy state that the visceral systems (the internal organs: digestive tract, respiratory system, etc.) rely on the interconnection synchronicity between the motion of all the organs and structures of the body, and that at optimal health this harmonious relationship remains stable despite the body's endless varieties of motion. The idea is that both somato-visceral and viscero-somatic connections exist, and manipulation of the somatic system can affect the visceral system (and vice-versa).

Practitioners contend that visceral osteopathy relieves imbalances and restrictions in the interconnections between the motion of all the organs and structures of the body--namely, nerves, blood vessels, and fascial compartments. During the 1940s, osteopaths like H V Hoover and M D Young built on the work of Andrew Taylor Still to create this method of assessment and manipulation. The efficacy and basis of this treatment remains controversial even within the osteopathic profession.

Osteopathy around the world

The osteopathic profession has evolved into two branches, practitioners in the United States and Canada, and practitioners in European and Commonwealth countries. These groups have have grown so distinct that in practice they function as separate professions, though there have been attempts in the recent years to enhance exchange and dialogue between them.^[11]

In Europe, commonwealth countries and elsewhere, osteopaths rely on non-surgical, non-pharmaceutical approaches, and see themselves as a complete school of manual medicine or NMS specialists, complementary to most mainstream medical practices. Commonwealth osteopathic students may spend up to ten times as many hours training in osteopathic diagnosis and technique as their American counterparts. Because of this specialization, they have traditionally remained as an alternative to mainstream healthcare alongside naturopaths and chiropractors. In commonwealth countries, osteopaths have also had to compete with physiotherapists, many of whom have integrated manipulative therapy into their practice. Nevertheless, osteopathy is growing in size in many countries of the Commonwealth and Europe.

United States

Main article: Osteopathic medicine in the United States

In the 20th century, osteopathy in the United States moved closer to mainstream medicine in its philosophy and scope of practice. Although manipulation and other principles of traditional osteopathy are still taught in some form in U.S. osteopathic medical schools, they are used by a small minority of graduates in actual practice.^[12] The profession adopted the name "osteopathic medicine" to reflect its distinction from osteopathy.^[13] Since all former schools of "osteopathy" now refer to themselves as colleges of "osteopathic medicine", there are currently no schools of osteopathy in the United States.^[1]

United Kingdom

The first osteopathic college was established in the UK in 1917 by John Martin Littlejohn, a Scot who had studied under Andrew Taylor Still. Littlejohn altered the osteopathic curriculum to include the study of physiology. The UK school he founded, the British School of Osteopathy, was the first osteopathic education institution outside the USA, and it still exists today, now located in Borough High Street, Southwark. British osteopaths use manipulative techniques based on the philosophy of Andrew Taylor Still, but do not receive medical or surgical training and are not physicians. Some medical doctors do undertake osteopathic training as a postgraduate interest. The profession is subject to statutory regulation following the passing of the Osteopaths Act in 1993. The General Osteopathic Council (GOsC) was established by the act to regulate the profession. Most medical services in the UK are delivered through the state funded National Health Service, osteopathy is largely excluded from this with most osteopaths working in private practice. Several large studies in the UK have produced evidence that demonstrates positive clinical and cost effectiveness of manipulation in the management of lower back pain, the latest being the UK Back pain Exercise And Manipulation (UK BEAM) trial.^[14] ^[15] The physical manipulation condition of the UK BEAM trial involved "... a package of techniques representative of those used by the UK chiropractic, osteopathic, and physiotherapy professions."

Many UK osteopaths are also naturopaths, with one osteopathic college offering a dual training in osteopathy & naturopathy (the British College of Osteopathic Medicine) and another offering a post-graduate programme (the College of Osteopaths).

In 2005 the General Medical Council of Great Britain announced that U.S.-trained DOs would be accepted for full medical practice rights in the United Kingdom. This decision was an important departure from the United Kingdom's long-standing tradition of exclusively manual, or "traditional" osteopathy.

In the United Kingdom, courses in Osteopathy have recently become integrated into the university system. Instead of receiving a Diploma in Osteopathy (DO), with or without a Diploma in Naturopathy (ND), graduates now become Masters of Osteopathy, or Bachelors of Osteopathy or Bachelors of Osteopathic Medicine, or Bachelors of Science in either Osteopathy or Osteopathic Medicine, according to the institution attended:^[16] but these degrees do not lead to prescribing rights and in this case Osteopathy and Osteopathic Medicine are synonymous. There is one "cross-over" institution, the London College of Osteopathic Medicine^[17], which teaches osteopathy only to those already qualified in medicine. Before using the title of "osteopath," graduates have to register with the UK regulatory body by statute; the General Osteopathic Council.

Australia & New Zealand

In Australia the profession has developed along the same lines as in Britain, and Osteopathy celebrated 100 years in Australia in 2007. The professional body representing Osteopaths in Australia is the Australian Osteopathic Association (AOA), and in New Zealand the Osteopathic Society of New Zealand (OSNZ). Since the 1970s Australia has formally trained practitioners although many were trained less formally prior to that time. Both Australia and New Zealand require registration, and thus disallow osteopathic practice except by government registered practitioners. Osteopathic treatment is recognized and reimbursed by Workers' compensation, the various motor accident authorities, Medicare, private health insurers, and the Accident Compensation Corporation (ACC). Four publicly-funded Universities now offer osteopathic medical courses in Australia - RMIT, VU, SCU and UWS - and one course is offered at UNITEC in New Zealand.^[18] Australasian courses consist of a bachelor's degree in clinical science (Osteopathy) followed by a master's degree.

Canada

"Osteopathy in Canada" redirects here. For a branch of the medical profession in Canada, see Osteopathic medicine in Canada.

The first self-identified college of Osteopathy in Canada opened in 1981. Non-physician osteopaths in Canada are currently represented by the Canadian Federation of Osteopaths,^[19] a group that advocates for the standardization of training requirements and more legal recognition for the non-medical osteopathic profession. This organization and the schools from which its membership have graduated are not recognized or accredited by any Canadian federal or provincial regulatory authority.^[20] Colleges of Osteopathy in Canada are the Canadian College of Osteopathy in Toronto, the Canadian College of Osteopathic and Holistic Health Sciences in Hamilton, Ontario, and the Collège d'Études Ostéopathiques in Montreal, Quebec.^[21] Graduates of these schools do not currently qualify for registration to practice in Canada.^[22]

Osteopathic physicians educated in the United States should not be confused with non-physician osteopaths. Osteopathic physicians are educated and trained in the United States and may practice in Canada as fully licensed physicians. There are no colleges of Osteopathic medicine in Canada. Only those graduates of American Colleges of Osteopathic Medicine are eligible for licensure to practice osteopathy and Osteopathic Medicine in Canada. The authority for licensure of American osteopathic graduates lies with the provincial Colleges of Physicians and Surgeons.^[23]^[24]^[25]^[26]^[27]^[28] The Canadian Osteopathic Association^[29] has been representing osteopathic physicians in Canada for more than 80 years and has enabled near uniform licensure across Canada for American osteopathic graduates.

For more details on osteopathic physicians trained in the United States, see Osteopathic medicine in the United States.

Israel

In Israel a joint Osteopathy and Chiropractic Bill is in the process of going through the Knesset (Israeli Parliament). The bill will in effect define osteopathy as an academically based profession. Only those holding at least an undergraduate degree in osteopathy will be able to call themselves osteopaths in Israel. The members of the Israel Osteopathic Association have been working in conjunction with the Ministry of Health on drawing up the bill.

European Union

Within the EU there is no standardized training or regulatory framework for osteopaths but attempts are being made to coordinate the profession within the union. There is a conflict between the principle of free movement of labour - a cornerstone of the EU - and the right to practice osteopathy in different member states as there is cross-border equivalence in training and regulation of the profession. The UK's General Osteopathic Council, a regulatory body set up under the country's 1993 Osteopaths Act has issued a position paper on European regulation of osteopathy.^[30] The teaching of osteopathy in the United Kingdom, Belgium, France, Finland, Iceland, Denmark, Malta, Switzerland is well established - but not all European nations have yet embraced this form of medicine.

In the UK, since the Osteopaths Act, osteopathy has been a recognised profession. Some doctors within the country's National Health Service recognise osteopathy as a therapy and refer patients to its practitioners when other forms of treatment are not successful or are considered inappropriate ^[31] - but the NHS will not usually pay for any treatment.^[32]

Spain is into a recognition process. Nevertheless it has its national registry http://www.osteopatas.org. Recognized professionals should be listed on it.^[33]

Criticism

Osteopathy has been criticized for having limited research into the efficacy of treatment.^{[citation needed]} One placebo-controlled trial concluded that osteopathy is no better than sham treatment for chronic nonspecific lower back pain, although the authors acknowledged the difficulty of providing a non-therapeutic sham treatment for pain after knee/hip surgery.^[34]^[35] However, in a meta-analysis and systematic review of six randomized controlled trials of OMT that involved blinded assessments of lower back pain in ambulatory settings, it was concluded that OMT significantly reduces lower back pain, and that the level of pain reduction is greater than expected from placebo effects alone and persists for at least three months.^[36]

Another study, which aimed to identify cellular mechanisms at work during osteopathic treatment, was published in the Journal of American Osteopathic Association in December 2007. Data from this study suggest that fibroblast proliferation and expression/secretion of proinflammatory and anti-inflammatory interleukins may contribute to the clinical efficacy of indirect osteopathic manipulative techniques.^[37]

Safety concerns have also been raised in relation to manipulative techniques used by some osteopaths. 'Neck cracking', i.e. cervical high-velocity low-amplitude thrusting, has received particular attention in the popular media due to a possible risk of arterial occlusion and consequently of stroke. Although the existing data cannot provide a conclusive estimate of the cervical artery dissection risk researchers have stated that a stroke risk of about 1.3 per 100 000 chiropractic visits for individuals aged under 45 years, with a 95% confidence interval of 0.5–16.7 per 100 000 is a theoretically unbiased estimate^[38]. Although this data primarily concerns chiropractic visits, both osteopaths and chiropractors may practice cervical manipulations.

Naturopathy

2009-04-20T18:35:00.000-07:00

From Wikipedia, the free encyclopedia

Naturopathy (also known as naturopathic medicine or natural medicine) is an eclectic alternative medical system that focuses on natural remedies and the body's vital ability to heal and maintain itself. Naturopathic philosophy favors a holistic approach and minimal use of surgery and drugs. Naturopathy comprises many different treatment modalities of varying degrees of acceptance by the medical community; diet and lifestyle advice may be substantially similar to that offered by non-naturopaths, and acupuncture may help reduce pain in some cases, but homeopathy is often characterized as pseudoscience or quackery.^[1]^[2]^[3]^[4][5]

Naturopathy has its origins in the Nature Cure movement of Europe.^[6]^[7] The term was coined in 1895 by John Scheel and popularized by Benedict Lust,^[8]the "father of U.S. naturopathy".^[9]

Naturopathy is practiced in many countries, especially the United States and Canada, and is subject to different standards of regulation and levels of acceptance. The level of medical education among naturopaths also varies, though no naturopathic training program reaches the same level of training as an MD.^[10] In the United States and Canada, the designation of Naturopathic Doctor (ND) may be awarded after completion of a four year program of study at an accredited Naturopathic medical school that includes the study of basic medical sciences as well as natural remedies and medical care.^[11]^[12] The scope of practice varies widely between jurisdictions, and naturopaths in unregulated jurisdictions may use the Naturopathic Doctor designation or other titles regardless of level of education.^[13]

History

Some see the ancient Greek "Father of Medicine", Hippocrates, as the first advocate of naturopathic medicine, before the term existed.^[14]^[15] The modern practice of naturopathy has its roots in the Nature Cure movement of Europe.^[6]^[7] In Scotland, Thomas Allinson started advocating his "Hygienic Medicine" in the 1880s, promoting a natural diet and exercise with avoidance of tobacco and overwork.^[16]^[17] The term sanipractor has sometimes been used to refer to naturopaths, particularly in the Pacific Northwest region of the United States.^[9]

The term naturopathy was coined in 1895 by John Scheel,^[8] and purchased by Benedict Lust, the "father of U.S. naturopathy".^[9] Lust had been schooled in hydrotherapy and other natural health practices in Germany by Father Sebastian Kneipp; Kneipp sent Lust to the United States to spread his drugless methods.^[3] Lust defined naturopathy as a broad discipline rather than a particular method, and included such techniques as hydrotherapy, herbal medicine, and homeopathy, as well as giving up overeating, tea, coffee, and alcohol.^[1] He described the body in spiritual and vitalistic terms with "absolute reliance upon the cosmic forces of man's nature."^[18]

In 1901, Lust founded the American School of Naturopathy in New York; in 1902 he founded the Naturopathic Society of America (reorganized in 1919 as the American Naturopathic Association, ANA).^[9]^[19] ^[20] Naturopaths became licensed under naturopathic or drugless practitioner laws in 25 states in the first three decades of the twentieth century.^[9] Naturopathy was adopted by many chiropractors, and several schools offered both Doctor of Naturopathy (N.D.) and Doctor of Chiropractic (D.C.) degrees.^[9] Estimates of the number of naturopathic schools active in the United States during this period vary from about one to two dozen.^[9]^[8]^[5]

After a period of rapid growth, naturopathy went into decline for several decades after the 1930s. In 1910, the Carnegie Foundation for the Advancement of Teaching published the Flexner Report, which criticized many aspects of medical education, especially quality and lack of scientific rigour. The advent of penicillin and other "miracle drugs" and the consequent popularity of modern medicine also contributed to naturopathy's decline. Following Lust's death in 1945, the ANA split into six distinct organizations. In the 1940s and 1950s, a broadening in scope of practice laws led many chiropractic schools to drop their N.D. degrees, though many chiropractors continued to practice naturopathy. From 1940 to 1963, the American Medical Association campaigned against heterodox medical systems. By 1958, practice of naturopathy was licensed in only five states.^[9] In 1968, the United States Department of Health, Education, and Welfare issued a report on naturopathy concluding that naturopathy was not grounded in medical science and that naturopathic education was inadequate to prepare graduates to make appropriate diagnosis and provide treatment; the report recommends against expanding Medicare coverage to include naturopathic treatments.^[21]^[5] In 1977, an Australian committee of inquiry reached similar conclusions; it did not recommend licensure for naturopaths.^[22]

Naturopathy never completely ceased to exist, and beginning in the 1970s interest waxed in the United States and Canada.^[1]

Today, there are six accredited naturopathic medical schools in North America. In 1956, Charles Stone, Frank Spaulding, and W. Martin Bleything established the National College of Natural Medicine (NCNM) in Portland, Oregon in response to plans by the Western States Chiropractic College to drop its N.D. program. In 1978, Sheila Quinn, Joseph Pizzorno, William Mitchell, and Les Griffith established John Bastyr College of Naturopathic Medicine (now Bastyr University) in Seattle, Washington. The rise of the holistic health movement in the early 1970s contributed to this revival.^[9]

Principles

Naturopathic ideology focuses on naturally-occuring and minimally-invasive methods, trusting to the "healing power of nature."^[5] Such treatments as "synthetic" drugs, radiation, and major surgery are avoided, and rejection of biomedicine in favor of an intuitive and vitalistic conception of the body and nature is common.^[5]^[23] Prevention through stress reduction and a healthy diet and lifestyle is emphasized. The philosophy of naturopathic practice is self-described by six core values.^[24] Multiple versions exist in the form of the naturopathic doctor's oath,^[25]various mission statements published by schools^[26] or professional associations, and ethical conduct guidelines published by regulatory bodies:^[27]

First, do no harm; provide the most effective health care available with the least risk to patients at all times (Primum Non Nocere).
Recognize, respect and promote the self-healing power of nature inherent in each individual human being. (Vis Medicatrix Naturae, a form of vitalism^[28]).
Identify and remove the causes of illness, rather than eliminate or suppress symptoms (Tolle Causum).
Educate, inspire rational hope and encourage self-responsibility for health (Doctor as Teacher).
Treat each person by considering all individual health factors and influences. (Treat the Whole Person).
Emphasize the condition of health to promote well-being and to prevent diseases for the individual, each community and our world. (Health Promotion, the Best Prevention)

Practice

The focus of Naturopathy is on its philosophy of natural self-healing rather than specific methods, and practitioners use a wide variety of treatment modalities.^[29]^[30] Many methods rely on immaterial "vital energy fields," and naturopathy as a field tends towards isolation from general scientific discourse.^[31] ^[32]^[33] The effectiveness of naturopathy as a whole system has not been systematically evaluated, and efficacy of individual methods used varies.^[34]^[5]

A consultation typically begins with a lengthy patient interview focusing on lifestyle, medical history, emotional tone, and physical features, as well as physical examination.^[1] Naturopaths do not necessarily recommend vaccines and antibiotics, and may provide inappropriate alternative remedies even in cases where evidence-based medicine has been shown effective. All forms of naturopathic education include concepts incompatible with basic science, and do not necessarily prepare a practitioner to make appropriate diagnosis or referrals.^[35]^[36]^[37]

Methods

The particular modalities utilized by an individual naturopath varies with training and scope of practice. The demonstrated efficacy and scientific rationale also varies. These include:

Acupuncture
Applied kinesiology^[38]
Botanical medicine
Chelation therapy for atherosclerosis^[4]
colonic enemas^[3]
Color therapy^[38]
Cranial osteopathy^[35]
Hair analysis^[35]
Homeopathy
Iridology^[38]
Nutrition (examples include vegetarian and wholefood diet, fasting, andabstention from alcohol and sugar)^[39]
Ozone therapy^[5]
Physical medicine (includes naturopathic, osseous, and soft tissue manipulative therapy,sports medicine, exercise and hydrotherapy)
Nature cure - a range of therapies based upon exposure to natural elements such assunshine, fresh air, heat, or cold
Psychological counseling (examples include meditation,relaxation and other methods of stress management^[39])
Public health measures and hygiene^[24]
Reflexology^[38]

Rolfing^[23]

Traditional Chinese medicine

Practitioners

Naturopathic care is available from three broad categories: practitioners with a four year degree or similar formal training; practitioners who are self-taught or have been apprenticed to another naturopath; and practitioners who operate under another professional license while also offering some naturopathic methods.^[5] In unregulated jurisdictions, the designation Doctor of Naturopathy and similar terms are not protected and may be used by any practitioner regardless of qualifications.

Naturopathic doctors

Main article: Doctor of Naturopathic Medicine

Naturopathic doctor (ND) or a similar term is a protected designation with some form of licensing and training requirements in at least 15 US states, the District of Columbia, and five Canadian provinces.^[40]^[41] In these jurisdictions, naturopathic doctors must pass board exams set by the North American Board of Naturopathic Examiners(NABNE)^[42] after completing academic and clinical training at a college certified by the Council on Naturopathic Medical Education(CNME).^[43] Many naturopaths present themselves asprimary care providers.^[11]^[10]^[1] ND training includes the use of basic medical diagnostic tests and procedures such as medical imaging, minor surgery, andblood tests. The CNME also provides for the inclusion of optional modalities including minor surgery, natural childbirth and intravenous therapy; these modalities require additional training and may not be within the scope of practice in all jurisdictions. This training differs from that undertaken by MDs in that it includes scientifically disproven modalities, such as homeopathy, and concepts irreconcilable with modern medicine, such as vitalism.^[1]^[3]^[10]^[4]^[11]^[44] NDs do not engage in residency training.^[5] In 2005, the Massachusetts Medical Society opposed licensure in the commonwealth on these grounds.^[36]

The core set of interventions defined by the Council on Naturopathic Medical Education and taught at all six accredited schools in North America includes:^[2] acupuncture and Traditional Chinese medicine, botanical medicine, homeopathy, nature cure (a range of therapies based upon exposure to natural elements), nutrition, physical medicine, and psychological counseling.

Traditional naturopaths

Traditional naturopaths are guided by the same naturopathic philosophies and principles as board-licensed naturopathic doctors and often prescribe similar treatments. Traditional naturopaths however, are not primary care providers, whereas graduates of CNME accredited naturopathic medicine schools are classified as both alternative or complementary practitioners as well as primary care providers. Traditional naturopaths may voluntarily join a professional organization, but these organizations do not accredit educational programs in any meaningful way or license practitioners, per se.^{[citation needed]} The training programs for traditional naturopaths can vary greatly. Compared to naturopathic medical schools, traditional naturopaths' training programs are less rigorous and do not provide the same basic and clinical science education.^{[citation needed]} The professional organizations formed by traditional naturopaths are not recognized by the government of the USA or any US State or Territory.

Other health care professionals

According to a 1998 taskforce report, some physicians are choosing to add naturopathic modalities to their practice,^[45] and states such as Texas have begun to establish practice guidelines for MDs who integrate alternative and complementary medicine into their practice.^[46] Continuing education in naturopathic modalities for health care professionals varies greatly but includes offerings for practitioners: physicians, chiropractors, acupuncturists,dentists, researchers, veterinarians, physician’s assistants, and nurses.^[47] These professionals usually retain their original designation but may use terms such as 'holistic', 'natural', or 'integrative' to describe their practice.

Regulation

The examples and perspective in this article may not represent a worldwide view of the subject. Please improve this article or discuss the issue on the talk page.

Australia

There is no state licensure in Australia, rather the industry is self-regulated. There is no protection of title, meaning that technically anyone can practise as a naturopath. The only way to obtain insurance for professional indemnity or public liability is by joining a professional association, which can only be achieved having completed an accredited course and gaining professional certification. Currently the only registered modalities of natural medicine in Australia are those relating to Chinese medicine, and only in the state of Victoria.^[48]

In 1977 a committee reviewed all colleges of naturopathy in Australia and found that, although the syllabuses of many colleges were reasonable in their coverage of basic biomedical sciences on paper, the actual instruction bore little relationship to the documented course. In no case was any practical work of any consequence available. The lectures which were attended by the Committee varied from the dictation of textbook material to a slow, but reasonably methodical, exposition of the terminology of medical sciences, at a level of dictionary definitions, without the benefit of depth or the understanding of mechanisms or the broader significance of the concepts. The Committee did not see any significant teaching of the various therapeutic approaches favoured by naturopaths. Persons reported to be particularly interested in homoeopathy, Bach's floral remedies or mineral salts were interviewed, but no systematic courses in the choice and use of these therapies were seen in the various colleges. The Committee was left with the impression that the choice of therapeutic regime was based on the general whim of the naturopath and since the suggested applications in the various textbooks and dispensations overlap to an enormous extent no specific indications are or can be taught.^[49]

India

In India there is a 5 1/2 year degree course offering a Bachelor of Naturopathy and Yogic Sciences (BNYS) degree. There are a total of 11 colleges in India, of which 4 colleges are in the state of Tamilnadu.^{[citation needed]}

Naturopathy and Yoga, as an Indian system of medicine, falls under the Department of AYUSH, Ministry of Health & Family Welfare, Government of India.^{[citation needed]}

"Central Council for Research in Naturopathy & Yoga": The Government of India after having recognized the need for systematic Research and Development of Yoga & Naturopathy in the country, established the “Central Council for Research in Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy” in 1969 as an autonomous organization under the Ministry of Health and Family Welfare. This organization, first of its kind was established in India by the Central Government to conduct Scientific Research in Ayurveda, Siddha, Unani and Yoga, existed upto 1978. During this period, the development of Naturopathy was looked after by the Ministry of Health & Family Welfare directly. Later, in March 1978, this composite Council was dissolved to pave way for the formation of four independent Research Councils, one each for Ayurveda and Siddha, Unani, Homoeopathy and Yoga & Naturopathy.^{[citation needed]}

Hence, this Council (CCRYN) was established in 1978 with a view to provide better opportunities for alround development of Yoga and Naturopathy independently according to their own doctrines and fundamental principles.^{[citation needed]}

"National Institute of Naturopathy" - Department of AYUSH, Ministry of Health & Family Welfare, Government of India: The National Institute of Naturopathy, Pune came into existence on 22 December 1986. It encourages facilities for standardization and propagation of the existing knowledge and its application through research in Naturopathy throughout India. This Institute has a “Governing Body” headed by Union Minister for Health as its President.^{[citation needed]}

North America

In five Canadian provinces, fifteen US states and the District of Columbia, naturopathic doctors who are trained at an accredited school of naturopathic medicine in North America, are entitled to use the designation ND or NMD. Elsewhere, the designations "naturopath", "naturopathic doctor", and "doctor of natural medicine" are generally unprotected.^[13]

In North America, each jurisdiction that regulates naturopathy defines a local scope of practice for naturopathic doctors that can vary considerably. Some regions permit minor surgery, access to prescription drugs, spinal manipulations, obstetrics and gynecology and other regions exclude these from the naturopathic scope of practice.^[50]

Canada

Canadian provinces which license naturopathic doctors: British Columbia, Manitoba,Ontario, Saskatchewan and Nova Scotia.^[51] British Columbia has regulated naturopathic medicine since 1936 and is the only Canadian province that allows certified ND's to prescribe pharmaceuticals and perform minor surgeries.^[52]

United States

US jurisdictions that currently regulate or license naturopathy include: Alaska, Arizona,California, Connecticut, District of Columbia, Hawaii, Idaho, Kansas,Maine, Minnesota, Montana, Vermont, New Hampshire, Oregon, Puerto Rico,^[53] US Virgin Islands, Utah, Washington.^[40] Additionally,Florida and Virgina license the practice of naturopathy under a grandfather clause.^[54]

US jurisdictions that permit access to prescription drugs: Arizona, California,District of Columbia, Idaho, Kansas, Maine, Montana, Vermont, New Hampshire, Oregon, Utah, and Washington.
US jurisdictions that permit minor surgery: Arizona, District of Columbia, Idaho,Kansas, Maine, Montana, Oregon, Vermont, Utah, and Washington.

US states which specifically prohibit the practice of naturopathy: South Carolina,^[55]^[54] and Tennessee.^[56]^[54]

United Kingdom

In the United Kingdom, as there is no government sponsored regulation of the naturopathy profession, naturopaths are unregulated. The largest registering body, The General Council & Register of Naturopaths, recognises three courses in the UK, two being taught at osteopathic schools: the British College of Osteopathic Medicine; The College of Osteopaths Educational Trust; and one at the University of Westminster School of Integrated Health under the auspices of the BSc Health Science (Naturopathy) course.^{[citation needed]} These organisations are not recognized by the UK regulatory frameworks.

Members of this register will either have completed a three or four year full time course or possibly be a healthcare professional who has completed a two year post-graduate Naturopathic Diploma (ND).

Alternatively, there are the Association of Naturopathic Practitioners and The British Naturopathic Association whose members can practice and get indemnity insurance.^{[citation needed]}

Criticism

This section requires expansion.

Naturopathy is viewed with skepticism for its reliance on or association with unproven, disproven, and controversial alternative medical treatments, and for its vitalistic underpinnings.^[44] As with any alternative care, there is a risk of misdiagnosis; this risk may be lower depending on level of training.^[1]^[4] There is also a risk that ailments that cannot be diagnosed by naturopaths will go untreated while a patient attempts treatment programs designed by their naturopath. Certain naturopathic treatments, such as homeopathy and iridology, are widely considered pseudoscience or quackery.^[57]^[58]^[59] Natural methods and chemicals are not necessarily safer or more effective than artificial or synthetic ones; any treatment capable of eliciting an effect may also have deleterious side effects.^[3]^[5]^[60]^[61]

Naturopathic doctors are not mandated to undergo residency between graduation and commencing practice,^[5] except in the state of Utah.^[62]

Stephen Barrett (of Quackwatch and the National Council Against Health Fraud) has stated that the philosophy of naturopathy is "simplistic and that its practices are riddled with quackery."^[3]

K. C. Atwood writes, in the journal Medscape General Medicine, "'Naturopathic physicians' now claim to be primary care physicians proficient in the practice of both "conventional" and "natural" medicine. Their training, however, amounts to a small fraction of that of medical doctors who practice primary care. An examination of their literature, moreover, reveals that it is replete with pseudoscientific, ineffective, unethical, and potentially dangerous practices."^[10]

According to Arnold S. Relman, the Textbook of Natural Medicine is inadequate as a teaching tool, as it omits to mention or treat in detail many common ailments, improperly emphasizes treatments "not likely to be effective" over those that are, and promotes unproven herbal remedies at the expense of pharamceuticals. He concludes that "the risks to many sick patients seeking care from the average naturopathic practitioner would far outweigh any possible benefits."^[63]

Homeopathy

2009-04-20T18:22:00.004-07:00

From Wikipedia, the free encyclopedia

A homeopathic remedy prepared from marsh Labrador tea, diluted to the point where it almost certainly contains no molecules of the original herb.

Homeopathy is a form of alternative medicine that treats a disease with heavily diluted preparations created from substances that would ordinarily cause effects similar to the disease's symptoms. As first expounded by German physician, Samuel Hahnemann, in 1796, homeopathic preparations are serially diluted, with shaking ("succussing") after each step, under the belief that this increases the effect of the treatment. This dilution often continues until no molecules of the original substance remain.^[1]

Apart from the symptoms of the disease, homeopaths may use aspects of the patient's physical and psychological state to select between remedies.^[2] Homeopathic reference books known as repertories are then consulted, and a remedy is selected based on the index of symptoms. Homeopathic remedies are generally considered safe, with rare exceptions.^[3]^[4] However, homeopaths have been criticized for putting patients at risk with advice to avoid conventional medicine, such as vaccinations,^[5] anti-malarial drugs,^[6] and antibiotics.^[7] In many countries, the laws that govern the regulation and testing of conventional drugs do not apply to homeopathic remedies.^[8]

Claims of homeopathy's efficacy (beyond the placebo effect) are unsupported by the collective weight of scientific and clinical evidence.^[9]^[10]^[11]^[12]^[13] Specific pharmacological effect with no active molecules is scientifically implausible^[14]^[15] and violates fundamental principles of science,^[16] including the law of mass action.^[16] Supporters claim that studies published in reputable journals support the efficacy of homeopathy; however, there are only a handful of them, they are not definitive and they have not been replicated.^[17] Several high-quality studies exist showing no evidence for any effect from homeopathy, and studies of homeopathic remedies have generally been shown to have problems that prevent them from being considered unambiguous evidence for homeopathy's efficacy.^[9]^[11]^[12]^[18]^[19] The lack of convincing scientific evidence supporting homeopathy's efficacy^[13] and its use of remedies lacking active ingredients have caused homeopathy to be described as pseudoscience^[20] and quackery.^[21]^[22]^[23]

General philosophy

Homeopathy is a vitalist philosophy in that it interprets diseases and sickness as caused by disturbances in a hypothetical vital force or life force and sees these disturbances as manifesting themselves in unique symptoms. Homeopathy maintains that the vital force has the ability to react and adapt to internal and external causes, which homeopaths refer to as the "law of susceptibility". The law of susceptibility states that a negative state of mind can attract hypothetical disease entities called "miasms" to invade the body and produce symptoms of diseases.^[24] However, Hahnemann rejected the notion of a disease as a separate thing or invading entity and insisted that it was always part of the "living whole".^[25]

Law of similars

Hahnemann observed from his experiments with cinchona bark, used as a treatment for malaria, that the effects he experienced from ingesting the bark were similar to the symptoms of malaria. He therefore reasoned that cure proceeds through similarity, and that treatments must be able to produce symptoms in healthy individuals similar to those of the disease being treated. Through further experiments with other substances, Hahnemann conceived of the "law of similars", otherwise known as "like cures like" (Latin: similia similibus curentur) as a fundamental healing principle. He believed that by inducing a disease through use of drugs, the artificial symptoms empowered the vital force to neutralise and expel the original disease and that this artificial disturbance would naturally subside when the dosing ceased.^[24]

Miasms and disease

Hahnemann found as early as 1816 that the patients he treated through homeopathy still suffered from chronic diseases that he was unable to cure.^[26] In 1828, he introduced the concept of miasms, which he regarded as underlying causes for many known diseases.^[27] A miasm is often defined by homeopaths as an imputed "peculiar morbid derangement of [the] vital force".^[28] Hahnemann associated each miasm with specific diseases, with each miasm seen as the root cause of several diseases. According to Hahnemann, initial exposure to miasms causes local symptoms, such as skin or venereal diseases, but if these symptoms are suppressed by medication, the cause goes deeper and begins to manifest itself as diseases of the internal organs.^[29] Homeopathy maintains that treating diseases by directly opposing their symptoms, as is sometimes done in conventional medicine, is ineffective because all "disease can generally be traced to some latent, deep-seated, underlying chronic, or inherited tendency".^[30] The underlying imputed miasm still remains, and deep-seated ailments can only be corrected by removing the deeper disturbance of the vital force.^[31]

Hahnemann's miasm theory remains disputed and controversial within homeopathy even in modern times. In 1978, Anthony Campbell, then a consultant physician at The Royal London Homeopathic Hospital, criticised statements by George Vithoulkas claiming that syphilis, when treated with antibiotics, would develop into secondary and tertiary syphilis with involvement of the central nervous system. This conflicts with scientific studies, which indicate that penicillin treatment produces a complete cure of syphilis in more than 90% of cases.^[32] Campbell described this as "a thoroughly irresponsible statement which could mislead an unfortunate layman into refusing orthodox treatment".^[7]

Originally Hahnemann presented only three miasms, of which the most important was "psora" (Greek for itch), described as being related to any itching diseases of the skin, supposed to be derived from suppressed scabies, and claimed to be the foundation of many further disease conditions. Hahnemann believed psora to be the cause of such diseases as epilepsy, cancer, jaundice, deafness, and cataracts.^[27] Since Hahnemann's time, other miasms have been proposed, some replacing one or more of psora's proposed functions, including tubercular miasms and cancer miasms.^[29]

Preparation of remedies

Mortar and pestle used for grinding insoluble solids into homeopathic remedies including quartz and oyster shells.

Dilution and succussion

Main article: Homeopathic dilutions

In producing treatments for diseases, homeopaths use a process called "dynamisation" or "potentisation" whereby the remedy is diluted with alcohol or distilled water and then vigorously shaken by ten hard strikes against an elastic body in a process called "succussion". While Hahnemann advocated remedies which present symptoms similar to those of the disease he believed concentrated doses would only intensify the symptoms and exacerbate the condition, hence the dilution of the remedies. During the process of potentisation, homeopaths believe that the vital energy of the diluted substance is activated and its energy released by vigorous shaking of the substance. For this purpose, Hahnemann had a saddle maker construct a special wooden striking board covered in leather on one side and stuffed with horsehair.^[33]^[34] Insoluble solids, such as quartz and oyster shell, are diluted by grinding them with lactose (trituration).

Three potency scales are in regular use in homeopathy. Hahnemann created the centesimal or "C scale", diluting a substance by a factor of 100 at each stage. The centesimal scale was favored by Hahnemann for most of his life. A 2C dilution requires a substance to be diluted to one part in one hundred, and then some of that diluted solution diluted by a further factor of one hundred. This works out to one part of the original solution mixed into 9,999 parts (100 × 100 −1) of the diluent.^[35] A 6C dilution repeats this process six times, ending up with the original material diluted by a factor of 100^-6=10^-12. Higher dilutions follow the same pattern. In homeopathy, a solution that is more dilute is described as having a higher potency, and more dilute substances are considered by homeopaths to be stronger and deeper-acting remedies.^[36] The end product is often so diluted that it is indistinguishable from the dilutant (pure water, sugar or alcohol).^[1]^[37]^[38]

X Scale	C Scale	Ratio	Note
1X	—	1:10	described as low potency
2X	1C	1:100	called higher potency than 1X by homeopaths
6X	3C	10^-6
8X	4C	10^-8	allowable concentration of arsenic in U.S. drinking water^[39]
12X	6C	10^-12
24X	12C	10^-24	Has a 60% probability of containing one molecule of original material if one mole of the original substance was used.
60X	30C	10^-60	Dilution advocated by Hahnemann for most purposes: this would require giving two billion doses per second to six billion people for 4 billion years to deliver a single molecule of the original material to any patient.
400X	200C	10^-400	Dilution of popular homeopathic flu remedy Oscillococcinum
Note: the "X scale" is also called "D scale". 1X = 1D, 2X = 2D, etc.

Hahnemann advocated 30C dilutions for most purposes (that is, dilution by a factor of 10⁶⁰).^[40] A popular homeopathic treatment for the flu is a 200C dilution of duck liver, marketed under the name Oscillococcinum.

This bottle contains arnica montana (wolf's bane) D6, i.e. the nominal dilution is one part in a million (10⁶).

Some homeopaths developed a decimal scale (D or X), diluting the substance to ten times its original volume each stage. The D or X scale dilution is therefore half that of the same value of the C scale; for example, "12X" is the same level of dilution as "6C". Hahnemann never used this scale but it was very popular throughout the 19th century and still is in Europe. This potency scale appears to have been introduced in the 1830s by the American homeopath, Constantine Hering.^[41] In the last ten years of his life, Hahnemann also developed a quintamillesimal (Q) or LM scale diluting the drug 1 part in 50,000 parts of diluent.^[42] A given dilution on the Q scale is roughly 2.35 times its designation on the C scale. For example a remedy described as "20Q" has about the same concentration as a "47C" remedy.^[43]

Dilution debate

Critics and advocates of homeopathy alike commonly attempt to illustrate the dilutions involved in homeopathy with metaphors.^[44] Hahnemann is reported to have joked that a suitable procedure to deal with an epidemic would be to empty a bottle of poison into Lake Geneva, if it could be succussed 60 times.^[45]^[46]^[47] Another example given by a critic of homeopathy states that a 12C solution is equivalent to a "pinch of salt in both the North and South Atlantic Oceans",^[45]^[46] which is approximately correct.^[48] One third of a drop of some original substance diluted into all the water on earth would produce a remedy with a concentration of about 13C.^[49]^[44]^[50]

Not all homeopaths advocate extremely high dilutions. Many of the early homeopaths were originally doctors and generally tended to use lower dilutions such as "3X" or "6X", rarely going beyond "12X". The split between lower and higher dilutions followed ideological lines with the former stressing pathology and a strong link to conventional medicine, while the latter emphasised vital force, miasms and a spiritual interpretation of disease.^[51]^[52] Some products with such relatively lower dilutions continue to be sold, but like their counterparts, they have not been conclusively demonstrated to have any effect beyond the placebo.^[53] ^[54]

Scientific tests run by both the BBC's Horizon and ABC's 20/20 programs were unable to differentiate homeopathic dilutions from water, even when using tests suggested by homeopaths themselves.^[34]^[55]

Provings

In order to determine which specific remedies could be used to treat which diseases, Hahnemann experimented on himself and others for several years before using remedies on patients. His experiments did not initially consist of giving remedies to the sick, because he thought that the most similar remedy, by virtue of its ability to induce symptoms similar to the disease itself, would make it impossible to determine which symptoms came from the remedy and which from the disease itself. Therefore, sick people were excluded from these experiments. The method used for determining which remedies were suitable for specific diseases was called "proving", after the original German word "Prüfung", meaning "test". A homeopathic proving is the method by which the profile of a homeopathic remedy is determined.^[56]

At first Hahnemann used material doses for provings, but he later advocated proving with remedies at a 30C dilution,^[40] and most modern provings are carried out using ultradilute remedies in which it is highly unlikely that any of the original molecules remain.^[57] During the proving process, Hahnemann administered remedies to healthy volunteers, and the resulting symptoms were compiled by observers into a "Drug Picture". The volunteers were observed for months at a time and made to keep extensive journals detailing all of their symptoms at specific times throughout the day. They were forbidden from consuming coffee, tea, spices, or wine for the duration of the experiment; playing chess was also prohibited because Hahnemann considered it to be "too exciting", though they were allowed to drink beer and encouraged to exercise in moderation. After the experiments were over, Hahnemann made the volunteers take an oath swearing that what they reported in their journals was the truth, at which time he would interrogate them extensively concerning their symptoms.

Provings have been described as important in the development of the clinical trial, due to their early use of simple control groups, systematic and quantitative procedures, and some of the first application of statistics in medicine.^[58] The lengthy records of self-experimentation by homeopaths have occasionally proven useful in the development of modern drugs: For example, evidence nitroglycerin might be useful as a treatment for angina was discovered by looking through homeopathic provings, though homeopaths themselves never used it for that purpose at that time.^[59] The first recorded provings were published by Hahnemann in his 1796 Essay on a new principle.^[60] His Fragmenta de viribus (1805)^[61] contained the results of 27 provings, and his 1810 Materia Medica Pura contained 65.^[62] For James Tyler Kent's 1905 Lectures on Homoeopathic Materia Medica, 217 remedies underwent provings and newer substances are continually added to contemporary versions.

Repertory

Homeopathic repertory by James Tyler Kent.

Homeopaths generally begin with detailed examinations of their patients' histories, including questions regarding their physical, mental and emotional states, their life circumstances and any physical or emotional illnesses. The homeopath then attempts to translate this information into a complex formula of mental and physical symptoms, including likes, dislikes, innate predispositions and even body type.^[63]

From these symptoms, the homeopath chooses how to treat the patient. A compilation of reports of many homeopathic provings, supplemented with clinical data, is known as a homeopathic materia medica. But because a practitioner first needs to explore the remedies for a particular symptom rather than looking up the symptoms for a particular remedy, the homeopathic repertory, which is an index of symptoms, lists after each symptom those remedies that are associated with it. Repertories are often very extensive and may include data extracted from multiple sources of materia medica. There is often lively debate among compilers of repertories and practitioners over the veracity of a particular inclusion.

The first symptomatic index of the homeopathic materia medica was arranged by Hahnemann. Soon after, one of his students Clemens von Bönninghausen, created the Therapeutic pocket book, another homeopathic repertory.^[64] The first such homeopathic repertory was Georg Jahr's Symptomenkodex, published in German (1835), which was then first translated to English (1838) by Constantine Hering as the Repertory to the more Characteristic Symptoms of Materia Medica. This version was less focused on disease categories and would be the forerunner to Kent's later works.^[65]^[66] It consisted of three large volumes. Such repertories increased in size and detail as time progressed.

Some diversity in approaches to treatments exists among homeopaths. "Classical" homeopathy generally involves detailed examinations of a patient's history and infrequent doses of a single remedy as the patient is monitored for improvements in symptoms, while "clinical" homeopathy involves combinations of remedies to address the various symptoms of an illness.^[67]

Treatments

Remedies

Homeopathic remedy Rhus toxicodendron, derived from poison ivy.

Homeopathic remedy Oscillococcinum

"Remedy" is a technical term used in homeopathy to refer to a substance prepared with a particular procedure and intended for treating patients. Homeopathic practitioners rely on two types of reference when prescribing remedies: Materia medica and repertories. A homeopathic Materia medica is a collection of "drug pictures", organised alphabetically by remedy, that describes the symptom patterns associated with individual remedies. A homeopathic repertory is an index of disease symptoms that lists remedies associated with specific symptoms.^[68]

Homeopathy uses many animal, plant, mineral, and synthetic substances in its remedies. Examples include Arsenicum album (arsenic oxide), Natrum muriaticum (sodium chloride or table salt), Lachesis muta (the venom of the bushmaster snake), Opium, and Thyroidinum (thyroid hormone). Homeopaths also use treatments called nosodes (from the Greek nosos, disease) made from diseased or pathological products such as fecal, urinary, and respiratory discharges, blood, and tissue.^[66] Homeopathic remedies prepared from healthy specimens are called Sarcodes.

Some modern homeopaths have considered more esoteric substances, known as "imponderables" because they do not originate from a material but from electromagnetic energy presumed to have been "captured" by alcohol or lactose. Examples include X-rays^[69] and sunlight.^[70] Recent ventures by homeopaths into even more esoteric substances include thunderstorms (prepared from collected rainwater).^[71] Today there are about 3,000 different remedies commonly used in homeopathy.^[72] Some homeopaths also use techniques that are regarded by other practitioners as controversial. These include paper remedies, where the substance and dilution are written on a piece of paper and either pinned to the patient's clothing, put in their pocket, or placed under a glass of water that is then given to the patient, as well as the use of radionics to prepare remedies. Such practices have been strongly criticised by classical homeopaths as unfounded, speculative and verging upon magic and superstition.^[73]^[74]

Isopathy

Isopathy is a therapy derived from homeopathy and was invented by Johann Joseph Wilhelm Lux in the 1830s.^[66] Isopathy differs from homeopathy in general in that the remedies are made up either from things that cause the disease, or from products of the disease, such as pus. Many so-called "homeopathic vaccines" are a form of isopathy.^[75]

Flower remedies

Flower remedies can be produced by placing flowers in water and exposing them to sunlight. The most famous of these are the Bach flower remedies, which were developed by the homeopath Edward Bach. The relationship between these remedies and homeopathy is controversial. On the one hand, the proponents of these remedies share homeopathy's vitalist world-view and the remedies are claimed to act through the same hypothetical "vital force". However, although many of the same plants are used as in homeopathy, the method of preparation is somewhat different, with Bach flower therapies supposedly being prepared in "gentler" ways, such as placing flowers in bowls of sunlit water, and so on.^[76] There is no convincing scientific or clinical evidence for flower remedies being effective.^[77]

Veterinary use

The idea of using homeopathy as a treatment for other animals, termed veterinary homeopathy, dates back to the inception of homeopathy; Hahnemann himself wrote and spoke of the use of homeopathy in animals other than humans.^[78] The FDA has not approved homeopathic products as veterinary medicine in the U.S. In the UK, veterinary surgeons who use homeopathy belong to the Faculty of Homeopathy and/or to the British Association of Homeopathic Veterinary Surgeons. Animals may only be treated by qualified veterinary surgeons in the UK and some other countries. Internationally, the body that supports and represents homeopathic veterinarians is the International Association for Veterinary Homeopathy. The use of homeopathy in veterinary medicine is controversial, as there has been little scientific investigation and current research in the field is not of a high enough standard to provide reliable data.^[79] Other studies have also found that giving animals placebos can play active roles in influencing pet owners to believe in the effectiveness of the treatment when none exists.^[79]

Medical and scientific analysis

Homeopathy is unsupported by modern scientific research. The extreme dilutions used in homeopathic preparations usually leave none of the original material in the final product.^[80]^[81] Pharmacological effect without active ingredients is inconsistent with the observed dose-response relationships of conventional drugs,^[82] leaving only non-specific placebo effects^[10]^[83]^[84] or various novel explanations. The proposed rationale for these extreme dilutions – that the water contains the "memory" or "vibration" from the diluted ingredient – is counter to the laws of chemistry and physics.^[80] The lack of convincing scientific evidence supporting its efficacy^[13] and its use of remedies without active ingredients have led to characterizations as pseudoscience and quackery,^[20]^[21]^[22]^[85] or, in the words of a 1998 medical review, "placebo therapy at best and quackery at worst."^[23] Use of homeopathy may delay or replace effective medical treatment, worsening outcomes or exposing the patients to increased risk.^[5]^[7]^[12]^[86]

High dilutions

The extremely high dilutions in homeopathy have been a main point of criticism. Homeopaths believe that the methodical dilution of a substance, beginning with a 10% or lower solution and working downwards, with shaking after each dilution, produces a therapeutically active "remedy", in contrast to therapeutically inert water. However, homeopathic remedies are usually diluted to the point where there are no molecules from the original solution left in a dose of the final remedy.^[81] Since even the longest-lived noncovalent structures in liquid water at room temperature are only stable for a few picoseconds,^[87] critics have concluded that any effect that might have been present from the original substance can no longer exist.^[88] No evidence of stable clusters of water molecules was found when homeopathic remedies were studied using NMR.^[89]

Furthermore, since water will have been in contact with millions of different substances throughout its history, critics point out that any glass of water is therefore an extreme dilution of almost any conceivable substance, and so by drinking water one would, according to homeopathic principles, receive treatment for every imaginable condition.^[90]

Practitioners of homeopathy contend that higher dilutions (fewer potential molecules in each dose) result in stronger medicinal effects. This idea is inconsistent with the observed dose-response relationships of conventional drugs, where the effects are dependent on the concentration of the active ingredient in the body.^[82] This dose-response relationship has been confirmed in multitudinous experiments on organisms as diverse as nematodes,^[91] rats,^[92] and humans.^[93]

Physicist Robert L. Park, former executive director of the American Physical Society, has noted that

“

since the least amount of a substance in a solution is one molecule, a 30C solution would have to have at least one molecule of the original substance dissolved in a minimum of 1,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000 molecules of water. This would require a container more than 30,000,000,000 times the size of the Earth.^[94]

”

Park has also noted that "to expect to get even one molecule of the 'medicinal' substance allegedly present in 30X pills, it would be necessary to take some two billion of them, which would total about a thousand tons of lactose plus whatever impurities the lactose contained". The laws of chemistry state that there is a limit to the dilution that can be made without losing the original substance altogether.^[15] This limit, which is related to Avogadro's number, is roughly equal to homeopathic potencies of 12C or 24X (1 part in 10²⁴).^[44]^[83]^[95]

Research on medical effectiveness

Old bottle of Hepar sulph made from calcium sulfide

The effectiveness of homeopathy has been in dispute since its inception. The methodological quality of the research base is generally low, with such problems as weaknesses in design or reporting, small sample size, and selection bias. No individual preparation has been unambiguously demonstrated to be different from a placebo.^[9]^[96]

Positive results have been reported, but no single model has been sufficiently widely replicated. Local models proposed are far from convincing, and the nonlocal models proposed, often invoking "weak quantum theory",^[97] would predict that it is impossible to nail down homeopathic effects with direct experimental testing.^[98] For example, while some reports presented data that suggested homeopathic treatment of allergy was more effective than placebo,^[99]^[100] subsequent studies have questioned the conclusions.^[101]^[102] One of the earliest double blind studies concerning homeopathy was sponsored by the British government during World War II in which volunteers tested the effectiveness of homeopathic remedies against diluted mustard gas burns.^[103]

Meta-analyses, in which large groups of studies are analysed and conclusions drawn based on the results as a whole, have been used to evaluate the effectiveness of homeopathy. Early meta-analyses investigating homeopathic remedies showed slightly positive results among the studies examined, but such studies have warned that it was impossible to draw firm conclusions due to low methodological quality and difficulty in controlling for publication bias in the studies reviewed.^[19]^[104]^[105] One of the positive meta-analyses, by Linde, et al.,^[105] was later corrected by the authors, who wrote:

The evidence of bias [in homeopathic trials] weakens the findings of our original meta-analysis. Since we completed our literature search in 1995, a considerable number of new homeopathy trials have been published. The fact that a number of the new high-quality trials... have negative results, and a recent update of our review for the most “original” subtype of homeopathy (classical or individualized homeopathy), seem to confirm the finding that more rigorous trials have less-promising results. It seems, therefore, likely that our meta-analysis at least overestimated the effects of homeopathic treatments.^[14]^[18]

In 2001, a meta-analysis of clinical trials on the effectiveness of homeopathy concluded that earlier clinical trials showed signs of major weakness in methodology and reporting, and that homeopathy trials were less randomized and reported less on dropouts than other types of trials.^[19]

In 2005, a systematic review of the representation of homeopathy in the medical literature suggested that mainstream journals had a publication bias against clinical trials of homeopathy that showed positive results, and the opposite was the case for complementary and alternative medicine journals. The authors suggested that this could be due to an involuntary bias, or otherwise a submission bias, in which positive trials tend to be sent to CAM journals and negatives ones to mainstream journals.^[106] Reviews in all journals approached the subject in an apparently impartial manner, though most of the reviews published in CAM journals made no mention of the plausibility of homeopathy, whereas 9 out of 10 reviews in mainstream journals mentioned a lack of plausability of homeopathy in the introduction.^[106]

In 2005, The Lancet medical journal published a meta-analysis of 110 placebo-controlled homeopathy trials and 110 matched medical trials based upon the Swiss government's Program for Evaluating Complementary Medicine, or PEK. The study concluded that its findings were compatible with the notion that the clinical effects of homeopathy are nothing more than placebo effects.^[14]

A 2006 meta-analysis of six trials evaluating homeopathic treatments to reduce cancer therapy side effects following radiotherapy and chemotherapy found "encouraging but not convincing" evidence in support of homeopathic treatment. Their analysis concluded that there was "insufficient evidence to support clinical efficacy of homeopathic therapy in cancer care".^[107]

A 2007 systematic review of homeopathy for children and adolescents found that the evidence for attention-deficit hyperactivity disorder and childhood diarrhea was mixed. No difference from placebo was found for adenoid vegetation, asthma, or upper respiratory tract infection. Evidence was not sufficient to recommend any therapeutic or preventative intervention.^[12]

The Cochrane Library found insufficient clinical evidence to evaluate the efficacy of homeopathic treatments for asthma^[108] or dementia,^[109] or for the use of homeopathy in induction of labor.^[110] Other researchers found no evidence that homeopathy is beneficial for osteoarthritis,^[111] migraines^[112] or delayed-onset muscle soreness.^[67]

Health organisations such as the UK's National Health Service,^[113] the American Medical Association,^[11] and the FASEB^[88] have issued statements of their conclusion that there is no convincing scientific evidence to support the use of homeopathic treatments in medicine.

Clinical studies of the medical efficacy of homeopathy have been criticised by some homeopaths as being irrelevant because they do not test "classical homeopathy".^[114]^[115] There have, however, been a number of clinical trials that have tested individualized homeopathy. A 1998 review^[116] found 32 trials that met their inclusion criteria, 19 of which were placebo-controlled and provided enough data for meta-analysis. These 19 studies showed a pooled odds ratio of 1.17 to 2.23 in favor of individualized homeopathy over the placebo, but no difference was seen when the analysis was restricted to the methodologically best trials. The authors concluded "that the results of the available randomized trials suggest that individualized homeopathy has an effect over placebo. The evidence, however, is not convincing because of methodological shortcomings and inconsistencies."

Jack Killen, acting deputy director of the National Center for Complementary and Alternative Medicine, says homeopathy "goes beyond current understanding of chemistry and physics." He adds: "There is, to my knowledge, no condition for which homeopathy has been proven to be an effective treatment."^[13]

Research on effects in other biological systems

Old homeopathic belladonna remedy.

While some articles have suggested that homeopathic solutions of high dilution can have statistically significant effects on organic processes including the growth of grain,^[117] histamine release by leukocytes,^[118] and enzyme reactions, such evidence is disputed since attempts to replicate them have failed.^[119]^[120]^[121]^[122]^[123]

In 1987, French immunologist Jacques Benveniste submitted a paper to the journal Nature while working at INSERM. The paper purported to have discovered that basophils, a type of white blood cell, released histamine when exposed to a homeopathic dilution of anti-immunoglobulin E antibody. The journal editors, sceptical of the results, requested that the study be replicated in a separate laboratory. Upon replication in four separate laboratories the study was published. Still sceptical of the findings, Nature assembled an independent investigative team to determine the accuracy of the research, consisting of Nature editor and physicist Sir John Maddox, American scientific fraud investigator and chemist Walter Stewart, and sceptic and magician James Randi. After investigating the findings and methodology of the experiment, the team found that the experiments were "statistically ill-controlled", "interpretation has been clouded by the exclusion of measurements in conflict with the claim", and concluded, "We believe that experimental data have been uncritically assessed and their imperfections inadequately reported."^[124]^[125]^[126] James Randi stated that he doubted that there had been any conscious fraud, but that the researchers had allowed "wishful thinking" to influence their interpretation of the data.^[125]

Ethical and safety issues

As homeopathic remedies usually contain only water and/or alcohol, they are thought to be generally safe. Only in rare cases are the original ingredients present at detectable levels. This may be due to improper preparation or intentional low dilution. Instances of arsenic poisoning have occurred after use of arsenic-containing homeopathic preparations.^[3] Zicam Nasal Spray, which contains 2X (1:100) zinc gluconate, reportedly caused a small percentage of users to lose their sense of smell;^[127] 340 cases were settled out of court in 2006 for 12 million U.S. dollars.^[4]^[128]

Critics of homeopathy have cited other concerns over homeopathic remedies, most seriously, cases of patients of homeopathy failing to receive proper treatment for diseases that it is claimed could have been diagnosed or cured with conventional medicine. Several surveys demonstrate that some (particularly non-physician) homeopaths advise their patients against immunisation.^[5]^[129]^[130] Some homeopaths suggest that vaccines be replaced with homeopathically diluted "nosodes", created from dilutions of biological agents – including material such as vomit, feces or infected human tissues. While Hahnemann was opposed to such preparations, modern homeopaths often use them although there is no evidence to indicate they have any beneficial effects.^[131]^[132] Cases of homeopaths advising against the use of anti-malarial drugs have been identified.^[6]^[133]^[134] This puts visitors to the tropics who take this advice in severe danger, since homeopathic remedies are completely ineffective against the malaria parasite.^[6]^[133]^[134] Also, in one case in 2004, a homeopath instructed one of her patients to stop taking conventional medication for a heart condition, advising her on 22 June 2004 to "Stop ALL medications including homeopathic", advising her on or around 20 August that she no longer needed to take her heart medication, and adding on 23 August, "She just cannot take ANY drugs – I have suggested some homeopathic remedies ... I feel confident that if she follows the advice she will regain her health." The patient was admitted to hospital the next day, and died eight days later, the final diagnosis being "acute heart failure due to treatment discontinuation".^[135]^[136]

In 1978, Anthony Campbell, then a consultant physician at The Royal London Homeopathic Hospital, criticised statements made by George Vithoulkas to promote his homeopathic treatments. Vithoulkas stated that syphilis, when treated with antibiotics, would develop into secondary and tertiary syphilis with involvement of the central nervous system. Campbell described this as a thoroughly irresponsible statement which could mislead an unfortunate layman into refusing conventional medical treatment.^[7] This claim echoes the idea that treating a disease with external medication used to treat the symptoms would only drive it deeper into the body and conflicts with scientific studies, which indicate that penicillin treatment produces a complete cure of syphilis in more than 90% of cases.^[32]

A 2006 review by W. Steven Pray of the College of Pharmacy at Southwestern Oklahoma State University recommends that pharmacy colleges include a required course in unproven medications and therapies, that ethical dilemmas inherent in recommending products lacking proven safety and efficacy data be discussed, and that students should be taught where unproven systems such as homeopathy depart from evidence-based medicine.^[137]

Edzard Ernst, the first Professor of Complementary Medicine in the United Kingdom, has expressed his concerns about pharmacists who violate their ethical code by failing to provide customers with "necessary and relevant information" about the true nature of the homeopathic products they advertise and sell:

"My plea is simply for honesty. Let people buy what they want, but tell them the truth about what they are buying. These treatments are biologically implausible and the clinical tests have shown they don't do anything at all in human beings. The argument that this information is not relevant or important for customers is quite simply ridiculous."^[138]

Regulation and prevalence

Main article: Regulation and prevalence of homeopathy

Hampton House, the former site of Bristol Homeopathic Hospital, one of a handful of homeopathic hospitals run by the NHS.

Homeopathy is fairly common in some countries while being uncommon in others; is highly regulated in some countries and mostly unregulated in others. It is practised worldwide and professional qualifications and licenses are needed in most countries.^[8] Regulations vary in Europe depending on the country. In some countries, there are no specific legal regulations concerning the use of homeopathy, while in others, licenses or degrees in conventional medicine from accredited universities are required. In Germany, no specific regulations exist, while France, Austria and Denmark mandate licenses to diagnose any illness or dispense of any product whose purpose is to treat any illness.^[8] Some homeopathic treatment is covered by the public health service of several European countries, including France, the United Kingdom, Denmark, and Luxembourg. In other countries, such as Belgium, homeopathy is not covered. In Austria, the public health service requires scientific proof of effectiveness in order to reimburse medical treatments and homeopathy is listed as not reimbursable^[139] but exceptions can be made; private health insurance policies sometimes include homeopathic treatment.^[8]^[140] The Swiss government, after a 5-year trial, withdrew homeopathy and four other complementary treatments in 2005, stating that they did not meet efficacy and cost-effectiveness criteria.^[141]

History

1857 painting by Alexander Beydeman showing historical figures and personifications of homeopathy observing the perceived brutality of medicine of the 19th century

Historical context

In the 16th century the pioneer of chemical medicine Paracelsus declared that small doses of “what makes a man ill also cures him", anticipating homeopathy,^[142] but it was Hahnemann who gave it a name and laid out its principles in the late 18th century. At that time, mainstream medicine employed such measures as bloodletting and purging, used laxatives and enemas, and administered complex mixtures, such as Venice treacle, which was made from 64 substances including opium, myrrh, and viper's flesh.^[143]^[144] Such measures often worsened symptoms and sometimes proved fatal.^[145]^[146] While the virtues of these treatments had been extolled for centuries,^[147] Hahnemann rejected such methods as irrational and inadvisable.^[148] Instead, he favored the use of single drugs at lower doses and promoted an immaterial, vitalistic view of how living organisms function, believing that diseases have spiritual, as well as physical causes.^[25]^[149] (At the time, vitalism was part of mainstream science; in the 20th century, however, medicine discarded vitalism, with the development of microbiology, the germ theory of disease,^[150] and advances in chemistry.^[151]^[152]) Hahnemann also advocated various lifestyle improvements to his patients, including exercise, diet, and cleanliness.^[148]^[153]

Hahnemann's concept

Rise to popularity and early criticism

Homeopathy achieved its greatest popularity in the 19th century. In 1830, the first homeopathic schools opened, and throughout the 19th century dozens of homeopathic institutions appeared in Europe and the United States.^[159] By 1900, there were 22 homeopathic colleges and 15,000 practitioners in the United States.^[17] Because of then-current medicine's reliance on unscientific blood-letting and other untested, often dangerous treatments, patients of homeopaths often had better outcomes than those of the doctors of the time.^[160] Homeopathic remedies, even if ineffective, would almost surely cause no harm, making the users of homeopathic remedies less likely to be killed by the treatment that was supposed to be helping them.^[24] The relative success of homeopathy in the 19th century may have led to the abandonment of the ineffective and harmful treatments of bloodletting and purging and to have begun the move towards more effective, science based medicine.^[146] One reason for the growing popularity of homeopathy was its apparent success in treating people suffering from infectious disease epidemics.^[161] During 19th century epidemics of diseases such as cholera, death rates in homeopathic hospitals were often lower than in conventional hospitals, where the treatments used at the time were often harmful and did little or nothing to combat the diseases.^[162]

From its inception, however, homeopathy was criticized by mainstream science. Sir John Forbes, physician to Queen Victoria, said the extremely small doses of homeopathy were regularly derided as useless, "an outrage to human reason".^[163] James Young Simpson said of the highly diluted drugs: "No poison, however strong or powerful, the billionth or decillionth of which would in the least degree affect a man or harm a fly."^[164] 19th century American physician and author Oliver Wendell Holmes, Sr. was also a vocal critic of homeopathy and published an essay in 1842 entitled Homœopathy, and its kindred delusions.^[165] The members of the French Homeopathic Society observed in 1867 that some of the leading homeopathists of Europe were not only abandoning the practice of administering infinitesimal doses, but were also no longer defending it.^[166] The last school in the U.S. exclusively teaching homeopathy closed in 1920.^[24]

Revival in the late 20th Century

Main article: Regulation and prevalence of homeopathy

The Food, Drug, and Cosmetic Act (sponsored by New York Senator, and Homeopathic Physician Royal Copeland) of 1938 recognized homeopathic remedies as drugs. By the 1950s there were only 75 pure homeopaths practicing in the U.S.^[167] However, in the mid to late 1970s, homeopathy made a significant comeback and sales of some homeopathic companies increased tenfold.^[168] Greek homeopath George Vithoulkas performed a "great deal of research to update the scenarios and refine the theories and practice of homeopathy" beginning in the 1970s, and it was revived worldwide;^[67]^[169] for example, Brazil in the 1970s and Germany in the 1980s.^[170] The medical profession started to integrate such ideas in the 1990s^[171] and big mainstream pharmacies started competing for this business.^[172]