What is Complementary and Alternative Medicine?
by

Patricia Muehsam, M.D

A project made possible by the
Carol Ann Schwartz Cancer Education Fund

The field of complementary and alternative medicine encompasses a vast number of practices and systems of health care that, for a variety of cultural, social, economic, or scientific reasons, have not been adopted by conventional medicine.

Conventional medicine is sometimes referred to as allopathic medicine. The term allopathy is derived from the Greek allo, meaning opposite, and pathos, meaning suffering. In general, conventional medicine tends to focus on the disease and employs techniques to oppose it. For example, conventional medicine manages high blood pressure with medications ("antihypertensives") that lower blood pressure; it treats bacterial infections with drugs ("antibiotics") that kill the invading organisms; and for cancer, it employs chemotherapy, radiation, and/or surgery to remove a malignant tumor or eradicate cancerous cells.

A number of alternative and complementary therapies operate via this allopathic framework, including many of the biologic and pharmacologic approaches to treating cancer and other disorders (see below). Other methods derive from distinctly different origins and reflect concepts of health and disease that vary greatly from those of Western medicine. Among such practices are Traditional Chinese Medicine, Ayurveda, homeopathy, and naturopathy. Of those practices that have evolved from other, non-Western cultural traditions, there is often no correspondence with Western concepts of disease. For example, the notions of cancer and infectious disease have no parallels in Traditional Chinese Medicine, although the system can be used to treat such conditions.

Many complementary and alternative treatments involve difficult changes in lifestyle or outlook. Some involve bad-tasting herbs or even animal-based remedies. Conventional medicine is probably better than most complementary and alternative treatments at achieving quick fixes. However, complementary and alternative medicine is worth exploring as a source of both new treatments and new perspectives on health and disease, and for approaches to reinforcing the individual's "life force", balance, and harmony with the environment.

A few common complementary and alternative treatment approaches are described below to illustrate key concepts. This list is far from exhaustive. The inclusion or exclusion of specific modalities is not intended to imply a value judgment about the relative effectiveness or appropriateness of any one approach.

• Acupuncture/Acupressure
• Ayurvedic Medicine
• Biologic and Pharmacologic Therapies
• Chiropractic
• Dietary and Nutritional Therapies
• Energetic Therapies
• Homeopathy
• Mind-Body Approaches
• Naturopathy
• Osteopathy
• Traditional Chinese Medicine
• Western Herbalism

Acupuncture/Acupressure: Acupuncture, as a therapeutic intervention, originated more than 4,000 years ago from the medical practices of the Chinese and other Asian cultures. Traditional Chinese Medicine uses acupuncture to regulate the flow of Qi, or "vital energy" (see "Traditional Chinese Medicine," below). The insertion and manipulation of needles, or the application of pressure at specific points along the meridians or channels through which Qi is thought to flow, is believed to correct any imbalance, excess, deficiency, or lack of fluidity in the flow of Qi. In the West, some practitioners deliver acupuncture in the context of a broader Asian health care system; others offer it as a discrete technique for treating symptoms.

Ayurvedic Medicine: Ayurveda, first described in Vedic religious scriptures dating from 1200 B.C., is considered the traditional medicine of India. Central to Ayurvedic philosophy is the notion that optimal health consists of physical, mental, and spiritual harmony. The pathway to harmony depends on the individual's predominant "dosha," or constitution. Ayurvedic practitioners interview new patients in great detail about their personal as well as medical history. The four pillars of Ayurvedic health maintenance are: (1) cleansing and detoxification, (2) palliation, (3) rejuvenation, and (4) mental and spiritual hygiene. Diet is an important concern in Ayurveda, but specific dietary recommendations depend on the individual's primary constitution, and vary according to the season. Treatment may include dietary modification, herbal preparations, massage, yoga, meditation, and "pranayama", or breathing exercises.

Biologic and Pharmacologic Therapies: These approaches are similar to Western medicine in their use of specific treatment agents that are targeted at eliminating a disease or symptom. Examples include the use of shark or bovine cartilage, which advocates say has cancer-fighting properties; "antineoplaston" therapy, which employs a substance originally found in human urine, but which is now synthesized chemically, to fight various forms of cancer; chelation therapy, which involves using a chemical called EDTA; and oxygen therapy, which uses oxygen in various forms to counter various infections and other disorders.

Chiropractic: Chiropractic originated in ancient Egypt, where practitioners adjusted the spines of their patients to maintain health. Modern chiropractic is based on the principle that proper spinal column alignment is necessary for optimal health, and it employs manual manipulation of the spine to correct subluxations, or spinal misalignments. Because of the crucial role that the nervous system plays in both involuntary and voluntary bodily functions, chiropractors treat a wide variety of conditions with spinal manipulation and believe that preventive treatments are appropriate for maintaining health.

Dietary and Nutritional Therapies: Dietary and nutritional considerations are fundamental to many complementary and alternative healing approaches. Many non-Western cultural traditions make little distinction between medicine and food because diet is fundamental to health. Western medicine, too, has begun to acknowledge the potential importance of dietary and nutritional supplements to health.

Alternative and complementary dietary and nutritional modalities include macrobiotics, vegetarianism, orthomolecular medicine, and individualized dietary programs. Macrobiotics, based on Asian concepts of nutrition, tailors diet to both individual needs and the season. Vegetarian health diets vary widely: some exclude all animal products, whereas others include milk and/or eggs and/or fish. Many nutritional counselors support the use of supplements to replace nutrients that may be lacking in the diet. Practitioners of orthomolecular medicine prescribe "megadoses" of nutritional supplements for the prevention as well as treatment of particular health conditions. Other nutritional practitioners develop individualized dietary advice for clients, basing their recommendations on an analysis of the individual's unique metabolic characteristics.

Energetic Therapies: The term "energetic therapies" is used to describe practices, including Reiki, external Qi Gong, therapeutic touch, and bioenergetics, that involve nonlocal interactions-that is, interactions in which there is no physical contact between the practitioner and the patient. Some of these practices originated in non-Western cultures. Others were developed in the West but show the influence of non-Western concepts. All of them involve non-tactile, non-contact interactions between practitioner and patient, in which the practitioner uses information garnered from other senses to assess and treat the patient's condition. Traditional Chinese Medicine, for example, uses this approach to detect and release Qi.

Homeopathy: Contemporary Western homeopathic medicine, based on the work of the German physician and chemist Samuel Hahnemann some 200 years ago, aims to stimulate the individual's innate healing processes through the administration of minute (homeopathic) dilutions of specific remedies. Derived from the Greek homeo, meaning same, and pathos, meaning suffering, homeopathy essentially treats like with like. The patient describes his or her symptoms in detail, with equal emphasis placed on both physical and psychological symptoms. The practitioner then prescribes very small, nontoxic doses of a selected substance that, at higher doses, would produce the same symptoms in a healthy person.

Mind-Body Approaches: Although many of the practices described above inherently involve mind and body, the term mind-body is used to describe practices, such as yoga, guided imagery, relaxation techniques, biofeedback, and hypnosis, that involve self-responsibility and use the relationship between mind and body to promote health. Recent advances in psychoneuroimmunology, the study of the biochemical and molecular relationships between psychological states to health, have further validated these approaches to health care.

Naturopathy: Naturopathy is a comprehensive system of health care that draws on Traditional Chinese Medicine, Ayurveda, and Native American healing practices. According to naturopathic philosophy, health is a composite of physical, emotional, mental, and spiritual well-being. The body is seen as having an innate ability to heal itself and symptoms are therefore an expression of the body's attempts to heal itself. As opposed to symptoms, naturopathic philosophy believes it is the causes of disease that should be treated, and that prevention is better than cure. Naturopathic practice may encompass acupuncture, homeopathy, hydrotherapy, botanical medicine, dietary and nutritional considerations, and counseling and lifestyle modifications.

Osteopathy: Osteopathic practice rests on the notion that the mechanical structure of the body is inherently linked to its function and is the most important factor in maintaining health. Diagnostic methods rely on detecting structural abnormalities of the musculoskeletal system and are followed by manual manipulations to correct the structural problem.

Traditional Chinese Medicine: The system of Traditional Chinese Medicine (TCM) originated from Taoism some 4,000 years ago and, like other traditional systems, goes beyond prevention and treatment of disease. Health care is viewed as one of several means to a good life-defined as the individual's harmonious interaction with the community and with the physical and spiritual environment.

Central to this ethos is the notion of Qi, usually translated as "vital energy" or "life force." Qi encompasses that which distinguishes life from death, animate from inanimate. Although considered to be the substantive element in living systems, Qi permeates all of space. The body is thought to contain a supply of Qi, unique to each individual, that flows through circular channels or meridians and is exchanged with the Qi in one's surroundings. Optimal health results from an unobstructed flow and appropriate balance of Qi.

A second essential element of TCM is the concept of yin and yang. The terms refer to the Taoist concept of the interrelationship and interdependence of opposites. Although yin and yang are often used to refer to such opposites as hot and cold or male and female, the TCM practitioner uses them to describe the functions of organs and organ systems, illnesses and conditions, and treatments.

Although TCM is most commonly used in the West to treat illness, its essential purpose is to promote health and to prevent health problems. Methods include diet, exercise (T'ai Chi and internal Qi Gong), the use of herbs, acupuncture, and massage (Tui Na).

Western Herbalism: Herbal medicine is the most ancient form of health care. As complementary and alternative medicine grows in popularity, botanical products derived from Western plants are coming back into widespread use. Western herbalism classifies many herbs according to their opposing activity: for example, herbs may have anti-inflammatory, antimicrobial, antispasmodic, or hypotensive effects. Additional terms describe a supportive action: for example, adaptogenic herbs (those that increase resilience and resistance); tonics (supportive of vital energy); and emmenagogues (supporting the female reproductive system). Herbal preparations may be prescribed for ingestion as teas, as capsules or tablets, or as extracts or tinctures. Herbs may also be prepared as essential oils to be used topically, as are herbal preparations made into salves, balms, or ointments.

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