Complimentary and Alternative Medicine

Complementary and Alternative Medicine

Is a group of diverse medical and health care systems, practices, and products that are not presently considered to be a part of conventional medicine

Ex. acupuncture, chiropractic, massage, and homeopathy

Complementary and Alternative Medicine

People use CAM therapies in a variety of ways. CAM therapies used alone are often referred to as alternative. When used in addition to conventional medicine, they are often referred to as complementary.

Complementary and Alternative therapies are not the same -NCCAM

Complementary therapy
Used to supplement/ augment conventional therapy (guided imagery, music, relaxation techniques)

Alternative therapy
Generally used instead of conventional treatment Acupuncture instead of analgesic

Conventional Medicine
- Medicine practiced by holders of M.D. and D.O. ( doctor of osteopathy) degrees and by allied professionals.( Registered nurse, Physical therapist & Psychologist) - Some conventional practitioners are also practitioners of CAM ex. Using Aroma therapy to help lessen clients discomfort following surgery.

Integrative medicine
- Combines mainstream medical therapies and CAM therapies for which there is some high-quality evidence of safety and effectiveness. Ex. Nurses use combination of therapies when they use massage, touch, distraction and relaxation techniques in addition to use of analgesics for pain.

Why do people choose Alternative Therapies?

2 main reasons: High personal involvement in decision making. Hope for gaining therapeutic benefits
( Lazar and O Connor)

Factors affecting the use of Alternative Medicine

Desire for control over decision-making Hope to gain therapeutic benefit. Desire to avoid toxicities, invasiveness or other qualities of conventional treatments. Need to control undesirable side effects of conventional therapies. Preference of natural over synthetic medications.

Factors affecting the use of Alternative Medicine (cont)

Dissatisfaction with attitudes and practitioners conventional medicine Failure to determine diagnosis Failure of conventional therapy Chronic illness with poor prognosis Acute or chronic conditions for which conventional treatments are lacking or disappointing Reduced insurance coverage

Factors affecting the use of Alternative Medicine (cont)

Healing system that is part of a clients cultural or identity group heritage. Restraints on access to health care Increased costs of prescriptions and services. Increased interest in preventive strategies and holistic approaches to health such as eating a more nutritionally sound diet, maintaining fitness and reducing stress.

Issues Related to Herbal Remedies and Dietary Supplements

Current laws do not give a strict definition of the term supplement Manufacturers of supplements may only make general claims about their products Herb manufacturers are not required to demonstrate the safety, efficacy, or quality of their products Supplement manufacturers are not held to strict standards

Issues Related to Herbal Remedies and Dietary Supplements (cont)

Food companies can make health claims if most of the scientific evidence supports the claim The placebo effect plays a significant role in the use of herbal remedies and supplements Most medicinal plants are untested At least 30% of all modern drugs are actually derived from plants

Risks Posed by Complementary and Alternative Medicine (CAM)

Most herbal remedies and supplements are untested and therefore might have unknown adverse effects on the body CAM could interfere with prescribed medication, anesthesia or surgery

Dietary Supplement as Defined Under the Dietary Supplement Health and Education Act of 1994

It contains one or more of the following ingredients:

a vitamin, a mineral, an herb or other botanical (excluding tobacco), an amino acid, a dietary substance for use by man to supplement the diet by increasing the total daily intake (e.g., enzymes or tissues from organs or glands), a concentrate, such as a meal replacement or energy bar, or a metabolite, constituent, or extract.

It is intended for ingestion in pill, capsule, tablet, or liquid form. It is not represented for use as a conventional food or as the sole item of a meal or diet.

Benefits from Using Complementary and Alternative Medicine

Individuals might be more conscious and cooperative with their health management when CAM therapies are used
Individuals generally report marked improvement in their well-being after subscribing to CAM therapies

Role Of The Nurse

Obtains a health history from the client Initiates the discussion about the use of CAM modalities. Educates clients about possible adverse reactions, provide information from the NCCAM, and to teach lifestyle-modification behavior that could prevent the development of acute or chronic problems.

Methods to Facilitate Discussion of CAM therapies

Give permission for clients to raise the topic and ask questions. Ask, in every history and physical examination What else are you doing to care for your health? Listen for nondisclosing cues or references that may represent a clients effort to test the waters without making full disclosure.

Methods to Facilitate Discussion of CAM therapies (cont.)

Become familiar with local patterns of use Be frank with what you do not know Seek more information from clients. When asking clients about medications, ask specifically about any supplements or herbs.

I. Alternative Medical Systems

Alternative Medical System

Involve complete systems of theory and practice Independent or parallel to conventional medicine Many are traditional systems of medicine that are practiced by individual cultures throughout the world

 1. Alternative Medical Systems

Alternative medical systems are built upon complete systems of theory and practice TRADITIONAL CHINESE MEDICINE ACCUPUNCTURE ACCUPRESSURE AYUVEDIC MEDICINE HOMEOPATHY NATUROPATHIC MEDICINE NATIVE AMERICAN HEALING PRACTICES TIBETAN MEDICINE

Alternative Medical System

Major Eastern Whole Medical Systems
Traditional Chinese medicine
Acupuncture and Moxibustion Chinese Materia Medica Massage and Manipulation

Ayurvedic Medicine

Major Western Whole Medical Systems

Curanderismo Homeopathy Naturopathy

A. EASTERN WHOLE MEDICAL SYSTEM:

a. Traditional Chinese Medicine

The superior physician helps before the early budding of the disease; The inferior physician begins to help when the disease has already set in... -Yellow Emperors Classic of Medicine

Traditional Chinese Medicine

complete system of healing that dates back to 200 B.C. in written form Korea, Japan, and Vietnam based their medical system from practices originating China Principle: the body is a delicate balance
Yin represents cold, slow, or passive principle Yang represents hot, excited, or active principle

Qi, the Vital Energy

Invisible flow of energy that circulates the universe Qi flows throughout the body along a network of energy circuits called meridians Obstruction in the normal flow of Qi can cause illness

Five Phases and Seasons

Five Phases Theory
Dynamic connection between forces of nature and the body
Fire, earth, metal, water, and wood

Five Seasons
Four cardinal directions are connected with the Five elements Earth, the fifth element, is the center
South is the most important direction

Traditional Chinese Medicine

Diagnostic Methods
Inspection Auscultation/Olfaction
Sounds and odors of the body may signify imbalance

Inquiry
Comprehensive history taking

Palpation
Pulse diagnosis

Traditional Chinese Medicine

Treatments and Interventions
Acupuncture
Stimulation of anatomic points called hsueh where meridian passes close to the skin

Moxibustion
Application of heat from burning substances at acupuncture points

Chinese Materia Medica

standard reference book of information on medicinal substances that are used in Chinese herbal medicine

Acupressure

Acupressure
Method of maintaining health, treating disease and alleviating pain by applying pressure or massaging certain points on the body surfaces

Acupuncture

Acupuncture
involves the insertion of stainless steel needles into various body areas A low-frequency current may be applied to the needles to produce greater stimulation claims to restore balance

Tui Na Massage

Tui Na Massage
Chinese therapeutic massage Pushing and grasping combination of all massage styles including relaxation, deep tissues, acupressure, joint, or bone manipulations deals almost exclusively with physical/structural imbalance only

EASTERN WHOLE MEDICAL SYSTEM

b. Ayurvedic Medicine
The relationship between the body and the mind is so intimate that, if either of them get out of order, the whole system would suffer - Ghandi

Ayurvedic Medicine
Ayurveda is one of the oldest medical systems in the world Practiced for 4000 years in India Sanskrit word:
ayur means life veda means knowledge

Principle: Connection and balance between microcosm and macrocosm

Microcosm and Macrocosm

Microcosm the people Macrocosm the universe Understand the world to understand people Understand the people to understand the world Because of this assertion it is believed that human health is influenced by his environment

Ayurvedic Medicine
Diagnostic Methods
Pulse diagnosis
pulses are related to prana

Tongue diagnosis
Color of tongue indicates functional status of internal organs

Urine diagnosis Body observation

Cool, hot, rough, or dry skin indicates imbalance Nails that have longitudinal striations, bumps, or a parrot beak also indicates imbalance

Ayurvedic Medicine
Specific lifestyle interventions are a major preventive and therapeutic approach Individualized care and treatment Treatments and Interventions includes
Nutrition
balanced diet means balance of six tastes - sweet, sour, salty, pungent, bitter, and astringent

Yoga
Combination of exercise, meditation, breathing, and relaxation techniques

Ayurvedic Medicine
Treatments and Intervention (cont.)
Herbs Exercise Breathing Meditation Massage
Marma theraphy is similar to acupuncture and acupressure

Aromatheraphy Music Purification

CAM Alternative Medical Systems

B. Western Alternative Medical Systems
Curanderismo Homeopathic Medicine Naturopathic Medicine

Curanderismo

a. Curanderismo
Spanish verb curar or to heal Latin America Hispanic Americans Most characteristic of Mexican Americans Survives by growing, changing, and incorporating Western biomedical beliefs

Curanderismo
Various techniques
Prayer Herbal medicine Healing rituals Spiritualism Massage Psychic healing

Curanderismo
Healers call themselves curanderos and curanderas The only healer in the culture who can treat mal puesto - illnesses caused by witchcraft (brujos and brujas) Supernatural illness el don de Dios gift of healing from God

Don Martin performing a cure in front of his altar in Ojinga, Chihuahua, Mexico

Curanderismo
Three levels of healing
Material level
Use of physical or supernatural objects to heal

Spiritual level
Similar to shamanic healing rituals

Mental level
Transmits mental vibrations in a way that directly affects a persons condition

b. Homeopathy
Complete system of medical theory and practice Samuel Christian Hahnemann (1755-1843) German physicist Proving or human pathogenic trial Considers all the aspects of a persons health status - individualized Practitioners are called homeopaths

Homeopathy
Aims to stimulate the bodys own healing responses Administered in minute or potentially nonexistent material dosages Concepts
Law of Similars (like cures like) Law of Infinitesimals

Naturopathy

c. Naturopathy
System of healing Originated from Europe Body naturally heals itself Emphasizes health restoration and disease treatment Literally translates as nature disease

Naturopathy
Six principles
Healing power of nature Identification and treatment of the cause of disease The concept of "first do no harm" The doctor as teacher Treatment of the whole person Prevention

Naturopathy
Core modalities
Diet modification and nutritional supplements Herbal medicine Acupuncture and Chinese medicine Hydrotherapy Massage and Joint manipulation Lifestyle counseling

Naturopathy
No research study has regarded naturopathy as a complete system of medicine Examples
Propolis (a resinous product collected from beehives) and vitamin C for ear pain Cranberrry juice or tablet acts as prophylaxis against urinary tract infection

II. MIND-BODY TECHNIQUES

Drag your thought away from your troubles by the ears, by the heel, or any other way you can manage it. Its the healthiest thing a body can do Mark Twain

Mind-body interventions
Uses a variety of techniques designed to enhance the minds capacity to affect bodily function and manifestations Ex: client support groups and cognitivebehavioral therapy Other ex: aromatherapy; art, music, or dance therapy; biofeedback; hypnosis; imagery; meditation; shamanism; spiritual healing; Tai Chi; yoga

a. AROMATHERAPY

Aromatherapy

AROMATHERAPY
Use of fragrant compounds or essential (volatile) oils extracted from plants Used to improve mood and overall health Can be inhaled or applied during massage Popular compounds: CHAMOMILE, EUCALYPTUS, JASMINE, LAVANDER, PEPPERMINT, ROSEMARY

Application of AROMATHERAPY
Inhalation (directly or diffused into the air) Absorption through the skin (baths, massages, compresses) Absorption through the mucous membranes (oral rinses and gargles) Ingestion (occasionally prescribed, with caveats)

b. ART c. MUSIC d. DANCE THERAPY

ART, MUSIC OR DANCE THERAPY

Use drawing or art, music, or dance to help individuals cope or express emotions

BIOFEEDBACK
If you believe you can or if you believe you cant, youre right. Henry Ford

e. BIOFEEDBACK
Utilizes monitoring devices to assist individuals to make them more aware of their physiology and allow them better self-control over such things as blood pressure, muscle tension, temperature, and bladder control

 Biofeedback is a method of bringing unconscious biologic processes under conscious control. Biofeedback involves the use of electronic devices to measure and report back to the conscious mind information such as heart rate, blood pressure, muscle tension, and brain surface electrical activity

Types of BIOFEEDBACK
THERMAL FEEDBACK Primary tool for general relaxation training and treatment of specific vascular disease Sensors attached to your fingers or feet measure your skin temperature Blood flow in the hands responds to stress and relaxation, & clients learn to relax by watching the rise and fall of finger temp.

Types of BIOFEEDBACK
ELECTRODERMAL RESPONSE (EDR) or GALVANIC SKIN RESPONSE

Sensors measure the activity of your sweat glands and the amount of perspiration on your skin, alerting you to anxiety Highly sensitive to emotions and thoughts Method most commonly used by a lie detector machine

Types of BIOFEEDBACK
ELECTRODERMAL RESPONSE (EDR) or GALVANIC SKIN RESPONSE Used in general relaxation training to help people reduce the impact of significant stressors and anxiety, and to treat excessive sweating

Types of BIOFEEDBACK
ELECTROMYOGRAPHY (EMG) most common form of biofeedback measurement uses electrodes or other types of sensors to measure muscle tension mainly used as a relaxation technique to help ease tension in those muscles involved in backaches, headaches, neck pain and bruxism

Types of BIOFEEDBACK
ELECTROMYOGRAPHY (EMG) Used for general relaxation training and insomnia that is due to over activation of the autonomic nervous system

Types of BIOFEEDBACK
RESPIRATORY RESISTANCE Measures the rate, volume, and rhythm of respiration Useful in treating both asthma and the hyperventilation of anxiety and panic attacks

Types of BIOFEEDBACK
GASTROINTESTINAL FEEDBACK Helpful in treating irritable bowel syndrome, colitis, heartburn, functional dyspepsia, and Crohns disease CARDIOVASCULAR (EKG) FEEDBACK Available through portable heart rate monitors to augment a persons ability to control heart rate

Biofeedback

Types of BIOFEEDBACK
PELVIC MUSCLE DYSFUNCTION FEEDBACK Used for people with chronic constipation related to pelvic dysfunction Sensors measure the activity of internal and external renal sphincter for treatment of fecal incontinence and the activity of the detrusor mucle for the treatment of urinary incontinence

Types of BIOFEEDBACK
ELECTROENCEPHALOGRAPH (EEG) Also called NEUROTHERAPY Records information about brain wave activity from sensors placed on the scalp Used for mind quieting, attention control, short-term memory improvement, mood swings, posttraumatic stress disorder, and alcohol and drug addiction

f. HYPNOTHERAPY
The greatest discovery of any generation is that human beings can alter their lives by altering the attitude of their minds. Albert Schweitzer

HYPNOTHERAPY
application of hypnosis as a form of treatment, usually for relieving pain or conditions related to one's state of mind

HYPNOSIS State of restful alertness during which individual become more aware of his or her surroundings to change behavior or promote healthful practices

Techniques
Age Regression - by returning to an earlier ego-state the patient can regain qualities they once had, but have lost. Remembering an earlier, healthier, egostate can increase the patients strength and confidence. Revivification - remembering past experiences can contribute to therapy. For example; the hypnotist may ask "have you ever been in trance?" and then find it easier to revive the previous experience than attempt inducing a new state.

Techniques
Guided Imagery - a method by which the subject is given a new relaxing and beneficial experience. Parts Therapy - a method to identify conflicting parts that are damaging the well being of clients, then helps those parts negotiate with each other through the therapist to bring about a resolution.

Techniques
Confusion - a method developed by Milton Erickson in which the subject becomes receptive to ideas because confused. Repetition - the more an idea is repeated the more likely it is to be accepted and acted upon by the patient. Direct Suggestion - suggesting directly. "You feel safe and secure".

Techniques
Indirect Suggestion - using "interspersal" technique and other means to cause effect. Mental State - people are more receptive while relaxed, sleeping, or in a trance. Hypnoanalysis - the client recalls moments from his past, confronting them and releasing associated emotions, similar to psychoanalysis.

Techniques
Post Hypnotic Suggestion - a suggestion that will be carried out after the trance has ended. "When you re-awaken you will feel refreshed." Visualization - being told to imagine or visualize a desired outcome seems to make it more likely to actually occur. Techniques specific to medical disorders, such as gutdirected hypnotherapy protocols for Irritable Bowel Syndrome

HYPNOTHERAPY: Myths and Realities

MYTH
People are asleep during hypnosis.

REALITY
People are awake and aware throughout the entire process and are highly selective about where they focus their attention. All hypnosis is self-hypnosis since people cannot be hypnotized against their will People cannot be forced to reveal any secrets they would not disclose in a fully alert state

Hypnotized people have lost control and are under someones power People can be influenced to tell secrets

People might get stuck in a hypnotic trance

Because individuals control the situation, they can end the hypnotic trance any time

f. IMAGERY
The power which a mans imagination has over his body to heal it or make it sick is a force which none of us is born without Mark Twain

 Guided imagery involves the use of mental images to

promote relaxation and wellness, reduce pain facilitate healing of a particular ailment, such as cancer or psychologic trauma.

IMAGERY
Two way communication between the conscious and unconscious mind and involves the whole body and all of its senses. Mental exercise where the clients mind and thoughts are supposed to impact or assist a certain outcome

Kinds of IMAGERY
Feeling-state imagery End-state imagery Energetic imagery Cellular imagery Physiologic imagery Psychological imagery Spiritual imagery

Eight Characteristics to make IMAGERY effective as a HEALING TOOL 1. Images must be personal 2. Images must feel right to the person and be congruent with who they are and their values 3. Imagery works best in a permissive, unforced atmosphere 4. Images must be energetic and physical

Eight Characteristics to make IMAGERY effective as a HEALING TOOL 5. Images must be anatomically correct and accurate 6. Skill at using imagery increases with practice 7. Imagery should have an end-stage component 8. If people are receiving medical treatment concurrently, they should include it in the imagery

g. MEDITATION

In prayer we talk with God, in meditation we listen. Edgar Cayce

MEDITATION
meditari, means to consider or to pay attention to something General term for a wide range of practices that involve relaxing the body and stilling the mind Uses reflection or mental concentration to create a higher sense of well-being and relaxation

 In meditation, people regulate their attention or systematically focus on particular aspects of inner or outer experience. Meditation involves sitting or resting quietly, often with the eyes closed. Sometimes it involves the repetitive sounding of a phrase (a mantra) meant to help the person focus

SHAMANISM

h. SHAMANISM
a range of traditional beliefs and practices similar to Animism that claim the ability to diagnose and cure human suffering and, in some societies, the ability to cause suffering based on the premise that the visible world is pervaded by invisible forces or spirits that affect the lives of the living

 Shamanism is a range of traditional beliefs and practices that involve the ability to diagnose, cure, and sometimes cause human suffering by traversing the axis mundi and forming a special relationship with, or gaining control over, spirits. *Shamans have been credited with the ability to control the weather, divination, the interpretation of dreams, astral projection, and traveling to upper and lower worlds.

SHAMANS
he who knows originally referred to the traditional healers of TurkicMongol areas such as Northern Asia and Mongolia experts employed by animists or animist communities are not often organized into full-time ritual or spiritual associations, as are priests

 Shaman are spiritual beings with the ability to heal, work with energies and 'see' visions. The essential characteristics of shaman are mastery of energy and fire as a medium of transformation. Shamanistic practices are thought to predate all organized religions, and certainly date back to the neolithic period

i. Spiritual Healing

SPIRITUAL HEALING
direct interaction between the healer and a client with the intention of improving the clients overall or specific condition or potentially curing the disease Variations: Reiki, intercessory prayer, faith healing, therapeutic touch

FAITH and PRAYER

And if you would know God be not therefore a solver of riddles. Rather look about you and you shall see Him playing with your children. And look into space; you shall see Him walking in the cloud, outstretching His arms in the lightning and descending in the rain. You shall see Him smiling in flowers, then rising and waving His hands in trees

*FAITH and PRAYER

active effort to communicate with a deity or spirit, including a monotheist God, Saints, gods within a pantheon, or others; either to offer praise, to make a request, or simply to express one's thoughts and emotions People meditate and say prayers that elicit physiologic calm and a sense of peacefulness, both of which contribute to loner survival

TAI CHI
A Chinese Martial Art

TAI CHI
great ultimate fist supreme boxing or root of all motion system originally taught by the Chen family to the Yang family starting in 1820 promoted and practiced as a martial arts therapy for the purposes of health and longevity considered a soft style martial art, an art applied with as complete a relaxation or "softness" in the musculature as possible

TAI CHI: Three primary subjects

Health - an unhealthy or otherwise uncomfortable person will find it difficult to meditate to a state of calmness or to use T'ai Chi as a martial art. T'ai Chi's health training therefore concentrates on relieving the physical effects of stress on the body and mind.

TAI CHI: Three primary subjects

Meditation - the focus meditation and subsequent calmness cultivated by the meditative aspect of T'ai Chi is seen as necessary to maintain optimum health (in the sense of effectively maintaining stress relief or homeostasis) and in order to use it as a soft style martial art

TAI CHI: Three primary subjects

Martial art - the ability to competently use T'ai Chi as a martial art is said to be proof that the health and meditation aspects are working according to the dictates of the theory of T'ai Chi Ch'an

The T'ai Chi Symbol or T'ai Chi T'u

to physically and energetically balance yin (receptive) and yang (active) principles "From ultimate softness comes ultimate hardness."

CLASSICAL and MODERN TAI CHI

YOGA
Mindful yoga invites us to observe the arising and passing of sensations, thoughts, and emotions like clouds within the all-embracing sky of awareness Jon Kabat-Sin

YOGA
From the Sanskrit word yuj meaning to yoke or to join a combination of breathing exercises, physical postures, and meditation, practiced for over 5,000 years Hinduism: a journey of the body, mind, and spirit on a path toward unity

YOGA
Form of therapy has improved quality of life for some clients by leading to relaxation and reduced stress levels

Yoga

Physical and Psychological Benefits of YOGA

Increases flexibility of muscles and joints Tones and strengthen muscles Improves endurance Increases circulation Lowers blood pressure Increases lymphatic circulation Improves digestion and elimination

Physical and Psychological Benefits of YOGA

Promotes deeper breathing Increases brain endophins, enkephalins, serotonin Increases mental acuity Augments alpha and theta brain wave activity Promotes relaxation Manages stress

MIND OVER MATTER!

Biological Based Therapies

Use substances found in nature such as herbs, foods, and vitamins.

Biological Based Therapies

Includes, but is not limited to, botanicals, animalderived extracts, vitamins, minerals, fatty acids, amino acids, proteins, prebiotics and probiotics, whole diets, and functional foods Includes natural and biologically-based practices, interventions, and products, many of which overlap with conventional medicine's use of dietary supplements Herbal, special dietary, orthomolecular and biological therapies

Biological Therapy
Use of natural but scientifically unproved therapies Use of laetrile and shark cartilage to treat cancer

Use of bee pollen to treat autoimmune and inflammatory diseases

Herbal Therapy
Herbal medicine or herbalism, the oldest known form of health care, uses plants and plant extracts to treat disease and promote wellness. A single herb or a mixture of different herbs can be used.

Herbal Therapy
Employs individual or mixtures of herbs for therapeutic value Herb - a plant or plant part that produces and contains chemical substances that act upon the body EXAMPLES: Valerian tea for improved sleep Echinacea to treat or prevent colds Garlic Peppermint Chamomile St. John's wort Ginkgo biloba Ginseng

Orthomolecular Medicine
Uses combinations of vitamins, minerals, and amino acids normally found in the body to treat specific conditions and to maintain health. Referred to as nutritional medicine Emphasizes supplementing the diet with high-dose combinations of vitamins, minerals, enzymes, hormones (such as melatonin), and amino acids. Dosages often far exceed the amounts normally consumed in the diet. A common form of orthomolecular medicine is megavitamin therapy, often with doses well above the recommended daily allowances (RDAs).

Special Diet Therapy

More than 40 alternative diets are believed to prevent and/or control a variety of conditions as well as promote health Macrobiotic diets based on belief that disease is caused by an imbalance of yin and yang Gerson diet vegan diet, high in potassium and low in sodium, to prevent cancer Atkins low carb diet to treat nutritional disorders and obesity Ornish vegetarian diet formulated to reverse heart disease Pritikin low-fat, high carb diet

Dietary Supplements
A product taken by mouth that contains a "dietary ingredient" intended to supplement the diet ( Congress, DSHEA 1994 ) Dietary ingredients include vitamins, minerals, herbs or other botanicals, amino acids, and substances such as enzymes, organ tissues, glandulars, and metabolites Extracts or concentrates (in tablet, capsule, softgel, gelcap, liquid, or powder form)

Regulated differently by FDA than drug products (prescription or OTC)

Drug vs. Dietary Supplement

The difference between a dietary supplement and a drug lies in the use of the agent, not in the nature of the agent itself. Dietary supplement used to resolve a nutritional deficiency or to improve or sustain the structure or function of the body Drug used to diagnose, prevent, treat, or cure a disease

FDA Regulation Drugs vs. Dietary Supplements

Drugs
Follow defined good manufacturing practices (GMPs)

Dietary Supplements
Follow existing manufacturing requirements for foods

Drugs
Approved by the FDA as safe and efficacious prior to marketing

Dietary Supplements
Marketed dietary supplements monitored for adverse effects after they are on the market Newly marketed dietary supplements not subject to premarket approval or a specific postmarket surveillance period * manufacturers of dietary supplements are responsible for ensuring that their products are safe

Drugs
Require claims of benefit, and citation of existing literature to validate such claims

Dietary Supplements
Do not require substantiation data *the Federal Trade Commission has primary responsibility for monitoring dietary supplements for truth in advertising

Drug
Subject to investigational new drug (IND) requirements

Dietary Supplement
Not subject to IND requirements

History
Italian Alps (1991) Ice Mans personal effects included medicinal herbs Middle Ages medicinal herbs inventoried for their medicinal effects Formed the basis of modern drugs

Interactions with Drugs

Because of widespread use and because they are natural, people assume that dietary supplements are inert or harmless. Studies show that interactions between drugs and dietary supplements do occur.
EXAMPLE: Gingko extract antioxidant and inhibits platelet aggregation bleeding reported with the combined use of gingko and drugs with anticoagulant or antiplatelet effects

Interactions with Drugs

Garlic, glucosamine, ginseng (Panax), saw palmetto, soy, valerian, and yohimbe are also thought to potentiate or interfere with prescription drugs

Toxicity
May be due to misidentification, contamination, and adulteration May result from the products themselves Ex. Kava - fulminant liver failure, ephedra

Common Plant-Derived Conventional Medicines Drug Plant Name Drug Classification Atropine Atropa belladonna Anticholinergic, antispasmodic, antidysrhythmic Topical analgesic Topical anesthetic Analgesic Antigout

Capsaicin Cocaine Codeine Colchicine

Capsicum frutescens Erythroxylon coca Papaver somniferum Colchicum autumnale

Common Plant-Derived Conventional Medicines Drug Digoxin Ephedrine Ipecac Physostigmin e Plant Name Digitalis purpurea Ephedra sinica Caphaelis ipecacuanha Physostigma venenosum Drug Classification Antidysrhythmic Appetite suppressant Antidote, emetic Cholinergic

Quinine

Cinchona officinales

Antimalarial, antimyotonic

Common Plant-Derived Conventional Medicines Drug Salicylin Scopolamine Senna Taxol Vincristine Plant Name Salix purpurea Datura fastuosa Cassia acutifolia Taxus brevifolia Catharanthus roseus Drug Classification Analgesic, Antipyretic Antiemetic, anticholinergic Laxative Antineoplastic Antineoplastic

Manipulative and Body-Based Methods

 Chiropractic manipulation Osteopathic manipulation Massage therapy Tui Na Reflexology Rolfing Bowen technique Trager bodywork Alexander technique Feldenkrais method

Manipulative and body-based practices focuses on: structures of the body bones and joints the soft tissues the circulatory system lymphatic systems.

Practices were derived from traditional systems of medicine from: China India Egypt

DEFINITIONS
Alexander technique: Patient education/guidance in ways to improve posture and movement, and to use muscles efficiently. Bowen technique: Gentle massage of muscles and tendons over acupuncture and reflex points. Chiropractic manipulation: Adjustments of the joints of the spine, as well as other joints and muscles. Craniosacral therapy: Form of massage using gentle pressure on the plates of the patient's skull. .

 Feldenkrais method: Group classes and hands-on lessons designed to improve the coordination of the whole person in comfortable, effective, and intelligent movement
Massage therapy: Assortment of techniques involving manipulation of the soft tissues of the body through pressure and movement. Osteopathic manipulation: Manipulation of the joints combined with physical therapy and instruction in proper posture.

 Reflexology: Method of foot (and sometimes hand)

massage in which pressure is applied to "reflex" zones mapped out on the feet (or hands).

Rolfing: Deep tissue massage (also called structural

integration).

Trager bodywork: Slight rocking and shaking of

the patient's trunk and limbs in a rhythmic fashion.

Tui Na: Application of pressure with the fingers and thumb, and manipulation of specific points on the body (acupoints).

Chiropractic

What is Chiropractic
form of health care that focuses on the relationship between the body's structure, primarily of the spine, and function use a type of hands-on therapy called manipulation (or adjustment) as their core clinical procedure

Key Points
Chiropractic is most often used to treat musculoskeletal conditions--problems with the muscles, joints, bones, and connective tissue such as cartilage, ligaments, and tendons.

 The risk of experiencing complications from chiropractic adjustment of the low back appears to be very low The risk appears to be higher for adjustment of the neck.

Basic Concepts
The body has a powerful self-healing ability The body's structure (primarily that of the spine) and its function are closely related, and this relationship affects health Chiropractic therapy is given with the goals of normalizing this relationship between structure and function and assisting the body as it heals

What kind of training do chiropractors receive?

Chiropractic training is a 4-year academic program consisting of both classroom and clinical instruction At least 3 years of preparatory college work are required for admission to chiropractic schools Students who graduate receive the degree of Doctor of Chiropractic (D.C.) and are eligible to take state licensure board examinations in order to practice

What do chiropractors do in treating patients?

health history physical examination, with special emphasis on the spine

What do chiropractors do in treating patients?

Chiropractors perform adjustments Given mainly to the spine, chiropractic adjustments involve applying a controlled, sudden force to a joint To increase the range and quality of motion in the area being treated

What do chiropractors do in treating patients?

Most chiropractors use other treatments in addition to adjustment, such as mobilization, massage, and nonmanual treatments
Examples of Nonmanual Chiropractic Treatments1 Heat and ice Ultrasound Electrical stimulation Rehabilitative exercise Magnetic therapy Counseling about diet, weight loss, and other lifestyle factors Dietary supplements Homeopathy Acupuncture

MASSAGE THERAPY

MASSAGE THERAPY
It is an assortment of techniques involving manipulation of the soft tissues of the body through pressure and movement.

BENEFITS OF MASSAGE THERAPY

increases blood supply, oxygen, and nutrition to muscles, tissue, joints, and the vital organs improves circulation throughout the body, which helps muscles to recover more quickly from exertion and fatigue helps to relieve the pain and discomfort associated with muscle tension, fractures, sprains, sciatica, and stiff joints

BENEFITS OF MASSAGE THERAPY

aids in the relief of muscle spasms and cramping helps in the prevention of muscular atrophy. helps break up scar tissue especially useful in the breakup of post surgical adhesions and edema promotes a greater range of motion in joints keeps ligaments and tendons supple lowers blood pressure and heart rate reduces stress, anxiety, and depression.

MASSAGE TYPES
Craniosacral Therapy - Via a gentle, noninvasive manipulative technique This encourages own natural mechanisms to improve the functioning of your brain and spinal cord to dissipate the negative effects of stress, promote good health, and enhance resistance to disease.

MASSAGE TYPES
Deep Tissue Massage - is used to release chronic muscle tension through slower strokes and more direct pressure or friction applied across the grain of the muscles.
is a process of detection of stiff or painful areas by determining the quality and texture of the deeper layers of musculature, and slowly working into the deep layers of muscle tissue.

MASSAGE TYPES
Shiatsu - traditional hands-on Japanese healing therapy.
can help in a wide range of conditions - from specific injuries to more general symptoms of poor health. help to prevent the build up of stress in our daily lives. Relives: back pain menstrual problems headaches, migraines digestive problems whiplash injuries asthmatic symptoms neck stiffness sports injuries joint pain and reduced mobility

MASSAGE TYPES
Swedish massage - collection of techniques designed
primarily to relax muscles by applying pressure. uses oil or baby powder to reduce friction. can relax muscles, increase circulation, remove metabolic waste products speed venous return from the extremities. shortens recovery time from muscular strain by flushing the tissue of lactic acid, uric acid and other metabolic wastes. improves circulation without increasing heart load. It stretches the ligaments and tendons, keeping them supple.

Energy Therapies
May the force be with you...

ENERGY THERAPIES
Energy medicine is a domain in CAM that deals with energy fields Two types: Biofield therapies
(putative)

Bioelectromagnetic
(veritable)

ENERGY THERAPIES
Biofield therapies
intended to affect energy fields that supposedly surround and penetrate the human body. Examples: qi gong, Reiki, and Therapeutic Touch

ENERGY THERAPIES
Bioelectromagnetic involve the unconventional use of electromagnetic fields

employ mechanical vibrations and electromagnetic forces involve the use of specific, measurable wavelengths and frequencies to treat patients

Biofield Therapies

BIOFIELD THERAPIES
Background based on the concept that human beings are infused with a subtle form of energy

Asian practitioners postulated that the flow and balance of life energies are necessary for maintaining health and described tools to restore them Practitioners of energy medicine believe that illness results from disturbances of these subtle energies

BIOFIELD THERAPIES
Examples: Acupuncture Reiki Qi Gong Therapeutic Touch

BIOFIELD THERAPIES
Acupuncture

BIOFIELD THERAPIES
Acupuncture
a family of procedures involving stimulation of anatomical points on the body by a variety of techniques method of healing developed in China at least 2,000 years ago involves penetrating the skin with thin, solid, metallic needles that are manipulated by the hands or by electrical stimulation.

BIOFIELD THERAPIES
Acupuncture more than 2,000 acupuncture points in the body

12 main and eight secondary pathways called meridians Meridians: conduct energy or gi throughout the body

BIOFIELD THERAPIES
Acupuncture for pain Acupuncture points are believed to stimulate the central nervous system to release chemicals into the muscles, spinal cord and brain three main mechanisms: Conduction of electromagnetic signals Activation of opioid systems Changes in brain chemistry, sensation and involuntary body functions

BIOFIELD THERAPIES
Reiki

BIOFIELD THERAPIES

Reiki
means "universal life energy. originated in Japan practitioner places his hands on or near the person receiving treatment, with the intent to transmit ki Ki: life-force energy

BIOFIELD THERAPIES
Reiki
Ki: Is spiritual in origin. Makes up and moves through all living things. Is available in infinite quantities, positive in nature, and important to all aspects of health. Is present both inside the body and on its surface. Flows throughout the body in specific channels. Has its flow disturbed by negative thoughts or feelings.

BIOFIELD THERAPIES
Reiki
if ki's flow is disrupted, the body's functioning becomes disrupted, and health problems can occur Health related purposes: Effects of stress. Chronic pain. Improving immunity. Mental clarity. Sense of well-being and/or spirituality. Enhancing sense of peace in dying people

BIOFIELD THERAPIES
Reiki Procedure practitioner places her hands on or slightly above the client's body uses 12 to 15 different hand positions Each hand position is held until the practitioner feels that the flow of energy has slowed or stopped (typically 2-5 mins)

BIOFIELD THERAPIES
Qi Gong

BIOFIELD THERAPIES
Qi Gong
ancient form of exercise therapy, often translated as 'energy work' or 'breath discipline, Combining breathing, mental focus, stretching, and movement
promotes enhancement of the flow of qi in the body, improve blood circulation, and enhance immune function.

BIOFIELD THERAPIES
Qi Gong
art of cultivating one's energy, both internal and external
based on the belief that all human beings contain a type of energy that circulates throughout their bodies via 12 pathways

qi gong master heals a patient by clearing away the blockages and re-balancing the body's energy balance.

BIOFIELD THERAPIES
Therapeutic Touch

BIOFIELD THERAPIES
Therapeutic Touch
derived from an ancient technique called laying-on of hands
based on the belief that living beings have an energy field or aura which extends beyond the surface of the body that can be manipulated by the therapist

healing is promoted when the body's energies are in balance

BIOFIELD THERAPIES
Therapeutic touch
works with the interaction between the energy fields (auras) of healer and patient the healer must have an active intent for healing to occur
the patient must desire (even unconsciously) a return to health

Bioelectromagnetic Therapy

Energy is not obtained from the gross molecular aspects of food and air, but rather from what can be called its vibrational essence or its electromagnetism

BIOELECTROMAGNETIC THERAPY
Magnetic Therapy
Use of static magnets to relieve pain or to obtain other alleged benefits based on belief that magnetic fields from permanent magnets placed close to the body can cause bones to heal faster, relieve pain, and perform other forms of healing It has recently been shown that static magnetic fields affect the microvasculature of skeletal muscle

BIOELECTROMAGNETIC THERAPY
Millimeter Wave Therapy
Low-power millimeter wave (MW) irradiation elicits biological effects, and is used to treat a variety of conditions
the nature of MW action is not well understood unclear whether MW yields clinical effects beyond a placebo response.

BIOELECTROMAGNETIC THERAPY
Sound Energy Therapy
referred to as vibrational or frequency therapy includes music therapy presumptive basis of its effect is that specific sound frequencies resonate with specific organs of the body to heal and support the body used to entrain mood states and reduce acute or chronic pain

BIOELECTROMAGNETIC THERAPY
Light Therapy
Use of natural or artificial light to treat various ailments
High-intensity light therapy has been documented to be useful for seasonal affective disorder Low-level laser therapy is claimed to be useful for relieving pain, reducing inflammation, and helping to heal wounds

MAGNETIC THERAPY
Magnetic therapy involves the use of magnets of varying sizes and strengths that are placed on the body to relieve pain and treat disease.

Magnets produce energy fields of different strengths, which proponents believe can penetrate the human body, correcting disturbances and restoring health to the afflicted systems, organs, and cells.

 Homeopathy is based on the belief that like cures like. Miniscule amounts. In other words, a small amount of the substance that would cause the illness is administered to the person with the illness Homeopathy - is a gently and effective natural medical science that recognizes disease as an energy imbalance, a disturbance of the bodys vital force.

 Q: Are there any side effects of homeopathic medicines? It is a very friendly system of treatment and it is well known that homeopathic medicines have no harmful side effects. Q: How long does it take to cure The treatment time depends on the nature and severity of the case. Usually acute cases respond earlier whereas chronic cases take time

 Q: Can homeopathy be used alongside another treatment system? It is generally recommended that only one medical system be used at a time to avoid any disagreement between the action of medicines. If medicines from two different systems are used simultaneously, they might neutralize the effects of each other leaving the patient in disappointment.

 Q: Are there specialists for various diseases in homeopathy? The human body always works as one integrated unit while performing any function. None of the major organs can survive without the active support of other organs. Heart, liver, kidneys, spleen, stomach, brain and all other organs must function as an integrated whole. If one part (organ) does not function properly, other organs will be affected one way or the other, less or more. Therefore, all of the physical, emotional and mental symptoms must be considered together, in totality. This is what homeopathy does.

 Q: What precautions should be taken during homeopathic treatment? Homeopathic medicines are quite effective but there are some precautions that should be taken for better results. It is very important that correct diet be taken at least during the treatment otherwise the medicines might not give the desired results.

 Generally, any thing that contains Caffeine, Coca (e.g. Coca-Cola), Menthol, Camphor, Peppermint, excessive Salt etc. should be avoided because these may antidote (but not always) the effects of some homeopathic medicines. Coffee is one item that needs to be avoided in most of the cases.

 Q: How homeopathic medicines should be taken? It is very simple. No bad tastes, no large quantities. Generally, it is taken in the following manner.
If your medicine is in the shape of tablets or powder, it should be dissolved under the tongue in a clean mouth. It is preferable to have a mouthwash with plain water before taking the medicine, especially if you are a smoker. Smoking, eating or drinking any thing (except plain water if necessary) soon after taking the medicine should be avoided.

 If your medicine is in the shape of drops, it should be taken in about 1/2 cup of plain water. Homeopathic medicine should preferably be taken either at least 15 minutes before meals or an hour after, unless your homeopath has advised differently. Try to avoid touching the tablets by hand.