Traditional and Alternative Techniques
The Philip Lief Group
These days, as vast numbers of female baby boomers are reaching the age of menopause, the change of life is changing too. These women—better informed than previous generations and ready to take a more active role in their own health care—are demanding new and better solutions to common menopausal concerns, and they’re looking more and more to a mix of traditional and complementary therapies for relief.
In that respect they’re part of a general population trend. In 1998, a landmark issue of the Journal of the American Medical Association (JAMA) reported that over 40 percent of Americans had broadened their health care menu to include such “alternative” specialties as stress-reduction techniques, massage, herbal medicine, acupuncture, and homeopathy. In the past decade, visits to nontraditional healers jumped 50 percent. In fact, Americans are spending a whopping $27 billion a year on complementary and alternative treatments, herbs, and books—much of that out of their own pockets, since most of what’s classified as “alternative” is not covered by health insurance.
Just what’s driving the move to complementary medicine? A number of factors come into play:
an ever-increasing emphasis on disease prevention, wellness, and the quest for optimal health—those areas where complementary medicine can deliver the greatest benefits xxx
Complementary practitioners say that people don’t look for alternatives if they’re satisfied with what they already have. They argue that CAM looks at the entire person, not just the set of symptoms, and that complementary interventions tend to be more gentle and less invasive.
Complementary/Alternative Medicine Today: When Did It Begin?
While it may seem to some that alternative medicine has only recently found the media spotlight, that’s not really the case. Much of what we think of today as nontraditional medical practice—acupuncture, Ayurvedic medicine, traditional Chinese medicine—has been around for several thousand years. It’s really conventional Western—also known as allopathic—medicine that’s the new kid on the block.
In this country, the current interest in complementary /alternative medicine was sparked in 1971 during President Richard Nixon’s historic visit to China. On that trip, New York Times reporter James Reston was stricken with acute appendicitis and underwent emergency surgery at the Anti-Imperialist Hospital in Beijing. Reston’s post-operative pain was treated with acupuncture and he later wrote about the experience, bringing this ancient Eastern healing practice to the attention of health-conscious Westerners.
At about the same time, we were introduced to transcendental meditation by Maharishi Mahesh Yogi, personal guru to the Beatles and other luminaries. In the years to come, other nontraditional therapies were brought to our attention by such physicians-turned-talk show guests/authors as Bernie Siegel, Andrew Weil, Deepak Chopra, Dean Ornish, and Christiane Northrup, among others. In the meantime even the Federal government was beginning to sit up and take notice.
In 1992 the United States Congress got into the act by establishing the Office of Alternative Medicine, a part of the National Institutes of Health. Renamed as the National Center for Complementary and Alternative Medicine (NCCA) in 1998, the office is using its increased autonomy and budget to fund research through its ten specialty centers focusing in such areas as HIV/AIDS, general medicine, women’s health, strokes and other neurological diseases, addictions, aging, asthma and allergies, pain, and cancer.
It wasn’t just government agencies that were beginning to focus their attention on complementary medicine. It was the public as well. In 1993 Dr. David Eisenberg, a Harvard University researcher, reported in the New England Journal of Medicine that one in three Americans were using at least one form of nontraditional therapy. The following year a Gallup Poll revealed that 17 percent of Americans were using herbal supplements, a significant jump of 14 percent from the previous year.
As public interest and acceptance has continued to grow, the bastions of traditional Western medicine—medical schools and mainstream health care organizations—have begun to incorporate complementary medicine into their own programs and services. In 1993, for example, New York City’s Columbia University College of Physicians and Surgeons became one of the first medical schools in the country to begin exploring alternative therapies. The university’s Richard and Hinda Rosenthal Center for Complementary and Alternative Medicine supports a number of projects—from studying the relationship between religious belief and healing, to the development of electives in complementary medicine for the college’s medical students. Today more than half of all U.S. medical schools offer electives in nontraditional therapies.
At the Center for Integrative Medicine at Thomas Jefferson University Hospital in Philadelphia, board-certified physicians will not only check your heart and blood pressure, but also suggest treatment options that might include yoga, massage therapy, or acupuncture, while here in Colorado, Centura Health Systems, the state’s largest hospital system, now has a department of alternative and complementary medicine because they realized that with forty percent of the population using these therapies, the medical community has an ethical, moral obligation to get involved, to help provide credible information, and to make sure it’s done in a safe, rational way.
Perhaps the most telling evidence of the popularity and effectiveness of certain alternative therapies is the fact that more and more health insurance companies now offer coverage for certain treatments, most commonly chiropractic and acupuncture. American Western Life of Foster City, California, was one of the first insurance companies to offer coverage for complementary therapies, while Oxford Health Plans, a managed care company headquartered in Norwalk, Connecticut, was the first medical insurer to offer its members a network of alternative care providers.
A Double Standard for Proof?
When it comes to alternative medicine, traditionally trained physicians have, more often than not, turned their back on nontraditional therapies. Years of training in the scientific method tends to foster their skepticism and a hunger for data among those evaluating unconventional therapies. Patients, on the other hand, are more inclined to accept what seems to work rather than what they can see proven through scientific methods. But the mainstream scientific support that conventionally trained doctors have been seeking is now slowly, but surely, forthcoming.
A 1997 panel organized by the National Institutes of Health found, for example, that acupuncture can quell the nausea and vomiting associated with surgery, chemotherapy, postoperative dental pain, and pregnancy. The panel also identified a number of pain-related conditions for which acupuncture can work in combination with, or as an acceptable alternative to, standard treatment. These disorders include addiction, strokes, headaches, menstrual cramps, tennis elbow, fibromyalgia, lower back pain, capral tunnel syndrome, and asthma.
In 1998, the Journal of the American Medical Association presented results of six scientific studies in its special issue on alternative medicine. Among the findings:
•Acupuncture, in combination with moxibustion (the burning of herbs in conjunction with the stimulation of specific acupoints) is a safe, effective way to turn fetuses in a breech position.
•Chinese herbal medicine may be useful in treating irritable bowel syndrome.
• Yoga can help ease the pain of carpal tunnel syndrome.
Although most complementary practitioners agree that Western medicine has its drawbacks—pointing, for example, to drug side effects or new antibiotic-resistant strains of infection—most also agree that Western medicine is peerless when it comes to acute care and saving lives. Emergency situations call for emergency intervention; if you have a broken leg, you don’t want to take an herb.
Conventionally-trained health care practioners have not been as quick to return the compliment. They've tended to look the other way when complementary or alternative practitioners claimed that their therapies can be as effective, or even more effective, in managing chronic pain or the symptoms of long-term illnesses.
Complementary therapies with centuries, if not millennia, of clinically demonstrated effectiveness may not have double-blinded, placebo-controlled studies that meet the methodological criteria of academicians.
In some cases, though, there are excellent studies, meeting the most stringent criteria, which consistently show benefits from complementary interventions in well-defined situations. However, there may not be a theory or mechanism which explains the outcomes in scientific terms that conventionally trained physicians understand.
With one in three Americans using complementary therapies, it is hard to categorize the whole field as irrelevant. Nonetheless, some physicians still believe this is an irrelevant fad that will go the way of the pet rock.
That reluctance to acknowledge other healing systems has softened in recent years. TheAmerican Medical Association (AMA) and state and local medical societies can no longer ignore the fact that patients are seeking out alternative practitioners and getting excellent results. These organizations, while not specifically endorsing complementary medicine, are encouraging their members to become more familiar with CAM modalities in order to discuss these approaches with their patients.
Complementary/Alternative Medicine: Multiple Choices
What does the increasing recognition and acceptance of complementary medicine mean for you? Hopefully, the integration of the scientific and technological strengths of Western medicine with the centuries-old body-mind-spirit orientation of complementary practice. In other words, the best of all possible worlds as doctor and patient work together to make good choices in the use of both conventional and complementary therapies.
Making Sense of the Confusion
There are more than 300 CAM therapies, with an even greater number of offshoots and variants. These therapies run the gamut, quite literally, from A to Z—from acupuncture to zone therapy (the earliest verion of what is known today as reflexology), from aromatherapy to Zen Buddhism.
To make sense of the vast landscape of CAM, it’s helpful to group similar therapies into broader categories. There are many ways to do this, and no one classification scheme is complete or authoritative.
One approach is to sort the various healing systems into three general classifications:
•medicinal therapies such as naturopathy, homeopathy, Ayurveda, and Chinese medicine
•touch and movement therapies such as massage, reflexology, osteopathy, chiropractic, yoga, acupuncture, and aromatherapy
•mind and emotion therapies such as relaxation and breathing, meditation, and visualization
Another classification scheme, developed by the National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health (NIH), sets up well-defined categories based on a rigid conceptual framework. The problem with this system is that all therapies that are difficult to categorize are lumped into a broad classification called “Alternative Systems of Medical Practice,” the intellectual equivalent of “other.”
The approach I prefer groups therapies on the basis of the mechanism(s) by which they work, or claim to work. While this approach is not as clean and precise for definition purposes, it has the advantage of being useful for both diagnosis and treatment. The disadvantage is that some therapies or systems of healing involve multiple, complex mechanisms, requiring that they be listed under several categories.
Here’s a brief introduction to many of the complementary therapies that offer new and interesting approaches to the management of menopausal symptoms.
Medicinal Therapies
AYURVEDA
Ayurveda—a Sanskrit word meaning “longevity knowledge—is an ancient system of healing from India which promotes health through the balance of the mind, body, spirit, and energy.
At the root of Ayurvedic medicine is the holistic philosophy that each person has a vital energy—known as prana—that is found in various energy centers—called chakras—throughout the body. An imbalance of prana is thought to cause illness. This balance can be restored through a variety of interventions involving diet, yoga, lifestyle modifications, nutrition supplments, stress reduction techniques, meditation, and individualized therapies.
A personalized treatment strategy is developed by analyzing the constitutional makeup of the patient. According to Ayurvedic philosophy, each person contains some amount of the universe’s five elements—earth, air, fire, water, and ether (or space). The three constitutional types (doshas), based on both physical and personality traits are: vata, pitta, and kapha.
Vata, or wind, combines air and space. It is said to influence the movement of cells and fluid through the body and thoughts through the mind. People who are strongly influenced by vata, say Ayurvedic healers, are active and often restless.
Pitta, or bile, is made up of fire and regulates the body’s metabolic activities. Those who are influenced by pitta may be competitive and aggressive.
The third dosha, kapha, or phleghm, is made up of earth and water and provides the body’s physical strength, stability, and recuperative powers. A person whose makeup is predominantly kapha may have a heavy, muscular body and a serene personality.
A person’s natural makeup, called his prakriti, is a balance of the three doshas. Every prakriti contains elements of all the dosha, but only one predominates. Ayurvedic healers believe that if you live the life your prakriti dictates, you will remain in balance, in harmony, and in good health.
An Ayurvedic physician will closely examine your pulse, tongue, nails, eyes, face, and posture, and ask you detailed questions about your life. He will design an individualized health plan for you based on his examination and your answers, and will recommend herbs, nutrition, massage, yoga postures, breathing exercises, and meditation.
By taking into acccount the uniqueness of the individual and the mind, body, spirit, and energy factors that affect health, Ayurvedic medicine aims to treat the whole person. This approach can be quite useful for people with stress-related conditions or chronic illnesses.
Ayurvedic medicine has become increasingly popular in recent years through the best-selling books and television appearances of physician Deepak Chopra, who was born and raised in India, and has integrated Ayurveda into his medical practice in this country.
CAUTION: If you’re already taking a prescription medicine, talk to your doctor before using any Ayurvedic herbs or medicines. Some contain dangerous substances such as lead, mercury, and arsenic; avoid any that contain even the smallest amounts of these ingredients.
Ayurvedic healers currently are not required to be licensed or certified in the U.S.
CHINESE HERBAL MEDICINE
Chinese herbs have always played a central role in Traditional Chinese Medicine. TCM, in fact, recognizes more than 6,000 healing substances, grouped by four basic properties—hot, cold, warm, and cool. Herbalists choose plants that can help balance conditions that are caused by excessive heat or cold. A “hot” herb, such as cinnamon bark, may be prescribed for a “cold” condition, a “cool” herb, such as chrysanthemum flower, for a “warm” condition.
Herbs are also classified by flavor—pungent, sour, sweet, bitter, or salty. Each flavor influences a certain organ-—pungent for the lungs, sour for the liver, sweet for the spleen or pancreas, bitter for the heart, and salty for the kidneys. In Chinese philosophy, the concept of organs is much broader than it is in the West. The Chinese “heart,” for example, refers to the physical heart, as well as clarity of mind.
Chinese herbs are generally prescribed in combinations of five to ten at a time. They are usually prepared in a soup or a strong tea to be drunk at room temperature (never hot). Many herbs are also available in powder or pill form, as tinctures, and as pastes that can be applied to the skin. Be prepared to be patient. Like Western herbal remedies, Chinese herbal treatments take some time to work.
CAUTION—To avoid potentially serious interactions, make sure you tell all your health care practitioners about any prescriptions and herbs you are taking. Some Chinese herbs can be poisonous in large doses.
If you live in a city with a large Asian population, you should be able to find a TCM practitioner who was trained in China or Taiwan or at one of the programs accredited by the National Accreditation Commission for Schools and Colleges of Acupuncture and Oriental Medicine. If not, look for a medical doctor, osteopath, chiropractor, or licensed acupuncturist who has received at least 500 hours of training in Chinese herbs.
HERBAL MEDICINE
Herbs have been used in folk remedies around the world since ancient times. They were used in early Greek and Roman civilizations, and were introduced to Europe during the Crusades. In the United States, herbs were used for many years to prevent illnesses and to treat minor complaints. Until the 1930s, in fact, herbs were the primary choice of many physicians in this country—peppermint to soothe an upset stomach, for example, garlic, to prevent colds and flu.
As medical technology advanced and new pharmaceuticals were developed and became widely available, the use of herbal remedies declined. There has been a renewed interest in natural botanicals, however, in recent years, thanks in large part to the expense of synthetic drugs and some of their serious side effects.
Many synthetic drugs are, in fact, based on plant remedies. Aspirin, for example, was originally developed from willow bark, while quinine, used to treat malaria, comes from Peruvian bark (cinchona succiruba), harvested from a type of evergreen tree indigenous to South America and cultivated in hot climates. More than 40 approved drugs commonly used in this country today are derived from herbs. These include tamoxifen, a powerful drug used to combat breast cancer, which comes from the Pacific yew tree; morphine, a painkiller derived from the opium poppy; and digitalis, a heart medication derived from foxglove.
It’s usually safe to treat yourself with herbs for minor conditions such as colds (try some echinacea) or mild digestive complaints (sip a cup of peppermint tea). But even herbs that are generally safe need to be used with caution. High doses of licorice root, for example, can raise your blood pressure. Chamomile can trigger a reaction if you’re allergic to ragweed. And too much ginger can cause gas, nausea, and vomiting—although in smaller doses it can ease those very same symptoms.
In general, it’s a good idea to consult your physician to rule out a more serious condition which might require conventional (allopathic) drugs and to ask whether an herb can safely be added to your treatment plan. Avoid taking potentially toxic herbs, including chaparral, comfrey (taken orally), ephedra (ma huang), germander, Indian snakeroot, kombucha, lobelia, pennyroyal, wormwood, and yohimbe.
Critics of herbal therapy contend, with some justification, that because herbal preparations are not regulated by the Food and Drug Administration (FDA), as pharmaceuticals are, the potency can vary from brand to brand, even from bottle to bottle from the same manufacturer.
Nevertheless, herbs are big business—in American alone we spend $2.5 billion a year on natural plant remedies. If you’re interested in exploring herbal therapies, follow these guidelines:
•Consult an herbalist or Chinese medicine practitioner before taking any herbs. Herbal medicine is not a one-size-fits-all therapy,
•Inform all your health care practitioners about all the medicines and preparations you’re taking. Some herbs can cause allergic reactions or don’t mix well with conventional drugs.
•Learn as much as you can about an herb before you take it. Are there side effects or warnings? How much and how often should you take it? Does it work best as a tablet or capsule, a tincture or tea?
•Buy from reputable manufacturers. U.S. and European botanicals are generally the best quality. The FDA now requires herbal preparations to be labeled with the herb’s scientific name, the amount of active ingredient, and the plant parts used. Product labels should also include the company’s address, batch and lot numbers, expiration date, and dosage guidelines.
•Start with the lowest possible dose, and don’t exceed the recommended dose.
•Don’t pick herbs yourself from chemically treated lawns or gardens.
•Don’t use herbs if you’re pregnant.
•Consult a physician before taking herbs if you have any allergies, are sensitive to any drugs, or are taking prescription medications for a chronic illness.
•Consult a physician before giving herbs to children under 12 or to adults over 65.
•Be patient; herbs take longer to work than synthetic drugs.
•If you experience any side effects, such as diarrhea or headache, stop taking the herb immediately and call your doctor. You can also call the FDA hotline at 800-332-1088.
It’s always best to use herbs under the care of a health care practitioner who is familiar with herbal medicine. In the United States this would include a naturopath, a specialist in botanical medicine, an acupuncturist trained in Chinese herbalism, an Ayurvedic healer, or a trained medical or clinical herbalist. Your practitioner will devise a treatment strategy based on your condition and on your medical and family history. The type of preparation and the dosage will depend on the strength of the herb, your age, your general result, and the results sought.
What to Look for on the Label
•Standardization (%of active ingredients)
•Milligram dose of each ingredient
•Recommended dosing
•Potential side effects
•Expiration date
•Batch/lot number
•Phone number to call with questions
•Verification of contents by independent laboratory
•Product-specific research
Making Herbal Preparations
It’s easy to make a variety of herbal preparations including decoctions, tinctures, infusions, infused oils, creams, and ointments. Use infusions and decoctions within a day of preparation. Infused oils, creams, and ointments will last for several months, and tictures last up to two years.
Make a decoction by boiling tough plant materials, such as bark, root, and berries to extract their active ingredients. You can use fresh or dried herbs, alone or in combination. Drink decoctions hot or cold. To prepare, place herbs in a saucepan, cover with cold water, and bring to a boil. Simmer until the liquid has been reduced by about one-third. Strain the liquid into a jar, then cover and store in a cool place.
Prepare a tincture by soaking one or more herbs in alcohol and water for two weeks and then straining the mixture into a jar. Discard any herbs that are left after straining. Use dark bottles and store for up to two years.
Infusions are similar to teas and can be drunk hot or cold. Place herbs—either alone or in combination—in a teapot and cover with boiling water. Cover the teapot and let the mixture steep for 10 minutes. Pour the infusion through a strainer into a cup, and add honey if you prefer a sweetened drink. Strain any remaining infusion into a jar. Cover and store in a cool place.
Infused oils are used for massage or in creams and ointments. Prepare hot infused oils by placing chopped herbs and oil in a glass bowl, setting the bowl in a pan of boiling water, and simmering gently for 2-3 hours. Remove the mixture from the heat, cool, and strain. Pour the oil into dark glass bottles, seal, and store for up to a year. Prepare cold infused oils by using sunlight.
Skin creams are made by melting emulsifying wax in a glass bowl that has been set into a pan of boiling water. Add herbs, glyceriine, and water, stir, and simmer for about 3 hours. Strain the mixture using a piece of cheesecloth, then stir until it cools and sets. Place in dark glass jars, seal with an airtight lid, and store in the refrigerator. Ointments to protect the skin are made by placing olive oil and beeswax in a glass bowl set into a pan of boiling water. Add herbs and simmer for several hours. Strain the liquid through a piece of cheesecloth, pour quickly into dark glass jars, and cool and set. Seal the jars after the ointment has cooled.
HOMEOPATHY
Homeopathy, developed in Germany over 250 years ago, uses highly diluted substances from plants, animals, and minerals as medicine. This healing system is based on the precept that like cures like. While a conventional physician would tend to recommend a standard pharmaceutical remedy (such as acetaminophen) to reduce fever, a homeopathic practitioner would recommend a very dilute remedy derived from a substance that actually causes a fever in a healthy person. The diluted remedy is thought to stimulate the body’s own protective healing response, somewhat like an immunization does.
Another tenet of homeopathy is that the patient is not his disease—that is, not every treatment works on every patient, and each patient must be seen as an individual, not as an illness. This holistic philosophy is one of the pillars of alternative medicine.
Homeopathic remedies should not be used to treat a medical emergency. They are most effective when used to treat chronic conditions such as allergies, skin problems, headaches, premenstrual syndrome, colds and flu, stress, and various auto-immune disorders, such as chronic fatigue syndrome. They are safe, however, to use with any medication you are taking, and can be taken by children, the elderly, even pets.
Homeopathic remedies are sold in health food stores, pharmacies, and grocery stores. The preparations come in tablets, powders, wafers, and liquids in an alcohol base. Certain over-the-counter remedies are targeted to common ailments such as insomnia, colds, flu, sore throat, and headaches. For occasional problems, you can use these preparations to treat yourself. Homeopathic preparations for serious conditions are recognized and regulated by the FDA; those sold over the counter are not.
For chronic conditions, it’s best to check with a professional homeopath, who will take an extensive medical history and will discuss your physical and psychological symptoms before prescribing a remedy tailored to your individual needs. Response times vary from minutes to months, and the remedies can work in conjunction with other conventional and/or complementary therapies. However, some energy-based therapies, such as acupuncture and magnets, can interfere with the activity of homeopathic remedies, so consult a professional for guidance.
Licensing requirements for homeopathic practitioners can vary from state to state. Most homeopaths have medical training, such as a degree in medicine, osteopathy, or naturopathy.
Using Homeopathic Remedies
There are about 200 to 300 commonly used homeopathic remedies, each designed to target a specific symptom. Homeopathic preparations can be prescribed by a homeopathic physician or bought over the counter.
If you’re using homeopathic remedies on your own, look for products with a potency in the range of 6c to 12c. The number preceding “c” indicates how many hundred times the remedy has been diluted. The most diluted forms are the most potent. A professional homeopath may use products with potencies of 30c or higher, but it’s best to start out on the lower end if you’re doing it yourself.
If you’re using a homeopathic remedy in tablet form, be careful not to touch the pills. Pour the tablets into the bottle cap, then tip them directly onto or under your tongue. If you spill any, throw them away. Don’t take anything by mouth for 15 minutes before or after taking the tablets.
Store homeopathic remedies in their original container, away from heat, sunlight, and strong aromas—such as perfumes, camphor, and eucalyptus—that might contaminate them. Avoid strong herbal teas, as well as products, including toothpaste, that contain mint which can also contaminate the pills.
NATUROPATHY
Naturopathic physicians (N.D.s) are very eclectic in their approach and use a wide variety of natural healing methods to stimulate the body’s own innate healing response. Depending on their training and philosophy, therapies may include nutritional interventions, mind-body techniques, homeopathy, musculoskeletal manipulations, lifestyle modification, environmental medicine, acupuncture, or herbal medicine.
Taking their cue from Hippocrates, the father of modern medicine, naturopathic physicians choose treatments that are noninvasive and have few side effects. Every illness, they say, has an underlying cause. Find the cause and the illness won’t come back. Naturopathic practitioners stress holistic care and frequently treat conditions that are affected most by lifestyle and environment. For individuals with high blood pressure treatment may involve a combination of diet, vitamins and minerals, herbs, and lifestyle changes. For arthritis sufferers, a regiment oculd involve diet, homeopathic medicines, acupuncture, hydrotherapy, and masssage.
A visit to a naturopath will include a standard physical exam. The practitioner will take a medical history and ask questions about your lifestyly, including diet, exercise, stress, and emotional issues. Then the patient and practitioner work together to establish a treatment program that emphasizes lifestyle changes that can lead to better health. Naturopathy holds that prevention is the best health strategy, that by changing unhealthy habits, you can avoid more serious problems in the future. For a specific complaint, the practitioner may prescribe one or more complementary therapies.
Licensing requirements for naturopathic doctors vary from state to state. In some states, naturopaths are licensed to prescribe conventional medications, give vaccinations, and perform outpatient surgery. Most who have licenses have graduated from one of the three accredited naturopathic schools in the United States: National College of Naturopathic Medicine, Bastyr University, or the Southwest College of Naturopathic Medicine and Health Sciences. Naturopaths follow a pre-med course as undergraduates, followed by four years of graduate school. They study such traditional medical subjects as anatomy, histology, pharmacology, and pathology, as well as naturopathic philosophy, Chinese medicine, nutrition, hydrotherapy, and other complementary therapies. They also work in a clinical setting with a licensed naturopath before obtaining an ND degree.
TRADITIONAL CHINESE MEDICINE
Traditional Chinese Medicine (TCM) is one of the oldest healing systems in the world and has been practiced in China and Eastern Asia for nearly 5,000 years. Two concepts are central to TCM: balance and flow. The TCM practitioner helps the individual achieve internal balance (yin and yang), as well as balance with the external environment. The second concept, flow, relates to energy or life force (chi) within each individual.
The nature of your illness depends on the particular imbalance between your yin and yang. Too much yin, for example, results in "cold” symptoms like chills; too much yang results in “hot” symptoms like fever. Different organs are characterized as yin or yang; the liver, for example, is yin, while the stomach is yang.
Chi is thought to move through the body along 12 pathways called meridians. TCM holds that when chi is blocked or out of balance, illness results. Chi can become weak, stagnant, or misdirected. Weakened chi can result in loss of appetite, dizzy spells, and a weak pulse. Stagnant or blocked chi can lead to tightness of the chest, abdominal pain, and painful and/or irregular periods. Misdirected chi, in which the energy flows in the wrong direction, can cause asthma, coughs, vomiting, and fainting.
Reestablishing the normal flow of chi and balancing yin and yang is thought to restore health and prevent illness. TCM differs from Western medicine in that it focuses on the entire body, as opposed to treating specific parts of the body that are affected by disease or injury.
To promote balance and get your chi moving again, TCM practitioners may suggest Chinese herbal medicine, acupuncture, or Chinese medical massage (acupressure). Attempts to translate TCM terminology into Western terms can sometimes be confusing. However, there are many studies documenting its clinical effectiveness for a wide variety of conditions. Some of these include arthritis, asthma, cerbral palsy, colitis, depression, diabetes, eczema, hay fever, herpes, hypoglycemia, impotence, infertility, insomnia, menopause, premenstrual syndrome, sciatica, stroke, and vaginitis.
Touch and Movement Therapies
ACUPRESSURE (CHINESE MEDICAL MASSAGE)
Like acupuncture, acupressure is based on the concept of chi (energy) circulating through the body’s pathways (meridians). When chi is flowing freely, you remain healthy and in harmony; when chi is stagnant, overstimulated, or unbalanced, you become ill.
Acupressure uses the same acupoints as acupuncture, but the practitioner uses deep finger pressure instead of needles. The technique is particularly helpful for stress-related symptoms such as headaches, neck and back pain, depression, anxiety, and insomnia. Other conditions that respond well to treatment include nausea, motion sickness, constipation, allergies, menstrual problems, and muscle aches.
Whereas acupuncture requires the services of a trained practitioner, acupressure can be self-administered. Consult a practitioner or pick up a self-help guide in the library or bookstore to learn about the different acupoints. When you have identified the point that coincides with your symptom, press it lightly with one finger. Increase the pressure gradually until you’re pressing as firmly as you can. Hold this pressure steadily until you feel a faint, even pulse at the point; this should take between three to ten minutes, perhaps longer. Release the pressure slowly. When performing acupressure, concentrate on your breathing; deep breathing helps the pressure points release pain or tension and increases the flow throughout your body.
There is no correct amount of pressure or required amount of time. You may feel some discomfort; if the pressure is really painful, ease up. For best results, wear comfortable clothing and do not try acupressure just before or after a heavy meal, while bathing, or within four hours of taking any drugs or medication, including alcohol. You can perform the procedure every day, but limit your sesions to an hour; when too much energy is released, you can wind up nauseated or with a headache.
In addition to its healing benefits, acupressure may help you stay well. The release of muscle tension increases the flow of blood and nutrients to the tissues, promoting physical and emotional relaxation.
CAUTION—If you have a chronic condition or illness, check with your physician before trying acupressure.
Unlike acupuncturists, acupressurists are not licensed. To find a trained specialist, contact the American Association of Oriental Medicine.
ACUPUNCTURE
Acupuncture is an ancient technique which originated in China at least 2,500 years ago. The painless insertion of very fine disposable needles in points along the meridians (pathways) of energy flow is intended to relieve symptoms by correcting energy imbalances and restoring the normal, healthy flow of energy in the body.
A more scientific explanation, say many Western-trained physicians and researchers, is that acupuncture works by releasing the body's endorphins, which are natural painkillers.
Regardless of whether you believe in energetic or biochemical mechanisms, acupuncture has been found to be useful for pain control, the nausea associated with chemotherapy or pregnancy, drug withdrawal (including smoking), stress reduction, and the management of gastrointestinal problems and menstrual disorders. When used with conventional medical treatment, it can also relieve osteoarthritis, asthma, and headaches. Many people have had good results using acupunture to treat high blood pressure, sinusitis, and depression.
Most acupuncturists working today use presterilized disposable needles that come packaged in sealed envelopes. The number of needles used, and their placement, varies from person to person, even from session to session, depending on the results being sought. Some practitioners swab the acupuncture point with alcohol before inserting the needles. Others may use a treatment called moxibustion. This consists of applying heat directly above acupuncture points by means of small bundles of smoldering herbs, usually mugwort leaf. Moxibustion frequently accompanies the insertion of needles, but it can be used alone.
Once the needles are inserted, you usually lie quietly for thirty mintes to an hour. The acupuncturist will then remove the needles and discard them. You may occasionally have a slight bruise if the needle has hit a nerve but that happens only rarely.
The number of treatments depends on your condition. Sometimes one or two visits can do the trick; other times six, eight, or ten treatments might be in order. And once you feel that you’re back on track, you may want to schedule treatment on a regular basis; many people opt for monthly or quarterly sessions to stay in balance.
Choose an acupuncturist who is a physician or who is board-certified by the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM). This organization publishes an annual directory of board-certified practitioners. You can also contact the American Association of Oriental Medicine and request a list of qualified acupuncturists in your area. Currently M.D.s and chiropractors can perform acupuncture in many states without formal training. To experience maximum benefit, it’s important to seek out a qualified practitioner.
AROMATHERAPY
Ever have a realtor suggest baking chocolate chip cookies before showing your house to a prospective buyer? Does the smell of newly mown grass take you back to the lazy days of a childhood summer? If so, then you already know the power of scent.
Aromatic oils, herbs, flowers, and other natural substances have been used since ancient Egyptian times for medicinal, as well as cosmetic and religious purposes. The mdoern scientific use of essential oils was discovered by French chemist Rene-Maurice Gattefosse, who worked in a perfume factory in the 1920s and coined the term aromatherapy.
Aromatherapy involves the therapeutic use of essential oils which are applied on the skin or inhaled. There can be a physiologic/biochemical effect as these oils are absorbed into the body. There can also be a psychological or mind/body effect mediated through the olfactory nerve, triggering a strong emotional response via the limbic system, that part of our central nervous system that controls our breathing, heart rate, body temperature, and blood sugar level, as well as such primitive emotions as sexual desire. There is even speculation that there may be an energetic effect related to the vibrational frequencies of the essential oils, although currently there is no research to support this concept.
The essential oils used in aromatherapy may be helpful for such conditions as anxiety, arthritis, menstrual irregularities, muscle aches, headaches, insomnia, psoriasis, insect stings, digestive problems, chest and nasal congestion, yeast infections, cystitis, and wound healing.
Essential oils are sold in tiny, dark-tinted bottles in health food shops, holistic pharmacies, and through the mail. Buy from a reputable merchant and make sure the bottle is well-sealed and labeled “essential oil.” Store in a cool place, away from the light.
Oils can be used by themselves or in combination, and can be inhaled from a cotton ball or handkerchief; misted into the air with a diffusor, humidifer, or vaporizer; massaged into the skin; added to the bath; or added to a sachet to scent a drawer or closet.
For inhalations, sprinkle 4-5 drops of oil on a handkerchief, tissue, or cotton ball, hold to your nose, and take several deep breaths. You can also add a few drops of oil (be careful—these are potent!) to a bowl of steaming water, cover your head with a towel, lean over the bowl, with your eyes closed, and inhale for up to 10 minutes. Do not inhale oils directly from the bottle.
To use oils in a vaporizer, place 2-3 drops in a bowl with a small amount of water and place over a lighted candle. You can also mist the room with a diffusor (sold where you have bought your oils) or with a humidifer to which you’ve added several drops of oil.
For an aromatherapy bath, add 6-8 drops of essential oil to a warm bath, and soak for at least 10 minutes.
Essential Oils Commonly Used for Menopause
Lavender—for headaches, depression, insomnia, stress, menstrual pain, muscle and joint pain
Rosemary—for bloating, mild depression
Peppermint—for headaches
Clary sage—for anxiety stress, mild depression, menstrual, and menopausal symptoms
Neroli—for tension and anxiety
Juniper—for muscle and joint pain, bloating
Rose—for dry skin, anxiety
CAUTION—Essential oils can be harmful if used incorrectly or in the wrong dosage. Some oils can be taken internally, but others—such as thuja, wormwood, mugwort leaf, tansy, hyssop, sage, and eucalyptus—can be toxic. Consult a health care professional before taking any oils internally. If you have asthma, don’t use essential oils before checking with your physician.
Essential oils should not be applied directly to the skin full-strength, but should be diluted in a carrier oils such as apricot kernel oil, sunflower oil, or sweet almond oil. The customary formula is 10 drops of essential oil per 20 ml of carrier oil. For sensitive skin or if you are pregnant, use 5 drops of essential oil per 20 ml of carrier oil. Make sure you’re not allergic to the oil before using. Test yourself by applying a drop inside your elbow and waiting 24 hours. If you’re allergic, a rash will develop.
There is no licensing process for aromatherapy practitioners in the United States.
CHIROPRACTIC
Chiropractic is a century-old healing art form that emphasizes the prevention of chronic disease through the maintenance of a healthy neuromusculosketletal system. The specialty dates back to 1895 when Dr. Daniel David Palmer was able to cure a man’s deafness by pushing a vertebra in the man’s back into proper alignment. Palmer took this as proof that spinal misalignment could lead to health problems and that spinal realignment could restore the flow of nerve impulses throughout the body.
A chiropractor uses medical diagnostic procedures, including, but not limited to, x-rays of the spine, to assess any dysfunction. He then uses a combination of spinal manipulation, exercise, and nutritional therapy to adjust the spinal column, correct structural imbalances, and restore joint mobility.
Chiropractic care can offer pain relief without the use of drugs or surgery. Patients find it an effective way to manage lower back pain, tension and migaine headaches, neck problems, ringing in the ears, and dizziness. It can also complement traditional medical treatment for such long-term disorders as asthma, chronic fatigue syndrome, and irritable bowel syndrome.
During an office visit, a chiropractor will take your medical history, ask you about your lifestyle and symptoms, and evaluate your posture and walk. During the examination, he will feel your vertebrae and joints and may perform a reflex test to check for nerve function. He will ask you to bend forward, backward, and sideways to check your range of motion. He may ask for x-rays to determine if there are any underlying joint problems that could be made worse by treatment.
Once a diagnosis is made, the chiropractor will adjust your joints by means of a controlled push that moves the joint beyond its restricted range of motion. Treatments are painless, and many people see results in nine to twelve sessions.
Today there are more than 50,000 chiropractors in the United States. More than 20 million people a year visit a chiropractor, making chiropractic the most popular form of nontraditional therapy.
Many doctors, however, continue to be skeptical of chiropractic for any condition other than back pain and minor muscle and joint pain. Skeptics maintain that chiropractors don’t have the training to diagnose or treat any other condition and could misdiagnose a patient or prevent her from getting necessary medical treatment as quickly as possible. A qualified chiropractor will, hwoever, refer a patient to a medical doctor if symptoms warrant.
CAUTION—Chiropractic can cause severe damage in cases involving a fracture or a tumor. There is a small risk of damage to blood vessels in the brain as a result of manipulation of the neck.
As college undergraduates, chiropractors follow a pre-med course of study for at least two years, followed by five years at an accredited chiropractic college. The curriculum is similar to the medical school curriculum, with additional emphasis on anatomy, nutrition, physiology, and rehabilitation, Chiropractors are licensed to practice in all 50 states and in the District of Columbia. To be licensed, they must be graduates of an accredited chiropractic college and pass a rigorous exam. Chiropractors maintain their licenses by taking continuing education courses.
HYDROTHERAPY
The use of water to relieve symptoms of health problems can be traced to many ancient cultures, among them the Romans, Egyptians, Hebrews, and Native Americans. Water can be used internally and externally in a variety of treatment applications, including whirlpool baths, ice packs, saunas, douches, colonic irrigation, sitz baths, compresses, wraps, and mineral drinking waters.
Hot water treatments can relax muscles and increase joint mobility. Cold water treatments can be effective for pain relief and reducing inflammation. Alternating hot and cold treatments can increase blood circulation through the elimination organs (such as the kidneys, liver, and skin), thereby detoxifying the system and improving the quality of the blood.
MASSAGE AND BODYWORK
You know how good a massage feels. But do you know what good it does? Massage, the manipulation of soft tissues, won’t cure what ails you, but it can go a long way toward relieving symptoms, especially those caused by stress. A good massage helps you relax. It can also be effective in the treatment of sports-related injuries, muscle and joint problems, headaches, and chronic pain—even sinus problems and digestive difficulties.
Massage can stretch tissues, increase range of motion, help lower blood pressure and heart rate, and improve breathing. Researchers believe that massage helps the brain produce endorphins, chemicals that act as natural painkillers.
There are several types of massage to choose from, including:
•Swedish massage, which uses long strokes, kneading, and various rubbing, vibrating, and pressure techniques
•Contemporary Western massage, which combines the basic techniques of Swedish massage with deep massage to relax specific muscles
•Sports massage, designed to help athletes—professionals and weekend warriors alike-avoid injuries, perform better, and, in the case of injury, heal more quickly.
While massage is generally safe for everyone, consult your health care practitioner if you have heart disease, circulatory problems, cancer, an infectious illness, or a skin condition. Massage can encourage bleeding and swelling and can promote the spread of disease throughout your body.
Bodywork is another one of the touch therapies, designed to help your body move more easily by improving muscle function, expanding your range of motion, increasing your coordination and balance, and reducing your level of stress. Bodywork techniques—many of them named after the individuals who developed them—include:
•Alexander Technique, a system to restore your range of motion through correct movement
•Feldenkrais Method, a system that combines gentle touch and movement training and is designed to increase your range and ease of motion and improve your flexibility and coordination
•Hellerwork, a form of therapy that uses deep massage and retrains you in basic movements
•Myotherapy, any treatment that affects your muscles, including physical therapy and massage
•Pilates, a series of precise movements used to condition your body and increase flexibility and strength, without causing bulky muscles
•Polarity Therapy, gentle touch applied to the craniosacral system (the bones of the skull) to balance the body’s energy fields
•Reiki, a Japanese system of healing the body, mind, and spirit in which energy flows from the practitioner through his hands and into your energy field without touching you
•Rolfing, a form of deep tissue massage that realigns your body
•Therapeutic Touch, touch-free massage by trained practitioners who manipulate the energy fields by passing their hands over your body
•Tragerwork, a combination of light massage strokes with gentle bouncing, shaking, and rocking movements of your trunk and limbs
The National Certification Examination in Therapeutic Massage and Bodywork is used by a number of states to license massage therapists; laws are pending in other states. Most states require 500 hours of training from a recognized professional school along with an examination.
OSTEOPATHY
Osteopathy, or ostepathic medicine, dates back to the 1870s. Frontier doctor Andrew Taylor Still believed that a person’s bones, muscles, ligaments, and connective tissues—the musculoskeletal system—was the basis for good health. On the basis of this belief, Dr. Still created a system of healing that employed touch and gentle manipulation of muscles and joints to the body’s own ability to heal itself, often without drtugs or surgery.
Osteopathic physicians gear their treatment toward three objectives: relieving tension so that muscles, ligaments, and joints are properly aligned; improving blood circulation and stimulating the nervous system; and correcting posture and other body mechanics to prevent health problems.
In addition to performing a complete physical exam with standard lab tests, an osteopath will conduct a structural exam to evaluate your posture, spine, and balance. He’ll press on your muscles, tendons, and ligaments to see if you feel tenderness, tension, or weakness, and he’ll evaluate your joints to assess your range of motion.
If a structural probem is found, the osteopath will use a technique known as osteopathich manipulative therapy (OMT) that involves various forms of massage, muscle pressure, and joint alignment. OMT is designed to relieve tension in affected muscles and ligaments, improve circulation, and improve posture and movement. It has been shown to work well on people with knee problems, lower back pain, neck problems, headaches, and chronic pain, as well as on other problems such as migraines and menstrual pain.
For acute illnesses and for those not caused by a structural abnormality, the osteopath may well rely on conventional medical techniques, including drugs or surgery.
Osteopathic physicians (D.O.s) are licensed in all 50 states as full physicians and can prescribe medication. They undergo the same basic training as M.D.s in terms of basic and clinical sciences. They must be graduates of a four-year accredited college of osteopathy and must have gone through a one-year internship in primary care. Many osteopaths also complete a residency in one of the 120 medical specialties. The medical boards make no distinction between D.O.s and M.D.s when it comes to standards of medical practice. The difference is that osteopathic doctors have additional training in the use of musculoskeletal diagnosis and manipulation.
REFLEXOLOGY
Reflexology, sometimes referred to as “zone therapy,” has been practiced in one way or another for centuries. The theory is that specific reflex points on the feet, hands, and ears mirror activity in other parts of the body. Manipulating these reflex points stimulates the healing response in the corresponding parts of the body.
Your toes, for example, correspond to your head and neck, your heel to your pelvic area, and so on. Pressure on corresponding points may cause soreness or tenderness. The more tenderness you feel, say reflexologists, the greater the need to balance your energy in that area. While some characterize this modality as a form of massage, reflexologists feel it is an energy-based intervention that promotes health by helping correct energy imbalances.
Practitioners say the treatment improves blood circulation, balances overactive or underactive glands, and relieves stress. Daily treatment is thought to balance the body’s energy and help you stay healthy. The technique is also used to treat a number of ailments including insomnia, headaches, premenstrual syndrome, sinusitis, and constipation.
Reflexology can be done by a professional practitioner or you can try it yourself or with a partner. Learn which points to work on by visiting a trained reflexologist or by consulting self-help books. The points are anatomically similar to the area that is troubling you—for example, the elbow would correspond to the knee and the wrist to the ankle.
The basic technique involves using the inside edge of the thumb pad, or the edge closest to the thumb of the index finger, in a slow, forward movement, bending the first joint of the thumb or finger slightly as it moves ahead. Hold your foot with one hand—the sole flat and the toes straight—and work on it with the other hand. To work on the hands, use the thumb of one hand on the palm of the other, or the index finger on the areas between the fingers. Feel for tension or gritty spots beneath the skin, known as “crystals.” These are believed to be signs of the blockage causing your individual symptoms.
Reflexologists are not licensed, but many are certifed by the International Institute of Reflexology.
Mind-Body Medicine
Mind-body medicine is a broad field with many different interventions which have been shown to alter physiology. Typical responses include reduced blood pressure, reduced blood clotting, elevated endorphins (which relieve pain and promote a feeling of well being), reduced cortisol and adrenaline levels (stress hormones that lower immunity and alter ciruclation), reduced muscle tension, and improved circulation.
Some of the better known mind-body therapies include behavioral therapy (counseling), biofeedback, guided imagery, hypnotherapy, laughter therapy, and meditation.
There’s a great deal of research that supports the effectiveness of mind-body therapies in the treatment of allergies, angina, anxiety, asthma, back pain, depression, headaches, hypertension, irritable bowel syndrome, post-traumatic stress disorder, and Raynaud’s syndrome. We’re just starting to grasp how powerfully our thought affect our physiology, and we can expect this growing awareness to lead to more widespread use of these therapies.
MEDITATION
Meditation can help relax your body and mind. While the practice is used as a pathway to spiritual enlightenment in Eastern cultures, in the West meditation is used in a non-religious context to promote peace of mind and ease stress-related symptoms such as chronic pain, high blood pressure, panic disorders, headaches, respiratory problems, insomnia, and premenstrual syndrome.
Most meditation techniques practiced today come from ancient Eastern traditions. All have a few simple steps in common. Sit quietly and focus on a single thought, a single sound, or on your breathing. Ignore all distractions. Let all other thoughts that come to your mind float away.
One of the most widely recognized forms of meditation in the West is known as transcendental meditation (TM), introduced to the United States by Maharishi Mahesh Yogi in the 1960s. Practitioners of TM meditate by reciting a certain word or sound, called a mantra, often selected for the individual by a meditation instructor, or guru. Any word will work, however.
You can learn to meditate on your own by using self-help books, audiotapes, or videotapes, but a trained instructor can help you develop your skills more quickly.
There are no licensing requirements for instructors of meditation. Many hospitals, wellness centers, and continuing education programs offer classes and workshops.
YOGA
Yoga, a Sanskrit word meaning “union,” originated in India more than 5,000 years ago. The practice of yoga involves a series of physical poses, known as asanas, designed to quiet the mind by teaching you how to pay attention to your breathing and to the movement—or stillness—of your body.
Yoga postures reestablish structural integrity by stretching and strengthening muscles to expand the natural range of motion, massaging internal organs, relaxing nerves, and increasing blood circulation. Depending on which poses you use, yoga can work on every muscle, nerve, and gland in your body. And because it focuses and calms the mind, it can help ease feelings of anxiety, fatigue, and depression, preventing or alleviating many stress-related conditions.
Yoga is useful not only as a stress-reducer, but as a way to ease back and neck problems and relieve symtoms associated with heart disease, high blood pressure, arthritis, asthma, chronic fatigue syndrome, allergies, diabetes, and digestive problems.
Although yoga is one aspect of the Hindu religion, yoga itself is not a religion and can be practiced by people of all religions and philosophies. It was developed by spiritual students who wanted to strengthen and energize their bodies to better withstand the rigors of long hours of meditation.
The most popular form of yoga in Western culture is Hatha yoga, which focuses on the balance between the body and the mind and uses physical postures, breathing techniques, and meditation. By helping establish the proper alignment of energy within the body, yoga promotes general good heal in the individuals who practice it.
Classes are taught at health clubs, colleges, hospitals, and community centers. There are also a number of self-help books and videos that can teach you the basics.
Yoga instructors are not licensed. Some organizations do offer certification, but the requirements differ from group to group.