INTRODUCTION
- The complementary and alternative medicine (CAM) field is
complex, involving practitioners of many types, terminology that is not
generally a part of allopathic or conventional healthcare, and various levels of
scientific evidence guiding its use.
- The term “CAM” grew
out of a movement that had defined
itself as “wholistic” or “holistic”
medicine and has since addressed similar topics as the more recent field of
integrative health and medicine.
- Of note, a broader term “healthcare” is replacing “medicine”
in this discussion, allowing the involvement of many associated healthcare
practitioners, including physicians, nurses, nutritionists, and pharmacists.
- Table 1
addresses some of the main characteristics of these terms, and despite
considerable overlap in philosophy and approach to treatment, for the sake of
simplicity of discourse, this article will refer to the overall field as CAM
- Purpose: To
provide a general overview of some of the main components of CAM, or integrative
health/medicine, as defined by governmental groups, academic centers, and
individual associations, complete with basic definitions and some
representative research trials
- Goals: For the
reader to learn basic characteristics about the main CAM modalities, be exposed
to some examples of related scientific evidence, and know where to go to learn
more.
- It is beyond the scope of this article to explain in depth
the theory or philosophical underpinnings, mechanisms of action, or applications
in specific disease states, or to provide a complete review of relevant
research; to these ends, the readers will be directed to other sources of
information and further education.
- The CAM modalities in this article, reviewed alphabetically below, focus on the most
common health practices in the United States and were selected from CAM use review
articles, governmental groups, and academic research initiatives that have
defined the field, including energy
medicine, herbal medicine, homeopathy, mind-body medicine, nutrition, physical
medicine, and a section dedicated to healthcare systems based in Asia but that are being popularly used
and studied in North America.
VARIOUS CAM
MODALITIES
1) Energy Medicine
- Includes numerous techniques
- In general, involves measurable, or veritable, energy and
immeasurable, or putative, energy
- Veritable energies
treat patients with mechanical vibrations (sound) and electromagnetic forces
- Putative energy
therapies are predicated on the concept that humans are “infused with a subtle
form of energy” (ie, vital energy or life force) that is not measurable by our
Western scientific paradigm.
- Those who practice energy
medicine believe that illness results from disturbance of these energy fields.
- Energy medicine is considered one of the more controversial CAM practices
because of the difficulty in studying the energy fields and quantifying the therapeutic
effects of the practices.
Example of putative energy treatment technique
a) Reiki
- Reiki uses subtle
vibrational energy through light
touch of the hands.
- It is believed that Reiki heals by charging affected parts of a
person’s energy field with positive energy, which in turn causes the
negative energy to fall away.
- The ultimate effect is to clear, straighten, and heal energy pathways,
allowing the life force to flow in healthy and natural way
- This technique was developed in
mid–nineteenth century Japan by Mikao Usui, a
Japanese monk who would place his
hands on people for healing as part of his spiritual practice.
- Nearly a century later, Usui’s
technique has evolved and become a popular healing modality throughout the
world for a variety of medical conditions, though most commonly for chronic pain,
cancer pain, arthritis pain, depression, and anxiety.
- There is a paucity of evidence supporting Reiki as a viable therapeutic
modality, most likely because of the difficulty of studying putative energy
therapies.
- One recent review concluded that
the evidence is insufficient to suggest Reiki as an effective treatment for any
condition, and therefore the clinical value remains unproven
b) Therapeutic touch (TT)
- Usually involves the TT
practitioner moving his or her hands over the patient’s body to become familiar
with the patient’s condition and enhance their natural potential to heal.
- It was started at the
Theosophical Society retreat center in New York state by Dora Kunz and her
colleague Dolores Krieger, PhD, RN, in 1972, and currently is most often used
by nurses.
- Like Reiki, there are many
clinical uses for TT, such as anxiety, stress reduction, relaxation, pain
relief, and wound healing, though convincing evidence of efficacy is lacking.
- There has been 1 favorable
recent review, showing efficacy for TT in treating acute and chronic pain
2) Herbal Medicine
- It is estimated that 80% of the
world’s population relies on traditional medicine, largely herbs, to meet their
primary healthcare needs.
- Herbal medicine infuses the
current medical system not just from this popularity, but also from the
multitudes of pharmaceutical products that are directly or indirectly derived
from plants; examples include taxol from the Pacific yew (Taxus brevifolia),
vincristine and vinblastine from the rosy periwinkle (Catharantheus roseus),
and digoxin from foxglove (Digitalis spp.).
- These connections are often the
basis behind healthcare practitioners’ motivation to begin the process of learning
about herbal medicines
- For the clinical
application of herbal medicine, practitioners of many different backgrounds base
clinical recommendations on the level of evidence of efficacy and risk of use
(ie, documented or theoretical possibility for adverse effects), taking into consideration
what other treatment options that a particular individual has for a given
medical condition (Table 2).
- The clinical integration of
these factors is one way to provide structure in learning about and prescribing
herbal medicines.
- One example is given for each
category, though the reader is encouraged to use the many resources available (Table 3) to begin learning about other
plants that can be used for medicinal purposes and their potential adverse effects,
and to begin developing a referral network of herbal medicine experts, such as
herbalists, naturopathic physicians, or other practitioners with advanced
training in the field.
3) Homeopathy
- Homeopathy, considered one of
the “Whole Medical Systems” by the National Center for Complementary and Alternative
Medicine (NCCAM), is founded on the principle that a substance that causes symptoms in large doses can alleviate those
symptoms when given in markedly diluted doses; in some cases, the doses are
so low that little, if any, of the original substance remains, leading some
practitioners to consider homeopathy one of the energy medicine modalities (the
remedy is based more on remaining energetic properties of the substance than
the substance itself).
- Treatment using homeopathic
remedies can be determined in different ways, such as in “constitutional homeopathy,”
which is based on an extensive patient intake, or in more acute prescribing,
usually using combinations of individual remedies.
- The practice of homeopathy,
pairing a remedy with a specific patient and his or her specific set of
symptoms, inherently makes it difficult
to study in the conventional sense of a randomized, placebo-controlled trial.
- Nonetheless, some clinical
trials have been undertaken to examine the use of one of several homeopathic
remedies for a given clinical entity, or the effect of a single homeopathic
product on a group of patients.
- For example, one of the first
research trials on this topic randomized 81 children with acute diarrhea to
receive either one of 18 individualized homeopathic remedies or placebo.
- The homeopathic treatment group
showed a statistically significant decrease in the number of days until there
were less than 3 unformed stools.
- Homeopathy is commonly studied
using numerous individualized treatments in this way
- Since some of this initial
research, other applications for homeopathy have been analyzed in clinical
trials, including postoperative pain, sinusitis, injuries, skin conditions, and
ADHD, 29 among many others.
- The results have been mixed,
with some trials showing no effect.
- The appearance of meta-analyses
should begin to shed light on the medical conditions for which homeopathy is
most effective
- One of the benefits often mentioned
for the use of homeopathy is the almost complete absence of adverse effects;
remedies are extreme dilutions of single substances, leaving mostly an
“essence” of the compound, and such a low dose is considered very unlikely to
cause an adverse effect.
- This advantage of homeopathic
remedies makes them very interesting candidates for adjunctive therapy in
combination with conventional treatment, as well as for clinical entities with
a paucity of convincing allopathic medical options
Note on Homeopathy (ZYL):
- One meta-analysis published in
Lancet in year 1997 by Linde et al, concluded that “there is insufficient
evidence that homoeopathy is clearly efficacious for any single clinical
condition” DOI: 10.1016/S0140-6736(97)02293-9
- Another more recent
meta-analysis of RCTs by Mathie et al (2014) concluded that “Medicines
prescribed in individualised homeopathy may have small, specific treatment
effects. The low or unclear overall quality of the evidence prompts caution in
interpreting the findings. New high-quality RCT research is necessary to enable
more decisive interpretation”. DOI: 10.1186/2046-4053-3-142
4) Mind-Body Medicine
- Defined as treatments that focus
“on the interactions among the brain,
mind, body, and behavior, and on the powerful ways in which emotional,
mental, social, spiritual, and behavioral factors can directly affect health.”
- The physiologic theory underlying mind–body medicine is the brain and
central nervous system’s modulation of immunologic, endocrine, and autonomic functioning,
which in turn influences states of health and disease.
- A central focus has been the deleterious effects of the stress response; mind–body modalities seek to alter this process via
various forms of stress management, relaxation, coping skills training, and
cognitive behavioral techniques combined with health and disease-specific education.
- There are numerous mind–body
techniques; the most commonly used and largely substantiated modalities include
cognitive behavioral therapy, hypnosis, biofeedback, autogenic training,
progressive muscle relaxation, guided imagery, and meditation
- Clinical research is beginning
to support the use of mind-body techniques as a component of treatment for arthritis,
chronic low-back pain, coronary artery disease and cardiac rehabilitation,
headaches, hypertension, insomnia, incontinence, disease treatment–related
symptoms of cancer, and for improving postsurgical outcomes.
- Other research has explored
possible mechanisms of action in the above conditions.
- However, it should be noted that
comprehensive analysis of mind-body
medicine has been difficult because
of poor methodological quality of
studies and reporting biases
Example of application of
mind-body medicine
a) Cardiovascular disease and
hypertension
- In one study, when incorporated
into cardiac rehabilitation programs, mind–body therapies have demonstrated
reductions in mortality and recurrent cardiac events along with improvements in
diet, exercise, weight, smoking, cholesterol, and blood pressure
- A recent 2-part article
discusses the evidence relating chronic stress, insulin resistance, and
cardiovascular disease to the potential role of mind–body therapies in
disrupting these pathological processes. (Part I: Innes et al. Alt Ther Health
Med. 2007;13:46-52. Part II: Innes et al. Alt Ther Health Med.
2007;13:44-51)
- Two recent systematic review
have demonstrated significant reductions in both systolic and diastolic blood pressure
associated with the practice of transcendental meditation. (Rainforth et al. Curr
Hypertens Rep. 2007;9:520-528 & Anderson et al. Am J Hypertenstion.
2008; 21:310-316)
- The use of biofeedback in
patients with congestive heart failure has been shown to improve cardiac output,
entrain slower breathing, and improve exercise tolerance. Further, the
relaxation response induced via biofeedback serves to decrease activation of
the sympathetic nervous system and, much like the action of β-blockers, may
facilitate remodeling of the heart
b) Oncology Care
- A significant amount of
literature has demonstrated that mind-body therapies are beneficial for
reducing physical and emotional symptoms and improving quality of life among cancer survivors. For example,
psychosocial stress may have a role in physical and mental health status and
outcomes in cancer patients.
- Specifically, symptoms related
to stress include anxiety, depression, traumatic stress symptoms, fatigue,
pain, impaired sleep, increased morbidity and mortality, decreased immune
function, increased relapse, and decreased quality of life.
- Mind-body techniques that
function to address this stress can be powerful
adjuncts to regular oncology care, thereby serving to improve health
status, disease outcome, and overall quality of life. Mechanism of action and
efficacy data exist to support the benefit of these therapies. (Monti et al. Cancer.
2008;112(11 suppl):2607-2616)
c) Pain-related disorders
- Research has also investigated
the role of mind–body therapies in pain-related disorders.
- A review examining the use of
biofeedback for tension and migraine headaches demonstrated a reduction in
headache frequency, medication use, and associated depression and anxiety.
(Nestoriuc et al. App Psychophysiol Biofeedback. 2008;33:125-140)
- For patients with chronic pain, various
techniques such as hypnosis, meditation, biofeedback, guided imagery, and
cognitive behavioral therapy have all demonstrated efficacy and share a common
goal of instilling self-control and self-management. Among these techniques,
cognitive behavioral therapy is the most extensively studied and supported
approach. (Turk et al. Can J Psychiatry. 2008;53:213-223)
d) Other potential applications
- Additional promising areas of
inquiry that have recently been reviewed involve the use of mind–body techniques
to reduce seizure frequency and improve quality of life in patients with
epilepsy; to modulate perceived stress, mood, and perinatal outcomes; to manipulate
the interaction of brain and immune system, hereby altering the course of
autoimmune disease; in the treatment of depression and anxiety; and in the treatment
of irritable bowel syndrome in adults
5) Nutrition
- Dietary modification is a
cornerstone of CAM for both prevention and treatment of various conditions.
- It is well known that food
choices have a large impact on health and that specific nutrition interventions
can significantly affect many diseases.
- One approach to the large topic
of nutrition is to focus on general diets or types of food choices and healthful
eating
- The Mediterranean Diet and the
Anti-inflammatory Diet (AID), for which there is some of the best clinical data
in favor of disease modification and health promotion, will be discussed.
a) Mediterranean Diet
- The Mediterranean Diet is a
composite of the eating styles of Spain, southern France, Italy, Greece, Crete,
and parts of the Middle East. This diet rose to Western popularity beginning in
the 1940s, but it was the physiologist Ancel Keys in 1975 who pioneered the
investigation of
the relationship between dietary
fat and serum cholesterol and the risk of coronary heart disease.
- This diet includes a high intake
of fruit, vegetables (mostly wild plants), nuts, cereals, olive oil, a moderate
intake of mostly red wine, and fish, with a lower intake of meat and dairy
products
- Analysis of this dietary pattern
shows a number of protective substances, such as selenium, glutathione, a
balanced ratio of ω-6 to ω-3 fatty acids, high amounts of fiber, antioxidant
phytochemicals (especially resveratrol from wine and polyphenols from olive
oil), and vitamins E and C, some of which have been shown to be associated with
lower risk of cancer and with other health benefits.
- Multiple small studies have been
published that demonstrate the health benefits of adhering to the Mediterranean
Diet, but there are 2 larger-scale studies that prove its efficacy on a
population level.
- A randomized, secondary-prevention
trial known as the Lyon Diet Heart Study
tested whether the Mediterranean Diet may reduce the rate of recurrence after a
first myocardial infarction (MI). The study confirmed the protective effect of
the Mediterranean Diet and its ability to prevent recurrence of MI up to 4
years after the first infarction
- The second study, the National Institutes of Health American
Association of Retired Persons (AARP) Diet and Health Study, investigated
the effect of the Mediterranean dietary pattern on mortality. Men (n = 214,284)
and women (n = 166,012) ages 50-71 participated in this prospective study and
were followed for 10 years. The results revealed that adherence to the
Mediterranean diet was associated with reduced all-cause and cause-specific
mortality
b) The Anti-inflammatory Diet
(AID)
- The AID is not intended as a
temporary weight loss program, but rather as a way of selecting and preparing
foods to help decrease an unhealthful inflammatory response.
- Focuses on the types of carbohydrates and fats, promotes the
intake of dietary antioxidants by eating fruits and vegetables from the full color spectrum, and encourages
changing from coffee to green tea (Camellia
sinensis) to take advantage of the antioxidant polyphenols in green tea,
and recommends that people increase consumption of culinary spices with anti-inflammatory properties
such as ginger, turmeric, and garlic.
- By focusing on the types of fat intake, the AID involves decreasing intake of saturated fat and trans
fatty acids, and decreasing the ω-6 fatty acid intake and increase ω-3
fatty acid intake to approach a 1:1
ratio of ω-6:ω-3.
- With respect to carbohydrate types, the AID involves
more low-glycemic index (GI)
carbohydrates and less high-GI carbohydrates; the goal is to moderate serum blood
glucose spikes, leading to fewer compensatory insulin increases and the
associated inflammatory response thought to result from high insulin levels
- The majority of the research
pertaining to the AID as a whole centers around ω-3 fatty acids. When ω-3 fatty
acids (vs ω-6 fatty acids) are preferentially metabolized by cyclooxegnase and
lipoxegnase, less arachadonic acid is formed and the creation of less
pro-inflammatory prostaglandins and leukotrienes is promoted. The overall
result of an ω-6 to ω-3 ratio closer to 1:1 (more typical in the Western diet
is 10-20:1) is a shift to a less inflammatory physiological state.
(Note from ZYL: Personally, I disagree that nutrition be
categorized under CAM. In my opinion, CAM are treatment that lacks extensive
research, and nonessential (the ‘unused’ of CAM will not put the patient at
risk of worsening of disease if proper treatment is given under modern medicine).
However, nutrition (medical nutrition therapy) is derived from extensive research
and is indispensable in the management of diseases such as diabetes,
hypertension, cardiovascular diseases etc. What do you think?)
6) Physical Medicine
- Called “body-based practices” by
NCCAM, physical medicine and manual therapy are general terms used to describe
treatments aimed at affecting the
structure or function of some part of the body, such as soft tissue
(muscle, fascia, ligaments, tendons) or bones.
- Examples of modalities that fall under physical medicine are chiropractic, massage, and osteopathic
manipulation; there are other techniques that could be listed under these
modalities, such as craniosacral therapy
and muscle-energy release
- Practitioners with various levels
of training are involved in physical medicine, including chiropractors (doctors of chiropractic, or DC), massage therapists (licensed massage
therapists, or LMT), osteopathic
physicians (doctors of osteopathy, or DO), naturopathic physicians (naturopathic doctors, or ND), and allopathic healthcare providers who
have obtained additional training.
- An overlap with some treatments
that are considered within the realm of conventional medicine, such as physical
and occupational therapy, often exists; there are state-to-state variations in
the scope of practice of the different physical medicine practitioners that may
affect which specific techniques fall into the realm of which particular
practitioner
- The decision about whether to use physical medicine treatments or refer
a patient for physical medicine depends on the physical medicine practitioner’s
specialties and particular skill set (does it overlap with the patient’s
complaints?), as well as, after an examination including palpation of the
affected joint(s) or muscle, whether the physical medicine specialist sees a
possible pairing of a specific treatment modality with that patient’s health
condition. Furthermore, numerous clinical trials, some of which are reviewed
below, are attempting to clarify which diagnoses fit best with which
modalities.
- Most of the research has been on
spinal manipulation for various musculoskeletal complaints.
- For acute or chronic low-back pain, one review of 39 trials found that spinal
manipulation did not appear to be statistically superior to analgesics, general
medical care, physical therapy, exercises, or classes about a healthful back
care regimen (“back school”), taking into account methodological quality, the
training of the practitioner, and other therapies used.
- For neck pain, a review of 4 clinical trials found that for neck pain
of various etiologies, there was no difference between exercise therapy and
chiropractic spinal manipulation; the authors clarified that the paucity of
research on manual medicine makes it difficult to say that manual medicine is
as effective as exercise regimens. None of the trials were sham controlled,
compromising the research quality
- For chronic headaches, one review of 9 trials that included 683 people demonstrated
the challenges of pooling physical medicine data to provide clinical
recommendations.
- The studies involved varied in
methodological quality and examined headaches of different etiologies, but the authors
were able to draw the preliminary
conclusions that spinal manipulation
appeared to be better than massage for cerviogenic headaches, similar to
tricyclic antidepressants for chronic tension headaches, and not additionally useful
from massage for episodic tension headaches
- Researchers have also examined
the use of massage for low-back pain and
functioning; some of the trials compare massage to sham treatments, whereas
other trials suffer from methodological flaws. Nonetheless, massage appears to be similar to exercise
and better than spinal manipulation, physical therapy, self-care instruction,
acupuncture, and relaxation therapy; these results do not hold for reflexology of the feet
- In summary, research has begun
to guide the clinical use of the different physical medicine modalities. For example,
the results have been mixed for which modality is the most effective for acute
low-back pain, but most modalities have consistently shown benefit for chronic low-back
pain. Also, spinal manipulation has shown benefit or neck pain and cervicogenic
headaches.
7) Ayurveda, Traditional Chinese Medicine, and Kampo Medicine
- In general, there are interesting
differences in philosophy, diagnosis, and treatment between these 3 systems,
often referred to collectively as “Eastern” medicine, and healthcare provision in
the United States and Europe, or “Western” medicine
- For example, Western medicine’s
concept of disease is pathogen based, with a specific treatment targeted
to the specific pathogen.
- Eastern medicine is more system based,
and disease is understood as a physiological manifestation of a disturbance or
weakening of the body; in this respect, prevention is often a key component of Eastern
medicine
- Additionally, treatments tend to be individualized to
the patient, and the presenting symptoms are adjusted as symptoms change and
may incorporate multiple modalities as well as components of herbal formulae
- It follows that isolating a single element from an entire
system of treatment may yield very different results than when examined
within a holistic treatment context.
- This background helps to explain
the variety of research results, ranging from evidence of potential benefit to
inconsistent or no clear evidence of efficacy; this variety is often a result
of a lack of high-quality randomized controlled
trials and the difficulty of designing studies that take into account Eastern
understanding of cause of disease, classification of disease, and approach to patient
treatment.
a) Ayurveda
- Ayurvedic medicine is an ancient
system of medicine, with origins approximately 5000 years ago.
- A key concept in understanding health and disease in Ayurvedic
medicine is the tri-dosha theory.
- The 3 doshas, or energies, are vata, pitta, and kapha.
- Each person is endowed with a
particular constitution, or prakruti, that is some combination of these doshas.
- There may be 1 prominent dosha,
co-dominance of 2 doshas, or occasionally an equal presence of all 3.
- One’s prakruti is said to
govern responses to mental and physiological occurrences
- As such, disease is understood to result from the combination of an imbalance of
the doshas, low immune function, and the presence of toxins, or ama.
- Therefore, an understanding of
one’s prakruti enables lifestyle changes to be implemented to prevent
manifestation of disease.
- Similarly, a balancing of the doshas
is an integral part of treating disease that is already present
- Ayurvedic treatment modalities are employed to remove the cause of imbalance or disease, strengthen the body’s
ability to eliminate toxins, and reestablish a state of balance.
- Detoxifying the body proceeds
via the use of active purging and purifying measures (panchakarma) or via
the use of herbs and fasting
- During and after this process,
proper lifestyle, diet, and exercise for one’s constitution must be maintained.
- Other modalities include pranayama
(breathing exercises), yoga, meditation, gemstones, crystals, metals,
sound, and color.
- Some of the treatment approaches
in Ayurvedic medicine have been subject to research studies.
- For example, many Ayurvedic herbs
now have data showing varying levels of efficacy.
- The herb curcumin is being
studied in many disease models, including multiple myeloma, pancreatic cancer,
myelodysplasia, monoclonal gammopathy of unknown significance, colon cancer,
Barrett’s metaplasia, ulcerative colitis, primary sclerosing cholangitis,
Alzheimer’s disease, and psoriasis.
- Also, yoga, another treatment
from the Ayurvedic tradition, has been investigated for many conditions, including
menopause, cancer, and depression.
b) Traditional Chinese Medicine
(TCM)
- The practice of TCM began
approximately 2000-3000 years ago and has its roots in Taoist, Buddhist, and
Neo-Confucian philosophy.
- Two central concepts of TCM are yin-yang
and wu xing
- TCM theory holds that the universe, including the body, is composed
of the 2 opposite components yin and yang.
- Yin is inactive, descending, internal, cold, and dark.
- Yang is active, ascending, external, hot, and bright.
- Based on these characteristics, the body’s physiological functions
and organs as well as signs and symptoms can be divided into yin and yang.
- Wu xing is the theory that all things in the
universe are composed of 5 elements—wood, fire, earth, metal, and water—each
associated with specific relationships to the others.
- Each of the internal organs represents an element, and the organs
interact according to these characteristic relationships.
- Harmony is maintained through the proper function of the internal
organs (zang-fu) and blood, body fluids, and qi (vital energy),
which circulate through the meridian (jing) and collateral (luo)
system
- Disease manifests from a disturbance in the body’s harmony, or
an imbalance in yin, yang, and wu xing.
- This disturbance manifests as disruption in qi, blood, body fluids,
or the internal organs, producing certain symptoms.
- Causes of imbalance and disease are classified as internal, external,
and other.
- External factors include
excessive wind, cold, heat, dampness, dryness, and fire.
- Internal factors are excesses
of the emotions.
- Other factors include
diet, taxation fatigue, trauma, sexual activity, and parasites
- A central theme of TCM treatment is prevention of disease through
proper lifestyle.
- When a disease is present, treatment for symptomatic relief may be
given, and then attention is focused on addressing the root cause.
- Treatment modalities include herbs; acupuncture; moxibustion (burning
the herb moxa, or mugwort, at acupuncture points either directly on the skin, held
over the skin, or attached to inserted acupuncture needles); massage and
acupressure (tui na); mind–body techniques (qigong and tai ji
quan); and dietary therapy.
- The research literature for TCM modalities is extensive, including
both foreign-language journals and, more recently, English-language journals.
- A complete review of the research is beyond the scope of this
article, but Table 4 lists some of the
current literature based on individual studies as well as systematic reviews.
- In addition to the difficulties in interpreting TCM research as
discussed above, some clinical trials have been found to lack randomization, further compromising the validity and
applicability of the research results
c) Kampo
- Kampo, or Traditional Japanese Medicine, is largely derived from the
introduction of TCM to Japan and has been in practice for approximately 1500
years.
- Accordingly, its philosophy
is similar to that of TCM, but it has a more practical symptom-based approach largely because of a later
Western medical influence and the necessity
of validating treatment to be included
in coverage by Japan’s national
health insurance (NHI) program.
- Therefore, although disease is understood to be a result of the
imbalance of the body’s systems, diagnosis and treatment focuses mainly on the
symptoms, or Sho, and the corresponding herbs used to treat such
symptoms.
- Treatment is primarily herbal, with more than 200 herbs in use, 148
of which are covered by the NHI program.
- As in TCM, acupuncture, acupressure (shiatsu), and moxibustion may also be part of a patient’s treatment
plan
- Of the 3 systems of medicine discussed in this section, Kampo has the
least amount of published research regarding
evaluation of its efficacy in treating disease as classified in Western terms.
- Much research has been devoted to the chemical analysis and more
recently, to the physiological, biochemical, pharmacological, and immunological
effects of Kampo herbs
CONCLUSIONS
- This article reviewed several of the main CAM modalities, providing
basic background and some of the relevant research studies.
- Complementary and alternative medicine is composed of many different
treatment techniques and approaches, is very popular in the United States, and is
becoming part of the provider-patient discussion in clinics of all types.
- The evidence for or against its use is accumulating; some of the
journals and other sources listed here will help practitioners interested in
CAM to further delve into the topic.
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