Complementary Medicine

Lecture 1

What is Complementary Medicine

Dr. M.Waleed M.Sadaka

► History:
 What is Complementary Medicine?
Complementary medicine (CM) refers to a group of therapeutic and diagnostic disciplines that exist
largely outside the institutions where conventional health care is taught and provided.

1970 these disciplines were mainly provided as an alternative to

conventional health care and hence became known
1980 collectively as ‘alternative medicine’.

The name ‘complementary medicine’ developed as the two systems began to be

used alongside (to ‘complement’) each other.

World Health Organization (WHO): Alma Ata Declaration on Primary Health Care (PHC):
1978 Integration of Traditional Medicine in PHC

US Congress established the National Center for Complementary and Alternative Medicine
1999 (NCCAM) in the National Institutes of Health (NIH) Bethesda, Maryland.
Dr. M. Waleed M. Sadaka 2
► Definitions and terms:
 Terminology:
Is most mainstream medicine practiced and determined by the
Conventional (or Modern) Medicine:
evolving scientific method.

Is eclectic mixture of healing approaches and therapies that

Complementary Medicine (CM): historically have not been included in conventional, mainstream
medicine.

Alternative Medicine (AM): Is unconventional practices used instead of mainstream medicine.

Is an approach to care that puts the patient at the center and

Integrative Medicine (IM): addresses the full range of physical, emotional, mental, social,
spiritual and environmental influences that affect a person’s health
Employing a personalized strategy that considers the patient’s unique conditions, needs and
circumstances, it uses the most appropriate interventions from an array of scientific disciplines
to heal illness and disease and help people regain and maintain optimum health.
Dr. M. Waleed M. Sadaka 3
► Definitions and terms:
 Definition of CM adopted by the Cochrane Collaboration Complementary Medicine Field:
Complementary medicine includes all such practices and ideas which are outside the
domain of conventional medicine in several countries and defined by their users as
preventing or treating illness, or promoting health and well being.
 National Institutes of Health (NIH) adopted the definition of complementary medicine as follows:
A broad domain of healing resources that encompass all health systems, modalities
and practices and their accompanying theories and beliefs, other than those intrinsic to
the politically dominant health care system of a particular society or culture in a given historical period.

 These practices complement mainstream medicine by:

1 Contributing to a common whole

2 Satisfying a demand not met by conventional practices

3 Diversifying the conceptual framework of medicine
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► Disciplines: Common complementary therapies
1 Acupressure 11 Hypnosis Which disciplines are complementary ?

2 Acupuncture 12 Massage This list is not exhaustive, and new

3 Anthroposophic medicine
4 Applied kinesiology
5 Aromatherapy
branches of established disciplines are
13 Meditation continually being developed.
14 Naturopathy
Also, what is thought to be conventional varies
15 Nutritional therapy between countries and changes over time.

6 Ayurveda 16 Osteopathy

7 Chiropractic 17 Reflexology
The boundary between
8 Environmental medicine 18 Reiki
complementary and conventional
9 Herbal medicine 19 Relaxation and visualization medicine is therefore blurred and
constantly shifting.
10 Homeopathy 20 Yoga
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► Organizational structure:
 The development of CM has taken place largely in the private sector. Until recently, most complementary
practitioners trained in small, privately funded colleges and then worked independently in relative
isolation from other practitioners.

 An increasing number of complementary therapies are now taught at degree and masters level in
universities.

 More complementary medical research exists than is commonly recognized.

over 6000 randomized trials and around 150 Cochrane reviews of complementary
the Cochrane Library and alternative medicine (CAM) have been published, but the field is still poorly
researched compared with conventional medicine.

 There are several reasons for this, some of which also apply to conventional disciplines like surgery,
occupational therapy, and speech therapy:
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► Organizational structure:
 Factors limiting research in complementary medicine:
1. Lack of research skills:
Complementary practitioners have traditionally had no training in critical evaluation of
existing research or practical research skills. However, research now features on some
training programmes and a number of practitioners now study to masters and PhD level.

2. Lack of an academic infrastructure:

most CAM practitioners have limited access to computer and library facilities,
statistical support, academic supervision, and university research grants. However,
a number of academic centres of excellence in CAM research are developing
and this will support research capacity in CAM
3. Insufficient patient numbers:
individual list sizes are small, and most practitioners have no disease ‘specialty’ and
therefore see very small numbers of patients with the same clinical condition.
Recruiting patients into studies is difficult in private practice
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► Organizational structure:
 Factors limiting research in complementary medicine:

4. Difficulty undertaking and interpreting systematic reviews:

Poor quality studies make interpretation of results difficult. Many different types of
treatment exist within each complementary discipline (for example, formula,
individualized, electro, laser, and auricular acupuncture)

5. Methodological issues:

responses to treatment are unpredictable and individual, and treatment is usually not
standardized. Designing appropriate controls for some complementary therapies (such as
acupuncture or manipulation) is difficult, as is blinding patients to treatment allocation.
Allowing for the role of the therapeutic relationship also creates problems

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► Approaches to treatment:
 The approaches used by different complementary practitioners have some common features. Although they
are not shared by all complementary disciplines, and some apply to conventional disciplines as well, understanding
them may help to make sense of patients’ experiences of complementary medicine.
1 Holistic approach S Spiritual

 Many, but not all, complementary practitioners have a

multifactorial and multilevel view of human illness.
 Disease is thought to result from disturbances at a
Family
F C Community

combination of physical, psychological, social, and Human

spiritual levels. The body’s capacity for self-repair, given being
appropriate conditions, is emphasized.
 According to most complementary practitioners, the purpose of
Physical
P E M Mental

therapeutic intervention is to restore balance and facilitate the

Environment
body’s own healing responses rather than to target individual
disease processes or stop troublesome symptoms.
 They may therefore prescribe a package of care, which could include modification of lifestyle, dietary change,
and exercise as well as a specific treatment.
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► Approaches to treatment:
2 Use of unfamiliar terms and ideas

 Complementary practitioners often use terms and ideas that are not easily translated into Western
scientific language.
For example
Reflex zones Qi energy
Dose not have any correlates to

Anatomical or Physiological

 It is important not to interpret terms used in complementary medicine too literally and to understand
that they are sometimes used metaphorically or as a shorthand for signs, symptoms, and syndromes that
are not recognized in conventional medicine.
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► Approaches to treatment:
2 Different categorization of illness

 Complementary and conventional practitioners often have very different methods of assessing and
diagnosing paients.
Thus, a patient’s condition may be described as
traditional acupuncturist homeopath conventional doctor

deficient liver Qi pulsatile constitution peptic ulcer

In each case the way the problem is diagnosed determines the treatment given

 It should be stressed that the lack of a shared world view is not necessarily a barrier to effective
cooperation. For example, doctors work closely alongside hospital chaplains and social workers, each
regarding the others as valued members of the healthcare team.
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► Whole Medical Systems:
 Whole medical systems are built upon complete systems of theory and practice.

1 Traditional Chinese Medicine (TCM)

 Traditional Chinese medicine, or TCM, is a healing system that dates back more than 2000 years.

 It is based on the concept that disease results from disruption in the flow of vital energy, or Qi in the
body.

 The flow of Qi is maintained by keeping a balance in the two forces known as yin and yang.

 TCM uses three main therapeutic approaches: acupuncture and moxibustion, herbs and other
natural products, and massage and manipulation.
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► Whole Medical Systems:
2 Ayurvedic Medicine

 Ayurveda, which means “the science of life” in Sanskrit, originated in India and evolved there over
thousands of years.

 Its goal is to prevent and treat disease by bringing the body, mind, and spirit into balance.

 Three qualities called doshas are believed to form important characteristics of each person’s body
constitution and to control bodily activities.

 Imbalances in the doshas, which can be caused by an unhealthy lifestyle, diet, stress, the weather,
chemicals, or germs, can lead to illness.

 Ayurvedic medicine relies on therapies such as diet, exercise, meditation, herbs, massage, exposure
to sunlight, and controlled breathing.
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► Whole Medical Systems:
3 Homeopathy
 Homeopathy originated in Europe and has been practiced in the United States since the early 19th
century.

 Its goal is to help the body heal itself by using very small doses of highly diluted substances that in
larger doses would produce illness or symptoms.

 Most homeopathic remedies are derived from natural substances that come from plants, minerals, or
animals.

 A homeopathic practitioner will select treatments based upon a total picture of a person’s symptoms,
not solely upon the symptoms of a disease.

 Homeopaths evaluate not only a person’s physical symptoms but emotions, psychological state,
lifestyle, nutrition, and other aspects.

 In homeopathy, different people with the same symptoms may receive different homeopathic remedies.
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► Whole Medical Systems:
4 Naturopathy

 Like homeopathy, naturopathy originated in Europe, but it also includes ancient and modern therapies
from other traditions.

 Naturopathy attempts to help the body heal itself, and naturopaths consider a person’s physical,
emotional, genetic, environmental, and social circumstances when evaluating treatment.

 Practitioners of naturopathy prefer to use treatment approaches that they consider to be the most
natural and least invasive, relying on methods other than standard medications and surgery.

 They focus on changes in diet and lifestyle and on preventing disease, together with CM therapies
such as herbs and massage.
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► Classification of CM Practices:
 Several taxonomies have been suggested to classify types of CM. The National Center for Complementary
and Alternative Medicine (NCCAM) has proposed a system that broadly classifies CM into five main
categories or domains:

1 Whole medical systems Whole medical systems are built upon

complete systems of theory and practice.

Mind-body medicine uses a variety of techniques designed to

2 Mind-body medicine
enhance the mind’s capacity to affect bodily function and symptoms.

3 Biologically based therapies Biologically based practices in CM use substances found in

nature, such as herbs, foods, and vitamins.

4 Manipulative and body-based practices Manipulative and body-based practices in CM are based on
manipulation and/or movement of one or more parts of the body.

5 Energy medicine Energy therapies involve the use of energy fields.

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► The Holistic Approach to Healing:
 Virtually all CM practices claim to be This approach is in line with the WHO's definition of
holistic, i.e. treating the whole person health as a ‘complete state of physical, mental, and social
rather than a condition in isolation. wellbeing’ and not simply the absence of disease’

This in turn leads to a highly individual approach, which means that patients
with apparently similar symptoms may be treated in a very different manner.
Conversely it also means that particular treatments may be used to
treat widely different conditions.

 The origin of the word ‘holism’ is attributed to Jan Christian Smuts (1870–1950), a South African
botanist and philosopher.
 Smuts wrote a book entitled Holism and Evolution in which he described holism as:
. . . the principle which makes for the origin and progress of wholes in the universe.
 More generally, the holism define as the treatment of the whole person, an approach that considers
body, mind and spirit as a single unit.
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► The Holistic Approach to Healing:
 The term holism is date back to Hippocrates, who said:

A physician without a knowledge of the cosmos should not call himself a physician.
There is one common flow, one common breathing, all things are in sympathy

 Modern society, embedded and invested in technology, has led us away from the natural
environment and the relations we as human organisms have with our own planet and the universe
beyond. More importantly, it has also led us away from the “inner space” of our own body organism.

 Reconnecting with our inner spaces is something that Yoga, Qigong and Humble (El-Khshooaa).

In CTM, it is recognized that the microcosm (body) is a reflection of the macrocosm (universe), and
the organ system is held in balance by the same powers that hold the cosmos in position.

The word “heal” comes from the Old English word Hal, which means “whole.”
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► The Holistic Approach to Healing:
 The treatment strategy arises from a consideration of both:
Physiological enhancement Physiological compensation
 Factors involved in disease causation can be divided into:
Predisposing Excitatory Sustaining
Any factor which renders the body Causes are the direct Causes usually come into play
more liable to disease. Such provoking causes of a as a result of the initiation of a
predisposing causes include stress, disease, such as infection disease process and hinder the
lowered vitality, poor diet, inherited and trauma. resolution of the disease.
defects and so on.
 In general, orthodox medical treatment is aimed only at excitatory and sustaining causes, at best.
 An example of treating the links in a causal chain can be illustrated by the following sequence of events:

Stress Insomnia Lowered vitality Weakened immunity Viral infection

Catarrhal state of mucous membranes Cough Symptomatic expression
Dr. M. Waleed M. Sadaka of the disease 20
► The Holistic Approach to Healing:
 Energy has a dynamic quality and is not measured in the usual ways that conventional medicine is
accustomed to describing things, on the basis of materialist, reductionist biomedical mechanisms.

 The idea that whole, living systems and organisms have a “vital energy” that may not be present in
nonliving entities or in parts or portions of an organism is an ancient concept among human cultures that
is also reflected in European and U.S.

 Vitalism contends that there is an “energy” to living organisms that is nonmaterial.

 When a patient visits a complementary practitioner for the first time, the consultation may well extend
to over an hour, although about 40 minutes is more usual.

 During this time a complete picture of the patient will be built up.

 The aim is to obtain the best therapeutic outcomes for patients, by integrating clinical expertise and
knowledge with patients’ needs and preferences, using the most current information available in a
systematic and timely way.
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► The Gathering Information from the Patient:
 In providing holistic care the CM practitioner needs to obtain information on:
- how the patient functions in a normal state of wellbeing.
- and hearing about symptoms that prompted the visit so that they may be returned to their own state of
good health.
- also environmental and social factors have to be considered.
 To obtain this information patients are often asked a list of seemingly unrelated questions on their first
visit including the following:
1 What type of food do you like – sweet, salty, spicy or bland? Patients’ style of
handwriting and color
2 What type of weather conditions do you prefer – hot, cold, wet, dry, etc.? preferences could be
useful in establishing
3 Do you like to be with other people or do you like to be alone?
various personality
traits, and therefore in
4 Are you a gregarious extravert type of person or are you quiet and introverted?
choosing an
5 Do you dream and if so can you remember the main subjects involved? appropriate therapy.
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► Self-Healing and Healing Energy:
The body heals itself
 This might seem to be an obvious statement, because we are well aware that wounds heal and blood and
tissue cells routinely replace themselves over time.

 This concept is central and profound among CM systems, because self-healing is the basis of all healing.

 External “medical” manipulations simply mobilize the body’s inner healing resources.

 Instead of wondering why the body’s cells are sick, complementary systems ask why the body is not
replacing its sick cells with healthy cells.

 The body’s ability to be well or ill is largely tied to inner resources, and the external environment-
social and physical-has an impact on this ability.
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► Self-Healing and Healing Energy:
The body is an energetic system
 Disruptions in the balance and flow of energy contribute to illness, and the body’s response to
energetic imbalance leads to perceptible disease.

 As the mind-body can heal itself, the mind-body may

ultimately also make itself sick when out of balance.

 Restoring or facilitating the mind-body to recover its own

balance restores health.

 The symptoms of a cold, flu, or allergy are caused by

physiologic responses to rid the body of the offending agent.

For example, by raising the body’s temperature, a fever

reduces bacterial reproduction (like an antibiotic, fever is
literally bacteriostatic), and, of course, sneezing physically
expels offending agents. Dr. M. Waleed M. Sadaka 28