Complementary / alternative medicine

What is complementary and alternative medicine (CAM)? It is a group of diverse medical and health care systems, practices and products that are not presently considered to be part of conventional medicine.

Are complementary medicine and alternative medicine different from each other?

Yes, they are different

Complementary medicine is used together with conventional medicine Complementary medicine is used together with conventional medicine. An example of a complementary therapy is using aromatherapy to help lessen a patient’s discomfort following surgery. Alternative medicine is used in place of conventional medicine. An example of an alternative therapy is using a special diet to treat cancer instead of undergoing surgery, radiation, or chemotherapy that has been recommended by a conventional doctor.

What are the major types of complementary and alternative medicine?

NCCAM classifies CAM therapies into five categories, or domains

Alternative Medical Systems. e. g Alternative Medical Systems. e.g. Traditional Chinese Medicine and Ayurveda Mind-Body Interventions. e.g. prayer, meditation, art, music, or dance. Biologically Based Therapies. e.g. dietary supplements & herbal products Manipulative and Body-Based Methods. e.g. chiropractic manipulation & massage Energy Therapies. Biofield therapies. e.g. qi gong Bioelectromagnetic-based therapies.

Medical Herbalism

Medical herbalism is the use of plant remedies in the prevention and treatment of illness. Today, medical herbalism, practiced by medical herbalists, draws on traditional knowledge, but increasingly this is interpreted and applied in a modern context.

Aspects of medical herbalism Herbalism takes an holistic approach. Herbalists select herbs on an individual basis for each patient. Herbalists aim to identify the underlying cause (e.g. stress) of a patient’s illness and to consider this in the treatment plan. Herbs are used to stimulate the body’s healing capacity, to ‘strengthen’ bodily systems and to ‘correct’ disturbed body functions rather than to treat presenting symptoms directly. Herbs may be used to provide long-term relief from the particular condition.

One of the tenets of herbalism is that the different constituents of a herb act together in some way that has beneficial effects. These could be: Additive effect: The combined effect of two drugs is equal to the sum of their individual actions. Synergistic effect: The combined effect of two drugs is greater than the sum of the individual effects.

Conditions treated Medical herbalists treat a wide range of acute and chronic conditions. e.g. Irritable bowel syndrome Premenstrual syndrome Menopausal symptoms Eczema Types of arthritis Depression Acne and other skin conditions Cystitis (Inflammation of the urinary bladder) Migraine Chronic fatigue syndrome

Herbalist’s prescriptions Generally, a combination of several different herbs (usually 4-6) is used in the treatment of a particular patient. sometimes, a single herb may be given, e.g. chasteberry (vitex agnus castus) for premenstrual syndrome and dysmenorrhea. Each patient’s treatment is reviewed regularly and is likely to be changed depending on whether or not there has been a response.

Comparison of herbalism with rational phytotherapy Assume that synergy or additive effects occur between herbs. Holistic prescribing. Preparations mainly formulated as tinctures. Mainly uses combinations of herbs. Opposition towards standardization. Not scientifically evaluated. Rational phytotherapy Seek evidence that synergy or additive effects occur between herbs. No holistic. Preparations mainly formulated as tablets and capsules. Single-herb products used mainly. Using standardization. Science-based approach.

Generally, medicinal herbs fall into two basic categories: tonic and stimulating. Tonics help cells, tissues, and organs to maintain tone, or balance, throughout the body. Some tonics activate and invigorate bodily processes or parts. Other tonics supply important nutrients that cells, tissues, and organs need to function properly. Tonics ordinarily are taken regularly for three to nine months at a time to gently strengthen and improve overall health and/or certain organ functions. Stimulating herbs have much stronger actions and are used to treat particular ailments. They should be taken in smaller doses than tonic herbs, and for shorter periods of time.

Evidence of efficacy and safety

Homoeopathy

Homoeopathy was founded around 200 years ago by Samuel Hahnemann (1755-1843), a German physician and apothecary. Today, around 1200 Homoeopathic remedies are commonly used.

Hahnemann outlined three basic principles of homoeopathy, which form the basis of classical Homoeopathy A substance which, used in large doses, causes a symptom(s) in a healthy person can be used to treat that symptom(s) in a person who is ill. For example, Coffee, a remedy prepared from the coffee bean (a constituent, caffeine, is a central nervous system stimulant) would be used to treat insomnia. This is the so-called ‘like cures like’ concept. The minimal dose of the substance should be used in order to prevent toxicity. Only a single remedy or substance should be used in a patient at any one time.

Modern homoeopathy Hahnemann’s principles of homoeopathy still form the basis of modern homoeopathic practice, with the exception of the single remedy rule, which is ignored by many homoeopaths in favor of multiple prescribing. Modern-day provings have involved rigorous study design (randomized, double-blind, placebo-controlled), while Hahnemann did not use rigorous study design.

In addition to the basic principles of homoeopathy, modern homoeopaths also believe: That illness results from the body’s inability to cope with challenging factors such as poor diet and adverse environmental conditions. That the signs and symptoms of disease represent the body’s attempt to restore order. That homoeopathic remedies work by stimulating the body’s own healing activity (the ‘vital force’) rather than by acting directly on the disease process. That the ‘vital force’ is expressed differently in each individual, so treatment must be chosen on an individual (holistic) basis.

Homoeopathic remedies Homoeopathic remedies and herbal medicines are often confused and/or deemed to be similar. The fundamental differences between the two types of preparation are: Homoeopathic remedies are (mostly) highly dilute whereas herbal medicines are used at material strengths. Many homoeopathic remedies (around 65%) originate from plants, whereas by definition all herbal medicines originate from plants.

Many of the plants from which homoeopathic remedies are derived have a history of medicinal use. Other types of material used in the preparation of homoeopathic remedies include animal, insect, biological, drug/chemical and mineral. The starting point for the production of most homoeopathic remedies is a mother tincture, usually an alcohol/water extract of crude plant material. The mother tincture is then diluted according to either the decimal (dilution steps of 1 in 10; denoted by D or X) or centesimal (dilution steps of 1 in 100; denoted by C or cH) scale to form homoeopathic remedies or potencies.

For example, on the decimal dilution scale, a 1X (or D1) remedy is prepared by taking one part mother tincture and adding it to nine parts diluent (dilute alcohol) and succussing the resulting 1 in 10 dilution. A 2X remedy is prepared by taking one part 1X remedy and adding it to nine parts diluent and succussing the resulting dilution, which is now a dilution of 1 in 100, and so on. The centesimal scale uses the same procedure except that each step involves adding one part mother tincture to 99 parts diluent so that the first step produces a 1 in 100 dilution (1C or 1cH), the second step a 1 in 10,000 dilution (2C) and so on. There are also LM potencies which involve serial dilutions of 1 in 50,000 at each step.

Dosage forms and potentization Homeopathic remedies come in pellets, tablets, and dilutions (liquids). The potentizing (mixing) affects the way a homeopathic medicine works. Generally speaking, the lower potencies, such as 3x or 6x, have a greater effect on the organs and are suited to acute illness. Medium potencies, such as 12x and 30x, affect the senses and nervous system. High potencies, 60x and above, affect mental condition.

The following is a rough guide to the various potencies, their effects, and uses: Frequency of Dosage What It Affects Potency One dose every ¼ hour to every 4 hours Body organs. Used for symptoms of acute conditions 6x, 12x, 6c, 12c One a day to 3 times a day Body organs plus the senses and nervous system. Used for symptoms of chronic conditions 30x, 30c Once a month to once a year Body organs, senses, nervous system, mind, and emotions 200x, 1m, 10m, LM

A typical dose of a homeopathic remedy is 3 tablets or 10 pellets for adults, 2 tablets or 5 pellets for children. Remedies should be taken on an empty stomach. The tablets should be placed under the tongue and held there for as long as possible while they dissolve. If possible, you should not swallow the tablets.

Aromatherapy

Aromatherapy is the therapeutic use of aromatic substances extracted from plants. The most important group of these substances is the essential oils. How essential oils are obtained ? Distillation Enfleurage Solvent extraction Expression

Essential oils Typically, essential oils contain around 100 or more chemical constituents, mostly present at concentrations below 1%, although some constituents are present at much lower concentrations. Some essential oils contain one or two major constituents, and the therapeutic and toxicological properties of the oil can largely be attributed to those constituent(s). The composition of an essential oil will vary according to the plant's environment and growing conditions, the plant part used and on methods of harvesting, extraction and storage.

The constituents of essential oils are largely volatile compounds which are sensitive to the effects of light, heat, air and moisture and should therefore be stored in a cool place in tightly closed, darkened bottles. There is the possibility of adulteration and contamination occurring during processing. Gross adulteration can be detected using established analytical techniques such as gas chromatography-mass spectrometry (GC-MS). Essential oils should be referred to by the Latin binomial name of the plant species from which a particular oil is derived.

Aspects of aromatherapy Aromatherapists believe that essential oils can be used not only for the treatment and prevention of disease, but also for their effects on mood and emotion. Aromatherapy is claimed to be an holistic therapy. Aromatherapists believe that the constituents of essential oils work synergistically. Essential oils are described not only with reference to reputed pharmacological properties (e.g. antibacterial), but also by terms that are not recognized in conventional medicine (e.g. balancing, energizing).

How Essential Oils Work Essential oils are believed to act both by exerting pharmacological effects following: Absorption into the circulation. The effects of their odor on the olfactory system.

Conditions treated Aromatherapy is widely used as an approach to relieving stress, and many essential oils are claimed to be ‘relaxing’. Many aromatherapists also claim that essential oils can be used in the treatment of a wide range of conditions. For example: digestive problems, eczema, headaches, insomnia. Aromatherapy is also used in a variety of conventional healthcare settings, such as mental health units and in specialized units caring for patients with HIV/AIDS, physical disabilities and severe learning disabilities.

Ways of Using Essential Oils 1. Inhaling through vaporization 2. Bathing 3. Compress 4. Massage

Special considerations Some oils should be avoided by people with certain conditions, such as: High blood pressure Epilepsy pregnancy