Herbs And Nutritional Supplements

COMPLEMENTARY AND ALTERNATIVE THERAPIES FOR NURSING PRACTICE

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F o u r t h E d i t i o n

Karen Lee Fontaine Professor, College of Nursing, Purdue University Calumet,

Hammond, Indiana

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Many of the designations by manufacturers and seller to distinguish their products are claimed as trademarks. Where those designations appear in this book, and the publisher was aware of a trademark claim, the designations have been printed in initial caps or all caps. Library of Congress Cataloging-in-Publication Data Fontaine, Karen Lee, 1943–author. [Complementary & alternative therapies for nursing practice] Complementary and alternative therapies for nursing practice / Karen Lee Fontaine, professor, College of Nursing, Purdue University Calumet, Hammond, Indiana.—Fourth edition. pages cm Revision of: Complementary & alternative therapies for nursing practice.—3rd ed.—©2009. Includes bibliographical references and index. ISBN-13: 978-0-13-334650-3 ISBN-10: 0-13-334650-1 1. Nursing. 2. Alternative medicine. I. Title. RT42.F64 2015 610.73—dc23 2013045244

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Dedication

This book is dedicated to Peggy Gerard, Dean, and Kathy Nix, Undergraduate Coordinator, College of Nursing,

Purdue University Calumet for all their support and enthusiasm as complementary and alternative medicine

was integrated into the curriculum.

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CONTENTS

Preface ix

Acknowledgments xiii

Reviewers xiv

UNIT 1 Healing Practices: Complementary and Alternative Therapies for Nurses 1

Chapter 1 Integrative Healing 3

Chapter 2 Basic Concepts Guiding Alternative Therapies 19

Chapter 3 The Role of Evidence-Based Health Care in Complementary and Alternative Therapies 37

UNIT 2 Systematized Health Care Practices 47 Chapter 4 Traditional Chinese Medicine 49

Chapter 5 Ayurvedic Medicine 70

Chapter 6 Native American Healing and Curanderismo 90

UNIT 3 Botanical Healing 111 Chapter 7 Herbs and Nutritional Supplements 113

Chapter 8 Aromatherapy 133

Chapter 9 Homeopathy 149

Chapter 10 Naturopathy 162

UNIT 4 Manual Healing Methods 169 Chapter 11 Chiropractic 171

Chapter 12 Massage 183

Chapter 13 Pressure Point Therapies 202

Chapter 14 Hand-Mediated Biofield Therapies 217

Chapter 15 Combined Physical and Biofield Therapy 230

UNIT 5 Mind–Body Techniques 239 Chapter 16 Yoga 241

Chapter 17 Meditation 256

Chapter 18 Hypnotherapy and Guided Imagery 269

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Chapter 19 Dreamwork 286

Chapter 20 Intuition 301

Chapter 21 Music as a Therapeutic Tool 311

Chapter 22 Biofeedback 320

Chapter 23 Movement-Oriented Therapies 327

UNIT 6 Spiritual Therapies 339 Chapter 24 Shamans 341

Chapter 25 Faith and Prayer 352

UNIT 7 Other Therapies 367 Chapter 26 Bioelectromagnetics 369

Chapter 27 Animal-Assisted Therapy 378

Appendix Alternative Therapies for Common Health Problems 393

Index 417

vi Contents

TRY THIS

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Energy 34 Massage 88 Positive Thoughts 107 Herbal Remedies 128 Soothing Potions 144 Top 10 Remedies 157 Pet Remedies 158 Visualization 167 Energy Boosters 181 Massage 199 Foot Massage 213 Experience Your Energy Field 227 Emotional First Aid 235 Redirecting the Flow of Energy 236 Heart Breathing 252 Loving–Kindness Meditation 266

Renovating Your Day 283 Shrinking Antagonistic

Forces 283 Improving Dream Recall 298 Positive Affirmations 308 Practice Intuition 309 Music for Stress Reduction 316 Mind Control of Muscular

Strength 324 Feel Your Qi 335 Wave Hands Like Clouds (Water

T’ai Chi) 336 Shamanic Journey 349 Absorbing Earth Energy 375 Going to the Mountains 376 Interacting with Your Pet 389

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PREFACE

The profession of nursing has advanced beyond the Western biomedical model to incorporate many healing tools used by our Asian, Latino, Native American, African, and European ancestors. We are rapidly rediscovering that these ancient principles and practices have significant therapeutic value. Some see this movement as a “return to our roots.” Others believe it is a response to runaway health care costs, growing dissatisfaction with high-tech medicine, and increasing concern over the adverse effects and misuse of med- ications. The growth of consumer empowerment also fuels this movement.

As nurses, how do you begin to assimilate thousands of years of healing knowledge? How do you begin this journey of integrating practices into your own lives? In your professional practice, how do you model healthful living? How do you help clients choose their own healing journeys? How do you break down the barriers between conventional and complementary and alter- native medicine (CAM)? Learning about CAM practices, like anything else, is a slow process involving a steady accumulation of bits of information and skills that eventually form a coherent pattern called knowledge. Although it is possible to learn a great deal about healing practices from reading, thinking, and asking questions, you must in the long run learn about healing through participation. Without hands-on experience, you can be a good student, but you can never be a great nursing practitioner of the healing arts. I trust this book will be one step in a lifelong exploration of and experiences with healing practices.

Consumers do not wish to abandon conventional medicine, but they do want to have a range of options available to them including herbs and nutri- tional supplements, manual healing methods, mind–body techniques, and spiritual approaches. Some CAM practices, such as exercise, proper nutrition, meditation, and massage, promote health and prevent disease. Others, such as herbs and homeopathic remedies, address specific illnesses. Many other CAM practices do both. The rise of chronic disease rates in Western society is increasingly motivating consumers to consider self-care approaches. As recently as the 1950s, only 30% of all disease was chronic, and curable—largely infectious—diseases dominated, for which medical interventions were both appropriate and effective. Now, 80% of all disease is chronic. Western medi- cine, with its focus on acute disorders, trauma, and surgery, is considered to be the best high-tech medical care in the world. Unfortunately, it is not responding adequately to the current epidemic of chronic illnesses.

Ethnocentrism, the assumption that one’s own cultural or ethnic group is superior to others, has often prevented Western health care practitioners from learning “new” ways to promote health and prevent chronic illness. With consumer demand for a broader range of options, we must open our minds to the idea that other cultures and countries have valid ways of preventing and curing diseases that could be good for Western societies.

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x Preface

Although the information may be new to us, many of these traditions are hun- dreds or even thousands of years old and have long been part of the medical mainstream in other cultures.

I have titled this book Complementary and Alternative Therapies for Nursing Practice because I believe we need to merge CAM approaches with Western- based nursing practices. I have tried to provide enough information about alternative therapies to help guide practice decisions. This text, as an over- view and practical guide for nurses, does not pretend to be an exhaustive col- lection of all the facts and related research in CAM, nor does it offer meticulous documentation for all claims made by the various therapies. The goal of the text is to motivate you, the reader, to explore CAM approaches, increase your knowledge about factors that contribute to health and illness, and expand your professional practice appropriately.

It is possible to classify alternative practices in any number of ways. I have chosen to present more than 40 approaches categorized into seven units. In Unit 1, I introduce the philosophical approaches to both Western bio- medicine and complementary and alternative medicine, as well as evidence- based health care in CAM therapies. Concepts common to many approaches are defined and discussed, such as energy, breath, spirituality, and healing. Unit 2 presents a number of health care practices that have been systematized throughout the centuries worldwide. These typically include an entire set of values, attitudes, and beliefs that generate a philosophy of life, not simply a group of remedies. The chapters cover Traditional Chinese Medicine, Ayurvedic medicine, and Native American healing and curanderismo. Unit 3 comprises chapters relating to botanical healings used by 80% of the world’s population. Chapters cover herbs and nutritional supplements, aromather- apy, homeopathy, and naturopathy. Unit 4 presents manual healing methods—some from ancient times and some developed in the latter half of the 20th century. The chapters discuss chiropractic, massage, pressure point therapies, hand-mediated biofield therapies, and combined physical and biofield therapies. The chapters in Unit 5 cover types of mind–body tech- niques for healing and include yoga, meditation, hypnotherapy and guided imagery, dreams, intuition, music as a therapeutic tool, biofeedback, and movement-oriented therapies. Unit 6 presents two spiritual approaches to therapeutic intervention: working with shamans and the use of faith and prayer. Unit 7 includes two chapters on miscellaneous practices: bioelectro- magnetics and animal-assisted therapy.

The appendix provides specific information on managing the types of common health problems that respond well to alternative therapies and life- style modification.

This book does not recommend treatments but, rather, describes alterna- tive practices, their backgrounds and claims, preparation of practitioners, con- cepts, diagnostic methods, treatments, and evidence from research studies. “Integrated Nursing Practice” is an important section of every chapter designed to help you, the nurse, expand your practice by providing you with specific information and suggestions. “Try This” features throughout the

Preface xi

chapters provide you with examples of how you can integrate these practices into your own life and also give you ideas for client education. A list of resources is also included in the chapters.

In this new fourth edition, I have continued the “Considering the Evi- dence” feature with all new research relating to the chapter topic. Eight of these features present a systematic review of randomized control trials, while two present primary research . “Considering the Evidence” boxes not only present current studies but also are designed to further critical thinking and perhaps inspire you to design studies to answer your own questions. Each study answers the following questions: What was this study about? How was the study done? What were the results of the study? What additional ques- tions might I have? And how can I use this study?

Changes to the fourth edition:

• Updated all research sections and greatly increased the number of sys- tematic reviews of randomized controlled trials

• Changed the focus of the chapter on music from music therapy to music as a therapeutic tool to broaden the focus for the practicing nurse

• Expanded the lists of resources to include more international resources • Deleted polarity therapy and crystal healing for lack of research and

evidence • Added sections on

• Music thanatology • Aromachology • Restorative yoga • Latest technology for biofeedback self-tracking

• Expanded cautions for pregnant women and young children

Nurses are in a unique position to take a leadership role in integrating alternative healing methods into Western health care systems. Nurses have historically used their hands, heart, and head in more natural and traditional healing interactions. By virtue of their education and relationships with clients, nurses can help consumers assert their right to choose their own healing journey and the quality of their life and death experiences.

My dear friend and colleague has written the following letter to you about her lived experience uniting biomedicine with CAM approaches.

Dear Reader,

It is both a pleasurable and enlightening experience for me to contribute to your text, Complementary and Alternative Therapies for Nursing Practice , through the development of the “Considering the Evidence” feature. I approach this work hopeful that it may inspire you, the reader, to engage in critical thinking, assist in your understanding of the significance of research to inform your nursing practice and, perhaps, propose studies to answer your own researchable questions. However, with this edition, I have asked Karen Lee Fontaine to allow me the privilege of sharing with you my personal journey with complementary and alternative therapies. I hope I can thus inspire you

xii Preface

to reflect on and embrace the important content of this text. After learning of my diagnosis of bilateral breast cancer, I actively participated in myriad Western medicine therapies while integrating complementary and alternative therapies. Although the chemotherapy experience was both mentally and physically challenging, I considered the massage therapist as part of “my team,” and I looked forward to this dimension of comfort during this challenging time. Engaging in yoga enhanced “restful sleep” as a response to the overwhelming fatigue that frequently accompanies Western therapies such as chemotherapy and radiation and just the daily awareness that “you have cancer.” Acupressure relieved uncomfortable postoperative symptoms. T’ai chi continues to be an opportunity to focus on myself and reflect on the positives associated with this journey. Reiki and reflexology is my specified “me time.” As I engage in the associated deep breathing exercises, it stimu- lates my mind to drift to affirmative thoughts and so many positive memories from my life. For me, “living with cancer “is more of an “inconvenience” in my life’s journey. I can appreciate this may not be the experience for every- one, but I can personally assure you that integrating many of the therapies discussed in this text allows me a “quality of life” while simultaneously working with conventional medicine’s goal for a “quantity of life.” With the combination of both, I feel I have been given the power to survive!

I hope my story gives you a sense of hope and empowerment in caring for persons both professionally and personally who are embarking on a stren- uous journey related to their health. I can recall in my nursing practice experi- encing feelings of helplessness when caring for persons undergoing complex t reatments with so many uncertainties related to their health outcome. I can attest that your understanding, knowledge, and support in the implementa- tion of complementary and alternative therapies can significantly affect their “quality of life” and allow you the privilege of making a difference in their health journey.

Warm regards, Dolores M. Huffman, RN, PhD

ACKNOWLEDGMENTS

I would like to express thanks to the many people who have inspired, com- mented on, and in other ways assisted in the writing and publication of the fourth edition of this book. On the publishing and production side at Pearson, I was most fortunate to have an exceptional team of editors and support staff. My thanks go to Julie Alexander, Publisher, and Erin Rafferty, Program Manager, who provided support and guidance throughout this project. Maria Reyes, Project Manager, kept this book on schedule and dedicated her time and skill to its completion.

I would like to thank all those who reviewed this text and provided sug- gestions and guidance for the fourth edition.

Karen Lee Fontaine Purdue University Calumet

Contributors Dolores M. Huffman, RN, PhD

Associate Professor College of Nursing Purdue University Calumet Director of Transfer: Northwest Indiana Center for Evidence Based Practice: A Joanna Briggs Institute Collaborating Centre Hammond, IN

Sheila O’Brien Lewis, BScN, MHSc Associate Lecturer Department of Nursing, Faculty of Health York University Toronto, ON, Canada

Leslie Rittenmeyer, PsyD, CNS, RN Professor Collegel of Nursing Purdue University Calumet Research Associate: Northwest Indiana Center for Evidence Based Practice: A Joanna Briggs Institute Collaborating Centre Hammond, IN

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Dot E. Baker, Ed.D., MSN., BSN.

Professor Wilmington University Georgetown, DE

Debra Rose Wilson, PhD, RN, IBCLC, AHN-BC, CHT

Professor Middle Tennessee State University Murfreesboro, TN Walden University Minneapolis, MN

Lynn Rew, Ed.D, RN, AHN- BC, FAAN

Professor The University of Texas at Austin Austin, TX

Sheila Stroman, PhD, RN Assistant Professor University of Central Arkansas Conway, AR

Susan Cohen, DSN, APRN, FAAN

Associate Professor University of Pittsburgh Pittsburgh, PA

Kimberly Arcoleo, PhD, MPH Professor

Ohio State University Columbus, OH

Lori Edwards, DrPH, RN, APRN, BC

Instructor Johns Hopkins University School of Nursing Baltimore, MD

Rose Mary Gee, PhD, RN Assistant Professor Georgia Southern University Statesboro, GA

Sue Hritz, MEd, PC, RN, CHT, PHN

Lecturer Kent State University Kent, OH

Gretchen Ezaki, MSN, RN Instructor Fresno City College Fresno, CA

Kathleen Murphy, PhD, MMT Assistant Professor University of Evansville Evansville, IN

Vicki Moran, MSN/MPH, RN Instructor Saint Louis University St. Louis, MO

REVIEWERS

Healing Practices: Complementary and Alternative

Therapies for Nurses

Happiness, grief, gaiety, sadness are by nature contagious. Bring your health and your strength to the weak and sickly,

and so you will be of use to them. Give them, not your weakness, but your energy, so you will revive

and lift them up.

Henri-Frederic Amiel

1 U N I T

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1 Integrative Healing

Time is generally the best doctor.

Ovid

Most of nursing education in the United States, Canada, the United Kingdom, Europe, and Australia—often referred to as Western countries—has been under the umbrella of biomedicine, and thus Western nurses are familiar and comfortable with its beliefs, theories, practices, strengths, and limitations. Fewer nurses have studied alternative medical theories and practices and as a result may lack information or even harbor misinformation about these healing practices. Unlike the profession of medicine in general, however, the profession of nursing has traditionally embraced two basic concepts embodied by alternative therapies—holism and humanism—in its approach with clients. Nurses have long believed that healing and caring must be approached holistically and that biological, psychologi- cal, emotional, spiritual, and environmental aspects of health and illness are equally important. This humanistic perspective includes propositions such as the mind and body are indivisible, people have the power to solve their own problems, people are responsible for the patterns of their lives, and well-being is a com- bination of personal satisfaction and contributions to the larger community. This theoretical basis gives nurses a solid foot in each camp and places them in the unique position to help create a bridge between biomedicine and alternative medicine ( Buchan, Shakeel, Trinidade, Buchan, & Al-See, 2012 ; Halcon, Chlan, Kreitzer, & Leonard, 2003 ; Peplau, 1952 ; Quinn, 2000 ; Shreffler- Grant, Hill, Weinert, Nichols, & Ide, 2007 ).

BACKGROUND

Many interesting exchanges around the world have debated the appropriate terminology of various healing practices. Some people

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4 Unit 1 • Healing Practices

become vested in the use of particular terms and have difficulty getting past the language limitations. For example, many people view the term alternative medi- cine as being too narrow or misleading and are concerned that the term lacks a full understanding of traditional healing practices. It would be helpful for a common language to be developed without these constraints. As language evolves, the terms used today may be quite different from those used 20 years from now. For consistency, the terms chosen for this text are conventional med- icine or biomedicine to describe Western medical practices, and the terms alternative medicine or complementary medicine to describe other healing practices. Traditional medicine refers to indigenous medical systems such as Traditional Chinese Medicine (TCM). There are no universally accepted terms. The following list presents commonly used words and their counterparts:

Mainstream Complementary/Alternative Modern Ancient Western Eastern Allopathic Homeopathic; holistic Conventional Unconventional Orthodox Traditional Biomedicine Natural medicine Scientific Indigenous healing methods

The line between conventional and complementary and alternative medicine is imprecise and frequently changing. For example, is the use of megavitamins or diet regimens to treat disease considered medicine, a life- style change, or both? Can having one’s pain lessened by massage be consid- ered a medical therapy? How should spiritual healing and prayer—some of the oldest, most widely used, and least studied traditional approaches—be classified? Although the terms alternative and complementary are frequently used, in some instances they represent the primary treatment modality for an individual. Thus, conventional medicine sometimes assumes a secondary role and becomes a complement to the primary treatment modality.

Conventional Medicine

Biomedical or Western medicine is only about 200 years old. It was founded on the philosophical beliefs of René Descartes (1596–1650)—that the mind and body are separate—and on Sir Isaac Newton’s (1642–1727) principles of physics—that the universe is like a large mechanical clock in which every- thing operates in a linear, sequential form. This mechanistic perspective of medicine views the human body as a series of body parts. It is a reductionist approach that converts the person into increasingly smaller components: sys- tems, organs, cells, and biochemicals. People are reduced to patients, patients are reduced to bodies, and bodies are reduced to machines. Health is viewed as the absence of disease or, in other words, nothing is broken at present, and sick care is focused on the symptoms of dysfunction. Physicians are trained to

Chapter 1 • Integrative Healing 5

fix or repair broken parts through the use of drugs, radiation, surgery, or replacement of body parts. The approach is aggressive and militant— physicians are in a war against disease, with a take-no-prisoners attitude. Both consumers and practitioners of biomedicine believe it is better to

• do something rather than wait and see whether the body’s natural pro- cesses resolve the problem.

• attack the disease directly by medication or surgery rather than try to build up the person’s resistance and ability to overcome the disease.

Biomedicine views the person primarily as a physical body, with the mind and spirit being separate and secondary or, at times, even irrelevant. It is powerful medicine in that it has virtually eliminated some infectious dis- eases, such as smallpox and polio. It is based on science and technology, per- sonifying a highly industrialized society. As a “rescue” medicine, the biomedical approach is appropriate. It is highly effective in emergencies, trau- matic injuries, bacterial infections, and some highly sophisticated surgeries. In these cases, treatment is fast, aggressive, and goal oriented, with the responsi- bility for cure falling on the practitioner.

The priority of intervention is on opposing and suppressing the symp- toms of illness. This approach is evidenced in many medications with prefixes such as an or anti , as in analgesics, anesthetics, anti-inflammatories, and anti- pyretics. Biomedicine characterizes each disease in terms of its mechanisms of action, based on the belief that most individuals are affected in the same way. Thus, treatment is basically the same for most people. Because conventional medicine is preoccupied with parts and symptoms and not with whole work- ing systems of matter, energy, thoughts, and feelings, it does not do well with long-term systemic illnesses such as arthritis, heart disease, and hypertension. Despite higher per capita spending on health care in the United States than in all other nations, in 2013, U.S. life expectancy ranked only 37th, and the infant mortality rate ranked 33rd among the nations studied ( World Health Rankings, 2013 ). The United States has failed to be a world leader in providing a healthier quality of life.

Complementary and Alternative Medicine

Complementary and alternative medicine (CAM) is an umbrella term for as many as 1,800 therapies practiced worldwide. Many forms have been handed down over thousands of years, both orally and in written records. These ther- apies are based on the medical systems of ancient peoples, including Egyp- tians, Chinese, Asian Indians, Greeks, and Native Americans. Others, such as osteopathy and naturopathy, evolved in the United States during the past two centuries. Still others, such as some of the mind–body and bioelectromagnetic approaches, are on the frontier of scientific knowledge and understanding. The National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health (NIH) defines CAM therapies as a broad range of healing philosophies, approaches, and therapies that conventional

6 Unit 1 • Healing Practices

medicine does not commonly use, accept, study, understand, or make avail- able. NCCAM also defines complementary therapies as those used with con- ventional medicine and alternative therapies as those used instead of conventional medicine (National Center for Complementary and Alternative Medicine, 2012).

Although they represent diverse approaches, CAM therapies share cer- tain attributes. They are based on the paradigm of whole systems and the belief that people are more than physical bodies with fixable and replaceable parts. Rather, mental, emotional, spiritual, and environmental components of well- being are considered to play crucial and equal roles in a person’s state of health. Interventions are individualized within the entire context of a person’s life ( Duncan, Liechty, Miller, Chinoy, & Ricciardi, 2011 ). Even Hippocrates, the father of Western medicine, espoused a holistic orientation when he taught physicians to observe their patients’ life circumstances, emotional state, stresses, environment, inherited constitution, and their subjective experience of an ill- ness. Socrates agreed, declaring, “Curing the soul; that is the first thing.” In alternative medicine, symptoms are believed to be an expression of the body’s wisdom as it reacts to cure its own imbalance or disease. Other threads or con- cepts common to most forms of alternative medicine include the following:

• An internal self-healing process exists within each person. • People are responsible for making their own decisions regarding their

health care. • Nature, time, and patience are the great healers.

When Albert Einstein (1879–1955) introduced his theory of relativity in 1905, our way of viewing the universe changed dramatically. Einstein said that mass and energy are equivalent and interconvertible, and all matter is connected at the subatomic level. No single entity could be affected without all its connecting parts being affected. In this view, the universe is not a giant clock but a living web. The human body is animated by an integrated energy called the life force . The life force sustains the physical body but is also a spiritual entity that is linked to a higher being or infinite source of energy. When the life force flows freely throughout the body, a person experiences optimal health and vitality. When the life force is blocked or weakened, organs, tissues, and cells are deprived of the energy they need to function at their full potential, and illness or disease results.

Alternative medicine is especially effective for people with chronic, debilitating illnesses for which conventional medicine has few, if any, answers. It has much to offer in the arena of health promotion and disease prevention. As costs of conventional medicine increase and people continue to suffer from chronic illnesses and degenerative diseases, alternative medicine is moving closer to the mainstream. A growing number of complementary and alterna- tive therapies are eligible for reimbursement by third-party payers in the United States. The most commonly reimbursed treatments are chiropractic, biofeedback, acupuncture, hypnotherapy, and naturopathy. Box 1.1 provides an overview of the paradigms of conventional and alternative medicine.

Chapter 1 • Integrative Healing 7

Integrative Medicine

Integrative medicine embodies both conventional and complementary and alternative medicine, making use of the best available evidence of all three approaches to healing. It is a multidisciplinary, collaborative, holistic approach that encompasses mind, body, and spirit. It stresses the relationship between the client and the practitioner as well as the human capacity for healing. Inte- grative practitioners believe that clients have the right to make informed choices about their health care options. The focus is on “using the least inva- sive, least toxic, and least costly methods to help facilitate health” ( Willison, 2006 , p. 255 ). The goal of integrative medicine is to find new solutions to pre- vention and treatment of health care problems.

Dr. Andrew Weil has been the driving force for integrative medicine in the United States and hopes to reform the entire medical delivery system by changing the way we look at health and disease and by modifying the educa- tion of physicians. His program at the Arizona Center for Integrative Medi- cine at the University of Arizona College of Medicine was the first to adopt this new curriculum. Nursing must also be open to change to meet the goal of true integrative care. In 2008, the World Health Organization (WHO) stressed the importance of integrative medicine and advocated the inclusion of com- plementary and alternative therapies in biomedical health care education ( Quartey, Ma, Chung, & Griffiths, 2012 ).

BOX 1.1

Paradigms of Medicine

View Conventional Medicine Alternative Medicine

Mind/body/spirit are separate are one The body is a machine a living microcosm of the universe Disease results parts break energy/life force becomes unbalanced when Symptoms dysfunctional and need communicators about the state of the to be fixed whole person Role of medicine to combat disease to restore mind/body/spirit harmony Approach treat and suppress search for patterns of symptoms disharmony or imbalance Focuses on parts/matter whole/energy Treatments attempt to “fix” broken support self-healing; personalized for parts; specific to disease the individual Primary drugs, surgery, diet, exercise, herbs, stress interventions radiation management, social support System sick care health care

8 Unit 1 • Healing Practices

ASSUMPTIONS

In understanding conventional and alternative medicine, it is helpful to study the assumptions basic to their theories, practices, and research. These assump- tions include the origin of disease, the meaning of health, the curative process, and health promotion.

Origin of Disease

Biomedicine and alternative medicine have widely divergent assumptions regarding the origin of disease. Biomedicine was shaped by the observations that bacteria were responsible for producing disease and pathologic damage and that antitoxins and vaccines could improve a person’s ability to ward off the effects of pathogens. Armed with this knowledge, physicians began to conquer a large number of devastating infectious diseases. As the science developed, physicians came to believe that germs and genes caused disease, and once the offending pathogen, metabolic error, or chemical imbalance was found, all diseases would eventually yield to the appropriate vaccine, antibiotic, or chemical compound.

Conventional medicine has also been influenced by Darwin’s concept of survival of the fittest; that is, all life is a constant struggle, and only the most successful competitors survive. Applied to medicine, this notion means that humans live under constant attack by the thousands of microorganisms that, in the Western view, cause most diseases. People must defend themselves and counterattack with treatments that kill the enemy. Based on this assumption, symptoms are regarded as harmful manifestations and should be suppressed. For example, a headache is an annoyance that should be eliminated, and a fever should be reduced with the use of medications.

Complementary and alternative medicine is based on the belief of a life force or energy that flows through each person and sustains life. Balance refers to harmony among organs in the body and among body systems, and in rela- tionships to other individuals, society, and the environment. A balanced organ- ism presents a strong defense against external insults such as bacteria, viruses, and trauma. When the life force or energy is blocked or weakened, the vitality of organs and tissues is reduced, oxygen is diminished, waste products accu- mulate, and organs and tissues degenerate. Symptoms are the body’s way of communicating that the life force has been blocked or weakened, resulting in a compromised immune system. Disease is not necessarily a surprise encounter with a bacterium or a virus, since these are ever present, but rather the end result of a series of events that began with a disruption of the life force. Based on this assumption, symptoms are not suppressed unless they endanger life, such as a headache from an aneurysm or a body temperature above 105°F. Rather, symptoms are cooperated with because they express the body’s wis- dom as it reacts to cure its own disease. For example, a headache is a signal that one’s whole system needs realignment, and a fever may be the result of the breakdown of bacterial proteins or toxins. When symptoms are suppressed, they are not resolved but merely held in abeyance, gathering energy for renewed expression as soon as the outside, counteractive force is removed.

Chapter 1 • Integrative Healing 9

Meaning of Health

If you were to ask a healer from the Chinese, Indian, or Native American tra- ditions about the meaning of health, you would receive answers very differ- ent from those given by a Western physician. The biomedical view of health, in the past, was often described as the absence of disease or other abnormal conditions. That definition has been expanded to include the view that health is not a static condition; the body constantly changes and adapts to both inter- nal and external environmental challenges. The majority of conventional medical practitioners would define health as a state of well-being. They may disagree, however, about who determines well-being—the health profes- sional or the individual. With some exceptions, wellness and health promo- tion have, for the most part, been left to the initiative of the individual.

Those practicing complementary and alternative medicine (CAM) describe health as a condition of wholeness, balance, and harmony of the body, mind, emotions, and spirit. Health is not a concrete goal to be achieved; rather, it is a lifelong process that represents growth toward potential, an inner feeling of aliveness. Physical aspects include optimal functioning of all body systems. Emotional aspects include the ability to feel and express the entire range of human emotions. Mental aspects include feelings of self-worth, a positive identity, a sense of accomplishment, and the ability to appreciate and create. Environmental aspects include physical, biologic, economic, social, and political conditions. Spiritual aspects involve self, others, and society. Self-components are the development of moral values and finding a meaningful purpose in life. Spiritual factors relating to others include the search for meaning through relationships and the feeling of connectedness with others and with an external power often identified as God or the divine source. Societal aspects of spiritual health can be understood as a common humanity and a belief in the fundamental sacredness and unity of all life. These beliefs motivate people toward truth and a sense of fairness and justice to all members of society.

Curative Process

The curative process is another area of divergent viewpoints. Conventional medicine promotes the view that external treatments—drugs, surgery, radia- tion—cure people, and practitioners are trained to fix or repair broken parts. The focus is on the disease process or abnormal condition. Alternative practi- tioners look at conditions that block the life force and keep it from flowing freely through the body. Healing occurs when balance and harmony are restored. The focus is on the health potential of the person rather than the dis- ease problem. The cure model and the healing model are presented with greater detail in Chapter 2 .

Health Promotion

Conventional and complementary and alternative medical systems have somewhat different foci on promotion of health. The thrust of conventional

10 Unit 1 • Healing Practices

medicine is disease prevention. Consumers are taught how to decrease their risk of cancer, cardiac disorders, obesity, and other life-threatening diseases that kill most people prematurely in Western society. Although these behav- iors are important, disease prevention is only one piece of health promotion. From the complementary and alternative perspective, health promotion is a lifelong process that focuses on optimal development of people’s physical, emotional, mental, spiritual, and environmental selves. An individual’s worldviews, values, lifestyles, and health beliefs are considered to be of criti- cal importance. Consumers are encouraged to adopt healthier lifestyles, to accept increased responsibility for their own well-being, and through greater self-reliance, to learn how to handle common health problems on their own. As the Healthy People 2020 report illustrates ( U.S. Department of Health and Human Services, 2010a ), the health care delivery system of the future must make use of all approaches that effectively promote optimal health using best available evidence and knowledge. Box 1.2 describes the strategic plan 2011– 2015 of NCCAM. In the United States, the Patient Protection and Affordable Care Act, a federal statute, was signed into law by President Barack Obama in 2010. One goal of this act is to provide affordable health care for every American. ( U.S. Department of Health and Human Services, 2010b .)

RESEARCH

Scientific beliefs rest not just on facts but on paradigms (broad views of how these facts are related and organized). Differences in views among groups of nursing and medical researchers are a reflection of the different scientific paradigms—quantitative and qualitative research. Although each method results in a different type of knowledge, both provide information to research- ers and consumers. Evidence-based practice is covered in Chapter 3 .

Quantitative research represents the principles of the Western scientific method, which include formulating and testing hypotheses and then rejecting

BOX 1.2

NCCAM Strategic Plan 2011–2015

• Advance the science and practice of symptom management of CAM approaches. • Develop effective, practical, personalized strategies for promoting health and

well-being. • Enable better evidence-based decision making regarding CAM use and its integra-

tion into health care and health promotion.

Source: National Center for Complementary and Alternative Medicine ( 2011 ).

Chapter 1 • Integrative Healing 11

or accepting the hypotheses. Every question is reduced to the smallest possi- ble part. Results can be replicated and generalized, and outcomes can be pre- dicted and controlled. Quantitative research is said to be objective in that the observer is separate from what is being observed. Another part of this objec- tive paradigm is that all information can be derived from physically measur- able data. This type of research has been extremely effective for isolating causative factors of disease and developing cures. However, it cannot explain the whole person as an integrated unit.

Qualitative research seeks to understand events in context-specific set- tings. It studies the context and meaning of interactive variables as they form patterns reflective of the whole. Researchers observe, document, analyze, and qualify the interactive relationship of variables. In the science of physics, it is believed that objectivity is ultimately not possible. The Heisenberg uncer- tainty principle states that the act of observing phenomena necessarily influ- ences the behavior of the phenomena being observed. Another part of the paradigm relates to the belief that interactions between living organisms and environments are transactional, multidirectional, and synergistic in ways that cannot be reduced. This holistic approach (the whole is greater than the sum of the parts) is basic to qualitative research.

Practitioners of conventional medicine believe that procedures and sub- stances must pass blinded randomized controlled trials (RCTs) to be proven effective. As a testing method, an RCT examines a single procedure or sub- stance in isolated, controlled conditions and measures results against another existing therapy or the best available treatment. This approach is based on the assumption that single factors cause and reverse illness, and these factors can be studied alone and out of context. In contrast, practitioners of complemen- tary and alternative medicine (CAM) believe that no single factor causes any- thing, nor can a magic substance single-handedly reverse illness. Multiple factors contribute to illness, and multiple interventions work together to pro- mote healing. RCTs are incapable of reconciling this degree of complexity and variation.

Although major complementary and alternative medical systems may not have been subjected to a great deal of quantitative research, they are gen- erally not experimental therapies. They rely on well-developed clinical obser- vational skills and experience that is guided by their explanatory models. Likewise, many biomedical practices are guided by observation and experi- ence and have not been tested quantitatively. New medicines must have rigor- ous proof of efficacy and safety before clinical use. Tests, procedures, and treatments, however, are not similarly constrained. Western physicians, like alternative practitioners, use the same well-developed clinical observational skills and experience, guided by their explanatory biomedical model. Some of these discrepancies are disappearing, and the emphasis is now on evidence- based practice and the rapid growth of CAM research.

This text does not offer meticulous documentation for all claims that are made by the various therapies. The National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health (NIH) has

12 Unit 1 • Healing Practices

been mandated to explore complementary and alternative healing practices in the context of rigorous science, to train researchers, and to provide the public with authoritative information. NCCAM has established 16 research centers to explore the safety and efficacy of a wide range of therapies. In addition, NCCAM funds hundreds of research projects and grants every year. The NIH Office of Dietary Supplements is conducting scientific studies regarding the role of dietary supplements in the improvement of health care. As a result of these and other international efforts, the evidence base for alternative thera- pies has grown significantly.

The results of scientific studies can be accessed at two websites. NCCAM and the National Library of Medicine (NLM) have partnered to create CAM on PubMed ( nccam.nih.gov/research/camonpubmed/ ). This site provides access to citations from the MEDLINE database and links to many full-text articles at journal websites. The Cochrane Library ( www.update-software. com/cochrane/ ), an international effort, consists of a regularly updated col- lection of evidence-based medicine databases, including the Cochrane Data- base of Systematic Reviews. This site lists thousands of randomized trials for various alternative therapies. This information is extremely helpful for both consumers and providers of health care. The reader is advised to access these sites for information regarding the latest research results. Chapter 3 covers evidence-based nursing practice in more detail.

CONSUMERS

Many Americans are looking beyond conventional medicine for relief from illness and improvement of health. According to a number of random sur- veys, two thirds of adults in the United States use one or more types of alter- native medicine, often to treat a chronic medical condition such as one of those listed in Box 1.3 . Most of these consumers fail to discuss the use of alter- native therapies with their primary conventional practitioner, even though the vast majority of people use both approaches simultaneously. In general, alternative therapies are more commonly used by women than by men, as well as by people with higher levels of education. Latinos have a higher rate of use (50%–90%) compared with European Americans ( Buchan et al., 2012 ; Lachance et al., 2009 ; Ortiz, Shields, Clauson, & Clay, 2007 ; Sirois, 2008 ). A random study of 1,261 adults in Australia found that 61.7% of the individuals had used self-prescribed CAM or visited a CAM practitioner. A significant proportion of the sample did not seek advice from their primary care physi- cian before using CAM ( Thomson, Jones, Evans, & Leslie, 2012 ).

The mainstream medical community can no longer ignore alternative therapies. The public interest is extensive and growing. One has only to look at the proliferation of popular health books, health food stores, and clinics offering healing therapies to realize that this interest cannot be dismissed. In March 2000, President Clinton ordered the establishment of the White House Commission on Complementary and Alternative Medicine Policy in an attempt to integrate conventional and alternative medicine. The mission of

Chapter 1 • Integrative Healing 13

the advisory committee was to make legislative and administrative recom- mendations for the education and training of health care professionals and to make suggestions for access and delivery of health care.

What are consumers seeking from alternative medicine? Some have the same goal for both types of medicine, such as control of chronic pain with pain medications and acupuncture. Other consumers may have a different expectation for each approach, such as seeing a conventional practitioner for antibiotics to eradicate an infection and using an alternative practitioner to improve natural immunity through a healthy lifestyle. A person receiving chemotherapy may use meditation and visualization to control the side effects of the chemotherapeutic agents. People who combine conventional and alter- native therapies are making therapeutic choices on their own and assuming responsibility for their own health.

It is important for nurses to understand the reasons consumers choose alternative practitioners. Some utilize alternative healers because of financial, geographic, and cultural barriers to biomedical care. Many turn to alternative healers for a sense of hope, control, personal attention, physical contact, and regard for the whole person that seems to be overlooked in conventional med- icine. Some of the common reasons for seeking alternative practitioners are listed in Box 1.4 .

It may be difficult for consumers to figure out how and where to get the best health care. At times it may be problematic to find reliable information to

BOX 1.3

Frequently Reported Conditions of Those Seeking Alternative Therapies

Back pain Head cold Neck pain Joint pain Arthritis Anxiety/depression Stomach upset Headache Chronic pain Insomnia

Source: National Center for Complementary and Alternative Medicine. 2007 Statistics on CAM Use in the United States. Retrieved from http://nccam.nih.gov/news/camstats/2007/index.htm

14 Unit 1 • Healing Practices

help separate the healers from those who pretend to have medical knowledge. Consumers should be wary of healers who

• say they have all the answers. • maintain that theirs is the only effective therapy. • promise overnight success. • refuse to include other practitioners as part of the healing team. • seem more interested in money than in people’s well-being. ( Tiedje, 1998 )

Some alternative specialties are more regulated and licensed than oth- ers, but none come with guarantees any more than conventional medicine comes with guarantees. Consumers may want to research the background, qualifications, and competence of any health care provider—alternative, con- ventional, or integrative. Most types of alternative practices have national organizations of practitioners that are familiar with legislation, state licensing, certification, or registration laws. Many of these organizations are found in the resource section at the back of each chapter in this text.

INTEGRATED NURSING PRACTICE

Nursing has been moving away from a biomedical orientation that has largely defined and directed it toward a nursing-caring-healing model. Watson (1997) described it as a shift from a nursing qua medicine paradigm (nurses helping

BOX 1.4

Reasons for Choosing Alternative Therapies

Pursue therapeutic benefit Seek a degree of wellness not supported in biomedicine Attend to quality-of-life issues Prefer high personal involvement in decision making Practitioners spend more time with clients Believe conventional medicine treats symptoms, not the underlying cause Find conventional medical treatments to be lacking or ineffective Avoid toxicities and/or invasiveness of conventional interventions Decrease use of prescribed or over-the-counter medications Identify with a particular healing system as a part of cultural background

Sources: Clement, Chen, Burke, Clement, & Zazzali, 2006 ; National Center for Complementary and Alternative Medicine, 2012. 2007 Statistics on CAM Use in the United States. Retrieved from http:// www.nccam.nih.gov/news/camstats/2007/index/.htm ; Saydah & Eberhardt, 2006 .

Chapter 1 • Integrative Healing 15

physicians practice medicine) to a nursing qua nursing paradigm (practicing the distinct art and science of nursing). This movement has reconnected nurses with the finest tradition of Florence Nightingale in using their hands, heart, and head in creating healing environments. The modern nurse–healer draws on biomedical and caring–healing models by utilizing technology and focusing on caring relationships and healing processes. Dossey, Keegan, and Guzzetta ( 2005 ) have described the modern nurse–healer as having a hybrid of scientific skills and spiritual commitment. Nurses need scientific principles, methods, and skills, but they also need to teach people ways to become more self-reliant as they shift from caregivers to healers.

In 1979, Watson published her text Nursing: The Philosophy and Science of Caring, which evolved from her experiences of nursing within the limitations of traditional biomedical models. She sought to bring new meaning to the nursing paradigm of caring-healing and health. Her caritas process was devel- oped to balance the “cure” stance of Western medicine. Watson’s theory has since evolved into “clinical caritas processes.” This perspective describes nurse–client relationships based on spirituality, love, caring, healing environ- ments, wholeness, and unity of being ( Watson, 2007 ).

The art of nursing is in being there, with another person or persons, in an atmosphere of caring. Caring involves compassion and sensitivity to each person within the context of her or his entire life. In the past, the biomedical model urged nurses not to care too much or get too involved. Caring, success- ful nurses, however, do get involved with clients as they practice nursing as an art instead of nursing as just a day-to-day job. Caring is a philosophy or context within which nurses practice nursing. Their practice is made caring not by the tools they use but by the attitude or perspective they bring. It is possible, of course, to use the tools of alternative therapies in the same reduc- tionist way of biomedicine. For example, if one knows the pressure point for headaches and simply uses this pressure point for pain relief without any fur- ther assessment, it can hardly be considered holistic or healing. The symptom of headache has been addressed, but the meaning of the headache and the person’s experience of the pain has been totally ignored.

The plurality of the sick care, health care system may be one of its great- est strengths. It enables us to meet the diverse needs of diverse populations. The question is, How can we combine the best ideas of conventional nursing practice and complementary and alternative healing practices? First, we must have education. At the basic level, our nursing curricula must include courses in caring and alternative therapies. All nurses could learn Therapeutic Touch (TT), healthy dietary plans, the use of basic herbs, as well as the use of visual- ization in the healing process. Since 2004, basic alternative therapies content is included in the NCLEX-RN examination. Because state boards of nursing vary in their detail of criteria for alternative therapies and nursing practice, it is critical that you check the Nurse Practice Act of your state.

The White House Commission on Complementary and Alternative Medicine states that “since the public utilizes both conventional health care and complementary and alternative medicine (CAM), the Commission

16 Unit 1 • Healing Practices

believes that this reality should be reflected in the education and training of all health practitioners” ( National Institutes of Health, 2002 , p. 51 ). The Com- mission goes on to say that “although there has been notable progress in introducing CAM into medical, nursing, and other fields of conventional health care education in recent years, more needs to be done” (p. 51 ). We must also participate in continuing education courses to expand our knowledge beyond the basic level. With additional education, we can learn such thera- pies as basic massage and reflexology, meditation, and yoga. Some nurses will choose to continue their education through master of science in nursing degrees with a holistic nursing concentration or through certificate programs for nurse practitioners. Other nurses will choose to complete formal programs in alternative medicine such as naturopathy, Ayurveda, homeopathy, chiro- practic medicine, or hypnotherapy. Advanced practice nurses should provide leadership in research and education in alternative therapies ( Denner, 2007 ).

Next, we must provide community education. We must provide people with information, tools, skills, and support to enable them to make healthy decisions about life and negotiate their way through the health care systems. As nurses, we have the opportunity to initiate conversations about alternative therapies. Growing immigrant populations call for more attention to a variety of health expectations, needs, and preferences. We must also become familiar with the alternative practices immigrants bring with them. An important con- sideration in evidence-based practice is patient preference. We must also attempt to keep ourselves healthy and to exemplify good health because teaching by example is a powerful influence. We can teach wherever our prac- tice is located: acute care, long-term care, community nurse-managed centers, and in areas of advanced practice nursing. And, finally, we must document our findings, utilize and participate in nursing research, keep current with evidence-based practice, and design new studies to measure the effectiveness of various healing practices.

Self-Care

Before we nurses can care for clients, we must first learn to value and care for ourselves. One of your goals in reading this text might be to discover how to care for yourself more effectively, because only then will you have the energy to care for your clients. Caring for yourself means reducing unnecessary stress, managing conflict effectively, communicating clearly with family and friends, and taking time out for yourself. Caring for yourself may include developing a daily routine in practices such as relaxation, meditation, prayer, yoga, communion with nature, and other such forms of contemplation. In Watson’s words, “If one is to work from a caring-healing paradigm, one must live it out in daily life” ( Watson, 1997 , p. 51 ). The following guidelines will help you maintain your self-care practices ( Jahnke, 1997 ):

• Choose self-care activities that appeal to you and fit into your lifestyle. • Do one or more of these practices every day. Consider them as impor-

tant as food and sleep.

Chapter 1 • Integrative Healing 17

• Seek guidance and support from teachers/practitioners if appropriate. • Find a good spot for your practice that is physically and mentally com-

fortable. • Build up your practice slowly. Success is not gained by aggressive or

compulsive practice. • Look for opportunities to practice with others. • Focus on relaxing. The foundation of all self-healing, health enhance-

ment, stress mastery, and personal empowerment is deep relaxation.

References

Buchan, S., Shakeel, M., Trinidade, A., Buchan, D., & Ah-See, K. (2012). The use of complementary and alternative medicine by nurses. British Journal of Nursing, 21(11): 672–675.

Clement, J. P., Chen, H. F., Burke, D., Clement, D. G., & Zazzali, J. L. (2006). Are consumers reshaping hospitals? Complementary and alternative medi- cine in U.S. hospitals, 1999–2003. Health Care Management Review, 131(2): 109–118.

Denner, S. S. (2007). The advanced prac- tice nurse and integration of comple- mentary and alternative medicine. Holistic Nursing Practice , 21(3): 152–159.

Dossey, B. M., Keegan, L. G., & Guzzetta, C. E. (2005). Holistic Nursing: A Hand- book for Practice (4th ed.). Sudbury, MA: Jones & Bartlett.

Duncan, A. D., Liechty, J. M., Miller, C., Chinoy, G., & Ricciardi, R. (2011). Employee use and perceived benefit of a complementary and alternative med- icine wellness clinic at a major military hospital. Journal of Alternative and Com- plementary Medicine, 9(17): 809–815.

Halcon, L. L., Chlan, L. L., Kreitzer, M. J., & Leonard, B. J. (2003). Complementary therapies and healing practices: Faculty/student beliefs and attitudes and the implications for nursing edu- cation. Journal of Professional Nursing , 19(6): 387–397.

Jahnke, R. (1997). The Healer Within . San Francisco, CA: Harper.

Lachance, L. L., Hawthorne, V., Brien, S., Hyland, M. E., Lewith, G. T., Verhoef, M. J., . . . Zick, S. (2009). Delphi-derived development of a common core for mea- suring complementary and alternative medicine prevalence. Journal of Alterna- tive and Complementary Medicine, 15(5): 489–494. doi: 10.1089/acm.2008.0430

National Center for Complementary and Alternative Medicine. (2011). Third strategic plan: 2011–2015. Retrieved from www.nccam.nih.gov/about/ plans/2011?nav=gsa

National Institutes of Health. (2002). White House Commission on Complemen- tary and Alternative Medicine Policy, Final Report . Washington, DC: U.S. Government Printing Office. Retrieved from www.whccamp.hhs.gov

Ortiz, B. I., Shields, K. M., Clauson, K. A., & Clay, P. G. (2007). Complementary and alternative medicine use among Hispanics in the United States. Annals of Pharmacotherapy , 41(6): 994–1004.

Peplau, H. E. (1952). Interpersonal Relations in Nursing. New York, NY: Putnam.

Quartey, N. K., Ma, P. H. X., Chung, V. C. H., & Griffiths, S. M. (2012). Comple- mentary and alternative medical edu- cation for medical profession: Systematic review. Evidence Based Complementary and Alternative Medi- cine. doi: 10.1155/2012/656812

Quinn, J. F. (2000). The self as healer: Reflections from a nurse’s journey. AACN Clinical Issues , 11(1): 17–26.

18 Unit 1 • Healing Practices

Saydah, S. H., & Eberhardt, M. S. (2006). Use of complementary and alternative medicine among adults with chronic diseases. Journal of Alternative and Com- plementary Medicine , 12(8): 805–812.

Shreffler-Grant, J., Hill, W., Weinert, C., Nichols, E., & Ide, B. (2007). Com- plementary therapy and older rural women: Who uses it and who does not? Nursing Research , 56(1): 28–33.

Sirois, F. M. (2008). Provider-based com- plementary and alternative medicine use among three chronic illness groups. Complementary Therapies in Medicine , 16: 73–80.

Thomson, P., Jones, J., Evans, J. M., & Leslie, S. J. (2012). Factors influencing the use of complementary and alterna- tive medicine and whether patients inform their primary care physician. Complementary Therapies in Medicine, 20: 45–53. doi: 10.1016/j.ctim.2011.10.001

Tiedje, L. B. (1998). Alternative health care: An overview. Journal of Obstetric, Gynecologic, and Neonatal Nursing , 27(5): 557–562.

U.S. Department of Health and Human Services. (2010a). Healthy People 2020. Washington, DC: U.S. Government Printing Office.

U.S. Department of Health and Human Services. (2010b). Patient Protection and Affordable Care Act. Retrieved from http://www.hhs.gov/healthcare/ rights/law/index.html

Watson, J. (1979). Nursing: The Philosophy and Science of Caring . New York, NY: Little, Brown.

Watson, J. (1997). The theory of human caring: Retrospective and prospective. Nursing Science Quarterly , 10(1): 49–52.

Watson, J. (2007). Caring theory defined. University of Colorado Denver, Col- lege of Nursing. Retrieved from www. nursing.ucdenver.edu/faculty/ theory_caring.htm

Willison, K. D. (2006). Integrating Swedish massage therapy with primary health care initiatives as part of a holistic nurs- ing approach. Complementary Therapies in Medicine , 14: 254–260.

World Health Rankings. (2013). Retrieved from www.worldlifeexpectancy.com

Resources

American Holistic Health Association

P.O. Box 17400

Anaheim, CA 92817–7400

714.779.6152

www.ahha.org

American Association of Integrative Medicine

2750 E. Sunshine St.

Springfield, MO 65804

877.718.3053

www.aaimedicine.com

Australian National Institute of Complementary Medicine

www.nicm.edu.au

National Center for Complementary and Alternative Medicine

National Institutes of Health

9000 Rockville Pike

Bethesda, MD 20892

888.644.6226

www.nccam.nih.gov

2 Basic Concepts Guiding Alternative Therapies

For breath is life, and if you breathe well, you will live long on earth.

Sanskrit Proverb

In this book, separate chapters are devoted to each of the most widely used methods in complementary and alternative med-icine. Because the methods share many principles, there is overlap in the various types of complementary and alternative practices. Although practices are grouped in units, many of the practices could be placed in several units. Thus, before examining the specifics of each practice, it may be helpful to introduce sev- eral concepts common to most healing practices, namely, balance, spirituality, energy, and breath.

BALANCE

An expression in the Native American culture, “walking in bal- ance,” describes the philosophy of a peaceful coexistence and har- mony with all aspects of life. This concept of balance is found in all cultures throughout time. Balance is viewed as a path rather than a steady state, and it is believed that each of us has a unique path as we move through life. In terms of optimal wellness, the concept of balance consists of mental, physical, emotional, spiritual, and environmental components. Not only does each component have to be balanced, but equilibrium is necessary among the compo- nents. Physical aspects include optimal functioning of all body sys- tems. Emotional aspects include the ability to feel and express the

19

20 Unit 1 • Healing Practices

entire range of human emotions. Mental aspects include feelings of self-worth, a positive identity, a sense of accomplishment, and the ability to appreciate and create. Spiritual aspects involve moral values, a meaningful purpose in life, and a feeling of connectedness to others and to a divine source. Environmental aspects include physical, biologic, economic, social, and political conditions. Walking in balance is a learned skill and one that must be practiced regularly to engage in the process of healthy living. This concept of balance appears repeatedly throughout the various alternative healing practices.

Cyclic Rhythms

The daily lives of all living things are filled with various changes that take place in cyclic patterns. Circadian rhythms are regular fluctuations of a vari- ety of physiologic factors over 24 hours. Most familiar is the 24-hour tempera- ture and sleep patterns. These include adrenal, thyroid, and growth hormone-secreting patterns, as well as temperature, sleep, arousal, energy, appetite, and motor activity patterns. Ultradian rhythms are regular fluctua- tions repeated throughout a 24-hour day. An example of an ultradian rhythm is the 90-minute REM/non-REM sleep cycle. Infradian rhythms are regular fluctuations over periods longer than 24 hours, such as the menstrual cycle. The constant rhythmic processes bring about a dynamic, healthy balance in the body.

Rhythms may be desynchronized by external or internal factors. An example of external desynchronization is jet lag, in which rapid time zone changes result in a decreased energy level and ability to concentrate, as well as mood variations. In some individuals, internal desynchronization may result in depression. The tendency toward internal desynchronization is prob- ably inherited, but stress, lifestyle, and normal aging influence it. Attention to the rhythmic nature of one’s own being reveals an intimate relationship with the rhythms of the surrounding natural world.

Musical Rhythms

Health is about balance or harmony of body, mind, and spirit. In a state of optimal health, all frequencies are in harmony, like a finely tuned piano. In fact, music is often employed in healing, from the ancient use of the drum, rattle, bone flute, and other primitive instruments to the current use of music as a prescription for health. Several nursing research studies have demon- strated the effectiveness of music therapy for persons with mental disorders, autism, dementia, cancer, cognition disorders, and neurological problems. Chapter 21 covers music and its research in greater detail.

Dr. Andrew Weil, the leader in the field of integrative medicine, has cre- ated the Mindbody Tool Kit ( 2005 ) to help people utilize self-healing techniques. Sound therapy consists of classical music combined with healing sound fre- quencies. The combination of sounds entrains the brain to theta and delta brain waves, the state of deep relaxation in which the body and mind can heal

Chapter 2 • Basic Concepts Guiding Alternative Therapies 21

themselves. The benefits of sound therapy are far reaching. People who may benefit from sound therapy include those

• experiencing an illness. • who are having or have had surgical procedures. • who are having or have had chemotherapy infusions. • in intensive care. • in labor and delivery. • experiencing anxiety, depression, or insomnia. • who wish to maintain a high level of wellness.

Drumming and chanting are powerful ways to bring oneself in balance with self, others, and the world. The drumbeat serves as a focus for concentra- tion and quiets the chattering mind. The pace of the drumbeat enhances theta brain wave production. In one study, group drumming improved the social- emotional behavior of preteens experiencing the effects of chronic stress ( Ho, Tsao, Bloch, & Zeltzer, 2011 ).

SPIRITUALITY

Spiritual healing techniques and spiritually based health care systems are among the most ancient healing practices. Spirit is the liveliness, richness, and beauty of one’s life. It is who one is and how one exists in the world. Spirituality is the drive to become all that one can be, and it is bound to intuition, creativity, and motivation. It is the dimension that involves relationship with oneself, with others, and with a higher power. Spirituality is that which gives people mean- ing and purpose in their lives. It involves finding significant meaning in the entirety of life, including illness and death ( Jampolsky, 2005 ; Taylor, 2002 ).

Many people are searching for wholeness in their lives and a way to allow their innermost selves to grow and expand. Spiritual healing practices guide individuals to places within themselves they did not know existed, through techniques as ancient as prayer, contemplation, meditation, drumming, story- telling, and mythology. In consciously awakening the energies of the spirit, peo- ple are able to move toward healing places and sacred moments in their lives.

During periods of stress, illness, or crisis, people search for meaning and purpose in their pain and suffering. They ask questions such as Why am I sick? or Why did this bad thing happen? This spiritual quest for meaning can lead to insight and healing or to fear and isolation. In the words of Ken Wilber:

A person who is beginning to sense the suffering of life is, at the same time, beginning to awaken to deeper realities, truer realities. For suffering smashes to pieces the complacency of our normal fictions about reality, and forces us to become alive in a special sense—to see carefully, to feel deeply, to touch ourselves and our world in ways we have heretofore avoided. It has been said, and truly I think, that suffering is the first grace. (quoted in Borysenko & Borysenko, 1994 , p. 191 )

22 Unit 1 • Healing Practices

Spirituality is often confused with religiosity, which is not surprising, because the two constructs are closely related. Religion involves a search for the sacred, a group identity, and a sense of belonging. Spirituality , a much broader concept, is the search for wholeness and purpose that underlies the world’s religions. Removing the dogma, the politics, and cultural influence from any of the world’s religions uncovers the same questions, the same seek- ing, and the same answers. The concept of spirituality does not undermine any religion but rather enhances all religions by illuminating their common- alities and the unity of all people. Spirituality reveals far more similarities than differences among individuals. Chapter 23 covers faith and prayer as it relates to health and well-being.

Many traditions also speak of spiritual guides. Some individuals think of them as guardian angels, and others, as Beings of Light who guide people through near-death experiences. Buddhists think of them as devas . Cherokees call them Adawees , the great protectors of the Four Directions. Malakh , or “messenger,” is the Hebrew word for angel. There are the cherubim and the seraphim and the four great archangels: Uriel, Raphael, Michael, and Gabriel. The Iranian angel Vohu Manah is believed to have revealed the message of God to Zoroaster some twenty-five hundred years ago. Similarly, the archangel Gabriel is credited for revealing the Quran to Muhammad a thousand years later. Gabriel, honored by Jews, Christians, and Muslims, has a special role as a mediator between human consciousness and the higher realms from which spirit descends into the body. Although no Western scientific evidence supports the existence of angels, one can find phenomenological evidence. Many first-person accounts of near-death occurrences involve angels and similar experiences from people of different ages, from diverse cultures, and with different personal and religious beliefs ( Borysenko & Dveirin, 2007 ).

ENERGY

The concept of energy has been recognized for centuries and in most cultures. Many ancient and current cultures have great respect for the subtle and unseen forces in life. Most spiritual traditions share the belief that energy is the bridge between spirit and physical being. Meditation and prayer are believed to be subtle energy phenomena that represent contact with the spiritual dimension.

Chinese Taoist scholars believed that energy, not matter, was the basic building material of the universe. Albert Einstein and other physicists proved that matter and energy are equivalent and that energy is not only the raw material of the cosmos but the glue that holds it together. Modern scientists now view the universe in terms of forces instead of tiny particles of matter. Their experimental findings are similar to the intuitive observations of China’s ancient scholars. Everything in the world—animate and inanimate—is made of energy. People are beings of energy, living in a universe composed of energy.

Chapter 2 • Basic Concepts Guiding Alternative Therapies 23

Although Western scientists agree on this theory, they do not yet fully agree that a distinct energy system exists within the human body. For energy to be “real,” it must be measurable by scientific instruments. By this logic, of course, brain waves did not exist prior to the invention of electroencephalo- graphs! Because technology is not yet capable of measuring all the energy fields in the body, references to energy are not often found in conventional medicine.

For more than 2,000 years, various practitioners worldwide have insisted that a person is more than the physical body. According to these healers, a “life force” of subtle energy surrounds and permeates every person. Energy is viewed as the force that integrates the body, mind, and spirit; it is that which connects everything. The Japanese call this energy ki (pronounced “key”); the Tibetans refer to it as lung (pronounced “loong”); the Polynesians call it mana ; Native Americans call it oki, orenda , or ton ; Americans call it subtle energy or bioenergy; the Greeks call it pneuma ; and the Hindus give it the name prana . Prana is sometimes translated from the Sanskrit as “primary energy,” “breath,” or “vital force.” The Chinese refer to this energy as qi or chi ( pronounced “chee”) and believe that it takes the form of two opposite but complementary phases, yin and yang. Yin is the earth, moon, night, fall and winter, cold, wetness, darkness, the feet, the left side, the female gender, and passivity. Yin is involved in tissue growth. Yang is the sun, day, spring and summer, heat, dryness, light, the head, the right side, the male gender, and aggressiveness. Yang is involved in tissue breakdown. It is believed that each person is a unique combination of the complementary energies yin and yang. This union of opposites constitutes wholeness. Figure 2.1 shows the t’ai chi symbol, which illustrates the yin and yang of Chinese thought. The white dot on the black portion of the symbol and the black dot on the white section are reminders that each quality contains some of its opposite. Further descriptions of yin and yang are found in Chapter 4 .

It is believed that qi creates qi. In other words, physical activities such as eating, work, and rest, as well as nonphysical aspects of life such as will, moti- vation, feelings, desires, and a sense of purpose in life, are all made possible

Yang Yin

FIGURE 2.1 T’ai Chi Symbol

24 Unit 1 • Healing Practices

by qi. Those same activities and aspects also create more qi. Most schools of thought basically agree on the following points regarding energy:

• Energy comes from one universal source. • Movement of energy is the basis of all life. • Matter is an expression of energy and vice versa. • All things are manifestations of energy. • The entire earth has energetic and metabolic qualities. • People are composed of multiple, interacting energy fields that extend

out into the environment. • People’s relationships with one another are shaped by the interactions of

their energies. • Qi, ki, and prana have no exact counterpart in conventional medicine,

though the concept of a physical bioenergy system is under research. It is described as a weak but complex electromagnetic field that is hypothesized to involve electromagnetic bioinformation for regulating homeodynamics. ( Newman & Miller, 2006 ; Warber, Cornelio, Straughn, & Kile, 2004 )

Chakras

The Hindu concept of chakras (a Sanskrit word for “spinning wheel”) describes seven major energy centers within the physical body. Chakras have been described by most Eastern cultures and several South American cultures (such as Mayan) for thousands of years. Chakras are major centers of both electromagnetic activity and circulation of vital energy. They are usually thought of as funnels of perpetually rotating energy and are considered the gateways through which energy enters and leaves the body. Each chakra in the body is recognized as a focal point of the life force relating to physical, emotional, mental, and spiritual aspects of people and is the network through which the body, mind, and spirit interact as one holistic system. Figure 2.2 illustrates the sites of the chakras in the body.

The concept of chakras may be foreign to the Western scientific mind, but chakras are not completely unknown to those familiar with Judeo- Christian culture, particularly in the artwork and sculptures passed down through the ages. For centuries, the crown chakra, which signifies a conscious awareness of the divine, has been painted as a halo over those who are con- sciously aware of a divine presence in their lives.

The seven main chakras are vertically aligned up the center of the body from the base of the pelvis to the top of the head. Each has its own individual characteristics and functions, and each has a corresponding relationship to various organs and structures of the body, to one of the endocrine glands, as well as to one of the seven spectral colors of the rainbow. The characteristics of the seven major chakras are described in Box 2.1 . Of the many smaller chakras throughout the body, the most significant are in the palms of the hands. The hand chakras are considered extensions of the heart chakra and, as such, radiate healing and soothing energies. Spiritual healers who practice the

Chapter 2 • Basic Concepts Guiding Alternative Therapies 25

(continued)

BOX 2.1

The Chakras

1. Root chakra Location: base of the spine Center of: physical vitality, urge to survive Gland: adrenal glands Organs/Structures: kidneys, bladder, spine Color: red

2. Sexual or navel chakra Location: slightly below the navel, in front of the sacrum Center of: sexual energy, ego, extrasensory perception Gland: gonads Organs/Structures: reproductive organs, legs Color: orange

FIGURE 2.2 The Chakras and the Auric Field

26 Unit 1 • Healing Practices

laying on of hands concentrate energy in their hand chakras. Each chakra has a purpose and a function that

• regulates the human energy system and maintains an equilibrium of health (purpose); and

• links body, mind, and spirit and exchanges energy (function).

Each chakra also operates at its own optimum frequency; generally, the lower the chakra on the body, the lower its frequency. If one frequency is out of sync, all others will be also.

The main purpose in working with and understanding the chakras is to create integration and wholeness within people. The chakras are the “door- ways” through which the energy from within and without is distributed to cells, tissues, and organs. If chakras stop functioning properly, the intake of energy will be disturbed, and the body organs served by that chakra will not

3. Solar plexus chakra Location: slightly above the navel Center of: unrefined emotions, urge for power Gland: pancreas Organs/Structures: stomach, liver, gallbladder Color: yellow

4. Heart chakra Location: middle of the chest at the height of the heart Center of: unconditional affection, compassion, devotion, love, spiritual growth Gland: thymus Organs/Structures: heart, liver, lungs, circulatory system Color: emerald

5. Throat chakra Location: throat area Center of: communication, self-expression, creativity Gland: thyroid Organs/Structures: throat, upper lungs, digestive tract, arms Color: blue

6. Third-eye chakra Location: middle of the forehead, a little higher than the eyebrows Center of: the will, intellect, spirit, spiritual awakening, visualization Gland: pituitary Organs/Structures: spine, lower brain, left eye, nose Color: purple

7. Crown chakra Location: at the top of the head at the fontanel Center of: highest level of consciousness or enlightenment, intuition, direct spiritual vision Gland: pineal Organs/Structures: upper brain, right eye Color: golden white

Chapter 2 • Basic Concepts Guiding Alternative Therapies 27

get their needed supply of energy. Eventually, organ functioning will be dis- rupted, leading to weakened organs with a diminished immune defense. If this process continues, the end result will be dysfunction and disease ( McGuinness, 2012 ). Dr. Dean Ornish ( 1999 ), well known for his program to reverse coronary artery disease through diet, exercise, support groups, and meditation without surgery or drugs, believes that a closed heart chakra (unresolved anger and fear) is related to blocked coronary arteries. Conse- quently, the meditation technique he incorporates into his program involves opening the heart chakra. His holistic approach has now become a recognized program practiced nationwide.

Aura

Closely related to the notion of chakras is the concept of aura. The aura is the energy field surrounding each person as far as the outstretched arms and from head to toe. This energy field is both an information center and a highly sensitive perceptual system that transmits and receives messages from the internal and external environments. Each of the seven layers of the auric field is associated with a chakra; the first layer is related to the first chakra, and so on. Each layer has physical, mental, emotional, and spiritual dimensions and purposes, and the lay- ers function together through the transmission of energy. Box 2.2 lists

BOX 2.2

Seven Layers of the Auric Field

Level 1. Etheric Body Location: 1/4 inch to 2 inches beyond the physical body Center of: physical functioning and physical sensation Color: light blue to gray Level 2. Emotional Body Location: 1 to 3 inches beyond the physical body; roughly follows the outline of the physical body Center of: emotional aspects of person Color: all colors of the rainbow Level 3. Mental Body Location: 3 to 8 inches beyond the physical body Center of: instinct, intellect, intuition Color: bright yellow with additional colors superimposed Level 4. Astral Body Location: 6 to 16 inches beyond the physical body Center of: love Color: same colors as in level 3 but infused with the rose light of love Level 5. Etheric Template Body Location: 18 to 24 inches beyond the physical body

(continued)

28 Unit 1 • Healing Practices

characteristics of the auric field, and Figure 2.2 shows a diagrammatic view of the auric field. Virtually every alternative healing therapy has a way of interpreting the body’s subtle energy , which will be discussed throughout this text .

Meridians

A person’s vital energy is not simply radiated outward but has patterns of cir- culation within the body, referred to as the meridian system. Meridians are a network of energy circuits or lines of force that run vertically through the body, connecting all parts. Meridians may be understood more clearly if they are com- pared to a major city’s highway system with entrance and exit ramps, merging roads, and connecting surface streets. If a flood blocks an exit ramp, the streets served by this ramp become inaccessible, which, in turn, affects the people who live and work on those streets. Also, the traffic may back up on the highway, as cars wait for the ramp to reopen, creating a traffic jam. Meridians operate simi- larly in a person’s body. If some type of blockage affects one’s hip, for example, the pathways of energy leading to that hip get “backed up.” Pain or discomfort restricts the motion of the hip, which may affect the position of the foot, which creates a strain on other sets of muscles. These changes in the body’s general posture affect the positions of the internal organs, which, in turn, restrict the nutrition to the organs, alter organ function, and thereby change the body’s bal- ance. As the body and mind are affected, the person will think and feel differ- ently, leading to more tension and more changes ( Zhu, 2012 ).

Each meridian passes close to the skin’s surface at places called hsueh , which means “cave” or “hollow” and is translated as point or acupuncture point. Because each meridian is associated with an internal organ, the acu- puncture points offer surface access to the internal organ systems. The flow of qi can be strengthened or weakened by manipulating specific points. Keeping the flow of energy open and regular contributes to a state of balance and health.

The California Institute for Human Science ( www.cihs.edu ) is the U.S. center for research on a device called the Apparatus for Meridian Identifica- tion (AMI). The AMI measures the flow of ions through the body and in 10 minutes can completely evaluate the condition of a person’s meridian system

Center of: higher will connected with divine will, speaking, listening, working, tak- ing responsibility for our actions Color: clear lines on cobalt blue background Level 6. Celestial Body Location: 24 to 33 inches beyond the physical body Center of: celestial love, spiritual ecstasy, protection and nurturance of all life Color: shimmering pastel colors Level 7. Causal Body Location: 30 to 42 inches, forming an egg shape around the body Center of: higher mind; integration of spiritual and physical body Color: shimmering gold threads

Chapter 2 • Basic Concepts Guiding Alternative Therapies 29

and the corresponding internal organs related to those meridians. This stream of ions is not vital energy or qi itself. Rather, it is a secondary electromagnetic effect of qi—in a sense, its imprint in the physical domain. The AMI is now available for distribution as a diagnostic tool in complementary and alterna- tive therapies and in conventional medicine ( Ahn & Martinsen, 2007 ).

Energy Concentration

The mind’s energy, or willpower, can be developed by individuals to control their body’s energy system to an extraordinary degree. Healers can concentrate and manipulate energy in remarkable ways using their energy to align and balance the electromagnetic field of the patient. In attempting to trace the source of healers’ energy, studies demonstrate that it seems to come from the central body in the area between the solar plexus and the lower abdomen. The Chinese refer to this spot as the tan dien or the home of qi, and the Hindus refer to it as the solar plexus chakra or the seat of prana ( Zhu, 2012 ).

Grounding and Centering

Two terms common in various healing practices and related to energy and bal- ance are grounding and centering . Grounding , as its name suggests, relates to one’s connection with the ground and, in a broader sense, to one’s whole con- tact with reality. Being grounded suggests stability, security, independence, having a solid foundation, and living in the present rather than escaping into dreams. It means having a mature sense of responsibility for oneself. Much of the sense of grounding comes from identification with the lower half of one’s body—the parts of being that are less conscious and have more instinctive functions of movement. Learning to breathe into the belly, for example, is vital for grounding, for if the breath is shallow, contact with feelings and reality is limited. Many of the practices in this text , such as biofield therapies, mind– body techniques, and spiritual therapies, help increase one’s groundedness.

Centering refers to the process of bringing oneself to the center or mid- dle. When people are centered, they are fully connected to the part of their body where all their energies meet. Centering is the process of focusing one’s mind on the center of energy, usually in the navel or solar plexus chakra. All movement in the body originates from this center, providing the meeting point for body and mind. It is commonly considered the “earth” center, for it gathers energy from the earth rising up through the legs. Centering can be done through movement, as in t’ai chi, or can be found in stillness, as in med- itation. Being centered allows one to operate intuitively, with awareness, and to channel energy throughout the body.

BREATH

Breath is at the center of all spiritual and religious traditions. In many languages, the words for spirit and breath are one and the same—Sanskrit prana , Hebrew ruach , Greek pneuma , and Latin spiritus . In Christianity, the Holy Spirit

30 Unit 1 • Healing Practices

is referred to as “the breath of life.” To inspire, or take in spirit, means not only to inhale but to encourage, motivate, and give hope. To expire, or lose spirit, means not only to exhale but to die, cease to exist, to end, or be destroyed.

In Eastern cultures, when air is inhaled, so is vital energy, which flows into the body to nourish and enliven. In traditional Chinese medicine, the exhalation is considered the yin part of the breath, and the inhalation is yang. It is impossible only to breathe in without breathing out or to breathe out without breathing in. It is the continuous dynamic balance of yin and yang that contributes to health and well-being. Most of the healing traditions worldwide believe breath is the most important function of life, and restric- tions in breathing lead to dysfunction and disease.

In Western culture, the breath has been considered simply a mechanical, metabolic function of the body. Scientists are now beginning to recognize that breath can be used for healing, improving the body’s self-repair processes, and reducing vulnerability to illness. Oxygen is toxic to viruses, bacteria, yeasts, and parasites in the body, and cancer cells find it more difficult to survive in an oxygen-rich environment. Andrew Weil ( 1995a ) believes that “breath is the master key to health and wellness, a function we can learn to regulate and develop in order to improve our physical, mental, and spiritual well-being” (p. 86 ).

The breath is constantly adapting to accommodate the needs of the situa- tion at hand. When people eat heavy meals or exercise rapidly, when their noses are congested or dry, or when their environment is filled with pleasant or unpleasant smells, their breathing changes. Every change in posture has an effect on the combination of muscles used to breathe. Breath does not feel the same standing or sitting as when one is lying down. Breathing also changes under stress. For example, anxious people take shallow “chest” breaths, using only their chest muscles to inhale rather than their diaphragm. As a result, only the top part of their lungs fills with air, depriving the body of the optimal amount of oxygen.

Many people, even when feeling relaxed, breathe in a shallow way that keeps them in a constant state of underoxygenation that contributes to a decreased level of energy and increased vulnerability to illness. The typical shallow chest breath moves about half a pint of air, whereas a full abdominal breath can move eight to ten times that amount. Forming healthy breathing habits can produce dramatic results. Probably no other single step that people can take will so profoundly and positively affect body, mind, and spirit. Deep breathing can counter stress. Just three deep, full belly breaths can move indi- viduals from panic to calmness by increasing their oxygen intake. Much of perceived stress is worrying about the future or the past, and deep breathing is a great way to return to the present. Twenty minutes of deep breathing exercises a day can lower blood pressure by increasing oxygen intake, which decreases workload on the cardiovascular system ( Anselmo, 2013 ; Ody, 2011 ).

INTEGRATED NURSING PRACTICE

In complementary and alternative medicine, the focus of restoring health is within each person and cannot be “given” to a client by any health care practitioner. Drugs, herbs, procedures, surgeries, or mind–body techniques

Chapter 2 • Basic Concepts Guiding Alternative Therapies 31

may be helpful or necessary but by themselves do not cure disease. People must, and do, rebalance and repair themselves. The profession of nursing was founded on this philosophy and view of life as noted by Florence Nightingale’s ( 1860 ) basic premise that healing is a function of nature that comes from within the individual. She saw the role of the nurse as putting the “patient in the best condition for nature to act on him.”

In contrast, biomedicine has taught people to listen to external authori- ties and to view themselves as helpless victims of disease. Conventional medi- cine is based on the idea of cure, which usually refers to the elimination of the signs and symptoms of disease. “Curing,” however, is effective for only about 15% to 20% of the sick population. In 80% to 85% of acute disruptions of health, one of three things happens with or without medical intervention: The person gets well, develops a chronic disorder for which there is no cure, or dies. When the focus is on cure, death is seen as a failure. Certainly, the curative aspects of Western medicine have allowed many people to live healthy, productive lives. But for many others, fixing the body is not enough. As individuals search for meaning in their illness and their life, as well as a sense of connectedness with others, they begin the healing process. Box 2.3 compares the philosophy and beliefs of the medical-curing model with the nursing-healing model.

Many sick people eventually get better no matter what treatment is given or even if no treatment is given. If the person is given “something,” recovery is even more likely because of the placebo effect . The concept of the placebo effect follows directly from biomedicine’s denial of the power of self-healing.

(continued)

BOX 2.3

The Cure Versus Heal Models

Medical-Curing Model Nursing-Healing Model

Diseases are cured People are healed Focus on diagnosis Focus on meaning Patient is dependent Person is autonomous Effective for 15%–20% of Effective for everyone; healing is always

population; cure may or may not possible be possible

Body is viewed as a machine; Body is a living microcosm of the disease results when parts break universe; disease results through imbalance

Role of medicine is to combat Role of medicine is to restore harmony; disease; practitioners are soldiers practitioners are the Peace Corps, in a war fostering learning and growth

Body is passive recipient of Body is capable of self-healing treatments to fix it

32 Unit 1 • Healing Practices

In Western research studies, the placebo is a simulated biomedical treatment with no inherent medical value. The placebo response complicates researchers’ experiments. In study after study, the placebo has been found effective in at least 30% to 35% of the cases. In fact, the rate is as high as 70%; typically, 40% of individuals report excellent results, and another 30% report good results ( Benson, 1997 ; Bishop, Adams, Kaptchuk, & Lewith, 2012 ; Harrington, 2008) . Norman Cousins, author of Anatomy of an Illness ( 1991 ) and The Healing Heart ( 1985 ), described the placebo as the “doctor who resides within.” In fact, the placebo response in Western scientific literature demonstrates the unity of mind–body and provides great evidence of humans’ self-curing capacity. Janet Quinn ( 1989 ), a leader in holistic nursing, believes that because the site of all curing is within the individual, “there are no longer any ‘real’ or ‘placebo’ treatments and effects. There are only stimuli for healing processes” (p. 554 ). Andrew Weil ( 1995b ) regards the placebo response as a “pure example of healing elicited by the mind; far from being a nuisance, it is, potentially, the greatest therapeutic ally doctors can find in their efforts to mitigate disease” (p. 52 ).

Beliefs can also work against people. The nocebo is the placebo’s negative counterpart. It is destructive thinking that contributes to sickness and even death. The body is good at healing, but at times individuals inhibit this pro- cess by worrying or doubting their ability to overcome the illness. Nurses must routinely assess clients’ beliefs and expectations for health and use them systematically in the healing process. The goal is not to deny reality but to help people project healthy images. When a person acts “as if” the preferred reality were true, the body responds, and improved health can emerge ( Hauser, Hansen, & Enck, 2012 ).

The word heal comes from the Greek word halos and the Anglo-Saxon word haelan , which mean “to be or to become whole.” (Interestingly, the word holy is derived from the same source.) Thus “healing” means “making whole”—that is, restoring balance and harmony. It is a movement toward a sense of wholeness and completion. Healing comes from surrendering to life as it is, including all feelings, from anger and despair through joy and peace- fulness. The irony is that in the process of accepting life as it is, most people feel more alive and live more fully, even when facing death. When the focus is on healing, success does not depend on whether the person lives. Healing can take place even as the body weakens. Through healing, people allow them- selves to be everything they already are and move toward a greater sense of

Primary treatments are drugs, Primary treatments are diet, herbs, stress surgery, radiation management, social support Focus on pain Focus on the human experience of pain, which is suffering Caring is seen as a means to an end Caring is the end in itself

Sources: Dossey & Keegan, 2013 , 2005; Quinn, 1989 ; Watson, 2007 .

Chapter 2 • Basic Concepts Guiding Alternative Therapies 33

the meaning of their experiences. Even when nothing can be done physically to alter the course of disease, still much can be done in a caring sense to make the human experience more meaningful and understandable ( Dossey & Keegan, 2013 ; Quinn, 1997 ). As Joellen Goertz Koerner ( 2011 ) stated: “The ‘being’ dimension of the role of the nurse is less about what nurses do and more about the how. . . . ‘Being’ is what slows down the nurse so that space is created for an authentic, deep connection with the patient and healing” (p. xiv).

Nursing has always focused on creating healing environments for those who have been entrusted to our care. We create healing environments when we use our hands, heart, and mind to provide holistic nursing care. We create heal- ing environments when we empower others by providing the knowledge, skills, and support that allow them to tap into their inner wisdom and make healthy decisions for themselves. Healing environments are a synthesis of the medical- curing approach and nursing-healing approach. We need a healthy balance between technology and compassion. We create healing environments when we take the time to be with clients in deeply caring ways. It is when we stop, become still, and enter the other’s subjective world that we are able to be wholly present for that person. This moment of spiritual connection is uplifting for both client and nurse. Karilee Shames ( 1993 ) described sacred healing moments that occurred when her “goal became to inspire, to share tenderness, and to help instill a will to live, or to surrender to the call of death peacefully, if that was most appropriate. In my highest vision, this is what nursing was all about” ( Shames, 1993 , p. 131 ).

Patients come to us at the most vulnerable times of their lives. Many suf- fer deeply as they try to make sense of serious illness, huge losses, and unan- swerable questions. Healing of spiritual suffering is as important as technical treatment of physical illness. Spirituality is also very important to the dying person’s ability to complete the end-of-life task of transcending the self. Until recently, many of us gave the spiritual health of our patients very little atten- tion. In the area of spiritual assessment, we nurses often simply wrote in the patient’s religious affiliation. We must ask our patients about their spiritual beliefs if we are to know who they are and how they cope with their illnesses. There are a number of tools for assessing spirituality, such as the following. Howden’s Spirituality Assessment Scale ( SAS ; Burkhardt and Nagai-Jacobson, 2002 ), the JAREL Spiritual Well-Being Scale ( Hunglemann, Kenkel-Rossi , Klassen, & Strollenwerk, 1997 ), the Spiritual Involvement and Beliefs Scale ( SIBS ; Hatch, Burg, Naberhaus, & Hellmich, 1998 ), and the Spiritual Assessment Tool ( Dossey & Keegan, 2013 ) are available to help us gain proficiency in the area of spiritual assessment. The tools ask questions regarding relationships, sense of balance and peace, sense of meaning and purpose in life, strengths and limitations, God or a higher power, and meditation or prayer.

We must also create healing environments for ourselves. Working with people can be draining work. As nurses, we need to learn how to restore our energy and replenish ourselves. We might compare our ability to care for others to a well of fresh, healing water. If the well is never dipped into, the water becomes stagnant and brackish. If the water is constantly drawn out and given away, with no source of replenishment, the well will soon run dry. What happens to nurses

34 Unit 1 • Healing Practices

who don’t sincerely care for others or take the time to replenish themselves? It soon becomes obvious by their behavior that they are stagnant or depleted; they are less patient, less tolerant, more irritable, and unhappy. Their state of “burn- out” contaminates all aspects of their professional and personal lives.

When we care for others, care for ourselves, and allow others to care for us, the well of healing is constantly replenished. There are many techniques in this book that can be incorporated into daily life. It is important that we take time for ourselves, even if for only 10 minutes a day. Learning to take care of ourselves means letting go of self-defeating behaviors and attitudes. We must teach ourselves to relax without feeling guilty or selfish for taking time out. Self-renewal is a continuous process. To be there for others and care for them in their times of need, we must first look after our own well-being. It is only when we walk in balance that we can help others learn how to balance their lives.

TRY THIS

Energy

See the Aura

Find a room with a plain white background that has natural lighting or lights other than fluorescent. The lights should not be too bright and should not be shining directly on the person/subject. If you wear glasses, try the experiment with glasses on and glasses off. Ask the person to stand 18 inches in front of the white background and relax and breathe deeply. Stand 10 feet away from the person and focus on the wall, past the person’s head and shoulders. You may notice a fuzzy white or gray field around the body, looking almost like a light behind the person. Continue to stare at the wall—DO NOT focus on the per- son. You may begin to see colors or sharp rays. This may take some time. Try different people as subjects.

You may want to try using your own hands. With the same background, hold your hands out at arm’s length, in front of your face, with your palms facing each other. Point the fingertips of each hand until they are 1 inch apart. Soften your gaze and look past your fingers. Look for a gray, white, or other-colored aura.

Energizing the Hands

Lightly oil your hands and sit in a chair with your back comfortably straight. Cup your hands slightly and bend your arms at the elbows and hold your hands up at the level of your heart. Feel the warmth or tingle as the energy enters your hands. Let the energy flow through your arms into your heart. Then, bring your hands together with the right hand on top of the left hand and rapidly rub the back of the left hand. Reverse the hands and rub the back of the right hand. Then, rub your palms together rapidly until they feel hot. Return your hands to the original position—cupped and at the level of your heart.

Source: Tulku ( 2007 ).

Chapter 2 • Basic Concepts Guiding Alternative Therapies 35

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Q uinn , J. F. (1989). On healing, whole- ness, and the haelan effect. Nursing and Health Care , 10(10): 553–556.

Quinn, J . F. (1997). Healing: A model for an integrative health care system. Advanced Practice Nursing Quarterly , 3(1): 1–7.

Shames, K. H. (1993). The Nightingale Con- spiracy . Montclair, NJ: Enlightenment Press.

Taylor, E. J. (2002). Spiritual Care: Nursing Theory, Research, and Practice . Upper Saddle River, NJ: Prentice Hall.

Tulku, T. (2007). Tibetan Relaxation . London, UK: Thorsons.

Warber, S. L., Cornelio, M. A., Straughn, J., & Kile, G. (2004). Biofield energy healing from the inside. Journal of

36 Unit 1 • Healing Practices

Alternative and Complementary Medi- cine , 10(6): 1107–1113.

Watson, J. (2007). Theoretical questions and concerns: Response from a caring science framework. Nursing Science Quarterly , 20(1): 13–15.

Weil, A. (1995a). Natural Health, Natural Medicine . Boston, MA: Houghton Mifflin.

Resources

Weil, A. (1995b). Spontaneous Healing . New York, NY: Knopf.

Weil, A. (2005). Mindbody Tool Kit . Boulder, CO: Sounds True.

Zhu, J. W. (2012). Chinese Medicine: Acupuncture, Herbal Medicine, and Therapies. Hauppauge, NY: Nova Science.

American Holistic Medical Association

27629 Chagrin Blvd, Suite 213

Woodmore, OH 44122

www.holisticmedicine.org

American Holistic Nurses Association

323 N. San Francisco St., Suite 201

Flagstaff, AZ 86001

800.278.2462

www.ahna.org

British Complementary Medical Association

P.O. Box 5122

Bournemouth BH8 OWG

0845.345.5977

www.bcma.co.uk

Canadian Holistic Nurses Association

www.chna.ca

3 The Role of Evidence-Based Health Care in Complementary and Alternative Therapies

Leslie Rittenmeyer PsyD, CNS, RN

Science is nothing but perception.

Plato

BACKGROUND

Evidence-based health care encompasses all the health profes- sions, including medicine, nursing, and allied health (Joanna Briggs Institute, n.d.). Evidence-based medicine was influenced by scholars such as David Sackett and A. L. Cochrane, and pre- ceded evidence-based nursing. The Cochrane Collaboration, which has played a leading role in promoting evidence-based practice, arose from a concern by its founder, A. L. Cochrane, that there was little information about the outcomes of health care practices. The emphasis of the Cochrane Collaboration was, and for the most part continues to be, the systematic review of randomized clinical trials (RCTs). Later in the chapter the rela- tionship of complementary and alternative medicine (CAM) to the Cochrane Collaboration will be discussed. Over the years

37

38 Unit 1 • Healing Practices

additional systematic review methodologies beyond RCTs have been devel- oped to take a more pluralistic approach. Philosophically, evidence-based practice means doing what works and doing it the right way to achieve the best possible patient outcomes ( Muir-Gray, 1997 , 18).

Definitions

Sackett, Rosenberg, Gray, Haynes, and Richardson ( 1996 ) provided the classic definition of evidence-based medicine. They described it as an explicit use of the best evidence available in making decisions about the care delivered to individual clients. Evidence-based medicine involves integrating individual clinical exper- tise with the best available external clinical evidence from systematic review.

A number of definitions of evidence-based nursing can be found in the literature. Generally, they all emphasize that evidence-based nursing is a set of tools, resources, and procedures for finding current best available evidence from various sources and applying this evidence to make clinical decisions that promote positive health outcomes or to inform policy. This process takes into account the situation, cultural context, resources, preferences of patients, clinical expertise and judgment, and common sense. The Honor Society of Nursing, Sigma Theta Tau International ( n.d. ), defines evidence-based nurs- ing as the integration of the best available evidence, nursing expertise, and the values and preferences of individuals, families, and communities who are served. DiCenso, Guyatt, and Ciliska ( 2005 ) defined evidence-based nursing as “the integration of best evidence with clinical expertise, and patient values to facilitate clinical decision making” (DiCenso et al., 2005 , p. 4 ).

The Joanna Briggs Institute (JBI), an interdisciplinary, not-for-profit, inter- national research and development agency, provides a comprehensive descrip- tion of evidence-based practice and its relationship to evidence-based nursing:

Simply defined, evidence-based practice is the melding of individ- ual clinical judgment and expertise with the best available external evidence to generate the kind of practice that is most likely to lead to a positive outcome for a client or patient. Evidence-based nurs- ing is nursing practice that is characterized by these attributes. Evidence-based clinical practice takes into account the context in which care takes place; the preferences of the client; and the clinical judgment of the health professional, as well as the best available evidence. ( Joanna Briggs Institute, n.d. )

As you can see all these definitions share some similarities, namely, best available evidence, clinical expertise, patient preference, and context of the situation. All parts of the definition are equally important, although discuss- ing them in depth is beyond the scope of this chapter. For a closer analysis refer to Hopp and Rittenmeyer ( 2012 ).

Several authors ( DiCenso et al., 2005 ; Ingersoll, 2000 ; Melnyk & Fineout- Overholt, 2005 ; Rycroft-Malone, 2004 ) differentiate evidence-based practice from research utilization. Research utilization focuses on the application of

Chapter 3 • The Role of Evidence-Based Health Care 39

individual research findings to planning and implementing patient care, whereas evidence-based practice is an integration of factors such as clinical expertise, clini- cal context, and patient preferences with the best available international evidence identified by a transparent, systematic research process called systematic review.

Systematic Review

A systematic review is the use of explicit, scientifically rigorous, and trans- parent research methods to critically appraise and synthesize the data from more than one research study. A systematic review protocol provides a plan to ensure scientific rigor and to minimize potential bias in the review. See Box 3.1 for the JBI steps in a systematic review protocol.

BOX 3.1

JBI Steps to a Systematic Review Protocol

1. Background: Provide a rationale for the systematic review through initial explora- tion of the research literature.

2. Review Questions/Objectives; Statement of PICO or PICo Questions; In quan- titative reviews, questions should be specific regarding the patient problem or pop- ulation (P), intervention (I), comparison intervention (C), and outcomes (O) (PICO questions) to be investigated. For instance, how effective is vitamin C compared with vitamin D in reducing pain in patients with osteoarthritis? Other types of ques- tions for systematic reviews focus on the meaning of an experience, as opposed to the effectiveness of an intervention. The focus is on the phenomena of interest (PI) and the context (Co) (PICo questions). These types of questions are sometimes called meaningful questions, and this research is usually qualitative in design. For example, what is the experience of receiving a massage after a chemotherapy treatment?

3. Inclusion Criteria: Include types of participants, interventions in quantitative reviews of phenomena of interest, outcomes or context in qualitative reviews.

4. Types of Studies: Choose RCTs or other quantitative designs, or the array of qual- itative designs in qualitative reviews.

5. Search Strategies: Strategies must be transparent; identify a search strategy and the databases to be searched.

6. Assessment of Methodological Quality: Identify the appraisal instruments to be employed for judging the quality of the included studies.

7. Data Collection: Identify the extraction tools that will be used to extract data from the studies.

8. Data Synthesis: State how the data will be synthesized, for example, by meta- analysis or meta-aggregation.

9. Statement of Conflict of Interest

Source: Joanna Briggs Institute.

40 Unit 1 • Healing Practices

Evidence-based nursing, although closely aligned with evidence-based medicine, has differentiated itself by the value the former places on holistic paradigms. This difference is partly reflected in the recognition that in addi- tion to meta-analysis of quantitative studies, evidence-based nursing requires meta-aggregation of qualitative studies ( Jensen & Allen, 1996 ; Sandelowski & Barroso, 2003 ; Walsh & Downe, 2005 ). The latter are particularly important to the discipline of nursing because it is a human science, and a large amount of qualitative research informs its practice.

Controversies Related to Evidence-Based Practice

Evidence-based nursing has not escaped controversy in the nursing literature. Fawcett, Watson, Neuman, Walker, and Fitzpatrick ( 2001 ) and Upton ( 1999 ) expressed concern that the practice of evidence-based nursing is more focused on the science of nursing than the art of nursing. They feared that this would compromise nursing’s holistic roots. Melnyk and Fineout-Overholt ( 2005 ) and Mitchell ( 1999 ) cautioned that the practice of evidence-based nursing could lead to a kind of cookbook nursing with emphasis on only the tech- nical side of practice. Ingersoll ( 2000 ) suggested that ethical concerns are raised when the reimbursement of health care is connected exclusively to a documented body of evidence.

These and other concerns were addressed by DiCenso et al. ( 2005 ), who pointed out that evidence-based practice not only is informed by research studies but also is determined by context, available resources, patient preferences, expert opinion, and feasibility. Rycroft-Malone ( 2004 ) supported this view in her contention that evidence-based practice involves both quantitative and qualitative evidence, clinical expertise, patient experiences, and consideration of local and organizational influences.

The scholarly debate pertaining to evidence-based nursing practice is healthy for the profession, and owing to the expansion of the definition to include patient preference, clinical expertise, and context of care, there appears to be less fear that the practice will diminish the holistic values of the disci- pline of nursing. Rittenmeyer ( 2012 ) contends that as long as one adheres to the expanded definition of evidence-based practice, it is hard to see the con- flict between the aims and structures of theory-guided practice and evidence- based practice.

EVIDENCE-BASED PRACTICE MODELS

The primary rationale for the use of evidence-based practice (EBP) is that it increases nurses’ confidence that medical care and nursing care will lead to better patient outcomes. Another reason is the long lag time between knowl- edge generation and the use of that knowledge in the planning and provision of care by clinicians. The summaries of systematic reviews, such as best prac- tice sheets, provide a more expedient way for clinicians to access knowledge.

Chapter 3 • The Role of Evidence-Based Health Care 41

It is difficult for busy clinicians to keep up when approximately 1,500 articles, 55 new clinical trials, 1,500 books, and more than 7,000 systematic reviews are produced annually.

Models of Practice

Numerous models of evidence-based practice can be found in the litera- ture. The ACE Star Model ( Academic Center for Evidence-Based Nursing, n.d. ) from the University of Texas, and the Iowa Model from the Univer- sity of Iowa ( Iowa Model of Evidence-Based Practice, n.d. ) are examples of these. A discussion of all models of evidence-based practice is beyond the scope of this chapter but can readily be found on their websites. This chap- ter focuses on the Joanna Briggs Institute (JBI) model of evidence-based practice.

The JBI model of evidence-based health care conceptualizes evidence- based practice as “clinical decision-making that considers the best available evidence, in the context in which the care is delivered, client preference and the professional judgment of the health professional” ( Pearson, Wiechula, Court, & Lockwood, 2007 , p. 85 ). Included in the model are four major compo- nents of the evidence-based health care process, namely, health care evidence generation, evidence synthesis, evidence (knowledge) transfer, and evidence utilization ( Pearson et al., 2007 ).

The JBI model depicts health care as a cyclical process that derives its foci from the identification of global health care needs by clinicians and patients or consumers and addresses those needs by generating knowledge and evidence to effectively and appropriately meet those needs “in ways that are feasible and meaningful to specific populations, cultures and set- tings” ( Pearson et al., 2007 , p. 86 ). Lastly, the evidence is then appraised and synthesized and transferred to health care delivery systems and clinicians who utilize and evaluate its impact on health outcomes ( Pearson et al., 2007 ). Figure 3.1 depicts the JBI model.

Barriers to Evidence-Based Practice

Grol and Grimshaw ( 2003 ) and Grol and Wensing ( 2004 ) contended that one of the most consistent findings in health services research is the gap between best practice and actual clinical care. A review of studies in countries such as the United States and the Netherlands indicated that 30% to 40% of patients do not receive care based on the best available scientific evidence. A study by Hannes, Vandersmissen, De Blaesar, Peeters, Goedhuys, & Aertgeerts ( 2007 ) of 53 Flemish nurses identified some of the following barriers to EBP: lack of time and resources, resistance to change, lack of responsibility in the uptake of evidence, and unequal power structures for decision making. Melnyk and Fineout-Overholt ( 2005 ) likewise identified such barriers to EBP in nursing as lack of knowledge, lack of time or resources, and overwhelming clinical responsibilities.

42 Unit 1 • Healing Practices

EVIDENCE-BASED PRACTICE AND COMPLEMENTARY AND ALTERNATIVE THERAPIES

The use of complementary and alternative therapies is becoming increasingly prevalent. Persons choose to pursue complementary treatment for myriad reasons, such as quality-of-life issues, holistic beliefs, unresolved pain, cultural

Disc ours

e

Hea lth c

are

inte rven

tion /act

ivitie s

F A M

E*

Experience Research Methods of utilisation

implementation F A M E*

Evidence Utilisation

Em bed system

organisational

change

Evidence (knowledge)

Transfer

Health Care Evidence

Generation

Evidence Synthesis

Syste ms

Inf orm

ati onPractice Change

Evaluation ofimpact onsystem/processoutcome

Ed uc

at io

n S

ys te

m at

ic R

ev ie

w

Theory

M ethodology

Evidence- based Practice evidence, context, client preference

judgement

Global Health

*F A M E

Feasibi l i ty

Appropr iateness

Meaningfulness

E ffect iveness

FIGURE 3.1 Joanna Briggs Institute of Evidence-Based Practice

Source: From The JBI Model of Evidence-Based Healthcare, by A. Pearson, R. Wiechula, A. Court, and C. Lockwood, 2005, International Journal of Evidence Based Healthcare, 3(8): 209.

Chapter 3 • The Role of Evidence-Based Health Care 43

values, or simply to avoid the invasiveness of biomedical treatments. Some have contended that the use of complementary and alternative therapies has increased because patients are dissatisfied with traditional Western health care. This may be true for some, but data from a U.S. national survey do not support this view. Adults often use and seem to value both. Of 831 respon- dents who saw a medical doctor and used complementary therapies in the previous 12 months, 79% perceived the combination to be superior to either one alone ( Eisenberg et al., 2001 ).

In an update of the work of Eisenberg et al., the National Center for Complementary and Alternative Medicine (NCCAM), a part of the National Institutes of Health (NIH), released the 2007 National Health Interview Sur- vey (NHIS) titled Costs of Complementary and Alternative Medicine (CAM) and Frequency of Visits to CAM Practitioners: United States, 2007 ( Nahin, Barnes, Stussman, & Bloom, 2009 ). The results of this study are found in Box 3.2 . Com- pared with the results of the earlier survey by Eisenberg et al., the data sug- gest that visits to CAM providers decreased (except for acupuncture), but the use of self-care CAM strategies increased.

To relate evidence-based health care to complementary and alternative health care may seem at first glance an uncomfortable fit, but it appears this is no longer true. It is significant that the Cochrane Collaboration has a working group called the Complementary Alternative Medicine Field. The mission of this group is to facilitate the systematic review of existing randomized con- trolled trials (RCTs) to provide information to benefit clinical decision making and the planning of future research in the field of complementary health care. The group also maintains a database of RCTs pertaining to CAM. Manheimer and Berman ( 2008 ) reported that as of 2007, there were 313 completed Cochrane complementary medicine systematic reviews in the Cochrane

BOX 3.2

• In 2007, adults spent $33.09 billion out of pocket on visits to CAM practitioners and purchase of CAM products.

• Nearly two thirds of the total out-of-pocket costs were for self-care purchases of CAM products.

• Approximately one third was spent on visits to CAM practitioners. • Approximately 38.1 million adults made an estimated 354.2 million visits to practi-

tioners of CAM. • About three quarters of both visits to CAM practitioners and total out-of-pocket

costs spent on CAM practitioners were associated with manipulative and body- based therapies.

• About $14.8 billion was spent on the purchase of nonvitamin, nonmineral natural products.

44 Unit 1 • Healing Practices

Collaborative Library and 180 complementary protocols. As of 2013, there were 568 documents relating to complementary and alternative therapies on the Cochrane Collaboration website. An increasing number of systematic reviews in the field of complementary interventions can be found in other sources as well, suggesting an increasing demand by health care practitio- ners for knowledge generated by systematic reviews of complementary and alternative therapies.

Web-Based Resources in Evidence-Based Practice

The following are valuable resources for practitioners seeking information on evidence-based practice:

• About the Cochrane Library www.cochrane.org • Evidence-Based Practice Centers www.ahrq.gov/professionals/clinicians-

providers/ • The Joanna Briggs Institute for Evidence Based Nursing and Midwifery

www.joannabriggs.edu.au/ • The NICHD Cochrane Neonatal Collaborative Review Group (alpha-

betic listing of systematic reviews) www.nichd.nih.gov/cochrane /Pages/cochrane.aspx

• Clinical Evidence (subscription required): clinicalevidence.com

Guidelines

• National Guideline Clearinghouse www.guideline.gov • CDC Recommends: The Prevention Guidelines System www.cdc.gov

/wonder/prevguid.html • Society of Critical Care Medicine www.sccm.org • Institute for Clinical Systems Improvement www.icsi.org/ • National Kidney Foundation Clinical Practice Guidelines www.kidney.

org/professionals/kdoqi/guidelines_commentaries.cfm • NIH Consensus Statements—Index by Date consensus.nih.gov • PDQ (Physician Data Query): NCI’s Comprehensive Cancer Database

www.cancer.gov/ncicancerbulletin/011012/page6 • Registered Nurses Association of Ontario (RNAO) www.rnao.org/ (see

Best Practice Guidelines)

Implementation and Links

• The Hartford Institute for Geriatric Nursing http://hartfordign.org/ • Getting Research into Practice (how to make a change in practice) www

.shef.ac.uk/scharr/ir/units/resprac/index.htm

Chapter 3 • The Role of Evidence-Based Health Care 45

References

Academic Center for Evidence Based Nurs- ing. (n.d.). Explanation of the ACE Star Model of Knowledge Transformation. Retrieved from www.acestar.uthscsa .edu/Learn_model.htm

DiCenso, A., Guyatt, G., & Ciliska, D. (2005). Introduction to evidence based nursing. In A. DiCenso, D. Ciliska, & G. Guyatt (Eds.), Evidence-Based Nursing: A Guide to Clinical Practice (pp. 3 – 19 ). St. Louis, MO: Elsevier.

Fawcett, J., Watson, J., Neuman, B., Walker, P. H., & Fitzpatrick, J. J. (2001). On nursing theories and evidence. Journal of Nursing Scholarship , 33(2): 115–119.

Grol, R., & Grimshaw, J. (2003). From best evidence to best practice: Effective implementation of change. Lancet , 362: 1225–1230.

Grol, R., & Wensing, M. (2004). What drives change? Barriers to and incen- tives for achieving evidence-based practice. Medical Journal of Australia , 180: 57–60.

Hannes, K., Vandersmissen, J., De Blaeser, L., Peeters, G., Goedhuys, J., & Aertgeerts, B. (2007). Barriers to evidence based nurs- ing: A focus group study. Journal of Advanced Nursing, 60(2): 162–171.

Hopp, L., & Rittenmeyer. L. (2012). Intro- duction to Evidence-Based Practice: A Practical Guide for Nursing . Philadelphia, PA: F.A. Davis.

Ingersoll, G. L. (2000). Evidence-based nursing: What it is and what it isn’t. Nursing Outlook , 48: 151–152.

Iowa Model of Evidence Based Practice. (n.d.). Explanation of the model. Retrieved from www.uihealthcare.com/depts /nursing/rqom/evidencebasedpractice /iowamodel.html

Jensen, L., & Allen, M. (1996). Metasyn- thesis of qualitative findings. Qualita- tive Health Research , 6(4): 553–560.

Joanna Briggs Institute. (n.d.). Definition of evidence based practice and nursing. Retrieved from www.joannabriggs .edu.au/

Manheimer, E., & Berman, B. (2008). Cochrane complementary medicine field: About the Cochrane Collabora- tion (fields). Cochrane Collaboration (2): CE000052.

Melnyk, B. M., & Fineout-Overholt, E. (2005). Making the case for evidence- based practice. In B. M. Melnyk & E. Fineout-Overhold (Eds.), Evidence-Based Practice in Nursing and Healthcare: A Guide to Best Practice (pp. 3 – 24 ). Philadelphia, PA: Lippincott Williams & Wilkins.

Mitchell, G. J. (1999). Evidence-based prac- tice: Critique and alternative view. Nurs- ing Science Quarterly , 12(1): 30–35.

Muir-Gray, J. A. (1997). Evidence Based Health Care: How to Make Health Policy and Management Decisions. New York, NY: Churchill Livingstone.

Nahin, R., Barnes, P., Stussman, B., & Bloom, B. (2009). Costs of complementary and alterna- tive medicine (CAM) and frequency of visits to CAM practitioners: United States, 2007. National Health Statistics Report; no. 18. Hyattsville, MD: National Center for Health Statistics.

Pearson, A., Wiechula, R., Court, A., & Lockwood, C. (2007). A re-construction of what constitutes “evidence” in the healthcare professions. Nursing Science Quarterly , 20(1): 85–88.

Rittenmeyer, L. (2012). Why bother with theory. In L. Hopp & L. Rittenmeyer, Introduction to Evidence-Based

46 Unit 1 • Healing Practices

Practice: A Practical Guide for Nursing. Philadelphia, PA: F. A. Davis.

Rycroft-Malone, J. (2004). The PARIHS framework: A framework for guiding the implementation of evidence-based practice. Journal of Nursing Care Quar- terly , 19(4): 297–304.

Sackett, L., Rosenberg, C., Gray, M., Haynes, B., & Richardson, S. (1996). Evidence-based medicine: What it is and what it is not. British Medical Journal , 312: 71–72.

Sandelowski, M., & Barroso, J. (2003). Creating metasummaries of qualitative

findings. Nursing Research , 52(4): 226–233.

Sigma Theta Tau International. (n.d.). Position statement on evidence based nursing. Retrieved from www .nursingsocieity.org/research/main.html

Upton, D. J. (1999). How can we achieve evidence-based practice if we have a the- ory-practice gap in nursing today? Jour- nal of Advanced Nursing , 29(3): 549–555.

Walsh, D., & Downe, S. (2005). Meta- synthesis method for qualitative research: A literature review. Journal of Advanced Nursing , 50(2): 204–211.

Systematized Health Care

Practices Everything on earth has a purpose, every disease an herb to

cure it, and every person a mission. This is the Indian theory of existence.

Mourning Dove

2 U N I T

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4 Traditional Chinese Medicine

A cheerful heart is good medicine, but a downcast spirit dries up the bones.

Proverbs 17:22

Traditional Chinese Medicine (TCM) originated in Chinese culture more than 3,000 years ago and has spread, with variations, throughout other Asian countries, particularly Japan, Korea, Tibet, and Vietnam. As a comprehensive health sys- tem, it has a range of applications, from preventive health care and maintenance to diagnosis and treatment of acute and chronic disorders.

BACKGROUND

Traditional Chinese Medicine has a long and extensive history. Shen Nong, the Fire Emperor, said to have lived from 2698 to 2598 b.c. , is considered the founder of herbal medicine in China. The written history itself is more than 2,500 years old, dating to the text on internal medicine of Huang Di, the Yellow Emperor. Written long before the birth of Hippocrates, the father of Western medicine, Yellow Emperor’s Classic of Medicine covers such princi- ples as yin and yang, the five phases, the effects of the season, and treatments such as acupuncture and moxibustion.

TCM is associated with early Taoists and Buddhists, who observed energy within themselves, in plants and animals, and throughout the cosmos. Based on a belief in the natural order of the universe and the direct correlation between the human body and the cosmos, TCM philosophy stresses the constant search for harmony and balance in an environment of constant change. By the close of the Han era ( a.d. 220), the Chinese had a clear grasp

49

50 Unit 2 • Systematized Health Care Practices

of pathology, preventive medicine, first aid, and dietetics and had devised breathing practices to promote longevity. During the fourth and fifth centuries a.d. , China’s influence spread throughout Asia, and both Taoism and Buddhism had a marked impact on ideas about health. Sun Si Mian ( a.d. 581– 682), a famous physician, established himself as China’s first medical ethicist. He advocated the need for rigorous scholarship, compassion toward patients, and high moral standards in physicians. In the 11th century, TCM began to focus more on social phenomena, especially human relations and ethical behavior. Initially, this orientation resulted in increased scientific medical study and publications. As TCM developed further, people began to take for granted that a breakthrough in one realm of knowledge would eventually solve all problems of human existence. (As in the West, some assume that advances in technology will solve all problems.) Eventually, sociological methods were used to solve medical problems, and clinical and empirical research reached a low point. Fortunately, the core of the scientific system was never obliterated, and the past 50 years have seen a worldwide revival of TCM ( McNamara & Ke, 2012 ; Zhu, 2012 ). In China today, TCM is practiced in hospitals along with Western medicine. Physicians study not only principles of anatomy, histology, biochemistry, bacteriology, and surgery but also acupuncture, acupressure, and herbal medicine. Patients can choose TCM or Western approaches or a combination of these for their particular problem. Inpatient and outpatient care is provided in large, well-equipped hospitals, as well as in private clinics and pharmacies.

PREPARATION

As of 2013, the Council of Colleges of Acupuncture and Oriental Medicine consisted of 53 schools of acupuncture in the United States that had been fully accredited or were candidates for accreditation with the Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM). An accredited graduate-level program consists of 2,625 hours or 146 credits covering Oriental medicine, acupuncture theory, Chinese herbs, and biomedicine theory. Additionally, 1,330 hours of clinical practice are required. Practitioners who already have a master’s degree in acupuncture are eligible for an herb certificate program of 450 hours of didactic instruction and 210 hours of clinical training in the use of Chinese herbs. Forty-three states plus the District of Columbia require passing a national board exam as a prerequisite for licensure. In addition, each state has its own eligibility requirements.

CONCEPTS

The focus of Traditional Chinese Medicine is on the patient rather than on disease, with the goal to promote health and improve the quality of life. A basic understanding of TCM requires recognition of its long-lived tradition, multiple philosophies, and varied practices. It is impossible to separate the individual concepts and the specific treatment approaches from the context of

Chapter 4 • Traditional Chinese Medicine 51

a complete theoretical system. Prevention, diagnosis, and treatment of dis- eases are based on the concepts of qi, yin and yang, the five phases, the five seasons, and the three treasures. Often only isolated fragments of TCM emerge in the West.

Qi

The concept most central to TCM is qi or chi (pronounced “chee”), which is translated as energy. Qi represents an invisible flow of energy that circulates through plants, animals, and people, as well as through the earth and sky. It is what maintains physiologic functions and the health and well-being of the individual. In TCM theory, energy is distributed throughout the body along a network of energy circuits or meridians connecting all parts of the body. The many different types of qi in the body are described according to their source, location, and function. Yin qi supports and nourishes the body, wei qi protects and warms the body, jing qi flows in the meridians, zang qi flows in the organs, and zong qi is responsible for respiration and circulation. Obstructed qi flow in the human body can cause problems ranging from social difficulties to illness. Its effects are specific to each individual—a person gets sick, has problems at work, or fights with family—and depend on each individual’s unique qi. Cer- tain TCM treatments such as meditation, exercise, and acupuncture are ways of enhancing or correcting the flow of qi ( Ody, 2011 ).

Yin and Yang

In Taoist philosophy, wholeness comprises the union of opposites—dark and light, soft and hard, female and male, slow and fast, and so on. These opposite but complementary aspects are called yin and yang . Originally, the terms desig- nated geographic aspects such as the shady and sunny side of a mountain or the southern and northern bank of a river. Currently, the terms are used to character- ize the polar opposites that exist in everything and make up the physical world.

From the health perspective, the basis of well-being is the appropriate balance of yin and yang as they interact in the body. Imbalance of yin and yang is considered to be the cause of illness. Yin is the general category for passivity and is like water, with a tendency to be cold and heavy. Yin uses fluids to moisten and cool the body. It provides for restfulness as people slow down and sleep. Yin is associated more with substance than with energy. Things that are close to the ground are yin or more earthy. Yin is associated with the symptoms of coldness, paleness, low blood pressure, and chronic conditions. People with excess yin tend to catch colds easily and are sedentary and sleepy. Yang is the general category for activity and aggressiveness. It is like fire, with its heating and circulating characteristics. Associated with things higher up or more heavenly, yang is the energy that directs movement and supports its substance. Symptoms such as redness in the face, fever, high blood pressure, and acute conditions are associated with yang. People with excess yang tend to be nervous and agitated and cannot tolerate much heat ( McNamara & Ke, 2012 ). It must be understood that yin and yang cannot exist

52 Unit 2 • Systematized Health Care Practices

independently of each other. Figure 2.1 in Chapter 2 showed the t’ai chi sym- bol of yin and yang. Nothing is either all yin or all yang. They are complemen- tary and depend on each other for their very existence—without night there can be no day, without moisture there can be no dryness, and without cold there can be no heat. It is the interaction of yin and yang that creates the changes that keep the world in motion; summer leads to winter, and night becomes day. Yin and yang are used in both the diagnosis and the treatment of illness. For example, if a person is experiencing too much stress—usually understood as an excess of yang—more yin activities, such as meditation and relaxation, constitute the appropriate treatment.

Five Phases

As they studied the world around them, the Chinese perceived connections between major forces in nature and particular internal organ systems. Seeing similarities between natural elements and the body, early practitioners developed a concept of health care that encompassed both natural elements and body organs. This theory is known as the five phases theory ( wu-hsing ). Five elements—fire, earth, metal, water, and wood—represent movement or energies that succeed one another in a dynamic relationship and in a continuous cycle of birth, life, and death. These elements do not represent static objects, since even mountains and rivers change constantly with time. In the five phases theory, it is not the substances themselves that are important but their interactions in making up the essential life force or qi ( McNamara & Ke, 2012 ; Zhu, 2012 ).

The rhythm of events resembles a circle known as the creation cycle. In this cycle, burning wood feeds fire; from its ashes, fire produces earth; earth in turn gives up its ore, creating metal; from condensation on its surface, metal brings forth water; and water nourishes and creates plants and trees, creating wood. Each element is related to a pair of internal organs. The yin organ is solid and dense, like the liver, while its yang partner is hollow or forms a pocket, like the gallbladder. The proper interaction of the organ partners influences how well the entire body functions. Fire is linked to the circulation of blood, hor- mones, and food. Its partner organs are the heart (yin) and small intestine (yang). Earth is linked to digestion and comprises the spleen/pancreas (yin) and the stomach (yang). Metal is linked to respiration and elimination and is made up of the lungs (yin) and large intestine (yang). Water is linked to elimination and comprises the kidneys (yin) and urinary bladder (yang). Wood is linked to toxic processing and is made up of the liver (yin) and gallbladder (yang). In addition, each organ is related to a time of day of optimal functioning. If a problem occurs during those hours when an organ is most vulnerable, the timing may alert a TCM practitioner of an imbalance in that organ system ( Zhu, 2012 ).

Five Seasons

The four cardinal compass directions—south, west, north, and east—are affiliated with four of the five elements: fire, metal, water, and wood. The fifth element, earth, is depicted in the center. The Chinese place so much

Chapter 4 • Traditional Chinese Medicine 53

importance on the direction south that they put it at the top of their maps and navigate from it in the same way that Westerners use north. Just as south rules the top of the compass, it also represents summer, the “high noon” of the year, and is linked to fire. West, the direction of the setting sun, is associ- ated with autumn and metal, which is used to make tools for harvesting. North is linked to winter and water, the opposite of the element fire, and is seen as a period of dormancy. East, the direction of the rising sun, is associ- ated with spring and with wood, which represents all growing things. The fifth and central element, earth, is related to the late summer season and a time of maturity. Figure 4.1 illustrates the five directions as they correlate to the five seasons and the five elements.

The etiology of disease in TCM is linked to the five phases, five seasons, and five directions. It is believed that if one component is overbearing and excessive, then another becomes weak and debilitated. It is a complex system of checks and balances that is often not easily grasped by those with a West- ern perspective. Diagnosis and treatment of illness depends on understanding the five elements, seasons, and directions and how they interact.

Three Treasures

The Chinese believe that a combination of life force elements makes up the substance and functions of the body, mind, and spirit, and that these three are all one and the same. One way to understand this connection is to think of water and its wet, fluid nature. Compare liquid water with ice, which not only appears different but feels hard and cold. And then consider steam and its hot, gaseous nature. Despite the differences in appearance, the three different

SOUTH

Summer Fire Peak

CENTER

Late summer Earth Maturity

EAST

Spring Wood Growth

WEST

Autumn Metal Tools

NORTH

Winter Water Dormancy

FIGURE 4.1 Five Directions/Seasons/Elements

54 Unit 2 • Systematized Health Care Practices

forms are the same substance. In the same way, body, mind, and spirit can be seen as different expressions of the same individual ( Ody, 2011 ).

The Taoists call body, mind, and spirit the three “vital treasures.” They are jing , meaning basic essence; qi , meaning energy or life force; and shen , mean- ing spirit and mind. The balance of their abundance or deficiency influences the state of health. Jing is the essence with which people are born. It is similar to Western concepts of genes, DNA, and heredity. Essence is the gift from one’s parents; it is the basic cellular material that allows that cell to function. It is the bodily reserve that supports life and must be restored by food and rest.

There are several types of qi: the hereditary qi, which is from the jing; the nutritive qi derived from food; and the cosmic qi from the breathed air. Wei qi is a specialized qi associated with the immune system. Wei qi circulates near the surface of the body and is the first level of protection when a bacterium or virus tries to enter the body. If the circulating wei qi is weak, it can allow a pathogen to enter the body, and illness ensues.

The vital treasure known as shen is the gift from heaven and represents spiritual and mental aspects of life. Shen comprises one’s emotional well- being, thoughts, and beliefs. It is the radiance, or inner glow, that can be per- ceived by others. For people to be healthy, their physical, emotional, mental, and spiritual aspects must be balanced ( Ody, 2011 ).

VIEW OF HEALTH AND ILLNESS

The Chinese regard the body as a system that requires a balance of yin and yang energy to enjoy good health. Each part of the body is also thought of as an individual system that requires its own balance of yin and yang to function properly. A headache is not just an event in the head, and it is more than just a pain. In Traditional Chinese Medicine, a headache is the obstruction of energy related to the overall energy patterns in the body as well as the circum- stances and lifestyle of the sufferer. TCM assumes that a balanced body has a natural ability to resist or cope with agents of disease. Symptoms are caused by an imbalance of yin and yang in some part of the body, and illness can develop if the balance is disturbed for any length of time. Therefore, health is maintained by recognizing an imbalance before it becomes a disease. It is believed that everything needed to restore health already exists in nature, and it is up to the individual, with or without the aid of a health practitioner, to free up energy and restore balance using diet, herbs, acupuncture, and other yin/yang treatments ( Ody, 2011 ; Zhu, 2012 ).

The Chinese believe that all living things—people, the earth, the universe—are connected by cosmic energy. Thus, the balance of qi in an indi- vidual is connected to the balance in the environment; the forces active within the world are the same forces active within the individual body. Simply put, nothing happens without consequence to something else. The concern for bal- ance and harmony is reflected not only in the TCM approach to the individ- ual but also in the view that the balance and well-being of the resources of the

Chapter 4 • Traditional Chinese Medicine 55

natural world and society are vital to the overall health of all who live on the earth. Practitioners never lose sight of the multifaceted relationship between individuals, communities, societies, and nature.

Because the human body is a microcosm of the universe, extremes of climate in the body can create problems, just as extreme environmental condi- tions can wreak havoc on the environment. Sometimes, people experience a “cold” or yin illness caused by too much coldness in the body. For example, the symptoms of a “cold” influenza include a low-grade fever, no sweating, headache, muscle aches, stuffy nose, and a cough with clear white phlegm. Some influenzas are “hot” or yang influenzas caused by too much heat in the body. Symptoms include high fever, sweating, headache, dry or sore throat, thirst, and nasal congestion with sticky or yellow mucus. Too much cold in the body requires “warming” remedies, and too much heat in the body requires “cooling” remedies ( Ody, 2011 ).

DIAGNOSTIC METHODS

The Traditional Chinese Medicine practitioner has four diagnostic methods ( szu-chen ): inspection, auscultation and olfaction, inquiry, and palpation. These methods gather information about the five phases and their related body systems. The practitioner examines how the person eats, sleeps, thinks, works, relaxes, dreams, and imagines. No part of the self is considered a neu- tral bystander when the body is in a state of imbalance.

Inspection

Inspection refers to the visual assessment of the spirit and physical body of patients. Spirit inspection or observation is an assessment of the person’s overall appearance, especially the eyes, the complexion, and the quality of voice. Good spirit, even in the presence of serious illness, indicates a more positive prognosis. Tongue diagnosis is a highly developed system of inspection of the physical body. The tongue is considered to be the visual gateway to the interior of the body. The whole body “lives” on the tongue, rather like a hologram. Different areas of the tongue correspond to the five phases and related organ systems, as depicted in Figure 4.2 . The central area of the tongue is related to the spleen/pancreas and stomach. The very back of the tongue reflects the kidneys and urinary bladder. The sides of the tongue are related to the liver and gallbladder. The very tip of the tongue corresponds to the heart, and surrounding the heart are the lungs in the front third of the tongue. The practitioner inspects the color, shape, markings, and coating of the tongue to gather information about the state of balance in the person’s body. For example, a moist tongue with a thin white coating may signal the presence of a “cold” or yin illness, whereas a dry, yellow, or dark tongue may signal a “hot” or yang illness ( McNamara & Ke, 2012 ).

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Auscultation/Olfaction

The second part of diagnosis, auscultation and olfaction, refers to listening to the quality of speech, breath, and other sounds, as well as being aware of the odors of breath, body, and excreta. Types of sound are associated with the five phases and organ systems. How the person is breathing is a good indication of the status of the organs. Phases and organ systems are associated with specific odors such as sickly sweet, rotten, putrid, rancid, and scorched. Odors can arise from the skin itself or from the ears, nose, genitals, urine, stool, or bodily discharges. The breath may also have a distinctive odor. Usually, the stronger the odor, the more serious the imbalance has become.

Inquiry

The third part of diagnosis, inquiry, is the process of taking a comprehensive health, social, emotional, and spiritual history. The practitioner questions the person not only about the presenting complaint but also about many other factors, including sensations of hot and cold, perspiration, excreta, hearing, thirst, sleep, digestion, emotions, sexual drive, and energy level.

Kidneys/urinary bladder

Spleen/pancreas stomach

Lungs

Heart

Liver/gallbladder

FIGURE 4.2 Tongue Map

Chapter 4 • Traditional Chinese Medicine 57

Palpation

Palpation is the fourth diagnostic method and includes pulse examination, general palpation of the body, and palpation of the acupuncture points. Read- ing the pulses, or pulse diagnosis , can provide key information about the person’s condition. For example, a fast pulse might indicate a problem with an overactive heart or liver; a slow pulse might indicate a sluggish digestive system; pulses described as wide, flat, and soft might indicate a spleen prob- lem; and narrow, forceful pulses might indicate a liver dysfunction. The radial pulse is felt in three positions and two layers on both the right and the left arm. The more superficial, or surface layer, belongs to the yang organs; the deeper layer belongs to the yin organs. The locations of major points used in pulse diagnosis are illustrated in Figure 4.3 . The pulse allows the practitioner to feel the quality of qi and blood at the different locations in the body. Twenty-nine pulse qualities are described according to size, rate, depth, force, and volume. Examples of qualities are surging, scattered, vacuous, slippery, stringlike, and flat ( Ody, 2011 ).

All this diagnostic information is compiled to arrive at a “pattern of dis- harmony,” or bian zheng . A single biomedical disease can be associated with a large number of Chinese diagnostic patterns. A lower urinary tract infection,

(s) Small intestine (d) Heart

(s) Gallbladder (d) Liver

(s) Urinary bladder (d) Kidney yin

(s) Large intestine (d) Lung

(s) Stomach (d) Spleen/pancreas

(s) Kidney yang (d) Pericardium

(s) = Superficial (d) = Deep

Left hand Right hand

FIGURE 4.3 Location of Major Points Used in Pulse Diagnosis

58 Unit 2 • Systematized Health Care Practices

for example, might be related to one of four distinct diagnostic patterns. Each of these patterns would be treated in different ways, as it is said, “one disease, different treatments.” Also, many different biomedical diseases may fall into one pattern, thus the saying, “different diseases, one treatment.”

TREATMENT

Because an individual’s combinations of yin and yang are unique, Traditional Chinese Medicine practitioners must tailor their treatment to each client. The goal of treatment is to reestablish a balanced flow of energy in the person through diet, herbs, massage, acupuncture, qigong, and gua sha. Feng shui, although not considered an actual treatment, is employed to improve health and well-being.

Diet

The simplest and most accessible treatment is diet. Dietary interventions are individualized on the basis of the individual’s pattern of disharmony. Foods are used to rebalance the body’s internal “climate” by bringing warmth to coldness or by cooling off too much heat. The thermal nature of food is described by the way a person feels after ingesting it. For example, after eating watermelon or asparagus, which are cooling foods, one feels physically and emotionally cooler. An internal feeling of warmth comes after eating warming foods such as salmon, lamb, or sweet potatoes. Neutral foods do not create a specific thermal quality and are thus good diet balancers. A diet to maintain health should be varied and include a minimum of seven different fruits and vegetables a day to avoid a cold or a hot imbalance. If a person is ill and the symptoms indicate a hot condition, then the diet should emphasize cooling foods, and vice versa. In addition to the overall daily diet, specific foods are used as medicines to correct hot and cold imbalances ( Zhu, 2012 ). Box 4.1 lists common foods and their thermal effects on the body.

Foods are categorized according to one of six tastes, each having a specific function in the body. Sweet foods are often used to aid digestion and qi, and influence the spleen and stomach. Salty foods affect the kidney and bladder and are often used to “soften” cysts or tumors and may be tried before surgery. Sour foods, such as lemons or tomatoes, are used to dry mucous membranes in the intestinal, urinary, reproductive, or respiratory surfaces. Pungent foods such as garlic and onion are used to aid digestion, stimulate circulation, and promote sweating. Bitter foods, such as greens or tonic water, also help in digestion and are used to regulate the bowels. Astringent foods, such as beans or potatoes, stop the flow of bodily secretions such as tears, saliva, and sweat.

Each food has both yin and yang energies, but often one predominates. Cooling foods and those with bitter and salty flavors are yin. Warming foods are yang, as are foods with pungent and sweet flavors. When people have an excess of yin they may be sluggish, laid back, calm, slightly overweight, and emotionally sensitive. To balance these overly yin tendencies, yang foods are

Chapter 4 • Traditional Chinese Medicine 59

added to the diet to help activate the metabolism and provide more energy. People experiencing an excess in yang may be tense, loud, hyperactive, and aggressive. Adding yin foods to the diet cools their internal tension.

TCM practitioners recommend certain foods for balancing and improv- ing a variety of conditions. Foods can be potent healers, especially when deal- ing with temporary illnesses, but they are never used as a lone treatment for serious or chronic conditions.

Herbs

Herbal medicine ( ahong yao ) is an integral part of TCM. In terms of the complex- ity of diagnosis and treatment, it resembles the practice of Western internal medicine. Herbs may be taken in the form of tea, or the substances may be pow- dered and made into pills, pastes, or tinctures for internal or external use. Just as with food, some herbs are warming (cinnamon) and some are cooling (mint).

With the exception of conditions that require surgery, herbs can be used to treat almost any condition in the practice of TCM. Herbs are often pre- scribed in complex mixtures and tend not to be used as isolated components, for example, as extractions from the parent plant. TCM practitioners believe that the healing benefits of herbs result from the synergistic interactions of all the components of the plant. The same herb can be used for many different disorders. Likewise, the same disorder in different people will be treated with different herbs, depending on the assessment of the individual. Herbs are used in the following ways: antiviral, antibacterial, antifungal, and anticancer. Herbs are also used to treat pain, aid digestion, lower cholesterol, treat colds and flus, increase resistance to disease, enhance immune function, improve

BOX 4.1

Thermal Food Qualities

Cooling

Pork, duck, eggs, clams, crab, millet, barley, wheat, lettuce, celery, broccoli, spinach, tomato, banana, watermelon, asparagus, ice cream, soy sauce

Neutral

Beef, beef liver, rabbit, sardines, yam, rice, corn, rye, potato, beet, turnip, carrot, lemon, apple

Warming

Tuna, turkey, salmon, lamb, venison, chicken, chicken liver, shrimp, trout, oats, cabbage, squash, kale, scallion, celery, ginger, sugar, garlic, pepper

60 Unit 2 • Systematized Health Care Practices

circulation, regulate menstruation, and increase energy ( Zhu, 2012 ). Box 4.2 lists herbs commonly used as tonics in TCM. Chapter 7 covers the use of herbs in greater detail.

Massage

Traditional Chinese massage methods were described in texts as early as 200 b.c. Tui na is the forerunner of all forms of massage therapy that exist today. It differs from other forms of massage in that it is used to treat not only muscu- loskeletal problems but also internal diseases. Tui na practitioners must know

BOX 4.2

Tonic Herbs Frequently Used in Traditional Chinese Medicine

Herb Use

Astragalus Enhances immune function by increasing activity of WBCs; increases production of antibodies and interferon

Dong quai Blood-building tonic that improves circulation, tones the uterus, balances female hormones

Garlic Lowers blood pressure, lowers cholesterol and triglycerides; antiseptic, antifungal

Ginger Warming effect; stimulates digestion, decreases nausea, relieves aches and pains

Gingko Mediates the allergic and inflammatory reaction in asthma; not to be taken with aspirin or other anticoagulants; discontinue before surgery

Ginseng Increases appetite and digestion, tones skin and muscles, restores depleted sexual energy

Siberian ginseng Enhances immune function, increases energy Green tea Lowers cholesterol; anticancer effects, antibacterial effects Ho shou wu Cleans the blood, nourishes hair and teeth, increases energy; pow-

erful sexual tonic Licorice Used as an expectorant in bronchitis and asthma;

anti-inflammatory, antitussive Ligusticum Inhibits bronchospasm through bronchodilation Ma huang Effective for mild asthma; because it contains ephedrine, in excess

it can cause hypertension, tachycardia, palpitations, headache, ner- vousness, and insomnia. Ephedrine products are banned in many countries because of their use in producing methamphetamines.

Onion (quercetin) Inhibits the platelet-activating factor in asthma

Chapter 4 • Traditional Chinese Medicine 61

Traditional Chinese Medicine to make a diagnosis before beginning treat- ment. Tui na is often combined with qigong exercises for building up general health, strength, and stamina. Both energizing and sedating techniques are used to treat and relieve many medical conditions. The following major tech- niques are in use ( Pritchard, 2010 ):

• Ma — rubbing with palm or fingertips • Pai — tapping with palm or fingertips • Tao — strong pinching with thumb and fingertip • An — rapid and rhythmical pressing with thumb, palm, or back of the

clenched hand • Nie — twisting, with both thumbs and tips of the index fingers grasping

and twisting the area being treated • Ning — pinching and lifting in a stationary position • Na — rhythmic compression along energy channels • Tui — pushing, often with slight vibratory effect

Massage increases circulation of blood and lymph to the skin and under- lying muscles, bringing added nutrients and pain relief. Massage can help restore proper movement to injured limbs and joints and help restore a sense of balance. Massage is an effective method of reducing stress and tension that usually leads to a feeling of relaxation. Massage is the treatment modality of first choice for children. Chapter 12 covers massage in greater detail.

Acupuncture

Acupuncture involves stimulating specific anatomic points called hsueh where each meridian passes close to the skin surface. Puncturing the skin with very fine needles is the usual method, but practitioners may also use pressure (shiatsu), friction, suction, heat, or electromagnetic energy to stimulate points. The primary goal of acupuncture is the manipulation of energy flow through- out the body following a thorough assessment by a TCM practitioner. Treat- ment is offered in the context of the total person and with the goal of correcting the flow of qi to restore health. Some Western health care practitioners who have learned the techniques of acupuncture miss the broader context and limit their focus to an injured or painful body part.

Acupuncture is effective in the treatment of acute and chronic pain and motion disabilities. In addition, it is used in respiratory and cardiovascular con- ditions (asthma, COPD, palpitations, hypertension); eye, ear, nose, and throat disorders (conjunctivitis, tinnitus, Ménière’s disease, rhinitis, sore throat); gas- trointestinal problems (gastritis, ulcers, colitis, constipation, irritable bowel syndrome); urogenital conditions (premenstrual syndrome, endometriosis, menopausal symptoms, prostatitis, incontinence, erectile problems); skin disor- ders (eczema, shingles, urticaria); psychiatric problems (anxiety, depression, schizophrenia); and in addictive disorders and withdrawal syndromes. Auricular acupuncture is a complete system of its own and is quite powerful for balancing the hormones and overall energy of the body. Contraindications

62 Unit 2 • Systematized Health Care Practices

to acupuncture are childhood, pregnancy, hemophilia, and acute cardiovascu- lar disorders ( Ody, 2011 ). Chapter 13 covers acupuncture in more detail.

Moxibustion is an application of heat from certain burning substances at acupuncture points on the body. A systematic review of moxibustion to correct breech birth presentation found it to be effective at 33 to 35 weeks of gestation. The Health Ministry of Spain has begun a multicenter, randomized controlled trial of moxibustion and breech birth ( Zhu, 2012 ).

Cupping is the application of suction cups on the skin. The cups create a vacuum on the skin and break up accumulated toxins. The first few applica- tions result in painless circular areas of erythema or ecchymosis. When the toxins are successfully removed from the body, cupping no longer creates these marks ( Zhu, 2012 ).

Qigong

Qigong (pronounced “chee-gong”) is the art and science of using breath, move- ment, self-massage, and meditation to cleanse, strengthen, and circulate vital life energy and blood. In India the comparable practice is called yoga. Both of these traditions of self-healing have been called “moving meditation” or “medi- tation in motion.” T’ai chi, which is familiar to many Americans, is a more phys- ical form of qigong. In China, millions of people from children, to workers, to elders, to patients in the hospital practice qigong daily. The techniques are easy to learn and simple to apply for all people, well or sick. Qigong decreases fatigue and forgetfulness and generates energy by enhancing bodily functions.

It is inevitable that taking a deep breath triggers a sense of relaxation. By adding the intention to relax with the breath, the effect is even greater. Add- ing gentle movements or self-massage to the deep breathing and relaxation generates increased self-healing abilities. The focus on deep and intentional relaxation allows for release of emotional stress, for a sense of tranquility, and for one’s natural spirituality to arise ( Ody, 2011 ).

Gua Sha

Gua sha (pronounced “gwaw saw”) is a TCM technique of smearing oil on the skin and then rubbing it with a flat jade stone, spoon, or other round- edged tool to bring out impurities in the body. Gua means “to rub or scrape.” Sha is the red rash that appears afterward, signifying that the impurities have been expelled through the skin. Most practitioners do gua sha on the arms, back, and chest, where many of the meridians are located. Gua sha is used to treat such problems as fibromyalgia, hypertension, arthritis, muscle aches, and early onset of colds and flu.

Feng Shui

Feng shui (pronounced “fung shway”) is the ancient Chinese system of arranging the environment for living in harmony with one’s surroundings. It began thousands of years ago in China and India as a process of decorating

Chapter 4 • Traditional Chinese Medicine 63

graves and has now gained popularity in many parts of the world. For mod- ern practitioners, feng shui is a design system based on the flow of energy through one’s home and environment. The primary objective is to control and balance surroundings in a way that brings happiness, prosperity, and health. Feng shui is based on the principles of qi, yin and yang, five phases, five sea- sons, and numbers and as such is an adjunct to other healing methods.

Many people are aware of the impact their surroundings have on them and use feng shui principles to improve their lives. Practitioners assess the interaction between the home’s energy field and those of the people who reside there. These combined energy forces are significant factors in why and how we develop certain diseases and can be altered to improve our health status. Feng shui practitioners help people determine placement of furniture, colors, and designs that are comfortable, healthy, and supportive. For exam- ple, the entrance to the home should draw people into its nurturing space. The front door is seen as an opening for qi, and obstructions near the door can block good qi, prosperity, and luck from entering the home. Feng shui describes stairway placement; front and back door alignment; bedroom arrangement; placement of electronic equipment; living room, dining room, kitchen, and bathroom arrangement; use of a fireplace; as well as the choice of art. Mirrors have many curative uses, such as lighting up dark corners, slow- ing down the flow of qi, and deflecting unwanted influences.

Color is a vibration to which people respond both consciously and unconsciously. Red is stimulating and dominant and is associated with warmth and prosperity. Yellow is associated with intellect, decisiveness, and optimism. Green symbolizes growth, fertility, and harmony, while blue is peaceful and soothing. Purple is dignified and spiritual, brown suggests stabil- ity and safety, pink is linked to happiness and romance, and orange encourages communication. White symbolizes new beginnings and purity. Black is myste- rious and independent. The aim of feng shui is to ensure good qi flow, bal- ance, and harmony with one’s surroundings. Feng shui music is designed to help people improve their physical and mental health through naturally bal- ancing the energy in the physical and etheric bodies ( Collins, 2008 ).

RESEARCH

Although extensive research has been done in China through the institutions of Traditional Chinese Medicine, much clinical research has been in the form of reports of observed results of various treatments. Many of these reports have been difficult to translate into Western languages and into the causal and analytic type of research modalities typical of the biomedical model. Research standards throughout the world are subject to cultural influences. Not all cul- tures require their medical practitioners to conduct randomized, double-blind clinical trials. Consequently, the research data are influenced by the location of the study. Research that is meaningful to the scientific communities of China and Japan may not have the same impact on European and North American biomedical communities.

64 Unit 2 • Systematized Health Care Practices

Extensive research has been published on the pharmacology and toxic- ity of many traditional herbs. Researchers in China and Japan have studied the therapeutic value of herbs in the following areas: chronic hepatitis, rheu- matoid arthritis, hypertension, atopic eczema, various immunologic disorders including AIDS, and certain cancers. Herbs are also given to control the side effects of chemotherapy and radiation. It would be useful to repeat these stud- ies using biomedical research criteria. Research on the medical effects of qigong has been continuing since the mid-1980s and is now focusing on qigong as a biophysical rather than a mystical force. Acupuncture is one of the most thoroughly researched and documented TCM practices. Research stud- ies are covered in more detail in the chapters devoted to these specific prac- tices. Research opportunities in the future might include studies regarding manual healing therapies, bioelectricity, magnetic physical interventions, and the use of mind–body interactions for health purposes. For the most up-to- date list of research studies available in the United States, contact the National Center for Complementary and Alternative Medicine at the National Insti- tutes of Health.

RELATED SYSTEMS

Tibet

In Tibetan Buddhism, religion and medicine are never separated from each other. The spiritual goal of Buddhism is to understand the nature of oneself and suffering and to develop compassion and compassionate action in one’s life. Tibetan medicine, a sophisticated system, is based on general medical and philosophical assumptions as well as on each individual’s emotions, atti- tudes, lifestyles, and spiritual beliefs. It is believed that one’s positive actions produce happiness, and one’s negative actions produce suffering. This belief in cause and effect is referred to as karma .

In Tibetan medicine, disease results from two causes. The first cause is spiritual, something brought from past-life karma. Spiritual diseases are mediated by a qualified teacher who uses meditation and yoga to balance body, mind, and spirit. The process of learning how to control one’s mind to function in a balanced mode with one’s body is called dharma .

The second cause of disease involves factors from this life, including sea- sonal changes, personal habits and behaviors, poisons, and negative spirits. Illness is considered to be a lack of internal harmony or balance or a lack of harmony with the larger external environment. The process of diagnosis is similar to that of Traditional Chinese Medicine. Essential components in help- ing people mobilize their resources for self-healing are caring and compas- sion. As Forde ( 2008 ) stated, “The most revered healing method in Tibetan medicine is compassion” (p. 14 ). We in the biomedical field should take care- ful note of that philosophy.

Other treatments include dietary changes, massage, exercise, yoga, med- itation, breath work, moxibustion, and acupuncture. Surgery is used only

Chapter 4 • Traditional Chinese Medicine 65

when absolutely necessary. Herbal medicines are made from a variety of herbs, minerals, fruits, twigs, roots, and animals. As in the Native American tradition, the state of the practitioner’s mind and the method of gathering are important to the medication’s therapeutic outcome. All preparation of medi- cines begins with prayer.

Korea

Chinese medicine arrived in Korea in approximately 200 b.c. The close relation- ship between China and Korea facilitated the exchange of ideas for hundreds of years. In the 10th century a.d. , Korea established its political independence from China, but cultural and medical exchange continued. A contemporary innovative system developed in Korea in 1971 involves hand and finger acu- puncture. Energy channels of the entire body are mapped onto the hands, where they are stimulated using short, fine needles and magnets. This system is rapidly gaining in popularity throughout the world ( Sing, 2012 ).

Japan

The history of medical information exchange dates to the first century a.d. By the eighth century, many Chinese medical texts were translated for use in Japan. Several factors contributed to the unique adaptation of Chinese medicine. The scarcity of herbs led to an emphasis on lower prescription doses in Japan. Palpation, as a part of the diagnostic process, includes palpation of the abdominal energy pathways. An area of specialization in Japanese medicine relegates acupuncture, massage, and herbs to separately licensed practitioners. In Japanese medicine, acupuncture involves the use of somewhat finer gauge needles than those used for Chinese acupuncture and shallower insertion. Shiatsu is a holistic health care model using energy techniques to support well-being and to prevent illness. Treatment is based on the relationship between the client and practitioner, who uses gentle pressure along the meridians to correct energy imbalances.

Europe

The history of Chinese medicine in Europe dates to the middle of the 16th century a.d., when European physicians who traveled and studied in China and Japan wrote texts on acupuncture. In the 1950s and 1960s, two notable English acupuncturists, Dr. Felix Mann and Dr. Sidney Rose-Neil, influenced the development of acupuncture in English-speaking countries ( Ergil, 2011 ).

United States

In 1826, Dr. Franklin Bache became one of the first U.S. physicians to use acu- puncture in his practice. When large numbers of Chinese laborers arrived in the United States, they were accompanied by TCM physicians and herbal merchants. Ah Fong Chuck became the first licensed practitioner of TCM in

66 Unit 2 • Systematized Health Care Practices

the United States in 1901 when he was awarded a medical license in Idaho. With the advent of World War II and the interruption of the herb supply from China, these practices disappeared or retreated into Chinatowns nationwide. In the 1970s, President Nixon reopened communication with China, and the practice of TCM began to gain visibility once again throughout the United States. Now, a clear interest in acupuncture, herbs, and qigong can be found among many North Americans ( Ergil, 2011 ).

INTEGRATED NURSING PRACTICE

For Chinese immigrants, Western medicine is used for acute or life-threatening situations. Traditional Chinese Medicine is their usual health practice. Managing one’s health and illness in the immigrant culture is a family affair rather than an individual process. Family and friends provide health information and share in the decision-making process. This understanding helps nurses provide culturally sensitive care ( Kong & Hsieh, 2012 ).

Although nurses are not educated as TCM practitioners, some principles are common to both nursing and TCM. Nursing and TCM practitioners believe that people are at once mind, body, emotions, and spirit; energy fields become unbalanced as a response to stress; energy fields are constantly inter- acting; people heal themselves; and the client–practitioner relationship is one of partnership.

Caring and compassion are considered to be essential components in helping people mobilize their resources for self-healing in both the practice of nursing and TCM. A critical attitude on the part of the compassionate nurse is one of intent to help and comfort. Even though outcomes of illness are not primarily in the hands of health care practitioners, nurses must still be willing to do their best. In addition to using their valuable technical skills, they must be present in the moment for each client. It means grounding and centering oneself before entering into a healing relationship with another person. It means keeping the focus on the other person rather than being distracted by personal internal dialogue. All levels of nursing practice incorporate princi- ples of caring as a guiding focus for nursing intervention. Some nurses will want to continue their education through in-depth study of the principles and practices of TCM. Requirements and programs of study can be obtained from the Council of Colleges of Acupuncture and Oriental Medicine, the address of which is found in the Resources section.

Before we can care for our clients, we must first learn to value and care for ourselves. Drawing from TCM, self-care means seeking ways to establish and maintain balance and harmony in our lives. Exercise programs might include vigorous exercise such as aerobics, running, or swimming; moderate exercise such as dancing or walking; or gentle movement exercise such as qigong, t’ai chi, or yoga. Touching and being touched are important to our sense of well-being. Self-massage, partner massage, and professional thera- peutic massage contribute to a sense of balance and connection with others. Meditation, prayer, and worship are spiritual aspects of self-care. Breath work

Chapter 4 • Traditional Chinese Medicine 67

is both a physical way to increase relaxation and decrease stress and a spiri- tual way to connect with the universe.

Diet is another area in which TCM can provide some practical guidelines. North Americans seem to fluctuate in their eating habits between overindul- gence in food and starvation diets that neglect the principle of balance. Limit- ing the diet to a few fruits and vegetables may be as harmful as a steady diet of hamburgers. In TCM it is believed that illness can be avoided by eating a var- ied diet as much as possible. For example, a cold or hot imbalance is avoided by eating a minimum of seven different fruits and vegetables each day.

For mild, temporary illnesses one might use a number of diet remedies. The cold type of the common cold and flu previously described as character- ized by low-grade fever, no sweating, headache, muscle aches, stuffy nose, and a cough with clear white phlegm is treated with warming foods such as garlic, ginger, chives, pepper, pumpkin, apple, onion, and lamb. The hot type of the common cold and flu with its symptoms of high fever, sweating, head- ache, dry or sore throat, thirst, nasal congestion, and sticky or yellow mucus responds to cooling foods such as watermelon, eggplant, banana, plums, tomato, and tofu. The cold type of low back pain that is characterized by cold- ness and severe pain in the lower back that gradually worsens over time, is not relieved by lying down, and is aggravated by rainy days is treated with hot foods including garlic, chicken, apple, yam, celery, onion, peach, and mustard greens. The hot type of back pain that includes symptoms such as soreness of the lower back that is relieved by lying down, weakness of the legs, and frequent relapses is treated with cooling foods such as peanuts, ses- ame, soybeans, beef, pineapple, and grapes.

Like many other forms of alternative therapies, TCM regards breath as an important function of life. Restrictions in breathing lead to dysfunction and disease. Forming healthy breathing habits can counter stress and help balance body, mind, emotions, and spirit.

Considering the Evidence

H. Cao, J. Liu, and G. T. Lewith, 2010, Traditional Chinese Medicine for treatment of fibromyalgia: A systematic review of randomized controlled trials, Journal of Alternative and Complementary Medicine, 16: 397–409.

What Was the Type of Research?

A systematic review of randomized controlled trials (RCTs).

What Was the Purpose of the Research?

To synthesize, appraise, and evaluate relevant randomized controlled trials concerning the beneficial and harmful effects in the use of Traditional Chinese Medicine in persons living with fibromyalgia.

(continued)

68 Unit 2 • Systematized Health Care Practices

How Was the Study Done?

The authors used a systematic review methodology to examine published and unpub- lished randomized controlled trials relevant to the purpose of this research. They utilized a comprehensive search strategy using selected keywords and six English and Chinese elec- tronic databases to identify randomized controlled trials focusing on Traditional Chinese Medicine and persons living with fibromyalgia. Two authors independently identified studies, extracted data, and assessed the quality of the studies. Initially, 883 citations were identified and narrowed to 35 studies for retrieval and review. Ultimately, 25 RCTs were included in this review, with a total of 1,516 participants in the selected studies.

What Were the Findings of the Research?

Traditional Chinese Medicine may be effective for treating fibromyalgia. Some side effects were reported in 11 of the randomized controlled trials, but no serious adverse effects related to TCM were identified. Acupuncture, and acupuncture combined with cupping and conventional medication were significantly more effective for reducing pain and the number of tender points in persons living with fibromyalgia than implementing only con- ventional medication as the treatment plan.

What Additional Questions Might I Have?

What would be the effect of Traditional Chinese Medicine used in combination with other complementary and alternative therapies? Could TCM have an effect on the quality of life of persons living with other health challenges? Are additional studies on TCM of good methodological quality currently being conducted to strengthen the evidence?

How Can I Use This Study?

This study has considerable clinical value for nurses caring for persons living with fibromy- algia. Nurses should recognize that Traditional Chinese Medicine may be an appropriate intervention for enhancing the quality of life for those individuals diagnosed with fibromy- algia, but they should be aware that additional research on the effectiveness of TCM is needed to strengthen the evidence.

Source: Contributed by Dolores M. Huffman, RN, PhD.

References

Collins, T. K. (2008). The Western Guide to Feng Shui for Prosperity . Carlsbad, CA: Hay House.

Ergil, K. V. (2011). China’s traditional medicine . In M. S. Micozzi (Ed.), Fun- damentals of Complementary and Alter- native Medicine (4th ed., pp. 373–402). St. Louis, MO: Saunders.

Forde, R. Q. (2008). The Book of Tibetan Medicine , New York, NY: Sterling.

Kong, H., & Hsieh, E. (2012). The social meaning of Traditional Chinese Medicine: Elderly Chinese immigrants’ health practice in the United States. Journal of Immigrant Minority Health. 14: 841–849. doi:10.1007/s10903-011-9558-2

Chapter 4 • Traditional Chinese Medicine 69

McNamara, S., & Ke, S. X. (2012). Tradi- tional Chinese Medicine. Charleston, SC: Create Space.

Ody, P. (2011). The Chinese Medicine Bible: The Definitive Guide to Holistic Healing. New York, NY: Sterling.

Pritchard, S. (2012). Tui Na: A Manual of Chinese Massage Therapy. Philadelphia, PA: Churchill Livingstone.

Sing, P. (2012). East Asian Traditional Medicine Including Traditional Chinese, Japanese, Korean, Mongolian, and Tibetan Medicine. Webster’s Digital Services.

Zhu, J. W. (2012). Chinese Medicine: Acu- puncture, Herbal Medicine and Therapies. Hauppauge, NY: Nova Science.

Resources

Academy of Chinese Culture and Health Science

1601 Clay Street

Oakland, CA 94612

510.763.7787

www.acchs.edu

American Academy of Medical Acupuncture

1970 E. Grand Ave., Suite 330

El Segundo, CA 90245

310.364.0193

www.medicalacupuncture.org

American Association of Acupuncture and Oriental Medicine

P.O. Box 162340

Sacramento, CA 95816

866.455.7999

www.aaaomonline.org

Australian Chinese Medical Association

P.O. Box 2328

Carlingford Court

NSW 2118

61.2.9873.6222

www.acma.org.au

Chinese Medicine and Acupuncture Association of Canada

154 Wellington Street

London, ON N6B 2K8

519.642.1970

www.cmaac.ca

Council of Colleges of Acupuncture and Oriental Medicine

600 Wyndhurst Ave, Suite 112

Baltimore, MD 21210

410.464.6040

www.ccaom.org

70

5 Ayurvedic Medicine

The secret of health for both mind and body is not to mourn for the past, not to worry about the future . . . but to live the

present moment wisely and earnestly.

Siddhartha Gautama Buddha

BACKGROUND

Ayurveda , one of the oldest medical systems in the world, has been practiced for more than 5,000 years in India. It is a holistic and sophisticated system encompassing balance of body, mind, and spirit, as well as balance between people, their envi- ronments, and the larger cosmos. Ayurveda is a Sanskrit word derived from two roots— ayur , which means “life,” and veda , or “knowledge”—and translates literally to the science of life. Ayurveda has been adapted by Hindu, Buddhist, and other religious groups and is undergoing a renaissance both in India and throughout the West.

Ayurveda is an intricate system with a tradition of integrat- ing that which is useful from other systems. This ancient system has adapted to modern science and technology, including bio- medical science and quantum physics. This blending of Ayurveda and conventional medicine has proved very compati- ble ( Jayasundar, 2012 ).

CONCEPTS

Ayurveda asserts a fundamental connection between the micro- cosm and macrocosm. People are a creation of the cosmos and as such are minute representations of the universe, containing within them everything that makes up the surrounding world. One must

Chapter 5 • Ayurvedic Medicine 71

understand the world to understand people and, conversely, must understand people to understand the world. Ayurveda emphasizes the interdependence of the health of the individual and the quality of societal life. Therefore, measures to ensure the collective health of society, such as pollution control and appro- priate living conditions, are supported. Much like in Traditional Chinese Medicine, the focus is on the person rather than on disease ( Pole, 2012 ).

Five Elements

Ayurveda views nature and people as made up of five elements or qualities. These elements are earth, water, fire, air, and space and contain both matter and energy. As they interact, these elements give rise to all that exists. The earth element is dense, heavy, and hard. In the human body, all solid struc- tures and compact tissues are derived from the earth element. The water ele- ment is liquid and soft and exists in many forms in the body, such as plasma, cytoplasm, saliva, nasal secretions, eye secretions, and cerebrospinal fluid. The fire element is hot and light and is believed to regulate body temperature as well as being responsible for digestion, absorption, and assimilation. The solar plexus is the seat of fire in the body. Fire manifests in the brain as the gray mat- ter that allows one to recognize, appreciate, and comprehend the world. The air element is cold, mobile, and rough and in the cosmos is the magnetic field responsible for the movement of the earth, wind, and water. In the body, the air element governs cellular function, the movement of breath, and move- ments of the intestines. Thought, desire, and will are also governed by the air principle. The space element is clear and subtle and makes up most of the body. Space plays a unique role because it allows the existence of sound, which needs space to travel. Sound includes not only audible sound like music but subtler vibrations that resonate in the body ( McIntyre, 2012; Pole, 2012 ).

People are a composite of these five elements, which combine in various ways to govern mind, body, and spirit. Ayurveda sees the body as doshas (vital energies), dhatus (tissues), and malas (waste products). It is the dosha’s job to assist with the creation of all the various tissues of the body and to remove any unnecessary waste products from the body.

Doshas

Doshas , or tridosha, are both structures and energy and are the mediators between body tissues, wastes, and the environment and are responsible for all physiological and psychological processes. The Sanskrit names for the three doshas are Vata, Pitta, and Kapha . As the driver or mover of the entire body, the Vata dosha is the most important. It is composed of the elements of air and space and is involved with all elimination, physical and mental movement, and nervous function. If Vata becomes imbalanced, it can cause the other two doshas to become imbalanced. The Pitta dosha is composed of the elements fire and water, governs enzymes and hormones, and is responsible for diges- tion, body temperature, hunger, thirst, sight, complexion, courage, and men- tal activity. The Kapha dosha, composed of the elements of earth and water, is

72 Unit 2 • Systematized Health Care Practices

the heaviest of the three doshas. It provides the structure, strength, and stabil- ity that the body needs. It is also responsible for lubrication, sexual power, and fertility. Figure 5.1 illustrates the connections between the elements and the doshas.

Body Types

Vata, Pitta, and Kapha are present in every cell, tissue, and organ, but each person is made up of unique ratios of the three doshas. This individual consti- tution is determined by genetics, diet, lifestyle, and emotions. Each dosha gives an indication of physical strengths and limitations. According to Ayurveda, there are 10 body types:

• Single-dosha types. One dosha is predominant: Vata Pitta Kapha

• Two-dosha types. One dosha is predominant, and there is a strong secondary dosha: Vata–Pitta, Pitta–Vata Pitta–Kapha, Kapha–Pitta Kapha–Vata, Vata–Kapha

• Three-dosha type. All three doshas are in equal proportions: Vata–Pitta–Kapha

Knowing one’s body type is the key to balancing one’s life in the way that nature intended. This balance goes beyond physical and mental health and includes personal relationships, work satisfaction, spiritual growth, and

VATA

Functions: nervous system, circulation, elimination, emotions, creativity

WATER

liquid/soft

EARTH

dense/heavy/hard

FIRE

hot/light

SPACE

Clear/subtle

AIR

Cold/mobile/rough

PITTA

Functions: digestion, body temperature, hunger, thirst, confidence, cheerfulness

KAPHA

Functions: lubrication, structure, strength, stamina, compassion

FIGURE 5.1 The Elements and the Doshas

Chapter 5 • Ayurvedic Medicine 73

social harmony. As a general rule, the strongest dosha in one’s constitution has the greatest tendency to increase, making people most susceptible to ill- nesses associated with an increase of that dosha ( Sumantran & Tillu, 2012 ).

Vatas are connected to the air and space, so they are similar to the wind—dry, cool, and capable of fast, variable movement and thought. The basic pattern of the Vata type is “changeable.” Vata people are unpredictable and often start things without finishing them. Stress usually leads to anxiety or fear. They are responsive to sound and touch and dislike loud noise. Bal- anced Vata people are happy, enthusiastic, and energetic. When out of bal- ance, they have a tendency to be impulsive. See Box 5.1 for characteristics of the Vata body type.

BOX 5.1

Learn Your Dosha

Vata Type • Light, thin build • Thin, dry skin • Dark, coarse, curly hair • Irregular hunger and digestion • Difficulty putting on weight • Light, interrupted sleep • Tendency toward constipation • Aversion to cold weather, craving for warmth • Bursts of mental and physical energy • Performs activity quickly • Quick to grasp new information but quick to forget • Tendency for worry, anxiety, fearfulness • Excitability, changing moods • Enthusiasm, vivaciousness • Fast talking

Pitta Type • Medium build • Fair, soft, warm skin • Fine, soft, blond, light brown, or red hair • Sharp hunger and thirst, strong digestion • Cannot skip meals • No problem gaining or losing weight • Aversion to hot weather, craving for coolness • Moderate strength and endurance • Sound but short sleep • Sharp, clear, precise speech • Sharp intellect and good, quick memory

74 Unit 2 • Systematized Health Care Practices

Pittas are aligned with fire and act with fervent determination. The basic pattern of the Pitta type is “intense.” Pitta people are ambitious, out- spoken, bold, orderly, and efficient. They tend to respond to the world visu- ally and enjoy being surrounded by fine objects. Balanced Pitta people are sweet, joyous, and confident. Box 5.1 lists the characteristics of the Pitta body type.

Kaphas are a combination of earth and water and, therefore, move slowly and gracefully. The basic pattern of the Kapha type is “relaxed.” Kapha people are stable, steady people who have a happy, tranquil view of the world. They are graceful people who wake up slowly, eat slowly, and speak slowly. They respond to the world through taste and smell and tend to place a great deal of importance on food. See Box 5.1 for characteristics of the Kapha body type.

Few people are single-dosha types. Most are two-dosha types, with one dosha predominant but not extreme. The dominant dosha gives people their primary reactions to the world, which are then moderated by the second dosha. Those with the two doshas of Vata–Pitta type are quick moving, friendly, and talkative with a sharp intellect. They are not as unpredictable or irregular as the single Vata type. They enjoy challenges, but stress makes them tense and hard driven. People who have a combination of Pitta and Kapha types are stable personalities but have a tendency toward anger and criticism. They have steady energy and good stamina but are less motivated to be active. Those whose doshas are the Kapha–Vata type may have a hard time identifying

• Enterprising character, likes challenges • Busy lifestyle, achiever • Tendency toward anger, irritability under stress, judgmental

Kapha Type • Solid, powerful build • Thick, pale, cold skin • Thick, wavy, lustrous hair • Tendency to obesity, hard to lose weight • Slow digestion, mild hunger • Heavy sleep and for a long period of time • Oily, smooth skin • Aversion to cold, damp weather • Steady energy, great strength and endurance • Graceful in action • Slow to grasp new information but good retentive memory • Good organizer • Affectionate, tolerant, forgiving • Tendency to be greedy and possessive • Tendency to be complacent • Slow speech that may be labored

Chapter 5 • Ayurvedic Medicine 75

themselves, since the Vata and Kapha tend to be opposites. Usually, they have a thin body type but with a relaxed, easygoing manner. They tend to procrastinate but can be quick and efficient when necessary. The three-dosha type tends to have good immunity, lifelong good health, and longevity ( McIntyre, 2012 ).

Tissues/Dhatus

The seven dhatus or tissues are the structures of the body, are responsible for nourishment, and must be retained for health. They are rasa (plasma), rakta (blood cells), mamsa (muscle), meda (adipose), asthi (bone), majja (bone mar- row), and shukra (reproductive tissue). In general, Ayurveda practitioners work to keep these tissues intact and healthy ( McIntyre, 2012 ).

Waste Products/Malas

The malas , or wastes, are the nonretainable substances within the body. Urine, feces, and sweat, for example, need to be released and eliminated as the body rids itself of toxins. Excretion of the malas cleanses; thus people are cautioned against inhibiting the body’s natural functions, including sneezing, yawning, burping, urinating, defecating, and passing gases. Vata is the dosha that causes these urges, and suppression of them disturbs Vata. Ayurveda encour- ages expression of these urges in a way that is not offensive to other people ( McIntyre, 2012 ).

Energy/Prana

Prana , which the Chinese call qi, in Sanskrit means “primary energy,” some- times translated as “breath” or “vital force.” Prana is not only the basic life force but also the original creative power. Prana has many levels of meaning, from the physical breath to the energy of consciousness. The five pranas are categorized according to movement, direction, and body region. The navel is considered the pranic center of the physical body. Prana vayu , forward- moving air, moves inward and regulates the intake of substances into the body. This prana moves energy from the head down to the navel. It is the basic energy that drives the person in life. Apana vayu , air that moves away, moves downward and directs all forms of elimination and reproduction. It controls the movement of energy from the navel down to the root chakra at the base of the spine. Udana vayu , upward-moving air, brings about the trans- formations of life energy. It governs the growth of the body and the release of positive energy. This prana moves energy from the navel up to the head. Samana vayu , balancing air, moves from the periphery to the center and moves energy from the entire body back to the navel. It aids in all types of process- ing—food, oxygen, and emotional and mental experiences. Vyana vayu , out- ward-moving air, moves from the center to the periphery and regulates energy out from the navel through the entire body. It directs the circulation of nutrients throughout the body ( Pole, 2012 ).

76 Unit 2 • Systematized Health Care Practices

VIEW OF HEALTH AND ILLNESS

When the doshas are balanced, individuals experience health on all levels: mental, emotional, physical, spiritual, and environmental. Health is much more than the mere absence of disease. Mentally healthy people have good memory, comprehension, intelligence, and reasoning ability. Emotionally healthy people experience evenly balanced emotional states and a sense of well-being or happiness. Physically healthy people have abundant energy with properly functioning senses, digestion, and elimination. From a spiritual perspective, healthy people have a sense of aliveness and richness in life, are developing in the direction of their full potential, and are in good relation- ships with themselves, with other people, and with the cosmos. Environmen- tally healthy individuals have minimal economic, social, and political stress.

Balancing one’s doshas does not mean trying to achieve an equal portion of Vata, Pitta, and Kapha. One cannot change the ratio of doshas that are pres- ent from conception. Health is the balance of each dosha that is right for that particular individual. Doshas, however, are responsive to people’s habits, such as diet, exercise, and daily routines, which can either deplete or increase the doshas. Although both states of imbalance lead to ill health or disease, increased doshas are more problematic than decreased doshas.

Imbalance in the doshas is the first sign that mind, body, and spirit are not perfectly coordinated. One type, called natural imbalance , is due to time and age. Natural imbalances are typically mild and normally do not cause problems. Each dosha becomes more predominant during certain times of day as energy moves through six cycles in each 24-hour period: Veta predom- inates from 2 to 6, day and night; Kapha during the hours of 6 to 10; and Pitta from 10 until 2. Each dosha also predominates during particular seasons and stages of life. Kapha dominates during childhood and during the spring sea- son, Pitta during summer and middle age, and Vata during fall and the latter part of one’s life.

Unnatural imbalances of the doshas can be caused by a variety of factors, each of which falls into one of three broad categories of disease. Adhyatmika diseases originate within the body and include hereditary and congenital dis- eases. Adhibhautika diseases originate outside the body and include trauma, bacteria, and viruses. Adhidaivika diseases originate from supernatural sources , including those diseases that are otherwise unexplainable, such as illnesses originating from seasonal changes, divine sources, planetary influences, and curses. While some of these causes are beyond individual control, lifestyle and diet are within one’s control. Preventing disease and improving overall health depends on the recognition of dosha imbalance and an understanding of the factors that increase and decrease each of the doshas ( Pole, 2012 ).

Imbalanced Vata shows up as rough skin, weight loss, anxiety, restlessness, insomnia, decreased strength, constipation, arthritis, hypertension, rheumatic disorder, and cardiac arrhythmia. Pitta imbalance includes a yellowish complex- ion, excessive body heat, insufficient sleep, weak digestion, inflammation, inflam- matory bowel disease, skin disease, heartburn, and peptic ulcer. Kapha imbalance

Chapter 5 • Ayurvedic Medicine 77

presents as a pale complexion, coldness, lethargy, excessive sleep, depression, sinusitus, respiratory disease, asthma, and excessive weight gain ( Pole, 2012 ).

Several factors aggravate or increase each of the doshas. Factors that increase Vata are excessive exercise; wakefulness; falling; cold; late autumn and winter; fear or grief; agitation or anger; fasting; and pungent, astringent, or bitter foods. Factors that increase Pitta are anger; fasting; strong sunshine; midsummer and early autumn; and pungent, sour, or salty food. Factors that increase Kapha are sleeping during the daytime; spring and early summer; heavy food; milk products; sugar; and sweet, sour, or salty foods ( Pole, 2012 ).

DIAGNOSTIC METHODS

The first question asked is not “What disease does this person have?” but “Who is this person” The complete process of diagnosis takes into account physical, mental, and spiritual components integrated with the social and environmental worlds in which the person lives. In addition to using X-rays or other biomedical diagnostic tools, Ayurvedic practitioners diagnose by observing people, touching them, taking pulses, and interviewing them.

Pulse Diagnosis

Pulse diagnosis is a highly specialized skill that requires great sensitivity. The process, as illustrated in Figure 5.2 , involves placing the index, middle, and ring fingers of the right hand on the radial arteries of the right hand of men and the

FIGURE 5.2 An Ayurvedic practitioner uses the index, middle, and ring fingers to locate three pulse points that are related to the flow of prana in the body and the three doshas.

Source: Dorling Kindersley Media Library/Andy Crawford

78 Unit 2 • Systematized Health Care Practices

left hand of women. The general feel of the pulse is related to body type. A Vata pulse, felt by the index finger, is irregular or wavering, resembling the move- ment of a snake. A Pitta pulse, felt at the middle finger, feels forceful and throb- bing, resembling the movement of a frog. A Kapha pulse, felt at the ring finger, is said to be gliding, resembling the movement of a swan. A three-dosha pulse resembles the movement of a woodpecker. Ayurvedic doctors may also take pulse readings at other points on the body as well. These points include the brachial artery above the elbow, the femoral artery, and pulse points at the tem- ples, ankles, and top of the feet. This basic form of pulse reading gives the prac- titioner a vital clue to the person’s body type. Pulse diagnosis is remarkably comprehensive. Experienced physicians not only can diagnose present diseases but also can tell what diseases the person has experienced in the past and which they are likely to develop in the future ( McIntyre, 2012).

Tongue Diagnosis

Tongue diagnosis can also reveal the functional status of internal organs. A healthy tongue should be pink, clear, and shiny. A discoloration and sensitivity of a particular area of the tongue, or both, indicate dosha dysfunction. Kapha imbalance is evidenced by a whitish tongue, Pitta imbalance by a yellow-green tongue, and Vata imbalance by a brown to black tongue ( McIntyre, 2012 ).

Urine Diagnosis

Ayurvedic practitioners do urine examinations as another way to understand dosha imbalances. A midstream specimen is collected first thing in the morn- ing. Healthy urine should be clear without much foam. Kapha imbalance gives the urine a cloudy appearance, Pitta imbalance imparts a dark yellow color, and a Vata imbalance presents as pale yellow and oily urine. The prac- titioner also puts a few drops of sesame oil in the urine and examines it in the sunlight. The shape of the drops signifies which dosha is imbalanced: A snakelike shape with wave movement indicates Vata; an umbrella shape with multiple colors, Pitta; and a pearl shape, Kapha. The movement of the oil in the urine indicates the prognosis of the disease. If the drop spreads immedi- ately, the illness is probably easy to cure. If the oil drops to the middle of the urine sample, the illness is more difficult to cure. If the oil sinks to the bottom, the illness may be impossible to cure ( Pole, 2012 ).

Body Observation

The practitioner carefully examines the skin, nails, and lips. Cool, hot, rough, or dry skin indicates imbalance. Imbalance can be visualized in the nails by longitudinal striations, bumps, or a parrot beak at the end of the nail. Dry, rough lips or inflammatory patches on the lips are another sign of imbalance. Coldness, dryness, roughness, and cracking indicate Vata imbalance. Hotness and redness indicate Pitta imbalance. Wetness, whiteness, and coldness indi- cate a Kapha imbalance ( Pole, 2012 ).

Chapter 5 • Ayurvedic Medicine 79

TREATMENT

Specific lifestyle interventions are a major preventive and therapeutic approach in Ayurveda. Each person is prescribed an individualized diet and exercise program depending on dosha type and the nature of the underlying dosha imbalance. Care is taken to not cause new symptoms by suppressing the presenting symptoms. Herbal preparations are added to the diet for pre- ventive or regenerative purposes, as well as for the treatment of specific disor- ders. Yoga, breathing exercises, and meditative techniques are also prescribed by the practitioner ( Murray, 2012 ).

Nutrition

In Ayurveda, a balanced diet is different from the Western balanced diet derived from the basic food groups of meat, dairy, fruit, grains, and vegetables. Ayurveda recognizes six tastes: sweet, sour, salty, pungent, bitter, and astrin- gent. A balanced Ayurveda diet must contain all six tastes at every meal but in different proportions depending on dosha type. The word taste includes not only the perceptions on the tongue but also the immediate effect of the sub- stances within the body. Each of the six tastes is derived from two of the five elements. Sour, salty, and pungent have the fire element and so increase body temperature, dilate body channels, and allow energy and toxins to flow out from the body. Sweet, bitter, and astringent have no fire and thus are cooling, promoting relaxation. Sweet, sour, and salty have the water element and soften tissues, lubricate mucous membranes, and increase water retention ( Pole, 2012 ).

Ayurveda describes the actions of each of the six tastes. Sweet promotes the vitality of body tissues, soothes the five senses, and adds bulk and firm- ness. Used in excess, sweet creates obesity, weak digestion, and a tendency to excessive sleep and heaviness. Sour improves the taste of food, increases digestion, and awakens the mind. In excess, sour wastes muscles and causes a buildup of toxins in the blood. Salty promotes digestion, moisturizes the body, softens all organs, and acts as a laxative and sedative. In excess, salty causes stagnation of blood, wasting of the muscles, wrinkling of the skin, and diges- tive hyperacidity. Pungent cleanses the mouth, opens the vessels, improves blood flow, and cures disorders of excess fluid in the body. In excess, pungent causes fatigue, emaciation, dizziness, and thirst. Bitter , though it does not taste good in itself, restores the sense of taste, detoxifies, relieves thirst, and is antibacterial, germicidal, and antipyretic. In excess, bitter causes wasting of the tissues, weakness, and dryness. Astringent is drying, firming, and sedat- ing. It stops bleeding and aids in healing of wounds. In excess, astringent causes premature aging, constipation, retention of wastes, spasms, and con- vulsions and weakens vitality ( Pole, 2012 ).

Three pairs of gunas, or qualities, are inherent in food: heavy or light, oily or dry, and heating or cooling. The following are examples:

• Heavy: wheat, beef, cheese • Light: barley, chicken, skim milk

80 Unit 2 • Systematized Health Care Practices

• Oily: milk, soybeans, coconut • Dry: honey, lentils, cabbage • Heating: pepper, honey, eggs • Cooling: mint, sugar, milk

It is not necessary to memorize which foods reduce which doshas because any number of books offer long lists of foods matched to the dosha, taste, and guna. Many people seem to know naturally what their bodies need for balance. See Box 5.2 for the relationship between the doshas, tastes, and gunas. To counter an excess of Vata, diet recommendations consist of warm food with moderately heavy textures; salt, sour, and sweet tastes; and added oil. Examples of foods to include are asparagus, carrots, green beans, avoca- dos, bananas, melons, rice, wheat, chicken, seafood, chickpeas, and tofu. To counter an excess of Pitta, diet recommendations are for cool or warm (but not hot) foods with moderately heavy textures and bitter, sweet, and astrin- gent tastes. Examples of foods to include are broccoli, cabbage, lettuce, apples, grapes, raisins, barley, oats, ice cream, chicken, shrimp, chickpeas, and tofu. Coconut, olive, and soy oils are acceptable. For an excess of Kapha, diet

BOX 5.2

Foods in Relation to Doshas

Vata

Balances Aggravates

Salt Hot Pungent Light

Sour Oily Bitter Dry

Sweet Heavy Astringent Cold

Pitta

Balances Aggravates

Bitter Heavy Pungent Hot

Sweet Cold Sour Light

Astringent Dry Salty Oily

Kapha

Balances Aggravates

Pungent Light Sweet Heavy

Bitter Dry Sour Oily

Astringent Hot Salty Cold

Sources: McIntyre (2012) ; Murray (2012) ; Pole (2012) .

Chapter 5 • Ayurvedic Medicine 81

recommendations include warm, light food, cooked without much water; pungent, bitter, and astringent tastes; and a minimum of butter and oil. Examples of foods to include are cauliflower, celery, leafy green vegetables, apricots, pears, dried fruits in general, barley, corn, rye, skim milk, chicken, shrimp, sunflower seeds, and raw honey ( Pole, 2012 ).

Every food can be characterized by taste and guna. In addition to a diet bal- anced in terms of fats, carbohydrates, and proteins, people need variety in salty, sour, sweet, pungent, bitter, and astringent foods. The goal of diet management is to avoid aggravating any of the doshas and keep them calm and balanced.

Herbs

In Ayurveda, natural medicines are primarily herbal but may include animal and mineral ingredients, and even powdered gemstones. Practitioners pre- scribe many thousands of herbs. Like food, herbs are classified according to the six tastes. Herbs, however, are more potent and specific in their action than is food. Some herbs used for preventive and regenerative purposes are readily available. The use of herbs for treating disease must be medically supervised. As in Traditional Chinese Medicine, the entire plant is used. It is believed that the plant contains other chemicals that buffer the active ingredi- ent, thus reducing possible side effects ( Sharma et al., 2007 ).

Like foods, herbs balance doshas. Vata-balancing herbs include ginseng, licorice, Indian Pennywort, bala, and sitopaladi. Aloe vera, comfrey root, Indian gooseberry, and saffron are used to balance Pitta; and elecampane, honey, and sitopaladi balance Kapha. Herbs usually take longer to work than Western medications prescribed by practitioners. Historically, Ayurvedic herbs have had little exposure outside India but are now becoming more familiar with the rapid explosion of interest in herbal medicines in North America. The following are a few of the more common herbs found in health food stores. Sitopladi is a very good herbal formula for colds and flu. Indian Pennywort (brahmi) enhances a person’s ability to focus mentally and learn new material. Guggulu is a powerful purifying agent, well known for lower- ing of blood cholesterol levels. Shilajit, with its antispasmodic qualities, is effective in acute and chronic respiratory illnesses. Bala, or Indian country mallow, is helpful in all types of nervous system disorders and certain types of heart disease. These few examples of herbs give one an idea of how they are used as natural body medicines ( Shukla, Bhatnagar, & Khurana, 2012 ). In some instances, heavy metals such as lead, mercury, and arsenic have been found in Ayurvedic herbal medicines. Thus, people have been cautioned about ordering these herbs from overseas or through the Internet ( WHO Drug Information, 2007 ). Chapter 6 presents herbs in more detail.

Exercise

According to Ayurveda, exercise should conform to one’s dosha type. Kapha people can perform moderately heavy exercise such as aerobics, running, dancing, and weight training. Because of their physical strength, Kaphas excel

82 Unit 2 • Systematized Health Care Practices

at endurance sports. Pitta people, who have more drive than endurance and an intense competitive spirit, should engage in a moderate amount of exer- cise. Brisk walking or jogging, hiking, swimming, and skiing are appropriate. People with a Vata dosha might enjoy jogging, but exercises like stretching, yoga, and t’ai chi are better choices. Such individuals have bursts of energy but tire quickly and may push themselves past their limits. Walking is proba- bly the best exercise for all people, because it calms all dosha types. Ayurveda recommends a brisk half-hour walk every day ( Murray, 2012 ).

For people over the age of 80 or under 10, as well as those who have seri- ous Vata and Pitta imbalances, exercise should be very gentle. Exercise should always leave a person ready for work as opposed to being work itself. Several other exercise precautions must be noted. One should not engage in exercise sooner than half an hour before and 1 to 2 hours after a meal. Exercising in the evening is discouraged because it is better for the body to slow down and prepare for sleep. Exercise is discouraged in wind or cold, since heavy breath- ing of cold, damp air is unhealthy for the respiratory tract. Also discouraged is exercise during the intense heat of the day, since environmental heat causes an even greater rise in body temperature.

The key to exercise is moderation and regularity. Ayurveda suggests that all exercise should be done at half of one’s capacity. That means working out just until sweat appears on the forehead, under the arms, and along the spinal column. This amount of exercise improves digestion, prevents consti- pation, improves circulation, stimulates metabolism, regulates body tempera- ture, and maintains body weight. Exercise keeps one’s senses and mind alert and attentive as well as being effective in inducing relaxation and sleep. Over- exercise, as indicated by panting and heavy sweating, may cause dehydration, muscle aches, breathlessness, and even chest pain. It is believed that overexer- cise eventually contributes to arthritis, sciatica, or heart conditions ( Pole, 2012 ).

Yoga

Yoga, developed in the Ayurvedic tradition, is one of the most effective forms of exercise for the body as well as nourishment for the mind and spirit. Hatha yoga, the most familiar form of yoga in North America, is a combination of body positions, breathing exercises, and mental focus on the present. Stretch- ing helps relax and tone the muscles, improves circulation, improves concen- tration, and helps one regain energy. Yoga is increasingly being recognized for maintaining general health as well as helping people manage chronic dis- orders such as headaches, insomnia, hypertension, and depression. Further information about yoga is found in Chapter 16 .

Breathing

Practicing controlled breathing is a valuable technique that leads to a health- ier lifestyle. Several techniques can be utilized to relax the mind and body. Simple breathing helps people become aware of their breath and often relieves tension. Simple breathing involves closing the eyes and observing the breath,

Chapter 5 • Ayurvedic Medicine 83

becoming more aware of its pattern and changes. Slow, easy breathing is con- tinued for several minutes until a sense of relaxation is achieved. Alternate nostril breathing, pranayama , is another technique that can ease difficulty in breathing by making the respiratory rhythm more regular, which in turn soothes the entire nervous system. Pranayama is helpful prior to meditation because it focuses attention inward. Pranayama is performed while seated with the eyes closed. Figure 5.3 illustrates the position. The index and middle fingers of the right hand are placed on either side of the nose. The thumb closes the right nostril while the person breathes in through the left nostril. The left nostril is then closed with the ring finger, and the right nostril is opened for the out-breath and the next in-breath. The right nostril is then closed, and the out-breath occurs through the left nostril. After several cycles, breathing naturally gets deeper and smoother.

Meditation

An important part of daily life in Ayurveda, meditation is considered a pow- erful tool to help maintain health. Meditation is a moment-to-moment aware- ness that cleanses the body, mind, and spirit. It is finding the quiet in the mind. As the mind is brought into a silent and receptive state, new energy comes into being, which is conducive to a state of health and peace. Further information about meditation is found in Chapter 17 .

Massage

Marma therapy is a massage technique focusing on 107 sensitive points, called marmas , located on the skin. These points are similar to the acupuncture

FIGURE 5.3 Pranayama/Controlled Breathing

84 Unit 2 • Systematized Health Care Practices

points called hsueh in Traditional Chinese Medicine. Marma therapy predates the Chinese approach and is likely the parent to acupuncture and acupres- sure. Marmas are activated through various methods. One is through yoga movements that gently stretch specific marma points. Warm oil dripped on the center of the forehead (shirodhara) on a major marma point can be pro- foundly soothing. A daily self-massage with oil can reach all the marmas on the skin. Once taught, these techniques can be practiced at home. Massage is covered in more detail in Chapter 12 .

Aromatherapy

Aromatherapy is based on olfactory stimuli used to help balance the doshas as each responds to specific signals. Specialized olfactory cells provide instant connection of odors with the brain. The hypothalamus responds through reg- ulation of body functions, the limbic system responds with emotions, and the hippocampus responds with memories, which explains how smells can elicit memories so vividly. In general, Vata is balanced by warm, sweet, and sour aromas such as basil, orange, rose geranium, clove, and other spices. Pitta is balanced by sweet, cool aromas like rose, mint, cinnamon, sandalwood, and jasmine. Kapha is balanced by warm aromas with spicy overtones such as juniper, eucalyptus, camphor, and clove. People whose doshas are out of bal- ance are given specific oils to restore dosha balance. Aromatherapy may be used at any time but is often prescribed at night because it helps induce sleep ( Murray, 2012 ). Aromatherapy is discussed further in Chapter 8 .

Music

India has a long tradition of merging music and medicine. Unlike the distinct tones of most Western music, the tones in Indian music tend to blend together, creating a soothing, unifying sound. As with taste and smell, doshas can be balanced with certain tones and rhythms. The three doshas peak at different times of the day, and traditional Indian music smooths the process of these transitions. Ten minutes of music can be used as a gentle wake-up in the morning, after a meal to settle digestion, just before bedtime to aid sleep, and during the recovery period from an illness. Music therapy is discussed further in Chapter 21 .

Purification

Panchakarma , or purification therapy, involves five procedures, any or all of which can be chosen based on the person’s general condition, the season, and the nature of the disease. The five therapies of panchakarma are experienced over a period of a week and involve purifying the body through the use of sweating, emetics, purgatives, enemas, and nasal inhalations. Commonly administered by an Ayurvedic physician with the help of a number of assis- tants, the benefits of panchakarma are relief from long-standing symptoms, renewed health, and extended longevity ( McIntyre, 2012 ).

Chapter 5 • Ayurvedic Medicine 85

RESEARCH

Many Western researchers believe that they look at reality in an objective way. In contrast, Ayurvedic researchers believe that nothing happens in a vacuum. Everything that happens does so in relationship to what is occurring around it. The principle of research is that knowledge cannot be separated from its context.

The National Center for Complementary and Alternative Medicine (NCCAM) has supported research for a number of years. Current studies are primarily focused on herbal preparations that have undergone systematic reviews ( Agarwal, Abhijnhan, & Raviraj, 2007 ; Singh et al., 2007 ; Sridharan, Mohn, Ramaratnam, & Panneerselvam, 2011 ).

As with Traditional Chinese Medicine, many studies have been diffi- cult to translate into Western languages and into the causal and analytic type of research modalities typical of the biomedical model. Research stan- dards throughout the world are subject to cultural influences. Not all cul- tures require their medical practitioners to conduct randomized, double-blind clinical trials. Consequently, the research data are influenced by the location of the study. Research that is meaningful to the scientific Ayurvedic communities may not have the same impact on Western biomed- ical communities.

INTEGRATED NURSING PRACTICE

Although most nurses have not been educated in Ayurvedic medicine, they can integrate a number of principles into their professional practice. Ayurveda teaches self-discovery and self-understanding; it encourages people to learn how they maintain their health and how and when they become sick; and it advocates lifestyle changes to maximize one’s well-being.

The designation of doshas and dosha imbalance is a highly sophisticated process performed by professional practitioners. Using Box 5.1 as a checklist, individuals can begin to learn their dosha or body type, as follows:

• Make a check mark next to the description that best fits how you have been most of your life. If two descriptions apply to you, check both.

• Consider the qualities carefully. There are no right or wrong answers. Be honest and check how you really are, not how you would like to be.

• Look for lasting trends. For example, if your sleep has been heavy and prolonged most of your life but is now light and fitful, the change is likely due to imbalance rather than dosha type. Check your usual pattern.

• Note whether each dosha has some checks, because everyone’s body type has Vata, Pitta, and Kapha components.

• Total the number of checks for each dosha. The dosha with the greatest number should be your body type. If the highest two dosha scores are close, you are probably a two-dosha type. If all three dosha scores are close, you are a three-dosha type.

86 Unit 2 • Systematized Health Care Practices

Determining their unique blend of doshas allows people to begin to understand how their health is affected by internal and external influences. As people become more familiar with their body, they can observe and expe- rience the effect of what they eat and do each day; how they think and feel; the state of their metabolism, digestion, and elimination; the relationships they engage in; their jobs; and the environment in which they find themselves. Because all these factors are interdependent, problems in one area can cause problems in other areas.

People’s dosha balance can be disrupted in a number of ways. An inap- propriate diet and lifestyle for one’s dosha type will cause a slowly develop- ing excess or deficiency in doshas. If people suffer significant trauma, however, the dosha levels can change immediately and dramatically. Dosha imbalance can also result from an accumulation of toxins or from too many experiences of a particular dosha without enough experiences from the other doshas. Once people understand their baseline dosha type, they can assess imbalances that may contribute to disease. Nurses can remind people that the strongest dosha in their constitution has the greatest tendency to increase. For example, Kapha-type clients have a natural tendency toward those things with Kapha qualities, and thus they increase their Kapha energy. Those indi- viduals whose lifestyle includes a desk job, overeating, not exercising, and sleeping excessively may experience an excess in their Kapha dosha. They may need to consciously add opposite qualities to pacify or balance their Kapha energy, such as decreasing food intake, eating more pungent and bitter vegetables and astringent fruits, and increasing exercise.

Achieving balance of the doshas does not happen quickly—people need to work at it consciously. In some cases, lifestyle changes may be difficult, such as the nature of one’s job, while others may be easier, such as a change in lei- sure activities. Typically, people find that diet, exercise, and leisure activities are the most amenable to change. For example, watching television and using computers increase Vata by stimulating the eyes and ears, and the passive nature of these activities increases Kapha. If a television program makes people angry, or their computer programs will not do what they wish, their Pitta may be stimulated. Limiting the time spent watching television and being selective with programs may help them balance their doshas and move toward a health- ier state. Likewise, if people spend a lot of time at their computer, they need to take frequent breaks, move and stretch their bodies, and rest their eyes.

Individuals whose strongest dosha is Vata need to develop more regu- larity in their daily routines, such as eating regular meals, having an estab- lished bedtime, and slowing down and taking time to think. Because these persons have a tendency to dry skin, they should oil their skin regularly. Peo- ple with Vata doshas are drawn to sensory experiences involving movement, speed, and action, and they may enjoy loud music and computer games. To maintain a healthy balance, Vata-type individuals should make an effort to balance those activities with quiet, creative pursuits such as writing, photogra- phy, or painting. Similarly, because they are attracted to vigorous exercise, they should try to engage in gentle exercise every day. Ayurveda suggests that

Chapter 5 • Ayurvedic Medicine 87

all exercise be done at half of one’s capacity. If people know they are exhausted after a 40-minute aerobics class, then they should do only 20 minutes of the class. People with Vata doshas enjoy spending their vacations sightseeing, touring, and filling their days and nights with many activities and returning home exhausted. A more beneficial vacation would be in a beautiful, sunny, and warm environment where they rest and limit their activities. Vata-type people wear clothes that are mostly dark shades, reflecting their mood.

Pitta-type individuals need to loosen up on setting and achieving goals and learn to enjoy the present moment. They can learn to achieve their ambi- tions without pressuring themselves. They also need to control their tendency to organize themselves and everyone else, because they become easily frus- trated when things do not go as planned. Pitta-type people are stimulated by competitive, mentally challenging situations that may increase aggression or determination to win. They should learn to use constructive criticism rather than confrontation. Engaging in noncompetitive leisure activities such as gar- dening may help prevent an excess of Pitta. Vacations in cooler climates, and water and winter sports will cool their tendency to be warm. Pitta types should avoid overly organizing their vacations and try to enjoy whatever hap- pens. Red clothing overstimulates Pitta and may contribute to a more aggres- sive approach to others. Cool, soft, pale colors help balance the Pitta dosha.

Kapha–type individuals need to vary their daily experiences to avoid becoming stuck in a rut, for example, by making small changes in the daily routine, and getting up early and going to bed late to limit the tendency to sleep too long. Because such people may prefer to sit and do nothing, they should find mentally and physically stimulating activities. Kapha is balanced by vigorous exercise, and Kapha types have good stamina, so they can exer- cise longer than Vata or Pitta types, but they will have to force themselves to do so. Kapha types prefer a vacation lying on a beach doing nothing but soak- ing up the sun. They will find, however, that sightseeing and touring will be more stimulating and balancing. All colors, except greens and dark blues, bal- ance Kapha. Bright, strong colors are exciting and balancing.

Helping people understand their doshas is an ongoing process. As peo- ple observe their mind, body, spirit, and relationships, they learn how they respond to different qualities in everyday activities. After helping clients determine their dosha type, have them review their lifestyles in terms of diet, work, leisure activities, exercise, daily routines, quiet times, sleep, and rela- tionships. By applying the principles of Ayurveda, people can begin making choices about the qualities they wish to incorporate into their lives. Rather than focusing on negatives (what they want to stop doing), have them focus on positives (what they want to start doing). Suggest that they limit their exposure to those qualities they do not want and enjoy those that will aid their well-being. Change begins with small steps and is a gradual process. Some people will want to seek the advice of an Ayurvedic practitioner to individu- alize a lifestyle change program. Remind clients that their mind and body always strive toward health and that every individual needs time, nurturing, routine, and gentle discipline to achieve a more complete level of well-being.

88 Unit 2 • Systematized Health Care Practices

TRY THIS

Massage

Sesame Oil Massage

Use the refined sesame oil sold in health food stores, not the heavy Chinese sesame oil. If you wish, you may use olive oil instead. Warm a quarter cup of oil in the microwave for 10 to 15 seconds, being careful not to overheat it.

Mini-Massage (1–2 minutes)

Use 1 tablespoon of warm oil and rub it into your scalp. Use small, circular motions with the flat of your hand. Using your palm, massage the forehead from side to side, and gen- tly massage your temples using circular motions. Gently rub the outside of the ears. Mas- sage both the front and the back of the neck.

Use a second tablespoon of warm oil and massage both feet using the flat of the hand. Massage each toe with your fingertips. Vigorously massage the soles of your feet. Sit quietly for a few seconds to relax, and then shower or bathe as usual.

Full-Body Massage (5–10 minutes)

Massage the scalp, ears, and neck with 1 tablespoon of warm oil as already described. Using more oil, vigorously massage your arms using long strokes on the long parts,

and circular motions at the joints. Adding oil as necessary, massage the chest, stomach, and lower abdomen using

gentle circular strokes in a clockwise direction. Massage as much of your back and spine as you can reach.

Massage the legs as you did the arms using vigorous movements. With the remaining bit of oil, massage the feet as described earlier. Bathe with

warm water and mild soap.

Source: Chopra (1991) .

References

Agarwal, V., Abhijnhan, A., & Raviraj, P. (2007). Ayurvedic medicine for schizo- phrenia. Cochrane Database of System- atic Reviews , Oct. 17(4): CD006867.

C hopra, D. (1991). Perfect Health . New York, NY: Harmony Books.

Jayasundar, R. (2012). Healthcare the Ayurvedic way. Indian Journal of Medi- cal Ethics, 9(3): 177–179.

McIntyre, A. (2012). The Ayurveda Bible. Richmond Hill, Ontario, Canada: Fire- fly Books.

Murray, A. H. (2012). Ayurveda for Dum- mies. Hoboken, NJ: For Dummies, Wiley.

Pole, S. (2012). Ayurvedic Medicine: The Principles of Traditional Practice. London, UK: Singing Dragon.

Chapter 5 • Ayurvedic Medicine 89

Sharma, H., Chandola, H. M., Singh, G., & Basisht, G. (2007). Utilization of Ayurveda in health care: Part 2— Journal of Alternative and Complementary Medi- cine, 13(9): 1011–1019.

Shukla, S. D., Bhatnagar, M., & Khurana, S. (2012). Critical evaluation of Ayurvedic plants for stimulating intrinsic antioxidant response. Fron- tiers in Neuroscience. doi: 10.3389/ frins.2012.00112

Singh, B. B., Vinjamury, S. P., Der- Martirosian, C., Kubik, E., Mishra, L. C., Shepard, N. P., . . . Madhu, S. G. (2007). Ayurvedic and collateral herbal treatments for hyperlipidemia: A sys- tematic review of randomized con-

trolled trials and quasiexperimental designs. Alternative Therapies in Health and Medicine, 13(4): 22–28.

Sridharan, K., Mohan, R., Ramaratnam, S., & Panneerselvam, D. (2011). Ayurvedic treatments for diabetes mellitus. Cochrane Database of Systematic Reviews , Dec. 7(12): CD008288.

Sumantran, V. N., & Tillu, G. (2012). Can- cer, inflammation, and insights from Ayurveda. Evidence-Based Complemen- tary and Alternative Medicine. doi: 10.1155/2012/306346

WHO Drug Information. (2007). Journal of Alternative and Complementary Medi- cine , 21(2): 91.

Resources

Ayurvedic Herbs—Circle of Health P.O. Box 719 Ashland, OR 97520 541.944.7243 www.ayurveda-herbs.com

Ayurvedic Practitioners Association (UK) 23 Green Ridge Brighton BN1 SLT 01273.500.492

apa.com.uk www.ayurveda-germany.com/ lancaster/

National Ayurvedic Medical Association 620 Cabrillo Avenue Santa Cruz, CA 95065 800.669.8914 www.ayurveda-nama.org

90

6 Native American Healing and Curanderismo

Morning Prayer I thank You for another day. I ask that

You give me the strength to walk worthily this day so that when I lie down at night I

will not be ashamed.

Evening Prayer At the end of each day, face west and say:

Thank you for all the things that happened today, the good as well as

the bad.

Prayers by Bear Heart, Native American Shaman

When it comes time to die, be not like those whose hearts are filled with the fear of death, so when their time comes they weep and pray for a little more time to live their lives over again in a different

way. Sing your death song, and die like a hero going home.

Chief Aupumut, Mohican, 1725

Chapter 6 • Native American Healing and Curanderismo 91

There are more than 556 distinct Native American tribes. Although each Native American Indian–based healing system is unique, the systems share a number of characteristics. This chapter presents the commonali- ties found among tribes. The population of today’s Native American tribes is only a fraction of what it was before Europeans invaded North America, and many customs have been lost forever. Nevertheless, many of the traditions and ceremonies practiced by Native Americans for centuries are still in evi- dence today ( Grandbois & Sanders, 2012 ).

BACKGROUND

Non-Indian people can learn a great deal from the Native American approach to life and traditional healing. To learn, people must be open to the ancient wisdom and understand it in the context of the entire Native American expe- rience. It is not something to be trivialized by simply purchasing medicine objects and trying them out at home. As one Sioux leader said, “First they took our land, now they want our pipes . . . all the wannabees, these New Agers, come with their crystals and want to buy a medicine bag to carry them around in. If you want to learn our ways, come walk the red road with us, but be silent and listen” ( Johnson, 1994 , p. 6 ).

In their earliest encounters, European American physicians devalued the skills of Native healers. This association has, in a way, come full circle. Western medicine is now advancing toward a holistic point of view that Native Americans have been practicing for thousands of years. Today, medi- cine women and men practice in a system that parallels conventional medi- cine. Some of them are traditional, meaning they adhere strictly to the old ways of life and reject any form of biomedicine. Others have acculturated, or adapted to the mainstream culture, and use both Indian medicine and con- ventional medicine. A third group of Native Americans has become assimi- lated and has virtually abandoned all traditional ways in favor of the dominant culture and utilizes only biomedicine ( Shimer, 2004 ).

Most tribal people have one or more types of health care specialists whose treatments frequently overlap. Some Native healers use herbs, some heal with songs, and some practice spiritual rituals. A midwife or a medi- cine woman or man might focus on natural medicines such as herbs and hands-on techniques but also use prayer and ceremony. Shamans , or holy people, emphasize spiritual healing but are often also knowledgeable about natural medicines. Kahunas are people, usually of Hawaiian ancestry, who have developed a level of spirituality that joins them with many of the spirit powers, allowing direct communication about the healing process. Shamans and medicine people are seen as channels the Creator has provided and trained. Some are born into families with medical or ritual skills, while oth- ers discover this path through a dream or vision. Selection is based on signs of devotion, wisdom, humility, and honesty. Once called, the individual seeks training, usually by apprenticing to a medicine person for a number of years. All knowledge comes from the Creator, and the elders are charged

92 Unit 2 • Systematized Health Care Practices

with the responsibility of keeping knowledge about healing foods, herbs, and medicine and passing it on. Trusted with all secrets, rituals, and legends of their people, Native healers are considered to be inspired individuals with great importance to the tribe. Training is complete when the teacher says it is complete and when the candidate has practiced the skills publicly and with success ( Bad Hand, 2002 ). See Chapter 24 for more information about shamans.

CONCEPTS

Spirituality

Spirituality and medicine are inseparable in Native American tradition. Essentially no distinction is made between religious and medical practices. “Making medicine” is an important part of traditional life. It is how people give thanks to the Spirit who helps, guides, nourishes, and clothes them. Medicine is the constant pipeline to the Creator. In Indian tradition, making medicine is a process for achieving a variety of positive outcomes: a good hunt, plentiful crops, connecting with someone, healing someone, a success- ful birthing, and so on. Medicine is the way people keep their balance; it provides them with the opportunity to grow in new and healthier ways ( Barnes, 2012) .

Native Americans believe in a singular living God but also believe that same God may be contacted through many ways, from many cultures. In Native languages, God is given such names as Great Spirit, Creator, Great Being, Great Mystery, Above Being, The One Who Oversees All Things, and He Who Gives Life. Everything is considered a gift from the Creator, and using these gifts is one way to create an atmosphere conducive to addressing the Creator ( Bear Heart, 1996 ).

Gratitude

Gratitude is a central aspect of Native American culture. Every day is a spiri- tual, sacred day as demonstrated in Bear Heart’s prayer at the opening of this chapter. Native Americans give thanks to the Great Power who makes all things possible. They give thanks not only for the good events but also for the bad things that happen throughout the day, because they believe that the more they show their appreciation, the more blessings they will receive.

Native peoples do not own or possess land but rather see themselves as caretakers of the earth for the Great Spirit. The land is considered the Mother, since all things come from her body. Animals, birds, trees, and grass all come from Mother Earth and are powerful living beings, just like human beings. When Native people take something from the earth, such as herbs or even a stone, they always give an offering, usually tobacco, in return and say a prayer that the item taken will be used in a good manner ( Bear Heart, 1996 ; Mackinnon, 2012 ).

Chapter 6 • Native American Healing and Curanderismo 93

Healing

Medicine women and men see themselves as channels through which the Great Power helps others achieve well-being in mind, body, and spirit. The only healer is the One who created all things. Medicine people consider that they have certain knowledge to assemble items to help the sick person heal, and that knowledge has to be dispensed in a certain way, often through ritual or ceremony. Healers receive their knowledge through fasting and asking for guidance from above. During the period of fasting, the Great Being might reveal a chant or the location of a particular herb and give instructions on how to use it for different illnesses ( Bear Heart, 1996 ).

Time is often considered an ally in recovery because it allows fears and problems to fade. Love is a key element in the healing process. The healer enters into the healing relationship with love and compassion, and the two individuals experience a joining or merging as this process unfolds. This merger symbolizes the cementing together of people and the Divine Spirit ( Barnes, 2012 ).

Circle

The circle represents the cycles of life, which have no beginning, no end, and no time element. The Great Spirit causes everything to be round. The sun, earth, and moon are round. The sky is deep like a bowl. Things that grow from the ground like the stem of a plant or plant roots are round. The circle, symbol of infinity and interconnectedness, is seen in the sweat lodge, the bowl of the Sacred Pipe, the Sacred Hoop, and the Medicine Wheel. In addition, the camp is circular, tepees are circular, and people sit in a circle in all ceremonies. When people come together in a circle, a spirit of oneness and a sense of sacredness come upon them.

Medicine Wheel

The Medicine Wheel is both an important conceptual scheme and a major ceremonial observance. The Sacred Hoop makes up the circumference, and the interior of the circle is divided into four quadrants. Each quadrant repre- sents a direction, a totem, an element, a color, a kingdom, a quality, a season, and a gateway to the individual. The four colors—white, black, yellow, and red—represent the races of humanity. See Figure 6.1 for an illustration of the Medicine Wheel.

The four directions of the Medicine Wheel are the basis for the astrologi- cal system. Each person is represented somewhere within that circle, depend- ing on birth date. Table 6.1 gives a brief summary of the Twelve Moons.

The Number 4

The number 4 is significant to Native American people and is incorporated into their daily lives through prayers, ceremonies, and activities. It is believed

94 Unit 2 • Systematized Health Care Practices

to be the number of completeness. Everything that grows from the earth con- sists of four parts: roots, stems, leaves, and fruit. Earth, air, fire, and water are the four life-giving elements. Four types of things take breath: those that crawl, those that fly, those that walk on four legs, and those that walk on two legs. There are four directions, four seasons, and four races of people—white, black, yellow, and red.

VIEW OF HEALTH AND ILLNESS

Health is viewed as a balance or harmony of mind and body. The goal is to be in harmony with all things, which means first being in harmony with oneself. Harmony is thought to neutralize problems and help one’s life become beauti- ful. Good health makes it easier for all people to do their part in the universe, to serve others, and to fulfill their personal life visions.

Life is considered in all its dualities: winter/summer, cold/hot, day/ night, mind/body, spiritual/physical, work/play, and so on. Native people

NORTH

totem—buffalo element—air color—white kingdom—animal quality—knowledge/wisdom season—winter gateway—to mind

SOUTH

totem—mouse element—water color—red kingdom—plant quality—trust, innocence season—summer gateway—to emotions

EAST

totem—eagle element—fire color—yellow kingdom—human quality—illumination, enlightenment season—spring gateway—to spirit

WEST

totem—grizzly bear element—earth color—black kingdom—mineral quality—introspection, intuition, change season—autumn gateway—to body

FIGURE 6.1 The Medicine Wheel

Sources: Hill (2006) ; www.medicinewheel.com ; Rutherford (2008) .

Chapter 6 • Native American Healing and Curanderismo 95

TABLE 6.1 Twelve Moons

Birth Date/Power Animal Characteristics

North December 22–January 19 Snow goose

Snow geese represent the chief at the top of the medicine wheel and have the potential for great power. People in this position have great vision and can send messages over long dis- tances. Often, just thinking of someone will be enough to get the person to call him or her.

January 20–February 18 Otter

People in this moon are as playful as the otter. Otter people like others as well as them- selves and are humanitarian in their views. They excel in communication, intellect, and romance. They may have psychic abilities.

February 19–March 20 Cougar

Others come to cougar people for advice, because they have a natural medicine power and psychic ability. They are deeply sensitive, hesitate to express their true feel- ings, and yearn for spirituality.

East March 21–April 19 Red-tailed hawk

Red-tailed hawk people look at the world with a sense of wonder. They are open to learn- ing new things, enjoy life and adventure, and are passionate about everything they do. Because they are fearless, they may act without thinking.

April 20–May 20 Beaver

Beaver people value hard work and focus on getting the job done. The results of their work can have great impact on people far away. They strive to create and maintain an orderly and beautiful environment.

May 21–June 20 Deer

Deer people often have many ideas and try to accomplish them all. They may have two or three jobs at a time. They have graceful, quick movements. Deer people appreciate the beauty in themselves, others, and the environment.

South June 21–July 22 Flicker (large woodpecker)

People in this position are intuitive and wild in some aspects of being but conservative in oth- ers. They have an ability to both heal and inspire. Flicker people have an excellent sense of humor and a strong desire for self-expression.

July 23–August 22 Sturgeon

Sturgeon people come into the world as teach- ers, with strong leadership abilities. They are always reading and studying to search for the truth. They have an outer shell that protects their inner sweetness from other people.

(continued)

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believe that the two sides of everything deserve equal attention and that both should be nourished with love. A healthy person who is walking in balance is energized and alert, and in the presence of disease will still feel alive and ful- filled ( Sue & Sue, 2012 ).

Traditionally, Native American people lived long, happy, healthy, and balanced lives. They did everything to respect and honor Mother Earth and the Great Spirit. They ate wholesome food and considered all food to be blessed as a gift of life from the Creator. They got up with the sun and went to bed with the moon. Exercise was a natural part of their lives, integrated into daily activ- ities. These good health habits, a sense of joy, and a purpose in life are key fac- tors for living into old age ( Sun Bear, Mulligan, Nuffer, & Wabun, 1989 ).

Illness occurs when balance is disrupted. It is believed that most illness begins in the head, and people must get rid of ideas that predispose them to illness. If the mind is negative, the body will be drained, making it more vul- nerable. Disease is also thought to be caused by “soul loss”—when individu- als stop being generous and become selfish and dishonest. When people open up to the universe, learn what is good for them, and find ways to be happier, they can begin to work toward a longer and healthier life. Many ancient peoples had ways to get rid of this negativity. The Mayan people of Mexico would stand in a stream of flowing water and talk out all their angers,

Birth Date/Power Animal Characteristics

August 23–September 22 Brown bear

Brown bear people have a natural creative curiosity. Their gut feelings tend to be very accurate as long as they don’t overanalyze. They have good sense and make fair deci- sions. They are confident and well balanced.

West September 23–October 23 Raven

Like ravens who fly together, these people tend to stay with the flock. If they can separate and follow their own convictions, they can be great leaders. They understand messages from the heart and are physically affectionate.

October 24–November 21 Snake

Snake people are powerful healers who are able to travel places where others may fear to go. They are often messengers for the spiritual aspects of life. They are inquisitive and able to create change.

November 22—December 21 Elk

Elk people are insightful, independent, determined, and open hearted. They are passionate about justice. They have an abil- ity to perceive the thoughts and feelings of others and may be clairvoyant.

Source: Adapted from Brother Eagle Soaring (2003) .

TABLE 6.1 (Continued)

Chapter 6 • Native American Healing and Curanderismo 97

fears, sorrows, or troubles over the water. The moving water would take all the emotions they poured out of themselves into the current and away from them. The Bear Dance was a way the Indian people of Northern California rid themselves of negativity. A man in a bear costume would dance around a circle of people who would use switches to hit him as they spoke about the things in their lives that were bothering them. When the bear had acquired everyone’s negativities, he went down into a stream, washing them away. Some Native people of the Southwest had dancers armed with swords who went through the village singing, chanting, and rattling, driving out the neg- ative forces as they went. Behind the dancers came people with brooms to sweep away anything that was left over. Most Indian tribes had some way of letting people get rid of negativity so that they could go on and build new positive patterns ( Garrett, 2003 ).

Dreaming is a powerful way for people to learn what is good for them. Dreams are a personal connection to the upper, spiritual realms. Divine guid- ance is thought to come through dreams and visions. In a period of illness, people may actually dream the healing. Dreaming is important in the healing practices of medicine women and men, because treatment information is often provided through dreams. Dream weavers, dream catchers, or dream nets are special medicine objects that allow the good dreams to reach the person through the hole in the center and catch the bad dreams to keep those away from the person.

DIAGNOSTIC METHODS

Healers must diagnose the source of the problem because they want to treat the cause, not just the effect. Much as in Traditional Chinese Medicine and Ayurveda, the diagnostic method takes into account all aspects of one’s inner self, lifestyle, emotions, social setting, and natural surroundings. Heal- ers always consider the total person, whether treating someone for physical illness or emotional problems. They look at the overall picture, determine what is out of balance within the whole, and then pinpoint the trouble spots. Some healers diagnose by going into a trance. While in a trance “hand trem- blers” pass their shaking hands over the body of the person; when the hands stop trembling, the locale of the illness is found, and the cause is usually identified. “Star gazers” also enter trance states to read cause in the stars. “Listeners” do not go into a trance but listen to the person’s story and on that basis identify the cause of the illness ( Struthers, Eschiti, & Patchell, 2004 ; Barnes, 2012 ).

TREATMENT

When people fall ill, they often experience anxiety and fear, which may inca- pacitate them. The healer is not so burdened and is able to supply coherence, calmness, and hope. Power flows through the healer to the patient. Patients’ preferences are always respected in determining their own path toward balance

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and healing. Healers use medicine objects to assist them, and treatments consist of ceremony, touch, herbs, singing, drumming, and sometimes peyote.

Items used to help make medicine are called medicine objects. Medicine objects can be anything that relates to the Great Spirit in a sacred way. The medicine bag contains healing objects, which vary in size and number but typically are such things as feathers, claws, bird or animal bones, an assort- ment of herbs or roots, smudges, or paints. The medicine bag may also con- tain personal items that represent the individual and personal experiences that are sacred to him or to her. Native Americans are protective of their med- icine bags because they carry a part of themselves and are among their most prized companions. The Medicine Wheel is a sacred circle usually built from stones. It is entered for the purpose of healing, giving thanks, praying, or meditating. The Pipe is one of the most sacred medicine objects and is an instrument of prayer.

The Indian art of healing is ceremonial or ritual in nature. Different cere- monies are conducted according to the type of illness or the severity of the person’s condition. Healing ceremonies are led by medicine people or holy people. There is a communal aspect of the ceremony—as many people as pos- sible participate to increase the power of the prayers. The primary purpose is to allow connection with the Great Healer, since physical health often fails without the aid of spiritual means. A secondary benefit is a cleansing of the body, mind, and spirit. A healing session is never a casual encounter. It is arranged through a formalized procedure after discussion by the patient, family, advisers, and healer. Acceptance by the healer is followed by instruc- tions on preliminary actions, which may include fasting, abstinences, prayers, or the preparation of offerings or feasts.

Smudging

Smudging is a cleansing and purifying process using smoke from burning sacred herbs, usually sweet grass, sage, cedar, or tobacco. Sweet grass is used to bless one’s self and one’s home to protect from evil spirits. It is also used to purify sacred prayer instruments. Sage has a variety of uses. It is used in the blessing of one’s home, it is part of the mixture used in the sacred smoking of the Pipe, and it is used in tea to flush out impurities. Cedar is considered the “tree of life” because it withstands the four elements no matter how harsh the seasons. Cedar is used in all sacred ceremonies as well as for its medicinal qualities. Tobacco is considered a gift from the Creator, and its smoke is a visual representation of people’s thoughts and prayers being carried to the Creator. People and all sacred objects are smudged so all can be centered and focused on the healing process. The smoke clears negativity, purifies the energy field of people and places, and is a prayer to the Creator. In addition to its use in healing ceremonies, smudging is used in the morning or evening as part of daily devotion. Smudging is a practice known to many religions; examples include the use of frankincense in Catholic churches and sticks of incense in Buddhist temples ( Barnes, 2012 ; Ewing, 2012 ).

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Sweat Lodge

The sweat lodge or purification ceremony is a ritual to cleanse body, mind, heart, and spirit. It may be held as its own ceremony or in preparation for another ceremony, such as a vision quest. Typically, the sweat lodge is held in a round structure covered with overlapped pieces of tarpaulin or blankets with a small door flap. When the flap is down, the place is nearly dark and almost sealed off from the outer air. Near the lodge is a fire pit, where rocks are heated and then passed into the lodge. Water from a bucket is splashed onto the stones, which creates a dense steam referred to as the Breath of Spirit. Depending on the illness, a variety of herbs are burned on the sweat rocks. Sacred songs and prayers go on for several hours. Everyone in the sweat lodge prays earnestly for the one needing healing, but it is the responsibility of the one being healed to pray that healing energies come to her or to him and to ask the Spirit to give guidance to the medicine person ( Sue & Sue, 2012 ).

The sweat lodge is also a powerful ceremony to keep people healthy, and many view it as the first line of defense in preventing illness. The sweat lodge raises the body’s temperature well above normal, killing heat-sensitive viruses and bacteria. The lodge is also a bringing together of the four elements: earth, air, fire, and water. Through sweating and praying, the body is cleansed of toxins, the mind of negativities, the heart of hatred, and the spirit of doubt. The sweat lodge is as sacred a place as a church or a temple ( Barnes, 2012 ).

Drumming and Chanting

Drumming and chanting are powerful ways to bring oneself in balance with self, others, and the world. Drumming harmonizes people with the heartbeat of Mother Earth. It is a pulse rather than a tempo. As people dance to the pulse of the drum, they dance in harmony with the Creator and with one another. Symbolically, the drum represents all life. The wood was once a tree, and the skin covering the drum was once life. These objects are related to life that has gone on, yet they are helping present lives. Chanting is a form of prayer through music. Holyway chants are used to attract good, to cure, and to repair; ghostway chants are used to remove evil; and lifeway chants are used to treat injuries and accidents ( Drake, 2012 ; Mackinnon, 2012 ).

Sing

A sing is a healing ceremony that lasts from 2 to 9 days and nights. A highly skilled specialist called a singer guides it. Used in healing, sings are attended by as many people in the community as are able to come because just being pres- ent is considered healing. Some songs are only for children and call on spirits who take care of little children. Some spiritual songs take care of adults only. Other songs focus on specific problems, such as the song for small burns that will cool them and keep them from blistering. To learn a single chant can take up to several years. It takes some people 40 years of singing before they master the chants and the accompanying herbal preparations ( Rutherford, 2008 ).

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Pipe Ceremony

The Pipe ceremony takes many different forms depending on how this sacred knowledge was given to the various tribes. The Pipe is one of the most sacred medicine objects and represents the universe to Native American people. The bowl represents the Earth Mother and the female powers of the universe. The stem represents the plant kingdom and the male powers of the universe. When the bowl and stem are joined together, the Pipe is sacred. The tobacco smoked in the Pipe is an instrument of prayer and has come to signify the sacredness of the ritual. As the smoke of the Pipe rises, it creates an atmosphere of prayer by symbolizing prayers going up to the Creator ( Barnes, 2012 ).

Pipes are used for private and group prayers. Prayers are transmitted in the smoke of the burning tobacco. Participants in the Pipe ceremony are as centered and focused as possible, since everything they think and feel is part of the prayers being offered. As in many other ceremonies, the number 4 has special significance. The Pipe is offered to the four directions and is often passed in four ritual repetitions ( Bad Hand, 2002 ).

Sun Dance

The sun dance includes the sweat lodge, the Pipe ceremony, monthly prayer rituals, and a yearly ceremony. During the monthly ceremony, songs are sung to carry the prayers upward, and people come forth to be healed. The yearly 3- to 4-day sun dance usually takes place in July. It is a very detailed and com- plex ceremony. The medicine person prays on behalf of the tribe, the world, and all creation. The dancers, who spend all their time praying to the Creator, move to the drumbeat around a center pole. Because the dancers fast for the entire time, many collapse or “take a fall.” This fall is often followed by a vision, similar to what happens on a vision quest. The sun dance ends with a purification ceremony so that tribe members can reenter the world refreshed and regenerated ( Walsh, 2007 ).

Vision Quest

An extremely powerful ceremony is the vision quest. Traditionally, it is a time of fasting, praying, isolation, and exposure to the elements, all of which contribute to a mystic experience with the goal of understanding self and communicating with the Great Spirit. Individuals ask themselves questions such as How can I best serve the people? How can I best serve Mother Earth? How can I best serve future generations? It is hoped that during the vision quest people find out who they are, what they are supposed to do, and what their life’s goal should be, as well as discover the purpose and meaning of their lives. The vision quest begins with a sweat lodge for purification, after which the person is taken to an isolated place in nature and begins the period of silence and fasting. During the vision quest, the individual focuses only on prayer and vision and in this way is pushed into the spirit world. After the vision quest, the person returns to the sweat lodge, and a Pipe ceremony is performed ( Mackinnon, 2012 ).

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Healing Touch/Acupressure

Native Americans have always considered touch to be therapeutic. The Cre- ator touches patients and transfers power to them through medicine people or shamans who are healing instruments. Touching, an expression of loving care, is essential for the healing process. It cleanses the affected area and relieves pain. The willingness to touch on the part of the healer demonstrates a lack of fear of contamination. Healing touch is a powerful way to remove barriers and create or restore relationships ( Shimer, 2004 ).

Some tribes have used a form of acupressure since ancient times. Com- pared with traditional Chinese practitioners, Native Americans use fewer pressure points, but the process is similar. Prior to using acupressure, medi- cine people warm their hands over a fire so that the Great Being can send healing warmth through them to the patient. It is believed that no harm will be done to a person as long as the pressure is applied slowly and in a relaxed way. Medicine people are taught that acupressure should be performed only with the utmost gentleness and love.

Herbs

Native Americans have long used herbs in maintaining health and treating disease. Botanical remedies are supplemented with ceremony and prayer dur- ing the healing process. The beneficial properties of herbs as medicines often depend on the greenness or ripeness of the plant and the part of the plant to be used, such as roots, barks, twigs, bulbs, rhizomes, fruit seed, tubers, leaves, and flowers. Knowing the best time for cutting and digging each type of plant, for peak effectiveness, is part of the knowledge of the Native healer. Whether it be in summer, winter, spring, or autumn, the timing must be appropriate for each plant. An herb gathered with prayers, cut or dug at the correct time, and prepared properly, will restore a person from illness to health ( Barnes, 2012 ).

Ancient Native people considered nature to be their pharmacy. They did not have aspirin, but they did have willow bark, which contains salicylic acid. The active ingredient in foxglove is digitalis, which was used in a tea to help people with heart problems. Particular molds, similar to those forming the basis of penicillin, were used to treat infections. Purple coneflower (echinacea) is an immune system booster and antibiotic that is held in high esteem by many people today. Goldenseal, which is a good disinfectant that promotes scab formation, is one of the most important Native American medicinal plants. Currently, it is also used as a gargle for sore throat or as a mouth rinse for canker sores, tonsillitis, and infected gums ( Barnes, 2012 ). For further information on herbs, see Chapter 7 .

Peyote

A hallucinogenic herb, peyote has been used by the Indians of North America for a long time. Native people do not use peyote to “get high” but rather to see teaching visions. Using peyote is a sacrament, and it provides a connection to

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the sacred world. Peyote makes people highly sensitive to sight and sound and more aware of what is around and inside them. It is used to heal all kinds of sickness, for clairvoyance, and in the worship of the Great Being. It is believed that the Creator put peyote on earth as a medicine to help people ( Bad Hand, 2002 ; Bear Heart, 1996 ).

Role of Medicine Women and Men

Although they are the primary care providers in many places, the responsi- bilities of medicine women and men go beyond healing illness. They also evaluate advice and treatment given by other health care practitioners. Medi- cine men and women often have a strong influence on the acceptance or rejection of the treatment plans from conventional health care providers. They may also function as tribal social mediators, dispensing traditional wis- dom and suggesting action. Medicine people reaffirm and strengthen tribal identity through the recounting of myth and song. They have an extensive knowledge of their communities and of family relationships and interaction. They are the formulators and teachers of the old religion and creators of the new. Medicine people are figures of authority and awe as instruments of the Creator ( Gonzales, 2012 ).

Navigator Programs

The goal of patient navigator programs is to improve outcomes for indige- nous people with cancer. The Native Sisters Program encourages the use of screening programs for breast cancer prevention and identification. The Walk- ing Forward Program seeks to remove treatment barriers and decrease mor- tality rates. Both programs are grounded in the traditions and knowledge of Native American populations ( Whop et al., 2012 ).

RESEARCH

Formal research into healing ceremonies is almost nonexistent. Native American medicine is a tradition that is subtle and difficult to document and communicate fully outside of its varied traditions and ceremonies. Anecdot- ally, many ailments and diseases—ranging from skin rashes and asthma to heart disease, diabetes, and cancer—have reportedly been cured by medicine people and shamans. A few studies, such as the following, are beginning to be reported in the scientific literature:

• A review of randomized and nonrandomized trials aimed at preventing the use of tobacco in Indigenous youth found only two studies that met the criteria for inclusion. Conclusions cannot currently be drawn on the efficacy of tobacco use prevention in this population ( Carson et al., 2012 ).

• Jewelweed has been used by Native American tribes to counteract the effects of poison ivy dermatitis. Jewelweed extracts were not effective, but jewelweed mash was effective. Soap made with jewelweed was not

Chapter 6 • Native American Healing and Curanderismo 103

more effective than non-jewelweed soap ( Abrams Motz, Bowers, Mull Young, & Kinder, 2012 ).

• A study of adolescents from the First Nations communities in Manitoba found the following variables to be correlated with an increased risk for suicide: being female, being depressed, being abused or having a fear of being abused, substance use, and a hospital stay ( Mota et al., 2012 ).

• The Creek Indians have used the Native American Method (NAM) for pain relief. A randomized, blinded study involved women with dysmenorrhea. The NAM healers moved their hands over the affected part of the body for 4 to 5 minutes. Each participant rated her intensity of pain before and after the intervention—either real or a simulation. NAM produced a significant decrease in the pain level compared with no change for the control (simulation) group ( Westerlund, González Medina, Pérez González, 2012 ).

CURANDERISMO

Curanderismo (pronounced “koo-rahn-dare-EES-mo”), from the Spanish verb curar , “to heal,” is a cultural healing tradition found in Latin America and among many Hispanic Americans in the United States. In Mexico, many beliefs are shared with Native American cultural traditions. Curanderismo, as described here, is most characteristically practiced by Mexican Americans. Although it is a traditional healing system, curanderismo survives by grow- ing, changing, and incorporating Western biomedical beliefs, treatments, and practices. It is also believed, however, that in certain types of illness and heal- ing, Native healers are more accomplished than practitioners of conventional medicine. Some professional nurses are also Native healers. They combine their knowledge of nursing science with the long tradition of curanderismo ( Gonzales, 2012 ).

Natural and Supernatural Illnesses

Illnesses are classified into two types: natural and supernatural. The natural source of illness includes genetic disorders, dysfunction of the body, improper self-care, infection, and psychological conditions. Supernaturally induced ill- nesses are said to be caused either by evil spirits or by a person practicing magic and placing a hex on the victim. Supernatural illnesses, which may resemble natural illness, occur when these negative forces damage a person’s health. It is believed that conventional medical practitioners are unable to intervene with supernatural illnesses ( Burns, 2012 ).

Healers

Curanderos (men) and curanderas (women) believe that they work by virtue of el don, a gift of healing, often believed to be a gift from God. In some areas, becoming a healer is a matter of inheritance; in other areas it is a matter of

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being called. Healers routinely deal with physical ailments as well as with problems of a social, psychological, or spiritual nature. Healers are always one of the people. Their healing awareness comes from living with the people, feeling their pain, knowing their illnesses, and experiencing their suffering ( Sobralske, 2006 ).

Three Levels of Healing

Three levels of care are practiced among curanderos and curanderas, namely, the material level, the spiritual level, and the mental level. Healers have the gift for working at only one of these levels because each requires distinct areas of knowledge, methods of diagnosis, and types of healing. The majority of the healers work at the material level, and most combine shamanic healing, herbal medicine, and first-aid techniques ( Burns, 2012 ).

The material level involves the use of physical or supernatural objects to heal or to change the person’s environment. Physical healers include mid- wives, bone setters, herbalists, and people who treat sprains and tense mus- cles. Objects and rituals are used for their curative powers. Objects include herbs, religious symbols (crucifix, pictures of saints, incense, holy water), and secular items (cards and ribbons). Several types of rituals are used for super- natural cures. One of the most frequently used is a cleansing ritual that includes prayers and invocations designed to remove the negative forces that are causing the illness, and a purification of the environment with incense. At the same time, the patient is given the spiritual strength necessary to achieve recovery.

The spiritual level of healing is similar to shamanic healing rituals. It is believed that spiritual beings who exist in another dimension are inter- ested in making contact with the physical world. These spirit entities come from once-living humans. Spiritual-level healers become a direct link or medium with these spirits. They enter a trance state and make contact with the spirit world. Some spirits have left tasks undone in their physical lives; some wish to help or harm others; and some wish to communicate with their friends and relatives. Healers believe that spirits can manipulate a person’s health by directing positive or negative forces at them from the spiritual realm.

The mental level is the least encountered level of practice. Healers have the ability to transmit, channel, and focus mental vibrations in a way that directly affects a person’s mental or physical condition. If healers are work- ing with physical illness, such as cancer, they channel vibrations to the afflicted area to retard the growth of abnormal cells and accelerate the growth of healthy cells. If healers are working with mental conditions, they send vibrations into the person’s mind to manipulate energies and modify behav- ior. Mental healing can be accomplished in person or over long distances ( Gonzales, 2012 ).

Most research done on curanderismo is traditional anthropological research such as participant observation and interviewing. Many of the home

Chapter 6 • Native American Healing and Curanderismo 105

remedies have been tested for biochemical and therapeutic activities and have demonstrated therapeutic actions that match the healers’ uses. Research regarding herbs is presented in Chapter 7 .

INTEGRATED NURSING PRACTICE

Just as Native American healers see themselves as channels through which the Great Power helps others achieve a sense of wellness, some nurses see God or the Divine Being at work in their professional practice. Although cli- ents may be unaware of this spiritual impetus, these nurses believe that the spiritual dimension provides the energy and momentum for their practice. Other nurses believe that their desire to care for others is what provides direc- tion for their practice. The art of nursing , for many, is in being there, with another person or persons, in a context of caring. As nurses return to their nursing roots in using their hands, heart, and head in creating healing envi- ronments, they approach the Native American ideal of healing practices.

Like Native Americans, nurses have traditionally looked at the total per- son in their care. The context of people’s lives is critically important to the nursing-healing model. In addition, nurses also believe that feelings or energy or caring flows from nurses to clients. People in distress or who are ill are anx- ious and fearful. Nurses who are centered and balanced can share their sense of calmness in the face of crisis. Before entering a client’s home or room, take a moment to center with a couple of deep, cleansing breaths and focus on what you are about to do with this person who is your client.

When you are with the client, touch may be an appropriate intervention. For some people who are suffering or in crisis, a touch on the arm or holding his or her hand may be the most effective nursing intervention you will pro- vide. It is important to remember that touch must always be appropriate and acceptable to the client.

Just as Native American tribes have rituals for cleansing the mind of negative thoughts and feelings that predispose to disease, nurses can help cli- ents modify unhealthy thinking patterns. Negative thinking not only occurs in the brain but also in the body; negative thoughts cause instantaneous chemi- cal changes in every cell. Continuous cellular disruption may contribute to the onset of illness and disease. To counteract negative thinking, some people find it helpful to look at themselves in the mirror and say aloud three good things about themselves. People might say, “I’m a good friend,” “I’m an hon- est person,” “I’m a caring person,” “My hair looks beautiful today,” “I am becoming healthier every day,” and so on. The goal is to say different positive qualities about themselves each day. Keeping a journal about feelings imme- diately after the exercise and feelings throughout the day is helpful in evaluat- ing the impact of positive statements on negative thinking.

Positive affirmations are another way to counteract negative thinking. In this nursing intervention you encourage people to make a list of positive things in their lives or things they would like to have happen. Affirmations

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are always stated as if they were a fact, even when they are still a dream. For example, an ill client might be thinking, “I’m never going to get better. I’m always going to be miserable.” You might suggest that he or she verbalize affirmations such as “I’m feeling better every day. My body is continuing to heal.” Encourage clients to write a list of affirmations over several days and repeat them several times a day. Because people tend to live their lives accord- ing to their expectations, changing expectations from negative to positive can improve the level of wellness.

Although it might not be reasonable to find a stream of flowing water to take away angers, fears, sorrows, or troubles, you can teach people to visualize that process. Direct clients through the relaxation process and have them mentally walk into a stream or actually stand in a shower that is com- fortable in temperature and force of the flow. As they stand in the stream, have them visualize the water washing out all their physical, mental, emo- tional, or relational problems. Similar to the Indian art of healing, this nurs- ing intervention may be beneficial for clients who feel weighted down with their problems or sorrows.

Gratitude is important in Native American culture. As a nurse, you can help others become more grateful for their life experiences. Many people find it extremely beneficial to keep a gratitude journal. At the close of every day, they write at least three things that happened during the day for which they are thankful. They may be thankful for a beautiful sunrise, a smile from a stranger, a hug from a child, an A on an exam, a wonderful dinner, an inti- mate moment with a partner, and so on. Focusing on gratitude is another way to become more in harmony with oneself and is thought to neutralize prob- lems and negative thinking.

A number of substance abuse programs, both Native American and non–Native American, have added drumming groups to their programs. In addition, drumming is being studied in the treatment of soldiers with post- traumatic stress disorder. Drumming enhances hypnotic susceptibility, increases relaxation, improves meditation, and synchronizes brain wave pat- terns. It facilitates an outlet for rage and a way to regain self-control. Drum- ming groups may also enhance recovery by encouraging social support and social networks. As a nurse, you can encourage the study and practice of drumming groups in these types of programs ( Dickerson, Robichaud, Teruya, Nagaran, & Hser, 2012 ).

Most people have objects that are significant to them. Although these objects are not medicine objects in the Native American tradition, they may engender a sense of comfort and perhaps protection. Encourage and support clients to have religious symbols or holy books around them if those items are important to them. Secular items can also be of great comfort, such as pictures of family and friends, get-well cards, poems, and beloved books. Most nurses do not have sweat lodges or sings as part of their healing practices, but many clients have a community of family or friends who may be sending their love and concern or praying for their healing. Actively support those activities that pro- vide love and hope to counteract the fears and doubts that accompany illness.

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Like Native Americans, nurse psychotherapists find the circle to be a beneficial design. Group therapy typically occurs with all the participants sit- ting in a circle, which contributes to the group’s sense of oneness and connect- edness. Circle arrangements foster cooperation rather than competition. It is often helpful to use a circle arrangement for nursing team conferences or interdisciplinary clinical conferences.

Integrated Nursing Practices Related to Herbs are Covered in Chapter 7 , those related to acupressure in Chapter 13 , and those related to dreams in Chapter 19 .

TRY THIS

Positive Thoughts

Often, individuals endure such runs of negative thoughts that they are unaware of the process until they have been “beating themselves up” for 10 to 15 minutes. To become more aware of this habitual process, tap one of your left fingers on a firm surface for every negative thought. When your finger becomes quite sore, you will have another level of awareness of your negativity. Negative thoughts can be countered with positive ones. When you catch yourself thinking and feeling a negative thought, such as how fat your body is or how dumb you are, STOP. Then, look for and substitute a positive thought or feeling in the place of the one you removed, such as how lovely your hair looks or how well you have succeeded at something. Listen to yourself saying the positive phrase out loud. Continue in this way, adding other phrases and wishes for yourself.

References

Abrams Motz, V., Bowers, C. P., Mull Young, L., & Kinder, D. H. (2012). The effectiveness of jewelweed, Impatiens capensis, the related cultivar I. balsamina, and the component lawsone in prevent- ing post poison ivy exposure contact dermatitis. Journal of Ethnopharmacology, 143(1): 314–318.

Bad Hand, H. P. (2002). Native American Healing . Chicago, IL: Keats.

Barnes, O. (2012). The Power of Native American Healing. Charleston, SC: CreateSpace.

Bear Heart. (1996). The Wind Is My Mother . New York, NY: Berkeley Books.

Brother Eagle Soaring. (2003). Retrieved from www.spiritalk.net/naheali4.htm

Burns, C. R. (2012). Health and medicine. Handbook of Texas Online. Texas State Historical Association. Retrieved from http://www.tshaonline.org/hand- book/online/articles/smhzcC

Carson, K. V., Brinn, M. P., Labiszewski, M. A., Peters, M., Chang, A. B., Veale, A., . . . Smith, B. J. (2012). Interventions for tobacco use prevention in indigenous youth. Cochrane Database of Systematic Reviews, Aug. 18 (8): CD009325.

Dickerson, D., Robichaud, F., Teruya, C., Nagaran, K., & Hser, Y. L. (2012). Utilizing

108 Unit 2 • Systematized Health Care Practices

drumming for American Indians/Alaska Natives with substance use disorders. American Journal of Drug and Alcohol Abuse, 38(5): 505–510.

Drake, M. (2012). Shamanic Drumming. Salem, OR: Talking Drum.

Ewing, J. P. (2012). Finding Sanctuary in Nature. Forres, UK: Findhorn Press.

Garrett, J. T. (2003). The Cherokee Herbal . Rochester, VT: Bear.

Gonzales, P. (2012). Red Medicine: Tradi- tional Indigenous Rites of Birthing and Healing. Tucson, AZ: University of Arizona Press.

Grandbois, D. M., & Sanders, G. F. (2012). Resilience and stereotyping: The experi- ences of Native American elders. Jour- nal of Transcultural Nursing. doi: 10.1177/1043659612451614

Johnson, S. (1994). The Book of Elders . San Francisco, CA: HarperSanFrancisco.

Mackinnon, C. (2012). Shamanism and Spir- ituality in Therapeutic Practice. London, UK: Singing Dragon.

Mota, N. M., Elias, B., Tefft, B., Medved, M., Munro, G., & Sareen, J. (2012). Cor- relates of suicidality: Investigation of a representative sample of Manitoba First Nations adolescents. American Journal of Public Health, 102(7): 1353–1361.

Rutherford, L. (2008). The View Through the Medicine Wheel: Shamanic Maps of How the Universe Works . Ropley, Hants, UK: John Hunt.

Shimer, P. (2004). Healing Secrets of the Native Americans . New York, NY: Black Dog & Leventhal.

Sobralske, M. (2006). Machismo sustains health and illness beliefs of Mexican American men. Journal of the American Academy of Nurse Practitioners , 18: 348–350.

Struthers, R., Eschiti, V. S., & Patchell, B. (2004). Traditional indigenous healing: Part 1. Complementary Therapies in Nursing & Midwifery , 10: 141–149.

Sue, D. W., & Sue, D. (2012). Counseling the Culturally Diverse: Theory and Prac- tice . Hoboken, NY: Wiley.

Sun Bear, Mulligan, C., Nufer, P., & Wabun. (1989). Walk in Balance . New York, NY: Simon & Schuster.

Walsh, R. (2007). The World of Shamanism . Woodbury, MN: Llewellyn.

Weatherup, K. (2006). Practical Shaman- ism: A Guide for Walking in Both Worlds . San Diego, CA: Hands Over Heart.

Westerlund, S., González Medina, M. E., & Pérez González, O. (2012). Effect of human electromagnetic fields in relief of minor pain by using a Native American method. Integrative Medicine, 11(1): 39–44.

Whop, L. J., Valery, P. C., Beesley, V. L., Moore, S. P., Lokuge, K., Jacka, C., & Garvey, G. (2012). Navigating the cancer journey: A review of patient navigator programs for Indigenous cancer patients. Asia-Pacific Journal of Clinical Oncology. doi: 10.1111/j.1743- 75632012.01532.x

Resources

Association of American Indian Physicians

1225 Sovereign Row, Suite 103

Oklahoma City, OK 73108

405.946.7072

www.aaip.org

Dance of the Deer Foundation, Center for Shamanic Studies

P.O. Box 699

Soquel, CA 95073

831.475.9560

www.shamanism.com

Chapter 6 • Native American Healing and Curanderismo 109

Feathered Pipe Ranch Foundation

P.O. Box 1682

Helena, MT 59624

406.442.8196

www.featheredpipe.com

National Alaska Native American Indian Nurses Association

www.nanaina.com

National Association of Indian Nurses of America

P.O. Box 190

Elmsford, NY 10523

www.nainanusa.com

The School of Lost Borders

P.O. Box 796

Big Pine, CA 93513

530.305.4414

www.schooloflostborders.com

Singing with the Wheel (compact disc)

West Winds

P.O. Box 16729

Mobile, AL 36616

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Botanical Healing

The Lord hath created medicines out of the earth; and he that is wise will not abhor them.

Ecclesiasticus 38:4

Let your food be your medicine and your medicine your food.

Hippocrates

3 U N I T

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7 Herbs and Nutritional Supplements

Physicians pour drugs, about which they know little, to cure diseases, about which they know less, into humans, about whom

they know nothing.

Voltaire

The Great Spirit is our father, but the earth is our mother. She nourishes us; that which we put into the ground, she

returns to us, and healing plants she gives us likewise.

Big Thunder

Also known as botanical medicine or phytotherapy ( phyto means “plant”), herbal medicine is used by 80% of the world’s population. Herbs are also the most popular com- plementary and alternative (CAM) therapy in the United States, with more than 750 herbs now on the market. According to the National Center for Complementary and Alternative Medicine (NCCAM), Americans spend more than $14.8 billion a year on herbal remedies and dietary supplements. For many conditions, herbs are the treatment of choice because they are milder and have fewer side effects than prescription drugs ( Bardia, Nisly, Zimmerman, Gryzlak, & Wallace, 2007 ). Vitamins, minerals, diet

113

114 Unit 3 • Botanical Healing

supplements, and specialized diets are beyond the scope of this text. Entire books are devoted to each of those topics, to which the reader is referred.

BACKGROUND

Throughout history, almost all societies have used plants for therapeutic pur- poses. For example, the oldest surviving garlic prescription, carved into a clay tablet, dates to 3000 b.c. Over thousands of years, a medical pharmacopoeia developed in every culture, from Asia to the Americas, to Europe and Africa. Over an extensive period of time, Chinese herbalists documented the healing properties of more than 7,000 herbs and thousands of herbal combinations. Saint-John’s-wort has a 2,500-year history of safe and effective use and was prescribed as medicine by Hippocrates (460–377 b.c. ) himself. Galen ( a.d. 129– 200) described 130 herbal antidotes and medicines, and Dioscorides (first cen- tury a.d. ) wrote about the medicinal properties of 500 plants and described how to prepare 1,000 simple remedies. The ancient Egyptians used pepper- mint and spearmint to relax the digestive tract, while Chinese and Ayurvedic doctors used mint to treat colds, coughs, and fevers ( Castleman, 2009 ).

When Europeans came to the Americas, they found that Native Americans had a vast pharmacopoeia of medicinal plants such as birch, blackberry, cone- flower, ginseng, goldenseal, and ginger that had been handed down from gen- eration to generation. Early Jesuit missionaries in Canada discovered American ginseng in the early 1700s and exported it to Asia, where it became a highly revered tonic. The Shakers (Church of the United Society of Believ- ers), who were great friends of Native Americans, were the first to cultivate medicinal plants in mass quantities and became the first reputable pharma- ceutical manufacturers in the United States. Until the Civil War disrupted their efforts, the Shakers sold 354 varieties of therapeutic herbs. During the early 20th century, tincture of echinacea was highly valued for its antibiotic properties until synthetic antibiotics became available. Kava, used to calm the nervous system and decrease anxiety, was even sold during the 1920s in the Sears, Roebuck and Company catalog. Many herbs used in ancient times are still in use today throughout the world. Herbal medicine has generally been more widely accepted outside the United States, where health care providers often combine it with conventional therapy ( Castleman, 2009 ).

In the 1960s, the U.S. Food and Drug Administration (FDA) developed the current regulations regarding medications. At that time, herbal medicine was not very popular and thus was virtually ignored by the FDA. Herbs are viewed as dietary supplements and are controlled by the 1994 Dietary Supplement Health and Education Act. Under this act, dietary supplements cannot make specific medical claims, as can prescription and over-the-counter (OTC) drugs. General statements such as “improves memory” or “promotes regularity” can be used as long as a disclaimer notes that the herb is not approved by the FDA and that the product is not intended to diagnose, treat, cure, or prevent any disease.

Researchers are intensifying their efforts to collect and screen more nat- ural products for their medicinal properties. Gordon Cragg, former chief of

Chapter 7 • Herbs and Nutritional Supplements 115

the Natural Products Branch (NPB) of the National Cancer Institute’s (NCI) Division of Cancer Treatment and Diagnosis, stated, “Nature produces chem- icals that no chemist would ever dream of at the laboratory bench” ( Hallowell, 1997 , p. 19 ). A great variety of some of the most concentrated healing herbs are found in a wide band around the equator. Unfortunately, destruction of these natural plant habitats, especially tropical rain forests, is driving many species to extinction before they can be found and studied.

It is unlikely that most herbal medicines will ever win FDA approval, since the process costs approximately $100 million per drug. Large pharma- ceutical companies are willing to invest this fortune in new drugs that can be patented and sold at high profits. In contrast, obtaining exclusive rights or patents to most herbs, such as garlic or ginseng, is nearly impossible, which takes away the financial incentive to get them approved for medicinal use. The lack of profit, rather than the lack of efficacy of herbs, keeps drug compa- nies from advocating for FDA approval of herbs.

Much of what is known about herbs comes from Germany, where an expert panel called Commission E, set up in 1978, has reviewed all available literature on 650 medicinal herbs, issuing recommendations for their use. The National Center for Complementary and Alternative Medicine is actively involved in researching healing herbs. In addition, NCI is screening plants for compounds active against the AIDS virus and nine major types of cancer. Since 1986 NCI has received samplings of thousands of plants from ethno- botanists throughout the world. Indigenous people have been testing and using healing plants for thousands of years, but only recently have Western researchers sought their knowledge.

CONCEPTS

Synergism

The active chemicals in herbs work synergistically ; that is, the combined action of two or more substances produces a greater effect than the sum of the effects of the individual substances acting alone. Most herbal medicines rely on the complex interplay of many chemicals for their therapeutic action, and many lose their activity when purified and isolated. For example, a num- ber of antimicrobial compounds are found in tea tree oil, but studies indicate that no single compound in the oil is responsible for its remarkable germ- fighting ability; rather, the interaction of at least eight distinct chemicals in the oil seems to produce the effects. This complexity makes it nearly impos- sible for an infectious microbe to build up resistance to tea tree oil. One of the primary problems with conventional antibiotics is the ability of many microbes to develop resistance to them, thus rendering the drugs useless. Antioxidant defenses also operate synergistically. For example, a number of carotenoids working together have higher anticancer properties than does a single carotenoid. Thus beta-carotene supplements may not provide the same protection as eating fruits and vegetables rich in beta-carotene. Other substances in a plant may help the body utilize its benefits as well as buffer

116 Unit 3 • Botanical Healing

any side effects. Including the whole plant in the final product often ensures that some measure of the natural “checks and balances” will be retained ( Castleman, 2009 ; Duke, 2002 ).

Various herbs and other substances may also work synergistically with one another. A rather dramatic example of this effect was observed during the testing of plant samples from the rain forest in Ecuador for chemicals that could be used to treat diabetes. The leaves from the plant were immersed in an alcohol extract and then a water extract. The researchers debated whether to throw a live crab into the extract, just as native healers did. Some believed it might make a difference, while others believed the crab was simply ritualis- tic. Amazingly, the only extract that demonstrated therapeutic effect was the one with the crab in it. It turned out that a component in a crab’s shell is needed to extract the active chemical compound from the plant ( Cray, 1997 ).

Phytonutrients

Phytonutrients are chemicals present in plants that make the plants biologi- cally active and are responsible for giving plants their color, flavor, and nat- ural disease resistance. Phytonutrients are products of photosynthesis or are substances that serve as defense mechanisms against attacks by insects and other predators. These active components of plants usually occur in groups that complement one another’s protective and healing effects. Descriptions of the most important phytonutrients and their uses are found in Table 7.1 .

Antioxidants

Antioxidants are a group of vitamins, minerals, enzymes, and herbs that help protect the body against naturally occurring free radicals, which are molecular species containing an unpaired electron. In the body, free radicals of both oxy- gen and nitrogen are produced during normal metabolic processes, as well as being derived from external sources. Free radicals are unstable and highly reac- tive. They gain stability by either donating or accepting an electron from another molecule, thus creating more free radicals in the process. Because free radicals react so readily with other compounds, they can effect significant changes in the body. Many different factors can lead to the production of free radicals. Internal sources , in addition to metabolic processes, include emotional stress and strenu- ous exercise. External sources include air pollution, cigarette smoke, factory and car exhaust, smog, pesticides, herbicides, food contaminants, chemotherapy, and radiation. All cause the overproduction of free radicals. Oxidative damage can be visualized, for example, on the exposed surface of a cut apple, which turns brown as it oxidizes, that is, reacts with the oxygen in air. Humans, how- ever, cannot “see” the damage being done by free radicals in the body. An excess of free radicals is, in part, responsible for the effects of aging and is impli- cated in cancer and a variety of chronic and degenerative conditions, including arthritis and heart disease ( Atsumi & Tonosaki, 2007 ; Duke & Castleman, 2009 ).

Free radicals are normally kept under control by antioxidant enzymes, which act as scavengers to search out and neutralize dangerous free radicals.

Chapter 7 • Herbs and Nutritional Supplements 117

TABLE 7.1 Phytonutrients

Name Properties Use/Effects

Alkaloids Group of nitrogen-containing compounds; analgesic, local

anesthetic, sedating, antispasmodic, hallucinatory; poisonous to varying degrees

Affect both the nervous and circulatory systems. Most

familiar are atropine, caffeine, cocaine, morphine, nicotine, and quinine.

Bitter principles

Group of chemicals that have an extremely bitter taste

Through a reflex action via taste buds, stimulate appetite and

flow of digestive juices, stimulate liver activity and flow of bile; some act as diuretics. Viewed as overall tonics.

Carbohydrates Main energy source and structural support of plants

In some herbs, such as coltsfoot and marshmallow, the cellulose

combines with other chemicals to form mucilage, a gummy substance that, when ingested by humans, soothes and protects irritated or inflamed internal tissue.

Carotenoids Yellow, orange, or red pigments in photosynthetic plants;

converted to vitamin A in liver

Three most important to humans: Beta-carotene may aid in cancer prevention by neutralizing free

radicals; used in conjunction with topical sunscreens for better prevention of sunburn and skin damage.

Lycopene may prevent prostate cancer and decrease risk of

heart attacks. Lutein may be useful in prevention of macular

degeneration, a leading cause of blindness in the elderly.

Essential oils Vaporize when heated; combinations give plants

their particular smell

Garlic is an antiseptic, thyme is an expectorant; chamomile

relieves gaseous distention and painful intestinal spasms.

Fatty oils Mixture of triglycerides, glycerol, fatty acids

Omega-3 fatty acids are used against cardiovascular disease

and depression; improve cognition.

(continued)

118 Unit 3 • Botanical Healing

Name Properties Use/Effects

Glycosides Complex organic substances; some of the most potent herbal

remedies and among the most toxic substances known

Cardiac glycosides include foxglove and lily of the valley, which

affect cardiac contractions; used to correct arrhythmias.

Mustard glycosides are used externally and have antiseptic

and analgesic effects.

Cyanogenic glycosides release hydrogen cyanide when chewed

or digested, resulting in antispasmodic, purgative, and sedative effects. Found in some nuts, vegetables, and the seeds of some fruits. Hydrogen cyanide, sometimes called prussic acid, is highly poisonous.

Phenolic glycosides include salicylic derivatives found in

willow and other plants; salicylic acid derivative is main ingredient in aspirin; antiseptic, analgesic, and anti-inflammatory effects.

Coumarin glycosides strengthen capillary walls and

act as an anticoagulant.

Anthraquinone glycosides are used as laxatives.

Flavonoid glycosides, known as bioflavonoids or flavonoids,

improve circulation, stimulate bile production, lower cholesterol levels, and strengthen the liver.

Isoflavones Compounds similar to human estrogen; found primarily in

soy products

May prevent hormone-related cancers; lower cholesterol,

relieve menopausal symptoms, prevent osteoporosis by increasing bone density.

Tannins Chemical substances with astringent and antiseptic

properties

Form a protective layer on the skin and mucous membranes and are

useful in treatment of burns and local inflammation; used for eye and mouth infections.

TABLE 7.1 (Continued)

Chapter 7 • Herbs and Nutritional Supplements 119

As people age they produce fewer of these enzymes, and they may benefit from dietary antioxidants such as vitamin C, vitamin E, carotenoids, the min- eral selenium, and the hormone melatonin. Herbs with antioxidant properties include bilberry, ginkgo, grape seed extract, green tea, and flavonoids. Fruits and vegetables are the primary sources of antioxidants.

Plant-Derived Products

Herbal medicines were in use even before pharmaceutical companies came into existence. In many parts of the world, treating illness with herbs is still the only medicine available. Even though only a tiny fraction of plants have been studied for medicinal benefits, conventional physicians use plant-derived products regularly. Fifty percent of all prescription and over-the-counter (OTC) drugs sold in the United States are derived from plants. Examples of herbal remedies that have been synthesized into modern drugs are reserpine from Indian snakeroot, digoxin from foxglove, quinine from Peruvian bark, aspirin from willow tree bark, morphine from opium poppy, cocaine from coca leaves, and atropine from deadly nightshade. Paclitaxel (Taxol, Abraxane) is found in Pacific yew bark and is currently being used in the treatment of early and advanced breast cancer and ovarian tumors. The drug vincristine (Oncovin) has been isolated from the Madagascar periwinkle and has been found to arrest cell division so dramatically that it is being used to treat acute leukemia and Hodgkin’s disease ( Bowden, 2008 ; Koudelka & Turanek, 2012 ).

Safety

Not all plant life is beneficial. Most plant-related poisonings are due to acci- dental consumption of toxic ornamental plants such as jade, holly, poinsettia, schefflera, philodendron, and dieffenbachia rather than herbs. Data compiled by the American Association of Poison Control indicate that medications such as analgesics, sedatives, antipsychotics, antidepressants, cold/cough prepara- tions, and cardiovascular drugs are much more likely to cause adverse reac- tions and fatalities than are herbs ( Bronstein et al., 2011 ).

Although the safety of herbs has not been completely established through an evidence-based approach, it is thought that the vast majority of herbal med- icines present no danger if taken appropriately. Some can, however, cause seri- ous side effects if taken in excess or, for some individuals, if taken over a prolonged period. For example, comfrey , a digestive remedy; coltsfoot , used to treat cough; and kava , used for anxiety, can cause liver damage if taken in large doses. Beta-carotene increases the risk of lung cancer among smokers. Vitamin E supplements increase the incidence of prostate cancer among healthy men. Yohimbe may lower blood pressure and contribute to a heart conduction disor- der that may result in death. Willow bark may result in Reye’s syndrome in children. Ephedra can increase blood pressure and contribute to seizures, myo- cardial infarctions, or strokes (Bronstein et al., 2011 ; Zhang, Xue, & Fong, 2011 ).

Herbs can also interact with drugs, and caution should be used when combining herbs with prescription and OTC medications (see Table 7.2 ).

120 Unit 3 • Botanical Healing

TABLE 7.2 Herb Interactions

Herb/Supplement May Interact with Potential Effects

Black cohosh Hormone replacement medications

May potentiate one another

Capsicum Anticoagulants, aspirin May prolong bleeding time

Theophylline Increases absorption, may cause toxicity

Echinacea Immunosuppressants Reduces effectiveness of immunosuppressants

Antifungals; drugs known to elevate liver enzymes

May cause liver damage

Evening primrose oil

Phenothiazine medications, Wellbutrin

May increase risk of seizures

Feverfew Anticoagulants, aspirin May increase anticoagulant effects

Garlic Anticoagulants, aspirin May increase anticoagulant effects

Hypoglycemics May cause hypoglycemia

Antihypertensives May require increased dose of antihypertensive

HIV medications May increase or decrease effectiveness of medications

Ginger Anticoagulants, aspirin May increase anticoagulant effects

Ginkgo Anticoagulants, aspirin May increase anticoagulant effects

Anticonvulsants May decrease effectiveness of anticonvulsants

Ginseng Oral contraceptives Increases the potency of estrogen in oral contraceptives causing side

effects such as weight gain, breast pain, and vaginal bleeding

MAO inhibitors May result in mania

Caffeine May cause irritability

Glaucoma medications May decrease effectiveness of glaucoma medications

Goldenseal Anticoagulants, aspirin Decreases effectiveness of anticoagulants

Diuretics Increases diuretic effect

General anesthetics May increase hypotensive effect of anesthetic

Licorice Hypoglycemics May interfere with regulation of blood sugar levels

Lanoxin, Lasix, Hygroton, Lozol, Bumex

Licorice depletes potassium; may cause hypokalemia

Chapter 7 • Herbs and Nutritional Supplements 121

(continued)

Herb/Supplement May Interact with Potential Effects

Thyroid replacement medication

May require higher doses of thyroid replacement drugs

Oral contraceptives May cause high blood pressure, fluid retention, hypokalemia

Antihypertensives Decreases effectiveness of antihypertensives

Ma huang Most antihypertensives May increase blood pressure and risk of cardiac arrhythmia

Antidepressants May increase blood pressure and risk of cardiac arrhythmia

Decongestants May increase blood pressure and risk of cardiac arrhythmia

Lanoxin Increases risk of cardiac arrhythmia

Hypoglycemics May interfere with regulation of blood sugar levels

Milk thistle Oral contraceptives Reduces effectiveness of oral contraceptives

Psyllium Laxatives May increase effects

Saint-John’s-wort Oral contraceptives Reduces effectiveness of oral contraceptives

Tetracyclines, sulfa drugs, Feldane, Prilosec, Prevacid

Extreme photosensitivity may occur; increasing risk for severe

sunburn

Antidepressants May potentiate one another, causing severe agitation,

nausea, confusion, and possible cardiac problems

Anticonvulsants

Anticoagulants

May decrease effectiveness of anticonvulsants May increase anticoagulant effect

Dioxin, immunosuppressants, protease inhibitors

May reduce effectiveness of these medications

Theophylline May decrease serum theophylline levels

General anesthetics May prolong effect of anesthesia

Saw palmetto Proscar May potentiate each other, resulting in overdose

Valerian Antianxiety medication, Benadryl, Vistaril,

anticonvulsants

May increase sedative effects

General anesthetics Prolongs anesthesia

122 Unit 3 • Botanical Healing

Herb/Supplement May Interact with Potential Effects

Vitamin A Accutane for acne Toxicity may occur, resulting in severe headaches, dry

eyes and skin, hair loss, and possible liver damage

Vitamin B 6 Carbidopa, levodopa May decrease effectiveness, resulting in breakthrough

symptoms such as tremors

The majority of people who use herbs do not inform their medical providers of this fact. Such lack of communication can lead to herb–drug interactions that might otherwise have been avoided. Any herbs that act as anticoagu- lants or those that potentiate anesthesia must be discontinued before sur- gery if at all possible ( Shaw, Graeme, Pierre, Elizabeth, & Kelvin, 2012 ).

The processing and manufacturing of herbal products varies from coun- try to country, with varying degrees of quality assurance. Contamination with heavy metals, pesticides, herbicides, insects, animals, and/or animal excreta can result in unsafe herbal products. In the United States herbs are sold as dietary supplements and have significantly fewer requirements compared with prescription and OTC drugs. The requirements apply only to how the final product is manufactured, not to suppliers of the herbal ingredients.

TREATMENT

Medicinal herbs are available at health food stores, herb shops, supermarkets, and pharmacies. They can be used as a preventive, a tonic, or a treatment. Herbs can be prepared and used in a number of ways. Extracts or tinctures are made by pressing herbs with a heavy press and soaking them in alcohol or water, which after evaporation yields a concentrated extract. Extracts are gen- erally measured in drops and diluted in a small amount of water for inges- tion. A preparation of the delicate parts of plants—that is, leaves, flowers, and seeds—is called an infusion , a process similar to making tea. Hot water is poured over the herb, steeped for 3 to 5 minutes, and strained before drink- ing. Honey or lemon may be added to taste. Decoction is the preparation of the more resilient parts of plants, such as the bark, roots, and berries. These parts of the herb are usually boiled for 10 to 20 minutes and strained before drinking. A compress is a cloth soaked in a warm or cool herbal solution and applied directly to an injured area. An herbal poultice is made by mixing pow- ered herbs with enough hot water to make a thick paste that is then applied directly to the skin. Poultices are used to reduce swelling, relieve pain, decrease muscle spasms, draw out toxins from the body, increase circulation, and speed healing. Table 7.3 lists some of the more common herbs as well as their action, dosage, and side effects.

TABLE 7.2 (Continued)

Chapter 7 • Herbs and Nutritional Supplements 123

TABLE 7.3 Common Herbs

Name Properties/Use Side Effects/Contraindications

Asian ginseng Improve mental and physical performance; lower blood glucose; improve immune function

Headaches, sleep problems, GI problems People taking medicine to lower blood sugar should use extra caution NOT for people with hypoglycemia

Bilberry Diarrhea; menstrual cramps; varicose veins; venous insufficiency

High doses or extended use of the leaf or extract may lead to possible

toxic effects

Black cohosh Menopause; dysmenorrhea Minimal side effects NOT for people with a liver disorder NOT to be used with hormone replacement therapy NOT to be used with hormone-sensitive breast cancer

Butterbur Antihistamine for allergy symptoms; migraines

Belching, GI issues, asthma, fatigue NOT for children

Chamomile Anxiety, sleeplessness, GI upset, infant colic, mouth ulcers from cancer treat- ment; drug withdrawal

NOT for those with extreme allergy to ragweed.

NOT for pregnant or lactating women

Cranberry Prevent urinary tract infections or H. pylori infections that can lead to stomach ulcers; antioxidant

Use with caution for people taking anticoagulants or medications that affect the liver

Echinacea Prevent colds, flu; stimulate immune system

Few side effects

Evening primrose oil

Eczema; rheumatoid arthritis; breast pain

Well tolerated by most people NOT for pregnant or lactating women

Fenugreek Diabetes; loss of appetite; stimulate milk production in breastfeeding women; skin inflammation

Gas, bloating, diarrhea NOT for pregnant women

Feverfew Migraines; rheumatoid arthritis; psoriasis, allergies; tinnitus; dizziness

No serious side effects NOT for pregnant women

Garlic High cholesterol; slow development of atherosclerosis; hypertension

Nausea, garlicky scent NOT for people with clotting disorders NOT prior to surgery

Ginger Nausea and vomiting of various causes; arthritis

Safe during pregnancy

(continued)

124 Unit 3 • Botanical Healing

Name Properties/Use Side Effects/Contraindications

Ginkgo Dementia; memory impairment; intermittent claudication; tinnitus

Headache, nausea, GI upset NOT for people with clotting disorders NOT prior to surgery

Goldenseal Respiratory tract infections; eye infections; vaginitis; canker sores

Few side effects

Grape seed extract

Hypertension; high cholesterol; poor circulation; vascular fragility; edema; antioxidant

Few side effects

Green tea Cancer; mental alertness; weight loss; high cholesterol

Contains caffeine

Horse chestnut

Venous insufficiency Do NOT use raw or unprocessed plant parts, as they are poisonous

Licorice root Stomach ulcers; bronchitis; sore throat; hepatitis

Use with caution with diuretics, as potassium levels could drop dangerously low; use with caution for people with hypertension

Milk thistle Liver disorders; high cholesterol;

NOT for pregnant or lactating women Use with caution for people with

diabetes or hypoglycemia

Noni Antioxidant; immune stimulating; tumor fighting properties

High in potassium; use with caution for people with renal disease

Red clover Menopause; high cholesterol; osteoporosis; prostate enlargement

Few side effects Unclear if it is safe for pregnant or

lactating women or hormone- sensitive cancers

St. John’s wort Minor depression Photosensitivity, anxiety, dry mouth Sexual problems

NOT for use with other antidepressants

NOT for children NOT for pregnant or lactating women

Saw palmetto Urinary antiseptic; benign prostatic hyperplasia

Few side effects NOT for pregnant or lactating women

Tea tree oil Antifungal, antiseptic; acne; minor wounds and cuts; athlete’s foot; nail infections; herpes; douche for yeast infections

Only for topical use

Valerian Insomnia; menopause; men- strual and intestinal cramps

Excitability, uneasiness, fatigue, headache

TABLE 7.3 (Continued)

Chapter 7 • Herbs and Nutritional Supplements 125

RESEARCH

Most herbal medicines have not been tested as thoroughly as have prescription drugs in the United States, although the National Center for Complementary and Alternative Medicine, the National Cancer Institute, and the Society for Integrative Oncology fund many herbal research trials. South Africa has more than 20,000 plant species, several thousand of which are used by traditional healers. Research teams from the United States are teaming up with the South African Herbal Science and Medicine Institute to study the medicinal proper- ties, safety, and effectiveness of several of these African plants. In contrast, many scientific studies have been conducted outside the United States on a variety of herbal remedies, such as those by Commission E in Germany, men- tioned previously. In the coming years, the pharmacopoeia of useful herbs is likely to expand, since research in the field of herbal medicine is on the rise worldwide.

In 1995, the American Herbal Pharmacopoeia (AHP) was organized as an educational foundation to disseminate information regarding the pharma- cology, actions, indications, dosages, side effects, contraindications, drug interactions, and toxicology of herbs. To date, their information covers 140 medicinal plant species, representing 90% of the herb sales in the United States. The goal of AHP is for health care providers in the United States to integrate herbal medicines into treatment plans, as their contemporaries have done in other countries.

Evidence summaries produced by the Joanna Briggs Institute found the following:

• Treatment of acute ischemic stroke with Ginkgo biloba extract should be guided by clinical judgment until high-quality research is conducted ( Jahan, 2012 ).

• A fixed dose of 1 gram of ginger is recommended for reducing postop- erative nausea and vomiting in patients having gynecologic or lower limb extremity surgery ( Moola, 2012 ).

The Joanna Briggs Institute Clinician Information on Aromatherapy and Herbal Medicine ( Carstens, 2010 ) found the following:

• Herbs may be beneficial in treating a variety of conditions, but caution must be used owing to possible complications and lack of evidence (Grade B).

• Herbal remedies can affect laboratory test results, so good communica- tion among patients, primary care providers, laboratory scientists, and pathologists is important (Grade A).

A sample of randomized clinical trials sponsored by the National Cancer Institute include studies of

• selenium for both prostate cancer prevention and non–small cell lung cancer.

• psilocybin for clinically significant depression or anxiety secondary to cancer.

126 Unit 3 • Botanical Healing

• ginseng for preventing respiratory infection and reducing antibiotic use in patients with chronic lymphocytic leukemia. It is also being studied in people with cancer and the related fatigue.

• green tea for former smokers with chronic obstructive pulmonary dis- ease (COPD).

• grape powder for estrogen levels in postmenopausal women. • valerian for improving sleep in people with cancer. • ginger for nausea related to chemotherapy.

The quality of herbal products can affect study outcomes and the degree to which herbs can be integrated into evidence-based medicine. Quality can be affected by environmental conditions; herb collection practices; handling, storage, and manufacturing conditions; and contamination.

INTEGRATED NURSING PRACTICE

Because herbs are marketed as “natural” or promoted as foods, consumers may assume incorrectly that herbs are safe and without side effects. It is important to remember that natural remedies must be approached with respect. They work because they have strong pharmacological activity. It is important to teach clients that although herbs are generally much safer than prescription drugs, if herbs are abused or overused, they can cause harm.

Although herbs can be quite effective, it is important to caution people about becoming overzealous about their use. If they have a life-threatening illness such as asthma or if they experience chest pain or if they notice more benign symptoms that persist for longer than a few days, they should seek medical attention. While it may be helpful to take echinacea for an incipient cold, any serious ailment should first be diagnosed by a health care practitio- ner. Self-diagnosis and self-care are by nature subject to limits. Conventional medicine is best used in crisis situations, and herbs are best used in noncrisis situations. Professionals can save consumers from treating something that does not exist or failing to treat something that does. Further, health practi- tioners can help individuals evaluate the extent of their progress on the herbal regimen. Consultation is especially important if people are taking other medications; although some herbs can work with prescription drugs, others may not. Some herbs potentiate the effects of drugs, so individuals may need a lower dose of their regular medication. Suddenly stopping a pre- scription can be hazardous to one’s health. Pregnant and lactating women should always consult their primary care practitioner before taking any herbal medicines.

Herbs should be used with caution with children. Children are not “small adults” and may experience side effects that are different from those experienced by adults. Parents or caregivers should consult with the child’s primary care professional before using any herbs with children.

Nurses must be open to exploring and discussing their clients’ use of and questions about herbal medicine. This clinical screening allows evaluation

Chapter 7 • Herbs and Nutritional Supplements 127

of herbal intake against known and potential adverse interactions with pre- scription and over-the-counter (OTC) medications.

As a nurse, you need to educate consumers about potential actions and interactions of herbal remedies. People cannot expect to take an herb for a few days to undo 10 years of poor health habits nor to replace a healthy diet with herbal supplements. If people eat a healthful, varied diet that is high in fresh foods, especially fruits, vegetables, and whole grains, they do not need to take supplements unless they have special needs ( Weil, 1998 ).

Sometimes, walking into a health food store or pharmacy is highly con- fusing. Many people are overwhelmed by the wide assortment of products and brands. As a nurse, you can teach consumers the following basic guide- lines in selecting herbal medicines:

• Store clerks are not experts. They do not have an adequate scientific background to counsel people.

• Go with a name brand. Since the industry is unregulated, it is best to choose products made by large, reputable companies that have been in business for a long time. Many excellent products are produced in Germany and France, where they must meet strict production standards.

• Check the label. Look for the word standardized , which tells you that the product consistently contains a certain percentage of a specific chemical.

• Check to see whether the claims are reasonable. Be wary of promises of instant cures for complicated disorders. If something sounds too good to be true, it probably is.

• Consider the product’s form. A liquid, powder, or solid extract is gener- ally best. Bulk herbs can lose their potency quickly. Many herbal tinc- tures are 50% grain alcohol, which may be a problem for people with a history of alcohol abuse or for those who take drugs that can interact with alcohol.

• Be wary of ultracombination products. If the product has more than six ingredients, it probably contains a small amount of each. A combination of herbs does not necessarily make the product better. If you need ginkgo to boost your memory, it is better to get it full strength than to get a product diluted with ginseng, garlic, and other herbs.

• Take the right dose. Do not take higher doses than the label recommends. Exceeding the recommended dose can lead to toxicity. Most herbal rem- edies are not to be given to children under the age of 1 unless directed by an experienced practitioner. Children ages 1 to 6 are typically given one third the adult dose, while children ages 6 to 12 receive half the adult dose. People over the age of 65 may need a reduced dosage.

• Watch for side effects. If you have any unusual symptoms, such as aller- gies, rashes, heart palpitations, or headaches, stop taking the herb imme- diately and see a health care practitioner.

• Give the product time to work. Evaluate how it makes you feel. After 30 days, ask yourself whether the product has made a difference in your health. If you are not sure, stop taking the herb to gauge the difference.

128 Unit 3 • Botanical Healing

• Inform your primary health care practitioner about the herbal remedies you are taking.

• If you plan on regularly using herbal remedies, invest in a good herbal reference guide to ensure your access to proper information, or consult with the one of the organizations in the resource list. The U.S. Depart- ment of Agriculture provides free access to 80,000 records, developed by Dr. James A. Duke, on herb taxonomy and use of herbs worldwide.

As a nurse, it is also important that you warn consumers about remedies that can be risky. Chaparral, sold as teas and pills to fight cancer and “purify blood,” has been linked to serious liver damage. Dieter’s teas, containing such ingredients as senna, aloe, rhubarb root, buckthorn, cascara, and castor oil act as laxatives that when consumed in excessive amounts can disrupt potassium levels and contribute to cardiac arrhythmias. Ephedra is a cardiac and ner- vous system stimulant that can cause anxiety, psychotic episodes, hyperten- sion, stroke, tachycardia, arrhythmias, and cardiac arrest. The Food and Drug Administration has banned the sale in the United States of supplements con- taining ephedra. The ban does not apply to traditional Chinese herbal remedies that are regulated as conventional foods.

TRY THIS

Herbal Remedies

Peppermint Tea

Used to soothe an upset stomach, aid digestion, relieve menstrual cramps, soothe sore throats, improve alertness.

How to Combine 1 to 2 teaspoons of dried peppermint leaf with 8 ounces of water. Steep 3 to 5 minutes. Strain and drink the tea.

Chamomile

An excellent home remedy for indigestion, heartburn, and infant colic. It also soothes skin and has mild relaxant and sedative properties.

How to For an infusion, use 2–3 heaping teaspoons of dried or 1/3 cup of fresh flowers per cup of boiling water. Steep 10–20 minutes. Strain and drink up to 3 cups a day. Diluted infusions may be given to infants for colic.

For a relaxing herbal bath, fill a cloth bag with a few handfuls of dried or fresh flow- ers and let the water run over it.

Chapter 7 • Herbs and Nutritional Supplements 129

The U.S. public is demanding more information about herbal remedies. In the best of all worlds, consumers would have an educated professional—a nurse, a pharmacist, or a doctor—to help guide them through the process of using herbal remedies. That is the situation in Germany, where health care practitioners and pharmacists must be knowledgeable about natural reme- dies, their approved uses, their potential side effects, and how they should be prescribed. This is not the case in the United States, but it surely will

For allergic skin rashes, tightly pack a jar of flower heads, and cover them with olive oil. Cover and set in a sunny place for 3 weeks. Strain and apply to rashes.

Comfrey

External use only. Promotes the growth of new cells and has a mild anti-inflammatory action. Used in wound and burn treatment.

How to Mix the powdered root with water to make a paste. Apply to the injured area and cover with a clean bandage. Change daily.

Ginger

Decreases nausea, boosts the immune system, lowers blood pressure.

How to Use 2 teaspoons of powdered or grated root per cup of boiling water. Steep 20 minutes, strain, and add juice from half a lemon and honey to taste. Drink hot up to 3 cups a day. Dilute ginger infusion to treat infant colic. If you buy whole root, refrigerate it.

Mint

Relaxes the digestive tract; used to treat colds, coughs, and fevers.

How to For an infusion, use 1 teaspoon of fresh herb or 2 teaspoons of dried leaves per cup of boiling water. Steep 10 minutes, strain, and drink up to 3 cups a day. Peppermint has a sharper taste than spearmint and feels cooler in the mouth.

For a relaxing herbal bath, fill a cloth bag with a few handfuls of dried or fresh leaves and let the water run over it.

Rosemary

Stimulates circulation and relaxes tired and sore muscles.

How to For tired, sore feet, make a footbath by adding 10 drops of essential oil to a basin of hot water large enough to hold both feet. Stir the oil into the water with your hand.

130 Unit 3 • Botanical Healing

change in the near future. Schools of nursing and schools of medicine are including courses on complementary and alternative medicine in their cur- riculum. Pharmacy schools now require their students to take a course in herbal therapy.

As nurse–author Carolyn Kresse Murray ( 1996 ) said, “Part of patient advocacy is making sure you help your patient with all his [her] therapies. Equipping yourself with knowledge about herbal therapies is another way to keep him [her] from harm” (p. 59 ).

Considering the Evidence

C. V. Little, T. Parsons, and S. Logan, 2009, Herbal therapy for treating osteoarthritis, Cochrane Database of Systematic Reviews, (4): CD002947. doi: 10.1002/14651858. CD002947

What Was the Type of Research?

Systematic review of randomized control trials (RCTs)

What Was the Purpose of the Research?

To synthesize, appraise, and evaluate relevant RCTs concerning the effectiveness of herbal therapies in treating osteoarthritis compared with placebo use

How Was the Research Done?

The authors used a systematic review methodology to examine RCTs relevant to the pur- pose of this research. They employed a comprehensive search strategy using selected keywords and 10 electronic databases to identify relevant studies. In addition, the authors hand searched the reference lists from retrieved articles to locate additional studies meet- ing the inclusion criteria. Two reviewers assessed the methodological quality of the stud- ies. Five studies (four different herbal treatments) were identified as meeting the established inclusion criteria for this review.

What Were the Findings of the Research?

There is some evidence to support the use of avocado-soybean unsaponifiables (natural vegetable extract made from avocado and soybean oils) in helping persons living with chronic but stable osteoarthritis of the hip. Owing to the lack of studies, there needs to be additional research related to other herbal remedies for persons living with osteoarthritis.

What Additional Questions Might I Have?

Would avocado-soybean unsaponifiables have a positive effect on other types of arthritic conditions? Are there any side effects associated with the use of avocado-soybean unsa- ponifiables? Are there additional studies of good methodological quality currently being done to investigate the effect of herbs on osteoarthritis?

Chapter 7 • Herbs and Nutritional Supplements 131

References

How Can I Use This Study?

This study has clinical value for nurses caring for persons living with pain associated with osteoarthritis and desiring to enhance their quality of life. Nurses can incorporate the find- ings of this review in educating and promoting the health of persons living with this chal- lenge. Nurses should be aware that additional research of good methodological quality on the effectiveness of herbal treatment for patients with osteoarthritis is needed to strengthen the evidence.

Source: Contributed by Dolores M. Huffman, RN, PhD

Atsumi, T., & Tonosaki, K. (2007). Smell- ing lavender and rosemary increases free radical scavenging activity and decreases cortisol level in saliva. Psy- chiatry Research , 150(1): 89–96.

Bardia, A., Nisly, N. L., Zimmerman, M. B., Gryzlak, B. M., & Wallace, R. B. (2007). Use of herbs among adults based on evidence-based indications: Findings from the National Health Interview Survey. Mayo Clinic Proceed- ings , 82(5): 561–566.

Bowden, J. (2008). The Most Effective Natu- ral Cures on Earth . Beverly, MA: Fair Winds Press.

Bronstein, A. C., Spyker, D. A., Cantilena, L. R., Green, J., Rumack, B. H., & Dart, R. C. (2011). 2010 annual report of the American Association of Poison Con- trol Centers’ national poison data sys- tem (NPDS). Clinical Toxicology , 49: 910–941. doi: 10.3109/15563650.2011.635149

Carstens, J. (2010). Complementary thera- pies (aromatherapy and herbal medi- cine): Clinician information. Joanna Briggs Institute Clinician Information. Retrieved from http://connect.jbiconnectplus.org/ ViewDocument.aspx?0=3771

Castleman, M. (2009). The New Healing Herbs . Emmaus, PA: Rodale Press.

Cray, D. (1997). Money that grows on trees. Time , Fall special issue, 150(19): 21.

Duke, J. A. (2002). The Green Pharmacy Herbal Handbook . New York, NY: St. Martin’s Press.

Duke, J. A., & Castleman, M. (2001). The Green Pharmacy Anti-Aging Prescriptions . Emmaus, PA: Rodale.

Hallowell, C. (1997). The plant hunter. Time , Fall special issue, 150(19): 17–22.

Jahan, N. (2012). Stroke (acute ischaemic): Ginkgo biloba. Joanna Briggs Institute Evidence Summary. Retrieved from http://connect.jbiconnectplus.org/ ViewDocument.aspx?0=6846

Koudelka, S., & Turanek, J. (2012). Liposo- mal paclitaxel for mutations. Journal of Controlled Release. doi: 10.1016/ j.jconrel.2012.09.006

Moola, S. (2012). Postoperative nausea and vomiting: Complementary therapies. Joanna Briggs Institute Evidence Sum- mary. Retrieved from http://connect. jbiconnectplus.org/ViewDocument. aspx?0=7166

Murray, C. K. (1996). Walking the Spiritual Walk . Virginia Beach, VA: A.R.E. Press.

Shaw, D., Graeme, L., Pierre, D., Elizabeth, V. V., & Kelvin, C. (2012). Pharmacovigi- lance of herbal medicine. Journal of Eth- nopharmacology, 140(3): 513–518.

Weil, A. (1998). Ask the experts. Natural Health , (January–February): 24–28.

Zhang, A. L., Xue, C., & Fong, H. H. S. (2011). Integration of herbal medicine into evidence-based clinical practice. In F. F. Benzie and S. Wachtel-Galor (Eds.), Herbal Medicine: Biomolecular and Clinical Aspect (2nd ed., pp. 453–464). Boca Raton, FL: CRC Press.

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Resources

American Botanical Council

P.O. Box 144345

Austin, TX 78714-4345

512.926.4900

www.abc.herbalgram.org

American Herbalists Guild

P.O. Box 230741

Boston, MA 02123

857.350.3128

www.americanherbalistsguild.com

American Herbal Pharmacopoeia

P.O. Box 66809

Scotts Valley, CA 95067

831.461.6318

www.herbal-ahp.org

British Herbal Medicine Association

P.O. Box 583

Exeter EX1 9GX

44 (0) 845.680.1134

www.bhma.info

Herb Research Foundation

4140 15th St.

Boulder, CO 80304

800.748.2617

www.herbs.org

NAPRALERT (NAtural PRoducts ALERT)

The Program for Collaborative Research in the Pharmaceutical Sciences

College of Pharmacy

University of Illinois at Chicago

833 South Wood St.

Chicago, IL 60612

312.996.9035

www.napralert.org

National Herbalists Association of Australia

4 Cavendish St.

Concord West NSW 2138

02.8765.0071

www.nhaa.org.au

Ontario Herbalists Association

P.O. Box 123, Station D

Etobicoke, ON M9A 4X2

877.642.4372

www.herbalists.on.ca

U.S. Food and Drug Administration

10903 New Hampshire Ave

Silver Spring, MD 20993-0002

888.463.6332

www.fda.gov

Wise Woman Apprentice Program

P.O. Box 64

Woodstock, NY 12498

845.246.8081

www.susunweed.com

133

8 Aromatherapy

Earth laughs in flowers.

Ralph Waldo Emerson

Aromatherapy is the therapeutic use of essential oils of plants to heal the body, mind, and spirit. It is an offshoot of herbal medicine, and its basis of action is the same as that of modern pharmacology. The chemicals found in the essen- tial oils are absorbed into the body, resulting in physiological or psychological benefit. Aromatherapy is used to treat symptoms, so it has neither a theory of health and illness nor a system of diagnosis, in contrast with biomedicine, Traditional Chinese Medicine, and the like.

Scientists have long known that certain scents have the power to evoke strong physical and emotional reactions, but rarely has that knowledge been used in conventional medicine. Healthy humans can smell as many as 10,000 different odors, ranging from the deep fragrance of jasmine to the putrid stench of sewage. Most people, however, do not realize how much the sense of smell affects their daily lives.

Aromatherapy has been forgotten and ignored for many years but is now one of the fastest growing alternative therapies in Europe and the United States. The term aromatherapy has become more than a buzzword since the mid-1980s. In the United States, it is now a generic term in the public domain and, as such, cannot be trademarked by an individual or business.

Aromachology is a term coined by the Sense of Smell Insti- tute to describe the scientific study of fragrances, both natural and synthetic, as applied to psychology and human behavior. A systematic review of 18 studies found that odors can affect mood and behavior in humans ( Herz, 2009 ).

Essential oils come from all over the world—lavender from France, sandalwood and jasmine from India, rose from Turkey

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134 Unit 3 • Botanical Healing

and Bulgaria, geranium from the island of Réunion, eucalyptus and tea tree from Australia, and mint from the United States, to name a few examples. Today, only 3% of essential oils are used in therapy; the remaining 97% are used in the perfume and cosmetic industry. Owing to increased popularity, aromatherapy has become a $1 billion industry.

BACKGROUND

Almost all ancient cultures recognized the value of aromatic plants in main- taining health. Ancient Egyptians used scented oils daily to soften and protect their skin from the harsh, dry climate. They created various fragrances for personal benefit as well as for use in rituals and ceremonies. Fragrances were considered a part of the personal purification necessary to reach a realm of higher spirituality. Oils were dispersed into the air to purify the environment and to protect against evil spirits. Egyptians were the first to perfect embalm- ing with the use of aromatic plants and oils ( Tucker, 2012 ).

Priests and physicians used oils thousands of years before the time of Christ. The Ebers Papyrus, discovered in 1817, dates to 1500 b.c. and mentions more than 800 different formulas of herbal prescriptions and remedies. The Romans diffused oils in their temples and political buildings and bathed in hot tubs scented with oils. Ancient Arabian people studied the chemistry of plants and developed the process of distillation for extraction of essential oils. Throughout Asia perfumes were prized for both medicinal and cosmetic properties. Hundreds of references are made to oils in the Bible such as frank- incense, myrrh, and cinnamon. Many were used as protection against disease and for anointing and healing the sick ( Cline et al., 2008 ). Hippocrates, the father of Western medicine, reportedly said, “The way to health is to have an aromatic bath and scented massage every day” ( Thomas, 2002 , p. 10 ).

In the 12th century, trade routes from the Middle East introduced spices, herbs, and exotic scents to Europe, leading to the compilation of many books on therapeutic plant remedies. In the Americas, shamans also used herbs and aromatics in bathing patients to transform their energy field. Smoke from plants was often blown over patients as part of healing ceremonies ( Schiller, Schiller, & Schiller, 2013 ).

Although oils were used with great effectiveness in ancient times, they were largely forgotten by the Western world until resurrected in the 20th century by a French cosmetic chemist, Maurice-Rene Cattefosse. While working in his laboratory in 1920, he had an accident that resulted in a third-degree burn of his hand and forearm. He plunged his arm into a vat of lavender oil, thinking that it was water. To his surprise, the burning stopped within a few moments. With the continual application of lavender oil over the next few weeks, the burn healed completely without a trace of a scar. This incident was the beginning of Cattefosse’s fascination with the therapeutic properties of essential oils. He carried out experiments using oils to cure burns, to treat wounds, and to prevent gangrene and in 1937 coined the term aromatherapie ( Schiller et al., 2013 ).

Chapter 8 • Aromatherapy 135

PREPARATION

Since the 1980s, numerous schools of massage and aromatherapy have opened in the United Kingdom, France, and Japan. Training in aromatherapy has grown, and courses in it are part of the nursing degree program in some nurs- ing colleges and universities. Aromatherapists practice in a number of set- tings, including private practices, general medical clinics, and hospitals.

Some people in the United States, after a weekend course, call themselves “aromatherapists.” They may know little about plant chemistry and the specific ways in which the oils need to be formulated. Their self-proclaimed title is fine if they use oils only for fragrance and perfume. However, it is inappropriate for individuals with this limited knowledge to use oil formulas for a specific thera- peutic action. Jane Buckle, PhD, RN, ( www.rjbuckle.com ) offers a 45 hour CEU program that is available only to registered nurses (RNs) and licensed Massage Therapists (LMTs). Those who successfully complete the program receive a Certificate in Clinical Aromatherapy. Valerie Cooksley, RN, OCN, FAAIM, and Laraine Kyle Pounds, RN, MSN, who founded the Integrative Institute of Aromatherapy, offer an Integrative Aromatherapy© Certification Program, which consists of 310 contact hours for RNs ( Valerie@aroma-rn.com ).

Both these programs have been developed in conjunction with and approved by the American Holistic Nurses Association. In addition, the National Association for Holistic Aromatherapy has established certification guidelines and Standards of Training Levels.

CONCEPTS

Essential Oils

Essential oils are volatile liquids that are distilled or cold pressed from plants. Although chemically they are oils and as such do not mix with water, the term oil is somewhat misleading, since essential oils feel like water rather than oil. Varying amounts of essential oil can be extracted from a particular plant, which influences the price of the oil. For example, 1 ounce of jasmine may cost $150, while the same amount of tea tree oil may cost only a few dollars. The orange tree is a good example of a plant from which oils are extracted from various parts. Neroli oil comes from the orange tree blossoms, orange oil from the fruit itself, and petitgrain oil from the leaves of the tree. The following are other examples of plant parts from which oils are derived:

Leaves: eucalyptus, peppermint, petitgrain Flowers: lavender, rose Blossoms: neroli Fruits: lemon, mandarin, orange Grasses: lemongrass Wood: camphor, sandalwood Barks: cinnamon

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Gum: frankincense Bulbs: garlic, onion Dried flower buds: clove

Essential oils are stored in tiny pockets between plant cell walls. As the oil is released, it circulates through the plant and sends messages that help the plant function efficiently. Oils activate and regulate such activities as cellular metabolism, photosynthesis, and cellular respiration. They may also trigger immune responses to assist in coping with stressful changes in the environ- ment and climate. Some oils protect the plant from predators, especially microorganisms, and in so doing are essentially antibacterial, antiviral, and antifungal. Some oils protect the plant by repelling harmful insects, while others attract insects or animals that are useful for propagation ( Clark, 2009 ).

Plant oils are highly concentrated, and it is important to respect their power. One drop of oil is the medical equivalent of 1 ounce of the parent plant material used in herbal medicine. Essential oils are chemically diverse and may contain a mixture of more than 100 organic compounds, including esters, alcohols, aldehydes, ketones, phenols, and acids. Each oil may contain more of some compounds than others, which impart to the oil its particular thera- peutic properties. Table 8.1 lists some of the major chemical components and their therapeutic effects.

Hydrosols

Hydrosols , sometimes called plant waters, are extracted from plants during the process of steam distillation. In addition to the essential oil, a conden- sate water is produced that contains all the components of the plant. In essence, a hydrosol is equivalent to a homeopathic version of the essential oil and is diluted in the same manner (see Chapter 9 for information on dilution) . The use of hydrosols in aromatherapy is quite new but growing, since they are gentle, safe, and highly effective in extremely low dilutions ( Schiller et al., 2013 ).

How Essential Oils Work

The sense of smell is an important part of aromatherapy. Inside the human nose is a small cavity called the vomeronasal organ (VNO), which is lined with a cell type that is unlike any other in the human body. The VNO is far less prominent in people than in animals, which depend more heavily on smell for guidance. Pheromones are chemical substances produced by an animal that cause a specific reaction in another, usually of the same species, through smell. The VNO appears to specialize in detecting pheromones without people’s conscious awareness. In other words, people do not “smell” pheromones in the same way they smell freshly baked apple pies or essential oils. The scent, however, is registered at some brain level, and people respond to it emotion- ally and/or physically ( McGuigan, 2007 ).

Chapter 8 • Aromatherapy 137

In addition to the VNO, the nose contains 5 million smell-sensing cells that allow people to consciously register smells. Each cell has 6 to 12 hairlike receptors (cilia) that hang down into the stream of air rushing into the nose. These olfactory receptors are the only sensory pathways that open directly to

TABLE 8.1 Chemical Compounds of Essential Oils and Their Therapeutic Actions

Chemical Compound Therapeutic Action Examples of Oils

Aldehydes Anti-inflammatory, vasodilators, calm

central nervous system

Citronella, melissa, cinnamon bark,

lemongrass, lemon, lime, verbena

Esters Similar to alcohols; antifungal,

anti-inflammatory, antispasmodic; generally safe; low toxicity

Ylang-ylang, neroli, bergamot, lavender,

clary sage, petitgrain, geranium, citronella

Hydrocarbons Terpenes

Antiseptic, bactericidal, antiviral; may be

expectorant, decongestant, stimulant

Bay, verbena, pine, juniper, tea tree

Ketones Calming, sedative, analgesic, promote

wound healing; not for long-term use; never used in pregnancy

Caraway, dill, spearmint, peppermint, jasmine,

rosemary, sage, fennel

Lactones Calming; potentially photocarcinogenic;

triggered by action of light; never use before sun exposure

Bergamot, orange, mandarin, lemon

Oxygenated hydrocarbons

Alcohols

Antiviral, bactericidal, stimulate immune

system; non–skin irritating; generally safe for children and the elderly

Rose, geranium, citronella, rosewood, coriander, euca-

lyptus

Phenols Antiseptic, bactericidal, stimulate immune

system, stimulate central nervous system; very potent; handle with great care, since these can irri- tate the skin and mucous membranes

Thyme, sage, oregano, clove, cinnamon leaf,

ylang-ylang

Sources: Clark ( 2009 ); Schiller et al. ( 2013 ); Schnaubelt ( 2011 ).

138 Unit 3 • Botanical Healing

the brain. The cilia detect scents, and the nerve cells relay this information directly to the limbic system, triggering memories and influencing behavior. The amygdala of the limbic system, which stores and releases emotional memories, is most sensitive to odor or fragrance. Thus, the sense of smell can evoke powerful memories in a split second and change people’s perceptions and behaviors. Odors are powerful memory stimulants even when they are not actually present. Just thinking or talking about a particular odor can unleash many memories. Olfactory stimulation can trigger negative responses such as intense fear or panic, or can trigger positive feelings with increased release of endorphins and neurotransmitters. Odors stimulate the pituitary gland and hypothalamus and thus affect the production of hor- mones that control appetite, insulin production, body temperature, metabo- lism, stress levels, and sex drive. Unlike vision and hearing, the sense of smell is fully functional at birth. Newborns can recognize their mothers by smell, and this sensory response is an important part of bonding. In adult relationships, the sense of smell has a significant role in sensual and sexual attraction ( Krautwurst, 2008 ).

In addition to activating the central nervous system, inhaled oil mole- cules enter the respiratory system. There the molecules attach to oxygen mol- ecules and circulate throughout the body, bringing with them the potential for activating self-healing processes. The equivalent in conventional medicine is the use of inhalers in the treatment of asthma. Essential oils can be inhaled directly or mixed with a carrier oil. Electrical and fan-assisted equipment or an aromatherapy lightbulb ring may be used to scent a room for therapeutic purposes or to simply make the environment more pleasant. Steam inhalers can be used in the treatment of respiratory infections.

Applied externally, essential oils can calm inflamed or irritated skin, soothe sore muscles, decrease muscular tension, and release muscle spasms. Molecules of essential oils are so tiny they are quickly absorbed through the skin and enter the intercellular fluid and the circulatory system, bringing healing nutrients to the cells. Some oils such as basil, tea tree, and thyme encourage the production of white blood cells, while others such as lavender and eucalyptus fight harmful bacteria, viruses, and fungi. Oils may be applied just about anywhere: neck, face, wrists, over the heart, back, arms, legs, and feet. Massage therapists and acupuncturists often use essential oils in their treatments. Benefits are gained not only from the penetration of the oil through the skin but also from inhalation of the vapor and from direct massage of the skin and muscles. Essential oils do not remain in the body but are excreted in urine, feces, perspiration, and exhalation, usually in 3 to 6 hours ( Schiller et al., 2013 ).

A diffuser is a special air pump designed to disburse the oil as an extremely fine vapor into the atmosphere, where it stays suspended for sev- eral hours. Diffusing releases antiviral, antibacterial, and antiseptic properties. Unlike commercial air fresheners, which mask odors, essential oils clean the air by altering the structure of the molecules that create an unpleasant smell. Essential oils help remove dust particles from the air and, when diffused in

Chapter 8 • Aromatherapy 139

the room, can be an effective air filtration system. Diffusers should be used with caution by people with respiratory problems and or allergies, by children, and by pregnant women.

It is also believed that there is a psychological component to the effect of essential oils. Odors associated with either positive or negative emotional feelings and experiences trigger the same feelings when smelled at a later date. For example, a person may smell bus fumes and instantly recall a bus trip taken as a young child. The olfactory nerve is only two synapses away from the amygdala (involved in emotions) and three synapses away from the hippocampus (involved in memory). Thus, both feeling and memories are an almost instantaneous response to certain odors ( Herz, 2009 ).

TREATMENT

Essential oils influence health on physical, mental, and emotional levels. They have the ability to penetrate cell membranes and transport oxygen and nutri- ents to the cell, and many have antiviral, antibacterial, antifungal, and anti- septic properties. This property of oils may be significant in the future as microbes continue to mutate and develop resistance to known medications. Aromatherapy can be used to

• prompt the body and mind to function more efficiently. • decrease and manage stress. • refresh or recharge oneself. • regulate moods, either by energizing or sedating. • aid restful sleep. • act as a first-aid measure. • reduce weight. • boost the immune system. • minimize the discomforts of illness and speed recovery. • refresh a room environment.

The purity and authenticity of essential oils is critical to their effec- tiveness. Oils that are diluted, adulterated, or synthetic should not be used for aromatherapy. Those identified as commercial-grade essential oils are likely to be diluted or adulterated in some way. Some are diluted with chemical carriers and passed on to the consumer as “pure essential oils.” These are often found in bath and cosmetic shops. Those labeled as “infused oils” are also adulterated. “Nature identical” oils are synthetic petrochemical-based products. They have been developed to closely mimic the smell and composition of essential oils. They are not identical, how- ever, and lack many of the healing components of essential oils. Other names for synthetic oils are aroma-chemicals, perfume oils , and fragrance oils . Manufacturers are not restricted in labeling essential oils. In general, those described with terms such as genuine, authentic , or premium are more likely

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to be pure essential oils. Informed consumers read labels carefully and buy from reputable dealers.

Essential oils are quite potent and can irritate the skin, so they should be diluted with a carrier oil before being used on the skin. Carrier oils con- tain vitamins, proteins, and minerals that provide the body with added nutrients. Some carrier oils can be purchased at supermarkets, while oth- ers may be available only at health food stores. Carrier oils include apricot kernel oil, sunflower oil, soy oil, sweet almond oil, grapeseed oil, sesame

BOX 8.1

Blending Oils According to Effects

Soothing oils: Chamomile Uplifting oils: Black pepper, coriander, jasmine, juniper, eucalyptus, peppermint, tea tree Balancing oils: Cypress, lavender Uplifting and soothing oils: Basil, bergamot, frankincense, ginger, neroli, orange, patchouli, sandalwood Uplifting and stimulating oils: Cedarwood, lemon, lemongrass, myrrh, pine, rose, rosemary, ylang-ylang Uplifting and balancing oils: Clary sage, geranium

Examples of Blends Basil, lavender Bergamot, cypress, jasmine Chamomile, lavender Clary sage, lavender, sandalwood Eucalyptus, chamomile, lavender, bergamot Geranium, bergamot, lemon, lavender Ginger, lavender, orange, neroli Jasmine, rose, lemon, black pepper Juniper, bergamot, geranium, frankincense Lemon, tea tree, ylang-ylang Pine, eucalyptus, lavender Patchouli, bergamot, geranium Peppermint, lavender Sandalwood, ylang-ylang, black pepper, neroli

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oil, avocado oil, jojoba, and wheat-germ oil. The fragrance does not have to be intense to be effective. In fact, the more intense the odor, the less pleasant it becomes.

Blending together two or more pure essential oils can create a synergis- tic effect; that is, the blend can be more powerful than the sum of its parts. The interaction of the oils also adds vibrancy to the blend. Essential oils that com- plement each other are combined. For example, the calming effects of laven- der and bergamot or rosemary work well together. Oils that produce opposite effects, such as a soothing oil and a stimulating oil, should not be blended. It is also important that the blend have a pleasing scent. See Box 8.1 for catego- ries of oils to consider when formulating blends. See books on essential oils for amounts of oils to use.

RESEARCH

The research basis for aromatherapy is in its infancy. Much of the research has been performed on animals and isolated tissue cultures. Few trials have been conducted on humans under clinical conditions. Many of the studies are prac- tice based and anecdotal, and little is known at this time about possible inter- actions with conventional medications or treatments. Nurses are conducting much of the aromatherapy research in conventional health care settings. A number of studies are being done in intensive care settings and in the fields of midwifery, palliative care, and geriatric care. Difficulties with research include chemical inconsistencies across laboratories, the impact of culture on odor perception, individual experiences with odors, and gender differences in sen- sitivity to odors.

The following is a small sample of findings of aromatherapy studies:

• An evidence summary by the Joanna Briggs Institute found that aroma- therapy should be considered as an adjunct therapy to antiemetic drug therapy to prevent postoperative nausea and vomiting (Grade A; Moola, 2012 ).

• An evidence summary by the Joanna Briggs Institute found that there is insufficient evidence to recommend aromatherapy for pain manage- ment in patients with cancer ( Woodward, 2011 ).

• An evidence summary by the Joanna Briggs Institute found that aroma- therapy in conjunction with massage may assist in short-term relief of anxiety ( Carstens, 2010 ).

• A systematic review of studies involving aromatherapy for treatment of hypertension found no convincing evidence of effectiveness ( Hur, Lee, Kim, & Ernst, 2012 ).

• In a randomized double-blind clinical trial on the use of lavender, clary sage, and marjoram for women with primary dysmenorrhea, the partici- pants applied the essential oil massage cream to their lower abdomen. The aromatic oil massage significantly reduced the duration of men- strual pain ( Ou, Hsu, Cai, Lin, & Lin, 2012 ).

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• A pilot study examining the impact of inhalation of a rose and lavender blend indicated significant improvement in anxiety and depression lev- els in high-risk postpartum women ( Conrad & Adams, 2012 ).

INTEGRATED NURSING PRACTICE

Worldwide, nurses are increasingly providing aromatherapy in a variety of health care settings. Essential oils can be combined with carrier oils and used for back rubs and foot rubs to help clients relax and decrease their levels of anxiety. Other essential oils can be used as an adjunct to conventional approaches to boost the production of white blood cells and to utilize their antibacterial or antiviral action. Acute-care and long-term care settings often have unpleasant smells in rooms and hallways. Essential oils such as rose- mary, lemon, tangerine, mandarin, and lemongrass can be diffused into the air to alter the structure of the molecules creating the odor, thus refreshing the environment. Diffusion of essential oils can also help boost the client’s immune system, decrease anxiety and stress, aid restful sleep, and speed recovery. Essential oils can be used to enhance sedation, thereby decreasing the need for nighttime medication.

Nurses can teach people a number of things about the use of essen- tial oils. As a general rule, people should purchase essential oils in natu- ral and health food stores rather than stores selling beauty products and perfumes. Oils should be stored in tightly closed dark vials away from heat, light, or dampness. Essential oils should not be ingested, because even modest amounts can be fatal. They must be kept away from chil- dren and pets. Pregnant women, children, and persons with pulmonary disorders, allergies, or epilepsy should consult a knowledgeable health care practitioner or qualified aromatherapist before using essential oils. Some oils can trigger bronchial spasms, so persons with asthma should consult their primary health care provider before using oils. Oils other than lavender or tea tree oil must always be diluted before being applied to the skin. Individuals who have sensitive skin or allergies should take extra care in massaging the oils into the skin or inhaling the essential oil aromas. People should not rub their eyes if they have any essential oil on their hands. Several oils are photosensitive or phototoxic and can cause severe sunburn if the skin is exposed to the sun within 6 hours after application. These oils include clove, bergamot, angelica, verbena, bitter and sweet orange, lemon, lime, and mandarin. Certain oils can be highly toxic, so their use should be limited to qualified aromatherapists. These oils include boldo leaf, calamus, yellow camphor, horseradish, rue, sas- safras, savin, tansy, wintergreen, wormseed, and wormwood.

Professional aromatherapists use up to 50 oils. Most people can meet their home needs with just 10: chamomile, clove, eucalyptus, geranium, lav- ender, lemon, peppermint, rosemary, tea tree, and thyme. Box 8.2 describes helpful oils you can encourage people to have available at home.

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BOX 8.2

Helpful Oils to Have at Home

Oil Use

Basil Decrease sinus congestion; soothe GI tract, aid digestion; decrease headache; decrease anxiety; decrease menstrual cramps Bergamot Decrease anxiety, decrease depression; urinary antiseptic; acne, disinfectant for wounds, abscesses, boils Cedarwood Decrease respiratory congestion and coughs, expectorant; for pain swelling of arthritis; antifungal for skin rashes Chamomile Soothe muscle aches, sprains, swollen joints; GI antispasmodic; rub on abdomen for colic, indigestion, gas; decrease anxiety,

stress-related headaches; decrease insomnia; can be used with children

Clary sage Induce sleep; increase sense of well-being; massage or warm compress for menstrual cramps; do not use in pregnancy

until onset of labor Coriander Improve digestion, decrease colic, decrease diarrhea; decrease muscle aches and stiffness in joints; decrease mental fatigue,

and increase memory and mental function Cypress Massage or cold compress for rheumatic aches; bruising or varicose veins; respiratory antispasmodic (put couple of drops

on handkerchief or tissue and inhale deeply), decrease coughs, asthma, bronchitis

Elemi Boost immune system; cystitis; speed bone healing (massage in prior to casting); speed healing of cuts, sores, wounds; cool

inflamed skin; sedative Eucalyptus Feels cool to skin and warm to muscles; decrease fever; relieve pain; anti-inflammatory; antiseptic, antiviral, and expectorant for

respiratory system in steam inhalation; boost immune system Frankincense Bronchodilatory, acts on mucus, enabling sputum to be expelled; infected sores; deepen breathing to induce calmness;

incense creates a state conducive to prayer or meditation Geranium Antibacterial; insecticidal; antidepressant; improve yeast infections; first aid on minor cuts and burns Ginger Help ward off colds; calm upset stomach, decrease nausea; soothe sprains, muscle spasms Green apple Reduce headache severity; decrease anxiety; aid in weight reduction program; reduce symptoms of claustrophobia Jasmine Uplifting and stimulating, antidepressant; massage abdomen and lower back for menstrual cramps Juniper Calming, decrease stress; diuretic; muscle aches and pains

(continued )

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TRY THIS Soothing Potions

Rosewater

Instead of using soap, try splashing your face with rosewater, a simple infusion from rose petals containing some of the flowers’ essential oils. Rose oil has mild antiseptic and

Lavender Calming, sedative, for insomnia; massage around temples for headache; inhale to speed recovery from colds, flu; massage

chest to decrease congestion; heal burns Lemongrass Sedative; skin antiseptic for acne Marjoram Insomnia, decrease tension; muscle and joint pain; inhale to clear sinuses and clear congestion; massage abdomen for

menstrual cramps Neroli Gentle sedative for insomnia, panic attacks; massage abdomen for irritable bowel syndrome Orange General tonic; decrease anxiety; GI antispasmodic for colic and indigestion; massage abdomen for constipation; can be used

with children Peppermint Increase alertness; GI antispasmodic for colic and indigestion; massage on temples for headache; decongestant for colds, flu Petitgrain Useful for acne and oily skin; decreases muscle spasms; gentle sedative Rose Antidepressant; increase alertness; compress for eyestrain, headaches; use in massage for PMS Rosemary Stimulating; increase circulation to skin; compress on swollen joints; decrease respiratory congestion; antifungal, antibacterial;

deodorize the air Sandalwood Calm and cool body; decrease inflammation; drops on handkerchief for sore throat, congestion; in bath water for

cystitis; improve chapped dry skin; increase sense of peace in meditation or prayer

Tea tree First-aid kit in a bottle; antifungal, good for athlete’s foot; soothe insect bites, stings, cuts, wounds; in bath for yeast

infection; drops on handkerchief for coughs, congestion Vetiver Stimulate production of red blood cells; increase circulation; induce restful sleep; decrease tension Ylang-ylang Soothe CNS, decrease depression, increase euphoric mood; decrease blood pressure; regulate respiration; calm heart

palpitations

Sources: Harding ( 2013 ); Schiller et al. (2013); Tucker (2012).

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anti-inflammatory action, and it can reduce redness in the skin by constricting the tiny blood vessels. It is also used in aromatherapy to calm the nerves and elevate mood. You can buy rosewater in any natural food store, but you can also make your own. Put a handful of fresh rose petals into a small saucepan, add enough water to cover the petals completely, simmer for 15 minutes, and then remove the pan from the heat. When the mixture is completely cooled, strain away the petals and transfer your rosewater to a clean glass bottle.

Adult Cold Care

2 drops eucalyptus

5 drops geranium

3 drops peppermint

5 drops rosemary

Mix oils together. Use in any of the following ways:

• Put several drops in a diffuser. • Put 2 drops on a tissue and breathe in the aroma. • Put 4 drops in a bath. • Add 8 drops to 2 tablespoons of carrier oil and massage the chest, back, neck,

forehead, nose, and cheekbones.

Natural Sleep Aid

• Put 2 drops of lavender on your pillowcase. • Combine 3 drops chamomile, 4 drops lavender, 3 drops orange, and 5 ounces of

water. Using a spray bottle, spray linens and room air before sleeping.

Body Scrub

• 2 parts small-grain salt or sugar • 1 part oil (olive, coconut, almond, safflower, vegetable, baby) • 5 drops of preferred essential oil • Use on dry skin to exfoliate. Rinse well.

Source: Fitzsimmons & Bousquet ( 1998 ); Hoffman & Fox ( 2006 ); Schiller et al. ( 2013 ).

Considering the Evidence

Y.-L. Lee, B. Wu, H. W. H. Tsang, A. Y. Leung, and W. M. Cheung, 2011, A systematic review on the anxiolytic effects of aromatherapy in people with anxiety symptoms, Journal of Alternative and Complementary Medicine, 17: 101–108.

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What Was the Type of Research? Systematic review of randomized clinical control trials (RCTs)

What Was the Purpose of the Research? To synthesize, appraise, and evaluate relevant RCTs concerning the anxiolytic effects of aromatherapy as an intervention in persons living with anxiety symptoms identified through valid inventories

How Was the Research Done? The authors used a systematic review methodology to examine RCTs relevant to the purpose of this research. They employed a comprehensive search strategy using selected keywords and nine databases and the Handbook of Psychiatry to identify randomized clinical controlled trials focusing on anxiety disorders, anxiety, anxious symptom or anxiolytic effects, aromatherapy aroma, or essential oil. The researchers independently identified RCTs that used aromatherapy as the intervention to decrease anxiety symptoms that were measured by a valid tool. Fifty-two studies were considered relevant for evaluation. Ultimately, 16 RCTs met the inclusion criteria. A total of 25,377 subjects were included in the 16 studies, the majority of whom were female, and ages ranged from 18 to 90. Types of aromatherapies included aromatherapy massage, inhalation, tablet intake, and footbath. Duration of exposure to aromatherapy massage was from 20 minutes to 1 hour, and duration of inhalation ranged from 5 minutes to 60 minutes. Lavender was the most commonly used essential oil used in the studies. All the studies included participants experiencing anxiety secondary to another primary diagnosis. None of the subjects had a primary diagnosis of anxiety disorder.

What Were the Findings of the Research? Fourteen studies suggested positive findings related to the anxiolytic effects of aroma- therapy. The subjects in the treatment group exposed to aromatherapy experienced better outcomes in reducing anxiety than the control group. Seven studies suggested that the benefits of aromatherapy were superior to those of conventional therapy or a placebo. One study reported that an oral lavender oil capsule was as effective as some medications used for generalized anxiety disorders.

What Additional Questions Might I Have? What would be the effect of aromatherapy in combination with other complementary and alternative therapies? Could aromatherapy have an effect on the quality of life in persons living with other health challenges? Does aromatherapy have long-term effects on decreasing anxiety? Are there side effects associated with the oral intake of lavender oil? What is the effectiveness of aromatherapy in persons with a primary diagnosis of anxiety disorder? Are there additional studies currently being done to investigate the effect of anxiolytic effects of aromatherapy to strengthen the evidence?

How Can I Use This Study? This systematic review has considerable clinical value for nurses caring for persons living with anxiety. Nurses should recognize that aromatherapy may be an appropriate, inexpensive, and safe intervention for enhancing the quality of life for those individuals experiencing anxiety.

Source: Contributed by Dolores M. Huffman, RN, PhD.

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References

Carstens, J. (2010). Complementary ther- apies (aromatherapy and herbal med- icine): Clinician information. Joanna Briggs Institute Evidence Summary. Retrieved from http://connect .jbiconnectplus.org/ViewDocument .aspx?0=3771

Clark, S. (2009). Essential Chemistry for Safe Aromatherapy (2nd ed.). Edinburgh, UK: Churchill Livingstone.

Cline, M., Taylor, J. E., Flores, J., Bracken, S., McCall, S., & Ceremuga, T. E. (2008). Investigation of the anxiolytic effects of linalool, a lavender extract, in the male Sprague-Dawley rat. American Association of Nurse Anesthetists Journal , 76(1): 47–52.

Conrad, P., & Adams, C. (2012). The effects of clinical aromatherapy for anxiety and depression in the high risk postpartum woman: A pilot study. Complementary Therapies in Clinical Practice, 18: 164–168. doi: 10.1016/ j.ctcp.2012.05.002

Harding, J. (2013). The Essential Guide to Oils. London, UK: Watkins.

Herz, R. S. (2009). Aromatherapy facts and fictions: A scientific analysis of olfactory effects on mood, physiology and behav- ior. International Journal of Neuroscience. doi: 10.1080/00207450802333953

Hoffman, R., & Fox, B. (2006). Alternative Cures That Really Work . New York, NY: Rodale.

Hur, M.-H., Lee, M. S., Kim, C., & Ernst, E. (2012). Aromatherapy for treat- ment of hypertension: A systematic review. Journal of Evaluation in Clinical Practice, 18: 37–41. doi: 10.1111/j.1365-2753.2010.01521.x

Krautwurst, D. (2008). Human olfactory receptor families and their odorants. Chemistry & Biodiversity , 5(6): 842–852.

McGuigan, M. (2007). Hypothesis: Do homeopathic medicines exert their action in humans and animals via the vomeronasal system? Homeopathy , 96(2): 113–119.

Moola, S. (2012). Postoperative nausea and vomiting: Complementary Therapies. Joanna Briggs Institute Evidence Sum- mary. Retrieved from http://connect .jbiconnectplus.org/ViewDocument .aspx?0=7166

Ou, M.-C., Hsu, T.-F., Lai, A. C., Lin, Y.-T., & Lin, C.-C. (2012). Pain relief assessment by aromatic essential oil massage on outpatients with primary dysmenorrhea: A randomized, double- blind clinical trail. Obstetrics and Gyn- aecology Research, 38: 817–822. doi: 10.1111/j.1447-0756.2011.018002.x

Schiller, D., Schiller, C., & Schiller, J. (2013). The Aromatherapy Encyclopedia . Laguna Beach, CA: Basic Health.

Schnaubelt, K. (2011). The Healing Intelli- gence of Essential Oils. Rochester, VT: Healing Arts Press.

Thomas, D. V. (2002). Aromatherapy: Mythical, magical, or medicinal? Holis- tic Nursing Practice , 17(1): 8–16.

Tucker, L. (2012). Introductory Guide to Aromatherapy (2nd ed.). London, UK: EMS.

Woodard, E. (2011). Cancer patients: Pain management by complementary ther- apies. Joanna Briggs Institute Evidence Summary. Retrieved from http://connect .jbiconnectplus.org/ViewDocument .aspx?0=6654

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Resources

Aromatherapy Registration Council 5940 SW Hood Ave. Portland, OR 97039 503.244.0726 www.aromatherapycouncil.org

Institute of Integrative Aromatherapy P.O. Box 19241 Boulder, CO 80308 303.545.2002 www.aroma-rn.com

International Federation of Aromatherapists 20A The Mall Ealing, London W5 2PJ 44(0).567.2243 www.ifaroma.org

National Association for Holistic Aromatherapy (NAHA) P.O. Box 1868 Banner Elk, NC 28604 828.898.6161 www.naha.org

Smell and Taste Treatment and Research Foundation 845 N. Michigan Ave., Suite 990W Chicago, IL 60611 312.649.5829 www.smellandtaste.org

9 Homeopathy

Miracles do not happen in contradiction of nature, but in contradiction to what we

know about nature.

Saint Augustine

The term homeopathy is derived from the Greek words omoios , meaning “similar,” and pathos , meaning “feeling.” It is a self-healing system, assisted by small doses of remedies or medicines, that is useful in a variety of acute and chronic disor- ders. The practice of homeopathy in the United States has increased tremendously since the 1980s, corresponding to the increase in other forms of alternative medicine. Homeopathic medicine is practiced worldwide, especially in Europe, Latin America, and Asia.

In the United States, the homeopathic drug market has grown into a multimillion-dollar industry. Most of these reme- dies are not regulated by the U.S. Food and Drug Administration (FDA) and are available as over-the-counter medications.

BACKGROUND

As a therapeutic system, homeopathy is approximately two hun- dred years old. It was developed by Samuel Hahnemann (1755– 1843), a German physician and chemist. Homeopathy spread through most of Europe and to the United States, Russia, and Latin America in the 1830s. During epidemics of cholera, typhus, and scarlet fever, homeopathy was significantly more effective than the conventional medical approaches of the times. In 1869, the American Institute of Homeopathy opened free dispensaries for the poor and voted to admit female physicians, unheard of in conventional medicine. By the 1890s, 15% of U.S. physicians were using some homeopathic remedies in their practice, were being

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educated in the 22 homeopathic medical schools, and were practicing in more than 100 homeopathic hospitals ( Feingold, 2008 ).

During and after the Civil War, the practice of medicine began to change with technical achievements such as anesthesia, antisepsis, surgery, microbi- ology, vaccines, and antibiotics. State legislatures began to license physicians and to accredit medical schools. The American Medical Association (AMA) invited homeopaths to become members in exchange for licensing, seeking to create a monopoly against lay healers, midwives, and herbalists. When homeopaths chose not to join forces, the AMA began to persecute homeopa- thy and, in 1914, proposed uniform standards of medical education. The AMA also assumed the power of accreditation, using it to phase out homeopathic colleges. Between the 1920s and 1970s, homeopathic education in the United States was almost nonexistent ( Wauters, 2007 ).

PREPARATION

About half the homeopaths in the United States are physicians. The others are licensed health care practitioners such as nurse practitioners, dentists, naturo- pathic physicians, chiropractors, acupuncturists, and veterinarians. Nonlicensed homeopathic practitioners can “counsel” people, but they cannot state or imply that they can diagnose or treat illnesses. The Council for Homeopathic Certifica- tion administers the certification process, which involves a specified number of hours of training, 3 years of clinical practice, and written and oral examinations. Certification gives one the right to place the designation DHt after one’s name.

CONCEPTS

Law of Similars

Hahnemann proposed the use of the law of similars, which claims that a nat- ural substance that produces a given symptom in a healthy person cures it in a sick person. The substance whose symptom-picture most closely resembles the illness being treated is the one most likely to initiate a curative response for that person—hence the name homeopathy —“similar feeling.”

If taken in large amounts, these natural compounds will produce symp- toms of disease. In the doses used by homeopaths, however, these remedies stimulate a person’s self-healing capacity. As Andrew Weil stated, “The dif- ference between a poison and a medicine is the dose” ( Frye, 1997 , p. 846 ). An example is the use of ipecac, which in large doses causes severe nausea and vomiting. People who are experiencing nausea and vomiting, however, can use a remedy made with ipecac to cure those same symptoms ( Waisse, 2012 ).

Law of Infinitesimals

Natural healing compounds are specially prepared for homeopathic use through a process of serial dilution. The compound is first dissolved in either water or a water/alcohol mixture and is called the “mother tincture.”

Chapter 9 • Homeopathy 151

One drop of the tincture is then mixed with 9 drops of water/alcohol to form a 1:10 dilution, and this dilution process is repeated many times depending on the potency being prepared. At each step of the dilution, the vial is vigorously shaken, a process called succussion, which is an essential step. Thus, the nota- tion 6X on a remedy means that the procedure (diluting and succussing) has been repeated sequentially six times. The concentration of the active substance is then one part in 10 raised to the sixth power (10 6 ), or one part per million. Dilutions of 30X and 200X are common. The homeopathic belief is that the more the substance is diluted, the more potent it becomes as a remedy.

The remedies are diluted beyond the point at which any molecules of the substance can theoretically still be found in the solution. This paradox, that the remedy becomes more potent through dilution, is the reason many biomedical scientists reject homeopathic medicine. Just as the mechanisms of many con- ventional drugs are not fully understood, it is not presently known how homeo- pathic remedies work, but a number of theories have been proposed.

A remedy may be like a hologram. No matter how many times a sub- stance is diluted, a smaller but complete essence of the substance remains. Modern chaos theory supports the observation that major changes occur in living organisms when bodily substances are activated only slightly. The basic assumption of chaos theory is that minute changes can have huge effects. Advances in quantum physics have led some scientists to suggest that the imprinting of electromagnetic energy in the remedies interacts with the body on some level. Gas discharge visualization technology may provide an elec- tromagnetic probe into the properties of homeopathic remedies in the future. Researchers in physical chemistry have proposed the memory-of-water the- ory in which the structure of the water/alcohol solution is altered during the process of dilution and retains its new structure even after the substance is no longer present. It seems likely that remedies work through a bioenergetic or subatomic mechanism that is not yet capable of being understood. The situa- tion may be likened to any number of advances in the understanding of energy such as radio, television, microwave ovens, and cordless telephones that previously were virtually unimaginable ( Griffith, 2012 ; Waisse, 2012 ).

In the 1920s and 1930s, Dr. Bach, a bacteriologist, a pathologist, a homeo- pathic physician, and an intuitive healer, discovered flower essences. He believed that emotions such as anger, hate, or fear negatively affect the immune system, leading to stress, pain, and illness. He experimented with a number of flowers, eventually creating a treatment system involving 38 dif- ferent types of wildflowers. Flowers are placed in a clear glass bowl filled with purified water and placed in direct sunlight, which transfers the energy of the blossom into the water—a process called infusion. Bach’s flower essences are diluted but not as much as homeopathic remedies. The remedies are placed under the tongue or in a glass of liquid four times a day. They are usually safe for even infants and the elderly and are thought to contribute to physical, emotional, mental, and spiritual healing. The best known remedy is the Bach Rescue Remedy, which is used to calm people (and pets) in any stressful situation ( Balch, 2010 ).

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VIEW OF HEALTH AND ILLNESS

Homeopathy is a method for treating the sick rather than a set of hypotheses about the nature of health and illness. However, the underlying assumption is that a vital force—known as qi or prana in other traditions—exists. It is necessary to have adequate nutrition, exercise, rest, good hygiene, and a healthy environment to establish and to maintain homeostasis. In other words, health is the ability of people to adapt their equilibrium in response to internal and external change. Illness is primarily a disturbance of the vital force manifesting as symptoms of distress. Vital force or life energy is the ultimate origin of health and illness alike, ending only with the death of the person ( Griffith, 2012 ).

Symptoms of illness represent a body’s attempts to heal itself. Thus, homeopathy views symptoms as an adaptive reaction that is the best possible response that can be made in the present circumstances. For example, a cough is the body’s attempt to clear the bronchi; inflammation is the body’s effort to wall off and burn out invading foreign bodies; and fever is the body’s way of creating an internal environment that is less conducive to bac- terial or viral growth. Given this perspective, the therapeutic approach is to aid the body’s efforts to adapt to stress or infection. Thus, for someone with a high fever, homeopaths may recommend belladonna, which increases the natural healing response of body heat. The law of similars is a stimulation of immune and defense responses leading to spontaneous resolution of symp- toms as the illness is conquered. In like manner, two of the few conventional therapies that seek to stimulate the body’s own healing reaction, immuniza- tion and allergy treatment, have the homeopathic law of similars as their basis. Other applications in conventional medicine include the use of radia- tion in the treatment of cancer and Ritalin in the treatment of children with hyperactivity disorders. The majority of interventions in biomedicine, how- ever, attempt to oppose symptoms by exerting a greater and opposite force. Medicines are designed to “cure” by suppressing symptoms, such as when aspirin is used in an effort to control or limit fevers. The danger is that, over time, suppressive treatments may actually strengthen disease processes instead of resolving them ( Schmidt, 2012 ).

DIAGNOSTIC METHODS

Homeopathic diagnosis is holistic and detailed; the initial assessment may last several hours. Practitioners assess the whole person, examining every aspect of physical, emotional, and mental life. A multitude of factors are con- sidered, such as nutritional status, emotional imbalance, and environmental stress. It is believed that no part can be isolated from the whole person. The homeopathic interview itself is a powerful healing experience because clients are encouraged to tell their story in its entirety. They are encouraged to speak for as long a time as possible. This process of sharing pain and suffering begins the healing process. During the interview, the practitioner observes

Chapter 9 • Homeopathy 153

everything about the person, including posture, dress, facial expression, tone of voice, rate of speech, and so forth. The physical exam is a head-to-toe assessment with the inclusion of laboratory work as needed to establish a diagnosis. Answers to questions are elicited in an attempt to fully understand the significance of symptoms:

• Subjective symptoms such as pain, vertigo, fatigue, or anger • Localization of symptoms such as one sided, wandering, radiating,

or diffuse • Factors that modify the symptoms, making them better or worse, such

as time of day, hot or cold, weather, diet, or emotional state • Quality of symptoms such as burning, aching, throbbing • Rate of onset or resolution of the symptoms, such as sudden or gradual • Symptoms that appear simultaneously or in sequence

Symptoms are classified into three categories—the general physical symptoms, the local symptoms, and the mental and emotional symptoms. General physical symptoms include such factors as sleep, appetite, energy, tem- perature, or generalized body pain. Local symptoms occur in particular parts of the body, such as swelling in the right elbow or pain in the left leg. Included in local symptoms are those related to a specific organ function, such as short- ness of breath or palpitations. Mental and emotional symptoms include anxiety, irritability, anger, tearfulness, isolation, or suspiciousness. This composite picture of the person is far more important than any isolated laboratory find- ings or abstract disease category in formulating the diagnosis. Homeopathic practitioners do not hesitate to refer to biomedical specialists for conventional drugs or surgery.

TREATMENT

Homeopathy is not a complete system of medicine in itself and should be used in conjunction with biomedicine. As in other complementary and alternative practices, the initial question is always, Who is the person? rather than, What is the disease? This focus ensures an individualized approach to treatment. Each person with the same presenting complaint may be treated with different rem- edies depending on the totality of physical, mental, and emotional symptoms. A person with a sore throat may be prescribed one of six or seven common remedies for sore throats, depending on whether the pain is worse on the right or left side, what time of day it is worse, how thirst and appetite are affected, and the individual’s emotional state ( Feingold, 2008 ).

Homeopathic practitioners see the purpose of treatment as stimulating the individual’s self-healing powers. The science and the art of homeopathy is to find the remedy with the ability to mimic most closely the sick person’s pattern of symptoms. Practitioners use only one remedy at a time, since administering different remedies for different symptoms makes it difficult to know which remedy was effective. Not only are the smallest possible doses used but typically only one dose is given, which allows time for the remedy

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to complete its action without further interference. If necessary, a dose may be repeated or another remedy may be tried. A temporary worsening of the symptoms may occur after receiving the remedy, which is usually mild and short-lived and may be an indication that the correct remedy was chosen ( Waisse, 2012 ).

Homeopathy is used to treat both acute and chronic health problems as well as for health promotion. It cannot cure conditions resulting from structural, long-term organic changes such as cirrhosis, diabetes, chronic obstructive lung disease, advanced neurological diseases, or cancer. In some of these cases, homeopathy can palliate the symptoms and increase the client’s comfort level. Traumatic injuries affect nearly everyone in similar ways, and  thus the remedies are fairly standard. Epidemic infectious diseases also tend to affect most victims in the same way, and individuals are usually treated with the same remedy. Common infectious illnesses such as urinary tract infections, respiratory infections, and ear infections demonstrate more individual symptoms and require more individualization in selecting the remedy. Chronic illness such as ulcerative colitis, rheumatoid arthritis, asthma, and skin disorders are considered to be constitutional. Thus, these disorders require the most skillful assessment, individualized prescription, and follow-up ( Schmidt, 2012 ; Schneider, Schneider, Hanisch, & van Haselen, 2008 ).

The Homeopathic Pharmacopoeia of the United States ( Borneman & Foxman, 1989 ), listing more than 2,000 remedies, is the official standard for preparation and prescription. Most remedies come from plants used in traditional herbal medicine. A few remedies come from animal sources, and others, from natu- rally occurring chemical compounds. Box 9.1 lists examples of remedies. Some, such as mercury and belladonna, would be poisonous in large doses but are safe in the superdilute homeopathic doses. These remedies rank among the safest medicines available ( Waisse, 2012 ). Homeopathic medicines found in most health food stores are called combination medicines or formulas because they contain between three and eight different homeopathic medi- cines mixed together. The various manufacturers choose the medicines most commonly prescribed for specific symptoms and assume that one of them will help cure the ailment of each consumer. Professional homeopaths believe that the remedy individually chosen for the person tends to work more often and more effectively than these combinations.

RESEARCH

As in other areas of medical research, the two questions to be answered are, How does it work? and How well does it work? Many researchers are study- ing the physics of how homeopathic remedies work. It currently seems likely that remedies work through a bioenergetic or subatomic mechanism that is not yet understood or measurable. Research in the areas of quantum physics, physical chemistry, and biochemistry may someday be able to explain how the remedies work.

Chapter 9 • Homeopathy 155

One of the difficulties in using the standard randomized, placebo- controlled paradigm for homeopathic remedies is that the treatments are individualized. Unlike with biomedicine, each person with the illness is likely to be prescribed a different remedy based on holistic assessment. In addition, there is no uniform prescribing standard for homeopaths.

A small sampling of studies included the following findings:

• A systematic review of homeopathy for eczema found that the three clinical trails that met the inclusion criteria failed to show that homeopa- thy is an effective treatment for this skin disorder ( Ernst, 2012 ).

• A study of EEG changes in response to olfactory stimulation with two remedies showed some positive correlation, indicating the need for additional neuroimaging research on the physiologic effects of homeo- pathic remedies ( Bell, Howerter, Jackson, Brooks, & Schwartz, 2012 ).

BOX 9.1

Examples of Homeopathic Remedies

Plant Mineral Animal

Herbs: comfrey, eyebright, Metals: copper, gold, Venoms: jellyfish, insects, mullein, yellow dock lead, tin, zinc spiders, mollusks, crustaceans, fish, snakes, amphibians Foods and spices: Salts: calcium sulfate, Secretions: ambergris, cayenne, garlic, sodium chloride, musk, cuttlefish ink mustard, onion potassium carbonate Fragrances, resins, Acids: hydrochloric, Milks residues: amber, nitric, phosphoric, petroleum, charcoal sulfuric creosote Mushrooms, lichens, Elemental substances: Hormones mosses carbon, hydrogen, iodine, phosphorus, sulfur Constituents of earth’s Glandular and tissue crust: silica, aluminum extracts oxide, ores, rocks, lavas, mineral waters Disease products: vaccines, abscesses, tuberculosis, gonorrhea, syphilis

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• An observational, nonrandomized, multicenter study of children with migraine headaches found that homeopathic treatment decreased the frequency, severity, and duration of migraine attacks ( Danno, Colas, Masson, & Bordet, 2013 ).

• A review of current evidence found that homeopathy was not an effec- tive treatment for generalized anxiety or for specific anxiety disorders ( Sarris et al., 2012).

INTEGRATED NURSING PRACTICE

Nurses, like homeopathic practitioners, emphasize listening to clients’ stories of their lives. It is within the context of people’s lives that nurses identify pat- terns of response to illnesses and disorders and formulate nursing diagnoses. Nursing diagnoses and outcome criteria focus attention on adaptations that may help people live healthier lifestyles. The study of mental health nursing in the basic educational program teaches the value of listening and attending to people’s pain as an intervention to help them begin the process of healing. These principles are common to both nursing and homeopathy, illustrating, once again, the broad base of nursing practice. Some nurse practitioners, valu- ing the contributions of homeopathy to well-being, continue their education and achieve licensure to practice homeopathic medicine. Nurses educated in Western approaches are more likely to suppress symptoms in an attempt to “cure” the disease. In many situations, it may be more beneficial to follow the homeopathic approach and view symptoms as the body’s attempt to heal itself. Clients may improve more quickly when non-life-threatening symp- toms are supported rather than suppressed, such as low- to moderate-grade fevers or productive coughs.

People who are interested in homeopathic remedies can find low- potency remedies in health food stores. Higher potency remedies are obtained from homeopathic pharmaceutical companies under the direction of experi- enced homeopathic prescribers. Because remedies are inactivated by direct sunlight and heat, nurses should teach people to store the preparations in a dark, dry place, away from other strong-smelling substances. When taking a remedy, patients should have nothing by mouth for at least 30 minutes before and after the dose. Many homeopaths discourage the use of coffee, mint, cam- phor, and other strongly aromatic substances while undergoing treatment, since such substances may reverse the effects of the remedy. Camphor is a component in chest rubs as well as in many cosmetics, skin creams, and lip balms. If the remedy is in the form of a pellet, it should be held under the tongue and allowed to dissolve slowly. If the remedy is a liquid, it should be held in the mouth for 1 to 2 minutes before swallowing.

Prescription medications, especially those given for potentially life- threatening disorders such as asthma, should not be stopped abruptly when homeopathic care is begun. As the person improves, however, a downward titration of the biomedical prescription may be needed. Acupuncture and

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chiropractic medicine should not be started at the same time as homeopathic remedies, but if already instituted, may be continued ( Griffith, 2012 ).

A number of homeopathic remedies can be used to speed recovery and prevent recurrences of acute conditions such as colds, stomachaches, coughs, and headaches. Although many remedies are used for conditions that subside on their own, remedies can dramatically speed recovery and often prevent recurrences. Because homeopathic medicines are considerably safer than conventional drugs, it often makes sense to use them first and then consider using conventional drugs if the homeopathic remedies work too slowly or not at all. Individuals should read all the information on the label to select the right remedy. If the label states, for example, that the remedy is best used when the symptoms appear suddenly, then that remedy is not likely to be effective for a condition that emerged almost unnoticed over several days. Nurses can teach clients the following three guidelines for the use of homeopathic remedies:

1. The more the better. The more the symptoms match that of the remedy, the more likely it will work.

2. The less the better. The more dilute the remedy, the more powerful it is. 3. It’s working if you feel better within 24 hours. If not, you may have the

wrong remedy and may need a different remedy or may need to see a health care practitioner.

Many people keep homeopathic remedies on hand and ready to use. See “Try This: Top 10 Remedies” for the most popular remedies that help with the majority of common physical problems and emotional difficulties.

TRY THIS

Top 10 Remedies

Bryonia (wild hops): Used for coughs that are worsened by simple breathing; head- aches that are increased by bending over, walking, or even moving the eyes; consti- pation with dry, hard stools.

Allium cepa (onion): Used for colds or respiratory allergies in which symptoms resemble the reaction of a person exposed to the mist produced when an onion is cut: watery eyes, clear nasal discharge, and sneezes, all of which are aggravated by exposure to heat.

Pulsatilla (windflower): Need is based on the type of person, rather than a specific ailment. Helpful for people who are highly emotional, weepy, impressionable, easily influenced, fearful of abandonment, and worried about what others think of them. May also be used for digestive disorders, allergies, earaches, headaches, insomnia, and premenstrual syndrome.

Ignatia (St. Ignatius bean): Used by persons experiencing anxiety or grief. (continued)

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Arsenicum album (arsenic): Used for many conditions, especially when symptoms are worse after midnight, when burning symptoms are predominant, when great thirst occurs, or when the person is high strung and restless.

Belladonna (deadly nightshade): Used for fever or inflammation that begins rapidly, with a red or flushed appearance; the person is hypersensitive to touch or light.

Gelsemium (yellow jessamine): Used for classic flu symptoms accompanied by lack of thirst. Helpful for headaches in the back part of the head.

Nux vomica (poison nut): Useful after overdosing with food or drink, indigestion, constipation, and headaches that are worse at night and on waking.

Aconitum (monkshood): Used for colds, flu, coughs, and sore throats with rapid onset.

Rhus toxicodendron (poison ivy): Helpful for arthritis syndromes, flu, sprains and strains, and sore throats; used by people who feel pain on initial motion that eases with continued motion and who have symptoms that worsen in cold or wet weather.

Sources: Feingold ( 2008 ); Griffith ( 2012 ); Wauters ( 2007 ).

Considering the Evidence

S. Kassab, M. Cummings, S. Berkovitz, R. van Haselen, & P. Fisher, 2009, Homeopathic medicines for adverse effects of cancer treatments, Cochrane Database of Systematic Reviews, Apr. 15 (2): CD004845. doi: 10.1002/14651858.CD004845.pub

TRY THIS

Pet Remedies

Mercurius solubilis: Inflamed gums; swollen nasal bones and a greenish thick discharge

Podophyllum: Diarrhea with gushy feces containing mucus

Baryta carb: Diarrhea in puppies and young dogs

Arsenicum album or allium cepa: Respiratory symptoms with thin, watery nasal and ocular discharge

Sulfur: Red, itchy skin

Lycopodium or thallium acetas: Hair loss secondary to skin disorders

Source: Kachnic ( 2012 ); Macleod ( 2012 ); Madrewar & Glencross ( 2011 ).

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What Was the Type of Research? Systematic review of randomized clinical control trials (RCTs)

What Was the Purpose of the Research? To synthesize, appraise, and evaluate relevant RCTs concerning the effectiveness and safety of homeopathic medicines used to prevent or treat adverse effects of cancer treatments

How Was the Research Done? The authors used a systematic review methodology to examine published and unpub- lished RCTs relevant to the purpose of this research. They employed a comprehensive search strategy using selected keywords and extensive electronic databases, gray litera- ture sources, and conference proceedings to identify randomized clinical controlled trials focusing on homeopathic medicines and prevention of adverse effects in persons receiv- ing cancer treatments. Reviewers independently identified the studies, appraised, and extracted the data. Eight RCTs meeting the established criteria were included in this review, which included a total of 664 participants. Three studies focused on the adverse effects associated with radiotherapy, three studies concentrated on the adverse effects of chemotherapy, and two studies investigated menopausal symptoms associated with breast cancer treatment.

What Were the Findings of the Research? Preliminary data suggest that topical calendula for prophylaxis of acute dermatitis during radiotherapy may be effective. In addition, TRAUMEEL S mouthwash may be effective in the treatment of chemotherapy-induced stomatitis. However, the reviewers indicated that the studies need to be replicated to strengthen the evidence. There is no convincing evi- dence to date regarding the use of homeopathy medicines to treat menopausal symp- toms in women living with breast cancer.

What Additional Questions Might I Have? Are there any adverse or harmful effects associated with topical calendula and TRAUMEEL S mouthwash use in persons living with cancer and receiving cancer treatments? Are there additional studies currently being done to investigate the effect of homeopathic medicines in persons living with cancer to strengthen the evidence?

How Can I Use This Study? This study has considerable clinical value for nurses caring for persons living with cancer. The findings from this review should help inform nursing practice in supporting and edu- cating patients concerning the use of topical calendula and TRAUMEEL S mouthwash to decrease the incidence of adverse effects associated with cancer treatments such as radia- tion therapy and chemotherapy. Cancer therapy can be a very stressful time, and dimin- ishing the untoward effects of some treatments may serve to enhance the quality of life for persons living with cancer.

Source: Contributed by Dolores M. Huffman, RN, PhD

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References

Balch, P. A. (2012). Prescription for Nutri- tional Healing (5th ed.). New York, NY: Avery.

Bell, I. R., Howerter, A., Jackson, N., Brooks, A. J., & Schwartz, G. E. (2012). Multiweek resting EEG cordance change patterns from repeated olfac- tory activation with two constitution- ally salient homeopathic remedies in healthy young adults. Journal of Alter- native and Complementary Medicine, 18: 445–453. doi: 10.1089/acm.2011.0931

Borneman, J. P., & Foxman, E. L. (1989). Homeopathic Pharmacopoeia of the United States . Southeastern, PA: Homeopathic Pharmacopoeia.

Danno, K., Colas, A., Masson, J. L., & Bordet, M. F. (2013). Homeopathic treatment of migraine in children. Journal of Alternative and Complemen- tary Medicine, 19(2): 119–123. doi: 10.1089/acm.2011.0931

Ernst, E. (2012). Homeopathy for eczema: A systematic review of controlled clin- ical trials. British Journal of Dermatology, 166: 1170–1172. doi: 10.1111.j.1365-2133. 2012.10994.x

Feingold, E. (2008). Homeopathy, Herbal Remedies, & Nutritional Supplements . Albany, NY: Whitston.

Frye, J. (1997). Homeopathy in office practice. Primary Care , 24(4): 845–864.

Griffith, C. (2012). The Practical Handbook of Homeopathy . London, UK: Watkins.

Kachnic, J. (2012). Your Dog’s Golden Years. Denver, CO: Wallingford Vale.

Macleod, G. (2012). Dogs: Homoeopathic Remedies. London, UK: Rider.

Madrewar, B. P., & Glencross, M. (2011). Therapeutics of Veterinary Homeopathy & Repertory. New Delhi, India: B. Jain.

Sarris, J., Moyaln, S., Camfield, D. A., Pase, M. P., Mischoulon, D., Berk, M., .  . . Schweiter, I. (2012). Complemen- tary medicine, exercise, meditation, diet, and lifestyle modification for anxiety disorders: A review of current evidence. Evidence-Based Complemen- tary and Alternative Medicine. doi: 10.1155/2012/809653

Schmidt. J. M. (2012). The biopsychosocial model and its potential for a new theory of homeopathy. Homeopathy, 101: 121–128. doi:10.1016/j.homp2012.02.001

Schneider, C., Schneider, B., Hanisch, J., & van Haselen. (2008). The role of a homeopathic preparation compared with conventional therapy in the treat- ment of injuries: An observational cohort study. Complementary Therapies in Medicine , 16: 22–27.

Waisse, S. (2012). The science of high dilutions in historical context. Home- opathy, 101: 129–137. doi: 10.1016/ j.homp.2012.01.001

Wauters, A. (2007). The Homeopathy Bible . New York, NY: Sterling.

Resources

American Institute of Homeopathy 101 S. Whiting St., Suite 315 Alexandria, VA 22304 888.445.9988 www.homeopathyusa.org

Australian Homoeopathic Association P.O. Box 7108 Toowomba South, QLD 4350 07.4636.5081 www.homeopathyoz.org

Chapter 9 • Homeopathy 161

European Council for Classical Homeopathy School House Market Place Kenninghall, Norfolk NR16 2AH 44.1953.888163 www.homeopathy-ecch.org

Hahnemann Center for Heilkunst 9-4338 Innes Rd. Ottawa ON K4A 3W3 613.692.6950 www.homeopathy.com

Homeopathic Educational Services 2124B Kittredge St. Berkeley, CA 94704 501.649.0294 www.homeopathic.com

The Academy of Veterinary Homeopathy P.O. Box 232282 Leucadia, CA 92023-2282 866.652.1590 www.theavh.org

162

10 Naturopathy

It is more important to know what sort of person has a disease than to know what

sort of disease a person has.

Hippocrates

Naturopathic medicine is not only a system of medicine but also a way of life with emphasis on client responsibility, cli-ent education, health maintenance, and disease prevention. It may be the model health system of the future with the movement toward healthy lifestyles, healthy diets, and preventive health care.

BACKGROUND

The basic precepts of naturopathy are similar to those of ancient medical systems throughout the world. Naturopathy can trace its philosophical roots to the Hippocratic school of medicine around 400 b.c. Hippocrates had a holistic approach to clients and instructed his students to prescribe only wholesome treatments and to avoid causing harm or hurt. Furthermore, Hippocrates thought that the entire universe followed natural laws, and the role of the physician was to understand and support nature’s own cures ( Pizzorno & Murray, 2012 ).

Naturopathic medicine grew out of the 19th-century medical systems of the United States and Europe. Dr. John Scheel of New York City coined the term naturopathy in 1895, although it was Benedict Lust who formalized it in 1902 as both a system of medi- cine and a way of life. By the early 1900s, more than 20 naturo- pathic schools of medicine were operating in the United States. In the 1920s and 1930s, naturopathic journals encouraged a diet high in fiber and low in red meat, the same type of diet promoted by the National Institutes of Health and the National Cancer Institute in the 1990s. With the development of antibiotics and vaccines in the

Chapter 10 • Naturopathy 163

1940s and 1950s, the popularity of naturopathy began to decline as people began to rely on these medical breakthroughs. The 1970s saw a renewal in the importance of nutrition, healthy lifestyles, and environmental cleanup programs. This interest continued to grow into what is now the U.S. interest in complementary and alternative medicine ( Pizzorno & Murray, 2012 ).

PREPARATION

For naturopathic medicine to become recognized as a legitimate health care system required that accredited schools be established and credible research be conducted. Currently there are seven schools in the United States and Canada: Bastyr University in Kenmore, Washington; National College of Naturopathic Medicine in Portland, Oregon; the Southwest College of Naturopathic Medi- cine and Health Science in Tempe, Arizona; University of Bridgeport College of Naturopathic Medicine in Bridgeport, Connecticut; National University of Health Sciences in Lombard, Illinois; Canadian College of Naturopathic Medi- cine in North York, Ontario; and Boucher Institute of Naturopathic Medicine in New Westminster, British Columbia. The Council on Naturopathic Medical Education is the accrediting agency for programs in the United States and Canada. Schools in Australia include Southern Cross University, the Univer- sity of Western Sydney, and Victoria University.

In the United States, state law determines the scope of naturopathic practice, since there is no national licensure for naturopathy. The laws typi- cally allow standard diagnostic procedures, a range of therapies, vaccinations, and limited prescriptive rights. Some states allow the practice of natural child- birth. In states that do not license naturopathic doctors, anyone can call herself or himself a naturopathic doctor after completing some correspondence courses. These individuals may give seminars and advise people on healthy lifestyles, but they are not permitted to diagnose illness or to prescribe treatment. When seeking a naturopathic doctor as a primary care physician, people must ask for verification of graduation from an accredited naturopathic medical school.

The education of naturopathic physicians is extensive and similar to con- ventional medical education. Four years of medical school follow a college degree in a biological science. The first two years of medical school include courses in anatomy, cell biology, nutrition, physiology, pathology, neurosciences, histol- ogy, pharmacology, biostatistics, epidemiology, and public health as well as alternative therapies. Some differences are significant. For example, conventional medical students may have only 4 course hours in nutritional education, while naturopathic medical students have 138 course hours in nutrition. The third and fourth years of medical school are oriented toward clinical experience in diagno- sis and treatment. The profession has redefined itself in terms of current advances in health care and the evolution of scientific knowledge. Today’s naturopathic doctor is an extensively educated primary care physician able to utilize a broad range of conventional and alternative therapies.

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CONCEPTS

Naturopathic medicine holds the same view of human physiology, bodily functions, and disease processes as does conventional medicine. Although many alternative health care professions are defined by the therapies used, naturopathy is defined by basic concepts.

Healing Power of Nature

It is believed that the body innately knows how to maintain health and heal itself. Natural laws of life operate inside and outside the body, and the physi- cian’s job is to support and restore them by using techniques and medicines that are in harmony with the natural processes. These natural methods are geared to strengthen the body’s own healing ability. Faith, hope, and beliefs may be the most significant aspects of any treatment. Many studies have documented the ability of the mind to affect the process of disease, either positively or nega- tively. Physicians consider issues such as, What does it mean, for this person, to be in balance? and What healing powers are available for this person?

First Do No Harm

Iatrogenic illness, an inadvertent complication as a result of medical treatment—either traditional or alternative—is a major health problem in the United States. Adverse drug reactions send thousands of people to hospital emergency departments, and hospital-acquired ( nosocomial ) infections have become a major problem in the United States.

As Hippocrates said, “Above all else, do no

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