The definition of CAM developed above is almost equivalent to defining it as everything except conventional medicine. This creates a challenge to categorize and classify countless therapies and systems of healing in a way that makes sense and provides an intellectual handle on a large and disparate field.
We can broadly separate all of CAM into three main classifications: world medicine systems, other comprehensive systems of medicine that are not culturally based, and individual therapies (Figure 23.1). Unlike individual therapies, a system of medicine provides treatment for a whole spectrum of symptoms, illnesses, or diseases. It is generally a complete system of medicine with its own philosophy or science of health and disease, and its own diagnostic approach. A world medicine system evolves from the belief system and cultural practices of a society. Examples of world medicine are traditional Chinese medicine and Ayurvedic medicine, which originates from India. Other systems of medicine, such as homeopathy, may evolve from a philosophical construct of health and disease, but is not part of a world cultural tradition.
Mindful - - Spiritual
Nutriceutical — Stimulation based
Movement-based — Mechanical/manipulative Energy-based
Alternative and complementary medicine J_
Systems of medicine
Homeopathy Osteopathy Herbal medicine
Chiropractic Naturopathy Mind-body healing Prayer — Meditation
Native American healing and other indigenous systems
World medicine systems
■Traditional Chinese medicine
Ayurvedic medicine ^
Figure 23.1 Organization of alternative and complementary therapies.
Individual therapies treat a narrower range of conditions with a specific type of intervention; but do not by themselves provide a model of health and illness. Hypnosis, massage, vitamin therapy, and relaxation techniques are examples of individual therapies.
To further classify individual therapies it is useful to think of them as falling into one or more of seven functional categories of treatment:
6. mechanical or manipulative;
These are shown in Table 23.1 with examples in each category. Mindful therapies utilize the mind to produce changes in physical and emotional status. Meditation, hypnosis, and yoga fall into this category. Spiritual therapies imply a letting go of the mind, giving up control to a higher power as with prayer. Energy-based techniques rely on a construct of a vital energy or energy field that exists in living systems. When the flow of energy is out of balance or obstructed, disease can occur. The goal of energy-based treatments is to restore the optimal energy balance to achieve health. Therapeutic touch and acupuncture use this concept as their foundation. Note that yoga can be considered as mindful, spiritual, energy-based, and movement-based. Acupuncture is a stimulation-based technique, but it is part of a world medicine system, traditional Chinese medicine, which uses the concept of a vital energy (Qi). Aromatherapy is also a stimulation-based approach to healing. It consists of inhaled essences of plants or topically applied essential oils. The absorption of micromolecules through the skin or respiratory mucosa is believed to produce favorable chemical changes; thus aromatherapy may also be a form of nutriceutical treatment. Vitamins, herbs, and diets are also examples of nutriceutical therapies which involve the absorption and assimilation of substances into the body to produce a change in state that is favorable to the living system.
Movement-based therapies include dance therapy, T'ai chi ch'uan, exercise, yoga, and other techniques that rely on movement and posture to promote health. Many of these movement-based therapies also rely on concepts of energy medicine as part of their foundation. Mechanical or manipulative therapies include chiropractic, osteo-pathic, cranio-sacral therapy, and massage. These approaches usually apply external forces to correct a mechanical problem of the spine, bones, muscle, or other soft tissues.
Organizing the universe of CAM into these seven functional categories helps the clinician plan a treatment strategy. When a patient is not having success achieving pain control, and has tried several therapies within one or two categories, suggesting choices from a different category makes sense. When faced with a vulnerable patient, certain types of treatment may pose challenges that are best avoided. The abuse victim may have difficulty with mindful and spiritual therapies that require a process of letting go. They also may not tolerate the vigorous physical contact inherent in some of the manipulative therapies. If they are seeking complementary treatment, the clinician should discuss these issues and may recommend less threatening types of treatment from the nutriceutical or movement-based groups.
In the following sections we will describe selected complementary and alternative treatments that span the three main groups (world medicine systems, other complete systems, and individual therapies) and most of the seven functional categories of alternative treatments. We will also describe CAM treatments most commonly used in pain clinics in the United States.
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