Philosophy of naturopathic medicine

INTRODUCTION
This chapter examines the philosophical foundation of naturopathic medicine and its modern applications. Unlike most other health care systems, naturopathy is not identified by any particular therapy or modalities. In fact, there is a wide variety of therapeutic styles and modalities found within the naturopathic community (see Table 3.1 ). For example, there are still practitioners who adhere to the strict “nature cure” tradition and focus only on diet, “detoxification”, lifestyle modification, and hydrotherapy. There are also those who specialize in homeopathy, acupuncture or natural childbirth. At the other end of the spectrum are found naturopathic physicians who extensively use natural medicinal substances to manipulate the body’s biochemistry and physiology. Finally, there is the majority who practice an eclectic naturopathic practice that includes a little of everything.
From its inception 100 years ago, naturopathic medicine has been an eclectic system of health care. This has allowed it to adopt many of this century’s more effective elements of natural and alternative medicine, as well as to adopt conventional medicine’s basic and clinical sciences and diagnostics (see Ch. 2 for further discussion). Through all of this eclecticism, it has always identified the Latin expression vis medicatrix naturae (the healing power of nature) as its philosophical linchpin.

TABLE 3-1 — Naturopathic modalities
Naturopathic physicians are trained to use a number of diagnostic and treatment techniques. These modalities include:
• Diagnosis – all of the conventional clinical laboratory, physical diagnosis, and imaging (i.e. X-ray, etc.) techniques, as well as holistic evaluation techniques
• Counseling – lifestyle, nutritional and psychological
• Natural medicines– nutritional supplements (i.e. all food constituents), botanical medicine, and homeopathy
• Physical medicine– hydrotherapy, naturopathic manipulative therapy, physiotherapy modalities, exercise therapy and acupuncture
• Family practice – natural childbirth, minor surgery, natural hormones, biologicals, and natural antibiotics
However, the expression vis medicatrix naturae, by itself, does not provide a clear picture of naturopathic medical philosophy, or an understanding of the practice of naturopathic medicine in all of its varied forms. With the profession’s history of eclecticism, no two practitioners will treat any individual patient exactly alike. While this has its advantages (i.e. individualization of each patient’s care, more therapeutic options, etc.), it also makes it difficult to perceive the profession’s philosophic cohesiveness. Another major disadvantage of this eclecticism is the difficulty in developing consistent practice standards.
To attempt to solve this problem, the modern profession has articulated a general statement of naturopathic principles expanding on vis medicatrix naturae (see Table 3.2 ). However, this statement of principles is probably still not adequate to address the issues that concern modern students of naturopathic medicine or other professionals. Therefore, in order to gain a more in-depth understanding of naturopathic medicine, it is necessary to discuss medical philosophy in general.
MEDICAL PHILOSOPHY
The issues fundamental to medical philosophy have changed little since naturopathy first appeared as a distinct profession at the end of the 19th century. What has changed is the level of understanding of the biological process and the language of science. Most people who study the early writers on naturopathic medical philosophy quickly get lost in the archaic language and arguments used to justify the theories. This chapter translates these concepts and issues into modern terms.
Vitalism vs. mechanism
Historically, there have been two main medical philosophies, those of vitalism and mechanism. Their origins can be traced to the Hippocratic writings of ancient Greece. Throughout history, the line separating these two schools of thought has not always been clear, but their philosophical perspectives have generally been in opposition. The conflicting goals and philosophical foundations of these two concepts remain relevant as the modern practices of conventional and alternative physicians come into conflict. As will be seen, the foundations of naturopathic medical philosophy are found in vitalism. However, naturopathy also recognizes the practical value of the mechanistic approach to health care.
Mechanism
Up to the early part of the 20th century, there was considerable debate over the issue of vitalism vs. mechanism in the field of biology. The mechanists, or materialists, maintained that the phenomenon of life could be explained exclusively as the product of a complex series of chemical and physical reactions. They denied the possibility that the animate had any special quality that distinguished it from the inanimate. It was their contention that the only difference between life and non-life is the degree of complexity of the system.
Mechanism has several other distinctive characteristics. Its most obvious is that it is reductionistic. In fact, “reductionism” is often used as a synonym of mechanism. Mechanistic science is also characterized by an emphasis

TABLE 3-2 — The principles of naturopathic medicine
• The healing power of nature: vis medicatrix naturae
Nature acts powerfully through healing mechanisms in the body and mind to maintain and restore health. Naturopathic physicians work to restore and support these inherent healing systems when they have broken down, by using methods, medicines, and techniques that are in harmony with natural processes.
• First do no harm:primum non nocere
Naturopathic physicians prefer non-invasive treatments that minimize the risks of harmful side-effects. They are trained to know which patients they can treat safely, and which ones they need to refer to other health care practitioners.
• Find the cause:tolle causam
Every illness has an underlying cause, often in aspects of the lifestyle, diet or habits of the individual. A naturopathic physician is trained to find and remove the underlying cause of a disease.
• Doctor as teacher: docere
A principal objective of naturopathic medicine is to educate the patient and emphasize self-responsibility for health. Naturopathic physicians also recognize and employ the therapeutic potential of the doctor–patient relationship.
• Treat the whole person
Health or disease comes from a complex interaction of physical, emotional, dietary, genetic, environmental, lifestyle, and other factors. Naturopathic physicians treat the whole person, taking these factors into account.
• Preventive medicine
The naturopathic approach to health care can prevent minor illnesses from developing into more serious or chronic degenerative diseases. Patients are taught the principles with which to live a healthy life; by following these principles they can prevent major illnesses.
on linear causality. Without its emphasis on reductionism and linear causality, Western science and medicine would probably have not been so successful. As the 20th century advanced, each new discovery in biological and medical science reinforced the arguments for mechanism, until by the middle of the 20th century, the biology community had almost exclusively embraced the philosophy of mechanism.
Mechanism is the philosophical foundation of biomedical science and conventional medicine. Mechanistic medicine identifies disease and its accompanying signs and symptoms as simply the result of a disruption of normal chemical reactions and physical activities. Such disruptions are caused by the direct interference in these reactions and activities of a “pathogenic agent”. (For the purposes of this discussion, the general expression “patho-genic agent” refers to any known or unknown etiological agent or condition. Examples include microbial agents, autotoxins, genetic defects, environmental toxins, non-end-product metabolites, and physical and emotional stress and trauma.) A living organism, then, is simply a very complex machine which, due to external agents and “wear and tear”, breaks down. Because the signs and symptoms of disease are thought to be due only to these mechanical disruptions and interference with reactions, they are considered to be completely destructive phenomena and are therefore to be eliminated. Disappearance of the signs and symptoms indicates that the pathogenic agent and its resulting disease have been eradicated, or at least controlled. The goals of mechanistic medicine tend to be the quick removal of the signs, symptoms, and the pathogenic agent.
Mechanistic medicine is being practiced in cases where the intention of the therapy is to intervene in the perceived mechanism of the disease and/or relieve the symptoms. Examples would be the use of antihistamines to relieve rhinitis, vitamin B6 to help PMS, surgery and emergency care for traumatic injuries, coronary bypass surgery, anti-inflammatory agents in systemic lupus erythematosus (SLE), or insulin in juvenile onset diabetes. Mechanism is also being used when an identified pathogenic agent is directly attacked or eliminated. Instances of this would be the use of antibiotics or the isolation of a patient from a particular allergen. Clearly, mechanistic medicine can be very effective in achieving its goals. In the face of modern medical technology, it is easy to see how this philosophy came to dominate biology, medicine, and the attention of the public.
However, the unsolved problems of mechanistic medicine – particularly those of chronic degenerative disease, authoritarianism which alienates patients from responsibility for their own health, and the increasing cost of health care – suggest that there are limits to the mechanistic perspective and explain why vitalism has not disappeared and is, in fact, in resurgence.
Vitalism
The philosophy of vitalism is based on the concept that life is too well organized to be explained simply as a complex assemblage of chemical and physical reactions (i.e. a living system is more than just the sum of its parts). This is in contrast to the mechanist’s contention that “the only difference between life and non-life is the degree of complexity”. Throughout the 19th century, the debate between vitalism and mechanism was mostly carried on by biologists whose interests were mainly in the study of the organism’s specific cellular activities, such as morphological development. These activities were argued to be “vital” and, therefore, not explainable by mechanistic science. The tendency was to infer a metaphysical quality to this concept. As can be imagined, these earlier debates lurched from one specific argument to the next as modern biology unraveled the secrets of cellular metabolism. Fortunately, the debate has now shifted back to the relevant and holistic general concepts.
While modern vitalism is inherently holistic in its view and has an emphasis on circularity as its causality (i.e. feedback loops), there is no conflict with the findings of biomedical science. Eventually, all of the individual chemical and physical reactions that are found in the processes of life will probably be identified. What is significant is not the individual reaction, but the fact that they are all coordinated to such a degree as to produce the special activities of a living organism. An organism’s unique complexity – as demonstrated by its ability to grow and develop, respond to stimuli, reproduce, and repair itself – requires a level of organization and coordination that suggests a distinct quality that is not readily explained by mechanism. This organization and coordination has been identified as “homeostasis” by physiology. All organisms, up to the point of death, are attempting to return to this ideal state when injured or ill. As there is no inanimate counterpart to this level of complexity and organization, this is the most dramatic general argument in favor of vitalism.
A less dramatic argument used to support the vitalistic perspective is the “problem of entropy”. Entropy is the tendency of any closed system to find equilibrium, i.e. the state of least organization. In other words, systems tend to run down and become less complex over time. In defiance of this universal rule, life, up until the point of death, consistently creates more complex systems out of simple ones. To do this, life actively pursues external matter and energy to incorporate into itself, while at the same time selectively eliminating by-products from its utilization of this matter and energy.
When the problem of entropy is examined on the molecular level, the same individual chemical processes and elements may be found in both animate and inanimate systems. In the inanimate system, however, there is a constant move toward a state of chemical equilibrium. This type of system cannot maintain an unstable chemical state and always seeks stabilization. Even after the addition of external exciting energy, the system will return to the simplest, least reactive state possible. The animate system is virtually the opposite. It is continuously in a state of dynamic chemical instability, actively seeking energy to maintain this instability, and consistently moving to more complex and organized states (and back again). It is only at the onset of death that an animate system begins to move towards equilibrium.
The third general argument in favor of a vitalistic view of life is evolution. For evolution to exist as a force in nature, generations of living organisms have to survive long enough to grow, reproduce and then evolve. In order for this survival to take place, the organisms’ homeostatic and repair processes must be consistently directed towards maintaining a state of balance with the external environment (i.e. health). Any organisms that did not behave biochemically and physiologically in this manner would have died and not evolved. Thus the phenomenon of evolution, as the action of countless living organisms over eons, multiplies life’s anti-entropic quality and is incompatible with a mechanistic view of living systems.
These easily observable examples of life’s “special quality” suggest an “organizing force” that goes beyond what is possible from mere chemistry. This quality that makes life unique should not be mistaken as a metaphysical concept, although is not intended to argue here for or against such concepts. The point is only that vitalism is a medical philosophy based on observable scientific phenomena. Unfortunately, a definitive definition of this quality (in the old literature called the “vital force”, defense mechanism, or simply “Nature”) will have to wait for more research.
At this point in the discussion, not many mechanistic practitioners would have reason to be uncomfortable, as the ideas proposed are relatively non-controversial and just follow generally accepted physiological principles. Interestingly, many of these practitioners probably have personal belief systems that are quite compatible with this stage of the vitalistic argument. However, the conflict becomes evident upon examination of the premises upon which the practice of vitalistic medicine is based. What truly separates vitalism from mechanism, and makes it useful as a medical philosophy, is its perspective on disease and the associated symptoms.
Meaning of disease
Vitalism maintains that the pathogenic agent does not directly cause the symptoms accompanying disease; rather, they are the result of the organism’s intrinsic response or reaction to the agent and the organism’s attempt to defend and heal itself. Symptoms, then, are part of a constructive phenomenon that is the best “choice” the organism can make, given the circumstances at any particular point in time.
These symptoms can be further described as arising from two situations. The first and most common situation is when they are from a “healing reaction”, which is the organism’s concerted and organized attempt to defend and heal itself. These healing reactions produce what can be called “benign symptoms”. Examples include fever and inflammation in infections, almost any reaction of the immune system, and many of the symptoms of chronic disease.
This interpretation of symptoms is generally ignored by mechanism. Instead, it views them as the result of a destructive process and focuses on intervening by relieving the symptom or manipulating the pathological mechanism. Mechanistic medicine is therefore most often working contrary to homeostasis and the organism’s healing attempt (in fact, this is usually its intent). When this therapeutic approach is effective, vitalists call the result a “suppression” (see Table 3.3 ). This approach to health care is so pervasive that most people, lay and professional alike, today routinely suppress mild fevers with antipyretics.
In contrast, vitalism considers these symptoms to be the product of a constructive phenomenon and therapeutically stimulates and encourages this directed healing process. Rather than simply trying to eliminate a pathogenic agent, as mechanistic therapy might, vitalism focuses more on augmenting the organism’s resistance to that agent. That is not to say that vitalists object to removing the agent, only that it should be done in the context of simultaneously increasing resistance (in other words, decreasing susceptibility). The importance of this approach becomes evident when one recognizes that disease is only possible when both a pathogenic agent and a susceptibility to that agent are present.
Healing reactions can take several forms, as shown in Table 3.4 . In the first type, an organism’s response to a

TABLE 3-3 — Cure, suppression and palliation
When symptoms improve following treatment (regardless of the therapeutic system), it is for one of three reasons:
• Cure. The symptoms go away and the patient’s overall health improves. In this case the treatment can be discontinued and the patient continues to do well.
• Suppression. The symptoms go away but overall the patient becomes less healthy. The treatment can be discontinued and the symptoms will stay away, but the patient feels worse generally (i.e. deceased sense of well-being, energy or moods), or new, often more limiting, symptoms eventually develop (e.g. suppressed eczema leading to asthma).
• Palliation. The symptoms are improved but only as long as the treatment is continued. At best, palliation is something that is done while a curative treatment is given time to work. In and of itself, palliation will never lead to a cure, but unfortunately, continued palliation may eventually lead to suppression.
TABLE 3-4 — The four types of healing reactions
Reaction
Description
Acute, asymptomatic
Organism easily defends itself
“Healing crisis”
Relative strength of pathogenic agent and organism similar; symptoms of body defending itself apparent
Vigorous but unsuccessful
Pathogenic agent stronger than organism; death if no intervention
Chronic, mildly symptomatic
Healing reaction feeble, but adequate to maintain life; progressive degeneration
pathogenic agent does not produce symptoms. When it is capable of easily defending itself from the agent, no symptoms will be perceivable. This is a common homeostatic process and is demonstrated when a potential pathogen, such as beta-hemolytic streptococcus, is cultured from a healthy person’s throat. However, when the organism is more susceptible or the relative strength of the pathogenic agent is greater, a threshold is reached and symptoms become perceivable. Successful healing reactions of this type would include vigorous acute diseases that quickly resolve. The early naturopaths would have called these acute reactions “healing crises”. As the susceptibility of the organism increases relative to the strength of the pathogenic agent, there is a greater likelihood that the healing attempt will not be successful. When such a reaction is unsuccessful but vigorous, death may result, unless there is timely application of vitalistic or mechanistic therapy. Examples of this situation might be acute bacterial meningitis or cholera.
When the healing attempt is feeble and therefore ineffective, it usually goes into the “chronic disease” stage of the reaction. Vitalists observe that suppression seems to increase the likelihood that the reaction will be forced to go into such a chronic stage. In this situation the reaction is “smoldering”, and most often the organism cannot overcome the pathogenic agent unassisted. It just “holds its own”, and if the organism’s general health decreases over the years, the reaction gradually degenerates, producing symptoms that become less benign as it moves to an end-stage pathology. If the organism can be therapeutically stimulated to produce a more vigorous healing reaction, it can often successfully complete the original healing attempt. This augmented reaction is another example of a naturopathic healing crisis and would also be called an “aggravation” by the vitalists who practice homeopathic medicine.
Intervening in the mechanism of disease by relieving symptoms does little to stimulate or encourage the healing response; in fact it usually actually inhibits the healing response. In contrast, vitalistic therapies can be very effective in helping these healing reactions, because their goals are precisely the same as those of the organism. Thus, it is thought that vitalistic medicine works because, by honoring this process and thereby strengthening the whole organism, it encourages a more effective healing effort. Ideally, the organism is then able to accelerate and complete its reaction against the pathogenic agent, leading to the permanent disappearance of the symptoms as it returns to a state of health.
It would be naive to say that every stage of the healing reaction is positive and in the best interest of the organism, or that no symptoms should be palliated. The modern vitalist acknowledges that intervention is sometimes necessary. On the other hand, it is important to note that routine intervention can encourage its own worst-case scenarios. When mechanistic therapies successfully suppress an organism’s chosen healing reaction, a less effective and less desirable response is often produced. Therefore, when suppression occurs, it can lead to a more complicated medical situation. Consequently, the very practice of mechanistic medicine tends to reinforce its practitioner’s conviction that intervention is usually necessary. It should be noted, however, that not all intervention leads to suppression. It happens less often when the pathogenic agent can be readily eliminated, such as in non-recurring acute bacterial infections, or when relatively non-invasive therapies are used, such as natural medicines.
The second type of symptom-producing situation occurs when the organism produces symptoms in response to an organic lesion that arises from the direct pathological influence of a pathogenic agent. These can be called “morbid symptoms” and examples would include symptoms from the mass of an invasive tumor, shortness of breath from emphysema, and pain of an injury or MI. It should be mentioned that even these symptoms are the result of the organism’s overall effort to maintain homeostasis; benign symptoms are also often present. In addition, a morbid symptom is not necessarily produced for a negative reason. For instance, pain is valuable as an indication of tissue damage. As can be seen, many, if not most, of these situations involve “end-stage” pathology. Here mechanistic therapies can be very positive when the goals of the therapy do not conflict with those of the organism.
There are instances when invasive intervention will probably be required to save “life and limb”. These include such conditions as birth and genetic defects, serious traumatic injuries, crisis situations, overwhelming infections, and many malignancies. Unfortunately, conventional intervention does not guarantee a successful outcome either. Even in these situations, however, the effectiveness of vitalistic and natural therapy should not be underestimated, and their concurrent use will certainly augment any mechanistic intervention.
Although the concept of benign and morbid symptoms can be a useful tool to help understand the healing and disease process, in many situations it may not be possible to categorize the type of symptoms produced. A rough rule of thumb, however, would be that virtually all symptoms accompanying “reversible” or functional pathology are benign. On the other hand, many of the symptoms associated with traumatic injury and end-stage pathology would be morbid symptoms.
Changing society
After this discussion of vitalism’s perspective on disease, the question that comes to mind is: “If most health problems are likely to respond to vitalistic medicine, then why is mechanism dominant?” The best answer is probably found in examination of the general attitudes held by society during the Industrial Age just ending. Mechanism came into dominance during this period because it neatly fit into the Industrial Age’s world-view. This is the “man conquers nature” view that holds humanity as above and separate from the world in which it lives. It follows that nature is simply a resource that technology will eventually subdue or subjugate and put into order. Although this perspective is still very strong in Western society, there has been a dramatic change within the last 30 years.
Attitudes are now shifting in favor of the ecological integration of humanity into the environment. This “new” world-view holds that humanity is part of an orderly nature and that to ignore this creates situations that eventually become problems. Most ecological disasters are excellent examples of the results of the old view. In addition, the new view contends that if an effort is made to understand how nature functions and an attempt is made to work within that understanding, humanity’s needs can be more efficiently met.
Mechanistic medicine, as part of the “old” world-view, generally sees disease as something to conquer and put into order. Vitalistic medicine, on the other hand, looks at the order that is already present and attempts to integrate its therapy into that orderly process. As a result, vitalism is becoming increasingly popular as society shifts from the old to the new world-view.
The belief systems of many mechanistic practitioners recognize this order. However, due to education and peer pressure, these personal beliefs are rarely translated into clinical practice. The mechanistic view is still relatively pervasive in society, and because mechanism is convenient (e.g. taking aspirin for a headache), vitalistic practitioners can generally shift their perspective and successfully use mechanistic therapy (although their therapeutic goals may be different). On the other hand, since mechanists dispute the premises upon which vitalistic medicine is based, they generally have great difficulty when attempting to practice or research a vitalistic therapy and frequently cannot demonstrate its efficacy.
Scientific medicine
While mechanism and vitalism represent opposing perspectives, the systems of medicine that represent these philosophies can be successfully tested and examined with the scientific method.* That is not to say that the philosophy of vitalism has been unquestionably proven – only that the validity of vitalistic interventions can be scientifically demonstrated. If a therapy can be proven effective, then that implies the accuracy of the philosophy upon which it is based. Unfortunately, very few of the vast resources of the 20th century biomedical community have been directed toward investigating vitalistic medicine.
Conventional medicine, as the dominant health care system and a representative of mechanism, has claimed for itself the title of “scientific medicine”. However, it is inherently no more or less scientific than vitalistic medicine. A system is scientific only when it has met the criteria of the scientific method. This method requires the collection of data through observation and experimentation, and the formulation and testing of hypotheses. Non-prejudicial science can effectively study any system, but the researcher must understand the system’s particular paradigm. Experiments on a vitalistic therapy based on a reductionistic and mechanistic model are going to be less than satisfactory.
The criteria of the scientific method can be met by vitalistic medicine, but only when the researchers recognize that it cannot be studied as though it is reductionistic or based on a simplistic model of linear causality. When the experimental model acknowledges the complexity of a living system in a social context (i.e. holism and circularity), vitalistic medicine proves to be both verifiable and reproducible, and thus scientific. Unfortunately, due to conventional medicine’s current political and economic dominance, it is in the position to dictate (through economic and publication control) that research, and therefore the scientific method, will primarily be applied to itself. The result is that most conventional practitioners dismiss vitalistic medicine, along with all alternatives, as unscientific.
This is unfortunate because most vitalistic physicians also have extensive training in mechanistic and/or conventional medicine. Generally, they are capable of practicing mechanistically, and do so to greater or lesser degrees. The conflict between the practitioners of these different systems is very often due to a lack of constructive dialog. This can be attributed to two general causes: the first is simply that each system defines the world of “correct” medicine in terms of its own principles; the second is the issue of who controls the economic and political power.
NATUROPATHIC PHILOSOPHY
Historically, naturopathy is a vitalistic system of medicine. However, over the last 100 years it has also incorporated a number of therapies that can function mechanistically. What makes them acceptable, given naturopathic medicine’s vitalistic foundation, is that they are natural therapies. Natural medicines and therapies, when properly used, generally have low invasiveness and there is little evidence that they cause suppression or side-effects. When used mechanistically, they allow some intervention while still allowing the organism’s healing abilities the opportunity to continue unopposed, especially when used to support the body’s own healing processes.
Vis medicatrix naturae
Naturopathic physicians assert that all true healing is a result of vis medicatrix naturae (the healing power of nature). Unfortunately, some people in the field of alternative medicine (including some naturopathic physicians and students) have mistakenly translocated this concept to the therapy. These practitioners tend to operate as though this “healing power” is an intrinsic property of the natural therapy or medicinal substance itself. In contrast, vitalism and naturopathic medicine have always understood that the “healing power of nature” is an inherent property of the living organism. Vis medicatrix naturae is the living organism’s “desire” and ability to heal itself.
The application of this principle in practice is, of course, dependent upon the patient’s needs. Ideally, it involves only the use of therapies that support the organism and encourage its intrinsic healing process to work more effectively. It also avoids the use of medicines and procedures that interfere with natural functions or have harmful side-effects. Natural medicines and therapies are therefore preferred, since, when used properly and in appropriate circumstances, they are the least harmful, least invasive, and best able to work in harmony with the natural healing process.
Since the total organism is involved in the healing attempt, the most effective approach to diagnosis and treatment is to consider the whole person. In addition to physical and laboratory findings, important consideration is given to the patient’s attitude, psychological and spiritual state, social circumstances, lifestyle, diet, heredity, and environment. Careful attention to each person’s unique individuality and susceptibility to disease is critical to the proper evaluation and treatment of any health problem.
Naturopathic physicians contend that most disease is the direct result of the ignorance and violation of what would be traditionally called “natural living laws”. These general lifestyle (including diet) rules are based on the concept that there is an environment (both internal and external) that optimizes the health of an organism. Analysis of the lifestyles of Paleolithic and healthy primitive and modern cultures gave naturopathic physicians and their progenitors many clues as to what a healthy lifestyle should include.
Throughout most of modern history, biomedical science has focused primarily on researching the sick. Recently it has finally begun to evaluate what makes for a healthy lifestyle. To no-one’s surprise, this lifestyle looks like the same one advocated by naturopaths for the last 100 years. A healthy lifestyle could be generalized to include: the consumption of natural unrefined foods; getting adequate amounts of exercise and rest; living a moderately paced lifestyle; having constructive and creative attitudes; avoiding toxins and polluted environments; and the maintaining of proper elimination. During illness, it is also important to control these areas in order to remove as many unnecessary stresses as possible and to optimize the chances that the organism’s healing attempt will be successful. Therefore, patient education and responsibility, lifestyle modification and preventive medicine are fundamental to naturopathic practice.
While the practice of naturopathic medicine is grounded in vis medicatrix naturae, it also recognizes that intervention in the disease process is sometimes efficacious and, at times, absolutely necessary. Naturopathic physicians treat patients using a wide variety of therapeutic modalities. Some of these are vitalistic and some mechanistic. It is the goal of the therapy that ultimately determines which approach is utilized. Naturopathic physicians have a long-standing tradition of integrating the best aspects of traditional, alternative, and conventional medicine in the interest of the patient. As appropriate, patients are referred to other health care practitioners. Whenever possible, every effort is made to use all treatment techniques in a manner that is harmonious with the naturopathic philosophy.
Natural medicines and therapies
The medicines administered and prescribed by naturopathic physicians are primarily natural and relatively unprocessed. Although it is recognized that some situations may require the use of synthesized medicines, their use is considered less desirable. Some of the arguments in favor of natural medicinal substances have already been discussed. In addition to the reasons noted above, natural agents are preferred because their constituents have been encountered in nature for millions of years. This long period of exposure has enabled the body to develop metabolic pathways capable of effectively utilizing, processing, and detoxifying these medicines.
Four categories of natural medicines can be defined. The first includes substances found in nature that have been only minimally processed. Examples would include, but are not limited to, foods, clean air and water, and whole herbs. The early “nature cure” practitioners used this category primarily. The second category includes agents extracted or made from naturally occurring products. Although these have undergone pharmacological processing, the constituents of the medicines are still in the form found in the original natural substance. These first two types of natural medicinal substances have synergistic constituents that allow their use at lower doses with a resultant broader and safer therapeutic index. Examples of this category include tinctures and other botanical extracts, homeopathic medicines, glandulars and other substances of animal origin.
The third type of natural medicines are those highly processed medicinal substances that are derived from a natural source. These often have everything removed but the identified active ingredient and no longer have any synergistic constituents. Examples include many new phytotherapeutic agents, constituents of biochemical pathways, enzymes, amino acids, minerals, vitamins, and other food extracts.
The fourth category that may be considered “natural” are those manufactured medicines which are presumed to be identical to naturally occurring substances. These have the advantage of being less expensive and are typically available in higher concentrations. However, their use is less desirable due to:
• the difficulty of determining whether they are indeed the equivalent of the natural product
• their lack of natural synergistic components
• the inclusion of contaminates from the manufacturing process. These contaminates are often chemically and structurally similar to the desired medicine, but generally interfere with the normal pathways rather than enhance them.
Examples of these manufactured “natural” medicines include hormones, synthetic vitamins and analogs of plant and animal constituents.
Increasingly, medicines of the types identified in cate-gories three and four are being grown “synthetically” by microorganisms specially engineered to produce the desired medicinal substance. It is difficult to say which of these categories best describes this situation. There are also potential problems with this kind of manufacturing process as evidenced by the tryptophan disaster of several years ago.
Naturopathic physicians also use many natural therapies. What makes a therapy “natural” is that it is derived from a phenomenon of nature and is used to stimulate the body to heal itself. Examples of these phenomena are air, light, heat, electricity, sound and mechanical force. Some of these natural therapies include mechanical and manual manipulation of the bony and soft tissues (naturopathic manipulative therapy), physiotherapy modalities (e.g. electrotherapy and ultrasound), hydrotherapy, and exercise therapy. Naturopathic physicians also use lifestyle modification, counseling and suggestive therapeutics. These therapies are all discussed in more detail in other chapters.
Family and specialty practice
Naturopathic physicians, like other types of primary care providers, develop practices that meet their personal interests and skills. While most are engaged in general and family practice, many have also specialized in particular therapeutic modalities and/or types of health problems. However, in all situations the emphasis is still on treating the whole person. The practice of family medicine requires the use of some techniques and devices that are not, in the strict sense of the word, natural therapies, but belong among the comprehensive family practice services offered by the naturopathic profession.
Included in family practice are such services as the prescription and fitting of birth control devices, first aid, and minor surgery. Minor surgery includes the repair of minor wounds and lesions and the removal of growths and foreign bodies from superficial tissues. When necessary, it includes the use of local anesthetics and appropriate first aid procedures. First aid includes the treatment of ambulatory acute injuries and conditions that are routinely seen and handled in general practice.
Many naturopaths have also developed advanced expertise in different natural therapeutic modalities. These practitioners have usually invested in postgraduate training, such as that available through residencies. Three therapeutic specialties that merit mention are natural childbirth, acupuncture, and homeopathy.
THE PHILOSOPHICAL CONTINUUM
When the various healing systems are examined and placed on a philosophical continuum, mechanism and vitalism are on different ends of the same health care spectrum. Both ends of this health care continuum have their strengths and weaknesses. Mechanistic medicine is effective for trauma, crisis care, end-stage pathology and many acute diseases. It is essentially a failure with chronic disease. In fact, conventional medicine considers most chronic diseases incurable. Vitalistic medicine, on the other hand, has its most dramatic successes with chronic disease and is effective with many kinds of acute disease. It is not very effective with trauma and crisis care and end-stage pathology, although it can be a very useful complement to conventional medicine. As can be seen, both ends of the health care spectrum are necessary if every patient’s health care needs are going to be met.
Although aspects of naturopathic (e.g. constitutional hydrotherapy) and conventional medicine (e.g. chemotherapy) represent the archetypes of vitalism and mechanism, the area between the ends of this spectrum is a gray area within which both naturopathic and conventional physicians operate on a continual basis. While naturopathic physicians integrate vitalistic therapies with some mechanistic therapies, it is not possible for everyone to be experts in everything. The vast majority of naturopathic or conventional physicians are not going to be able to learn and competently practice all types of health care. Consequently, to effectively meet society’s health care needs, it is necessary to create an integrated health care system. Such an integrated system would have both vitalistic and mechanistic practitioners working together in the same clinical settings.
The trends of popular culture and a biomedical science that is finally beginning to study alternative medicine suggest that the creation of an integrated health care system is now underway. However, it takes no great skill for a mechanistic medical doctor to switch from giving a synthetic drug for a disease to giving a natural medicinal substance. If naturopathic medicine becomes just another mechanistic system using natural medical substances to treat disease (instead of a system identified with treating the whole person vitalistically), it will lose its unique niche in an integrated health care system. For naturopathic medicine to survive and thrive in this new environment, it will need to keep its vitalistic roots. With a thorough grounding in vis medicatrix naturae, modern naturopathic medicine will flourish and achieve a leadership position as the dominant health care paradigm shifts to the integrated medicine of the future.
CONCLUSION
The practice of naturopathic medicine can be summarized most simply as helping the body/mind heal itself in the least invasive, most fundamentally curative manner possible. This approach is not tied to any particular therapy or modality, but rather is oriented to a rational blend of vitalistic and mechanistic principles working with the whole person, and educating the patient in the ways of health.
As naturopathic knowledge of health and disease grows, new therapies and approaches to health care will be added as they satisfy the principle of vis medicatrix naturae. As the larger health care system becomes more integrated, naturopathic medicine’s place is assured as the profession that truly understands each unique human being’s power to heal.