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Clinical Naturopathic Medicine

Leah Hechtman

MSci Med [RHHG] (USYD), BHSc (UNE), ND (NCC) MACNEM,

MASRM, MATMS, MESHRE, MFSA, MNHAA

President, The National Herbalists Association of Australia (NHAA)

Lecturer UG and PG, School of Biomedical and Health Science,University of Western Sydney, NSW

Faculty Member and Lecturer, Green Medicine Institute (GMI)

Director, The Natural Health and Fertility Centre, Natural Health and Fertility Pty Ltd

Private Practitioner, Sydney, NSW

Sydney Edinburgh London New York Philadelphia St Louis Torontosample proofs only

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Churchill Livingstoneis an imprint of Elsevier

Elsevier Australia. ACN 001 002 357(a division of Reed International Books Australia Pty Ltd)Tower 1, 475 Victoria Avenue, Chatswood, NSW 2067

2012 Elsevier Australia

This publication is copyright. Except as expressly provided in the Copyright Act 1968and the Copyright Amendment (Digital Agenda) Act 2000, no part of this publicationmay be reproduced, stored in any retrieval system or transmitted by any means (includingelectronic, mechanical, microcopying, photocopying, recording or otherwise) without prior

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This publication has been carefully reviewed and checked to ensure that the content is asaccurate and current as possible at time of publication. We would recommend, however, thatthe reader verify any procedures, treatments, drug dosages or legal content described in thisbook. Neither the author, the contributors, nor the publisher assume any liability for injuryand/or damage to persons or property arising from any error in or omission from this publication.

National Library of Australia Cataloguing-in-Publication Data

___________________________________________________________________

Hechtman, Leah.

Clinical naturopathic medicine / Leah Hechtman. Revised ed.

9780729541510 (pbk.) Includes index.

Naturopathy. Clinical medicine. Integrative medicine.

615.535

___________________________________________________________________

Publisher: Sophie KalinieckiDevelopmental Editor: Neli BryantPublishing Services Manager: Helena KlijnProject Coordinators: Natalie Hamad and Stalin ViswanathanEdited by Stephanie Pickering, Sylvia Sullivan, Julie Gorman & Harriet Stewart-JonesProofread by Sandra Slater and Annette MuskerCover design by Modern Art Production GroupIllustrated by Rod McCleanIndex by Jan RossTypeset by TNQ Books & Journals Pvt. Ltd.Printed by CTPS, China

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Foreword

One of the greatest problems limiting the reemergenceof naturopathic medicine has been the lack of moderntextbooks, especially ones based on science. When I wasa student in the early 1970s, the most current textbook

in the US had been published the year I was born! Foralmost a century the mantra of conventional medicinehas been that naturopathic medicine is not only notscientific, it is misguided, giving patients false hopeat best and, at worst, delaying needed medical inter-ventions. I still remember a debate I had with an MDwhile I was working as a research associate at a medicalschool before I decided to enter naturopathic school. Ihad become a vegetarian and noticed many changes inmy body and health. I asked one of my fellow research-ers what these changes meant and was told, These areerrors in your observations, diet does not affect you.!The problem for me in the debate, however, was that Idid not have any research to refute him, only my experi-

ences. Interestingly, when I asked a naturopathic doctorthe same question, he took Guytons Medical Physiology then a standard textbook for medical schools off hisbookshelf and showed me what was happening. I wasvery impressed that the naturopathic doctor knew physi-ology better than those I was working with in medicalresearch. I asked him if I could spend a few days withhim, watching him see patients. After seeing incurablepatient after incurable patient get better with his care,I was convinced that there was something special here.Clearly diet and natural therapies though discountedby conventional medicine were indeed effective. Butwhen I asked my mentor for research supporting histherapies, or modern books on naturopathic medicine to

read, he had nothing to offer.Happily, this problem is being addressed, albeit slowly.

The first modern textbook of naturopathic medicine wasco-authored in 1985 by Michael Murray, ND, and me.The Textbook of Natural Medicine broke an almost fourdecade hiatus. Now in its third edition, the Textbooksmajor contribution was beginning the documentationof the research support for natural medicine. The 2000page text cites over 10,000 references documenting theefficacy of natural therapies. Another important contri-bution was that we brought together for the first timenaturopaths as the experts for a scholarly publication.

And finally, we developed and documented protocols forthe use of natural therapies in the treatment of a widerange of diseases. Unfortunately, it has for far too longbeen the lone standard for the profession. Finally, this

has changed with the emergence of Hechtmans ClinicalNaturopathic Medicine.

The major contribution of Clinical Naturopathic Medicine(CNM) that differentiates it from the Textbook of Natu-ral Medicine (TNM) is that it is unabashedly focusedentirely on naturopathic medicine. Hechtman and hercolleagues expertly look at the historic origins of natu-ropathic concepts and therapies and then integrate thesewith scientific research to provide a strong foundationfor modern clinical naturopathy. While there is plenty ofscience, I especially appreciate how the authors carefullyconsidered traditional naturopathic approaches andtherapies in the context of modern science to providestudents and practitioners guidance on how to thinkabout and treat patients. This is key strength of CNM:practical guidance.

As appropriate, almost every chapter covers not onlywhat to do, but how to do it and optimize for the unique-ness of each patient. Nutrient dosages, herbal combina-tions, potential adverse interactions with conventionaldrugs, laboratory tests and clinical criteria identifyingpatient characteristics that require modification of theintervention, etc. are all covered. It is truly, a remarkablecompilation of how to practice naturopathic medicineconscientiously, effectively and safely.

Another very interesting aspect of CNM is that it is sys-

tems, rather than disease, oriented. This means that mostof the content is oriented towards physiological systemsand what goes wrong rather than the disease the personhas and how to treat it. While there is plenty of guidanceon how to treat diseases, there is far more attention paidto understanding the function of the system, why it goeswrong and what to do about it. Included also is somevery sophisticated guidance on understanding the adverseeffects of the drugs used by conventional medicine foreach disease and how to mitigate their effects withoutimpairing their efficacy. This latter guidance is extremelyimportant as few realise the prevalence of adverse drugreactions. Research has shown that 25% of patients suffer

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F O R E W O R Di

an adverse event as a result of medical care.1Worse, inthe US adverse reaction to properly prescribeddrugs is thefourth leading cause of death.2Fortunately, many of theseadverse events can be prevented by the expert use of naturaltherapies or alternative to the drugs both fully describedin CNM. Dont get me wrong here, as this is not a bookabout alternatives to conventional medicine but rather ofnaturopathic medicine as an integral part of the health-care system. While there are plenty of examples of naturo-pathic therapies as alternatives to conventional medicine,

there are also many examples of how these medicines cancollaborate for the very best patient outcomes.

I am extremely impressed with this work and wish it hadbeen available when I was a student. Conscientious clini-cians will use the great resource every day. My congratu-lations go to Leah Hechtman and her expert colleagues.

This outstanding book will have a profound impacton improving the clinical quality and efficacy of ourprofession.

1Gandhi TK, et al. Adverse drug events in ambulatory care. NEJM 2003;348:1556-64.

2Lazaraou J, et al. Incidence of drug reactions in hospitalized patients:a meta-analysis of prospective studies. JAMA 1998;279:1200-5.

Dr. Joseph Pizzorno, NDEditor-in-Chief,Integrative Medicine, a Clinicians Journal

Founder, Bastyr UniversityCommissioner, U.S. White HouseCommission on Complementary and Alternative Medicine Policy

Licensed naturopathic physician with prescriptive rights, State of Washington

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iii C O N T E N T S

Chapter 8 The Hepatobiliary System, 210

Overview of the Hepatobiliary System, 210

Role of the Naturopath, 212

Investigations, 217

Potential Interactions, 218

Cholelithiasis, 221

Cholecystitis, 230

Non-Alcoholic Fatty Liver Disease (NAFLD), 238Viral Hepatitis, 248

Cirrhosis, 258

Chapter 9 The Immune System, 280

Overview of the Immune System, 280


Investigations, 289

Naturopathic Treatment, 294


Autoimmune Disease, 337

HIV (Human Immunodeciency Virus), 354

Cancer, 385

Chapter 10 The Respiratory System, 418

Overview of the Respiratory System, 418


Investigations, 425

Potential interactions, 432

Conjunctivitis, 448

Sinusitis and Allergic Rhinitis, 454

Acute Rhinopharyngitis and Inuenza, 462

Pharyngitis and Tonsillitis, 469

Asthma, 476

Pneumonia, 485

Bronchitis, 491Chronic Obstructive Pulmonary Disease (COPD), 498

Chapter 11 The Musculoskeletal System, 508

Overview of the Musculoskeletal System, 508


Investigations, 512


Osteoarthritis, 537

Gout, 551

Fibromyalgia, 561

Osteoporosis, 575

Rheumatoid Arthritis, 586

Systemic Lupus Erythematosus (SLE), 602

Chapter 12 The Dermatological System, 631

Overview of the Dermatological System, 631



Dermatitis/Eczema, 645

Investigations, 646

Psoriasis, 652

Acne Vulgaris, 660

Skin Infections, 665

Leg Ulcerations, 672

Urticaria, 678

Chapter 13 The Urinary and Renal Systems, 689

Overview of the Urinary and Renal System, 689


Investigations, 694

Potential Interactions, 701Urinary Tract Infections (Cystitis), 708

Enuresis, 721

Renal Failure, 727

Chapter 14 The Female Reproductive System, 734

Overview of the Female Reproductive System, 734



The Menstrual Cycle, 761

Premenstrual Syndrome (PMS), 768

Polycystic Ovarian Syndrome, 780

Uterine Fibroids, 794

Endometriosis, 805Pelvic Inammatory Disease, 829

Menopause, 842

Chapter 15 The Male Reproductive System, 872

Overview of the Male Reproductive System, 872


Investigations, 874


Benign Prostatic Hyperplasia, 882

Prostatitis, 894

Erectile Dysfunction, 904

Andropause, 918

Chapter 16 The Cardiovascular System, 936

Overview of the Cardiovascular System, 936


Investigations, 943


Hypertension, 963

Coronary Artery Disease (Atherosclerosis, Dyslipidaemia), 977

Cardiovascular Ischaemia (Angina), 993

Coronary Heart Failure, 1005

Chapter 17 The Endocrine System, 1025

Overview of the Endocrine System, 1025Role of the Naturopath, 1030

Investigations, 1031


Hypothyroidism, 1052

Hyperthyroidism, 1068

Diabetes Mellitus, 1083

Hypoglycaemia, 1108

Stress, 1111

Addisons Disease, 1124

Cushings Syndrome/Disease, 1126

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C O N T E N T S

Chapter 18 The Nervous System, 1138

Principles of the Naturopathic Approach to the

Nervous System, 1138

Role of the Naturopath Neurological System, 1141

Role of the Naturopath Psychological System, 1171



Sleep Disorders, 1200Headaches and Migraines, 1214

Multiple Sclerosis, 1232

Depression, 1248

Part 4: The Lifecycle, 1291

Chapter 19 Fertility, 1292

Epidemiology, 1292

Classication, 1294

Aetiology, 1296

Complications, 1304


Therapeutic Considerations, 1313Therapeutic Application, 1313

Chapter 20 Pregnancy and Breastfeeding, 1367

Pregnancy, 1367

Introduction, 1367

First Trimester, 1377

Second Trimester, 1383

Third Trimester, 1390

Labour, 1393

Post Partum, 1395

Breastfeeding, 1397

Chapter 21 Paediatrics, 1411Dosage Calculations, 1411

Growth and Development, 1422

Colic, 1428

Teething, 1430

Cradle Cap, 1430

Nappy Rash, 1431

Constipation, 1431

Diarrhoea, 1433

Fever, 1435Recurrent and Chronic Infections, 1435

Otitis Media, 1438

Warts, 1441

Autism and Autism Spectrum Disorders (ASD), 1441

Attention Decit (Hyperactivity) Disorder AD(H)D, 1454

Immunisation, 1459

Special Diets, 1460

Appendices

Appendix 1: Herbal Medicine Dosage Chart, 1475

Appendix 2: Herbal Medicines During Pregnancy

and Lactation, 1487Appendix 3: Nutrients: Lifespan Requirements

and Pharmacological Dosage, 1491

Appendix 4: Dietary Nutrient Sources, 1508

Appendix 5: Nutritional Assessments and Physical

Examination, 1510

Appendix 6: Symbols and Abbreviations, 1515

Appendix 7: Laboratory Reference Values, 1529

Appendix 8: Herbal Medicines and Laboratory

Investigation Interactions, 1540

Index, 1545

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In Naturopathy, a clinician emerges whose sole intentionis to find the cause of a patients complaint, to educate andempower them to understand their health manifestation,and to support their presentation with a natural meansof treatment. This treatment has evolved over time to beboth clinically effective but also rigorously researchedand assessed. It is an essential part of the changing face ofmodern medicine.

The practice of Naturopathy currently finds itself in a

unique position of change. Within Australia, our currentstatus is the one that is moving towards greater integra-tion within the healthcare system and closer to registra-tion. As such, our treatments require greater responsibilityand specificity and a willingness to share this informationamongst our colleagues. Without this, our treatments andwisdom risk being lost to other disciplines. As naturo-paths, we offer a unique perspective of health care andprovide significant support and relief for patients. Ourtreatments encourage self-responsibility and involvementin the healing process. They foster gentle, restorative andameliorating approaches to medical conditions. Theirvalidity is time-tested and long-standing.

The structure of the text was crucial to the design of theproject. It was important that the content was easilyaccessible, logical and articulate. The textbook has beendivided into five sections: Part 1 Principles of Naturo-pathic Medicine providing an overview to our maintreatment approaches; Part 2 Naturopathic Treatments a specific overview of the two main treatments, nutri-tion and herbal medicine; Part 3 Body Systems eachsystem of the body and relevant major conditions;

Part 4 The Lifecycles a naturopathic perspective to themajor lifecycle events; and Part 5 Appendices Relevantfor the Student and Clinician.

Each section of this book has been arranged in a system-atic manner; each chapter pertaining to a specific systemof the body or unique topic; and each condition organ-ised according to specified pedagogy that ensures that thecontent is comprehensively covered. Within each condi-tion, the reader can view the content as an overview for

quick access or as a detailed discussion that may provokecritical thought, reflection and consideration. The tradi-tional approach to the topic has been incorporated andintegrated into the carefully researched content that hasfollowed. Each reference that was included was not solelyas it supported a statement, but was considered andreflected to ensure that the content delivered was soundand accurate. At the conclusion of each condition, thereader is provided with a comprehensive case study. Thisensures that each contributors unique clinical perspec-tive enriches the content and translates the theory intorealistic clinical practice.

At the heart of Naturopathy, we must lean on our elderswhose traditional system knew that the essence of ourtreatment relied on the relationship that was formedbetween the patient and the clinician. Evidence-basedmedicine forms a component of our system of knowl-edge. It provides us with a lens to explain the efficacy ofour treatment but can never replace the healing relation-ship. The consultation room continues to be the greatestenvironment for growth and understanding and ulti-mately the platform for change and healing.

Preface

Leah Hechtman,MSci Med [RHHG] (USYD), BHSc (UNE), ND (NCC) MACNEM, MASRM,MATMS, MESHRE, MFSA, MNHAA

President, The National Herbalists Association of Australia (NHAA)Lecturer UG and PG, School of Biomedical and Health Science, University of Western Sydney, NSW

Faculty Member and Lecturer, Green Medicine Institute (GMI)Director, The Natural Health and Fertility Centre, Natural Health and Fertility Pty Ltd

Private Practitioner, Sydney, NSW

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xii

As we near the end of this project, I continue to be inspiredat what a group of individuals can achieve. A book ofthis magnitude is near impossible without the support,dedication and commitment of everyone involved in theproject.

I have had the honour of working with some esteemedprofessionals throughout this journey. In the order of theircontribution, my appreciation to Kylie Seaton, RachelArthur, Ondine Spitzer, Dr Hanni Gennat, David Kirk,

Justin Sinclair, Jane Daley, Ses Salmond, Kathy Harris,Karen Bridgeman, Michael Thomsen, Lisa Costa-Bir,Dr Matthew Leach, Kathleen Murphy, Dr Tini Gruner,Dr Suman Naik, Emily Bradley and Helen Padarin. Aspecial note of gratitude goes to Dr Hanni Gennat forher contribution of both Chapter 4 and each of the inter-action tables within each system or lifecycle chapter. Ihave learnt much from working with you all. Your dedi-cation to the project and commitment to sharing yourknowledge, experience and insight has been inspiring.Additionally, my thanks to Dr Joseph Pizzorno. I amhonoured and privileged to include your foreword isthe text.

Due to the size of this text and the time involved in itsproduction, those involved have had their share of lifeexperiences. I can safely say that the team has experiencedalmost all major life changes and I sincerely appreciateeach contributors integrity to the project. Heartfelt grati-tude goes to Ruth Kendon whose contribution unfor-tunately had to be omitted due to time restrictions.Ruth your humility and grace made the process mucheasier thank you. The text was reviewed by a numberof individuals in the industry. Due to the review process,I was not aware of their identity but sincerely appreci-ated their thoroughness, feedback and enthusiasm torelease the best text possible. To Jane Daley, your effortsas technical advisor were supportive, valuable, informa-

tive and knowledgeable. I am humbled to consider you acolleague and value your place in my life.

My sincere appreciation goes to the team at Elsevierpublishers. Their support, direction and dedication tothe project have been impeccable. Many thanks to LuisaCecotti, Neli Bryant, Sunalie Silva, Natalie Hamad,Helena Klijn and everyone else who assisted with the

project. I have utmost respect and gratitude to SophieKaliniecki. Without her patience, support, motivationand vision, this text would have been impossible.

Thank you to Marianne Trees and Nadine Campbell fortheir contributions as research assistants. Your passion,thirst for knowledge and enthusiasm is inspirational.A special thank you to Lisa Costa-Bir as without herresearch prowess I would have not been able to perseverein the latter parts of the journey. She embodies one whose

passion for knowledge is the foundation of her strengthas a clinician. It has been a blessing to see her potentialunravel over the years and my gratitude is immense. Tomy assistant and colleague Annmarie Cannone, your sup-port and friendship especially when deadlines were tight,has helped beyond words.

My colleagues on the board of NHAA educate, inspireand challenge me in positive ways. Thank you all foryour unrelenting passion to drive our profession towardsexcellence. To my colleagues at the University of WesternSydney, Sydney University, fellow clinicians and othercolleagues, my past lecturers, teachers and mentors you each hold a place in my lineage and have providedme with inspiration and guidance and have helped mebecome the person and clinician that I am today.

To each patient who I have been fortunate enough to treat,you are my greatest teachers. Theory holds limited placein the consultation room and you have each remindedme to respect the innate healing ability of the body, thewisdom and gifts from nature and the tenderness andhumility of the human spirit.

Special thanks to Marie-Pierre Cleret whose supervisionprovided grounding, stability and comfort; my friendsand family for their encouragement, patience and under-standing; my cats for their company when writing intothe night and above all my husband, Justin Denes, with-

out whom none of this would have been possible. Yourinsight that this journey has been bigger than anticipatedand your continual love and respect helps me be the per-son that I am and achieve all that I do.

Finally, my gratitude to all herbalists and naturopathsboth past and present that continue the tradition theknowledge is not lost.

Acknowledgements

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Contributors

Rachel Arthur,BHSc, BNat(Hons) (SCU),MACNEM, MNSA, MNHAA, MANTALecturer, School of Health and HumanSciences, Southern Cross University, NSWProfessional and corporate educatorPrivate Practitioner, NSWChapter 2, Principles of Nutritional Medicine

Emily Bradley,ND (SSNT), MHSc, NMed(RMIT), MANTALecturer, Faculty of Naturopathy, Southern

School of Natural Therapies and EndeavourCollege of Natural Health, VICPrivate Practitioner, VICChapter 20, Pregnancy and Breastfeeding

Karen E Bridgman,PhD M Sci (Hons), M Ed(Higher Ed), M App Sci, ND, DBM, Dip HomPart-time Lecturer, Faculty of Pharmacy,University of Sydney, NSW, AustraliaDirector, Starower Pty Ltd and StarowerHerbalsChapter 9, The Immune System

Lisa Costa Bir,B App Sc (Naturopathy), GradDip (Naturopathy), Certicate IV in Ayurvedic

Lifestyle Consultation, MATMSPrivate Practice, Caringbah, NSWChapter 11, The Musculoskeletal System

Jane Daley BHSc(CSU), MClinSc(SCU),DBM (NCC),GradCertAppSc(Swinburne University),MNHAASenior Lecturer Southern School of NaturalTherapies, VictoriaPrivate Practitioner, VictoriaChapter 7, The Gastrointestinal System

Dr Hanni Gennat Dip App Sc (UNE), BSc(UWA), PhD (UWA)

Medical Director, Global Natural MedicinePty LtdHealth Consultant, Private Practice,AustraliaChapter 4, Herb/Nutrient-Drug Interactions

Dr Tini Gruner,Dip.Teach, Dip.Psych.Ther, ND,MSc, RNutr, AdjProf(SPCNT), MANPA, MNSA,MNHCA, MISCMR, MNorphCAMCourse Coordinator Bachelor of ClinicalSciences, Lecturer in Nutrition andNaturopathy, Clinic Supervisor School ofHealth & Human Sciences, Southern CrossUniversityPrivate Practitioner, NSWChapter 17, The Endocrine System

Kathy Harris,MHScHMed (UNE), ND, BEd,MNHAALecturer, School of Biomedical and HealthScience, University of Western Sydney, NSWLecturer, Nature Care College, St Leonards,NSWPrivate Practitioner, NSWChapter 9, The Immune System

David A Kirk,Adv.Dip.Nat.Writer, researcher, educator andconsultant to the ComplementaryMedicines industryTechnical Support and Education Managerwith Nutrition Care Pharmaceuticals,

Victoria, AustraliaChapter 5, Naturopathic Treatments -Nutritional Medicine

Dr Matthew J Leach,RN, DipAppSci (Nat),DipClinNutr, BN (Hons), PhDResearch fellow, Health economics andsocial policy group,University of South AustraliaChapter 12, The Dermatological System

Kathleen Murphy,ND (ACNM) BA (UQ)Private practitioner, QLDClinical tutor, Endeavour College of NaturalHealth, Brisbane, QLD

Chapter 16, The Cardiovascular System

Dr Suman Naik,MS [Ophth.][India], MBBS[India], Adv.Dip. of Naturopathy/HerbalMedicine/Homoeopathy, Dip. of NutritionLecturer, Australasian College of NaturalTherapies, NSWNaturopathic practitioner, NSWChapter 18, The Nervous System

Helen Padarin,BHSc(Nat), ND, DN, DBM,DRM, MATMSPrivate Practitioner, Sydney Australia andWellington NZChapter 21, Paediatrics

Ses Salmond,BA (MU), ND, DBotMed,DHom, DNutr (NCC), FNHAASenior Lecturer, Western Herbal MedicineDepartment, Nature Care College, Sydney,NSWPrivate Practitioner, NSWChapter 8, The Hepatobiliary System

Kylie Seaton,BA (GU) GradDip (QUT) BHSc(UNE), MNHAA, Adv Dip Nat, Adv Dip WHM,Adv Dip Hom, Dip Nut (ACNT)Naturopath & Homeopath, Potts Point, NSWChapter 1, Naturopathic Philosophy

Justin Sinclair,ND (ACNT), BHSc (UNE),MHerbMed (USyd), MNHAA, MATMSSessional Lecturer, Endeavour College ofNatural Health, QLDPrivate Practitioner, QLDChapter 6, Naturopathic Treatments - Herbal

Medicine

Ondine Spitzer,MSocH (UM), BHSci (SSNT),BA (LTU), MNHAAProject Offi cer, Department ofPhysiotherapy, University of Melbourne, VICResearch Assistant, Department of Surgery,Alfred Hospital/Monash University, VICChapter 3, Principles of Herbal Medicine

Michael Thomsen,ND (NCC), MSc(Swinburne) MNHAAMedical Director, Global Natural Medicine,TasmaniaPrivate Practitioner, Hobart, Tasmania

Chapter 10, The Respiratory System

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xiv

ABOUT THE AUTHOR

SPECIAL CONTRIBUTIONSInteractions Tables for each System/Lifecycle chapter,researched and compiled by Dr Hanni Gennat, Dip AppSc (UNE), BSc (UWA), PhD (UWA)Medical Director, Global Natural Medicine Pty LtdHealth Consultant, Private Practice, Australia

Technical Review of Clinical Naturopathic Medicineby JaneDaley (BHSc (CSU), MClinSc (SCU), DBM (NCC), Grad-CertAppSc (Swinburne University), MNHAASenior Lecturer, Southern School of Natural Therapies,Victoria

REVIEWERSAnne Cowper,BHSc (CompMed) ND DBM FNHAAPractitioner, Morisset NSW, Lecturer WEA Newcastle

Stepanka Dumas,ND Dip.herbClinic supervisor/lecturer, Australian Institute of Holistic Medicine

Karen Martin, ND (SACBM), BTeach (Adults) (UniSA), MDEd (Deakin)Private Practitioner, SA

Brad McEwen, MHlthSc (Hum. Nutr.), BHlthSc, Grad. Cert. HlthSc(Hum. Nutr.), ND (Adv.), DBM, DNutr, DSM, DRM, MATMS and MNHAAPhD candidate (University of Sydney)Lecturer in Nutrition (Nature Care College), seminar presenterand researcher

Nicole Quaife,B.H.Sci.(Naturo)Clinic Supervisor and Lecturer in Clinical Nutrition, Southern Schoolof Natural Therapies, MelbournePrivate Practitioner, Hampton, VIC

Christine Sullivan,B.Soc.Wk (UQ), ND(ACNM), DHM (ACNM),BN (ACNM), PGD H Sc Nutrition Medicine (UNE)MNHAA, MANPA, AssMACNEMPrivate Practitioner, QLD

Caroline van der Mey,Ad Dip Naturopathy, Dip Hom, Post Graduate

Diploma in PhytotherapyLecturer, AIHM (Australian Institute of Holistic Medicine), Perth, WAPrivate Practitioner - Naturopathy, WA

Louise Zylan,ND (ACNM), MAIMA, MNHAALecturer, Southern School of Natural Therapies, VICLecturer, Endeavour College of Natural HealthPrivate Practitioner, VIC

Leah Hechtman is Director of The Natural Health andFertility Centre in Sydney where she specialises in fer-tility support and mental health. In addition, she isPresident of the National Herbalists Association ofAustralia, lectures at the University of Western Sydney to

both undergraduate and postgraduate students. Leah isalso a contributor to various professional texts and jour-nals, a presenter at conferences and seminars, and is amedia spokesperson for the industry.

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PRINCIPLES OF NATUROPATHIC

MEDICINE

P A R T

1

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2

2012 Elsevier Australia.

Naturopathic Philosophy1Kylie Seaton

CHAPTEROUTLINE

An Ancient Tradition 2

Nature Cure Europe 2

Naturopathy North America 3

Naturopathy in Australia 4

The Principles of Naturopathy (the Six Maxims) 8

The Naturopathic Approach 9

ANANCIENTTRADITIONNaturopathy is a term of recent origin; however, its philo-sophical basis is steeped in history. Its basic principlesare thousands of years old and retain a characteristic reso-nance today. The ancient Egyptian Ebers Papyrus datesback to the 16th century BC. Historians suggest much ofthe material it contained was orally transmitted from per-haps as much as five centuries before this. This 40-pagedocument contains the earliest written record of healingpractices. The Egyptians were well known for their holis-

tic approach to treatment through the therapeutic use ofherbs and food, massage, invocations and rituals.[1]

The Greek universe was ordered and understood accord-ing to four elements: fire, water, earth and air. On the sameprinciple, Hippocrates (460377 BC) understood that thebody was governed by four corresponding humours: san-guine, melancholic, phlegmatic and choleric. He viewedhealth and disease in terms of fluid balance and classi-fied herbs and food by their ability to affect this balance.The fundamental principle of the Hippocratic approachto healing was that the cure should be affected by natureand that the physician should only endeavour to facilitateand assist this natural healing process.[2]

Galen of Pergamum (AD130200) adopted the humoralapproach favoured by Hippocrates and in his mostfamous work, On the Natural Faculties, furthered theunderstanding of the development, nature and composi-tion of the humours in man and introduced the qualitiesof warmth, cold, dry and moist to the humoral doctrines.Much of Galens work underpinned Western knowledgeof medicine throughout the Middle Ages.[3]

InAD55 the Greek physician Dioscorides wrote a series ofbotanical volumes entitled De Materia Medica, which clas-sified drugs according to categories of action; herbs cameto be recognised for their warming, bitter, astringent,

diuretic or tonifying characteristics. This work became themost authoritative source of information on therapeuticsubstances and remained so through most of the Chris-tian era until modern times.[4]

Ibn Sina (AD9801037), or Avicenna as he became knownin the West, was a Persian physician who lived during thelate 900s and early 1000s. Avicenna wrote the most com-plex medical encyclopaedia of the time, the Kitah al Qanun(Canon of Medicine), which was the summation of themedical knowledge of the time and influenced medical

education for more than 600 years. Developed from theGalenic medical tradition, the Kitah al Qanunwas trans-lated into Latin in the 12th century and was used as medi-cal text in French universities until the 18th century.[5]

Hippocrates, Galen, Avicenna and Dioscorides allacknowledged the need for internal and external bal-ance for health to prevail. Underpinning much of ancienthealing was recognition of the vital force that has beenvariously understood in terms of chi, prana, the tem-peraments, the humours and the elements. Regardless ofsemantics, the bodys energetics have always been consid-ered important and the healing power of nature has beena unifying thread woven through all traditional healingpractices.

NATURECURE EUROPEWhilst there are a number of key players in the devel-opment of the European hydrotherapy and nature curemovement, the two most influential figures includeVincenz Priessnitz (17991852) and Sebastian Kneipp(182497). Their pioneering work in hydrotherapy wasthe subject of provincial rivalry and unrelenting profes-sional jealousy from the medical community, yet laidthe foundation for the practice of hydrotherapy and thenature cure movement throughout Europe.

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Chapter 1 Naturopathic Philosophy

Born into a peasant family in Austrian Silesia, Priessnitzreceived no official medical training. He began treatinginjuries from local farmyard accidents with cold water appli-cations, wet bandages and compresses. From these earlybeginnings, Priessnitz experienced overwhelming clinicalsuccess as he developed his art of water cure, with Chopinand Napoleon III among those who sought his clinicalexpertise.[6] His fame soon spread far beyond the confinesof Austria and patients from Britain, France, Italy, Constanti-nople, Philadelphia and Berlin soon sought his guidance.[7]

Like Priessnitz, Kneipp came from humble beginnings.Too poor to afford medical help, he cured himself fromdebilitating tuberculosis with cold water therapy; nightlydips in the icy waters of the Danube during winter werethe key to his success.[6] Word of his successful watercures spread and he combined this therapy with the judi-cious use of herbs to effect cure. Kneipps popularity sooncrossed the Atlantic and American institutions begantreating patients and teaching students the basis of hishealing system.[8]

NATUROPATHY NORTHAMERICANaturopathy evolved from the European hydrotherapyand nature cure tradition using the principles of naturecure in combination with other modalities like massage,homeopathy and spinal manipulation.

THOMSONIANISM, PHYSIOMEDICALISMAND THE ECLECTICS

Samuel Thomson (17691843) developed a method ofhealing that was heavily based on the use of Native Amer-ican herbal remedies and sweat baths. His approach waslabelled heroic but was considered less harmful than the

orthodox medicines being used at the time. Thomsonian-ism developed from the over-enthusiastic use of bleeding,mercury and arsenic by medical practitioners of the timewhich left patients debilitated and often in a worse statethan they were before treatment. Thomsons simple heal-ing system was based around the concepts of heat andcold; heat was considered life-supporting and cold wasconsidered life-threatening. Substances that stimulatedheat in the body, such as diaphoretics, were acceptedwhile substances that introduced cold into the body, suchas like mercury, aconite and opium, were avoided.[9]

Thomson had a strong belief in an individuals abilityand right to self-treat and firmly believed that the practiceof healing should remain with lay people. Underpinning

his adamant belief that his system of healing should beonly practised by householders was his strong aversionto medical education. He sold franchises to his healingmethod which he called friendly botanic societies upuntil the time of his death, in 1843.[10]

The physiomedicalist movement was initiated by one ofThomsons assistants in reaction to Thomsons rejectionof educational progression. In 1835, Thomson enlistedthe support of Alva Curtis, a young and popular practi-tioner from Ohio who claimed to have lost only one outof 200 patients. Curtis used this position bestowed uponhim by Thomson to gather support for his own system

of healing and led a breakaway movement in 1838 withthe establishment of his Independent Thomsonian BotanicSociety.[11]In contrast to Thomsons aversion to furtheringmedical knowledge, Curtis established medical schools toteach and develop his system of healing which was largelybased on the use of herbal medicine.

The physiomedicalist movement also initiated the use of

an energetic diagnostic system. Patients in deficient stateswere regarded as asthenic and those in excessive stateswere regarded as sthenic. Diagnostic procedures such astongue analysis and pulse diagnosis were also employedso that the most appropriate herbal remedies could beselected. Although physiomedicalism did not flourish inthe United States,[12]the system of healing was exportedto Britain and was taught at the British School of Phyto-therapy until the 1970s.

After initial work by Curtis and Cook, the physiomedical-ist movement was further refined by Thurston[13]in 1900as a:

medical philosophy founded on the Theorem of a vital force or

energy, inherent in living matter of tissue-units, whose aggregateexpression in health and disease is the functional activities of

the organism and whose inherent tendency is integrative andconstructive; resistive, eliminative, and reconstructive to inimi-cal invasion, or disease-causations.

The detailed and comprehensive work of Thurston pro-vided the physiomedicalist movement with a philosophi-cal basis. In his 400-page document, Thurston provideda rational outline of the failure of regular medicine andwent on to set out the theorems of physiomedicalism,the principles of the physiomedicalist movement, and acomprehensive manifesto on medical education, medi-cal terminology, body systems, pathology, disease states,

symptoms, diagnosis, food, immunity and the role of thephysician.

Wooster Beach (17941868), established the reformedbotanic movement which drew on the professionalism ofmedicine and the heritage of indigenous herbal medicineand European and American healing traditions.[14]As thenumbers of practitioners and the popularity of this newmovement increased, Beachs influence diminished andthe practice of this system of healing came to be knownas the eclectic movement. Beach is widely considered tobe the founder of eclectic medicine.[15]This movementallowed practitioners to incorporate modalities of otherhealing systems into their repertoire. Free to experimentwith a range of healing modalities, the numbers of eclec-

tic practitioners soared. At its peak, eclecticism claimedover 20,000 practitioners in the United States; thesenumbers presented serious competition for the practiceof orthodox medicine.[16]

THE RISE AND FALL OF AMERICANNATUROPATHY

Naturopathy was formalised as a professional healingmodality in the United States of America under the guid-ance of Benedict Lust in the early 20th century. Lust was adisciple of Kneipp and introduced the practice of Kneippshydrotherapy to the United States. Trained in osteopathy

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P A R T 1 : P R I N C I P L E S O F N AT U R O P AT H I C M E D I C I N E

and chiropractic, he opened the first health food shop inAmerica and founded massage and chiropractic schoolsin New York. Lust purchased the rights to the term Natu-ropathy from Dr John Scheel in 1902.[17,18]

In the United States, the popularity of naturopathy con-tinued to increase during the 1920s and 1930s, a periodoften referred to as the halcyon years. Medicine had

offered the public little up until this time and the generalpublic were taken with this new healing art: when natu-ropathic conventions were held throughout the country,both professionals and the public flocked to them. In1924, a naturopathic convention in Los Angeles drew acrowd of 10,000 people, naturopathic journals educatedthe public on disease prevention and health promotionand were widely read. Naturopaths began linking dietand chemical exposure with chronic disease; this think-ing was revolutionary for the time.[18]

The 1940s and 1950s, however, brought revolutions inmodern medicine and several definitive moments in mod-ern medicine crippled the holistic approach to health.

Penicillin was introduced in 1941[19]

and by the end of1945, treatment for pneumonia, syphilis, gonorrhoeaand scarlet fever had become available. Streptomycin wasused to cure the first case of tuberculosis in 1950[20]andany notion of preventative health care took a back seat withthe introduction of the intensive care unit[21] and newmethods of treatment for the polio epidemic.[22]The firstheart lung bypass was conducted in 1953[23]and the drugchlorpromazine was used to treat schizophrenia in theearly 1960s.[24]Within 30 years, modern medicine hadbecome seemingly invincible. Such revolutionary devel-opments transformed the publics perceptions about thevalue and possibilities of medicine.

Augmenting the impact of new technology, naturopathyfaced an impossible battle against the might of the AmericanMedical Association (AMA). Under the guidance of GeorgeH. Simmons and Morris Fishbein, the AMA transformeditself into a powerful hegemony from advertising revenuederived primarily from drug companies and the tobaccoindustry. The AMA established a propaganda department in1913 headed up by Morris Fishbein; the media was used todiscredit, ridicule, suppress and quash any form of healingnot condoned by either Fishbein or Simmons.[25]

The Flexner Report, published in 1910, also severelyimpacted the practice of both homeopathy and naturop-athy in the United States. Although it has been praisedfor unifying the training of medical practitioners at the

time,[26] the Flexner Report ensured that only schoolsendorsed by the AMA survived.[27] Allopathic, naturo-pathic, eclectic and homeopathic institutions alike folded;only one eclectic school and one homeopathic school sur-vived. The Flexner Report saw the demise of eclectic, natu-ropathic and homeopathic medicine in the United Statesand determined the future path for medical education.

The popularity of miracle medicine, the rise in power andinfluence of the AMA, the Flexner Report, the death ofBenedict Lust in 1945 and an un-unified naturopathiccommunity plagued by inner conflict saw naturopathy inAmerica decline and virtually disappear.

NATUROPATHY INAUSTRALIA

EARLY INFLUENCES, 17881861

The successful introduction of naturopathy into Australiawould not have been possible without the acknowledg-ment of medicines limitations since European colonisa-tion. The prohibitive cost of medicines in the colonies

encouraged the practice of self-prescription as a necessaryform of primary health care; herbal cures for headaches,venereal disease and rheumatism that were either knownas family recipes or found in English medical handbookswere popular. The influence of women as healers duringthe 1800s reveals a secret and hidden history of healingin Australia kept within the walls of the family home;the art of disease prevention, a tenet of naturopathy, wasregarded as womens work.[28]

The migration of hydrotherapy from Europe to Americais well documented and early beginnings of naturopathyin Australia can also be traced back to a pamphlet thatwas published in Launceston, Tasmania, in 1846 detailing

Priessnitzian hydrotherapy.[29]

The Victoria HydropathicEstablishment opened for business in Malvern Hill in 1861under the direction of Monsieur and Madame La Moileand offered overnight or daily hydrotherapy treatments.Turkish baths were also popular in central Melbourne andwere promoted for their ability to cure illness.[28]

Australian naturopathy also has its traditions in the prac-tice of herbalism and homeopathy as the first reportednatural therapists in Australia were homeopaths andherbalists.[30] A growing community of Chinese goldprospectors saw Chinese herbalism introduced to thegoldfields; by the late 1850s, numerous Chinese herbalshops had opened in central Melbourne. By 1867 it isestimated that 50 Chinese medical practitioners wereoperating on the Victorian goldfields alongside 25 legallyregistered doctors.[31]

Perhaps one of the most famous European herbal prac-titioners in Victoria during the 19th century was JohnBroadbent. Broadbent, the author of two publications,The Australian Botanical Guide(1887) and Botanic Multimin Parvo (1899),[32] established a herbal practice whichthrived until the 1930s. His clinical practice at 109 BourkeStreet, Melbourne, was famous for its shingle:

Botanic Laboratory: All Herbs Guaranteed Pure, Fresh, andTrue to Nature. Importers of Medical Herbs from Every Part ofthe Globe: Herbs, Roots, Barks, Seeds, Blossoms. Herbal rem-

edies for all diseases: No Family Should Be Without Them.Deeds Not Words.[33]

THE EMERGENCE OF AUSTRALIANNATUROPATHY, 191040

The period of emergence is marked by the presence ofChinese herbalists on the Victorian goldfields; it has beensuggested that Chinese herbalists were the largest groupof practitioners using herbal medicines in Australia inthe early 1900s.[34] Although naturopathy was only inits early incarnation, the popularity of herbalism at thetime was reflected in the formation of Australias oldest

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medical association, the National Herbalists Association ofAustralia (NHAA), in 1920. In 1925, the Victorian parlia-ment attempted to introduce a bill outlawing the practisingof herbalism by anyone but pharmacists; Chinese herbalistsin Victoria reportedly launched a publicity campaign andusing petitions managed to gather 6000 signatures from asupportive general public. The bill was withdrawn.[31]

The herbal community in Sydney in the early 1900s wasinfluenced heavily by the Newton and Wheeler families.Gilbert Wheeler was an early practitioner of herbalism inSydney and came from a family who had practised herbalmedicine in Australia from the days of early settlement.Edward James Newton, the grandson of Edward AllenNewton, was another popular herbalist and ran his clini-cal practice from an office in Pitt Street. Newton becamea major importer and supplier of herbs and the herbalformulas handed down by his father were very popularwith the local community.[35]

Australian naturopathy as we know it today would nothave been able to develop without the insight, dedica-

tion and benevolence demonstrated by Frederick Rob-erts and Maurice Blackmore. Roberts (18921976)played a key role in the development of osteopathy,chiropractic and naturopathy in Australia. He trained atthe London School of Natural Therapies and in 1929he established the Roberts Naturopathic Institute inMelbourne.[34]Roberts set up health clinics in Ballarat,Geelong, Brisbane, Ipswich, Newcastle, Toowoomba,Maryborough, Bundaberg, Mackay, Adelaide, Perth andFremantle, effectively bringing naturopathy to regionalAustralia. Maurice Blackmore graduated from the BritishNaturopathic College and immigrated to Australia in1923. Blackmore was another pioneer of naturopathyin Australia and opened both a naturopathic clinic and

Australias first health food shop, in Brisbane in 1934.[36]

THE POSTWAR PERIOD

The practice of naturopathy in North America was pro-foundly affected by the development of pharmaceuticaldrugs and technological advances attributed to WorldWar II; the American naturopathic professional fell intodecline as great advances in technology dominated dur-ing this period. In Australia, the growing pharmaceuticalindustry began to dominate and dictate orthodoxy andthe practice of Chinese herbalism in Victoria suffered withthe continuing impact of the white Australia policy fol-lowing Federation. Although the impact of these changeson naturopathy has not been specifically researched, nat-

ural therapies practitioners in Australia entered a difficulttime.

A herbal teaching hospital was established in FrancisStreet near Hyde Park in Sydney in the early 1950s by theNHAA. The teaching hospital was used to train herbal-ists and free herbal treatment was offered to patients whoqueued for hours to receive treatment; those who couldafford to left donations so that the rent on the prem-ises could be paid. The herbal teaching hospital kept itsdoors open for 10 years, herbalists worked relentlessly forfree to serve the community and all medicines were dis-pensed at no cost. Despite the success of the clinic and

its increasing popularity with the local community, theNHAA was forced to close the hospital in the early 1960sas making repayments on the premises had become animpossibility.[35]

Despite the closure of the herbal hospital in Sydney,and difficult times faced in North America, naturopa-thy in Australia continued to grow through the 1960s as

early pioneers like Maurice Blackmore and Cyril Flowersbegan to train other practitioners. Alf Jacka establishednaturopathic clinics in Melbourne and in regional Victo-rian towns during the 1950s, 1960s and 1970s and, withBlackmores encouragement, he established a naturo-pathic college in Melbourne in 1961.[34]

NATUROPATHY BOOM FROM THE 1970sONWARDS

Naturopathy experienced a resurgence in the late 1960sand early 1970s as the public became increasingly disillu-sioned with orthodox medicine. The tragic repercussionsof thalidomide treatment in pregnancy became appar-

ent and for the first time, the reductionist approach ofmedicine was being challenged. In 1962, Rachel Carsonpublished Silent Springand as a result became an eminentfigure in the modern environmental movement. For thefirst time, the general public were warned about the indis-criminate use of pesticides and fertilisers and the booksimpact was not limited to North America. The 1960s and1970s saw a worldwide interest in health and the evolu-tion of human consciousness; the general public turned toalternative medicine for answers. Jacka[34]estimates thatduring the mid-1970s, the student intake at the SouthernSchool of Natural Therapies increased by 400%, reflectingthis worldwide trend.

The development of naturopathy in Australia has beenheavily influenced by the practice of herbal medicine inparticular. Denis Stewart established the Southern CrossHerbal School and in 1978, the school awarded Diplomasof Medical Herbalism to its first graduates. Since the origi-nal Friday night lectures at the Glebe Town Hall in Sydney,Stewart has been involved with the training of hundreds ofstudents and some of Australias finest and most influentialpractitioners, with Nick Burgess, Andrew Pengelly, AnneCowper and Christina Scalone all training under Stewart.

Stewart is well respected for his system of dosing whichevolved from what he considered to be a lack of disci-pline in existing dosing regimes. Stewart was impressedby the dosing stipulations outlined in the British Herbal

Pharmacopoeiaof 1983 and began to use those doses inhis formulations. Stewart has always maintained thatunless a herb is prescribed within the stipulated doserange, maximum benefit from that benefit cannot beachieved. He has been a great exponent of the use ofthe 1:1 fluid extracts which were the basis of British andCommonwealth Herbal Medicine practitioners formula-tions (personal communication from D. Stewart, herbal-ist, 29 June 2009).

Denis Stewart and Dorothy Hall have been two key play-ers who have helped shape the clinical practice and train-ing of herbalists and naturopaths in Australia. Despite the

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opposing dosage principles that underpin the philosophyof their individual styles of clinical practice, their dedica-tion to naturopathic training established precedents forthe movement of naturopathic training into the domainof private colleges and eventually, the university system.

Australian naturopathy has also been heavily influencedby the successes of several other individual practitioners.

Robyn Kirby (b. 1936) was a practising herbalist for 26years and ran successful clinics on the central coast andin Sydney. She was a student of Denis Stewart and thefirst female president of the National Herbalists Associa-tion of Australia. Kirby is widely respected for her SinusTonic, which is still manufactured and sold today. Kirbyauthored several books during her career which addedvaluable information to the practice of naturopathy inAustralia (personal communication from R. Kirby, herb-alist, 15 June 2009).

The presence of naturopathy in Australia can also beaccredited to ongoing support provided by professionalassociations such as the National Herbalists Association

of Australia. The success and popularity of the conferencesorganized by Anne Cowper and the quality of researchpublished in the Australian Journal of Medical Herbalism,edited by Cowper, has allowed naturopathy in Australiato survive and grow underpinned by relentless and pro-fessional support. Cowper herself has also made signifi-cant contributions to the practice of herbal medicine inAustralia, writing several publications on herbal manu-facturing, running a successful private clinical practicesince 1988 and teaching students at naturopathic colleges(personal communication from A. Cowper, herbalist, 18June 2009).

In recent times, Kerry Bone has perhaps been one of themost influential contributors to the practice of naturop-

athy in Australia. Bone trained at the School of HerbalMedicine in the United Kingdom from 1980 to 1984 andwas heavily influenced by Simon Mills and Hein Zeylstra.Over the last 20 years, Bone has relentlessly promoted thevalue of herbal research to inform clinical practice, butnot at the expense of traditional knowledge, and his dedi-cation to research has provided the naturopathic profes-sion with six textbooks that illustrate this approach. Heestablished a masters course in clinical herbal medicineat the University of New England, which was the firstof its kind in the world (personal communication fromK. Bone, herbalist, 27 May 2009).

Augmenting the very herbal influence on naturopathy is

the nutritional approach to naturopathy. Henry Osieckihas been one of the key contributors to both the nationaland international naturopathic nutritional knowledgebase over the past 25 years. Osiecki was professionallytrained as a biochemist, dietitian and nutritionist and hasbeen heavily involved in research and product develop-ment during his career. He has written a number of text-books and his Physicians Handbook of Clinical Nutritionhas become a key undergraduate text and an importantclinical reference. More recently, Osiecki has broughttogether medical models and traditional therapies toform a comprehensive understanding of the biochemi-cal processes involved in cancer development and mood

disorders (biography of H. Osiecki supplied by Biocon-cepts, Brisbane (QLD), May 2009).

WHAT IS MODERN AUSTRALIANNATUROPATHY?

The practice of naturopathy in Australia is evolving. Fromits early beginnings with the practice of herbal medicine

in early settlements and on the goldfields to the moreformalised practice of herbal medicine within clinicalsituations through the 1900s, the use of herbal medicinehas always been a key naturopathic modality. With theinfluence of the European hydrotherapy movement andthe new interest in nature cure which was booming inthe United States, naturopathy in Australia came to rep-resent the practice of herbal medicine and nutrition withthe flexibility of other modalities such as massage, flowerremedies, iridology, tissue salts and celloids.

The formalised teaching of naturopathy programmesin private colleges and universities has predominantlyinfluenced the practice of naturopaths in Australia.With increasing emphasis on herbal medicine and clini-cal nutrition, underpinned with sound knowledge inthe health sciences (anatomy and physiology, pathol-ogy, pharmacology), naturopathy is becoming less of anumbrella term for an array of modalities and is streamlin-ing into a practice heavily driven by herbal medicine andclinical nutrition. Naturopathy is taught at the advanceddiploma and Bachelor level at private colleges (accreditedthrough the Vocational Education and Training Accredi-tation Board (VETAB)) and in line with current healthtraining package requirements. A full time naturopathyprogramme is also taught at undergraduate level at univer-sity in Australia. Postgraduate qualifications are availablethrough universities which recognise students undergrad-

uate qualifications. This enables access to higher educationopportunities including Masters level training for herbalmedicine and nutrition and various PhD pathways.

The eclectic and inclusive nature of the art of naturo-pathic healing, has seen the foundational modalities ofherbal medicine, nutritional medicine and nutritionalsupplementation combined in clinical practice withoptional modalities including iridology, flower essences,massage, chiropractic, osteopathy and homeopathy. Thisintegration and practice of several modalities is a definitestrength, allowing for flexibility in practice and multipletreatment options that can be chosen and tailored to suitthe individual case presentation.

More recently, the term naturopathic medicine hasemerged and embraces the original European concept ofnature cure and the modalities of naturopathy and hasplaced them within the framework of modern scienceand medicine. Such placement has resulted in consider-able focus on herbal medicine, nutrition and nutritionalsupplementation as key naturopathic modalities, withother modalities available as treatment electives. Suchflexibility means that the practice of naturopathy can,however, be hard to quantify at times. Smith[37]regardsthe practice of naturopathy as a unique system of primaryhealth care that is not limited to a single modality of heal-ing that combines the art and science of medicine using

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traditional forms of healing and modern scientific knowl-edge to prevent and treat illness.

Notwithstanding the ability of the modern naturopath todon any cap required is significant not only for the cur-rent practice of naturopathic medicine but also for thedevelopment of the profession. With recognition of andrespect for the limitations of practice, the naturopathic

practitioner has the flexibility to direct and manage caseswith the most appropriate therapeutic techniques. Life-style modifications are essential, and it could be arguedthat they often underpin the degree of clinical success in acase. Change strategies are important, but more importantare the techniques that the naturopath uses so that long-term and life-altering change can be made by the client.

Motivational support is essential. For effective clinicalpractice and results, there is increasing demand on thepractitioner to understand patient motivation and atti-tudes to health and success and to be able to fathom thepatients physical, emotional, spiritual, familial, social,occupational and financial stressors. As such, it is impor-

tant that the practitioner engage in the mindful practiceof self-awareness. Once an understanding of self beginsto develop, the practitioner then develops an ability tobe able to see a case presentation more objectively andwith greater clarity. The lived experience of the naturo-path is an essential therapeutic tool; any work done onthe self will directly benefit the type of patient who pres-ents and the outcome for that patient. The ability to giveand the extent of what is offered in a therapeutic situationis directly related to the amount that the clinician investsin his or her own health and self-awareness.

NATUROPATHY WITHIN THE AUSTRALIANHEALTHCARE SYSTEM

There are three forms of regulation available to healthpractitioners in Australia. These include self-regulation,statutory registration and co-regulation. Naturopathy inAustralia is self-regulated and is practised under commonlaw, which allows for the practice of naturopathy with-out any training whatsoever. However, because of thestrict educational and professional registration require-ments imposed by health insurance companies, althoughin theory it is possible to set up and practise as a natu-ropath without qualifications, it is much more difficultin practice. Such unqualified practice also detracts fromthe professionalism and legitimisation that naturopathypractitioners seek from the health care system and publicperception.

Although there is no official recognition for naturopathswithin the Australian healthcare system, naturopathicpractitioners are already working within a primary andallied healthcare network. Despite strong lobbying cam-paigns, naturopaths in Australia to this point have failedto obtain statutory registration even though naturopathyis taught at both a college and university level; chiroprac-tors and osteopaths have managed to gain registration inall states and territories and Traditional Chinese Medicinepractitioners have gained registration in Victoria. As such,naturopaths in Australia continue to take a back seatand are often relegated to being the last port of call for

patients with chronic or unresolvable conditions or forpatients who suffer life-threatening illness and want tomake sure all treatment bases are covered.

At present, there is a prevalence of complementary andalternative medicine use in Australia and research indi-cates that in 2006, 1.9 million naturopathic consultationswere conducted.[38]Australia is experiencing a quick evo-

lution towards naturopathic professionalism, and, moreand more, naturopathy is being accepted as mainstream.However, despite the progress in public awareness, a defi-nite split within the profession is apparent. One sectorof the profession is rallying to retain the traditional prin-ciples of a healing art that has been viewed as a fringemodality, a cottage industry of sorts, that has prevailedthroughout various political agendas of recent decadesbecause of its underground nature. The other sector isstriving for professional legitimisation of naturopathyand is pushing for statutory registration, giving naturo-paths recognition that has until now been reserved forallied health professionals such as physiotherapists, podi-atrists and osteopaths.

Such division within the profession leaves the practiceof naturopathy undefined; a lack of cohesion within theprofession provides an environment where therapeuticimperialism can thrive. The existence of a multitude ofprofessional associations has stifled the voice of a unifiedprofession and it is this lack of unity that has made gov-ernment negotiation difficult. The push towards registra-tion surely provides a framework which will ensure thesurvival of naturopathic practice. The movement towardsregistration has already begun; rather than questionwhether registration is in fact a necessity, the professionalshould be asking whether they want to drive the pro-cess, or whether they are satisfied to be mere passengers.

A cohesive movement into the future is required to notonly preserve traditional practices but also to legitimisecurrent practice.

At present, increased interest in complementary medicinehas been attributed to a decline in faith in the previouslyunquestioned power of modern medicine. Rather thanbeing pushed away from orthodox medicine, however,studies have reported that the general public is pulledtowards complementary medicine.[39,40]The very founda-tions of naturopathy, once dismissed and ridiculed, arenow being accepted. The importance of fresh food, freshair, exercise, good quality sleep and rest are now acceptedas is the need to limit the bodys toxic overload. Integra-tive medicine conferences now refer to the six maxims

of naturopathy as fundamental principles of medicine.They may be the principles of healing in the future, butthey certainly have not been the principles of medicinein the past.

The failure of modern medicine explains the increasedpopularity of integrative medicine. At present, integrativemedicine at its worst relies on cherry picking evidence-based medicines that can be used in conjunction withor in place of pharmaceuticals. Its scope is overwhelm-ingly limited, but in effect still provides solutions to bothgeneral practitioners and patients. At this point, orthodoxand integrative medicine cannot offer what naturopathy

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can. Integrative practitioners are for the most part stilldictated to by evidence-based research limited by thecurrent scientific paradigm. Time constraints and strictmedico-legal guidelines augment this. Naturopaths, onthe other hand, are freer to explore both empirical andevidence-based knowledge from several healing modali-ties. The flexibility of naturopathic practice means thatthe naturopaths toolkit can assume a Tardis-like statusand naturopathic solutions to health problems far exceedwhat the few evidence-based herbs or supplements canoffer.

We are perhaps, at this point, in the process of accumu-lating the research, ideas and concepts that will eventu-ally instigate a shift in consciousness and a more evolvedunderstanding of human health. Until that point, thoseplayers restricted by the paradigm within which they workmust continue to further their understanding of healthand disease. Those players not trapped by the paradigmof modern medicine must also continue to seek answersto questions that are so central to the human conditionbut relegated to the fringe. Each player must keep with

them an appreciation of the limits of modern medicineand an understanding of the infinite possibilities of heal-ing which have been demonstrated in the past, and whichare still to be experienced. Each healer, whether ortho-dox or complementary, brings a unique set of experiencesand values to their work, and consequently will attractpatients who resonate with that experience.

THEPRINCIPLESOFNATUROPATHYTHESIX MAXIMS

THE HEALING POWER OF NATUREVISMEDICATRIX NATURAE

An understanding of the first tenet of naturopathy neces-sitates both an acceptance and an appreciation of thepower of nature. This power exerts influence by dictatinghow the body responds to internal mechanisms that directcure and external influences that support and encouragecure. Naturopathy recognises that nature is both perfectlybalanced and organised intelligently to create, maintain,repair and destroy matter synchronistically. The bodyalso has its own intuitive and sophisticated mechanismof healing that operates in congruence with the laws ofnature. As nature regenerates itself without the need forhuman intervention so too does the human body. Theuse of natures healing agents (air, earth, water and sun)in combination with a clean diet, exercise, good sleep,

relaxation, meditation and an optimistic outlook areexamples of external factors that can influence and sup-port the bodys innate ability to heal. The naturopathsrole is to support and facilitate the bodys natural abilityto heal.

IDENTIFY AND TREAT THE CAUSETOLLECAUSAMUnderpinning this principle is the basic understand-ing that all illness must have a cause and for health tobe restored and optimised the cause or causes of the

disease state must be identified and removed. In thissense, symptoms are regarded as indicators of dishar-mony. They can be viewed as direct indicators of thecause of disease or as gross indicators of the intensehomeostatic effort required to adapt and repair. Amechanic would never remove a warning light froma cars dashboard to correct a mechanical problemdetected during a service; in the same way symptomsshould never be removed or suppressed from the bodyin order to restore health.

TREAT THE WHOLE PERSON TOLLETOTUMHealth and disease are the results of an intricate andintimate interplay of physical, emotional, mental, spiri-tual, social, familial and occupational factors. Failure toaddress all aspects relevant to a patients pattern of healthand disease fundamentally ignores the complexity of thehuman being. By its very nature, such ignorance motivateshealing interventions that are reductionist, short-sightedand founded in the disease rather than a health-focusedtreatment model.

FIRST DO NO HARM PRIMUMNONNOCEREThe principle of inflicting no harm on patients is a natu-ropathic reaction to the heroic medical procedures of thepast that saw the use of mercury, arsenic and the prac-tice of bloodletting. An understanding of this principlenecessitates an acknowledgement of the healing power ofnature. The naturopaths role is to facilitate the bodysnatural ability to heal and if this approach underpinspractice, then harmless practice will be a direct result.Naturopathic practice that respects the principle of harm-free treatment is traditionally non-invasive, and avoidsthe suppression of symptoms and the prescription of

harmful doses of medicine.

DOCTOR AS TEACHER DOCEREThe word doctor has a Latin origin and originally meantteacher. The maxim doctor as teacherreiterates the prin-ciple that as part of nature, the body can heal withouthuman intervention. The power to eliminate disease andoptimise health lies with the body itself not with thenaturopath, and in this sense the naturopath assumes therole of teacher so that the bodys natural healing mecha-nisms are supported. In this teaching role, the naturopathseeks to educate the patient and encourage self-education.The naturopath must be able to inspire and motivate thepatient and encourage self-motivation. Ultimately, natu-

ropathy seeks to empower the patient and encourageself-empowerment.

PREVENTION PREVENTARESeeing a naturopath to facilitate disease prevention is aconcept that is becoming increasingly difficult to pro-mote in a sickness-focused healthcare system. As a resultof this, the principle of disease prevention is more readilyapplied once a person is already under the care of a natu-ropath. Treatment of the primary complaint can begin andthrough a process of risk factor analysis, constitutional

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susceptibility and genetic tendency, naturopathy can beemployed to prevent both the sequelae of disease statesand the development of new states.

THENATUROPATHICAPPROACHThe naturopathic approach to health and disease focuseson the restoration of health where health has deteriorated,the optimisation of health where good health prevails,and the prevention or slowing of health deterioration.Naturopathy, in its basic form, is a celebration of simplic-ity with the promotion of fresh air, clean water, adequaterest, nutritious food and the use of herbal remedies andnutrition to assist with the bodys self-healing processes.Despite the complexities of modern disease pathogenesis,astounding improvements in the patients quality of lifecan be achieved by adhering to simple yet effective tech-niques to encourage self-healing.

As a key feature of naturopathic practice, simplicity doesnot necessitate that the naturopathic approach is in anyway unintelligent. The brilliance of this system of heal-

ing is the intelligence behind the simplicity. Comprehen-sive case taking plays a fundamental role in naturopathicpractice as practitioners strive to find answers in the manycauses of health deterioration rather than rely on a singlediagnosis. Naturopathic clinicians are often presentedwith numerous therapeutic challenges; informed clini-cal reasoning and case management will ensure optimalclient care. Modern medicine treats symptoms and oftensuppresses disease states. This method of approach doeslittle to identify and understand the dynamic causal inter-play of symptoms that can only be elicited with compre-hensive care taking.

Integral to treatment and optimal patient care is the natu-

ropaths understanding of their role. This reveals a com-prehension of the extent to which naturopathy can beused for patient benefit as well as an understanding of thelimits of treatment. In any case, successful case manage-ment requires that the naturopathic practitioner draws ona network of qualified and experienced practitioners fromother modalities (counsellors, acupuncturists, homeo-paths, osteopaths), so that the patient is offered thebest care.

A key strength of naturopathic practice is the abil-ity to offer consultations (between 30 minutes and1 hour) that enable and facilitate a longer comprehen-sive case taking process. The ability to offer appointmentsallows the practitioner and the patient to establish a rap-

port and provides a base where key issues (often not whatthe patient presents with) can be identified and discussed.This consultation time is what many patients seek, andfail to find, in the current healthcare system. Notwith-standing, naturopathy offers much more than just lend-ing an ear to patients, but it is this ear that opens dialogueand can unfold issues that block healing.

An initial visit to a naturopath would usually begin witha complete health history. If necessary, physical exami-nation or inspection will take place and the patientwill be referred to a general practitioner if necessary.

After the initial case has been taken, the naturopathmay order pathology tests through private laboratories;these can be general, functional or specialised. Otherspecific diagnostic tests can be requested, for example:comprehensive diagnostic stool analysis (CDSA), gas-trointestinal tract tests, functional liver detoxificationprofile (FLDP), Helicobacter pyloristool antigen (HpSA),intestinal permeability (IP), 3-day parasitology (3DP),genetic diagnostic testing, salivary hormone profiles,adrenal hormone profile, baseline hormone profiles,metabolic profiles, nutritional profiles, hair tissuemineral analysis (HTMA) and food sensitivity profiles.Some naturopaths choose to work with fewer labora-tory investigations and rely on laboratory tests orderedthrough the patients doctor and good case taking toidentify problems.

Augmenting the conventional medical history, the natu-ropathic assessment will also spend considerable timeassessing dietary, lifestyle, occupational, social, environ-mental and emotional influences and the impact thesehave on patient health and illness. The naturopath will

then formulate a treatment plan which addresses bothsymptomatic relief and the cause of the illness or diseasethe patient presents with. Herbal medicine, nutritionalsupplementation, nutritional advice and counselling arekey practice components with homeopathy, with floweressences and massage being introduced where necessary.

Follow-up appointments allow for treatments to beadapted, modified and tailored to suit ongoing or differ-ing demands. The second or third appointment can oftenintroduce the naturopath to many of the patients underly-ing drives that influence health. Follow-up appointmentsalso allow for an approach to healing that is shared by boththe patient and the practitioner as these appointments

allow the patient to report progress, setback, insights andexperiences all components are essential to healing.

At all times the naturopath must remain cognisant of theneed to do no harm. Often, patients will present withdebilitation from conventional treatments, so the prac-titioners job is to first restore then optimise health withas much care for patient safety and well-being as possible.Mills and Bone[41]refer to the need to balance physiologi-cal enhancement with physiological compensation. Inthis instance, physiological enhancement aims to createa state of robustness by raising vitality and physiologi-cal compensation attempts to compensate for organs ororgan systems that are over- or under-functioning.

THERAPEUTIC ORDERThe therapeutic order is the cornerstone of naturopathictreatment; it recognises the principles of naturopathicmedicine and prioritises treatment according to theseprinciples. This order fundamentally acknowledges theuse of non-invasive and restorative agents as the first lineof treatment. Treatments should then build in intensityas necessary. The therapeutic order is generally consistentfor each patient; however, individual treatments shouldalways be prescribed within the context of this therapeu-tic order. An Australian specific therapeutic order (after

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P A R T 1 : P R I N C I P L E S O F N AT U R O P AT H I C M E D I C I N E0

the original US order authored by Zeff and Snyder) is gen-erally understood to be as shown below:

Although the therapeutic order in the Unites States con-

tinues and suggests diagnosis and treatment with drugsand the inclusion of surgery, in Australia the therapeuticorder cannot progress unless the practitioner is qualifiedin conventional medicine or surgery. Referral at any nec-essary point during the therapeutic order is essential.

THE HOLISTIC PRACTITIONER

The holistic practitioner can be defined by the way thatpractitioner handles cases and relates to patients andfamily members of the patient, and by how other sup-port is sourced, introduced and managed. Effective casetaking and case management are imperative to holistictreatment and perhaps the ability to restore a patientshealth rests heavily on the quality of the case history that

is taken. The tradition of follow-up consultations is alsoimportant in holistic treatment. Trust between the patientand practitioner develops over time as the therapeuticrelationship develops and deepens, thus treatment canoften address concerns that would have otherwise goneunnoticed without this relationship. The importance offollow-up consultations is imperative to this deepeningtherapeutic relationship.

Holistic treatment must also endeavour to ascertain whata practitioner can bring to a therapeutic arrangement.Qualities such as confidence, certainty, presence (or theability to hold a space) and gratitude to the patient for

sharing their healing journey are key components of aholistic approach to healing. An area of holistic treatmentthat is often overlooked, either ignorantly or unasham-edly, is the health of the practitioner. With such emphasison the optimisation of patient health, practitioner healthis often overlooked and without investing in self-care, thepractitioner will fail to deliver the qualities necessary fora truly holistic treatment approach.

The first tenet of naturopathy introduces the conceptfirstdo no harm. Traditionally this has been interpreted toexplain the necessity of harmless practice and the impor-tance of patient safety. A more holistic interpretation cansee this tenet expanded to include the need for the natu-ropath to encourage the patient to do no harm to him/herself and for the naturopath to likewise do no harm tohim/herself. This brings with it the notion of practitionerself-care.

An understanding of the principle doctor as teacherwouldnot be complete without an understanding of disease asteacher. This transcendental view may not be appropri-

ate at all times; however, patients facing terminal illnessmay address this topic in consultation without beingprompted. In this teaching role, the naturopath alsobecomes a listener and a confidant. The ability to holdthe space is a prerequisite; advice and opinion are farless powerful than open ears, an open mind and an openheart. An understanding of the principle doctor as teacherwould not be complete without acknowledgement of thepatient as teacherrole in naturopathic practice. The abilityof a patient to continually teach is reliant on the practi-tioners ability to continually learn from patients. Such anorganic relationship is truly symbiotic and holistic.

MINDBODY MEDICINE ANCIENT

TRADITIONSAll ancient cultures acknowledge a role for the spiritwithin. It has only been with the superimposition ofallopathic medicine that this spirit has been dismissedand ridiculed as being unscientific. A Western under-standing of health is founded in mechanistic biomedicaltheory. Founded in reductionism and rationalism, thisunderstanding provides little framework within whichnon-dichotomous concepts of healing can exist. Withthe emergence of modern allopathic medicine, the holis-tic patient-specific model of healing was replaced by adisease-specific model with little room for mindbodyunderstanding, acceptance or investigation, and also withallopathic medicine came a shift from the art of healing

to the science of disease.

The interconnectedness of the body and mind is para-mount to all ancient and indigenous systems of healing.Healing temples in Ancient Greece provided healing inthe form of cleansing baths and fasts and the use of imag-ery and prayer, and hands-on healing was common prac-tice.[42,43]Paracelsus maintained a fundamental belief inthe mindbody connection; he believed that faith andimagination were the true vehicles of healing and thatphysicians were only able to heal by tapping into thepower of God.[44]Australian aboriginal concepts of healthhave also traditionally been holistic and based heavily on

1. Restore the basis of health by understanding and minimis-ing the obstacles to cure and promoting opportunities forhealing.

2. Identify potential obstacles to health and support/treataccordingly:

a. Hereditary/genetic influences including parental pre-conception health, inborn errors, epigeneticsb. Lifestyle considerations hygiene, environmental, spiri-

tual, social, relaxation, exercise, socioeconomic, interre-lationships, stress

c. Previous medical history and treatmentd. Dietary intake and assimilation.

3. Stimulate the bodys natural ability to heal by addressingthe cause of the disease.

4. Modulate body systems strengthen weakened organs andtonify overactive organs. The focus includes:

a. Strengthening the immune systemb. Eliminating toxinsc. Reducing inflammationd. Tonifying the nervous systeme. Balancing metabolic and hormonal activityf. Strengthening and toning other body systems as

necessary.5. Address structural disturbances referral to a massage ther-

apist or osteopath may be necessary.6. Address specific pathology or conditions and prescribe

accordingly once the cause has been identified and treated.7. Refer for suppression or surgical intervention if required.

Adapted from A Hierarchy of Healing: The Therapeutic Order. The UnifyingTheory of Naturopathic Medicine, Jared Zeff, ND, LacPamela Snider, ND,Stephen P. Myers, ND, BMed, PhD, in Textbook of Natural Medicine. Thiswas originally adapted from Zeff J, Snyder P. Course syllabus: NM51 71,Naturopathic clinical theory. Seattle: Bastyr University, 19972005.

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relationships between the people, the land and spiritualbelief. Traditional Chinese Medicine relies on the force ofchi, as Ayurveda relies on prana; the notion of universalenergy connecting mind, body and spirit and generatingeach individuals life force is fundamental to these heal-ing traditions.

EarlyResearchQuestionstheMindBodyDichotomy

The learned German abbess and mystic Hildegard ofBingen (10981179) practised mindbody medicinethrough her belief in the elements; the accumulationof black bile, for instance, was regarded not only as animbalance in the natural humours but also as a build upof suppressed emotion.[45]The dichotomous view can betraced back to the concept of dualism, which has largelybeen attributed to Descartes (15961650), who pro-posed that the mind and body are different substances.[46]Newton presented a departure from Descartess approachand the accepted notion of Cartesian duality at the time.In his student notebooks he showed an early interest inthe causal interdependence of the mind and body andexpressed a particular interest in the connection betweenmemory and physiology.[47]

In 1905 Darwin alluded to the as yet undiscovered con-cept of mindbody medicine when he linked emotionswith the potential of physical strength. He stated a manor animal driven through terror is endowed with wonder-ful strength, and is notoriously dangerous in the highestdegree.[48]The first scientific understanding of the mindbody connection was documented in the literature 6 yearslater by Walter Cannon. Cannon pioneered understand-ing of the emotional influence on disease states and theinfluence of hormonal and nerve transmission on bodily

functions. In 1911 he published research[49] that corre-lated emotional disturbance with digestion dysfunctionin animals. In 1914, he documented[50] the interactionbetween fear, rage, stress and asphyxia on bodily func-tion, and in revolutionary work in 1928 he suggested thatemotion could be transported either to the hypothalamusto influence peripheral movement, or to the neo-cortexwhere higher brain activity was stimulated.[51]In 1936[52]he published more extensive research on the role of emo-tion in disease formation. Cannon was the first investiga-tor of this emerging field of psychosomatic medicine thatattempted to link and explain emotional influences ondisease states.

In groundbreaking work in 1949, MacLean identified andnamed the limbic system and suggested that psychoso-matic disorders were the result of disrupted communica-tion between the limbic system and the neo-cortex. [53]In fact, the term psychosomatic was first introduced byMacLean; he described psychosomatics as the pursuit ofknowledge that attempts to explain how and why psycho-logical processes were expressed through physiologicalbody changes.[54] In the 1950s, Alexander[55] suggestedthat psychological disorder and conflict contributed tothe development and pathogenesis of medical condi-tions; his work was criticised as it failed to link psycho-logical function to the majority of disease states present

at that time. The failings of such early models provokedmore research and in the 1970s Engel[56] presented abiopsychosocial model of illness that identified interre-lationships among biologi

clinical naturopathic medicine rev hechtman 9780729541510

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