Understanding Differences Between Holistic, Alternative, and Complementary Medicine
IN THIS ARTICLE
The terms holistic medicine, alternative medicine and complementary medicine have often been used interchangeably. In fact, alternative medicine and complementary medicine are different and holistic medicine is a term which tends to embrace the larger definition of a system of treatment and practitioners who do not work within the system of conventional medicine. A more precise definition of the term is that holism is a philosophy that believes in treating the whole person and in the integration of mind, body and spirit. Holism promotes the belief that these three elements of a human being must be treated together in order to achieve any notion of ‘healing,’ rather than simply treating a person for a specific illness or injury.
In the holistic belief system, illness and injury are often the result of disharmony in the mind-body-spirit, which they see as one. The disharmony can often come about from a dysfunction in any one of these areas. But, holistic medicine believes that a dysfunction in one area affects the whole person and not just that one area of the body.Research in Australia demonstrated that one of the reasons so many Australians seek out alternative and complementary medicine is because of the holistic philosophy which guides their work. Conversely, it is also the reason why many Australians are becoming less enthusiastic about western or conventional medicine. They see it as non-holistic in nature (Hassed, 2004).
One of the terms which is increasingly popular in western culture is “wellness.” It is not only a term we see in popular magazines advertising day spas and on the shelves of health food stores; wellness is becoming a philosophy that is permeating western society. Universities, colleges and even huge corporations are beginning to offer wellness programs for their staff. The notion of ‘holistic’ is the foundation for this growing movement of wellness. Many people today have become tired of waiting long hours in an emergency room only to be treated by a tired doctor. They want to take their well being into their own hands and they feel empowered when they do.
Holistic medicine is as much about a way of life as it is about medical treatment. The holistic philosophy embraces an approach that promotes overall body wellness.
The term "Alternative Medicine" refers to alternative medical systems other than allopathic or traditional (conventional) western medicine. These include Traditional Chinese Medicine, Homeopathy and Herbalism. These all require certification and the practitioner is referred to as a doctor. They might carry the title of Naturopathic Physician or Doctor of Chiropractic. Alternative medicine is used in place of traditional or conventional medicine, although some people use them together.
The growing popularity of alternative medicine is due in large part to the growth of homeopathy. This 250-year-old science was developed in the late 18thcentury by the German doctor and biologist, Dr. Samuel Hahnemann. One of the primary principles in homeopathy is the Law of Similars. The premise states that ‘like cures like.’ “In other words, a substance produces symptoms of illness in a well person when administered in large doses. If we administer the same substance in minute quantities, it will cure the disease in a sick person” (Novella et al., 2008, p.9). Hahnemann had very different ideas about the body than his colleagues who practiced conventional medicine. He believed in the concept of the ‘constitution,’ the notion that the body must be treated as a whole and that the right remedy would literally ‘kick start’ the system into healing itself at the most basic level. In this way, homeopathy would not treat disease, it would heal the body. The second principle is the Law of Infintesimals, which states that “Substances become more potent when diluted” (Novella et al., 2008, p.9).
One must take into account that these principles were developed over 250 years ago. At that time, Hahnemann didn’t have the technological advantage which doctors and scientists enjoy today. Over the years since its inception, homeopathy has always been somewhat controversial. Some scientists have suggested that the remedies are so highly diluted that there’s actually nothing of the original substance left. There are doctors who have criticized homeopathy and suggested that people get well only because they’ve convinced themselves they’re better. An interesting roundtable discussion of scientists took place at Penn University earlier this year. After much initial skepticism, their conclusion was that homeopathy is indeed a valuable form of medical science. Novella (2008) states:
[…] Homeopathy is very plausible and there is both ample clinical and epidemiological evidence that it works. Homeopathy will become an integral part of medicine despite the paradoxical nature of its remedies and all other prejudices against it, simply because homeopathy is safe, efficacious, and cost effective (p.13).
The concept of the constitution is an important one in homeopathy. In many ways, this is the vital life force that Hahnemann believed exists in all of us. As a result of this belief, the Classical Homeopath engages in a highly detailed discussion with every patient especially during the initial visit. The Homeopath is concerned with everything, not just the physical symptoms occurring at the time. They want to know about the person’s emotions, their personal interactions, work life, stressors, dreams and anything else of importance in the person’s life. They also take into account the person’s appearance, demeanor and body language. “Homeopaths use the vital force assessment to guide dose (potency) selection and treatment pace and to judge the likely clinical course and prognosis” (Bell et al., 2004, p.124).
This notion of a vital force or constitution indicates that Hahnemann may have already known or understood (at least to a degree) what happens to the body on the atomic or molecular level. This is something that not even our present-day scientists can measure. The inability to measure this notion of the ‘life force’ or ‘constitution’ has been one of the criticisms leveled at homeopathy. The other has been its use of substances which are toxic in their natural state such as arsenic but are medicinal and safe in their diluted form such as Arsenicum Album, a well-known homeopathic remedy.
Jobst (2005) states her conclusions thusly:
In the meantime, if patients are recovering through the use of nontoxic homeopathic medicines and using the homeopathic method, let us, as physicians, get on and heal in the truest sense of that word, while as scientists we search to understand the mechanisms by which our activities might be working, and let us strive to always remain open (p.274).
Traditional Chinese Medicine
Traditional Chinese Medicine (TCM) may be one of the world’s oldest medical systems. It was developed over 2000 years ago and has only recently become popular in western cultures. One of the key concepts in TCM is the notion of qi or life-force. In some ways this notion of a life-force is somewhat similar to the notion of the vital force in homeopathy but they are understood and treated differently. There is no doubt that TCM is fundamentally different from western medicine in many essential ways. As well, even with a small similarity to homeopathy, it is also distinctly different from any other form of medical treatment. It’s important to take into account that TCM is a reflection of a specific culture, like Ayurvedic medicine which was developed in India. Some of the components that are essential to TCM include: personal observations of the physician, a subjective basis for diagnosis, healing as a way to balance the body’s processes, measuring the outcomes of treatment qualitatively (versus quantitatively) and gearing the treatment to the individual and not the condition (Shea, 2006).
One of the criticisms of TCM is that it is based on a physician’s subjective observations rather than an in-depth examination of the person. (Shea, 2006). This observation has even been made in China where many are beginning to question its efficacy. A second criticism has been the herbs used to treat the various conditions. A typical Chinese pharmacy has thousands of remedies made from an unbelievable combination of herbs, animal parts and other pharmacopeias.
Herbal medicine may have been humanity’s first attempt at a synthesis of conditions and corresponding treatments. Thousands of years ago, humanity was in its infancy and so was medical treatment. The very first treatments were likely the herbs and flowers that people found in their immediate surroundings. However, herbal medicine has come a long way since those early days of human civilization. In fact, the words ‘herbal’ and ‘natural’ seem to be everywhere. People in western countries are flocking to the stores to buy lotions with lavender, tea with chamomile and even cleaning products are being infused with natural and herbal elements. Today’s herbalists engage in training and they must be certified to practice. Although many advancements have been made in our understanding of what herbs can do and our preparations of herbal remedies, there are still concerns about the safety of these remedies.
“Safety issues related to herbal medicine are complex: possible toxicity of herbal constituents, presence of contaminants or adulterants, and potential interactions between herbs and prescription drugs” (Ernst, 2004, p.985). Given these concerns why is it that herbal remedies have become so popular and what is it that people and practitioners can do to ensure the remedies are safe and appropriate? One of the reasons for the increasing popularity of herbal remedies is the same reason for the boom in homeopathy and TCM. People are looking for natural answers to their problems. In fact there is a larger irony here. On the conventional side of medicine there are concerns over the safety of herbs and other alternative remedies. Yet, many people carry the same concern regarding pharmaceutical medicines and conventional treatments. People worry about radiation from CT scans and MRI’s. They wonder whether the medicines they’re taking won’t cause serious side effects as is the case with many medicines, which have had to be taken off the shelf permanently.
According to Ernst (2004), the ten best-selling herbs in the U.S. are: ginkgo baloba, echinacea, garlic, ginseng, soy, saw palmetto, st john's wort, valerian, cranberry, and black cohosh (p. 986). One concern which should be noted here is that unlike homeopathic remedies, herbs have the potential to interact with pharmaceutical drugs.
These are treatments that are given in conjunction with allopathic treatment and not in place of it. Complementary medicine prides itself on being non-invasive and non-pharmaceutical. However, it should be noted that some (not all) practitioners in this field of medicine are also highly regulated, undergo rigorous training and must be certified in order to practice.
While many people might think of chiropractic care as a relatively recent treatment, it was actually developed back in the late 19th century (Cooper & McKee, 2003). For decades, chiropractors fought to be accepted by mainstream conventional medicine. Even today, there are doctors who refuse to accept chiropractic care as a legitimate form of medical treatment. Yet, conventional medicine is becoming more supportive of chiropractors and many doctors (and even some surgeons) refer their patients to chiropractors before considering more invasive procedures such as surgery. Still, there are practitioners and people who are skeptical (and some even fearful) of chiropractic manipulations. This technique is called spinal manipulative therapy’ (SMT).
The primary reason people go to chiropractors is for musculoskeletal pain. Most often this is back or neck pain. They rely on the chiropractor’s use of SMT to alleviate their pain and hopefully avoid more invasive treatments. SMT is based on the principle that the spine experiences ‘subluxations’ of the joints. This literally means that joints go out of place and must be manipulated back into place. But, when they’re out of alignment, these joints can cause muscular, joint and nerve pain (Cooper & McKee, 2003). Unfortunately, some studies have suggested that SMT is not always reliable, has sometimes demonstrated adverse side effects and there is a problem with consistency of treatments among chiropractors which makes the treatments questionable (McKee and Cooper, 2003). Many insurance companies in the U.S. will not pay for chiropractic treatment and there are still concerns among conventional doctors about the efficacy of chiropractic care.
The growing popularity of massage therapy is not surprising. The thought of lying on a firm, supportive table, while soft music plays and someone kneads out the knots in our body has a positive ring to it. The question is whether or not massage therapy has any medicinal purpose. There are many different forms of massage such deep tissue, Swedish and Shiatsu (Japanese). Some doctors and researchers suggest that while having a massage is a nice experience and provides short-term pain relief, it does not have any long-term medicinal advantage. Others would disagree. Massage therapy is neither new nor unusual in western culture. Unlike other complementary and alternative forms of medicine which have only emerged recently, massage therapy seems to be an almost universal form of treatment. “Massage therapy, especially deep tissue massage (DTM), has been used for centuries to relieve myofascial syndromes including muscle spasm, muscle strain, and pain associated with numerous neuromuscular pathological processes” (Kaye et al., 2006, p.128).
Recently, doctors have become less skeptical about the long term benefits of massage therapy. People are being referred to massage therapists for a wide range of physical and psychological conditions. There have been clinical studies to suggest that massage therapy has both physical and emotional benefits. The use of massage therapy has broadened from being a luxury for an occasional ache or pain to being used for people with multiple sclerosis, cancer, HIV/AIDS, neurological trauma, sciatica, depression, anxiety disorders and many others. While some people do experience bruising, soreness, fatigue and increased discomfort (Cameron, Dexheimer, Coe, & Swenson, 2007), most people feel better after massage therapy.
The most famous treatment in TCM is probably acupuncture. It’s a treatment which has gained increasing popularity in western countries. Acupuncture is thought to be primarily for aches and pains or to alleviate the problems from an injury, however, it has a much broader medicinal application. Today, acupuncture is being used in clinical trials for a wide range of moderate ailments to life-threatening conditions. These include arthritis, chronic back pain, sciatica, HIV/AIDS and many others. The technique involves using various sized needles which the acupuncturist inserts into points along meridians in the body. These meridians are energy points and designed to stimulate the Qi, or the person’s life-force and the healing process. The ‘needling’ can be done dry or using electricity. “Acupuncture has established a reputation among the public for being a safe and effective treatment for a range of conditions. It relies greatly on its reputation for its widespread acceptance and growth as a valuable treatment technique” (White, 2007, p.9). Additional treatments in complementary medicine include; aromatherapy, ear candling, energy healing, crystal healing, reflexology, lymph drainage and cranial sacral therapy.
Further Insights: Integrating Holistic Medicine into Conventional Medical Training
One of the most promising applications is that of integrating these alternative and complementary medical treatments and philosophies into conventional medical training. It would be an enormous departure for western medical schools but might provide emerging doctors with a greater understanding of and respect for these medical systems which it’s likely they have no knowledge of or experience with. Although this represents an intriguing and perhaps promising concept, there are certainly hurdles to overcome before elements of homeopathy, Herbalism and TCM could be integrated into conventional medical training. There is still skepticism in conventional medicine concerning these alternative forms of medicine. Indeed, there would also be the issue of how much alternative information should and would be allowed.
However, given the increasing popularity of alternative medicine, and the fact that many people are turning to alternative practitioners, it may be to the advantage of conventional doctors that they have at least some level of knowledge regarding these medical systems. At the very least, they would be able to communicate with their patients in an informed and understanding way.
Given that millions of people worldwide are turning to alternative medicine and a more holistic approach in general to their healthcare, conventional medicine may begin to be out of step with the times if they don’t review the method for preparing/training new doctors and other practitioners to include the holistic approach.
Bell, I.R., et al. (2004). Strength of vital force in classical homeopathy: Bio-psycho-social-spiritual correlates within a complex systems context. Journal of Alternative & Complementary Medicine, 10 (1), 123-131.
Cambron, J.A., Dexheimer, J, Coe, P., & Swenson, R. (2007). Side-effects of massage therapy: A cross-sectional study of 100 clients. Journal of Alternative & Complementary Medicine, 13 Issue (8), 93-796.
Cooper, R.A., & McKee, H.J. (2003). Chiropractic in the United States: Trends and issues. Milbank Quarterly, 81(1), 107-138.
Ernst, E. (2004). Prescribing herbal medications appropriately. Journal of Family Practice, 53 (12), 985-988.
Hassed, C.S. (2004). Bringing holism into mainstream biomedical education. Journal of Alternative & Complementary Medicine, 10(2), 405-407.
Jobst, K.A. (2005). Homeopathy, Hahnemann, and the lancet 250 years on: A case of the emperor's new clothes? Journal of Alternative & Complementary Medicine, 11(5), 751-754.
Kaye, A.D., et al. (2008). The effect of deep-tissue massage therapy on blood pressure and heart rate. Journal of Alternative & Complementary Medicine, 14 Issue (2), 125-128.
Novella, S. et al. (2008). A debate: homeopathy—Quackery or a key to the future of medicine? :
Journal of Alternative & Complementary Medicine, 141(1), 9-15.
Shea, J. (2006). Applying evidence-based medicine to traditional Chinese medicine: Debate and strategy. Journal of Alternative & Complementary Medicine, 12(3), p255-263.
White, A. (2007). The safety of acupuncture techniques. Journal of Alternative & Complementary Medicine, 13(1), 9-10.