Philosophy of Naturopathic Medicine

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Chapter 5 Philosophy of Naturopathic Medicine

Rachelle S. Bradley, ND

Introduction

This chapter examines the philosophical foundation of naturopathic medicine and its modern applications. Unlike most other health care systems, naturopathy is not identified by any particular therapy or modalities (e.g., conventional medicine, drugs and surgery; chiropractic, spinal manipulation). A wide variety of therapeutic styles and modalities are found within the naturopathic community (Box 5-1). For example, there are still practitioners who adhere to the strict “nature cure” tradition and focus only on diet, “detoxification,” lifestyle modification, and hydrotherapy. There are also those who specialize in homeopathy, acupuncture, or natural childbirth. At the other end of the spectrum are naturopathic physicians who use botanical medicines, nutraceuticals, and pharmacology extensively to manipulate the body’s biochemistry and physiology. Finally, there is the majority, who practice an eclectic naturopathic practice that includes a little of everything.

BOX 5-1 Naturopathic Modalities

Naturopathic physicians are trained to use a number of diagnostic and treatment techniques. These modalities include the following:

• Diagnosis. All of the conventional clinical laboratory, physical diagnosis, and imaging (e.g., radiography) techniques, as well as holistic evaluation techniques

• Counseling. Lifestyle, nutritional, and psychological

• Natural medicines. Nutraceuticals (i.e., all food constituents, constituents of biochemical pathways, etc.), botanical medicine, and homeopathy

• Physical medicine. Hydrotherapy, naturopathic manipulative therapy, physiotherapy modalities, exercise therapy, and acupuncture

• Family practice. Natural childbirth, minor surgery, natural hormones, biologicals, and pharmaceuticals

Since its inception 120 years ago, naturopathic medicine has been an eclectic system of health care. This characteristic has allowed it to adopt many of this century’s more effective elements of natural and alternative medicine as well as to adopt conventional medicine’s basic and clinical sciences, diagnostics, and pharmacology. Through all of this eclecticism, naturopathic medicine has always identified the Latin expression vis medicatrix naturae (the healing power of nature) as its philosophical linchpin.

However, the expression vis medicatrix naturae, by itself, does not provide a clear picture of naturopathic medical philosophy or an understanding of the practice of naturopathic medicine in all of its varied forms. With the profession’s history of eclecticism, no two practitioners treat any individual patient exactly alike. This situation has its advantages (e.g., individualization of each patient’s care, more therapeutic options) but also makes it difficult to perceive the profession’s philosophic cohesiveness. Another major disadvantage of this eclecticism is the difficulty in developing consistent practice standards.

To attempt to solve this problem, the modern profession has articulated a general statement of naturopathic principles that expand on vis medicatrix naturae (Box 5-2). However, to gain a more in-depth understanding of naturopathic medicine, one must discuss medical philosophy in general.

BOX 5-2 The Principles of Naturopathic Medicine

The Healing Power of Nature: Vis Medicatrix Naturae

Nature acts powerfully through healing mechanisms in the body and mind to maintain and restore health. Naturopathic physicians work to restore and support these inherent healing systems when they have broken down by using methods, medicines, and techniques that are in harmony with natural processes.

First Do No Harm: Primum Non Nocere

Naturopathic physicians prefer noninvasive treatments that minimize the risks of harmful side effects. They are trained to know which patients they can treat safely and which ones they must refer to other health care practitioners.

Find the Cause: Tolle Causam

Every illness has an underlying cause, often in aspects of the lifestyle, diet, or habits of the individual. A naturopathic physician is trained to find and remove the underlying cause of a disease.

Doctor as Teacher: Docere

A principal objective of naturopathic medicine is to educate the patient and emphasize self-responsibility for health. Naturopathic physicians also recognize and employ the therapeutic potential of the doctor–patient relationship.

Treat the Whole Person

Health or disease comes from a complex interaction of physical, emotional, dietary, genetic, environmental, lifestyle, and other factors. Naturopathic physicians treat the whole person, taking all of these factors into account.

Preventive Medicine

The naturopathic approach to health care can prevent minor illnesses from developing into more serious or chronic degenerative diseases. Patients are taught the principles with which to live a healthy life; by following these principles they can prevent major illnesses.

Medical Philosophy

The issues fundamental to a discussion of medical philosophy have changed little since naturopathy first appeared as a distinct profession at the end of the nineteenth century. What has changed is the level of understanding of the biological process and the language of science. Most people who study the early writers on naturopathic medical philosophy quickly get lost in the archaic language and arguments used to justify the theories. This chapter translates these concepts and issues into modern terms.

Vitalism Versus Mechanism

Historically, there have been two main medical philosophies, those of vitalism and mechanism. Their origins can be traced to the Hippocratic writings of ancient Greece. Throughout history, the line separating these two schools of thought has not always been clear, but their philosophical perspectives have generally been in opposition. The conflicting goals and philosophical foundations of these two concepts remain relevant as the modern practices of conventional and alternative physicians come into conflict. As will be seen, the foundations of naturopathic medical philosophy are found in vitalism. However, naturopathy also recognizes the practical value of the mechanistic approach to health care.

Mechanism

Up to the early part of the twentieth century, there was considerable debate over the issue of vitalism versus mechanism in the field of biology. The mechanists, or materialists, maintained that the phenomenon of life could be explained exclusively as the product of a complex series of chemical and physical reactions. They denied the possibility that the animate had any special quality that distinguished it from the inanimate. It was their contention that the only difference between life and non-life was the degree of complexity of the system.

Mechanism has several other distinctive characteristics. Its most obvious is that it is reductionistic. Reductionism is often used as a synonym for mechanism. Mechanistic science is also characterized by an emphasis on linear causality. Without this emphasis on reductionism and linear causality, Western science and medicine would probably have not been so successful. As the twentieth century advanced, each new discovery in biological and medical science reinforced the arguments for mechanism, until, by the middle of the century, the biology community had almost exclusively embraced the philosophy of mechanism.

Mechanism is the philosophical foundation of biomedical science and conventional medicine. It is especially visible in the treatment modalities of surgery and most pharmaceuticals. Mechanistic medicine identifies disease and its accompanying signs and symptoms as simply the result of a disruption of normal chemical reactions and physical activities. Such disruptions are caused by the direct interference in these reactions and activities of a “pathogenic agent.” (For the purposes of this discussion, the expression pathogenic agent refers to any known or unknown etiologic agent, influence, or condition; examples are microbial agents, autotoxins, genetic defects, environmental toxins, non–end-product metabolites, and physical and emotional stress and trauma.) A living organism, then, is simply a very complex machine that, due to external agents and influences and “wear and tear,” breaks down. Because the signs and symptoms of disease are thought to be due only to these mechanical disruptions and interference with reactions, they are considered to be completely destructive phenomena and are therefore to be eliminated. Disappearance of the signs and symptoms indicates that the pathogenic agent and its resulting disease have been eradicated or, more likely, controlled. The goals of mechanistic medicine tend to be the quick removal of the signs, symptoms, and pathogenic agent.

Mechanistic medicine is being practiced in cases in which the intention of the therapy is to intervene in the perceived mechanism of the disease and/or to relieve the symptoms. Examples would be the use of antihistamines to relieve rhinitis, vitamin B₆ to help carpal tunnel syndrome, emergency care for traumatic injuries, coronary bypass surgery for blocked arteries, and insulin in juvenile-onset diabetes. Mechanism is also being used when an identified pathogenic agent is directly attacked or eliminated, for example, the use of antibiotics or the isolation of a patient from a particular allergen. Clearly, mechanistic medicine can be very effective in achieving its goals. In the presence of modern medical technology, it is easy to see how this philosophy came to dominate biology, medicine, and the attention of the public.

However, the unsolved problems of mechanistic medicine—particularly those of chronic degenerative disease; authoritarianism, which alienates patients from responsibility for their own health; and the rising cost of health care—suggest that there are limits to the mechanistic perspective and explain why vitalism has not disappeared and is in resurgence.

Vitalism

The philosophy of vitalism is based on the concept that life is too well organized to be explained simply as a complex assemblage of chemical and physical reactions (i.e., a living system is more than just the sum of its parts). This is in contrast to the mechanist’s contention that “the only difference between life and non-life is the degree of complexity.”

Throughout the nineteenth century, the debate between vitalism and mechanism was carried out mostly by biologists and, in medicine, between the “regular” doctors and those doctors who would now be called alternative. In the medicine of the nineteenth and early twentieth century these would have been homeopathic, hydrotherapy, nature cure, and eclectic doctors—all medical doctors with equivalent credentials under the laws of the time. Although the specific terms of “vitalism” and “mechanism” were not necessarily the nomenclature of their debate, the perspectives were the same.

Interestingly, through most of the nineteenth century this debate within the medical community was distinctively not based on science as we currently think of it. The “regular” doctors of the era, as represented by the American Medical Association, were still strongly influenced by Galen’s theory of disease of the four humors with its imaginary anatomy and physiology, bleeding, leeches, mercury, and other horrific treatments. Both the homeopaths and eclectic doctors argued based on empirical evidence; on the other side, the regular doctors argued based on a dogmatic theory that was more than 1500 years old and unsupported by any evidence. Harris Coulter produced the seminal work on this debate in his three-volume book The Divided Legacy.

The debate between vitalism and mechanism within the field of biology is well documented within the biology journals of the time. This was an era of amazing discoveries about how life functioned. Naturally, this is where the focus of this debate took place for biologists. As the secrets of cellular metabolism were revealed, this debate lurched from one specific argument to the next. The issue was where in the living organism did “God” have direct control. For example, at one point it was argued that the “seat of the soul” was the cell. As the cell was better understood, the place that was the point of God’s intervention was postulated to be the nucleus. As research further revealed how the organelles functioned, the vitalistic biologists gave up ground until vitalism as a distinct philosophy in biology was finally abandoned.

The error that doomed the vitalistic oriented biologists was that they were all reductionistic in the same way as the mechanistic biologists. Reductionistic science seems completely able to learn how life functions from a biochemical and biophysical perspective. Eventually, all of the individual chemical and physical reactions that are found in the processes of life will probably be identified. However, the vitalistic biologists missed the most essential aspect of vitalism: holism.

In naturopathy’s early years there were few interactions between it and the academic and research worlds. The great authors and practitioners came to naturopathy through “conversion,” in other words, most had been cured of some health problem by a natural cure and felt naturopathy and curing the sick was now their calling. There is no evidence that these naturopaths even knew that this debate between vitalism and mechanism was going on in the biology literature. Research in this early era of naturopathy consisted of observing nature and applying these observations to treating patients. This led to a deep appreciation of “nature’s” desire for balance and order (what a physiologist would call homeostasis). This holistic perspective, combined with the results of the naturopathic treatments, was the empirical evidence that drove their understanding of health and disease. It was only in the later half of the twentieth century that the field of naturopathic medicine began to converge with the academic and research worlds. Since the 1970s this convergence has moved at breakneck speed, until today there is no longer any real distinction (although this is not evident in some of the politically motivated diatribes against the field of natural medicine). However, by this time the academic and research worlds had long since forgotten about vitalism.

An organism’s unique complexity—as demonstrated by its ability to grow and develop, respond to stimuli, reproduce, and repair itself—requires a level of organization and coordination that suggests a distinct quality that is not readily explained by mechanism. This is studied extensively by all medical students in physiology class as the “normal” homeostatic process common to all living organisms. However, the tendency in conventional medical school is to put the concept aside when the student moves on to study pathology and the clinical sciences. Yet, up to the point of death, maintaining homeostasis is a prime, if not the primary, driving force in all living organisms. To think that homeostasis is only an important factor in “normal” physiologic processes and has no relevance in pathology is to ignore all of the basic sciences. All life is attempting to return to this ideal state whenever injured or ill. The only point in the life cycle that an organism is no longer “trying” to maintain homeostasis is death.

Reductionistic science has done a wonderful job elucidating the functions of the various components of life, but it tends to focus the researcher and the physician on the disease process as an isolated phenomenon rather than the result of a complex reaction of the whole organism to a pathologic agent. Fortunately, the debate between the vitalistic and mechanistic perspectives in the modern era focuses on the more relevant and holistic general concepts. Although modern vitalism is inherently holistic in its view, there is no conflict with the findings of biomedical science. What is significant is not the individual biochemical or biophysical reactions, but the fact that they are all coordinated to such a degree as to produce the special activities of a living organism. Because there is no inanimate counterpart to this level of complexity and organization, homeostasis is the most dramatic general argument in favor of vitalism.

A less dramatic argument supporting the vitalistic perspective is the “problem of entropy.” Entropy is the tendency of any closed system to find equilibrium, that is, the state of least organization. In other words, systems tend to run down and become less complex over time. In defiance of this universal rule, life, up until the point of death, consistently creates more complex systems out of simple ones. To do this, life actively pursues external matter and energy to incorporate into itself while also selectively eliminating by-products from its utilization of this matter and energy.

When the problem of entropy is examined on the molecular level, the same individual chemical processes and elements may be found in both animate and inanimate systems. In the inanimate system, however, there is a constant move toward a state of chemical equilibrium. This type of system cannot maintain an unstable chemical state and always seeks stabilization. Even after the addition of external exciting energy, the system returns to the simplest, least reactive state possible. The animate system is virtually the opposite. It is continuously in a state of dynamic chemical instability, actively seeking energy to maintain this instability and consistently moving to more complex and more organized states (and back again). It is only at the onset of death that an animate system begins to move toward equilibrium, and, of course, then it is no longer animate.

The third general argument in favor of a vitalistic view of life is evolution. For evolution to exist as a force in nature, generations of living organisms have to survive long enough to grow, reproduce, and then evolve. For this survival to take place, the organisms’ homeostatic and repair processes must be consistently directed toward maintaining a state of balance with the external environment (i.e., health). Any organism that does not behave biochemically and physiologically in this manner dies and cannot evolve. Thus the phenomenon of evolution, as the action of countless living organisms over eons, multiplies life’s anti-entropic quality and is incompatible with a mechanistic view of living systems.

These easily observable examples of life’s “special quality” suggest an “organizing force” that goes beyond what is possible from mere chemistry. This quality that makes life unique should not be mistaken as a metaphysical concept, although an argument for or against such concepts is not intended here. The point is only that vitalism is a medical philosophy based on observable scientific phenomena. Unfortunately, a definitive definition of this quality (in the old literature called the “vital force,” defense mechanism, or simply “Nature”) will have to wait for vitalistically or holistically oriented researchers. Reductionistic research has not provided much clarification of these special qualities of life—just ask a modern reductionistic biologist to explain how homeostasis works. They can describe what happens on a biochemical and biophysical level but they cannot describe why it happens.

At this point in the discussion, not many mechanistic practitioners would have reason to be uncomfortable. However, the conflict becomes evident with examination of the premises upon which the practice of vitalistic medicine is based. What truly separates vitalism from mechanism and makes it useful as a medical philosophy is its perspective on disease and its associated symptoms.

Meaning of Disease

Vitalism maintains that the pathogenic agent does not directly cause most symptoms accompanying disease; rather, they are the result of the organism’s intrinsic response or reaction to the agent and the organism’s attempt to defend and heal itself. Symptoms, then, are part of a constructive phenomenon that is the best “choice” the organism can make, given the circumstances at any particular time.

These symptoms can be further described as arising from two situations. The first and most common situation is when the symptoms are from what could be called a “healing reaction”—the organism’s concerted and organized attempt to defend and heal itself (i.e., the organism’s homeostatic process). These healing reactions produce what can be called “benign symptoms.” Examples are fever and inflammation in infections, almost any reaction of the immune system, and many of the symptoms of chronic disease.

This interpretation of symptoms is generally ignored by mechanism. Instead, it views a symptom as the result of a destructive process and focuses on intervening by relieving the symptom or manipulating the pathologic mechanism. Mechanistic medicine is therefore most often working contrary to homeostasis and the organism’s attempt at healing (this is usually its intent). When this therapeutic approach is effective, vitalists call the result a “suppression” (Box 5-3). This approach to health care is so pervasive that most people, lay and professional alike, still think nothing of suppressing mild fevers with antipyretics.

BOX 5-3 Cure, Suppression, Palliation, and Healing

Cure: A cure occurs when:

(a) a treatment is given to the person;

(b) the signs and symptoms of the disease go away;

(d) the whole person is healthier and less likely to get sick than before the illness.

This is almost always going to occur only when the whole person was treated, and not just the disease or its symptoms. Palliation and suppression never lead to cure in and of themselves.

Palliation: Palliation occurs when

(a) a treatment is given for the disease;

(b) the signs and symptoms of the disease go away; but

The symptoms of the disease are simply being controlled (not cured) as long as the treatment is continued.

It is a classic error of many practitioners and patients to equate palliation with moving towards cure. Palliation is on the opposite end of the spectrum as cure and is closer to suppression. Palliation can be useful, but in and of itself, never leads to cure—other more vitalistic and holistic interventions are necessary and may be as simple as changing to a healthier diet, removing some obstacle to recovery, or reducing stress, or as complex as classical homeopathy or traditional Chinese medicine. When palliation is used over a long enough time, suppression is the natural consequence.

Palliation is the most common result of almost all health care interventions. This is especially true of conventional medicine but also true for much of alternative medicine as well. Unfortunately, both the practitioner and the patient’s expectations are frequently satisfied with palliation. This is the most frustrating aspect of modern health care, whether conventional or alternative. Too few people are striving for a cure.

Suppression: Suppression is when

(a) a treatment is given for a disease;

(b) the signs and symptoms of the disease go away;

(d) the whole person is less healthy.

Although the symptoms of concern are better, the whole person is worse, which leads to more and worse disease in the future. In conventional medicine suppression is often a goal. Alternative medicine tries for a higher standard, but because palliation is often what happens, suppression can occur here, too.

Suppression frequently occurs because a treatment is given for a symptom or disease rather than the whole person being treated. Suppression leads later to another more invasive illness. An example is when steroids are given to suppress eczema and later asthma develops. If at this later point the person is given a treatment that is curative, there will be a return of the eczema as the asthma gets better.

Healing: Healing is what a living organism (body–mind) does, or attempts to do, for itself. A treatment can only

(a) control signs and symptoms (palliate or suppress);

(b) support life in a crisis (palliate or suppress);

(d) mechanically repair tissues that have been damaged or are malformed (palliate); or

(e) support and/or stimulate the organism’s innate healing processes while the body–mind does the work of healing itself (cure).

Curative treatment involves stimulating the whole organism to heal itself. The palliation and suppression of symptoms does not help to stimulate self-healing. Palliation tends to create the opposite effect and suppression actually gets in the way of the whole body–mind’s efforts to self-heal.

In contrast, vitalism considers these symptoms to be the product of a constructive phenomenon and therapeutically stimulates and encourages this directed healing process. Rather than simply trying to eliminate a pathogenic agent, as mechanistic therapy might, vitalism focuses more on augmenting the organism’s resistance to that agent. That is not to say that vitalists object to removing the agent, only that it should be done in the context of simultaneously increasing resistance (in other words, decreasing susceptibility). The importance of this approach becomes evident when one recognizes that disease is only possible when both a pathogenic agent and a susceptibility to that agent are present.

Healing reactions can take several forms. In the first type, an organism’s response to a pathogenic agent does not produce symptoms. When the organism is capable of easily defending itself from the agent, no symptoms are perceivable. This is a common homeostatic process and is demonstrated when a potential pathogen, such as β-hemolytic streptococcus, is cultured from a healthy person’s throat. However, when the organism is more susceptible or the relative strength of the pathogenic agent is greater, a threshold is reached and symptoms become perceivable. Successful healing reactions of this type include vigorous acute diseases that quickly resolve. The early naturopaths would have called these acute reactions “healing crises.” As the susceptibility of the organism increases relative to the strength of the pathogenic agent, there is a greater likelihood that the healing attempt will not be successful. When such a reaction is unsuccessful but vigorous, death may result, unless there is timely application of vitalistic or mechanistic therapy. Examples of this situation are acute bacterial meningitis and cholera.

When the healing attempt is feeble and therefore ineffective, the reaction usually goes into the “chronic disease” stage. Vitalists observe that suppression seems to increase the likelihood that the reaction will be forced to go into such a chronic stage. In this situation the reaction is “smoldering,” and most often the organism cannot overcome the pathogenic agent unassisted. It just “holds its own,” and as the organism’s general health decreases over the years, the reaction gradually degenerates, producing symptoms that become less benign as it moves to an end-stage pathology. Palliating the symptoms during this phase of the disease contributes to the declining health over time because palliation means that the underlying susceptibility or problem is not being addressed in a curative manner. If the organism can be therapeutically stimulated to produce a more vigorous healing reaction, it can often successfully complete the original healing attempt. This augmented reaction is another example of a naturopathic healing crisis and would also be called an “aggravation” by the vitalists who practice homeopathic medicine.

Intervening mechanistically by relieving symptoms does little to stimulate or encourage the healing response; it usually actually inhibits the healing response. In contrast, vitalistic therapies can be very effective in helping these healing reactions, because the goals of such therapies are precisely the same as those of the organism. Thus, it is thought that vitalistic medicine works because, by honoring this process and thereby strengthening the whole organism, it encourages a more effective healing effort. Ideally, the organism is then able to accelerate and complete its reaction against the pathogenic agent, leading to the permanent disappearance of the symptoms as it returns to a state of health.

It would be naive to say that every stage of the healing reaction is positive and in the best interest of the organism or that no symptoms should be palliated. The modern vitalist acknowledges that palliative intervention is sometimes necessary. In contrast, it is important to note that routine mechanistic intervention can encourage its own worst case scenarios. When mechanistic therapies successfully suppress an organism’s chosen healing reaction, a less effective and less desirable response is often produced. Therefore, when suppression occurs, it can lead to a more complicated medical situation. Consequently, the very practice of mechanistic medicine tends to reinforce its practitioner’s conviction that such intervention is usually necessary. It should be noted, however, that not all mechanistic intervention leads to suppression. It happens less often when the pathogenic agent can be readily eliminated, such as the use of an antibiotic in nonrecurring acute bacterial infections, or when relatively noninvasive therapies are used, such as natural medicines.

The second type of symptom-producing situation occurs when the organism produces symptoms in response to an organic lesion that arises from the direct pathologic influence of a pathogenic agent. These could be called “morbid symptoms,” examples of which are symptoms from the mass of an invasive tumor, shortness of breath from emphysema, and pain of an injury or myocardial infarction. It should be mentioned that even these symptoms are the result of the organism’s overall effort to maintain homeostasis, and benign symptoms are also often present. In addition, a morbid symptom is not necessarily produced for a negative reason. For instance, pain is valuable as an indication of tissue damage. As can be seen, many, if not most, of these situations involve end-stage disease. Here mechanistic therapies can be very positive when the goals of the therapy do not conflict with those of the organism.

There are instances when invasive mechanistic intervention will probably be required to save “life and limb.” These include such conditions as birth and genetic defects, serious traumatic injuries, crisis situations, overwhelming infections, and many malignancies. Unfortunately, mechanistic intervention does not guarantee a successful outcome either. Even in these situations, however, the effectiveness of vitalistic and natural therapy should not be underestimated, and their concurrent use will certainly augment any mechanistic intervention.

The concept of benign and morbid symptoms can be a useful tool to help the understanding of the healing and disease processes, but in many situations, it may not be possible to categorize the type of symptoms produced. A rough rule of thumb, however, would be that virtually all symptoms accompanying reversible or functional diseases are benign. In contrast, many of the symptoms associated with traumatic injury and end-stage pathology would be morbid symptoms.

Scientific Medicine

Although mechanism and vitalism represent opposing perspectives, the systems of medicine that represent these philosophies can be successfully tested and examined with the scientific method.^* That is not to say that the philosophy of vitalism has been unquestionably proven—only that the validity of vitalistic interventions can be scientifically demonstrated. If a therapy can be proven effective, the effectiveness implies the accuracy of the philosophy upon which it is based. Unfortunately, very few of the vast resources of the biomedical community have been directed toward investigating vitalistic medicine.

Conventional medicine, as the dominant health care system and a representative of mechanism, has claimed for itself the title “scientific medicine.” However, it is inherently no more or less scientific than vitalistic medicine. A system is scientific only when it has met the criteria of the scientific method. This method requires the collection of data through observation and experimentation and the formulation and testing of hypotheses. Nonprejudicial science can effectively study any system, but the researcher must understand the system’s particular paradigm. Experiments on a vitalistic therapy based on a reductionistic and mechanistic model are not going to be constructed to show success, or if they do show success, it will be entirely fortuitous.

The criteria of the scientific method can be met by vitalistic medicine, but only when the researchers recognize that it cannot be studied as though it is reductionistic or based on a simplistic model of linear causality. When the experimental model acknowledges the complexity of a living system in a social context (i.e., holism and circular causality/feedback loops), vitalistic medicine proves to be both verifiable and reproducible and, thus, scientific. Unfortunately, because of its current political and economic dominance, conventional medicine is in the position to dictate (through economic and publication control) that research and, therefore, the scientific method will be applied primarily to itself. The result is that most conventional practitioners dismiss vitalistic medicine, along with all alternatives, as unscientific. Ironically, most vitalistic physicians also have extensive training in mechanistic and/or conventional medicine. Generally, they are capable of practicing mechanistically and do so to greater or lesser degrees.

Naturopathic Philosophy

Vis Medicatrix Naturae

Naturopathic physicians assert that all true healing is a result of vis medicatrix naturae (the healing power of nature). Unfortunately, some people in the field of alternative medicine (including some naturopathic physicians and students) have mistakenly translocated this concept to the therapy. These practitioners tend to operate as though this “healing power” is an intrinsic property of the natural therapy or medicinal substance itself. In contrast, proponents of vitalism and naturopathic medicine have always understood that the “healing power of nature” is an inherent property of the living organism. Vis medicatrix naturae is the living organism’s “desire” and ability to heal itself. As mentioned, the homeostatic process best exemplifies this.

Historically, naturopathy is a vitalistic system of medicine. However, over the last 120 years its eclecticism has allowed it to incorporate a number of therapies that can function mechanistically. What makes these mechanistic therapies acceptable, given naturopathic medicine’s vitalistic foundation, is the emphasis on meeting each patient’s pragmatic health care needs. So the application of vis medicatrix naturae in practice is constantly adjusted depending on the situation at hand.

Ideally, naturopathic practice involves only the use of therapies that support the organism and encourage its intrinsic healing process to work more effectively while avoiding the use of medicines and procedures that interfere with natural functions or have harmful side effects. Natural medicines and therapies are therefore preferred, because when they are used properly and in appropriate circumstances, they are the least harmful, least invasive, and best able to work in harmony with the intrinsic natural healing process. In addition, their constituents have been encountered in nature for millions of years. This long period of exposure has enabled the body to develop metabolic pathways capable of effectively utilizing, processing, and detoxifying these medicines.

The total organism is involved in the healing attempt, so the most effective approach to diagnosis and treatment is to consider the whole person. In addition to physical and laboratory findings, important consideration is given to the patient’s attitude, psychological and spiritual state, social circumstances, lifestyle, diet, heredity, and environment. Careful attention to each person’s unique individuality and susceptibility to disease is critical to the proper evaluation and treatment of any health problem.

Naturopathic physicians contend that most disease is the direct result of the ignorance and violation of what would be traditionally called “natural living laws.” These general lifestyle rules (including diet) are based on the concept that there is an environment (both internal and external) that optimizes the health of an organism. Analysis of the lifestyles of Paleolithic and healthy primitive and modern cultures gives naturopathic physicians and their progenitors many clues as to what a healthy lifestyle should involve.

Throughout most of modern history, biomedical science has focused primarily on researching the sick. Recently it has finally begun to evaluate what constitutes a healthy lifestyle. To no one’s surprise, this lifestyle looks like the same one advocated by naturopaths for the last 120 years. A healthy lifestyle could be generalized to include the following:

• Consuming natural unrefined foods

• Getting adequate amounts of exercise and rest

• Living a moderately paced lifestyle

• Having constructive and creative attitudes

• Connecting to other people socially

• Being present to the spiritual aspects of life

• Avoiding toxins and polluted environments

• Maintaining proper elimination

It is also important to control these areas during illness to remove as many unnecessary stresses as possible and to optimize the chances that the organism’s healing attempt will be successful. Therefore, patient education and responsibility, lifestyle modification, and preventive medicine are fundamental to naturopathic practice.

Although the practice of naturopathic medicine is grounded in vis medicatrix naturae, it also recognizes that mechanistic intervention in the disease process is sometimes efficacious and, at times, absolutely necessary. Therefore, naturopathic physicians treat patients with a wide variety of vitalistic and mechanistic therapeutic modalities. It is the circumstances and the goal of the therapy that ultimately determines which approaches are utilized. Naturopathic physicians have a long-standing tradition of integrating the best aspects of traditional, alternative, and conventional medicine in the interest of the patient. As appropriate, patients are referred to other health care practitioners. Whenever possible, every effort is made to use all treatment techniques in a manner that is harmonious with the naturopathic philosophy.

Natural Medicines and Therapies

Traditionally, medicines administered and prescribed by naturopathic physicians have been primarily natural and relatively unprocessed. Four categories of natural medicines can be defined.

The first consists of substances found in nature that have been only minimally processed. Examples include, but are not limited to, foods, clean air and water, and whole herbs. The early “nature cure” practitioners used this category primarily. The second category involves agents extracted or made from naturally occurring products. Although these medicines have undergone processing, their constituents are still in the form found in the original natural substance. These first two types of natural medicinal substances have synergistic constituents that allow their use at lower doses with a resultant broader and safer therapeutic index. Examples of this category are tinctures and other botanical extracts, homeopathic medicines, glandular extracts, and other substances of animal origin.

The third category of natural medicines comprises those highly processed medicinal substances that are derived from a natural source. Often everything has been removed from such substances but the identified active ingredient, and they no longer have any synergistic constituents. Examples of these are the many new nutraceuticals made from plant substances, constituents of biochemical pathways, enzymes, amino acids, minerals, vitamins, and other food extracts.

The fourth category that may be considered natural are those manufactured medicines that are presumed to be identical to naturally occurring substances. They have the advantage of being less expensive and are typically available in higher concentrations. Examples of these manufactured natural medicines include bio-identical hormones, synthetic vitamins, and analogues of plant and animal constituents. However, their use is a compromise because:

• It is difficult to determine whether they are the equivalent of the natural product.

• They lack natural synergistic components.

• They include contaminates from the manufacturing process; these contaminates are often chemically and structurally similar to the desired medicine but generally interfere with the normal pathways rather than enhance them.

Naturopathic physicians also use many natural therapies. What makes a therapy natural is that it is derived from a phenomenon of nature and is used to stimulate the body to heal itself. Examples of these phenomena are air, light, heat, electricity, sound, and mechanical force. Some of these natural therapies are mechanical and manual manipulation of the bony and soft tissues (naturopathic manipulative therapy), physiotherapy modalities (e.g., electrotherapy and ultrasound), hydrotherapy, and exercise therapy. Naturopathic physicians also use lifestyle modification, counseling, and suggestive therapeutics. These therapies are all discussed in more detail in other chapters.

Family and Specialty Practice

Naturopathic physicians, like other types of primary care providers, develop practices that meet their personal interests and skills. Although most are engaged in general and family practice, many have also specialized in particular therapeutic modalities and/or types of health problems. In all situations, however, the emphasis is still on treating the whole person. The practice of family medicine requires the use of some medicines, techniques, and devices that are not natural but belong among the comprehensive family practice services offered by the naturopathic profession.

In the modern era of naturopathic medicine many states have expanded the scope of practice so that naturopathic physicians now practice much like other primary care practitioners with pharmaceutical prescribing rights. However, naturopathic physicians generally approach the use of pharmaceuticals differently than conventional physicians. They are seen as temporary interventions to be used to support the patient while other, more vitalistic natural therapies are used to help the patient recover his or her health with the ultimate goal of no longer needing the pharmaceutical.

Many naturopaths have also developed advanced expertise in different natural therapeutic modalities. These practitioners have usually invested in postgraduate training, such as that available through residencies. Three therapeutic specialties that merit mention are natural childbirth, acupuncture, and homeopathy. There is also a growing trend of specializing in organ systems (e.g., gastroenterology) or diseases (e.g., cardiology).

The Philosophical Continuum

When the various healing systems are examined and placed on a philosophical continuum, mechanism and vitalism are on different ends of the same health care spectrum. Both ends of this health care continuum have their strengths and weaknesses. Mechanistic medicine is effective for trauma, crisis care, end-stage disease, and many acute disorders. However, it is essentially a failure for chronic disease. Conventional medicine considers most chronic diseases incurable. Vitalistic medicine, in contrast, has its most dramatic successes with chronic disease and is effective with many kinds of acute disease. It is not very effective with trauma and crisis care or with end-stage disease, although it can be a very useful complement to conventional medicine. As can be seen, both ends of the health care spectrum are necessary if every patient’s health care needs are to be met.

Although aspects of naturopathic medicine (e.g., constitutional hydrotherapy) and conventional medicine (e.g., chemotherapy) represent the archetypes of vitalism and mechanism, the space between the ends of this spectrum is a gray area within which both naturopathic and conventional physicians operate on a continual basis. Naturopathic physicians integrate vitalistic therapies with mechanistic therapies, but it is not possible for everyone to be experts in everything. The vast majority of naturopathic or conventional physicians cannot learn and competently practice all types of health care. Consequently, to effectively meet society’s health care needs, it is necessary to create an integrated health care system. Such an integrated system would have both vitalistic and mechanistic practitioners working together in the same clinical settings.

The trends of popular culture and biomedical science that are finally beginning to study alternative medicine suggest that the creation of an integrated health care system is now under way. However, it takes no great skill for a mechanistic medical doctor to switch from giving a synthetic drug for a disease to giving a natural medicinal substance (both mechanistically oriented interventions). If naturopathic medicine becomes just another mechanistic system using natural medical substances to treat disease (instead of a system identified with treating the whole person vitalistically), it will lose its unique niche in an integrated health care system. To survive and thrive in this new environment, naturopathic medicine must keep its vitalistic roots. With a thorough grounding in vis medicatrix naturae, modern naturopathic medicine will flourish and achieve a leadership position as the dominant health care paradigm shifts to the integrated medicine of the future.

Conclusion

The practice of naturopathic medicine can be summarized most simply as helping the body–mind heal itself in the least invasive, most fundamentally curative manner possible. This approach is not tied to any particular therapy or modality, but rather is oriented to a rational blend of vitalistic and mechanistic principles working with the whole person and educating the patient in the ways of health.

As naturopathic knowledge of health and disease grows, new therapies and approaches to health care will be added as they satisfy the principle of vis medicatrix naturae. With integration of the larger health care system, naturopathic medicine’s place is assured as the profession that truly understands each unique human being’s power to heal.

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Philosophy of Naturopathic Medicine

Introduction

The Healing Power of Nature: Vis Medicatrix Naturae

First Do No Harm: Primum Non Nocere

Find the Cause: Tolle Causam

Doctor as Teacher: Docere

Treat the Whole Person

Preventive Medicine

Medical Philosophy

Vitalism Versus Mechanism

Mechanism

Vitalism

Meaning of Disease

Scientific Medicine

Naturopathic Philosophy

Vis Medicatrix Naturae

Natural Medicines and Therapies

Family and Specialty Practice

The Philosophical Continuum

Conclusion

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