sign in sign up
<<
Home , Daniel David Palmer, Qi, Reiki, Therapeutic touch, Zero balancing

Subclasses of IM Overview of 1. Complete Medical Systems - Traditional Chinese Medicine (, Integrative Medicine herbs, therapies) - Ayyurveda 2. Mind-body Therapies Linda Chun MD - OSU Center for Integrative Medicine - , guided imagery - art or music therapy - , tai

What is integrative Subclasses of CAM medicine? 3. Biologically-Based Therapies - herbal and dietary supplements • Evolved from Complementary and - nutrition (CAM) - • CbiCombines mai itnstream medi dilthical therapies 4. Manipulative & Body-Based Methods and CAM therapies - • Goal of incorporating complementary - osteopathic or manipulation therapies for which there is high-quality 5. Energy Therapies of safety and efficacy - • Different from alternative medicine - Gong -

1 Integrative Medicine Why Integrative?

• Economic burden of chronic disease • Healing-oriented medicine worsening with aging population • Attention to patient’s whole being • Conventional medicine too dependent on • Consideration of spiritual and emotional costly high-tech approaches, including aspects pharmaceuticals • Focus on supportive and preventative care • CAM provide patients with greater autonomy

Integrative Medicine Why Integrative?

• Emphasis on -patient relationship • Patients may desire more natural or less- as partnership invasive therapies • Exploration of natural approaches to healing • Current medical system not sustainable • Neither rejects conventional medicine nor • Need to shift towards disease prevention accepts complementary therapies uncritically

2 History of CAM and Integrative Medicine Integrative Medicine and Academics • Long history of “hostile” relations between allopathic and “irregular” practitioners • Multiple centers now with integrative • 3 waves of popularity: medicine programs or services 9 Mid 1800’ s (h omeopath y) , • CtifAdiHlthConsortium of Academic Health 9 1890’s to early 1920’s (naturopathic, osteopathic, Centers for Integrative Medicine chiropractic practices), currently with 44 members 9 1960’s and 70’s (massage and acupuncture arise) • OSU joined in 2008 • Renewed interest through 1990’s, with growing challenges of chronic disease and high costs of medical care

Increasing Interest Who is using CAM? • National Center for Complementary and • 2007 survey conducted by NCCAM – National Alternative Medicine (NCCAM) in 1999 Health Interview Survey • Recognition of new discipline of integrative • More than 23,300 interviews with American adults, and more than 9,400 adults on behalf a medicine child • Full NIH research center with $127.2 million • Included detailed questions on CAM use in prior budget for 2010 12 months • Commitment to studying CAM with well- • Released December 2008: designed randomized trials http://nccam.nih.gov/news/camstats/2007/

3 http://nccam.nih.gov/news/camstats/2007 http://nccam.nih.gov/news/camstats/2007

http://nccam.nih.gov/news/camstats/2007 http://nccam.nih.gov/news/camstats/2007

4 Issues of Concern

• Toxic or detrimental effects of CAM • Drug-herb interactions • Lack of regulation of herbal/dietary supplements • Reduction of effectiveness of conventional therapy • unaware of patient CAM use • True effectiveness versus • Lack of reimbursement for costly therapies • of a consumer-driven market http://nccam.nih.gov/news/camstats/2007

Spending on CAM

• 2007 governmental survey • U.S. public spent approx $33.9 billion out- of-pocket on CAM over previous 12 months Complete Medical • 11.2% of total out-of-pocket expenditures • $22 billion on CAM self-care costs Systems • 354.2 million visits to CAM practitioners = one-quarter of total out-of-pocket spending on physician visits ($11.9 billion)

5 Complete Medical Systems Acupuncture • Key component of Traditional Chinese Medicine • Traditional Chinese Medicine (TCM) • Practiced for 1000’s of years • • Health achieved by maintaining balance of • • Flow of Qi (vital energy) through meridians • can be blocked, deficient, excessive, imbalanced • Influence Qi at acupuncture points with thin, metallic needles

Common Indications for Traditional Chinese Medicine Acupuncture • Chemotherapy-induced nausea and vomiting • Nutrition • Post-op pain • Chinese herbs • Lower back pain • Myypofascial pain • • Osteoarthritis • Headaches • • Menstrual cramps • Acupuncture • Tennis • Carpal tunnel syndrome • Addiction • Asthma

6 Acupuncture Techniques Medical Acupuncture • – therapeutic application of heat to acupuncture points by burning herb (Artemesia • Combination of Western medicine and TCM vulgaris) concepts • Cupping – applying suction to skin with small glass jars • Treats wi scope of con di on s in cl udin g prevention • – manual pressure applied to acupressure points and meridians • Looks at both medical paradigms • Electroacupuncture – electric current applied to • Affords more holistic approach needle • American Board of Medical Acupuncture

Acupuncture Ayurveda • Culturally based healing tradition, • Education and training requirements for licensure originated in India vary from state to state • Emphasis on maintain balance of • In Ohio, acupuncture considered an extension of branch of medicine • Digestion considered root of all health • Medical license or licensed acupuncturist • Diet, lifestyle, herbs, meditation, yoga, (following training at accredited school) panchakarma (detoxification), jyotisha, • Chinese excluded from scope of (oil massage) practice of acupuncture in Ohio

7 Ayurveda Naturopathy

• Ayurvedic training in India either • 4 naturopathic medical schools in U.S. bachelor’s or doctorate degree • Accredited by Council on Naturopathic • U.S currently without educational or certificati on st and ard Medical Education • Some states with approved Ayurvedic • Doctor of Naturopathic Medicine (N.D.) educational institutions • Licensing requirements vary across states • Current NCCAM-funded studies on: curcuminoids/turmeric, ginger, boswellia • No laws regulating naturopathy in Ohio

Naturopathy

• Holistic approach, rooted in Germany • Central belief that living organisms have powe r to hea l t he m selv es Mind-Body Therapies • Practitioners prefer most natural and least invasive treatments • Seek to treat cause of disease, not symptoms

8 Mind-Body Therapies Movement Related

• Focus on inducing state of physiological relaxation and stillness • Yoga • Enhance mental and physical awareness • Help recognize negative and • TiTai chi patterns of thought • Restore physical and psychological well- • Qi gong being • 2nd highest used CAM therapy

Mind-Body Therapies • • • Guided imagery • Expressive writing Energy Therapies • Art, music, dance therapy • Hypnosis • Meditation • Movement-related meditations • Progressive muscle relaxation (PMR)

9 Energy Therapies Energy Therapies • Reiki • Concept of physical body as an energy field suffused with “life force” • Polarity therapy • Two types of energy fields: • Johrei • Veritable = can be measured • QiGong • Therapeutic touch • Putative = have yet to be measured • Healing Touch • Qi (TCM) or (Ayurveda) • Yoga • Free balanced flow of energy necessary for • Acupuncture health •

Energy Therapies Reiki • Potential adjunctive therapies to medical • Japanese based energy field therapy management • Idea of universal energy that supports the body’s • Negligible negative side effects if properly innate healing abilities used • Practitioners channel this energy through hands • Useful to match patient’s belief system to into patient’s body available modalities • Self-care • Certification guidelines and directories of practitioners available on-line for most • Current NIH funded studies of Reiki: fibromyalgia, modalities AIDS, prostate cancer, DM II

10 Healing Touch Biologically Based Therapies • Assists in balancing physical, emotional, mental, and spiritual well-being • These therapies use substances found in • Supports natural healing ability to treat illness or promote wellness. • Transfer of energy by laying of hands above or 9 Nutrition on the body 9 Supplements • Based in the system 9 Botanicals • Initially developed for nurses 9 Functional Medicine

Nutrition

• Health effects of food are related to specific Biologically Based interactions on molecular level • Dietary constituents participate in the Therapies regultilation of gene expressi on 9 Modulating the activity of transcription Ruslana Kurpita MD factors through the secretion of OSU Center for Integrative Medicine hormones that in turn interfere with a transcription factor

11 Nutrition - Diets Nutrition • Environmental Nutritional Medicine • Western • Anti-inflammatory 9 Food Additives and Preservatives • Vegetarian • Elimination 9 Food Pesticides, Toxins and • Mediterranean • DASH Con tamin an ts • High Fiber • Low Fat 9 Food Storage, Processing and Preparation • High Protein Low Carbohydrate • Drug-Nutrient Interactions (Statins deplete body of CoQ-10) • Inter-Nutrient Interactions (Absorption of Magnesium is hindered by excess fat)

Nutrition Supplements

• From the mid 1800s to 1980: – Fiber content of Western Diets fell 75% • Vitamins – Sugar consumption rose five-fold to 25% of • Minerals calories • Essential Fatty Acids – Fat intake rose four-fold, replacing starch • Non-essential Amino Acids • According to published USDA data, nutrient • Biomolecular supplements content of 43 foods (mostly vegetables) showed reliable declines in content for protein, Ca, P, Fe, riboflavin and ascorbic acid

12 Essential Fatty Acids Omega-3 (Alpha-linoleic)

• Decrease • Increase • Omega-3 (Alpha-linoleic) – EPA, DHA production of production of • Omega-6 (Linoleic) 9 Chemoattractants 9 Nitric Oxide - inversely related to 9 Growth factors 9 Endothelial BP, CAD 9 Adhesion relaxation • Linoleic/Alpha-linoleic molecules 9 Vascular ratio in Western diets 9 Inflammatory compliance is 20:1 to 40:1 – ideal cytokines thought to be 4:1 to 1:1

Omega-3 (Alpha-linoleic) Rationale for Nutritional Supplements EPA (eicosapentaenoic acid) DHA (docasahexaenoic acid) • Significant failure to consume the RDA for many of micronutrients • Soils are significantly depleted of essential Properties: minerals • Anti-atherogenic • Stress reduces body stores of magnesium, potassium, zinc, selenium and group B • Anti-thrombotic vitamins • Anti-inflammatory

13 Rationale for Nutritional Supplements Botanicals

• Loss of nutrients through the storage, shipping, freezing, preservation, milling, • Natural – YES bleachi ng • Benign - NO • Greater exposure to free radicals and toxins in western society requires greater • Herbs and Supplements are regulated as amounts of endogenous and exogenous drugs in Canada antioxidants

How to Find Quality Botanicals Products • Some of the first medicines • Look for Product Seals • Confirm the identity and quantity of the ingredient • About 80% of the population of uses declared on the label plant medicine as their primary source of • Confirm product is free of healing contaminants and • Chemistry of plants is much more complex undeclared ingredients • Demonstrate that of pharmaceutical agents conformance to industry • Different parts of the same plant can have GMPs different qualities • On-going monitoring

14 Reading the Label Reputable Web Recourses

• Statement of identity • Consumer Reports Rating http://www.consumerreports.org/health/home.htm • Net quantity • Natural Standard • Name and place of business http://www.naturalstandard.com • Nutrition labeling • Office of Dietary Supplements (ODS) Fact sheets • Ingredient list www.ods.od.nih.gov

Reputable Web Recourses Functional Medicine

• Canada’s Natural Health Products Compendium of Monographs • Personalized medicine that deals with www.hc-sc.gc.ca primary prevention and underlying causes instead of symptoms for serious chronic • Consumer Labs disease www.consumerlab.com/ • Looks for commonalities and root causes • Natural Medicine Comprehensive Database www.naturaldatabase.com/

15 Core Clinical Approaches Body-based Therapies

• Osteopathic • Hormonal and • Immune imbalances neurotransmitter imbalances • Chiropractic • Inflammatory imbalances • Oxidation-reduction imbalances and • Massage mitochondropathy • Digestive, absorptive, and microbiological imbalances • • Detoxification and • Alexander Technique biotransformational • Structural imbalances from imbalances cellular membrane function to the musculoskeletal system • Feldenkrais • Healing Touch

Osteopathic Medicine

• Founded in 1874 by A.T.Still, M.D. Body Based • Three tenets of OM: 9 The B od y i s a unit (b od y/ mi nd/ spi rit cannot b e Therapies separated) 9 Structure and function is interrelated 9 The body is self-healing

16 Osteopathic Medicine Rolfing

• Founded by PhD • Main focus is on wellness and prevention • Focused on unlocking restrictions in the as opposed to treatment of the disease fascia • Use variety of manual medicine techniques • Patient lies down and is guided through specific movements. During these Rolfer manipulated fascia until it returns to its original length

Chiropractic Alexander Technique

• Found by • Discovered by Frederic Alexander • Theory • Form of education that is applied to 9 altered nerve flow is the cause of all recognize and overcome reactive, habitual disease limitations in movement and thinking 9 misaligned spinal vertebrae have effect on nerve flow • Teaching to express thinking in movement, making new choice in spite of established • Use wide variety of techniques with habitual patterns significant variation from practitioner to practitioner

17 Feldenkrais Contraindications

• Israeli scientist, nuclear physicist Moshe • Caution with vertebral artery Feldenkrais • Known joint disease (RA, gout, etc.) • Studied , physiology, kinesi ol ogy, and anat omy • Bone pathology (osteoporosis) • Bone neoplasm • Educational method intended to give greater functional awareness of the self • Genetic disorder • Improving the ability to move can improve • Hypermobile joint one’s overall wellbeing

Massage Typical side effects

• Recorded in Egyptian and even during • Worsening pain (transient) Biblical times • Fatigue • Was recommended by Hippocrates • Soreness • Mostly practitioner dependent • Nausea

18 Case Study Integrative Medicine Approach

• Mood • 46 y/o WF with history of Fibromyalgia, 9 Actively treat depression Insomnia, Depression, Obesity and multiple • Psychology allergg,yies to medications, comes to your 9 Psychotherapy, relaxation techniques, coping office looking for more natural approach. mechanisms, cognitive behavioral therapy, mind-body Her pain is out of control, feels very tired practices (biofeedback, mediation, etc) all the time, irritable, also complains of • Body-based therapy constipation. 9 Massage, acupuncture • Energy Movement Practices 9 Yoga, Tai Chi

Why care about integrative Integrative Medicine Approach medicine? • Nutrition • All of us and our patients will be affected in some 9 Anti-inflammatory Diet capacity 9 High Fiber diet • Awareness about potential negative effects • Supplements • More effective communication with patients 9 Magnesium, D-ribose, L-carnitine, Omega 3 , MVI, B-complex, Vitamin D (screen for deficiency), SAMe • Gain insight on our patients’ needs • Sleep • Feedback on how well we are serving our 9 Melatonin, Valerian Root, Anti-depressants, Behavioral Modification patients • Physical activity • Potential benefits and additional treatments – 9 Physical therapy for rehabilitation more tools

19 OSU Center for Integrative Medicine

• Opened in 2005 • MDs • Nutrition/Supplements • Chiropractic • Massage therapy • Psychology – Mind-Body • Acupuncture • Ayurveda • Community classes (yoga, art therapy, etc)

20