Alternative medicine is a broad term encompassing a variety of medical modalities. These are typically supported by tradition and seldom taught in a Western medical setting. Such modalities range from the ancient Eastern practices of acupuncture and Tai chi, to herbal medicine, Reiki, chiropractic manipulation, and more. These services are often used interchangeably with the term "alternative medicine", a designation created in the 1800s that distinguished these modalities as “alternative” to allopathic medicine. Allopathic medicine is also commonly referred to as Western medicine, evidence-based medicine, conventional, or mainstream medicine. In the nineteenth century, allopathic medicine was based on a practice of opposites whereas the alternative branch suggested that “like cured like.” Present day differences remain but tend to revolve around a disease-centric (allopathic) versus a whole-body (alternative) approach. Alternative practices focus on stimulating the body’s ability to heal itself via energy alignment, herbal supplementation, and other balancing techniques. Conversely, allopathic medicine focuses on symptom-specific treatment, typically with pharmacological or invasive methods to remove the offending agent. With ancient records supporting alternative modalities and rigorous clinical trials supporting allopathic modalities, there continues to be disagreement over which method is proven beneficial and safe. Today, many physicians are embracing the beneficial aspects of both types of medicine through the practice of Integrative Medicine in which they combine appropriate alternative and allopathic techniques according to the patient, symptoms, and circumstances. Additionally, large trials attempting to solidify evidence for the anecdotal benefits of alternative medicine are increasing in popularity.

Common Forms of Alternative Medicine:

Acupuncture:

Acupuncture is an ancient Chinese technique used to balance chi, the energy of life.  According to the ancient beliefs, chi is an energy flow that courses along pathways within the body. These paths are termed meridians. With acupuncture, small needles are placed trans-dermally along these meridians to redirect chi. The needles are often manipulated via clockwise or counterclockwise twisting to further stimulate chi. Additionally, the needles can be connected to electric stimulators that provide intermittent or continuous electric stimulation. This newer form of acupuncture is termed Electroacupuncture. The placement and manipulation of the needles vary based on the goal of the treatment. Treatment applications are expansive and range from symptomatic treatment for depression[1], pain[2][3], gastrointestinal issues, allergic rhinitis[4] to specific goal-oriented approaches such as with fertility treatments or decreasing the risk of chronic diseases such as cardiovascular disease[5].

Ayurveda:

Ayurveda is an ancient Indian practice that originated thousands of years ago. In Sanskrit, Ayurveda translates to “The Science of Life” and is often referred to as the “Mother of All Healing.” This practice was passed down verbally and very few written documents are accessible today. Many alternative therapies are rooted in the basic belief system coined by Ayurveda that supports the promotion of health through the balance of mind, body, and spirit. It is believed that a unique combination of five universal elements makes up each individual: space, air, fire, water, and earth. These elements make up three doshas, or energies: Vata dosha, Pitta dosha, and Kapha Dosha. Each person has a unique combination of these energies, each with its own properties and controls. When one becomes ill, it is a result of an imbalance in their doshas that must be rebalanced. The Ayurveda practice focuses on maintaining a healthy balance amongst all these aspects of life to promote health and well-being. Many homeopathic and naturopathic practices are rooted in this belief system.

Herbal Medicine:

Herbal medicine is another loosely defined and broad term that encompasses a variety of practices. Many cultures throughout history have embraced botanicals and herbs for their healing properties. For example, the ancient Egyptians wrote a book in approximately 1550 BC called Ebers Papyrus in which they detailed the medicinal uses of over 850 plants. Similarly, much of today's knowledge on herbal supplements stems from Traditional Chinese Medicine in which herbs are prescribed and used for various ailments such as depression[6], respiratory symptoms including COPD[7], hepatic dysfunction[8] and chronic heart failure[9].

Today, many herbal products and supplements are sold over-the-counter in grocery stores, pharmacies, and clinics. An herbal product is any plant-based product used to improve health while an herbal supplement is an herbal product intended for internal use only. These products and supplements come in various forms including dried, minced, powdered or capsulated. They can then be utilized in various ways through methods such as ingestion (via pill or brewed teas), application (lotions, creams, and oils), or absorption (bath soaks).  In the United States, these substances are categorized as food as opposed to medication and are thus not regulated by the FDA (see more about this in the Issues of Concern section).

Many case reports have been documented describing the beneficial effects of herbs and Traditional Chinese Medicine claiming cures for various diseases. Several large-scale evaluations have been proposed to validate these claims and improve the legitimacy of herbal substances within the scope of Western medicine.

Some commonly used herbal supplements:

• Black cohosh: Primarily used for issues regarding the female reproductive system such as menstrual cramps.
• Echinacea: Used to enhance the immune system
• Garlic: Noted for its beneficial cardiovascular effects particularly cholesterol.
• Ginseng: A commonly used energy-boosting agent (often found in energy drinks)
• St Johns’ Wort: Claims improvement in mood, particularly mild to moderate depression.

Body Manipulation:

Yoga, massage, Tai chi, chiropractic, and Osteopathic manipulations all fall under the umbrella term “Body manipulation.” These practices vary greatly in their implementation but boast similar beneficial effects. Yoga and Tai chi are ancient exercises aimed at improving the health of both the mind and the body.

Yoga does this through asanas (postures and poses aimed to improve balance, flexibility, and circulation), pranayama breath, and samyama (meditation). Ancient yoga practices were rooted deeply in spiritual and religious beliefs; however, modern yoga has shifted the focus to a more personalized approach in which mindfulness and openness are encouraged as opposed to the subscription to certain religious beliefs. Many forms of yoga have emerged since its inception in ancient India (~300 BC) including vinyasa yoga which focuses on flowing movements coordinated with the breath, Bikram or “hot yoga” which is performed in a heated room, and Hatha yoga which incorporates a variety of different yoga techniques in one practice. While there are many challenges in studying the effects of yoga, there are numerous studies documenting the benefits of yoga such as improved balance, strength, flexibility, and decreased pain and inflammation.

Tai chi is an ancient Chinese practice that similarly focuses on strengthening the mind-body connection. Originally, it was performed as a form of self-defense, but has since morphed into martial-arts inspired movements coordinated with the breath. These movements are performed at the participant’s own pace in a slow and continuous method as a form of active meditation. The practice has many renditions varying from those focused on meditation to a more traditional self-defense approach. Tai chi claims comparable effects to those of yoga including improved mood, flexibility, stamina, and balance with decreased anxiety/depression and insomnia, among others.

Massage, chiropractic, and Osteopathic manipulations differ from yoga and tai chi in that a trained practitioner is adjusting one’s body with an external force. Each specialist uses a unique diagnostic approach consisting of observation, palpation, and possibly additional imaging modalities such as x-rays and other body scans. They then manipulate soft tissues, primarily muscles, and bones to realign the body to its intended alignment.

Other alternative modalities:

• Reiki
• Biofeedback
• Meditation
• Hypnosis
• Guided Imagery

While alternative modalities are rooted in thousands of years of tradition, there remain associated safety concerns. Implementing any alternative therapy can influence efficacy and dosing of many pharmaceutical agents, therefore knowledge of all ongoing medical treatments is imperative to safe care. Present-day practitioners are often open-minded about alternative techniques and can help incorporate appropriate methods into a comprehensive care plan.

Specific issues of concern:

Acupuncture:

Complications with acupuncture are relatively rare; however, always ensure patients are seeking care from a reputable, well-trained practitioner. Patients may be at higher risk for complications if they have a bleeding disorder or are taking blood thinners as these can increase the risk of bruising and/or blood loss. Additionally, electropuncture should be avoided in patients with a pacemaker. Pregnant patients should alert their practitioner as some puncture locations have been reported to stimulate labor. All patients should alert their acupuncture practitioner of any chronic illnesses and all prescribed medications.

Herbal Medicine:

In the United States, herbal products and supplements are not regulated by the Food and Drug Administration (FDA). Because of this, there is significant variation between batches regarding potency and additive amounts. Additionally, herbal products cannot advertise use for specific medical treatment which can cause confusion about their intended purpose amongst consumers. Finally, many supplements interact with enzymes in the body causing variation in the absorption and efficacy of other drugs. For example, St. John’s Wort is a Cytochrome P450 inducer[10] thus increasing the metabolism and possibly decreasing the efficacy of other medications including but not limited to antibiotics, anti-virals, and other medications predominately metabolized by the liver. Of note, many pharmaceutical drugs use purified botanical agents and are under strict regulation by the government for potency and clarity purposes and can be used as an alternative to herbal supplements. Careful consideration of side effect profiles for any treatment modality should be taken prior to recommendation.

Body Manipulation:

Overall, yoga and tai chi are considered low-impact and safe exercise modalities. As with any physical activity, the risk of injury is present. To help mitigate this risk, proper technique should be ensured by a certified instructor, limitations should be outlined for each individual patient, and the practice should be implemented slowly to allow the body to accommodate any changes.

Extrinsic manipulation of any kind should be performed by a trained and licensed practitioner. High-Velocity Low-Amplitude (HVLA) manipulation places patients at highest risk for injury. Recommendations vary with each manipulation technique and location, but generally, patients with the following medical conditions should avoid manipulation: pregnant women, individuals with osteoporosis, severe arthritis, or active infection, those taking blood thinners, individuals with known bone fractures, breaks or spurs and anyone with a known connective tissue disorder. Risk of artery dissection, herniated disk, and worsening of pain should be conveyed to all individuals prior to manipulation of any kind.

With the increase in research regarding alternative medical therapies, more and more physicians are embracing an integrative medical approach. Utilizing the benefits of both Eastern and Western practices for particular ailments works best. For example, alternative approaches lend themselves to the treatment of vague symptoms which Western medicine lacks definitive treatment options for such as fatigue, “cold” or flu symptoms, generalized gastrointestinal issues, etc. Other ailments necessitate the involvement of antibiotics and/or surgery such as appendicitis and certain bacterial infections. Remaining open-minded, tailoring treatment therapies to individual patients, their interests, and belief systems proves the most beneficial healing method. Finally, staying up to date on research supporting or refuting all types of medical treatment is vital to providing effective and appropriate care for your patients.