ALTERNATIVE

MEDICINE
 Introduction
Definition:
• These involve natural plant extracts, herbs, vitamins, minerals, dietary
supplements, and many techniques considered by some to be
unconventional.
• Such therapies include manipulative and body-based practices such as
acupuncture, hypnosis, biofeedback, and massage.
• They range from frank charlatanry (e.g. products based on unscientific
postulates, composed of diluent or of snake oil), through physical
therapies such as massage and aroma therapies which certainly please
(‘placebo’ means ‘I will please’) and do a great deal less harm than some
conventional therapies (e.g. surgery, chemotherapy).
• “Alternative” treatments are used in place of conventional medicine;
when used alongside standard medical practices, alternative
approaches are referred to as “complementary” medicine.
• Herbal remedies include dietary supplements (vitamins, minerals,
anti-oxidants and herbal products), phytomedicines (the use of plants
or plants components to achieve a therapeutic effect/outcome) and
botanical medicines (botanical supplements used as medicine).
Increase in the use of herbal remedies occur as a result of;
• Patient dissatisfaction with conventional medicine
• Patient desire to take more control of their medical treatment and
• Philosophical/cultural bias
CONTENT FOR ALTERNATIVE
THERAPIES
I. Systems of Health Care
• Traditional Chinese Medicine
• Native American medicine
• Homeopathy
II. Mind-Body Therapies
• Journaling (Provides a vehicle for expressing feelings)
• Imagery
• Meditation
CONTENT FOR ALTERNATIVE
THERAPIES
III. Manipulative Therapies
• Massage
• Tai Chi
IV. Biologic Based Therapies
• Aromatherapy
• Herbal preparations
V. Energy Therapies
• Healing touch
• Therapeutic touch
• Reiki
Integrative Health Care
• A Concept of Coordinated Health Care that Includes ALL the
Treatments (Conventional and CAMs) and Health Practices that Your
Patient uses in their Life.
• It is a total approach to care that involves the patient’s mind, body,
and spirit.
• It combines standard medicine with the CAM practices that have
shown the most promise.
example: learning to use relaxation as a way to reduce stress
during chemotherapy.
Holism
• Concept focused on Relationships among all living things.
• Therapeutic Encounters include:
• Enhancing Resistance to Illness
• Reducing aggravating behaviors
• Stress Management
• Goal is Optimal state of Wellness for each unique person
Complementary Medicine
• Complementary medicine is used along with standard medical
treatments.
example is using acupuncture to help with side effects of
cancer treatment.
Alternative Medicine
• Alternative medicine is used in place of standard medical treatments.
One example is using a special diet to treat cancer instead of a
method that a cancer specialist (an oncologist) suggests.
 Problems encounter in using alternate
medicine
• Lack of manufacturing or regulatory oversight, potential adulteration
and contamination of these herbal products.
• Little or no rigorous clinical trial evidence for efficacy and only
anecdotes about toxicity.
• Many patients who are highly attuned to potential harms of
conventional drugs (such as digoxin, a high quality drug derived
historically from extracts of dried foxglove of variable quality and
potency) fail to recognize that current herbals have as great or greater
potential toxicities, often putting their faith in the ‘naturalness’ of the
herbal product as an assurance of safety.
Types of Complementary and Alternative
Medicine (CAM)
• Mind-Body Medicines
• Biologically Based Practices
• Manipulative and Body-Based Practices
• Energy Medicine
• Whole Medical Systems
Mind-Body Medicines
These are based on the belief that your mind is able to affect your
body, examples include:
• Meditation: Focused breathing or repetition of words or phrases to
quiet the mind;
• Biofeedback: Using simple machines, the patient learns how to affect
certain body functions that are normally out of one’s awareness (such
as heart rate);
• Hypnosis: A state of relaxed and focused attention in which the
patient concentrates on a certain feeling, idea, or suggestion to aid in
healing;
• Yoga: Systems of stretches and poses, with special attention given to
breathing;
• Imagery: Imagining scenes, pictures, or experiences to help the body
heal;
• Creative outlets: Such as art, music, or dance.
Biologically Based Practices
This type of CAM uses things found in nature.
This includes dietary supplements and herbal products.
Some examples are:
• Vitamins
• Herbs
The most commonly used alternate
medicine
• Garlic (Allium sativum) used as hyperlipidaemic agent and
hypercholesterolaemi
• Ginkgo (Ginkgo biloba) used in treatment of dementia and claudication
• Echinacea (Echinacea purpurea) used in prevention of common cold
• Soy (Glycine max) Symptoms of menopause
• Saw palmetto (Serenoa repens) used in treatment of prostatic hypertrophy
• Ginseng (Panax ginseng) Fatigue
• St John’s wort (Hypericum perforatum) in treatment of depression (mild)
• Black cohosh (Actaea racemosa) Menopausal symptoms
• Cranberry (Vaccinia macrocarpon) Cystitis and UTI
• Valerian (Valeriana officinalis) Stress and sleeplessness
• Milk thistle (Silybum marianum) Hepatitis and cirrhosis
• Evening primrose (Oenothera biennis) Premenstrual symptoms
• Bilberry (Vaccinia myrtillus) Diabetic retinopathy
• Grape seed (Vitis vinifera) Allergic rhinitis
Manipulative and Body-Based Practices
These are based on working with one or more parts of the body. Some
examples are:
• Massage: Manipulation of tissues with hands or special tools;
• Chiropractic care (ky-ro-PRAK-tik): A type of manipulation of the
joints and skeletal system;
• Reflexology (ree-flex-AH-lo-gee): Using pressure points in the hands
or feet to affect other parts of the body.
Energy Medicine
Energy medicine involves the belief that the body has energy fields that
can be used for healing and wellness.
Therapists use pressure or move the body by placing their hands in or
through these fields. Some examples are:
• Tai Chi (ty-CHEE): Involves slow, gentle movements with a focus on
the breath and concentration;
• Reiki (RAY-kee): Balancing energy either from a distance or by placing
hands on or near the patient;
• Therapeutic touch (thair-a-PYU-tik): Moving hands over energy fields
of the body.
Whole Medical Systems
These are healing systems and beliefs that have evolved over time in
different cultures and parts of the world. Some examples are:
• Ayurvedic medicine (eye-yer-VAY-dik): A system from India
emphasizing balance among body, mind, and spirit;
• Chinese medicine: Based on the view that health is a balance in the
body of two forces called yin and yang.
• Acupuncture (AK-yoo-PUNK-cher) is a common practice in Chinese
medicine that involves stimulating specific points on the body to
promote health, or to lessen disease symptoms and treatment side
effects;
• Homeopathy (home-ee-AH-puh-thee): Uses very small doses of
substances to trigger the body to heal itself;
• Naturopathic medicine (na-chur-o-PATH-ik):Uses different methods
that help the body naturally heal itself.
Acupressure
• Acupressure is similar in practice to acupuncture, only no needles are
involved.
• Hands, elbows or feet to apply pressure to specific points along the body’s
“meridians.”
• Meridians are channels that carry life energy (qi or ch’i) throughout the
body.
• The reasoning holds that illness can occur when one of these meridians is
blocked or out of balance; acupressure is thought to relieve blockages so
energy can flow freely again, restoring wellness.
• Acupressure might decrease nausea for chemotherapy patients and reduce
anxiety in people scheduled to have surgery .
Acupuncture
• The term actually describes an array of procedures that stimulate
specific points on the body.
• The best-known variety consists of penetrating the skin with thin
needles controlled by a practitioner or electrical stimulation, and it’s
currently used by millions of Americans each year.
• Some studies find it helpful for chronic pain and depression.
Aromatherapy
• It is the use of essential oils (concentrated extracts from the roots,
leaves, seeds, or blossoms of plants) to promote healing.
• The oils can be inhaled, massaged into the skin or (in rare cases) taken
by mouth and each has a specific purpose:
• Some are used to treat inflammation or infections; others are used to
promote relaxation.
• Studies suggest aromatherapy might reduce pain, depression, and
anxiety, but more research is needed to fully determine its uses and
benefits .
Ayurvedic Medicine
• Also known as Ayurveda
• Ayurvedic medicine originated in India and has been around for
thousands of years.
• Practitioners use a variety of techniques, including herbs, massage,
and specialized diets, with the intent of balancing the body, mind, and
spirit to promote overall wellness.
Balneotherapy
• Also known as hydrotherapy
• Balneotherapy involves the use of water for therapeutic purposes,
and it dates as far back as 1700 B.C.E.
• It’s based on the idea that water benefits the skin and might treat a
range of conditions from acne to pain, swelling, and anxiety;
• Practitioners use mudpacks, douches, and wraps in attempts to reap
aqua’s rewards (water’s reward).
• Proponents of the therapy cite findings that water might boost
people’s immune systems, though research on balneotherapy’s
effectiveness remains inconclusive
Biofeedback
• Biofeedback techniques allow people to control bodily processes that
normally happen involuntarily—such as heart rate, blood pressure,
muscle tension, and skin temperature—in order to improve
conditions including high blood pressure, headaches, and chronic
pain.
• Patients work with a biofeedback therapist to learn these relaxation
techniques and mental exercises.
• In initial sessions, electrodes are attached to the skin to measure
bodily states, but eventually the techniques can be practiced without
a therapist or equipment.
• Researchers still aren’t sure how or why biofeedback works—but a lot
of research suggests it does work.
• Relaxation seems to be a key component, as most people who benefit
from the practice have conditions that are caused or exacerbated by
stress.
Chiropractic
• Chiropractic is pretty widely accepted in the medical community and
thus qualifies more as a “complementary” medicine than an
alternative one.
• The practice focuses on disorders of the musculoskeletal and nervous
systems, including pain in the back, neck, joints, arms, legs, and head.
• The most common procedure performed by chiropractors is “spinal
manipulation” (aka an “adjustment”), which involves applying
controlled force (typically the chiropractor’s hands) to joints that have
become “hypomobile.”
• The idea is that joints’ movements become restricted when
surrounding tissues are injured either during a single event (tweaking
a muscle during a weight-lifting session) or through repetitive stress
(sitting with poor posture for extended periods).
• Chiropractic adjustments of the affected area are intended to restore
mobility and loosen the muscles, allowing the tissues to heal and the
pain to resolve.
• Studies of chiropractic generally affirm its efficacy, with research
suggesting the practice can decrease pain and improve physical
functioning
Homeopathy
• Homeopathy functions in much the same way as a vaccine:
• It’s based on the principle of treating “like with like,” meaning a
substance that causes adverse reactions when taken in large doses
can be used—in small amounts—to treat those same symptoms.
• Homeopaths gather extensive background information on patients
before prescribing a highly diluted substance, usually in liquid or
tablet form, to jumpstart the body’s natural systems of healing.
• There’s some clinical evidence that homeopathy is more effective
than placebos, though more research is needed to determine its
efficacy
Naturopathy
• Naturopathic medicine is premised on the healing power of nature.
• Naturopathic doctors are trained in both conventional and alternative
medicines, and seek to understand the cause of a condition by
exploring its mental, physical, and spiritual manifestations in a given
patient .
• Naturopathy typically involves a variety of treatment techniques
including nutrition, behavioral changes, herbal medicine,
homeopathy, and acupuncture.
Reflexology
• Reflexology involves applying pressure to specific areas on the feet,
hands, or ears.
• The theory is that these points correspond to different body organs
and systems; pressing them is believed to positively affect these
organs and a person’s overall health.
• For example, applying pressure to a spot on the arch of the foot is
believed to benefit bladder function.
• A person can either use reflexology on her or his self, or enlist the
help of a reflexologist.
• Millions of people around the world use the therapy to complement
conventional treatments for conditions including anxiety, cancer,
diabetes, kidney function, and asthma.
Reiki
• Reiki is a form of energy healing based on the idea that a “life force
energy” flows through everyone’s body.
• According to this philosophy, sickness and stress are indications that
life force energy is low, while energy, health, and happiness signify a
strong life force.
• In a Reiki session, a practitioner seeks to “transfer” life energy to the
client by placing their hands lightly on the client’s body or a slight
distance away from the body.
• The purpose is to promote relaxation, speed healing, reduce pain, and
generally improve the client’s wellbeing.
• For the most part, there’s no regulation for Reiki practitioners.
HERBALS
• FDA categorized herbals as food and nutritional supplements not as
drugs

• The Dietary Supplement Health & Education Act (DSHEA) of 1994

• DSHEA requires no proof of safety or efficacy and sets no standards

40
Commonly used Herbals
• Know intended uses for each
• Know Caution & adverse effects of each
• Gingko bilboa
• Garlic
• Echinacea
• Ginseng
• St. John’s Wort

41
Garlic
• It has been used as a culinary spice and medicinal herb for thousands
of years.
• Active compound found in garlic is allicin which is produced along
with many additional sulphur compounds by the action of the enzyme
allinase when fresh garlic is crushed or chewed.
• Garlic lower serum cholesterol and triglyceride, but a recent trial has
shown limited to no benefit.
• Garlic is used in the treatment of many conditions, ranging from many
cardiovascular diseases, e.g. atherosclerosis including peripheral
vascular disease, hypertension, lipid disorders and sickle cell anaemia.
• Garlic can alter blood coagulability by decreasing platelet aggregation
and increasing fibrinolysis.
Adverse effects
• Gastro-intestinal symptoms such as halitosis, dyspepsia, flatulence
and heartburn.
• Headache
• Haematoma and
• Contact dermatitis.
Drug interactions
• Garlic inhibits many drug-metabolizing (CYP450) enzymes in vitro, but
induces CYP450s when administered chronically in vivo
• Garlic has no significant effect on the activity of CYP1A2 (caffeine),
CYP2D6 (debrisoquine, dextromethorphan) and CYP3A4 (alprazolam,
midazolam).
• Garlic significantly decreases the bioavailability of saquinavir and
ritonavir.
Ginseng
• There are different types of ginseng (Siberian, Asian, American and
Japanese), the most common type used in herbal preparations being the
Asian variety (Panax ginseng).
• Ginseng has been suggested to be a sedative-hypnotic, an aphrodisiac, an
antidepressant and a diuretic, and therapeutic benefits have been
claimed for many indications.
• Its pharmacologic properties include actions as a phytoestrogen,
suggesting that its use, as with soy supplementation, could be
disadvantageous in women with oestrogen-sensitive cancers (e.g. breast
or endometrium).
• The active component of ginseng, ginsenoside, inhibits cAMP
phosphodiesterase and monamine oxidase.
• These properties may partly explain purported central nervous system
(CNS) stimulant actions of ginseng (though not sedative/hypnotic
effects), potential modulation of the immune system and increase of
glycogen storage.
Adverse effects
• The adverse effects of ginseng are primarily CNS effects such as;
agitation, irritability, insomnia and headache.
• Others adverse effect include; hypertension and mastalgia.
Drug interactions
• In vitro evidence suggests that ginseng extracts inhibit CYP3A4 in
human hepatocytes.
Ginkgo biloba
• Originating from Chinese medicine, ginkgo (Ginkgo biloba ).
• It is used for a variety of ailments such as; antihypoxic, antioxidant,
antiplatelet, free radical scavenging and microcirculatory properties.
• It has been used in patients with asthma, brain trauma, cochlear
deafness, depression, retinitis, impotence, myocardial reperfusion
and vertigo.
• One of the components of ginkgo is ginkgolide B (potent antagonist of
platelet-activating factor).
• ‘Anti-stress’ effects as a result of monamine oxidase inhibition by
ginkgolides
Adverse effects
• Serious or fatal side effects of gingko include; spontaneous bleeding,
fatal intracerebral bleeding, seizures and anaphylactic shock.
• Less serious side effects are; nausea, vomiting, flatulence, diarrhoea,
headaches and pruritus
Drug interactions
• In vitro data suggest ginkgo can inhibit hepatic drug metabolizing enzymes.
• Ginkgo increased the plasma concentrations of the CYP3A4 substrate
nifedipine confirming the potential for enzyme inhibition observed in
vitro.
• Ginkgo significantly reduced the metabolism of omeprazole, a CYP2C19
substrate, in Chinese patients.
• Ginkgo may interfere with the pharmacokinetics of drugs metabolized by
CYP2C19 or CYP3A4.
• If it does inhibit MAO at therapeutic doses, adverse interactions with
tyramine containing foods and possibly with selective serotonin reuptake
inhibitors (SSRI) are to be anticipated
ECHINACEA
• There are nine species of the genus Echinacea, a member of the
sunflower family, found in North America.
• The most common and widespread of these are Echinacea
angustifolia, E. purpurea and E. pallida, each of which has a long
history of medicinal use.
• Constituents that have been identified include volatile oil, caffeic acid
derivatives, polysaccharides, polyines, polyenes, isobutylamides and
flavonoids of the quercetin and kaempferol type.
• Many studies of echinacea have pointed to effects on the immune
system.
• Proposed mechanisms of action include increased circulating
granulocytes, enhanced phagocytosis, inhibition of virus proliferation,
cytokine activation, increased T-lymphocyte production and an
increase in the CD4/CD8 T-cell ratio.
• Echinacea is currently most widely used to prevent the common cold
and influenza symptoms, but is also used for Candida infections,
chronic respiratory infections, prostatitis and rheumatoid arthritis.
Adverse effects
• It includes rashes such as ;erythema multiforme, arthralgias, allergic
reactions,
• Gastrointestinal disturbances including dysgeusia, dyspepsia and
diarrhoea.
Drug interactions
• Some flavonoids present in echinacea extracts can either inhibit or
activate human CYPs and drug transporters, depending on their
structures, concentrations and assay conditions.
• The oral bioavailability of Midazolam ( a substrate for CYP3A4 and
CYP3A5) is increased in the presence of Echinacea, indicating that the
hepatic and intestinal availabilities were altered in opposite
directions.
• The high variability observed in concentration of constituents of the
herb has implications for echinacea’s ability to modulate drug
absorption and disposition.
SOY
• Soy is from the plant Glycine max
• The principal constituents of soy, the isoflavones genistein and
daidzein, are structurally similar to 17α-oestradiol and produce weak
oestrogenic effects (i.e. they are phytoestrogens).
• It is prudent to discourage soy-derived products in patients with
oestrogen-dependent tumours (e.g. breast cancer or endometrial
cancer) because experimental data indicate that soy can stimulate the
growth of these tumours in mice.
• As genistein can negate the inhibitory effect of tamoxifen on breast
cancer growth, women taking this agent should especially avoid soy.
• Acute vasodilatation caused by 17β-oestradiol is mediated by nitric
oxide, and genistein (which is selective for the oestrogen receptor
ERβ, as well as having quite distinct effects attributable to tyrosine
kinase inhibition) is as potent as 17β-oestradiol in this regard, raising
the possibility of beneficial vascular effects.
Adverse reactions
• It includes; allergic reactions (pruritus, rash, anaphylaxis) and gastro-intestinal
disturbances (nausea, dyspepsia, diarrhoea).
Drug interactions
• Isoflavones, such as genistein and daidzein inhibit oxidative and conjugative
metabolism in vitro and in vivo.
• Soy is not an inducer of CYP3A4 in humans.
• Genistein interacts with transporters such as P-glycoprotein (MDR-1, ABCB1),
MRP1 (ABCC1) and MRP2 (ABCC2) which are involved in the intestinal
absorption and biliary secretion of many drugs.
• Soy may alter drug absorption and/or its disposition in humans.
Saw palmetto
• Saw palmetto (Serenoa repens) is derived from a tree native to
southeastern North America, particularly Florida.
• The main constituents of saw palmetto include carbohydrates, fixed
oils, steroids, flavonoids, resin, tannin and volatile oil.
• Saw palmetto is used in men with the hope of ‘toning and
strengthening the reproductive system, and specifically for symptoms
of prostate enlargement’.
• It has oestrogenic activity and reduces plasma testosterone
concentration.
• In women, the principal use of saw palmetto is to (hopefully) reduce
ovarian enlargement and to increase the size of small breasts.
• Although no drug interactions with, or medical contraindications to,
the use of saw palmetto have been reported, it would be prudent to
avoid concomitant use with other hormonal therapies, especially
oestrogens, and in patients with oestrogen-dependent cancers.
Adverse effects
• The adverse effects of saw palmetto involve gastro-intestinal
intolerance, nausea and diarrhoea, hepatitis and cholestasis,
gynaecomastia and impotence.
St John’s wort
• St John’s wort (Hypericum perforatum), a perennial plant native to
Europe, North America and western Asia, is one of the most
extensively studied herbal products and many of its uses are based on
observations noted in early Greek and Roman medicine.
• St John’s wort is still widely used for the treatment of mild to
moderate depression and other nervous conditions.
• St John’s wort extract is a very complex mixture of over 20 constituent
compounds.
• These include catechin-type tannins and condensed-type
proanthocyanidins, flavonoids (mostly hyperoside, rutin, quercetin
and kaempferol), bioflavonoids (e.g. biapigenin), phloroglutinol
derivatives like hyperforin, phenolic acids, volatile oils and
naphthodianthrones, including hypericin and pseudohypericin.
• With regard to the putative antidepressant effects of St John’s wort,
the pharmacological activities of hypericin and hyperforin, which
inhibit synaptic 5HT and catecholamine reuptake, could contribute its
effects
Adverse effects
• Adverse CNS effects include headaches, drowsiness, restlessness,
serotonin syndrome if used with SSRIs or TCAs, skin photosensitivity.
• Gastro-intestinal disturbances involve abdominal pain or discomfort,
and xerostomia.
• Drug interactions with therapeutic failure of concomitant drugs, e.g.
HIV protease inhibitors, ciclosporin, warfarin, theophylline,
antidepressants, oral contraceptives and anti-cancer agents, such as
irinotecan.
Drug interactions
• It has significant pharmacokinetic interactions with drugs from a variety
of therapeutic classes.
• There is a serious interactions between St John’s wort and digoxin,
theophylline, ciclosporin, oral contraceptives, phenprocoumon,
warfarin and sertraline, thought to be secondary to enzyme induction.
• The mechanism for most of the interactions observed in subsequent
clinical trials remains unclear, although for some agents, induction of
CYP3A4 (e.g. indinavir, midazolam, simvastatin), P-glycoprotein-ABCB1
(e.g. digoxin, fexofenadine), or both (e.g. ciclosporin) may explain their
increased clearance.
• St John’s wort produced significantly greater increases in CYP3A4
expression in women compared to men, unexplained by differences in
body mass index.
• St John’s wort enhanced the activity of transcription factors, including
the pregnane X receptor to transcribe the CYP3A4 and P-gp (ABCB1)
genes.
• Other drug metabolism enzymes induced by St John’s wort include
CYP1A2, CYP2C9 and 2C19 and possibly UGT1A1.
• It should be noted that studies of St John’s wort on CYP activity in
vitro suggest acute inhibition, followed by induction in the long term.
Glucosamine
• It is available as a non-prescription dietary supplement and in many
products is obtained from shellfish.
• It is one of several naturally occurring 6-carbon amino sugars found in
the body.
• Some commercial products contain glucosamine in combination with
chondroitin.
• In vitro data suggest glucosamine can stimulate cartilage cells to
synthesize glycosaminoglycans and proteoglycans.
• It is more likely that the cell produces smaller, soluble subunits;
assembly of these smaller, soluble subunits outside of the cell into a
soluble form of collagen has been proposed.
• Solubilized collagen, or tropocollagen, is a precursor of mature
collagen fibres.
• Chondroitin inhibits the enzymes that degrade cartilage.
• It has been documented that glucosamine is effective in the
treatment of patients with osteoarthritis
Adverse effects
• Gastro-intestinal disturbances, including dyspepsia, nausea,
constipation and diarrhea.
• Skin rashes and allergic reactions in patients with known shellfish
allergy.
Drug interactions
• No drug interactions have been defined with the use of glucosamine.