Definition/Introduction

Alternative medicine is a broad term encompassing a variety of medical modalities. Tradition typically supports these and is 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 "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 medicine, or mainstream medicine.

In the nineteenth century, allopathic medicine was based on a practice of opposites, whereas the alternative branch suggested “like cured like.” Present-day differences remain but revolve around a disease-centric (allopathic) versus a whole-body (alternative) approach. Alternative practices focus on stimulating the body’s ability to heal 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 a Chinese technique used to balance chi, the energy of life. According to ancient beliefs, chi is an energy flow that courses along bodily pathways. These paths are termed meridians. With acupuncture, small needles are placed transdermally along these meridians to redirect chi. The needles are often manipulated clockwise or counterclockwise, twisting to stimulate chi further.

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, pain, gastrointestinal issues, and allergic rhinitis to specific goal-oriented approaches such as fertility treatments or decreasing the risk of chronic diseases such as cardiovascular disease.[1][2][3][4][5][6]

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. The belief is that a unique combination of 5 universal elements makes up each individual: space, air, fire, water, and earth. These elements comprise three doshas, or energies: Vata dosha, Pitta dosha, and Kapha dosha.

Each person has a unique combination of these energies, each with its 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 among 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 encompassing various 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, which detailed the medicinal uses of over 850 plants. Similarly, much of today's knowledge of herbal supplements stems from Traditional Chinese Medicine, in which herbs are prescribed and used for various ailments such as depression, respiratory illnesses including chronic obstructive pulmonary disease (COPD), hepatic dysfunction, and chronic heart failure.[7][8][9][10]

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, whereas an herbal supplement is intended for internal use only. These products and supplements include dried, minced extracts, powdered, or capsulated products. They can then be utilized in various ways, 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 instead of medication and are thus not regulated by the FDA (see Issues of Concern below).

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 include:

• 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 purport that it improves 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 instead of subscriptions 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 its benefits, such as improved balance, strength, flexibility, decreased pain and inflammation, and cardiovascular risk reduction.[11] 

Tai chi is an ancient Chinese practice that similarly focuses on strengthening the mind-body connection. Originally, the practice was performed as a form of self-defense but has since morphed into martial arts–inspired movements coordinated with the breath. These movements are conducted at the participant’s 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 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 adjusts 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 adjust the body back to its intended alignment.

Other Alternative Modalities

• Reiki
• Biofeedback
• Meditation
• Hypnosis
• Guided imagery

Issues of Concern

Although alternative modalities are rooted in thousands of years of tradition, associated safety concerns remain. Implementing any alternative therapy can influence the 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 seek 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, the Food and Drug Administration (FDA) does not regulate herbal products and supplements. 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 variations in the absorption and efficacy of other drugs. For example, St. John’s Wort is a cytochrome P450 inducer, thus increasing the metabolism and possibly decreasing the efficacy of other medications, including but not limited to antibiotics, antivirals, and other medications predominately metabolized by the liver.[12]

Of note, many pharmaceutical drugs use purified botanical agents, 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, a certified instructor should ensure proper technique, limitations should be outlined for each patient, and the practice should be implemented slowly to allow the body to accommodate any changes.

A trained and licensed practitioner should perform extrinsic manipulation of any kind. High-velocity low-amplitude (HVLA) manipulation places patients at the 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. The risk of artery dissection, herniated disk, and worsening of pain should be conveyed to all individuals prior to manipulation of any kind.

Clinical Significance

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 treating vague symptoms, which Western medicine lacks definitive treatment options, such as fatigue, cold or flu symptoms, generalized gastrointestinal issues, and irritable bowel syndrome (IBS)[13]

Other ailments necessitate the involvement of antibiotics and/or surgery, such as appendicitis and certain bacterial infections. Some patients will seek out alternative medicine techniques initially, particularly if they are unlikely to cause harm or are less invasive, and reserve more allopathic remedies for instances in which alternative medicine has not been successful or situations that are more urgent. Alternative medicine has been shown to be helpful in augmenting treatment for mood disorders or behavior challenges in patients with dementia.[14][15] 

Remaining open-minded and 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.