Essentials of Complementary and Alternative Medicine (June 1999)

CHAPTER 17. N
ATUROPATHIC
 M
EDICINE
Michael T. Murray and Joseph E. Pizzorno
Background
 
Historical Perspective
 
Suppression and Decline
 
Naturopathic Medicine Reemerges
Principal Concepts
 
Naturopathic Principles in Clinical Practice: Case Analysis
Provider-Patient Interactions
 
Therapeutic Modalities
Therapeutic Approach
 
Use of Naturopathic Medicine for Treatment
 
Complementary Aspects of Naturopathic Medicine
 
Using Naturopathic Medicine as Prevention
 
Clinical Application of Naturopathic Principles
Research
Organization
 
Training
 
Professional Organizations
 
Licensing
 
Reimbursement Status
 
Relations with Conventional Medicine
Prospects for the Future
Chapter References
Nature is doing her best each moment to make us well. She exists for no other end. Do not resist. With the least inclination to be well, we should not be sick.
Henry David Thoreau
The doctor of the future will give no medicine, but will interest his patient in the care of the human frame, in diet and in the cause and prevention of disease.
Thomas Edison
BACKGROUND
Naturopathic medicine, also known as “nature cure,” is more than a health care system—it is a philosophy and, for many, a way of life. It is based on the belief in the 
ability of the body to heal itself—the  vis medicatrix naturae (the healing power of nature). The expectation that the body can heal, if given the proper opportunity, is 
fundamental to the practice of naturopathic medicine. This opportunity involves living within the laws of nature and using therapies that support normal body function, 
instead of using drugs that supplant body function. Naturopathy also involves a strong commitment to improving the quality of the environment.
Naturopathic physicians believe that most disease is the direct result of the ignorance and violation of Natural Living Laws. Healing will result from the following:
Consumption of natural, unrefined, organically grown foods
Ensuring adequate amounts of exercise and rest
Living a moderately paced lifestyle
Having constructive and creative thoughts and emotions
Avoiding environmental toxins
Maintaining proper elimination
The typical naturopathic practice is characterized by maintenance of health, prevention of disease, patient education and self-responsibility, as well as diagnosis and 
the use of natural therapies that support regeneration of the body's systems.
Although the term naturopathy was coined in the late nineteenth century, its philosophical roots date back thousands of years, drawing on the healing wisdom of many 
cultures, such as those of India (Ayurvedic), China (Taoist), Greece (Hippocratic), Germany (homeopathy, hydrotherapy, nature cure), the Roman Empire 
(hydrotherapy), England (botanical medicine), Native America (botanical medicine, spiritual guidance), and early America (natural hygiene, detoxification, spinal 
manipulation). Unlike many other health care systems, naturopathy is not identified with any particular therapy, but rather with a philosophy of health promotion rather 
than simply disease treatment or symptom alleviation.
This philosophical approach necessitates a broad range of diagnostic and therapeutic skills and accounts for the eclectic interests of the naturopathic profession. 
Because the goal of the naturopathic physician is to restore normal body function (rather than the application of a particular therapy), virtually every natural medicine 
therapy is used. In addition, virtually every disease is in the realm of naturopathic treatment because strengthening the body's own healing systems always benefits 
the patient regardless of the pathologic diagnosis. However, not every disease process can be reversed and, in keeping with their role as primary care physicians, 
naturopaths also employ office surgery, acute prescription drugs, and referral to specialists when it is in the patient's best interests.
In addition to providing recommendations on lifestyle, diet, and exercise, naturopathic physicians use a variety of therapeutic modalities to promote health. Some 
naturopathic physicians emphasize a particular therapeutic modality, whereas others use a number of modalities. Some naturopaths focus on a particular medical 
field, such as pediatrics, natural childbirth, or physical medicine, whereas others are generalists.
Today's naturopathic doctor (ND) is an extensively trained and state-licensed physician equipped with a broad range of conventional and unconventional diagnostic 
and therapeutic skills. The modern ND considers herself (66% of naturopaths are women) or himself an integral part of the health care system and takes full 
responsibility for the common public health issues.
Historical Perspective
Enriched by its philosophical links to many cultures, naturopathic medicine as a distinct profession in America grew out of natural healing systems of the eighteenth 
and nineteenth centuries. Naturopathy began with the teachings and concepts of Benedict Lust (1870–1945). In 1892, at the age of 23, Lust came from Germany as a 
disciple of Father Kneipp to bring hydrotherapy practices to America. Exposure in the United States to a wide range of practitioners and practices of natural healing 
arts broadened Lust's perspective. After a decade of study, he purchased the term  naturopathy from Scheel of New York City in 1902 (who coined the term in 1895) to 
describe the eclectic compilation of doctrines of natural healing that he envisioned as the future of natural medicine. Naturopathy, or “nature cure,” was defined by 
Lust as both a way of life and a concept of healing, employing various natural means of treating human infirmities and disease states (
1
). In 1902, Lust also opened 
the first health food store.
In a January, 1902, editorial in the first issue of  The Naturopathic and Herald of Health, Lust began promoting a new way of thinking of health care with the following:

We believe in strong, pure, beautiful bodies ... of radiating health. We want every man, woman and child in this great land to know and embody and feel the 
truths of right living that mean conscious mastery. We plead for the renouncing of poisons from the coffee, white flour, glucose, lard, and like venom of the 
American table to patent medicines, tobacco, liquor and the other inevitable recourse of perverted appetite. We long for the time when an eight-hour day 
may enable every worker to stop existing long enough to live; when the spirit of universal brotherhood shall animate business and society and the church; 
when every American may have a little cottage of his own ... when people may stop doing and thinking and being for others and be for themselves; when 
true love and divine marriage and pre-natal culture and controlled parenthood may fill this world with germ-gods instead of humanized animals.
In a word, Naturopathy stands for the reconciling, harmonizing and unifying of nature, humanity and God.
Fundamentally therapeutic because men need healing; elementary educational because men need teaching; ultimately inspirational because men need 
empowering .... (
2
)
Although the terminology is almost 100 years old, Lust's concepts provided a powerful foundation that has endured despite almost a century of active political 
suppression by the dominant school of medicine. The wisdom he garnered from the insights of many natural healers is now well documented. For example, in the 
modern textbook, Natural Medicine, there are 10,000 citations to the peer-reviewed scientific literature.
During the past century, the profession has progressed through several fairly distinct phases (
Table 17.1
) . Because of its eclectic nature, the history of naturopathic 
medicine is as complex as any healing art.
Table 17.1. Historical Overview of Naturopathic Medicine
T
HE
 H
ALCYON
 Y
EARS OF
 N
ATUROPATHY
Naturopathy was most popular from the 1920s until 1937. The success of the early naturopaths, in the face of the relative inadequacy of conventional medicine of this 
era, initiated a health fad movement that cause great public awareness, interest, and concern. Many famous people and politicians of the day proclaimed the benefits 
of naturopathic cures.
The naturopathic journals of the 1920s and 1930s provide insight into the prevention of disease and the promotion of health. Much of the dietary advice focused on 
correcting poor eating habits, including the lack of fiber in the diet and an over-reliance on red meat as a protein source. Although scientific data were lacking in the 
1930s, the pronouncements of the National Institutes of Health and the National Cancer Institute in the 1990s confirmed many of the early assertions of naturopaths 
that these dietary habits would lead to degenerative diseases, including cancers associated with the digestive tract and the colon.
The December 1928 volume of Nature's Path was the first American publication of the works of Herman J. DeWolff, a Dutch epidemiologist who was one of the 
earliest researchers to assert, based on studies of the incidence of cancer in the Netherlands, that there was an association between exposure to petrochemicals and 
various types of cancerous conditions. He saw a connection between chemical fertilizers and their usage in some soils, which led to the fertilizer remaining in 
vegetables after they had arrived at the market and were purchased for consumption. This was almost 50 years before orthodox medicine confirmed such assertions.
Suppression and Decline
In 1937, the popularity of naturopathy began to decline. Conventional medicine had developed effective therapies and the public became enamored by technology. 
Benedict Lust died in September of 1945 in residence at the Yungborn facility in Butler, New Jersey, preparing to attend the 49th Annual Congress of his American 
Naturopathic Association. Right before his death, he noted his concerns for the future, especially his frustration with the success of the medical profession in blocking 
the naturopaths' efforts to establish state licensing laws. These laws would not only establish appropriate practice rights for NDs, but also protect the public from the 
pretenders—that is, those who would call themselves naturopaths without attaining formal training—a problem that continues to plague the profession today. His 
concerns were part of the official program for the Annual Congress of the American Naturopathic Association in October 1945. Just before his death, he wrote:
Now let us see the type of men and women who are the Naturopaths of today. Many of them are fine, upstanding individuals, believing fully in the 
effectiveness of their chosen profession—willing to give their all for the sake of alleviating human suffering and ready to fight for their rights to the last ditch. 
More power to them! But there are others who claim to be Naturopaths who are woeful misfits. Yes, and there are outright fakers and cheats masking as 
Naturopaths. That is the fate of any science—any profession—which the unjust laws have placed beyond the pale. Where there is no official recognition 
and regulation, you will find the plotters, the thieves, the charlatans operating on the same basis as the conscientious practitioners. And these riff-raff 
opportunists bring the whole art into disrepute. Frankly such conditions cannot be remedied until suitable safeguards are erected by law, or by the 
profession itself, around the practice of Naturopathy. That will come in time.
The public infatuation with technology, introduction of “miracle medicine,” the second World War's stimulation of the development of surgery, the Flexner Report, 
growing political sophistication of the American Medical Association, the growth in numbers of the “pretenders,” and the death of Benedict Lust in 1945 combined to 
cause the decline of naturopathic medicine and natural healing in the United States.
Lack of insurance coverage, public confusion over educational standards, lost court battles, and a hostile legislative perspective progressively restricted practice until 
the core naturopathic therapies became essentially illegal and practices financially nonviable.
Naturopathic Medicine Reemerges
The combination of the counterculture years of the late 1960s, the public's reawakening interest in nutrition and the environment, and America's disenchantment with 
organized institutional medicine (when it became apparent that orthodox medicine has its limitations and is expensive), resulted in newfound respect for alternative 
medicine in general and the rejuvenation of naturopathic medicine. At this time, a new wave of students were attracted to the philosophical precepts of the profession. 
They brought with them a new appreciation for the appropriate use of science, modern college education, and matching expectations. In addition, the emergence of 
Bastyr University (founded in 1978), with its focus on teaching and researching science-based natural medicine, played a major role.
PRINCIPAL CONCEPTS
Naturopathic medicine is vitalistic in its approach—that is, life is more than the sum of biochemical processes, and the body is believed to have an innate intelligence 
that strives for health. The role of the physician is to understand and aid the body's efforts, and to help the patient understand why he or she is sick and how to 

become (and stay) healthy.
In this context, health is more than the absence of disease. Health is a vital dynamic state that enables a person to function well in a wide range of environments and 
stresses. Health and disease are points on a continuum, with death at one end and optimal function at the other. The naturopath believes that a person who engages 
in an unhealthy lifestyle will more rapidly progress to greater dysfunction.
The profession's efforts to codify this philosophy of health promotion and work in concert with nature has led to a series of principles to guide patient care:
Principle 1: The healing power of nature (vis medicatrix naturae)
Naturopathic physicians believe that the body has considerable power to heal itself. It is the physician's role to facilitate and enhance this process with the 
aid of natural, nontoxic therapies.
Principle 2: Identify and treat the cause (tolle causam)
The naturopathic physician is trained to seek the underlying causes of a disease rather than simply suppress the symptoms. Symptoms are viewed as 
expressions of the body's attempt to heal, and the causes may spring from the patient's physical, mental–emotional, and spiritual levels.
Principle 3: First do no harm (primum no nocere)
The naturopathic physician seeks to do no harm with medical treatment by employing safe and effective natural therapies.
Principle 4: Treat the whole person
Naturopathic physicians are trained to view an individual as a whole entity composed of a complex interaction of physical, mental–emotional, spiritual, 
social, and other factors.
Principle 5: The physician as teacher
The naturopathic physician is foremost a teacher educating, empowering, and motivating the patient to assume more personal responsibility for his or her 
health by adopting a healthy attitude, lifestyle, and diet.
Principle 6: Prevention is the best cure
Naturopathic physicians are preventive medicine specialists. Prevention of disease is accomplished through education and lifestyle habits that support 
health and prevent disease.
Principle 7: Establish health and wellness
Establishing and maintaining optimum health and promoting wellness are the primary goals of the naturopathic physician. Although health is defined as the 
state of optimal physical, mental, emotional, and spiritual well-being, wellness is defined as a state of health characterized by a positive emotional state. 
The naturopathic physician strives to increase the level of wellness regardless of the disease or level of health. Even in cases of severe disease, a high 
level of wellness can be achieved.
Naturopathic Principles in Clinical Practice: Case Analysis
Applying these principles to clinical practice takes extensive training, careful insight, and years of practice. When evaluating a patient, the well-trained naturopathic 
doctor asks the following questions:
What is the first cause of the disease or symptom?
How is the body trying to heal itself?
What is the minimum level of intervention needed to facilitate the self-healing process?
What are the patient's underlying functional weaknesses?
What education does the patient need to understand why he or she is sick and how to become healthier?
How does the patient's physical disease relate to his or her psychological and spiritual health?
Table 17.2
 lists more questions the naturopathic students is taught to consider. Although the practice of naturopathic medicine is grounded in  vis medicatrix naturae, it 
also recognizes that intervention in the disease process may sometimes be efficacious or absolutely necessary. Naturopathic physicians have a long-standing 
tradition of integrating aspects of traditional, alternative, and conventional medicine in the interest of the patient. As appropriate, patients are referred to specialists 
and 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.
Table 17.2. Naturopathic Case Analysis
PROVIDER–PATIENT INTERACTIONS
The modern naturopathic physician provides all phases of primary health care. Clinical assessment involves a medical history, physical examination, radiological and 
laboratory evaluation, and other well-accepted conventional diagnostic procedures that are supplemented with nonconventional diagnostic techniques. For example, 
naturopathic physicians use extensive laboratory methodologies to assess nutritional status, toxin load, detoxification function, food intolerance, intestinal bioses, 
digestive function, and other functional aspects.
A typical first office visit with a naturopathic physician lasts for one hour. Because teaching a patient how to live healthfully is a primary goal of naturopathy, the 
physician devotes time to discussing and explaining principles of health maintenance. This approach sets naturopaths apart from many other health care providers.
The physician–patient relationship begins with a thorough medical history and interview process designed to review all aspects of a patient's lifestyle. As appropriate, 

the physician performs diagnostic procedures, such as physical examination; blood, urine, and stool analysis; and various laboratory procedures to assess 
physiological function. When the patient's health and disease status is established and understood (making a diagnosis of a disease is only one part of this process), 
the doctor and patient together establish a treatment and health-promoting program. Proper assessment of outcomes using conventional assessment tools (e.g., 
patient interview, physical examination, laboratory tests, radiologic imaging) is an important part of patient follow-up.
Therapeutic Modalities
Naturopathy incorporates a variety of healing techniques. Naturopathic physicians are trained in a large scope of treatments: clinical nutrition, botanical medicine, 
homeopathy, Chinese medicine and acupuncture, hydrotherapy, physical medicine including massage and therapeutic manipulation, counseling and other 
psychotherapies, and minor surgery. In certain states (most notably Oregon and Washington), licensed naturopathic physicians are granted prescription privileges for 
naturally derived prescription substances, including vitamins, minerals, hormones (e.g., corticosteroids, estrogen, thyroxine), pancreatin, bile acids, antibiotics, and 
plant-based drugs (e.g., belladonna, scopolamine).
Naturopathic medicine uses natural medicines and intervention therapies as needed. When properly used, natural medicine and therapies generally have low 
invasiveness and rarely cause suppression of symptoms or side effects. These medicines and therapies generally support the body's healing mechanisms rather than 
take over or inhibit the body's processes.
C
LINICAL
 N
UTRITION
Clinical nutrition, or the use of diet as a therapy, serves as the foundation of naturopathic medicine. There is an ever-increasing body of knowledge that supports the 
use of whole foods and nutritional supplements in the maintenance of health and treatment of disease. The recognition of unique nutritional requirements due to 
biochemical individuality has provided a strong theoretical and practical basis for the appropriate use of megavitamin therapy. Controlled fasting is also used 
therapeutically.
B
OTANICAL
 M
EDICINE
Plants have always been used as medicines. Naturopathic physicians are professionally trained herbalists, and they know both the historical uses and modern 
pharmacological mechanisms of plants. Although many botanical medicines can be used (or misused) as replacement for conventional drugs, the naturopathic 
physician prefers to use them to support the body's healing processes.
H
OMEOPATHY
Homeopathy is a system of medicine that treats a disease with a dilute, potenized agent, or drug, that will produce the same symptoms as the disease when given to a 
healthy individual. The fundamental principle of this system is that  like cures like. Homeopathic medicines are derived from a variety of plant, mineral, and chemical 
substances.
T
RADITIONAL
 C
HINESE
 M
EDICINE AND
 A
CUPUNCTURE
Traditional Chinese medicine and acupuncture are part of an ancient system of medicine that enhances the flow of vital energy ( Chi). Acupuncture involves the 
stimulation of specific points on the body along  Chi pathways (termed meridians). Acupuncture points can be stimulated by inserting and withdrawing needles, 
applying heat (moxibustion), massage, laser therapy, electrical stimulation, or a combination of these methods.
H
YDROTHERAPY
Hydrotherapy is the use of water in any form (e.g., hot or cold; ice, steam) and methods of application (e.g., sitz bath, douche, spa and hot tub, whirlpool, sauna, 
shower, immersion bath, pack, poultice, foot bath, fomentation, wrap, colonic irrigations). Hydrotherapy is an ancient method that has been used to treat disease and 
injury by many different cultures, including the Egyptians, Assyrians, Persians, Greeks, Hebrews, Hindus, and Chinese. Its most sophisticated applications were 
developed in eighteenth-century Germany.