Essentials of Complementary and Alternative Medicine (June 1999)

Part II
 of this book for reported adverse effects from the use of herbs.)
ORGANIZATION
Training and the Legal Status
There are currently no standards of education for the study of herbalism in the United States. Many of the herbal teachers and practitioners are primarily self-taught 
through years of study and practice. The American Herbalists Guild is currently the only professional group of herbalists in the United States. They maintain a list of 
herb schools and training programs available at home and abroad and have devised a “skeleton” of what most Guild members feel should constitute an acceptable 
curriculum of training to allow one to practice phytotherapy safely (
40
). Many herbal programs offer some type of certificate, using titles such as Medical Herbalist, 
Clinical Herbalist, Herbalist, and Master Herbalist for those who complete their course. However, there is no consistency in curricula, requirements, and length of 
program from school to school. Therefore, one individual may spend 400 hours of study and receive a Herbalist certificate, whereas another may receive a Master 
Herbalist certification after two weekends of training. This disparity creates a dilemma for the public, who cannot reliably count on the education and level of training of 
a particular practitioner. In addition, herbal practitioners who do not have a medical, naturopathic, or acupuncture license are technically practicing their trade illegally.
The federal government regulates the practice of medicine; this is governed by each individual state. Many states have strict consumer protection statutes, which 
cover “illegal” medical practices. In most states, the enforcing agency is the Board of Medical Quality Assurance and the punishment for the unauthorized practice of 
medicine is a misdemeanor. There have been virtually no successful prosecutions of herbalists in the United States to date; however, the risk is real for those 
unlicensed herbalists who see clients, diagnose, and prescribe herbal medicines. The reason there has been so little prosecution of herbalists is probably because 
most herbalists use gentle herbal remedies with very little risk of adverse reactions and usually not in place of conventional treatment.
With the dramatic increase in the purchase and consumption of phytomedicine in the United States, the need for well-trained, qualified herbalists is essential. 
Naturopathic physicians and acupuncturists have formalized study in herbal medicine, but the extent of their training in Western phytotherapy is usually limited. 
Schools with a standardized, formal curriculum based around the sciences and herbal medicine are needed, and individual states need to become willing to license 
herbalists to practice legally. Herbalists need an established scope of practice and clear guidelines for conditions that must be referred to a physician for consultation. 
These factors would provide the consumer with an expert in the field of phytotherapy and also would offer the medical community a referral source for patients who 
want responsible herbal options to pharmaceutical medications.
Reimbursement Status
Currently, there is little reimbursement available for the patient who seeks the services of an unlicensed herbalist. Even when licensed physicians prescribe herbs for 
a particular condition, insurance companies often refuse to reimburse the expense. Unfortunately, with the cost of herbal products rising in the United States, 
phytotherapy is becoming a therapeutic approach primarily for the middle class. This is unfortunate, because there is a disproportionate amount of illness among the 
poor compared to those with more financial resources. By not including phytotherapy as a treatment option available in conventional Western medicine, many of those 
who could benefit will be unable to afford it. Even more ironic is the fact that herbal medicines are generally cheaper than most pharmaceutical drugs. However, if one 
is covered on a health plan in which prescriptions cost $3.00 and one must pay $10.00 for a herbal tincture, the choice becomes obvious for many.
Quality Assurance
Currently, there is no organization or government agency in the United States that certifies that a herbal product is what it claims to be. Quality control has been a 
problem within the herbal industry for many years, and errors abound. For example, it has been estimated that more than half of the Echinacea sold in the United 
States from the period of 1908–1991 was actually  Parthenium integrifolium. An article in JAMA reported an incident of infant androgenization occurring secondary to 
the consumption of Siberian ginseng  (Eleutherococcus senticosus) by the mother during pregnancy. The article incorrectly identified the product as panax ginseng. 
When investigated, it was discovered that the product the woman had taken was not Siberian ginseng at all, but was  Periploca sepium (
41
). Animal studies conducted 
on both Eleutherococcus and Periploca have not produced any androgenic effects. The androgenization of the infant was probably totally unrelated to the herb being 
consumed (
41
).
These examples demonstrate the need for accurate identification of the plant being traded. A certificate of analysis should include the Latin name and organoleptic 
results (i.e., macroscopic appearance, odor, and taste), microscopic analysis, and thin layer chromatography. Reference chromatographs have been established for 
most herbs in common use.
The British and German pharmacopoeias have set parameters for the acceptable total ash and acid-insoluble ash contents of many commercially traded plants. The 
essence of these tests is that when a plant part is burned, it produces a certain amount of ash, usually in the region of 5 to 15% of the total dry weight of the sample 
tested. Acid-insoluble ash is that portion of the total ash content that is not soluble in acid; basically, it is any “dirt” within the sample. These tests play an important 
role in determining the overall cleanliness, purity, and therefore quality, of the raw material.
Microbiological assays are becoming more important as worldwide legislation tightens with regard to herbal remedies. Europe has already set limits for the total 
number of live microorganisms, total yeast and molds, coliform count,  Escherichia coli, and Salmonella that may be present in an herbal product. Microbial counts will 
become an even greater issue as the number of immunocompromised individuals rises and the risk of opportunistic infection from contaminated herbs increases.
If a plant contains known active constituents, they should be properly identified and measured. In general, most herbs should be analyzed to ensure that they contain 
acceptable levels of active principles. It is important to know how much of the active constituent is present so that the practitioner can prescribe a safe, therapeutic 

dose while avoiding toxicity. Standardized extracts, in which the whole plant is used and a guaranteed level of active constituents is clearly labeled, are primarily 
made in Europe under strict guidelines set by the European Economic Council. Clearly, not all herbs have known actives and do not need standardization, but they 
should still be subjected to rigorous quality control to ensure the highest quality raw material and consistency from batch to batch using the most reasonable markers 
(see 
Chapter 6
).
PROSPECTS FOR THE FUTURE
Scientific research that validates the traditional uses of many of our ancient herbal medicines is currently available. A tremendous amount of money is being spent in 
Germany, France, Italy, and other countries to gain new knowledge about the medicinal uses of plants. In France and Germany, phytomedicine is often prescribed by 
physicians in place of a pharmaceutical drug; these physicians learn about phytotherapy as part of their medical training. In these countries, ginkgo leaf is prescribed 
for the treatment of both peripheral vascular and cerebral vascular disease, with more than 100 million prescriptions in Europe in 1990 alone. Clearly, science is 
opening the door to a new, broader pharmacopoeia that encompasses both the pharmaceutical and botanical worlds.
The use of phytomedicine in today's world is as important to our well-being as it ever has been. Plants enhance our lives in many ways. Who has not paused to take 
in the aroma of a rose and wonder at its beauty, or experienced the healing which occurs during a walk through the woods or a field of wildflowers? Humankind has 
coexisted with the plant kingdom since our earliest days on the planet, evolving side by side. It is our responsibility to ensure the continued existence of all life, 
especially the plants that support our very life. Phytotherapy is a system of medicine that does not harm the environment (if harvesting and collection is done 
ethically), is available to all peoples throughout the world, is generally safer and, for the most part, far less expensive than most industrialized drugs. If we are going to 
achieve health care for all in the twenty-first century, Western medicine must attempt to fulfill the recommendations set by the World Health Organization, which 
clearly state that traditional medicines and practices need to be incorporated into the health care systems of every country. There is much to be gained and little to be 
lost with the incorporation of herbalism into mainstream medicine.
The rise in herb use and the increasing desire by patients to avoid many pharmaceutical drugs has put both the physician and pharmacist in a bit of a bind. Neither is 
adequately trained in the United States to deal with the many issues surrounding the use of plant remedies: active constituents, therapeutic dosages, interactions with 
other drugs, possible side effects, and the therapeutic value inherent within the plant. The sheer volume of herbal products consumed in the pursuit of health 
obligates the allopathic health care practitioner to expand his or her knowledge base of these practices. The practitioner musk ask: Does this therapy work? What is 
the risk-benefit ratio, and how does it compare to Western allopathic treatment? What are the relative costs? What therapy does the patient prefer? How does this 
therapy fit with the patient's view of health and illness? It seems prudent to move toward a model of integration of complementary medicines.
C
HAPTER
 R
EFERENCES
1.
Weiss R. Herbal medicine. Beaconsfield, England: Beaconsfield Publishers, Ltd, 1988.
2.
Emmart EW. The Badianus manuscript, an Aztec herbal of 1552 by Martin de la Cruz and Juannes Badianus. Baltimore: Johns Hopkins Press, 1940.
3.
Roys RL. The ethno-botany of the Maya. Department of Middle American Research. New Orleans: Tulane University, 1931.
4.
Vogel V. American Indian medicine. Normal, OK: University of Oklahoma Press, 1970.
5.
Mills S. Out of the earth—the essential book of herbal medicine. London: Penguin Books, Ltd, 1991.
6.
Moore M. Medicinal plants of the desert and canyon west. Santa Fe, NM: Museum of New Mexico Press, 1989.
7.
Hoffman D. The contribution of herbalism to western holistic practice. In: Tierra M, ed. American herbalism: essays on herbs and herbalism by members of the American Herbalist Guild. 
Freedom, CA: Crossing Press, 1992.
8.
Mowrey D. The scientific validation of herbal medicine. Cormorant Books, 1986.
9.
Schilcher H. Phytotherapy in paediatrics—handbook for physicians and pharmacists. Stuttgart, Germany: Medpharm Scientific Publishers, 1997.
10.
Linde K, Ramirez G, Mulrow CD, et al. St. John's Wort for depression—an overview and meta-analysis of randomised clinical trials. Br Med J 1996;313:253–258.
11.
Mueller WE, Schaefer C. Johanniskraut. In-vitro Studie uber Hypericum-Extract, Hypericin und Kaempferol als Antidepressive. Dtsch Apoth Z 1996;136:1015–1022.
12.
Lavie G, Valentine F, Levin B, et al. Studies of the mechanisms of action of the antiretroviral agents hypericin and pseudohypericin. Proc Natl Acad Sci U S A 1989;86:5963–5967.
13.
Haensgen KD, Vesper J, Ploch M. Multizentrische Doppelblindstudie zur antidepressiven Wirksamkeit des Hypericum-Extractes LI 160. Nervenheilkunder 1993:12:285–289.
14.
Fach information: Helarium (R) Hypericum, hypericum extract. Neumarkt: Bionorica GmbH, 1996.
15.
Lehmann E, Kinzler E, Friedemann J. Efficacy of a special Kava extract (piper methysticum) in patients with states of anxiety, tension and excitedness of non-mental origin. A double-blind, 
placebo controlled study of four weeks treatment. Phytomedicine 1996;3:113–119.
16.
Cawte J. Psychoactive substance of the South Seas: betel, kava and pituri. Aust N Z J Psychiatry 1985;19:83–87.
17.
Fach information: Antares (R) 120, kava-kava extract. Goeppingen: Krewel Meuselbach GmbH & Co KG, 1996.
18.
Jamieson DD, Duffield PH. The antinociceptive actions of kava components in mice. Clin Exp Pharmacol Physiol 1990;17:495–508.
19.
Fach information: Antares (R) 120, kava-kava extract. Goeppingen: Krewel Meuselbach GmbH & Co KG, 1996.
20.
Fach information: Kavasporal (R) forte, kava-kava extract. Eitorg: Mueller Goeppingen GmbH, 1996.
21.
Norton SA, Ruze P. Kava dermopathy. J Am Acad Dermatol 1994;31:89–97.
22.
Luettig B, Steinmuller C, Gifford GE, et al. Macrophage activation by the polysaccharide arabinogalactan isolated from plant cell cultures of Echinacea purpurea. J Natl Cancer Inst 
1989:81:669–675.
23.
Schulz V, Haensel R. Rational phytotherapie. Ratgaber fuer die aertzliche Praxis. 3 Aufl. Berlin: Springer Verlag, 1996:306–310.
24.
Bauer R. Echinacea-Drogen-Wirkungen und Wirksubstanzen. ZaeF 1996;90:111–115.
25.
Dorsch W. Klinische Anwendung von Extrakten aus Echinacea purpurea oder Echinacea pallida. ZaeF 1996;90:117–122.
26.
German Commision E Monograph. Echinacea purpurea herb. Bundesanzeiger 1989;43.
27.
Wichtl M. In: Bisset N, ed. Herbal drugs and phytopharmaceuticals. Stuttgart, Germany: Medpharm Scientific Publishers, 1994.
28.
Schuessler M, Hoelzl J, Fricke U. Myocardial effects of flavonoids from Crataegus species. Arzneimittelforschung 1995;45:842–845.
29.
Uchida S, Ikari N, Ohtaa H, et al. Inhibitory effects of condensed tannins on angiotensin converting enzyme. Jpn J Pharmacol 1987;43:242–245.
30.
Schuessler M, Hoelzl J, Fricke U. Myocardial effects of flavonoids from Crataegus species. Arzneimittelforschung 1995;45:842–845.
31.
Fach information: Faros (R) 300, Weissdornblaetter, -blueten-Trockenextrakt. Berlin: Lichtwer Pharma, 1996.
32.
Rai GS, Shovlin C, Wesnes KA. A double blind, placebo controlled study of ginkgo biloba extract (‘Tanakan') in elderly outpatients with mild to moderate memory impairment. Curr Med Res 
Opin 1991;12:350–355.
33.
Huguet F, Drieu K, Piriou A. Decreased cerebral 5-HT1a receptors during aging: reversal by ginkgo biloba extract (Egb 761). J Pharm Pharmacol 1994;46:316–318.
34.
Klejnen J, Knipschild P. Ginkgo biloba for cerebral insufficiency. Br J Clin Pharmacol 1992; 340: 1136–1139.
35.
Blume J, Kieser M, Hoelscher U. Placebokontrollierte Doppelblindstudie zur Wirksamkeit von Ginkgo-biloba Spezialextrakt Egb 761 bei austrainierten Patienten mit Claudicato intermittens. 
VASA 1996;25:265–274.
36.
Klejnen J, Knipschild P. Ginkgo biloba. Lancet 1992;340:1136–1139.
37.
Haguenauer JP, Cantenot F, Koskas H, et al. Treatment of equilibrium disorders with Ginkgo biloba extract: a multi-center double blind drug vs. placebo study. Presse Med 1986;15:1569–1572.
38.
Lebuisson DA, Leroy L, Rigal G. Treatment of senile macular degeneration with Ginkgo biloba extract: a preliminary double-blind drug vs placebo study. Presse Med 1986;15:1556–1558.
39.
Siegel RK. Ginseng abuse syndrome. JAMA 1979;241:1641–1715.
40.
Tierra M, ed. American herbalism: essays on herbs & herbalism by members of the American Herbalist Guild. Freedom, CA: Crossing Press, 1992.
41.
Awang D. Maternal use of ginseng and neonatal androgenization. J Am Med Assoc 1991;266:363.

CHAPTER 21. S
PIRITUAL
 H
EALING
Essentials of Complementary and Alternative Medicine
CHAPTER 21. S
PIRITUAL
 H
EALING
Daniel J. Benor
Background
History and Development
 
Sixth and Seventh Century 
BC
 
Early Christian Era
 
Seventh to Seventeenth Century 
AD
 
Eighteenth Century 
AD
 
Nineteenth and Twentieth Century 
AD
 
Modern Health Care
Provider–Client Interactions
 
The Role of Diagnosis in Spiritual Healing
 
Types of Healing
Therapy and Outcomes
 
Responses to Healing
Major Modalities and Indications
 
Distant Healing
 
Therapeutic Touch
 
Healing and the Immune System
 
Pain Relief
 
Other Studies
Theoretical Basis for Spiritual Healing
 
Subtle Energies
 
Intuitive Perceptions
Indications for Treatment
Organization
 
Training
 
Certification and Licensure
Prospects for the Future
Chapter References
BACKGROUND
Spiritual healing is defined as “the systematic, purposeful intervention by one or more persons aiming to help (an)other living being (person, animal, plant, or other 
living system) or beings by means of focused intention, by touch, or by holding the hands near the other being, without application of physical, chemical, or 
conventional energetic means of intervention”(
1
).
Spiritual healing is probably the oldest recognized therapy, used in some form in every known culture. Some of these forms include shamanism, faith healing, laying 
on of hands, absent (or distant) healing, and mental healing. As  shamanism (
2
), it is practiced in traditional cultures, each of which dresses it in rituals and 
explanatory systems appropriate to its own time, place, and cosmologies. It may include meditation, prayer, chanting, and other practices, and it is often combined 
with herbalism. As faith healing, it is practiced in churches in which there is a belief that faith is required for healing. The popular press often uses faith healing as a 
generic term for spiritual healing. As  prani (
3
) or bioenergy healing, Qigong (
4
), Reiki (
5
), therapeutic touch (
6
), healing touch (
7
), polarity therapy (
8
), SHEN therapy 
(
9
), and similar approaches, it is given as a laying on of hands. In Europe it is often termed  paranormal healing, and in Eastern Europe it is termed bioenergotherapy. 
As absent, or distant, healing, it may be given through meditation, prayer, Reiki, LeShan, or other types of practices.  Mental healing is the heading for reports found in 
the Index Medicus.
Spiritual healing is a generic term used in Britain and is increasingly accepted around the world, despite some lingering proprietary claims of Christian 
fundamentalists. For the sake of brevity in this chapter, the term  healing is used to indicate spiritual healing. The term  spiritual healing, first used by Lawrence 
LeShan, acknowledges that participation in healing opens healers and healee (
10
) to awarenesses of spirituality, a connectedness with aspects of self that extend 
beyond the physical body and reaching towards the Divine, or the  All.
HISTORY AND DEVELOPMENT
Sixth and Seventh Century 
BC
Around the sixth century 
BC
, Pythagoras, a physician as well as a mathematician, astronomer, and philosopher, considered healing the noblest of his pursuits and 
integrated healing into his considerations of ethics, mind, and soul. He called the energy associated with healing  pneuma. His followers conceived of the pneuma as 
being visible in a luminous body, and they believed that light could cure illness. A century later,
... [Hippocrates] says, “It is believed by experienced doctors that the heat which oozes out of the hand, on being applied to the sick, is highly salutary ... It 
has often appeared, while I have been soothing my patients, as if there was a singular property in my hands to pull and draw away from the affected parts 
aches and diverse impurities, by laying my hand upon the place, and by extending my fingers towards it. Thus it is known to some of the learned that health 
may be implanted in the sick by certain gestures, and by contact, as some diseases may be communicated from one to another” (
11
).
Hippocrates hypothesized a healing energy—the  vis medicatrix naturae, or healing power of nature—as the vital force of life. He advised that physicians must identify 
blocking influences within individuals (and between them and the cosmos) to restore the proper flow of  pneuma. Nature, not the doctor, heals the patient.
The theory of the greater unity of mind and body, which the Pythagoreans had advanced, was soon superseded by the Hippocratic beliefs that mind and body are 
dichotomous. Plato criticized this view: “If the head and the body are to be well, you must begin by curing the soul; that is the first thing ... The great error of our day in 
the treatment of the human body [is] that physicians separate the soul from the body.” The Hippocratic system, which was codified by Galen in the second century 
AD
, 
became the standard for medical practice for many centuries thereafter.
Early Christian Era
Jesus was a great healer. The Bible and Gospels tell of numerous individual and group healings by Christ and the Apostles (
1
).They used touch, saliva, mud, and 
cloth vehicles, as well as words, prayers, exorcism, faith, and compassion for healing. Unfortunately, the Christian church gradually turned away from healing for a 
variety of reasons (
12
, 
13
 and 
14
). It deemphasized healing in its ministries, sometimes even denying its existence other than in metaphor or mythology.
In the early Christian era, many priests apparently were selected for their healing gifts. Treatments would involve exhortations to the diseases to leave and the laying 
on of hands. Saint Paul, who believed that healing was a personal gift, was believed to be able to transmit healing through objects he touched. Throughout the third 
century 
AD
, the church was well known for providing healing for its members. By the fourth century, Saint Chrysostom observed that miracles were becoming rare, 
although healing was still being given (
15
). The rites for ordination of priests continued to include a prayer for healing powers, and the relics of saints and their shrines 
were increasingly credited with healing powers.