The Process of Healing
The Process of Healing:
A Unifying
Theory of Naturopathic Medicine
Jared L. Zeff, N.D.
Introduction
Why do well-selected remedies or medicines not always work? How many of us feel confident that we can truly cure a patient who suffers from arthritis, cancer, chronic fatigue, or endometriosis? Do we understand how to bring about cure?
Our medicine is based upon the observation of innate healing. From this observation we have extracted six principles by which we define ourselves. These principles also instruct us that our role is not to direct healing but to help it emerge.
This article explores the process of healing as the origin of naturopathic philosophy. The primary intention is to set forth a clarification and expansion of naturopathic philosophy, and model the practice, which naturally arises from it. If this philosophy were better understood, and applied in a consistent and artful manner, we would know how to bring about cure and would approach our patients with a strong confidence.
Models of Medical Thought
Mainstream medicine is based upon a simple and elegant model: the diagnosis and treatment of disease. In brief, the doctor is expected to determine the specific nature and name of the disease process (diagnosis), and then apply the various tools or weapons which science and experience have provided to eliminate the disease (treatment).
This is taken as self-evident and unquestioned. Upon analysis it contains at least three assumptions:
that there are distinct disease entities which exist separate from the patient;
that these disease entities can be identified;
that these disease entities can be removed from the patient’s body.
In this conventional system, the doctor identifies the disease and then “does battle” with it, almost as if the patient were a neutral field upon which this battle takes place. The principal tools in this battle are drugs and surgery.
The Naturopathic Model
Naturopathic Medicine embraces different assumptions. In our medicine, the emphasis is upon health restoration rather than disease treatment. The first of these naturopathic assumptions is contained within Vis Medicatrix Naturae.
The naturopathic physician does not do battle with a disease entity. Instead, we rely upon the healing wisdom, vital energies and intelligence of the organism to restore normal and healthy function. The work of the naturopathic physician is to elicit healing by helping the patients to create or recreate conditions for health to exist within them. Health will occur where the conditions for health exist. Disease is the product of conditions, which allow for it.
A Model of Healing
The process of healing can be modeled very generally through a simple diagram. As one moves downward through this diagram, recognizable pathology appears as if these pathological events were entities rather than an organism in the process of challenge, reaction, and degeneration.
The Process of Healing
In this model, we begin with an organism demonstrating normal health. There may be an optimal health which sits above the normal, but attainment of that is unusual, and most people begin with a normal degree of health. Something, usually a multiplicity of stressors through time, disturbs this normal state. This can be any number of things, such as dietary factors, trauma, exposure of various types, emotional disturbances, etc. If the disturbance is severe enough, tissue will become irritated. When tissue is irritated, it will generate an inflammatory process.
Inflammation is caused by release of various chemicals from injured or irritated tissues, such as kinins, leukotrienes, prostaglandins, etc. These chemicals cause several events to occur. Among these are vasodilatation, increased vascular permeability, chemotaxis, diapedesis, nerve stimulation, and so forth. These are generally experienced by the patients as the cardinal signs of inflammation: heat, redness, swelling, and pain.
Upon simple analysis, such physical events can be seen to be intelligent and healing phenomena. The increased blood flow from vasodilatation, the increased vascular permeability, the diapedesis of white blood cells and plasma, etc., result in the symptoms of inflammation. However, the increased blood flow also brings increased oxygen, increased numbers of white blood cells, and other healing elements into the disturbed area. These are the front line healing processes, which the body employs. They are obviously intelligent and wise things for the body to do to heal itself. This is an example of what is meant by Vis Medicatrix Naturae.
If the disturbance is single, or short lived, these processes will bring the body, or the involved tissues, back to a normal state. The inflammation will be followed by discharge and then by resolution. This is most easily seen with the common cold. The common cold is not a disease entity; it is a healing process. The worst thing one could do is suppress the process with drugs, which interferes with the process of inflammation, discharge, and recovery.
The Origin of Chronic Disease
If any process of acute, restorative inflammation is suppressed, usually by drugs, the disturbing factors will persist. Toxemia accumulates. Function is increasingly disturbed and inflammation becomes more persistent and recurrent. This is the origin of chronic disease. As disturbing factors continue and are suppressed, the disturbance penetrates more deeply into the organism, and chronic inflammation ensues. Which tissues become involved will depend upon inherited weakness, acquired weakness, mechanical stresses, the nature of the specific toxins, and so forth.
Arthritis is a perfect example of this. Arthritis in general is an idiopathic inflammatory disease characterized by pain and degeneration. Cause is not conventionally understood, and conventional treatment is directed at reducing the pain and inflammation, which is partially successful, but the various treatments (drugs) generally create their own pathology, which may become devastating, including immune suppression, osteoporosis, ulceration of the stomach, etc.
Following the naturopathic model presented above, the physician would work with the patient to identify and remove the causes of disturbance, primarily found in diet, substance abuse and life stresses. We help the patient establish more healthful habits, improve digestion, stimulate the self-healing potential, or overcome the obstacles to health through a variety of therapeutic modalities. According to the inclination of the patient, or skill of the physician we might choose hydrotherapy, homeopathy, acupuncture, manipulation, botanical medicine, specific nutrition, and so forth. When we apply these therapies judiciously, and in the right order, we can expect to see rapid decrease in pain and inflammation.
When I began in practice I did not know how to treat arthritis. I used a variety of “anti-inflammatory” herbs or other substances, elimination of the “nightshades”, homeopathic remedies as indicated, physiotherapy, and whatever else I could recall, discover, or think of. But, nothing I did in this regard resulted in a permanent cure. When I later came to understand the naturopathic model for restoring health, through the tutelage of Dr. Harold Dick, my rate of success as well as my confidence began to increase.
Toxemia
Toxemia is the inappropriately high level of metabolic waste products and exogenous toxins in the blood. Most of it is due to the bacterial production of such toxins generated by the metabolism of poorly digested dietary elements in the large intestine. Some simple examples of this are the inappropriate bacterial degradation of tyrosine into phenol, tryptophan into toxic anthrenes, or cholesterol into estrogens. Hundreds of these reactions can occur, generating hundreds of different toxins. These products are absorbed into the blood, become a cause of tissue irritations and thereby the physical basis of most chronic inflammation, which ultimately will increase one’s susceptibility to acute disease. Dietary indiscretion is the most common “disturbance” in the model outlined above.
Mal-digestion, the origin of toxemia, is caused by eating foods which are not well digested by a particular body, by inappropriate food selection or preparation, by overeating or other inappropriate eating patterns, and by stress. Excess or unmanaged stress causes increased adrenal activity, which decreases circulation to the digestive system through the mediation of cortisol and adrenaline. The digestive processes are heavily dependent upon free and appropriate circulation of blood to function properly. Adrenaline and cortisol, intrinsic or extrinsic, will reduce this circulation to the gut and thereby reduce the effective functioning of digestion. As poorly digested food passes through the digestive tract, it is subject to the bacterial actions of fermentation and putrefaction.
The Process of Disease
Stress and dietary choices determine toxemia. Toxemia disturbs cellular function and results in irritation. Other factors may also disturb normal function: exogenous toxins, climactic or other exposures including pathologic bacteria or viruses, physical injury, traumatic family history, etc. Cellular irritation results in inflammation. If the disturbance is singular and short-lived, the inflammation will return the body to a normal state. If the disturbance persists, the inflammation too becomes persistent, and over time may cause degenerative changes. Suppression of inflammation will result in a deepening of the effect of disturbing factors, resulting in the development of disease deeper in the organism, that is, affecting more centrally important systems or organs. The classic example is that of suppressed eczema becoming asthma.
To reverse the decline towards degeneration, the disturbing factors must be removed or ameliorated. If suppression has occurred, or if the disease has deeply penetrated or damaged the organism, there will be a return of acute inflammation as the organism moves back toward health. This is called a healing reaction or healing crisis. The process of healing is the reverse of the process of disease. It is the inherent nature of living beings to display this phenomenon, which has been observed and reported upon over many centuries, beginning at least with Hippocrates in the West, and proceeding through Galen, Paracelsus, Ibn Senna, Sydenham, Preissnitz, etc. The tendency of self-healing is the theoretical basis of naturopathic medicine.
The Hierarchy of Therapeutics
In facilitating the process of healing, the naturopathic physician seeks to use those therapies which are most efficient in stimulating the self-healing mechanisms and which have the least potential to harm the patient. The concept of harm includes suppression of the natural healing process, such as inflammation and fever. These precepts, coupled to an understanding of the process of healing, result in a therapeutic hierarchy. This hierarchy is a natural consequence of how the organism heals. Therapeutic modalities are applied in a rational order, determined by the nature of the healing process.
If we examine the process discussed above, we can come to an understanding of appropriate therapeutic intervention and its natural order. Restoration of health can be defined by four principles:
Re-establishing the basis for health;
Stimulation of the Vis Medicatrix Naturae;
Tonification and nourishment of weakened systems;
Correction of structural integrity.
First, the physician must identify the nature and causes of whatever is disturbing the patient, which results in the presenting symptoms. The physician will then advise or otherwise work with the patient to remove or reduce the disturbing factors. The first intervention will usually include at least three therapeutic elements:
talking with the patient;
dietary and nutritional assessment and modification;
stress assessment and modification.
These three elements generally manifest as counseling about life style modification, including exercise prescription. They may also require specific attention to psycho-spiritual dysfunction.
The second part of therapeutic intervention is that which seeks to move the process “upward”, using therapies designed to stimulate the healing process. First use those therapies which most generally, most gently, and most effectively stimulate the healing process. Then, if needed, proceed with therapies that are more specific, more invasive, more potentially harmful, and more potentially suppressive. A natural hierarchy results from an examination of potential therapies via the naturopathic model. Such a hierarchy may present as follows:
1. General stimulation of the vital force. This is most efficiently accomplished through constitutional hydrotherapy: a method designed to stimulate circulation to the digestive and eliminative organs, stimulate the nervous system, stimulate the function of the digestive organs, and stimulate the “vital force”. This treatment is applied similarly to everyone, that is, it is not specific, and constitutes the most pure form of general stimulation of the Vis Medicatrix Naturae.
2. Specific stimulation of the vital force. This is accomplished through:
homeopathy, a patient-specific system of stimulation of the vital force, which works through bioenergetics, and
acupuncture, a patient -specific system of stimulation and balancing, more invasive than homeopathy.
3. Tonification and nourishment of weakened systems, using:
glandular and protomorphogen supplementation to provide specific nutrition and stimulation to the various organs and tissues;
botanical medicine to stimulate or normalize the function of specific organ systems, but with a potential for suppression or toxic reactions;
therapeutic exercise prescriptions designed to strengthen weakness or enhance circulation and mobility;
physiotherapy to stimulate specific organ systems through the application of electromagnetic or mechanical force;
specific nutrition through vitamin, mineral or other nutrient supplementation, a form of biologic pharmacology;
pharmacology, natural or synthetic, to control functions, but generally with toxic manifestations and great suppressive potential.
4. Correction of structural integrity through:
manipulation: specific systems of force applied to re-integrate structure, primarily but not exclusively to spinal vertebrae, or
surgery, the most invasive therapy and with the highest potential for irreversible harm, reserved for emergency repair, or as a last resort.
Whereas the specific placement of therapies in this “hierarchy” may be debatable, it is based upon potential for harm, the depth at which the treatments work (more general toward more specific), and their potential for stimulation of the Vis Medicatrix Naturae (the more invasive, the lower the potential).
This is offered as a summation of our philosophy, and as a guide to our newer practitioners. Two principal concepts deserve reiteration. First, success will often be based upon the order of the therapeutic intervention. For example, appropriate dietary change comes before specific stimulating therapies. This will allow the therapies to work in an improved “terrain” and therefore produce more lasting results. If the cause of the disturbance, usually improper diet, continues to be fed into the system, therapeutic intervention at a lower level in the hierarchy will rarely be curative and may even exacerbate the body’s inflammatory response. Second, therapy must attempt to stimulate the vital responses of the body and not be directed against pathology.
Naturopathic medicine is vitalistic, relying upon the wisdom and intelligence of the body rather than that of the doctor. Those therapies toward the top of this therapeutic hierarchy have the greatest potential to return the organism to normal unsupported function, that is, permanent cure. To send your patient out the door with a box full of supplements, without first having plumbed the causative elements of dietetics, digestion and stress, and acted to correct them, will generally not result in permanent nor efficient cure.
Conclusion
Naturopathic medicine is defined by a philosophy of healing, which is focused upon destroying disease. This is accomplished through a system of therapeutics, which is the natural result of the philosophy. The therapeutics function best, and fulfill the philosophy, when they are applied in a rational order as defined by the natural healing process. The hierarchy of therapeutics is a further refinement of the definition and philosophy of naturopathic medicine.
When naturopathic medicine is thus applied consistently in health care situations, the positive outcome should be predictable, observable, and reproducible. The naturopathic model for healing therefore presents a scientific basis for evaluation, in both teaching settings and clinical practice.
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