Chapter I

Introduction

Western physicians limit their help to the cure of disease--a biological disorder. They are generally unprepared to heal illness--the way the ill person experiences his or her disorder, in a given social and cultural context.  Alternative healing, by contrast, appears generally to address illness more than disease. (1988 McGuire and Kantor 6)

Overview

With an ever increasing frequency the topic of alternative health care is being discussed and questioned.
Worldwide, only an estimated 10 percent to 30 percent of human health care is delivered by conventional, biomedically oriented practitioners. The remaining 70 percent to 90 percent ranges from self-care according to folk principles to care given in an organized health care system based on an alternative tradition or practice. (1992 NIH)
One of the most appealing factors that generalize this subject of alternative medicine is its holistic approach to health.  Contrasted with this is modern scientific medicine, also known as allopathic medicine, which divides the body into organ systems that are treated largely as though they are independent of the other systems of the body and it's treatments include the modern drugs, surgery, and high tech approaches of most M.D.'s.  Alternative medicine is the general term used for a vast array of health care approaches that fall outside of the world view of traditional Western scientific medicine and encompasses health views that are a synthesis of both Western and non-Western healing principles.  The following are the general divisions of the different methods of alternative health care delivery:
Popular health care is the kind most people practice and receive at home, such as giving herbal tea to someone who has a cold. Community-based health care, which reflects the health needs, beliefs, and natural environments of those who use it, refers to the nonprofessionalized but specialized health care practices of many rural and urban people. Professionalized health care is more formalized; practitioners undergo more standardized training and work in established locations.  (1992 NIH)
Many consumers of these practices are from upper middle class and middle class backgrounds.  "The acceptability of belief in alternative healing systems among middle class persons belies the notion that marginal medicine is a characteristic of the lower classes, a remnant of folk culture that is waning as education and socioeconomic prospects increase" (1988 McGuire and Kantor).  "It is logical that the alternative therapists working with these middle-class, educated clients, would themselves need to be academically and socially sophisticated people" (1989 Heber 569).
     The popular definition of alternative health care would be simply any health care approach that is not Western scientific medicine.  This definition encompasses "a vast collection of theories and practices, some very ancient, some very recent, some sensible and worthy of study, others not so sensible" (1993 Family 9).    The National Institutes of Health (1992 NIH) has recognized the importance of this field and created the Office of Complementary and Alternative Medicine (OCAM).  Wayne Jonas, M.D., the director of the 1992 NIH's OCAM, gave the following explanation of alternative medicine in 1995: "Complementary and alternative medicine is defined through a social process as those pratices that do not form part of the dominant system for managing health and disease" (1997 Cohen 362).  This definition has allowed OCAM to fund various projects among which are research on acupuncture, Ayurvedic medicine, yoga, hypnosis, biofeedback, massage therapy, music therapy and prayer (1994 Consumer 51). OCCAM has recently been reorganized as the National Center for Complementary and Alternative Medicine, and "[i]ts small budget of $2 million in 1992 has grown to $68 million in Congressional funding for the year 2000" (2000 H.S.I. 50).
     The interest and popularity of alternative and complementary health care is growing considerably and it is gaining more acceptance by the population at large.  A 1990 survey found that Americans made 425 million visits to providers of uncoventional therapy, at a cost of close to 13.7 billion dollars, with 10.3 billion being out of pocket expenses;  as compared to 388 million visits to primary care physicians (1993 Eisenberg).  Confirming this trend, another study in 1997 showed, "more Americans visited an alternative therapist than a primary-care physician.  Meanwhile consumer demand for herbal medicines is skyrocketing; the American Botanical Council estimates 1997 sales at nearly $4 billion" (1999 Lemley 57-58).  "The Cochrane Collaboration, which analyzes statistics on health care research recently reported that randomized controlled trials in complementary therapies at prestigious universities around the country will increase to over 500 this year, up from 169 in 1988" (2000, H.S.I. 5). With such economic incentive considerable research is being directed in this area and is showing many beneficial results.
     What is regarded as alternative medicine is defined in large measure by cultural standards.  For example, in the early 20th century Western psychology was introduced to China yet, in the 1960's through the 1970's it was there regarded as a pseudoscience; thus, Chinese doctors who graduated after the 1960's had no knowledge of  Sigmund Freud, however,  in more recent years the field has gained more respect (1986 Shen 138).  Thus, it is often who is looking at a health care regimen that defines if it is "orthodox" or not.
     Many of the benefits of alternative medicine are claimed by Western medicine practitioners to simply be "placebo" effect.  Even if this were completely accurate is it necessarily so different from our scientific medicine.  "Perceived meaning has direct consequences to health. The placebo response is one of the most widely known examples of mind-body interactions in contemporary, scientific medicine, yet it is also one of the most undervalued, neglected assets in medical practice." (1992 NIH)  "It is commonly believed that placebo effects account for at least 33 percent of all cures attributed to allopathic medicine.  However when patient and healer believe in the efficacy of treatment, that figure is probably closer to 70 percent." (1997 Cohen 347).  When medically ineffective forms of therapy were used on 6931 patients , 40 percent had excellent outcomes, 30 percent good outcomes, and 30 percent poor outcomes (1993 Roberts 17).
Even the medical establishment itself is changing.  These days, 118 of the nation's 120 medical schools offer courses in alternative therapy.  Insurance companies are increasingly reimbursing for hypnotherapy, acupuncture, and similar once-fringe therapies. (1999 Lemley 58)
     We shall examine the various alternative health practices in use today by dividing our topic into the following five subdivisions:  movement;  bodywork;  nutrition;  herbal medicine; and the mind and health connection.  The problem encountered with this division is that it will artificially separate treatments that are part of a larger whole.  Many of these alternative techniques have their origins in Traditional Chinese Medicine (TCM), Ayurvedic Medicine and shamanism which all include elements of all five of the subdivisions.
     Out of the numerous areas of alternative medicine I will focus on the practice known as qigong (pronounced chee kung).  Qigong is of two types the active or external and the passive or internal.  This is an ancient component of Traditional Chinese Medicine that is receiving vigorous scientific study in China and to a lesser extent in other parts of the world.  This practice has many similarities to such practices as yoga and hypnotism and is concerned with regulating and increasing the "life force" known as chi or qi.  This practice is seen as very important as it is considered the basis and foundation of both Traditional Chinese Medicine (TCM), all martial arts, and ultimately life itself.  The majority of the research that is contained in the literature (that is the literature in English as much of the research is in Chinese and has not been translated) is concerned with hard science data.  Much of the research that is being conducted is examining the electromagnetic spectrum emitted by qigong practitioners and testing the claimed  psychic abilities of such people.  Only recently has survey research been started in the U.S. to look at the claimed health benefits of this practice.

Movement

     Movement includes various forms of exercises including exercises in different temperatures of water, yoga, martial arts and Qigong practice.  Water has long been used as a treatment and the spa has long been a part of treatment involving extremes of heat and cold.  The change of temperatures affects circulation and the water supports most of the body's weight and allows it to relax more.  In this state injuries can be rehabilitated faster and exercises can be done more easily.  Yoga was developed in India around 5000 years ago and involves stylized poses with meditation, stretching and breath exercises.  Various forms of martial arts exist and are generally divided into two groups the external or hard styles and internal or soft styles.  The most popular in the U.S. are the hard styles which include karate and kung-fu.  The hard styles develop martial ability quicker and often appear more athletic than the soft styles but, with age ability decreases.  Some of the  internal styles include T'ai chi, Hsing-I and Aikido and are generally considered by most martial artists to have better long term health benefits than external styles and with age ability is believed to increase.  Both hard and soft styles have components of each other in them and at higher training levels there is great deal of overlap in their techniques.  Many martial arts traditions have health care regimens that involve pressure points, meditation, massage, and herbal treatments which usually focus on training and combat injuries.  Qigong is similar to yoga, the two  methods share similar techniques and show evidence of borrowing from each other, and involves similar movement, meditation and breathing exercises.  There are qigongs designed for health, longevity and martial arts.  The martial applications were noticed as side effects of the other types and further refined.  Health qigong is used to treat certain conditions and prevent others.  Longevity qigong is used to slow the metabolic processes of the body to extend life.  Martial qigong allows individuals to receive powerful blows to the body with no bruising or injury and resist chokes and joint locks; and at its highest development to project energy at opponents and cause reactions without physically touching them.  This energy projection, which is also used by qigong healers, will be discussed further in the mind and health section. Qigong is an interesting phenomena that is being intensively studied in Asia and to less of an extent in the U.S.

Bodywork

     Bodywork includes various forms of massage such as Swedish, Rolfing, shiatsu, and reflexology along with such practices as acupuncture, and the Alexander technique.  Swedish massage uses "a variety of gliding, kneading, and percussive strokes..., along with deep circular movements and vibrations, in order to relax the muscles, improve circulation, and increase mobility" (1993 Family 156).  Rolfing is a form of deep massage that focuses on working the fascia in a sequential order of ten sessions that increasingly get deeper and sometimes more painful.  Shiatsu, reflexology and acupuncture all involve the use of pressure points for treatment.  The aim of these treatments is to free energy blockages in the body so that the body is able to heal itself.  Reflexology is an ancient healing massage technique, with versions of it used in Egypt, India, Africa, China and Japan, that utilizes primarily the feet and hands (1993 Family 170) .  The feet and hands are divided into zones that correspond to different organs and by massaging these areas these organs are effected and energy blockages released.  Acupuncture attempts to free energy blockages with the use of fine needles inserted into the pressure point.  The Alexander Technique is "a method of adjusting body posture to relieve chronic pain or muscle tension, and to increase range of motion" (1993 Family 180).  The treatment involves building good posture habits by "gentle physical and verbal instruction, clients learn how to eliminate such common problems as slouching, hunching, and the habitual (and harmful) tensing and twisting of the spine" (1993 Family 180).

Nutrition
...about 10,000 years ago the agricultural revolution began making
profound dietary changes in many human populations. The ability to produce and store large quantities of dried foods led to preferential cultivation of some foods, such as grains, which constituted new challenges to the human digestive system. Then about 200 years ago, the Industrial Revolution introduced advances in food production, processing, storage, and distribution. Recent technological innovations, along with increased material well-being and lifestyles that have allowed people more freedom in deciding what and when they wish to eat, have led to even further major dietary changes in developed countries. Because changes in the dietary patterns of the more technologically developed countries, such as the United States,
have been so dramatic and rapid, the people consuming these affluent diets have had little time to adapt biologically to the types and quantities of food that are available to them today. The longer term adverse health effects of the diet prevailing in these countries---characterized by an excess of energy-dense foods rich in animal fat, partially hydrogenated vegetable oils, and refined carbohydrates but lacking in whole grains, fruits, and vegetables---have become apparent only in recent decades.  (1992 NIH)
Nutrition has long been a component of many health care traditions and is gaining more recognition in Western scientific health approaches.  It is now generally agreed that poor nutrition is a leading factor in high blood pressure, strokes, colon and breast cancer, coronary artery disease, and diabetes.
Recent studies have also reported that certain cultural eating styles, such as the Asian and Mediterranean diets, appear to lower risk factors for heart disease and certain forms of cancer as well. Although there have been few controlled studies of the benefits of many traditional diets, such as those originally consumed by Native American Indians, diseases such as diabetes and cancer were not a problem for these populations until their diets became more Western, or affluent. 
(1992 NIH)
Among the alternative health approaches to nutrition are vegetarianism, macrobiotics, and vitamin and mineral therapy.  Vegetarianism is an interesting phenomena that has many subcategories.  Some vegetarians will only eat plant products while others will eat fish and diary products.  "Some studies show that vegetarians have lower levels of blood cholesterol and lower blood pressure than meat eaters--meaning that their risks for heart disease is also lower" (1993 Family 268).  Macrobiotics sees food as having an energy level and the goal is to eat meals that have balanced energy levels.  Macrobiotic cooking uses cast iron, stainless steel, enamel pots, and ceramic and tempered glass ovenware but it avoids copper or aluminum vessels as they may effect the vitamin content of food (1993 Family 270).  The regimen involves eating foods native to your region and in season while avoiding treated or processed foods, red meat, sugar, diary products, eggs, and coffee.  Vitamin and mineral therapy involves the use of supplements or whole foods to prevent or treat disease conditions.  One popular approach to using vitamins and minerals is taking megadoses of selected supplements.  Vitamin C is a popular candidate for megadose use as, preliminary research has indicated, it has possible benefits in treating and preventing various conditions.

Herbal Medicine

     Herbal medicine, also known as phytotherapy, is one of the most popular alternative health approaches today when measured economically as the profits continue to mount and the number of herbal products increase.  Herbs are used in several ways as they are used both internally and externally.  Some of the alternative health treatments utilizing herbs include aromatherapy, Bach flower remedies, and homeopathy.  Aromatherapy uses essential oils from plants to stimulate, relax and relieve pain.  This treatment is rather new to the U.S. but has been in use in Europe for some time.  "In France, pharmacies sell aromatic oils, and health insurance plans cover prescriptions for them" (1993 Family 329).  A similar treatment is Bach flower remedies developed by Bach, a British physician that rejected scientific medicines use of drugs for treating disease symptoms, who believed mental states contributed to illness.  The system uses 38 healing plants arranged into 7 groups with "each representing a mental state that could, according to his theory, contribute to sickness and interfere with healing: apathy, fear, uncertainty, loneliness, oversensitivity, despair, and overconcern for the welfare of others" (1993 Family 330).  A treatment  consists of taking a few drops in a drink or under the tongue four times a day.  The new scientific medicine field of psychoneuroimmunology now looks at the link between emotions and health and has found a link between emotional states and health.  Homeopathy was developed by Samuel Hahnemann in the early 19th century.  This was one of the most popular treatments before the advent of scientific medicine as we see in the following:
The first homeopathic college opened in Philadelphia in 1836, and others soon followed.  In 1844, the American Institute of Homeopathy was formed, the first national medical organization in the country.  By the end of the century, there were 15,000 practitioners and 22 homeopathic schools in the U.S.
(1993 Family 61)
Homeopathy can best be summarized as like cures like and less is more.  The problem that is run into is the less is more theory.  Homeopaths dilute their treatments down, in a process known as potensification, many times over to the point that their should be none of the original substance left.  The only explanation that homeopaths can offer is a theory that the water or alcohol used to potensify the curing substance has molecules that possibly have a "memory" or energy signiture that will allow them to resonate the curing substance through the body when taken.  Most researchers attribute the effects to the placebo effect, however, statistically significant effects have been demonstrated on infants and animals.

Mind and Health

     The connection between the mind and body, with the exception of the field of psychology, has been largely ignored by contemporary scientific medicine.  Most cultures traditional systems of healing, and many of the newer alternative medicine approaches, recognize the powerful interaction between the mind and its emotions with the human body.  The power of belief and expectation can dramatically influence an individual's health.  The so called "placebo effect" is an example that scientific medicine recognizes.  Among the popular treatments that rely heavily on the individuals belief and expectation (belief and expectation in the healer, the treatment, and in themselves) are the following:  faith healing;  meditation;  rituals and choreography; relaxation therapy; biofeedback and visualization; hypnosis;  dream therapy; psychoanalysis and its many derivatives; group therapy; creative therapy; primal therapy and rebirthing.  Many of these treatments are employed by psychologists and psychiatrists and have their origins in traditional Oriental religious and healing techniques.  MacHovec (1984) has traced Gestalt, existential, psychoanalytic, transactional-analysis, cognitive, and family therapy concepts back to ancient Taoist, Zen, Confucian, and Buddhist sources.  Jung was an important figure in researching and bringing to Western treatment techniques many of these traditional Oriental principles that have evolved into several treatment branches (1993 Family 103).
     Treatments that rely heavily on both the patient and health practitioner's belief and expectations are those that involve manipulating the patients life energy.  Reiki is a healing technique that was developed in Japan, by Dr. Mikao Usui, in the mid-1800's.  The techniques involves the "transfer of energy from one being to another" where the flow "of vibrations or radiant energy is reciprocal, with the practitioner and client both giving and receiving" (1993 Family 99).  "External Qigong refers to emission of Qi by a Qigong 'master' (Qigong practitioner with exceptional skill) with the objective of affecting someone or something other than himself; in that way the process is not unlike a medical procedure or treatment" (1991 Sancier 367).  The condition of the patient is treated when the master uses his Qi to balance the patients life energy.  A similar technique is known as therapeutic touch and was developed by Dolores Krieger, Ph.D., R.N. who believes that "the energy fields are somehow involved in blood hemoglobin levels" as she experimentally determined "a significant rise in hemoglobin levels among patients treated" (1993 Family 97).  The fact that such a technique was developed in the U.S. by a nurse, indoctrinated in the methods of scientific medicine, is not surprising when we observe that "nursing differs from medicine in its focus on the whole person" (1990 Kovner 91).  Thus, we have "Rogers (1970), another popular nursing theorist, descib[ing] the person as an energy field, having no real boundaries" and "she proposes that the energy field of each person is in constant interaction with the environment, which is itself an energy field that is everything outside the human field (Riehl & Roy, p. 332)" (1990 Kovner 91).

Alternative healer as a shaman

     "Shamanic healers have a far greater propensity to experience anomalous events than general populations and to use their beliefs arising from these episodes to produce ceremonies that change clients' perceptions of their illnesses" (1993 McClenon 107).  Western medicine and shamanism both "...provide experiences that convince clients that specific procedural methods alleviate illne (107).  Anomalous experiences are defined as "perceptions that seemingly refute current scientific principles, inspiring wonder" such as extrasensory perceptions (ESP), apparitions, out-of-body experiences, near-death experiences, precognitions, clairvoyance, night paralysis, syncronicities, and contacts with the dead (108).  "A growing number of surveys of random national samples of American and European contries reveal the extensiveness of psychic experience and occult belief (Gallup and Newport, 1991; Greeley, 1975; 1987; Haraldsson, 1981, 1985, 1988-89; McClenon, 1988; McCready and Greeley, 1976)" (109).
For example, in 1990, 25% of randomly sampled Americans reported having felt that they had been"'in touch with or getting a message from someone who was far away without using the traditional five senses"; 25% claimed to have been able to heal their bodies "using the power of [their minds] without traditional medicine", 17% had felt that they "were in touch with someone who has already died", and 9% claimed to have "seen or been in the presence of a ghost" (Gallup and Newport, 1991, p. 141).  American, Japanese, and Chinese student samples revealed correspondingly high rates of anomalous experience (McClenon, 1988, 1990 a,b). For example 71% of the Chinese, 88% of the Japanese, 44% of those at the University of Maryland, and 35% of the students at the predominately African-American college in North Carolina reported ESP experiences.  Among the Chinese, Japanese, and American student samples, the percentage reporting contact with the dead varied from 10% (Japanese) to 40% (Chinese).  The percentage stating that ESP was a "fact" or a "likely probability"  varied from 61% (Japanese) to 76% (Chinese).  The elite American scientists revealed far lower rates of experience: 26% reported ESP episodes and 10% had contacts with the dead.  Only 20% regarded ESP as "an established fact" or "a likely possibility"
(McClenon, 1982, 1984). (109)

Conclusion

     From this overview of alternative medicine several conclusions can be made.  The use of alternative health care is receiving greater attention and more research is being directed towards why it is used and what is being used.  Some of the reasons that both health care providers and patients are interested in alternative approaches are given in the following:
1.  The health practitioner may encounter clients who are faced
with problems that do not seem to respond to traditional health care.
2.  One way that some choose to confront these systematic
complaints is to employ some of the health traditions of other cultures and to view the body and mind as a balanced whole.
3.  Massage, acupuncture and acupressue, t'ai chi, and...[many
other alternative treatments] focus on the mind/body connection to facilitate healing through relaxation, pressure points, and movement.  (1993 Wanning 351)
     Increasingly, Western scientific medicine is looking to alternative approaches to health care.  Our current system of health care is geared more towards acute than chronic health conditions.  China is a good example to look to for the integration of alternative health practices (mainly TCM) with Western scientific medicine.
Modern medicine has first separated the body from the external world, taking it as a closed, self-contained system, and then by dissecting its structures into various organs has attempted to understand their respective functions.  In contrast, Eastern medicine has from the outset understood the body as an open system connected to the external world.  (1993 Yasuo 103)
When the two paradigms exist side by side and begin to meld as in China  the observed result is TCM generally being more effective for chronic conditions and scientific medicine generally more effective for acute conditions.  The logic behind this is clear as most chronic conditions are diseases of life-style and life-abuses.  Herbert Benson, M.D. elaborates that "between 60 percent and 90 percent of visits to physicians are prompted by conditions that are related to stress and are poorly treated by drugs and surgery" (1995 44).  TCM is a holistic health approach that integrates all of the categories we have covered and is much more concerned with prevention rather than treatment.  The differences between Western and Eastern ideologies is presented well in the following:
What are the fundamental differences between the modern Western pattern of thinking and the traditional Eastern pattern of thinking?  To approach this question in light of the mind-body function, modern Western medicine uses for its standard the normal condition of the great majority of people, that is, an unspecified, large number of cases.  For example, by observing cases of normal people that "this" organ functions in a certain way or "that" drug has a particular effect, an empirical law is formulated.  Generally speaking, modern empirical science adopts this method.  For this reason, a modern scientific law has general validity.  This approach, however, tends to ignore or treat lightly the exceptional cases. In contrast, Eastern medicine follows the principle of prescribing medication differently from patient to patient; even though the illnesses dealt with may seem identical, it is not uncommon for prescriptions to differ between patients.  This is because Eastern medicine does not formulate an empirical law by generalizing as its standard the cases of an unspecified, large number of people.  ....the traditional Eastern pattern of thinking takes as its standard people who after a long period of training have acquired a higher capacity than the average person, rather than the average condition of most people.  ...A law derived therefrom indeed lacks the general validity of the laws of modern science, but it has instead the advantage of grasping a deeper, potential mechanism which otherwise would remain incomprehensible. 
(1993 Yasuo 61)
These differing approaches have lead to different cultural attitudes towards health care.  The West relies on treatment oriented, technology quick fix solutions and often concentrates on the immediate effect more than the cause which lead up to the effect.  The East is prevention oriented and emphasizes healthy lifestyle choices and concentrates its focus on the underlying cause more than the resulting effect.  This paper will examine a product of this Eastern philosophy in the practice known as qigong, which is gaining popularity and interest in the West.

Chapter 2

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