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The Therapeutic Order and Alternative Medicine

“There’s a popular saying among doctors: There’s no such thing as alternative medicine; if it works, it’s just called medicine.”

What is the Therapeutic Order?

The therapeutic order is a framework for approaching patient care that emphasizes the use of the least invasive and most natural treatments first, before moving on to more aggressive interventions. It is central to the philosophy of naturopathic medicine and includes alternative forms of treatment, pharmaceutical treatment, and surgery. This framework includes diet and lifestyle as foundational to health and progresses to alternative medicine and lastly through the most invasive treatments such as pharmaceuticals and surgery when needed. Maintaining good health ideally would not require invasive treatments and instead embraces a healthy lifestyle and prevention of disease.

A graphic of the therapeutic order seen above is from Leslie Solomonian’s article[i] and is central to naturopathic medicine. This graphic provides a conceptual framework to understand how alternative forms of medicine, western medicine, and surgery can be integrated. Most Western physicians and patients in the US are not familiar with this concept. Taking the Hippocratic Oath is an important step in Western medicine, but the concept of “first do no harm,” is neglected in favor of pharmaceutical drugs or surgical interventions which are incentivized by payment structures in the United States. Western doctors receive little training in diet, lifestyle, and nutrition. Embracing a more inclusive view of health and treatments may prevent us from getting sick rather than treating us when we already are. Functional and Integrative medicine incorporate alternative methods of health care along with Western medicine.

Use of Alternative Medicine in Other Cultures.

Alternative forms of medicine such as Acupuncture, Naturopathic medicine, Ayurveda, Traditional Chinese Medicine, Kampo in Japan, Botanica in Latina America, homeopathy, and herbalism have been used historically as a way to maintain health. These treatments are generally safer in comparison to their pharmaceutical counterparts and have been used with benefits. Their mechanisms may not be fully understood, but research has been ongoing to better understand the mechanisms that provide benefits.

Most cultures have a history of use of traditional medicine and large parts of the world use traditional medicines as they do not have access to pharmaceutical drugs. According to the FDA, although many medicinal herbs are deemed Generally Recognized as Safe/Effective (GRAS/GRASE) by the US FDA. [ii]

In many countries doctors who practice Western medicine also receive training in traditional medicines and care is integrated. Patients in the united states are often afraid to discuss herbal and alternative medicine with their doctors and often do not report taking supplements or other treatments.

Use of Traditional Chinese Medicine in China

Since the 1950s doctors in China have received training in both traditional Chinese medicine as well as Western Medicine. Likewise, practitioners in Chinese medicine also receive training in Western medicine. In a 2015 survey of 20,000 respondents in China approximately 23% of the population surveyed in the China Health and Retirement Longitudinal study were using TCM.[iii]

Use of Herbal Medicine in Germany

According to a study published in BMC Health Services Research, the prevalence rates for herbal medicine (HM) for the general population in Germany are impressively high. The 12-month prevalence rate of HM use is 75.4% and the lifetime prevalence rate is 86.7%.[iv]

Use of Ayurvedic Medicine in India

According to a study published on ResearchGate, about 59% of the sample consisted of Asian Indians who had used or were currently using Ayurveda[v]. Additionally, a PBS report states that approximately two-thirds of India's rural people, who comprise 70 percent of the population, use Ayurveda for their primary healthcare needs[vi]. Therefore, it can be inferred that a significant percentage of East Indians use Ayurveda.

Integrating Treatment

By combining a variety of treatments, an integrative approach can help patients achieve better outcomes than they might with conventional treatments alone. This approach can help reduce pain and improve function while promoting overall health and well-being. The ideal state of health uses medicine and surgery only when needed and seeks to restore health through diet and lifestyle and safer treatments.

Citations [i] Solomonian L. Scope of Practice and Principles of Care of Naturopathic Medicine in North America: A Commentary. Children (Basel). 2021 Dec 24;9(1):8. doi: 10.3390/children9010008. PMID: 35053632; PMCID: PMC8773912. [ii] [iii] Xu L, Hu J, Liu L, Zhan S, Wang S. Trends and Patterns in Traditional Chinese Medicine Use Among Chinese Population in Late Adulthood: An Eight-Year Repeated Panel Survey. Am J Chin Med. 2021;49(2):269-283. doi: 10.1142/S0192415X21500142. Epub 2021 Feb 20. PMID: 33622208. [iv] Welz AN, Emberger-Klein A, Menrad K. The importance of herbal medicine use in the German health-care system: prevalence, usage pattern, and influencing factors. BMC Health Serv Res. 2019 Dec 10;19(1):952. doi: 10.1186/s12913-019-4739-0. PMID: 31823758; PMCID: PMC6905107. [v] Satow YE, Kumar PD, Burke A, Inciardi JF. Exploring the prevalence of Ayurveda use among Asian Indians. J Altern Complement Med. 2008 Dec;14(10):1249-53. doi: 10.1089/acm.2008.0106. PMID: 19123878. [vi]

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