WEEK 2 Complementary

COMPLEMENTARY AND ALTERNATIVE THERAPIES FOR NURSING PRACTICE

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F o u r t h E d i t i o n

Karen Lee Fontaine Professor, College of Nursing, Purdue University Calumet,

Hammond, Indiana

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Many of the designations by manufacturers and seller to distinguish their products are claimed as trademarks. Where those designations appear in this book, and the publisher was aware of a trademark claim, the designations have been printed in initial caps or all caps. Library of Congress Cataloging-in-Publication Data Fontaine, Karen Lee, 1943–author. [Complementary & alternative therapies for nursing practice] Complementary and alternative therapies for nursing practice / Karen Lee Fontaine, professor, College of Nursing, Purdue University Calumet, Hammond, Indiana.—Fourth edition. pages cm Revision of: Complementary & alternative therapies for nursing practice.—3rd ed.—©2009. Includes bibliographical references and index. ISBN-13: 978-0-13-334650-3 ISBN-10: 0-13-334650-1 1. Nursing. 2. Alternative medicine. I. Title. RT42.F64 2015 610.73—dc23 2013045244

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Dedication

This book is dedicated to Peggy Gerard, Dean, and Kathy Nix, Undergraduate Coordinator, College of Nursing,

Purdue University Calumet for all their support and enthusiasm as complementary and alternative medicine

was integrated into the curriculum.

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CONTENTS

Preface ix

Acknowledgments xiii

Reviewers xiv

UNIT 1 Healing Practices: Complementary and Alternative Therapies for Nurses 1

Chapter 1 Integrative Healing 3

Chapter 2 Basic Concepts Guiding Alternative Therapies 19

Chapter 3 The Role of Evidence-Based Health Care in Complementary and Alternative Therapies 37

UNIT 2 Systematized Health Care Practices 47 Chapter 4 Traditional Chinese Medicine 49

Chapter 5 Ayurvedic Medicine 70

Chapter 6 Native American Healing and Curanderismo 90

UNIT 3 Botanical Healing 111 Chapter 7 Herbs and Nutritional Supplements 113

Chapter 8 Aromatherapy 133

Chapter 9 Homeopathy 149

Chapter 10 Naturopathy 162

UNIT 4 Manual Healing Methods 169 Chapter 11 Chiropractic 171

Chapter 12 Massage 183

Chapter 13 Pressure Point Therapies 202

Chapter 14 Hand-Mediated Biofield Therapies 217

Chapter 15 Combined Physical and Biofield Therapy 230

UNIT 5 Mind–Body Techniques 239 Chapter 16 Yoga 241

Chapter 17 Meditation 256

Chapter 18 Hypnotherapy and Guided Imagery 269

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Chapter 19 Dreamwork 286

Chapter 20 Intuition 301

Chapter 21 Music as a Therapeutic Tool 311

Chapter 22 Biofeedback 320

Chapter 23 Movement-Oriented Therapies 327

UNIT 6 Spiritual Therapies 339 Chapter 24 Shamans 341

Chapter 25 Faith and Prayer 352

UNIT 7 Other Therapies 367 Chapter 26 Bioelectromagnetics 369

Chapter 27 Animal-Assisted Therapy 378

Appendix Alternative Therapies for Common Health Problems 393

Index 417

vi Contents

TRY THIS

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Energy 34 Massage 88 Positive Thoughts 107 Herbal Remedies 128 Soothing Potions 144 Top 10 Remedies 157 Pet Remedies 158 Visualization 167 Energy Boosters 181 Massage 199 Foot Massage 213 Experience Your Energy Field 227 Emotional First Aid 235 Redirecting the Flow of Energy 236 Heart Breathing 252 Loving–Kindness Meditation 266

Renovating Your Day 283 Shrinking Antagonistic

Forces 283 Improving Dream Recall 298 Positive Affirmations 308 Practice Intuition 309 Music for Stress Reduction 316 Mind Control of Muscular

Strength 324 Feel Your Qi 335 Wave Hands Like Clouds (Water

T’ai Chi) 336 Shamanic Journey 349 Absorbing Earth Energy 375 Going to the Mountains 376 Interacting with Your Pet 389

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PREFACE

The profession of nursing has advanced beyond the Western biomedical model to incorporate many healing tools used by our Asian, Latino, Native American, African, and European ancestors. We are rapidly rediscovering that these ancient principles and practices have significant therapeutic value. Some see this movement as a “return to our roots.” Others believe it is a response to runaway health care costs, growing dissatisfaction with high-tech medicine, and increasing concern over the adverse effects and misuse of med- ications. The growth of consumer empowerment also fuels this movement.

As nurses, how do you begin to assimilate thousands of years of healing knowledge? How do you begin this journey of integrating practices into your own lives? In your professional practice, how do you model healthful living? How do you help clients choose their own healing journeys? How do you break down the barriers between conventional and complementary and alter- native medicine (CAM)? Learning about CAM practices, like anything else, is a slow process involving a steady accumulation of bits of information and skills that eventually form a coherent pattern called knowledge. Although it is possible to learn a great deal about healing practices from reading, thinking, and asking questions, you must in the long run learn about healing through participation. Without hands-on experience, you can be a good student, but you can never be a great nursing practitioner of the healing arts. I trust this book will be one step in a lifelong exploration of and experiences with healing practices.

Consumers do not wish to abandon conventional medicine, but they do want to have a range of options available to them including herbs and nutri- tional supplements, manual healing methods, mind–body techniques, and spiritual approaches. Some CAM practices, such as exercise, proper nutrition, meditation, and massage, promote health and prevent disease. Others, such as herbs and homeopathic remedies, address specific illnesses. Many other CAM practices do both. The rise of chronic disease rates in Western society is increasingly motivating consumers to consider self-care approaches. As recently as the 1950s, only 30% of all disease was chronic, and curable—largely infectious—diseases dominated, for which medical interventions were both appropriate and effective. Now, 80% of all disease is chronic. Western medi- cine, with its focus on acute disorders, trauma, and surgery, is considered to be the best high-tech medical care in the world. Unfortunately, it is not responding adequately to the current epidemic of chronic illnesses.

Ethnocentrism, the assumption that one’s own cultural or ethnic group is superior to others, has often prevented Western health care practitioners from learning “new” ways to promote health and prevent chronic illness. With consumer demand for a broader range of options, we must open our minds to the idea that other cultures and countries have valid ways of preventing and curing diseases that could be good for Western societies.

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x Preface

Although the information may be new to us, many of these traditions are hun- dreds or even thousands of years old and have long been part of the medical mainstream in other cultures.

I have titled this book Complementary and Alternative Therapies for Nursing Practice because I believe we need to merge CAM approaches with Western- based nursing practices. I have tried to provide enough information about alternative therapies to help guide practice decisions. This text, as an over- view and practical guide for nurses, does not pretend to be an exhaustive col- lection of all the facts and related research in CAM, nor does it offer meticulous documentation for all claims made by the various therapies. The goal of the text is to motivate you, the reader, to explore CAM approaches, increase your knowledge about factors that contribute to health and illness, and expand your professional practice appropriately.

It is possible to classify alternative practices in any number of ways. I have chosen to present more than 40 approaches categorized into seven units. In Unit 1, I introduce the philosophical approaches to both Western bio- medicine and complementary and alternative medicine, as well as evidence- based health care in CAM therapies. Concepts common to many approaches are defined and discussed, such as energy, breath, spirituality, and healing. Unit 2 presents a number of health care practices that have been systematized throughout the centuries worldwide. These typically include an entire set of values, attitudes, and beliefs that generate a philosophy of life, not simply a group of remedies. The chapters cover Traditional Chinese Medicine, Ayurvedic medicine, and Native American healing and curanderismo. Unit 3 comprises chapters relating to botanical healings used by 80% of the world’s population. Chapters cover herbs and nutritional supplements, aromather- apy, homeopathy, and naturopathy. Unit 4 presents manual healing methods—some from ancient times and some developed in the latter half of the 20th century. The chapters discuss chiropractic, massage, pressure point therapies, hand-mediated biofield therapies, and combined physical and biofield therapies. The chapters in Unit 5 cover types of mind–body tech- niques for healing and include yoga, meditation, hypnotherapy and guided imagery, dreams, intuition, music as a therapeutic tool, biofeedback, and movement-oriented therapies. Unit 6 presents two spiritual approaches to therapeutic intervention: working with shamans and the use of faith and prayer. Unit 7 includes two chapters on miscellaneous practices: bioelectro- magnetics and animal-assisted therapy.

The appendix provides specific information on managing the types of common health problems that respond well to alternative therapies and life- style modification.

This book does not recommend treatments but, rather, describes alterna- tive practices, their backgrounds and claims, preparation of practitioners, con- cepts, diagnostic methods, treatments, and evidence from research studies. “Integrated Nursing Practice” is an important section of every chapter designed to help you, the nurse, expand your practice by providing you with specific information and suggestions. “Try This” features throughout the

Preface xi

chapters provide you with examples of how you can integrate these practices into your own life and also give you ideas for client education. A list of resources is also included in the chapters.

In this new fourth edition, I have continued the “Considering the Evi- dence” feature with all new research relating to the chapter topic. Eight of these features present a systematic review of randomized control trials, while two present primary research . “Considering the Evidence” boxes not only present current studies but also are designed to further critical thinking and perhaps inspire you to design studies to answer your own questions. Each study answers the following questions: What was this study about? How was the study done? What were the results of the study? What additional ques- tions might I have? And how can I use this study?

Changes to the fourth edition:

• Updated all research sections and greatly increased the number of sys- tematic reviews of randomized controlled trials

• Changed the focus of the chapter on music from music therapy to music as a therapeutic tool to broaden the focus for the practicing nurse

• Expanded the lists of resources to include more international resources • Deleted polarity therapy and crystal healing for lack of research and

evidence • Added sections on

• Music thanatology • Aromachology • Restorative yoga • Latest technology for biofeedback self-tracking

• Expanded cautions for pregnant women and young children

Nurses are in a unique position to take a leadership role in integrating alternative healing methods into Western health care systems. Nurses have historically used their hands, heart, and head in more natural and traditional healing interactions. By virtue of their education and relationships with clients, nurses can help consumers assert their right to choose their own healing journey and the quality of their life and death experiences.

My dear friend and colleague has written the following letter to you about her lived experience uniting biomedicine with CAM approaches.

Dear Reader,

It is both a pleasurable and enlightening experience for me to contribute to your text, Complementary and Alternative Therapies for Nursing Practice , through the development of the “Considering the Evidence” feature. I approach this work hopeful that it may inspire you, the reader, to engage in critical thinking, assist in your understanding of the significance of research to inform your nursing practice and, perhaps, propose studies to answer your own researchable questions. However, with this edition, I have asked Karen Lee Fontaine to allow me the privilege of sharing with you my personal journey with complementary and alternative therapies. I hope I can thus inspire you

xii Preface

to reflect on and embrace the important content of this text. After learning of my diagnosis of bilateral breast cancer, I actively participated in myriad Western medicine therapies while integrating complementary and alternative therapies. Although the chemotherapy experience was both mentally and physically challenging, I considered the massage therapist as part of “my team,” and I looked forward to this dimension of comfort during this challenging time. Engaging in yoga enhanced “restful sleep” as a response to the overwhelming fatigue that frequently accompanies Western therapies such as chemotherapy and radiation and just the daily awareness that “you have cancer.” Acupressure relieved uncomfortable postoperative symptoms. T’ai chi continues to be an opportunity to focus on myself and reflect on the positives associated with this journey. Reiki and reflexology is my specified “me time.” As I engage in the associated deep breathing exercises, it stimu- lates my mind to drift to affirmative thoughts and so many positive memories from my life. For me, “living with cancer “is more of an “inconvenience” in my life’s journey. I can appreciate this may not be the experience for every- one, but I can personally assure you that integrating many of the therapies discussed in this text allows me a “quality of life” while simultaneously working with conventional medicine’s goal for a “quantity of life.” With the combination of both, I feel I have been given the power to survive!

I hope my story gives you a sense of hope and empowerment in caring for persons both professionally and personally who are embarking on a stren- uous journey related to their health. I can recall in my nursing practice experi- encing feelings of helplessness when caring for persons undergoing complex t reatments with so many uncertainties related to their health outcome. I can attest that your understanding, knowledge, and support in the implementa- tion of complementary and alternative therapies can significantly affect their “quality of life” and allow you the privilege of making a difference in their health journey.

Warm regards, Dolores M. Huffman, RN, PhD

ACKNOWLEDGMENTS

I would like to express thanks to the many people who have inspired, com- mented on, and in other ways assisted in the writing and publication of the fourth edition of this book. On the publishing and production side at Pearson, I was most fortunate to have an exceptional team of editors and support staff. My thanks go to Julie Alexander, Publisher, and Erin Rafferty, Program Manager, who provided support and guidance throughout this project. Maria Reyes, Project Manager, kept this book on schedule and dedicated her time and skill to its completion.

I would like to thank all those who reviewed this text and provided sug- gestions and guidance for the fourth edition.

Karen Lee Fontaine Purdue University Calumet

Contributors Dolores M. Huffman, RN, PhD

Associate Professor College of Nursing Purdue University Calumet Director of Transfer: Northwest Indiana Center for Evidence Based Practice: A Joanna Briggs Institute Collaborating Centre Hammond, IN

Sheila O’Brien Lewis, BScN, MHSc Associate Lecturer Department of Nursing, Faculty of Health York University Toronto, ON, Canada

Leslie Rittenmeyer, PsyD, CNS, RN Professor Collegel of Nursing Purdue University Calumet Research Associate: Northwest Indiana Center for Evidence Based Practice: A Joanna Briggs Institute Collaborating Centre Hammond, IN

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Dot E. Baker, Ed.D., MSN., BSN.

Professor Wilmington University Georgetown, DE

Debra Rose Wilson, PhD, RN, IBCLC, AHN-BC, CHT

Professor Middle Tennessee State University Murfreesboro, TN Walden University Minneapolis, MN

Lynn Rew, Ed.D, RN, AHN- BC, FAAN

Professor The University of Texas at Austin Austin, TX

Sheila Stroman, PhD, RN Assistant Professor University of Central Arkansas Conway, AR

Susan Cohen, DSN, APRN, FAAN

Associate Professor University of Pittsburgh Pittsburgh, PA

Kimberly Arcoleo, PhD, MPH Professor

Ohio State University Columbus, OH

Lori Edwards, DrPH, RN, APRN, BC

Instructor Johns Hopkins University School of Nursing Baltimore, MD

Rose Mary Gee, PhD, RN Assistant Professor Georgia Southern University Statesboro, GA

Sue Hritz, MEd, PC, RN, CHT, PHN

Lecturer Kent State University Kent, OH

Gretchen Ezaki, MSN, RN Instructor Fresno City College Fresno, CA

Kathleen Murphy, PhD, MMT Assistant Professor University of Evansville Evansville, IN

Vicki Moran, MSN/MPH, RN Instructor Saint Louis University St. Louis, MO

REVIEWERS

Healing Practices: Complementary and Alternative

Therapies for Nurses

Happiness, grief, gaiety, sadness are by nature contagious. Bring your health and your strength to the weak and sickly,

and so you will be of use to them. Give them, not your weakness, but your energy, so you will revive

and lift them up.

Henri-Frederic Amiel

1 U N I T

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1 Integrative Healing

Time is generally the best doctor.

Ovid

Most of nursing education in the United States, Canada, the United Kingdom, Europe, and Australia—often referred to as Western countries—has been under the umbrella of biomedicine, and thus Western nurses are familiar and comfortable with its beliefs, theories, practices, strengths, and limitations. Fewer nurses have studied alternative medical theories and practices and as a result may lack information or even harbor misinformation about these healing practices. Unlike the profession of medicine in general, however, the profession of nursing has traditionally embraced two basic concepts embodied by alternative therapies—holism and humanism—in its approach with clients. Nurses have long believed that healing and caring must be approached holistically and that biological, psychologi- cal, emotional, spiritual, and environmental aspects of health and illness are equally important. This humanistic perspective includes propositions such as the mind and body are indivisible, people have the power to solve their own problems, people are responsible for the patterns of their lives, and well-being is a com- bination of personal satisfaction and contributions to the larger community. This theoretical basis gives nurses a solid foot in each camp and places them in the unique position to help create a bridge between biomedicine and alternative medicine ( Buchan, Shakeel, Trinidade, Buchan, & Al-See, 2012 ; Halcon, Chlan, Kreitzer, & Leonard, 2003 ; Peplau, 1952 ; Quinn, 2000 ; Shreffler- Grant, Hill, Weinert, Nichols, & Ide, 2007 ).

BACKGROUND

Many interesting exchanges around the world have debated the appropriate terminology of various healing practices. Some people

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4 Unit 1 • Healing Practices

become vested in the use of particular terms and have difficulty getting past the language limitations. For example, many people view the term alternative medi- cine as being too narrow or misleading and are concerned that the term lacks a full understanding of traditional healing practices. It would be helpful for a common language to be developed without these constraints. As language evolves, the terms used today may be quite different from those used 20 years from now. For consistency, the terms chosen for this text are conventional med- icine or biomedicine to describe Western medical practices, and the terms alternative medicine or complementary medicine to describe other healing practices. Traditional medicine refers to indigenous medical systems such as Traditional Chinese Medicine (TCM). There are no universally accepted terms. The following list presents commonly used words and their counterparts:

Mainstream Complementary/Alternative Modern Ancient Western Eastern Allopathic Homeopathic; holistic Conventional Unconventional Orthodox Traditional Biomedicine Natural medicine Scientific Indigenous healing methods

The line between conventional and complementary and alternative medicine is imprecise and frequently changing. For example, is the use of megavitamins or diet regimens to treat disease considered medicine, a life- style change, or both? Can having one’s pain lessened by massage be consid- ered a medical therapy? How should spiritual healing and prayer—some of the oldest, most widely used, and least studied traditional approaches—be classified? Although the terms alternative and complementary are frequently used, in some instances they represent the primary treatment modality for an individual. Thus, conventional medicine sometimes assumes a secondary role and becomes a complement to the primary treatment modality.

Conventional Medicine

Biomedical or Western medicine is only about 200 years old. It was founded on the philosophical beliefs of René Descartes (1596–1650)—that the mind and body are separate—and on Sir Isaac Newton’s (1642–1727) principles of physics—that the universe is like a large mechanical clock in which every- thing operates in a linear, sequential form. This mechanistic perspective of medicine views the human body as a series of body parts. It is a reductionist approach that converts the person into increasingly smaller components: sys- tems, organs, cells, and biochemicals. People are reduced to patients, patients are reduced to bodies, and bodies are reduced to machines. Health is viewed as the absence of disease or, in other words, nothing is broken at present, and sick care is focused on the symptoms of dysfunction. Physicians are trained to

Chapter 1 • Integrative Healing 5

fix or repair broken parts through the use of drugs, radiation, surgery, or replacement of body parts. The approach is aggressive and militant— physicians are in a war against disease, with a take-no-prisoners attitude. Both consumers and practitioners of biomedicine believe it is better to

• do something rather than wait and see whether the body’s natural pro- cesses resolve the problem.

• attack the disease directly by medication or surgery rather than try to build up the person’s resistance and ability to overcome the disease.

Biomedicine views the person primarily as a physical body, with the mind and spirit being separate and secondary or, at times, even irrelevant. It is powerful medicine in that it has virtually eliminated some infectious dis- eases, such as smallpox and polio. It is based on science and technology, per- sonifying a highly industrialized society. As a “rescue” medicine, the biomedical approach is appropriate. It is highly effective in emergencies, trau- matic injuries, bacterial infections, and some highly sophisticated surgeries. In these cases, treatment is fast, aggressive, and goal oriented, with the responsi- bility for cure falling on the practitioner.

The priority of intervention is on opposing and suppressing the symp- toms of illness. This approach is evidenced in many medications with prefixes such as an or anti , as in analgesics, anesthetics, anti-inflammatories, and anti- pyretics. Biomedicine characterizes each disease in terms of its mechanisms of action, based on the belief that most individuals are affected in the same way. Thus, treatment is basically the same for most people. Because conventional medicine is preoccupied with parts and symptoms and not with whole work- ing systems of matter, energy, thoughts, and feelings, it does not do well with long-term systemic illnesses such as arthritis, heart disease, and hypertension. Despite higher per capita spending on health care in the United States than in all other nations, in 2013, U.S. life expectancy ranked only 37th, and the infant mortality rate ranked 33rd among the nations studied ( World Health Rankings, 2013 ). The United States has failed to be a world leader in providing a healthier quality of life.

Complementary and Alternative Medicine

Complementary and alternative medicine (CAM) is an umbrella term for as many as 1,800 therapies practiced worldwide. Many forms have been handed down over thousands of years, both orally and in written records. These ther- apies are based on the medical systems of ancient peoples, including Egyp- tians, Chinese, Asian Indians, Greeks, and Native Americans. Others, such as osteopathy and naturopathy, evolved in the United States during the past two centuries. Still others, such as some of the mind–body and bioelectromagnetic approaches, are on the frontier of scientific knowledge and understanding. The National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health (NIH) defines CAM therapies as a broad range of healing philosophies, approaches, and therapies that conventional

6 Unit 1 • Healing Practices

medicine does not commonly use, accept, study, understand, or make avail- able. NCCAM also defines complementary therapies as those used with con- ventional medicine and alternative therapies as those used instead of conventional medicine (National Center for Complementary and Alternative Medicine, 2012).

Although they represent diverse approaches, CAM therapies share cer- tain attributes. They are based on the paradigm of whole systems and the belief that people are more than physical bodies with fixable and replaceable parts. Rather, mental, emotional, spiritual, and environmental components of well- being are considered to play crucial and equal roles in a person’s state of health. Interventions are individualized within the entire context of a person’s life ( Duncan, Liechty, Miller, Chinoy, & Ricciardi, 2011 ). Even Hippocrates, the father of Western medicine, espoused a holistic orientation when he taught physicians to observe their patients’ life circumstances, emotional state, stresses, environment, inherited constitution, and their subjective experience of an ill- ness. Socrates agreed, declaring, “Curing the soul; that is the first thing.” In alternative medicine, symptoms are believed to be an expression of the body’s wisdom as it reacts to cure its own imbalance or disease. Other threads or con- cepts common to most forms of alternative medicine include the following:

• An internal self-healing process exists within each person. • People are responsible for making their own decisions regarding their

health care. • Nature, time, and patience are the great healers.

When Albert Einstein (1879–1955) introduced his theory of relativity in 1905, our way of viewing the universe changed dramatically. Einstein said that mass and energy are equivalent and interconvertible, and all matter is connected at the subatomic level. No single entity could be affected without all its connecting parts being affected. In this view, the universe is not a giant clock but a living web. The human body is animated by an integrated energy called the life force . The life force sustains the physical body but is also a spiritual entity that is linked to a higher being or infinite source of energy. When the life force flows freely throughout the body, a person experiences optimal health and vitality. When the life force is blocked or weakened, organs, tissues, and cells are deprived of the energy they need to function at their full potential, and illness or disease results.

Alternative medicine is especially effective for people with chronic, debilitating illnesses for which conventional medicine has few, if any, answers. It has much to offer in the arena of health promotion and disease prevention. As costs of conventional medicine increase and people continue to suffer from chronic illnesses and degenerative diseases, alternative medicine is moving closer to the mainstream. A growing number of complementary and alterna- tive therapies are eligible for reimbursement by third-party payers in the United States. The most commonly reimbursed treatments are chiropractic, biofeedback, acupuncture, hypnotherapy, and naturopathy. Box 1.1 provides an overview of the paradigms of conventional and alternative medicine.

Chapter 1 • Integrative Healing 7

Integrative Medicine

Integrative medicine embodies both conventional and complementary and alternative medicine, making use of the best available evidence of all three approaches to healing. It is a multidisciplinary, collaborative, holistic approach that encompasses mind, body, and spirit. It stresses the relationship between the client and the practitioner as well as the human capacity for healing. Inte- grative practitioners believe that clients have the right to make informed choices about their health care options. The focus is on “using the least inva- sive, least toxic, and least costly methods to help facilitate health” ( Willison, 2006 , p. 255 ). The goal of integrative medicine is to find new solutions to pre- vention and treatment of health care problems.

Dr. Andrew Weil has been the driving force for integrative medicine in the United States and hopes to reform the entire medical delivery system by changing the way we look at health and disease and by modifying the educa- tion of physicians. His program at the Arizona Center for Integrative Medi- cine at the University of Arizona College of Medicine was the first to adopt this new curriculum. Nursing must also be open to change to meet the goal of true integrative care. In 2008, the World Health Organization (WHO) stressed the importance of integrative medicine and advocated the inclusion of com- plementary and alternative therapies in biomedical health care education ( Quartey, Ma, Chung, & Griffiths, 2012 ).

BOX 1.1

Paradigms of Medicine

View Conventional Medicine Alternative Medicine

Mind/body/spirit are separate are one The body is a machine a living microcosm of the universe Disease results parts break energy/life force becomes unbalanced when Symptoms dysfunctional and need communicators about the state of the to be fixed whole person Role of medicine to combat disease to restore mind/body/spirit harmony Approach treat and suppress search for patterns of symptoms disharmony or imbalance Focuses on parts/matter whole/energy Treatments attempt to “fix” broken support self-healing; personalized for parts; specific to disease the individual Primary drugs, surgery, diet, exercise, herbs, stress interventions radiation management, social support System sick care health care

8 Unit 1 • Healing Practices

ASSUMPTIONS

In understanding conventional and alternative medicine, it is helpful to study the assumptions basic to their theories, practices, and research. These assump- tions include the origin of disease, the meaning of health, the curative process, and health promotion.

Origin of Disease

Biomedicine and alternative medicine have widely divergent assumptions regarding the origin of disease. Biomedicine was shaped by the observations that bacteria were responsible for producing disease and pathologic damage and that antitoxins and vaccines could improve a person’s ability to ward off the effects of pathogens. Armed with this knowledge, physicians began to conquer a large number of devastating infectious diseases. As the science developed, physicians came to believe that germs and genes caused disease, and once the offending pathogen, metabolic error, or chemical imbalance was found, all diseases would eventually yield to the appropriate vaccine, antibiotic, or chemical compound.

Conventional medicine has also been influenced by Darwin’s concept of survival of the fittest; that is, all life is a constant struggle, and only the most successful competitors survive. Applied to medicine, this notion means that humans live under constant attack by the thousands of microorganisms that, in the Western view, cause most diseases. People must defend themselves and counterattack with treatments that kill the enemy. Based on this assumption, symptoms are regarded as harmful manifestations and should be suppressed. For example, a headache is an annoyance that should be eliminated, and a fever should be reduced with the use of medications.

Complementary and alternative medicine is based on the belief of a life force or energy that flows through each person and sustains life. Balance refers to harmony among organs in the body and among body systems, and in rela- tionships to other individuals, society, and the environment. A balanced organ- ism presents a strong defense against external insults such as bacteria, viruses, and trauma. When the life force or energy is blocked or weakened, the vitality of organs and tissues is reduced, oxygen is diminished, waste products accu- mulate, and organs and tissues degenerate. Symptoms are the body’s way of communicating that the life force has been blocked or weakened, resulting in a compromised immune system. Disease is not necessarily a surprise encounter with a bacterium or a virus, since these are ever present, but rather the end result of a series of events that began with a disruption of the life force. Based on this assumption, symptoms are not suppressed unless they endanger life, such as a headache from an aneurysm or a body temperature above 105°F. Rather, symptoms are cooperated with because they express the body’s wis- dom as it reacts to cure its own disease. For example, a headache is a signal that one’s whole system needs realignment, and a fever may be the result of the breakdown of bacterial proteins or toxins. When symptoms are suppressed, they are not resolved but merely held in abeyance, gathering energy for renewed expression as soon as the outside, counteractive force is removed.

Chapter 1 • Integrative Healing 9

Meaning of Health

If you were to ask a healer from the Chinese, Indian, or Native American tra- ditions about the meaning of health, you would receive answers very differ- ent from those given by a Western physician. The biomedical view of health, in the past, was often described as the absence of disease or other abnormal conditions. That definition has been expanded to include the view that health is not a static condition; the body constantly changes and adapts to both inter- nal and external environmental challenges. The majority of conventional medical practitioners would define health as a state of well-being. They may disagree, however, about who determines well-being—the health profes- sional or the individual. With some exceptions, wellness and health promo- tion have, for the most part, been left to the initiative of the individual.

Those practicing complementary and alternative medicine (CAM) describe health as a condition of wholeness, balance, and harmony of the body, mind, emotions, and spirit. Health is not a concrete goal to be achieved; rather, it is a lifelong process that represents growth toward potential, an inner feeling of aliveness. Physical aspects include optimal functioning of all body systems. Emotional aspects include the ability to feel and express the entire range of human emotions. Mental aspects include feelings of self-worth, a positive identity, a sense of accomplishment, and the ability to appreciate and create. Environmental aspects include physical, biologic, economic, social, and political conditions. Spiritual aspects involve self, others, and society. Self-components are the development of moral values and finding a meaningful purpose in life. Spiritual factors relating to others include the search for meaning through relationships and the feeling of connectedness with others and with an external power often identified as God or the divine source. Societal aspects of spiritual health can be understood as a common humanity and a belief in the fundamental sacredness and unity of all life. These beliefs motivate people toward truth and a sense of fairness and justice to all members of society.

Curative Process

The curative process is another area of divergent viewpoints. Conventional medicine promotes the view that external treatments—drugs, surgery, radia- tion—cure people, and practitioners are trained to fix or repair broken parts. The focus is on the disease process or abnormal condition. Alternative practi- tioners look at conditions that block the life force and keep it from flowing freely through the body. Healing occurs when balance and harmony are restored. The focus is on the health potential of the person rather than the dis- ease problem. The cure model and the healing model are presented with greater detail in Chapter 2 .

Health Promotion

Conventional and complementary and alternative medical systems have somewhat different foci on promotion of health. The thrust of conventional

10 Unit 1 • Healing Practices

medicine is disease prevention. Consumers are taught how to decrease their risk of cancer, cardiac disorders, obesity, and other life-threatening diseases that kill most people prematurely in Western society. Although these behav- iors are important, disease prevention is only one piece of health promotion. From the complementary and alternative perspective, health promotion is a lifelong process that focuses on optimal development of people’s physical, emotional, mental, spiritual, and environmental selves. An individual’s worldviews, values, lifestyles, and health beliefs are considered to be of criti- cal importance. Consumers are encouraged to adopt healthier lifestyles, to accept increased responsibility for their own well-being, and through greater self-reliance, to learn how to handle common health problems on their own. As the Healthy People 2020 report illustrates ( U.S. Department of Health and Human Services, 2010a ), the health care delivery system of the future must make use of all approaches that effectively promote optimal health using best available evidence and knowledge. Box 1.2 describes the strategic plan 2011– 2015 of NCCAM. In the United States, the Patient Protection and Affordable Care Act, a federal statute, was signed into law by President Barack Obama in 2010. One goal of this act is to provide affordable health care for every American. ( U.S. Department of Health and Human Services, 2010b .)

RESEARCH

Scientific beliefs rest not just on facts but on paradigms (broad views of how these facts are related and organized). Differences in views among groups of nursing and medical researchers are a reflection of the different scientific paradigms—quantitative and qualitative research. Although each method results in a different type of knowledge, both provide information to research- ers and consumers. Evidence-based practice is covered in Chapter 3 .

Quantitative research represents the principles of the Western scientific method, which include formulating and testing hypotheses and then rejecting

BOX 1.2

NCCAM Strategic Plan 2011–2015

• Advance the science and practice of symptom management of CAM approaches. • Develop effective, practical, personalized strategies for promoting health and

well-being. • Enable better evidence-based decision making regarding CAM use and its integra-

tion into health care and health promotion.

Source: National Center for Complementary and Alternative Medicine ( 2011 ).

Chapter 1 • Integrative Healing 11

or accepting the hypotheses. Every question is reduced to the smallest possi- ble part. Results can be replicated and generalized, and outcomes can be pre- dicted and controlled. Quantitative research is said to be objective in that the observer is separate from what is being observed. Another part of this objec- tive paradigm is that all information can be derived from physically measur- able data. This type of research has been extremely effective for isolating causative factors of disease and developing cures. However, it cannot explain the whole person as an integrated unit.

Qualitative research seeks to understand events in context-specific set- tings. It studies the context and meaning of interactive variables as they form patterns reflective of the whole. Researchers observe, document, analyze, and qualify the interactive relationship of variables. In the science of physics, it is believed that objectivity is ultimately not possible. The Heisenberg uncer- tainty principle states that the act of observing phenomena necessarily influ- ences the behavior of the phenomena being observed. Another part of the paradigm relates to the belief that interactions between living organisms and environments are transactional, multidirectional, and synergistic in ways that cannot be reduced. This holistic approach (the whole is greater than the sum of the parts) is basic to qualitative research.

Practitioners of conventional medicine believe that procedures and sub- stances must pass blinded randomized controlled trials (RCTs) to be proven effective. As a testing method, an RCT examines a single procedure or sub- stance in isolated, controlled conditions and measures results against another existing therapy or the best available treatment. This approach is based on the assumption that single factors cause and reverse illness, and these factors can be studied alone and out of context. In contrast, practitioners of complemen- tary and alternative medicine (CAM) believe that no single factor causes any- thing, nor can a magic substance single-handedly reverse illness. Multiple factors contribute to illness, and multiple interventions work together to pro- mote healing. RCTs are incapable of reconciling this degree of complexity and variation.

Although major complementary and alternative medical systems may not have been subjected to a great deal of quantitative research, they are gen- erally not experimental therapies. They rely on well-developed clinical obser- vational skills and experience that is guided by their explanatory models. Likewise, many biomedical practices are guided by observation and experi- ence and have not been tested quantitatively. New medicines must have rigor- ous proof of efficacy and safety before clinical use. Tests, procedures, and treatments, however, are not similarly constrained. Western physicians, like alternative practitioners, use the same well-developed clinical observational skills and experience, guided by their explanatory biomedical model. Some of these discrepancies are disappearing, and the emphasis is now on evidence- based practice and the rapid growth of CAM research.

This text does not offer meticulous documentation for all claims that are made by the various therapies. The National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health (NIH) has

12 Unit 1 • Healing Practices

been mandated to explore complementary and alternative healing practices in the context of rigorous science, to train researchers, and to provide the public with authoritative information. NCCAM has established 16 research centers to explore the safety and efficacy of a wide range of therapies. In addition, NCCAM funds hundreds of research projects and grants every year. The NIH Office of Dietary Supplements is conducting scientific studies regarding the role of dietary supplements in the improvement of health care. As a result of these and other international efforts, the evidence base for alternative thera- pies has grown significantly.

The results of scientific studies can be accessed at two websites. NCCAM and the National Library of Medicine (NLM) have partnered to create CAM on PubMed ( nccam.nih.gov/research/camonpubmed/ ). This site provides access to citations from the MEDLINE database and links to many full-text articles at journal websites. The Cochrane Library ( www.update-software. com/cochrane/ ), an international effort, consists of a regularly updated col- lection of evidence-based medicine databases, including the Cochrane Data- base of Systematic Reviews. This site lists thousands of randomized trials for various alternative therapies. This information is extremely helpful for both consumers and providers of health care. The reader is advised to access these sites for information regarding the latest research results. Chapter 3 covers evidence-based nursing practice in more detail.

CONSUMERS

Many Americans are looking beyond conventional medicine for relief from illness and improvement of health. According to a number of random sur- veys, two thirds of adults in the United States use one or more types of alter- native medicine, often to treat a chronic medical condition such as one of those listed in Box 1.3 . Most of these consumers fail to discuss the use of alter- native therapies with their primary conventional practitioner, even though the vast majority of people use both approaches simultaneously. In general, alternative therapies are more commonly used by women than by men, as well as by people with higher levels of education. Latinos have a higher rate of use (50%–90%) compared with European Americans ( Buchan et al., 2012 ; Lachance et al., 2009 ; Ortiz, Shields, Clauson, & Clay, 2007 ; Sirois, 2008 ). A random study of 1,261 adults in Australia found that 61.7% of the individuals had used self-prescribed CAM or visited a CAM practitioner. A significant proportion of the sample did not seek advice from their primary care physi- cian before using CAM ( Thomson, Jones, Evans, & Leslie, 2012 ).

The mainstream medical community can no longer ignore alternative therapies. The public interest is extensive and growing. One has only to look at the proliferation of popular health books, health food stores, and clinics offering healing therapies to realize that this interest cannot be dismissed. In March 2000, President Clinton ordered the establishment of the White House Commission on Complementary and Alternative Medicine Policy in an attempt to integrate conventional and alternative medicine. The mission of

Chapter 1 • Integrative Healing 13

the advisory committee was to make legislative and administrative recom- mendations for the education and training of health care professionals and to make suggestions for access and delivery of health care.

What are consumers seeking from alternative medicine? Some have the same goal for both types of medicine, such as control of chronic pain with pain medications and acupuncture. Other consumers may have a different expectation for each approach, such as seeing a conventional practitioner for antibiotics to eradicate an infection and using an alternative practitioner to improve natural immunity through a healthy lifestyle. A person receiving chemotherapy may use meditation and visualization to control the side effects of the chemotherapeutic agents. People who combine conventional and alter- native therapies are making therapeutic choices on their own and assuming responsibility for their own health.

It is important for nurses to understand the reasons consumers choose alternative practitioners. Some utilize alternative healers because of financial, geographic, and cultural barriers to biomedical care. Many turn to alternative healers for a sense of hope, control, personal attention, physical contact, and regard for the whole person that seems to be overlooked in conventional med- icine. Some of the common reasons for seeking alternative practitioners are listed in Box 1.4 .

It may be difficult for consumers to figure out how and where to get the best health care. At times it may be problematic to find reliable information to

BOX 1.3

Frequently Reported Conditions of Those Seeking Alternative Therapies

Back pain Head cold Neck pain Joint pain Arthritis Anxiety/depression Stomach upset Headache Chronic pain Insomnia

Source: National Center for Complementary and Alternative Medicine. 2007 Statistics on CAM Use in the United States. Retrieved from http://nccam.nih.gov/news/camstats/2007/index.htm

14 Unit 1 • Healing Practices

help separate the healers from those who pretend to have medical knowledge. Consumers should be wary of healers who

• say they have all the answers. • maintain that theirs is the only effective therapy. • promise overnight success. • refuse to include other practitioners as part of the healing team. • seem more interested in money than in people’s well-being. ( Tiedje, 1998 )

Some alternative specialties are more regulated and licensed than oth- ers, but none come with guarantees any more than conventional medicine comes with guarantees. Consumers may want to research the background, qualifications, and competence of any health care provider—alternative, con- ventional, or integrative. Most types of alternative practices have national organizations of practitioners that are familiar with legislation, state licensing, certification, or registration laws. Many of these organizations are found in the resource section at the back of each chapter in this text.

INTEGRATED NURSING PRACTICE

Nursing has been moving away from a biomedical orientation that has largely defined and directed it toward a nursing-caring-healing model. Watson (1997) described it as a shift from a nursing qua medicine paradigm (nurses helping

BOX 1.4

Reasons for Choosing Alternative Therapies

Pursue therapeutic benefit Seek a degree of wellness not supported in biomedicine Attend to quality-of-life issues Prefer high personal involvement in decision making Practitioners spend more time with clients Believe conventional medicine treats symptoms, not the underlying cause Find conventional medical treatments to be lacking or ineffective Avoid toxicities and/or invasiveness of conventional interventions Decrease use of prescribed or over-the-counter medications Identify with a particular healing system as a part of cultural background

Sources: Clement, Chen, Burke, Clement, & Zazzali, 2006 ; National Center for Complementary and Alternative Medicine, 2012. 2007 Statistics on CAM Use in the United States. Retrieved from http:// www.nccam.nih.gov/news/camstats/2007/index/.htm ; Saydah & Eberhardt, 2006 .

Chapter 1 • Integrative Healing 15

physicians practice medicine) to a nursing qua nursing paradigm (practicing the distinct art and science of nursing). This movement has reconnected nurses with the finest tradition of Florence Nightingale in using their hands, heart, and head in creating healing environments. The modern nurse–healer draws on biomedical and caring–healing models by utilizing technology and focusing on caring relationships and healing processes. Dossey, Keegan, and Guzzetta ( 2005 ) have described the modern nurse–healer as having a hybrid of scientific skills and spiritual commitment. Nurses need scientific principles, methods, and skills, but they also need to teach people ways to become more self-reliant as they shift from caregivers to healers.

In 1979, Watson published her text Nursing: The Philosophy and Science of Caring, which evolved from her experiences of nursing within the limitations of traditional biomedical models. She sought to bring new meaning to the nursing paradigm of caring-healing and health. Her caritas process was devel- oped to balance the “cure” stance of Western medicine. Watson’s theory has since evolved into “clinical caritas processes.” This perspective describes nurse–client relationships based on spirituality, love, caring, healing environ- ments, wholeness, and unity of being ( Watson, 2007 ).

The art of nursing is in being there, with another person or persons, in an atmosphere of caring. Caring involves compassion and sensitivity to each person within the context of her or his entire life. In the past, the biomedical model urged nurses not to care too much or get too involved. Caring, success- ful nurses, however, do get involved with clients as they practice nursing as an art instead of nursing as just a day-to-day job. Caring is a philosophy or context within which nurses practice nursing. Their practice is made caring not by the tools they use but by the attitude or perspective they bring. It is possible, of course, to use the tools of alternative therapies in the same reduc- tionist way of biomedicine. For example, if one knows the pressure point for headaches and simply uses this pressure point for pain relief without any fur- ther assessment, it can hardly be considered holistic or healing. The symptom of headache has been addressed, but the meaning of the headache and the person’s experience of the pain has been totally ignored.

The plurality of the sick care, health care system may be one of its great- est strengths. It enables us to meet the diverse needs of diverse populations. The question is, How can we combine the best ideas of conventional nursing practice and complementary and alternative healing practices? First, we must have education. At the basic level, our nursing curricula must include courses in caring and alternative therapies. All nurses could learn Therapeutic Touch (TT), healthy dietary plans, the use of basic herbs, as well as the use of visual- ization in the healing process. Since 2004, basic alternative therapies content is included in the NCLEX-RN examination. Because state boards of nursing vary in their detail of criteria for alternative therapies and nursing practice, it is critical that you check the Nurse Practice Act of your state.

The White House Commission on Complementary and Alternative Medicine states that “since the public utilizes both conventional health care and complementary and alternative medicine (CAM), the Commission

16 Unit 1 • Healing Practices

believes that this reality should be reflected in the education and training of all health practitioners” ( National Institutes of Health, 2002 , p. 51 ). The Com- mission goes on to say that “although there has been notable progress in introducing CAM into medical, nursing, and other fields of conventional health care education in recent years, more needs to be done” (p. 51 ). We must also participate in continuing education courses to expand our knowledge beyond the basic level. With additional education, we can learn such thera- pies as basic massage and reflexology, meditation, and yoga. Some nurses will choose to continue their education through master of science in nursing degrees with a holistic nursing concentration or through certificate programs for nurse practitioners. Other nurses will choose to complete formal programs in alternative medicine such as naturopathy, Ayurveda, homeopathy, chiro- practic medicine, or hypnotherapy. Advanced practice nurses should provide leadership in research and education in alternative therapies ( Denner, 2007 ).

Next, we must provide community education. We must provide people with information, tools, skills, and support to enable them to make healthy decisions about life and negotiate their way through the health care systems. As nurses, we have the opportunity to initiate conversations about alternative therapies. Growing immigrant populations call for more attention to a variety of health expectations, needs, and preferences. We must also become familiar with the alternative practices immigrants bring with them. An important con- sideration in evidence-based practice is patient preference. We must also attempt to keep ourselves healthy and to exemplify good health because teaching by example is a powerful influence. We can teach wherever our prac- tice is located: acute care, long-term care, community nurse-managed centers, and in areas of advanced practice nursing. And, finally, we must document our findings, utilize and participate in nursing research, keep current with evidence-based practice, and design new studies to measure the effectiveness of various healing practices.

Self-Care

Before we nurses can care for clients, we must first learn to value and care for ourselves. One of your goals in reading this text might be to discover how to care for yourself more effectively, because only then will you have the energy to care for your clients. Caring for yourself means reducing unnecessary stress, managing conflict effectively, communicating clearly with family and friends, and taking time out for yourself. Caring for yourself may include developing a daily routine in practices such as relaxation, meditation, prayer, yoga, communion with nature, and other such forms of contemplation. In Watson’s words, “If one is to work from a caring-healing paradigm, one must live it out in daily life” ( Watson, 1997 , p. 51 ). The following guidelines will help you maintain your self-care practices ( Jahnke, 1997 ):

• Choose self-care activities that appeal to you and fit into your lifestyle. • Do one or more of these practices every day. Consider them as impor-

tant as food and sleep.

Chapter 1 • Integrative Healing 17

• Seek guidance and support from teachers/practitioners if appropriate. • Find a good spot for your practice that is physically and mentally com-

fortable. • Build up your practice slowly. Success is not gained by aggressive or

compulsive practice. • Look for opportunities to practice with others. • Focus on relaxing. The foundation of all self-healing, health enhance-

ment, stress mastery, and personal empowerment is deep relaxation.

References

Buchan, S., Shakeel, M., Trinidade, A., Buchan, D., & Ah-See, K. (2012). The use of complementary and alternative medicine by nurses. British Journal of Nursing, 21(11): 672–675.

Clement, J. P., Chen, H. F., Burke, D., Clement, D. G., & Zazzali, J. L. (2006). Are consumers reshaping hospitals? Complementary and alternative medi- cine in U.S. hospitals, 1999–2003. Health Care Management Review, 131(2): 109–118.

Denner, S. S. (2007). The advanced prac- tice nurse and integration of comple- mentary and alternative medicine. Holistic Nursing Practice , 21(3): 152–159.

Dossey, B. M., Keegan, L. G., & Guzzetta, C. E. (2005). Holistic Nursing: A Hand- book for Practice (4th ed.). Sudbury, MA: Jones & Bartlett.

Duncan, A. D., Liechty, J. M., Miller, C., Chinoy, G., & Ricciardi, R. (2011). Employee use and perceived benefit of a complementary and alternative med- icine wellness clinic at a major military hospital. Journal of Alternative and Com- plementary Medicine, 9(17): 809–815.

Halcon, L. L., Chlan, L. L., Kreitzer, M. J., & Leonard, B. J. (2003). Complementary therapies and healing practices: Faculty/student beliefs and attitudes and the implications for nursing edu- cation. Journal of Professional Nursing , 19(6): 387–397.

Jahnke, R. (1997). The Healer Within . San Francisco, CA: Harper.

Lachance, L. L., Hawthorne, V., Brien, S., Hyland, M. E., Lewith, G. T., Verhoef, M. J., . . . Zick, S. (2009). Delphi-derived development of a common core for mea- suring complementary and alternative medicine prevalence. Journal of Alterna- tive and Complementary Medicine, 15(5): 489–494. doi: 10.1089/acm.2008.0430

National Center for Complementary and Alternative Medicine. (2011). Third strategic plan: 2011–2015. Retrieved from www.nccam.nih.gov/about/ plans/2011?nav=gsa

National Institutes of Health. (2002). White House Commission on Complemen- tary and Alternative Medicine Policy, Final Report . Washington, DC: U.S. Government Printing Office. Retrieved from www.whccamp.hhs.gov

Ortiz, B. I., Shields, K. M., Clauson, K. A., & Clay, P. G. (2007). Complementary and alternative medicine use among Hispanics in the United States. Annals of Pharmacotherapy , 41(6): 994–1004.

Peplau, H. E. (1952). Interpersonal Relations in Nursing. New York, NY: Putnam.

Quartey, N. K., Ma, P. H. X., Chung, V. C. H., & Griffiths, S. M. (2012). Comple- mentary and alternative medical edu- cation for medical profession: Systematic review. Evidence Based Complementary and Alternative Medi- cine. doi: 10.1155/2012/656812

Quinn, J. F. (2000). The self as healer: Reflections from a nurse’s journey. AACN Clinical Issues , 11(1): 17–26.

18 Unit 1 • Healing Practices

Saydah, S. H., & Eberhardt, M. S. (2006). Use of complementary and alternative medicine among adults with chronic diseases. Journal of Alternative and Com- plementary Medicine , 12(8): 805–812.

Shreffler-Grant, J., Hill, W., Weinert, C., Nichols, E., & Ide, B. (2007). Com- plementary therapy and older rural women: Who uses it and who does not? Nursing Research , 56(1): 28–33.

Sirois, F. M. (2008). Provider-based com- plementary and alternative medicine use among three chronic illness groups. Complementary Therapies in Medicine , 16: 73–80.

Thomson, P., Jones, J., Evans, J. M., & Leslie, S. J. (2012). Factors influencing the use of complementary and alterna- tive medicine and whether patients inform their primary care physician. Complementary Therapies in Medicine, 20: 45–53. doi: 10.1016/j.ctim.2011.10.001

Tiedje, L. B. (1998). Alternative health care: An overview. Journal of Obstetric, Gynecologic, and Neonatal Nursing , 27(5): 557–562.

U.S. Department of Health and Human Services. (2010a). Healthy People 2020. Washington, DC: U.S. Government Printing Office.

U.S. Department of Health and Human Services. (2010b). Patient Protection and Affordable Care Act. Retrieved from http://www.hhs.gov/healthcare/ rights/law/index.html

Watson, J. (1979). Nursing: The Philosophy and Science of Caring . New York, NY: Little, Brown.

Watson, J. (1997). The theory of human caring: Retrospective and prospective. Nursing Science Quarterly , 10(1): 49–52.

Watson, J. (2007). Caring theory defined. University of Colorado Denver, Col- lege of Nursing. Retrieved from www. nursing.ucdenver.edu/faculty/ theory_caring.htm

Willison, K. D. (2006). Integrating Swedish massage therapy with primary health care initiatives as part of a holistic nurs- ing approach. Complementary Therapies in Medicine , 14: 254–260.

World Health Rankings. (2013). Retrieved from www.worldlifeexpectancy.com

Resources

American Holistic Health Association

P.O. Box 17400

Anaheim, CA 92817–7400

714.779.6152

www.ahha.org

American Association of Integrative Medicine

2750 E. Sunshine St.

Springfield, MO 65804

877.718.3053

www.aaimedicine.com

Australian National Institute of Complementary Medicine

www.nicm.edu.au

National Center for Complementary and Alternative Medicine

National Institutes of Health

9000 Rockville Pike

Bethesda, MD 20892

888.644.6226

www.nccam.nih.gov

2 Basic Concepts Guiding Alternative Therapies

For breath is life, and if you breathe well, you will live long on earth.

Sanskrit Proverb

In this book, separate chapters are devoted to each of the most widely used methods in complementary and alternative med-icine. Because the methods share many principles, there is overlap in the various types of complementary and alternative practices. Although practices are grouped in units, many of the practices could be placed in several units. Thus, before examining the specifics of each practice, it may be helpful to introduce sev- eral concepts common to most healing practices, namely, balance, spirituality, energy, and breath.

BALANCE

An expression in the Native American culture, “walking in bal- ance,” describes the philosophy of a peaceful coexistence and har- mony with all aspects of life. This concept of balance is found in all cultures throughout time. Balance is viewed as a path rather than a steady state, and it is believed that each of us has a unique path as we move through life. In terms of optimal wellness, the concept of balance consists of mental, physical, emotional, spiritual, and environmental components. Not only does each component have to be balanced, but equilibrium is necessary among the compo- nents. Physical aspects include optimal functioning of all body sys- tems. Emotional aspects include the ability to feel and express the

19

20 Unit 1 • Healing Practices

entire range of human emotions. Mental aspects include feelings of self-worth, a positive identity, a sense of accomplishment, and the ability to appreciate and create. Spiritual aspects involve moral values, a meaningful purpose in life, and a feeling of connectedness to others and to a divine source. Environmental aspects include physical, biologic, economic, social, and political conditions. Walking in balance is a learned skill and one that must be practiced regularly to engage in the process of healthy living. This concept of balance appears repeatedly throughout the various alternative healing practices.

Cyclic Rhythms

The daily lives of all living things are filled with various changes that take place in cyclic patterns. Circadian rhythms are regular fluctuations of a vari- ety of physiologic factors over 24 hours. Most familiar is the 24-hour tempera- ture and sleep patterns. These include adrenal, thyroid, and growth hormone-secreting patterns, as well as temperature, sleep, arousal, energy, appetite, and motor activity patterns. Ultradian rhythms are regular fluctua- tions repeated throughout a 24-hour day. An example of an ultradian rhythm is the 90-minute REM/non-REM sleep cycle. Infradian rhythms are regular fluctuations over periods longer than 24 hours, such as the menstrual cycle. The constant rhythmic processes bring about a dynamic, healthy balance in the body.

Rhythms may be desynchronized by external or internal factors. An example of external desynchronization is jet lag, in which rapid time zone changes result in a decreased energy level and ability to concentrate, as well as mood variations. In some individuals, internal desynchronization may result in depression. The tendency toward internal desynchronization is prob- ably inherited, but stress, lifestyle, and normal aging influence it. Attention to the rhythmic nature of one’s own being reveals an intimate relationship with the rhythms of the surrounding natural world.

Musical Rhythms

Health is about balance or harmony of body, mind, and spirit. In a state of optimal health, all frequencies are in harmony, like a finely tuned piano. In fact, music is often employed in healing, from the ancient use of the drum, rattle, bone flute, and other primitive instruments to the current use of music as a prescription for health. Several nursing research studies have demon- strated the effectiveness of music therapy for persons with mental disorders, autism, dementia, cancer, cognition disorders, and neurological problems. Chapter 21 covers music and its research in greater detail.

Dr. Andrew Weil, the leader in the field of integrative medicine, has cre- ated the Mindbody Tool Kit ( 2005 ) to help people utilize self-healing techniques. Sound therapy consists of classical music combined with healing sound fre- quencies. The combination of sounds entrains the brain to theta and delta brain waves, the state of deep relaxation in which the body and mind can heal

Chapter 2 • Basic Concepts Guiding Alternative Therapies 21

themselves. The benefits of sound therapy are far reaching. People who may benefit from sound therapy include those

• experiencing an illness. • who are having or have had surgical procedures. • who are having or have had chemotherapy infusions. • in intensive care. • in labor and delivery. • experiencing anxiety, depression, or insomnia. • who wish to maintain a high level of wellness.

Drumming and chanting are powerful ways to bring oneself in balance with self, others, and the world. The drumbeat serves as a focus for concentra- tion and quiets the chattering mind. The pace of the drumbeat enhances theta brain wave production. In one study, group drumming improved the social- emotional behavior of preteens experiencing the effects of chronic stress ( Ho, Tsao, Bloch, & Zeltzer, 2011 ).

SPIRITUALITY

Spiritual healing techniques and spiritually based health care systems are among the most ancient healing practices. Spirit is the liveliness, richness, and beauty of one’s life. It is who one is and how one exists in the world. Spirituality is the drive to become all that one can be, and it is bound to intuition, creativity, and motivation. It is the dimension that involves relationship with oneself, with others, and with a higher power. Spirituality is that which gives people mean- ing and purpose in their lives. It involves finding significant meaning in the entirety of life, including illness and death ( Jampolsky, 2005 ; Taylor, 2002 ).

Many people are searching for wholeness in their lives and a way to allow their innermost selves to grow and expand. Spiritual healing practices guide individuals to places within themselves they did not know existed, through techniques as ancient as prayer, contemplation, meditation, drumming, story- telling, and mythology. In consciously awakening the energies of the spirit, peo- ple are able to move toward healing places and sacred moments in their lives.

During periods of stress, illness, or crisis, people search for meaning and purpose in their pain and suffering. They ask questions such as Why am I sick? or Why did this bad thing happen? This spiritual quest for meaning can lead to insight and healing or to fear and isolation. In the words of Ken Wilber:

A person who is beginning to sense the suffering of life is, at the same time, beginning to awaken to deeper realities, truer realities. For suffering smashes to pieces the complacency of our normal fictions about reality, and forces us to become alive in a special sense—to see carefully, to feel deeply, to touch ourselves and our world in ways we have heretofore avoided. It has been said, and truly I think, that suffering is the first grace. (quoted in Borysenko & Borysenko, 1994 , p. 191 )

22 Unit 1 • Healing Practices

Spirituality is often confused with religiosity, which is not surprising, because the two constructs are closely related. Religion involves a search for the sacred, a group identity, and a sense of belonging. Spirituality , a much broader concept, is the search for wholeness and purpose that underlies the world’s religions. Removing the dogma, the politics, and cultural influence from any of the world’s religions uncovers the same questions, the same seek- ing, and the same answers. The concept of spirituality does not undermine any religion but rather enhances all religions by illuminating their common- alities and the unity of all people. Spirituality reveals far more similarities than differences among individuals. Chapter 23 covers faith and prayer as it relates to health and well-being.

Many traditions also speak of spiritual guides. Some individuals think of them as guardian angels, and others, as Beings of Light who guide people through near-death experiences. Buddhists think of them as devas . Cherokees call them Adawees , the great protectors of the Four Directions. Malakh , or “messenger,” is the Hebrew word for angel. There are the cherubim and the seraphim and the four great archangels: Uriel, Raphael, Michael, and Gabriel. The Iranian angel Vohu Manah is believed to have revealed the message of God to Zoroaster some twenty-five hundred years ago. Similarly, the archangel Gabriel is credited for revealing the Quran to Muhammad a thousand years later. Gabriel, honored by Jews, Christians, and Muslims, has a special role as a mediator between human consciousness and the higher realms from which spirit descends into the body. Although no Western scientific evidence supports the existence of angels, one can find phenomenological evidence. Many first-person accounts of near-death occurrences involve angels and similar experiences from people of different ages, from diverse cultures, and with different personal and religious beliefs ( Borysenko & Dveirin, 2007 ).

ENERGY

The concept of energy has been recognized for centuries and in most cultures. Many ancient and current cultures have great respect for the subtle and unseen forces in life. Most spiritual traditions share the belief that energy is the bridge between spirit and physical being. Meditation and prayer are believed to be subtle energy phenomena that represent contact with the spiritual dimension.

Chinese Taoist scholars believed that energy, not matter, was the basic building material of the universe. Albert Einstein and other physicists proved that matter and energy are equivalent and that energy is not only the raw material of the cosmos but the glue that holds it together. Modern scientists now view the universe in terms of forces instead of tiny particles of matter. Their experimental findings are similar to the intuitive observations of China’s ancient scholars. Everything in the world—animate and inanimate—is made of energy. People are beings of energy, living in a universe composed of energy.

Chapter 2 • Basic Concepts Guiding Alternative Therapies 23

Although Western scientists agree on this theory, they do not yet fully agree that a distinct energy system exists within the human body. For energy to be “real,” it must be measurable by scientific instruments. By this logic, of course, brain waves did not exist prior to the invention of electroencephalo- graphs! Because technology is not yet capable of measuring all the energy fields in the body, references to energy are not often found in conventional medicine.

For more than 2,000 years, various practitioners worldwide have insisted that a person is more than the physical body. According to these healers, a “life force” of subtle energy surrounds and permeates every person. Energy is viewed as the force that integrates the body, mind, and spirit; it is that which connects everything. The Japanese call this energy ki (pronounced “key”); the Tibetans refer to it as lung (pronounced “loong”); the Polynesians call it mana ; Native Americans call it oki, orenda , or ton ; Americans call it subtle energy or bioenergy; the Greeks call it pneuma ; and the Hindus give it the name prana . Prana is sometimes translated from the Sanskrit as “primary energy,” “breath,” or “vital force.” The Chinese refer to this energy as qi or chi ( pronounced “chee”) and believe that it takes the form of two opposite but complementary phases, yin and yang. Yin is the earth, moon, night, fall and winter, cold, wetness, darkness, the feet, the left side, the female gender, and passivity. Yin is involved in tissue growth. Yang is the sun, day, spring and summer, heat, dryness, light, the head, the right side, the male gender, and aggressiveness. Yang is involved in tissue breakdown. It is believed that each person is a unique combination of the complementary energies yin and yang. This union of opposites constitutes wholeness. Figure 2.1 shows the t’ai chi symbol, which illustrates the yin and yang of Chinese thought. The white dot on the black portion of the symbol and the black dot on the white section are reminders that each quality contains some of its opposite. Further descriptions of yin and yang are found in Chapter 4 .

It is believed that qi creates qi. In other words, physical activities such as eating, work, and rest, as well as nonphysical aspects of life such as will, moti- vation, feelings, desires, and a sense of purpose in life, are all made possible

Yang Yin

FIGURE 2.1 T’ai Chi Symbol

24 Unit 1 • Healing Practices

by qi. Those same activities and aspects also create more qi. Most schools of thought basically agree on the following points regarding energy:

• Energy comes from one universal source. • Movement of energy is the basis of all life. • Matter is an expression of energy and vice versa. • All things are manifestations of energy. • The entire earth has energetic and metabolic qualities. • People are composed of multiple, interacting energy fields that extend

out into the environment. • People’s relationships with one another are shaped by the interactions of

their energies. • Qi, ki, and prana have no exact counterpart in conventional medicine,

though the concept of a physical bioenergy system is under research. It is described as a weak but complex electromagnetic field that is hypothesized to involve electromagnetic bioinformation for regulating homeodynamics. ( Newman & Miller, 2006 ; Warber, Cornelio, Straughn, & Kile, 2004 )

Chakras

The Hindu concept of chakras (a Sanskrit word for “spinning wheel”) describes seven major energy centers within the physical body. Chakras have been described by most Eastern cultures and several South American cultures (such as Mayan) for thousands of years. Chakras are major centers of both electromagnetic activity and circulation of vital energy. They are usually thought of as funnels of perpetually rotating energy and are considered the gateways through which energy enters and leaves the body. Each chakra in the body is recognized as a focal point of the life force relating to physical, emotional, mental, and spiritual aspects of people and is the network through which the body, mind, and spirit interact as one holistic system. Figure 2.2 illustrates the sites of the chakras in the body.

The concept of chakras may be foreign to the Western scientific mind, but chakras are not completely unknown to those familiar with Judeo- Christian culture, particularly in the artwork and sculptures passed down through the ages. For centuries, the crown chakra, which signifies a conscious awareness of the divine, has been painted as a halo over those who are con- sciously aware of a divine presence in their lives.

The seven main chakras are vertically aligned up the center of the body from the base of the pelvis to the top of the head. Each has its own individual characteristics and functions, and each has a corresponding relationship to various organs and structures of the body, to one of the endocrine glands, as well as to one of the seven spectral colors of the rainbow. The characteristics of the seven major chakras are described in Box 2.1 . Of the many smaller chakras throughout the body, the most significant are in the palms of the hands. The hand chakras are considered extensions of the heart chakra and, as such, radiate healing and soothing energies. Spiritual healers who practice the

Chapter 2 • Basic Concepts Guiding Alternative Therapies 25

(continued)

BOX 2.1

The Chakras

1. Root chakra Location: base of the spine Center of: physical vitality, urge to survive Gland: adrenal glands Organs/Structures: kidneys, bladder, spine Color: red

2. Sexual or navel chakra Location: slightly below the navel, in front of the sacrum Center of: sexual energy, ego, extrasensory perception Gland: gonads Organs/Structures: reproductive organs, legs Color: orange

FIGURE 2.2 The Chakras and the Auric Field

26 Unit 1 • Healing Practices

laying on of hands concentrate energy in their hand chakras. Each chakra has a purpose and a function that

• regulates the human energy system and maintains an equilibrium of health (purpose); and

• links body, mind, and spirit and exchanges energy (function).

Each chakra also operates at its own optimum frequency; generally, the lower the chakra on the body, the lower its frequency. If one frequency is out of sync, all others will be also.

The main purpose in working with and understanding the chakras is to create integration and wholeness within people. The chakras are the “door- ways” through which the energy from within and without is distributed to cells, tissues, and organs. If chakras stop functioning properly, the intake of energy will be disturbed, and the body organs served by that chakra will not

3. Solar plexus chakra Location: slightly above the navel Center of: unrefined emotions, urge for power Gland: pancreas Organs/Structures: stomach, liver, gallbladder Color: yellow

4. Heart chakra Location: middle of the chest at the height of the heart Center of: unconditional affection, compassion, devotion, love, spiritual growth Gland: thymus Organs/Structures: heart, liver, lungs, circulatory system Color: emerald

5. Throat chakra Location: throat area Center of: communication, self-expression, creativity Gland: thyroid Organs/Structures: throat, upper lungs, digestive tract, arms Color: blue

6. Third-eye chakra Location: middle of the forehead, a little higher than the eyebrows Center of: the will, intellect, spirit, spiritual awakening, visualization Gland: pituitary Organs/Structures: spine, lower brain, left eye, nose Color: purple

7. Crown chakra Location: at the top of the head at the fontanel Center of: highest level of consciousness or enlightenment, intuition, direct spiritual vision Gland: pineal Organs/Structures: upper brain, right eye Color: golden white

Chapter 2 • Basic Concepts Guiding Alternative Therapies 27

get their needed supply of energy. Eventually, organ functioning will be dis- rupted, leading to weakened organs with a diminished immune defense. If this process continues, the end result will be dysfunction and disease ( McGuinness, 2012 ). Dr. Dean Ornish ( 1999 ), well known for his program to reverse coronary artery disease through diet, exercise, support groups, and meditation without surgery or drugs, believes that a closed heart chakra (unresolved anger and fear) is related to blocked coronary arteries. Conse- quently, the meditation technique he incorporates into his program involves opening the heart chakra. His holistic approach has now become a recognized program practiced nationwide.

Aura

Closely related to the notion of chakras is the concept of aura. The aura is the energy field surrounding each person as far as the outstretched arms and from head to toe. This energy field is both an information center and a highly sensitive perceptual system that transmits and receives messages from the internal and external environments. Each of the seven layers of the auric field is associated with a chakra; the first layer is related to the first chakra, and so on. Each layer has physical, mental, emotional, and spiritual dimensions and purposes, and the lay- ers function together through the transmission of energy. Box 2.2 lists

BOX 2.2

Seven Layers of the Auric Field

Level 1. Etheric Body Location: 1/4 inch to 2 inches beyond the physical body Center of: physical functioning and physical sensation Color: light blue to gray Level 2. Emotional Body Location: 1 to 3 inches beyond the physical body; roughly follows the outline of the physical body Center of: emotional aspects of person Color: all colors of the rainbow Level 3. Mental Body Location: 3 to 8 inches beyond the physical body Center of: instinct, intellect, intuition Color: bright yellow with additional colors superimposed Level 4. Astral Body Location: 6 to 16 inches beyond the physical body Center of: love Color: same colors as in level 3 but infused with the rose light of love Level 5. Etheric Template Body Location: 18 to 24 inches beyond the physical body

(continued)

28 Unit 1 • Healing Practices

characteristics of the auric field, and Figure 2.2 shows a diagrammatic view of the auric field. Virtually every alternative healing therapy has a way of interpreting the body’s subtle energy , which will be discussed throughout this text .

Meridians

A person’s vital energy is not simply radiated outward but has patterns of cir- culation within the body, referred to as the meridian system. Meridians are a network of energy circuits or lines of force that run vertically through the body, connecting all parts. Meridians may be understood more clearly if they are com- pared to a major city’s highway system with entrance and exit ramps, merging roads, and connecting surface streets. If a flood blocks an exit ramp, the streets served by this ramp become inaccessible, which, in turn, affects the people who live and work on those streets. Also, the traffic may back up on the highway, as cars wait for the ramp to reopen, creating a traffic jam. Meridians operate simi- larly in a person’s body. If some type of blockage affects one’s hip, for example, the pathways of energy leading to that hip get “backed up.” Pain or discomfort restricts the motion of the hip, which may affect the position of the foot, which creates a strain on other sets of muscles. These changes in the body’s general posture affect the positions of the internal organs, which, in turn, restrict the nutrition to the organs, alter organ function, and thereby change the body’s bal- ance. As the body and mind are affected, the person will think and feel differ- ently, leading to more tension and more changes ( Zhu, 2012 ).

Each meridian passes close to the skin’s surface at places called hsueh , which means “cave” or “hollow” and is translated as point or acupuncture point. Because each meridian is associated with an internal organ, the acu- puncture points offer surface access to the internal organ systems. The flow of qi can be strengthened or weakened by manipulating specific points. Keeping the flow of energy open and regular contributes to a state of balance and health.

The California Institute for Human Science ( www.cihs.edu ) is the U.S. center for research on a device called the Apparatus for Meridian Identifica- tion (AMI). The AMI measures the flow of ions through the body and in 10 minutes can completely evaluate the condition of a person’s meridian system

Center of: higher will connected with divine will, speaking, listening, working, tak- ing responsibility for our actions Color: clear lines on cobalt blue background Level 6. Celestial Body Location: 24 to 33 inches beyond the physical body Center of: celestial love, spiritual ecstasy, protection and nurturance of all life Color: shimmering pastel colors Level 7. Causal Body Location: 30 to 42 inches, forming an egg shape around the body Center of: higher mind; integration of spiritual and physical body Color: shimmering gold threads

Chapter 2 • Basic Concepts Guiding Alternative Therapies 29

and the corresponding internal organs related to those meridians. This stream of ions is not vital energy or qi itself. Rather, it is a secondary electromagnetic effect of qi—in a sense, its imprint in the physical domain. The AMI is now available for distribution as a diagnostic tool in complementary and alterna- tive therapies and in conventional medicine ( Ahn & Martinsen, 2007 ).

Energy Concentration

The mind’s energy, or willpower, can be developed by individuals to control their body’s energy system to an extraordinary degree. Healers can concentrate and manipulate energy in remarkable ways using their energy to align and balance the electromagnetic field of the patient. In attempting to trace the source of healers’ energy, studies demonstrate that it seems to come from the central body in the area between the solar plexus and the lower abdomen. The Chinese refer to this spot as the tan dien or the home of qi, and the Hindus refer to it as the solar plexus chakra or the seat of prana ( Zhu, 2012 ).

Grounding and Centering

Two terms common in various healing practices and related to energy and bal- ance are grounding and centering . Grounding , as its name suggests, relates to one’s connection with the ground and, in a broader sense, to one’s whole con- tact with reality. Being grounded suggests stability, security, independence, having a solid foundation, and living in the present rather than escaping into dreams. It means having a mature sense of responsibility for oneself. Much of the sense of grounding comes from identification with the lower half of one’s body—the parts of being that are less conscious and have more instinctive functions of movement. Learning to breathe into the belly, for example, is vital for grounding, for if the breath is shallow, contact with feelings and reality is limited. Many of the practices in this text , such as biofield therapies, mind– body techniques, and spiritual therapies, help increase one’s groundedness.

Centering refers to the process of bringing oneself to the center or mid- dle. When people are centered, they are fully connected to the part of their body where all their energies meet. Centering is the process of focusing one’s mind on the center of energy, usually in the navel or solar plexus chakra. All movement in the body originates from this center, providing the meeting point for body and mind. It is commonly considered the “earth” center, for it gathers energy from the earth rising up through the legs. Centering can be done through movement, as in t’ai chi, or can be found in stillness, as in med- itation. Being centered allows one to operate intuitively, with awareness, and to channel energy throughout the body.

BREATH

Breath is at the center of all spiritual and religious traditions. In many languages, the words for spirit and breath are one and the same—Sanskrit prana , Hebrew ruach , Greek pneuma , and Latin spiritus . In Christianity, the Holy Spirit

30 Unit 1 • Healing Practices

is referred to as “the breath of life.” To inspire, or take in spirit, means not only to inhale but to encourage, motivate, and give hope. To expire, or lose spirit, means not only to exhale but to die, cease to exist, to end, or be destroyed.

In Eastern cultures, when air is inhaled, so is vital energy, which flows into the body to nourish and enliven. In traditional Chinese medicine, the exhalation is considered the yin part of the breath, and the inhalation is yang. It is impossible only to breathe in without breathing out or to breathe out without breathing in. It is the continuous dynamic balance of yin and yang that contributes to health and well-being. Most of the healing traditions worldwide believe breath is the most important function of life, and restric- tions in breathing lead to dysfunction and disease.

In Western culture, the breath has been considered simply a mechanical, metabolic function of the body. Scientists are now beginning to recognize that breath can be used for healing, improving the body’s self-repair processes, and reducing vulnerability to illness. Oxygen is toxic to viruses, bacteria, yeasts, and parasites in the body, and cancer cells find it more difficult to survive in an oxygen-rich environment. Andrew Weil ( 1995a ) believes that “breath is the master key to health and wellness, a function we can learn to regulate and develop in order to improve our physical, mental, and spiritual well-being” (p. 86 ).

The breath is constantly adapting to accommodate the needs of the situa- tion at hand. When people eat heavy meals or exercise rapidly, when their noses are congested or dry, or when their environment is filled with pleasant or unpleasant smells, their breathing changes. Every change in posture has an effect on the combination of muscles used to breathe. Breath does not feel the same standing or sitting as when one is lying down. Breathing also changes under stress. For example, anxious people take shallow “chest” breaths, using only their chest muscles to inhale rather than their diaphragm. As a result, only the top part of their lungs fills with air, depriving the body of the optimal amount of oxygen.

Many people, even when feeling relaxed, breathe in a shallow way that keeps them in a constant state of underoxygenation that contributes to a decreased level of energy and increased vulnerability to illness. The typical shallow chest breath moves about half a pint of air, whereas a full abdominal breath can move eight to ten times that amount. Forming healthy breathing habits can produce dramatic results. Probably no other single step that people can take will so profoundly and positively affect body, mind, and spirit. Deep breathing can counter stress. Just three deep, full belly breaths can move indi- viduals from panic to calmness by increasing their oxygen intake. Much of perceived stress is worrying about the future or the past, and deep breathing is a great way to return to the present. Twenty minutes of deep breathing exercises a day can lower blood pressure by increasing oxygen intake, which decreases workload on the cardiovascular system ( Anselmo, 2013 ; Ody, 2011 ).

INTEGRATED NURSING PRACTICE

In complementary and alternative medicine, the focus of restoring health is within each person and cannot be “given” to a client by any health care practitioner. Drugs, herbs, procedures, surgeries, or mind–body techniques

Chapter 2 • Basic Concepts Guiding Alternative Therapies 31

may be helpful or necessary but by themselves do not cure disease. People must, and do, rebalance and repair themselves. The profession of nursing was founded on this philosophy and view of life as noted by Florence Nightingale’s ( 1860 ) basic premise that healing is a function of nature that comes from within the individual. She saw the role of the nurse as putting the “patient in the best condition for nature to act on him.”

In contrast, biomedicine has taught people to listen to external authori- ties and to view themselves as helpless victims of disease. Conventional medi- cine is based on the idea of cure, which usually refers to the elimination of the signs and symptoms of disease. “Curing,” however, is effective for only about 15% to 20% of the sick population. In 80% to 85% of acute disruptions of health, one of three things happens with or without medical intervention: The person gets well, develops a chronic disorder for which there is no cure, or dies. When the focus is on cure, death is seen as a failure. Certainly, the curative aspects of Western medicine have allowed many people to live healthy, productive lives. But for many others, fixing the body is not enough. As individuals search for meaning in their illness and their life, as well as a sense of connectedness with others, they begin the healing process. Box 2.3 compares the philosophy and beliefs of the medical-curing model with the nursing-healing model.

Many sick people eventually get better no matter what treatment is given or even if no treatment is given. If the person is given “something,” recovery is even more likely because of the placebo effect . The concept of the placebo effect follows directly from biomedicine’s denial of the power of self-healing.

(continued)

BOX 2.3

The Cure Versus Heal Models

Medical-Curing Model Nursing-Healing Model

Diseases are cured People are healed Focus on diagnosis Focus on meaning Patient is dependent Person is autonomous Effective for 15%–20% of Effective for everyone; healing is always

population; cure may or may not possible be possible

Body is viewed as a machine; Body is a living microcosm of the disease results when parts break universe; disease results through imbalance

Role of medicine is to combat Role of medicine is to restore harmony; disease; practitioners are soldiers practitioners are the Peace Corps, in a war fostering learning and growth

Body is passive recipient of Body is capable of self-healing treatments to fix it

32 Unit 1 • Healing Practices

In Western research studies, the placebo is a simulated biomedical treatment with no inherent medical value. The placebo response complicates researchers’ experiments. In study after study, the placebo has been found effective in at least 30% to 35% of the cases. In fact, the rate is as high as 70%; typically, 40% of individuals report excellent results, and another 30% report good results ( Benson, 1997 ; Bishop, Adams, Kaptchuk, & Lewith, 2012 ; Harrington, 2008) . Norman Cousins, author of Anatomy of an Illness ( 1991 ) and The Healing Heart ( 1985 ), described the placebo as the “doctor who resides within.” In fact, the placebo response in Western scientific literature demonstrates the unity of mind–body and provides great evidence of humans’ self-curing capacity. Janet Quinn ( 1989 ), a leader in holistic nursing, believes that because the site of all curing is within the individual, “there are no longer any ‘real’ or ‘placebo’ treatments and effects. There are only stimuli for healing processes” (p. 554 ). Andrew Weil ( 1995b ) regards the placebo response as a “pure example of healing elicited by the mind; far from being a nuisance, it is, potentially, the greatest therapeutic ally doctors can find in their efforts to mitigate disease” (p. 52 ).

Beliefs can also work against people. The nocebo is the placebo’s negative counterpart. It is destructive thinking that contributes to sickness and even death. The body is good at healing, but at times individuals inhibit this pro- cess by worrying or doubting their ability to overcome the illness. Nurses must routinely assess clients’ beliefs and expectations for health and use them systematically in the healing process. The goal is not to deny reality but to help people project healthy images. When a person acts “as if” the preferred reality were true, the body responds, and improved health can emerge ( Hauser, Hansen, & Enck, 2012 ).

The word heal comes from the Greek word halos and the Anglo-Saxon word haelan , which mean “to be or to become whole.” (Interestingly, the word holy is derived from the same source.) Thus “healing” means “making whole”—that is, restoring balance and harmony. It is a movement toward a sense of wholeness and completion. Healing comes from surrendering to life as it is, including all feelings, from anger and despair through joy and peace- fulness. The irony is that in the process of accepting life as it is, most people feel more alive and live more fully, even when facing death. When the focus is on healing, success does not depend on whether the person lives. Healing can take place even as the body weakens. Through healing, people allow them- selves to be everything they already are and move toward a greater sense of

Primary treatments are drugs, Primary treatments are diet, herbs, stress surgery, radiation management, social support Focus on pain Focus on the human experience of pain, which is suffering Caring is seen as a means to an end Caring is the end in itself

Sources: Dossey & Keegan, 2013 , 2005; Quinn, 1989 ; Watson, 2007 .

Chapter 2 • Basic Concepts Guiding Alternative Therapies 33

the meaning of their experiences. Even when nothing can be done physically to alter the course of disease, still much can be done in a caring sense to make the human experience more meaningful and understandable ( Dossey & Keegan, 2013 ; Quinn, 1997 ). As Joellen Goertz Koerner ( 2011 ) stated: “The ‘being’ dimension of the role of the nurse is less about what nurses do and more about the how. . . . ‘Being’ is what slows down the nurse so that space is created for an authentic, deep connection with the patient and healing” (p. xiv).

Nursing has always focused on creating healing environments for those who have been entrusted to our care. We create healing environments when we use our hands, heart, and mind to provide holistic nursing care. We create heal- ing environments when we empower others by providing the knowledge, skills, and support that allow them to tap into their inner wisdom and make healthy decisions for themselves. Healing environments are a synthesis of the medical- curing approach and nursing-healing approach. We need a healthy balance between technology and compassion. We create healing environments when we take the time to be with clients in deeply caring ways. It is when we stop, become still, and enter the other’s subjective world that we are able to be wholly present for that person. This moment of spiritual connection is uplifting for both client and nurse. Karilee Shames ( 1993 ) described sacred healing moments that occurred when her “goal became to inspire, to share tenderness, and to help instill a will to live, or to surrender to the call of death peacefully, if that was most appropriate. In my highest vision, this is what nursing was all about” ( Shames, 1993 , p. 131 ).

Patients come to us at the most vulnerable times of their lives. Many suf- fer deeply as they try to make sense of serious illness, huge losses, and unan- swerable questions. Healing of spiritual suffering is as important as technical treatment of physical illness. Spirituality is also very important to the dying person’s ability to complete the end-of-life task of transcending the self. Until recently, many of us gave the spiritual health of our patients very little atten- tion. In the area of spiritual assessment, we nurses often simply wrote in the patient’s religious affiliation. We must ask our patients about their spiritual beliefs if we are to know who they are and how they cope with their illnesses. There are a number of tools for assessing spirituality, such as the following. Howden’s Spirituality Assessment Scale ( SAS ; Burkhardt and Nagai-Jacobson, 2002 ), the JAREL Spiritual Well-Being Scale ( Hunglemann, Kenkel-Rossi , Klassen, & Strollenwerk, 1997 ), the Spiritual Involvement and Beliefs Scale ( SIBS ; Hatch, Burg, Naberhaus, & Hellmich, 1998 ), and the Spiritual Assessment Tool ( Dossey & Keegan, 2013 ) are available to help us gain proficiency in the area of spiritual assessment. The tools ask questions regarding relationships, sense of balance and peace, sense of meaning and purpose in life, strengths and limitations, God or a higher power, and meditation or prayer.

We must also create healing environments for ourselves. Working with people can be draining work. As nurses, we need to learn how to restore our energy and replenish ourselves. We might compare our ability to care for others to a well of fresh, healing water. If the well is never dipped into, the water becomes stagnant and brackish. If the water is constantly drawn out and given away, with no source of replenishment, the well will soon run dry. What happens to nurses

34 Unit 1 • Healing Practices

who don’t sincerely care for others or take the time to replenish themselves? It soon becomes obvious by their behavior that they are stagnant or depleted; they are less patient, less tolerant, more irritable, and unhappy. Their state of “burn- out” contaminates all aspects of their professional and personal lives.

When we care for others, care for ourselves, and allow others to care for us, the well of healing is constantly replenished. There are many techniques in this book that can be incorporated into daily life. It is important that we take time for ourselves, even if for only 10 minutes a day. Learning to take care of ourselves means letting go of self-defeating behaviors and attitudes. We must teach ourselves to relax without feeling guilty or selfish for taking time out. Self-renewal is a continuous process. To be there for others and care for them in their times of need, we must first look after our own well-being. It is only when we walk in balance that we can help others learn how to balance their lives.

TRY THIS

Energy

See the Aura

Find a room with a plain white background that has natural lighting or lights other than fluorescent. The lights should not be too bright and should not be shining directly on the person/subject. If you wear glasses, try the experiment with glasses on and glasses off. Ask the person to stand 18 inches in front of the white background and relax and breathe deeply. Stand 10 feet away from the person and focus on the wall, past the person’s head and shoulders. You may notice a fuzzy white or gray field around the body, looking almost like a light behind the person. Continue to stare at the wall—DO NOT focus on the per- son. You may begin to see colors or sharp rays. This may take some time. Try different people as subjects.

You may want to try using your own hands. With the same background, hold your hands out at arm’s length, in front of your face, with your palms facing each other. Point the fingertips of each hand until they are 1 inch apart. Soften your gaze and look past your fingers. Look for a gray, white, or other-colored aura.

Energizing the Hands

Lightly oil your hands and sit in a chair with your back comfortably straight. Cup your hands slightly and bend your arms at the elbows and hold your hands up at the level of your heart. Feel the warmth or tingle as the energy enters your hands. Let the energy flow through your arms into your heart. Then, bring your hands together with the right hand on top of the left hand and rapidly rub the back of the left hand. Reverse the hands and rub the back of the right hand. Then, rub your palms together rapidly until they feel hot. Return your hands to the original position—cupped and at the level of your heart.

Source: Tulku ( 2007 ).

Chapter 2 • Basic Concepts Guiding Alternative Therapies 35

References

Ahn, A. C., & Martinsen, O. G. (2007). Electrical characterization of acupunc- ture points. Journal of Alternative and Complementary Medicine , 13(8): 817–824.

Anselmo, J. (2013). Relaxation. In B. Dosssey & L. Keegan (Eds.), Holistic Nursing: A Handbook for Practice (6th ed., pp. 327–361). Burlington, MA: Jones & Bartlett.

Benson, H. (1997). Timeless Healing . New York, NY: Fireside Books.

Bishop, F. L., Adams, A. E., Kaptchuk, T. J., & Lewith, G. T. (2012). Informed consent and placebo effects. PLoS One. doi: 10.1371/journal.pone.0039661

Borysenko, J., & Borysenko, M. (1994). The Power of the Mind to Heal . Carlsbad, CA: Hay House.

Borysenko, J., & Dveirin, G. (2007). Your Soul’s Compass: What Is Spiritual Guid- ance? Carlsbad, CA: Hay House.

Burkhardt, M. A., & Nagai-Jacobson, M. (2002). Spirituality: Living Our Connect- edness . Albany, NY: Delmar.

Cousins, N. (1985). The Healing Heart . New York, NY: W.W. Norton.

Cousins, N. (1991). Anatomy of an Illness . New York, NY: Bantam.

Dossey, B. M. & Keegan, L. G. (2013). Holis- tic Nursing: A Handbook for Practice (6th ed.). Burlington, MA: Jones & Bartlett.

Harrington, A. (2008). The Cure Within . New York, NY: W.W. Norton.

H atch , R. L., B urg , M. A., N aberhaus , D. S., & Hellmich , L. K. (1998). The spir- itual involvement and beliefs scale. Journal of Family Practice , 46: 476–486.

Hauser, W., Hansen, E., & Enck, P. (2012). Nocebo phenomena in medicine: Their relevance in everyday clinical practice. Deutcsches Arzteblatt Interna- tional. doi: 0.3238/arztebl.2012.0459

Ho, P., Tsao, J. C., Bloch, L., & Zeltzer, L. K. (2011). The impact of group drumming on social-emotional behavior in low-income children. Evidence Based

Complementary Alternative Medicine. doi:10.1093/ecam/neq072

H unglemann , J., K enkel -R ossi , E., K lassen , L., & S trollenwerk , R. (1997). Focus on spiritual well-being: Harmonious inter- connectedness of mind-body-spirit— Use of the JAREL spiritual well-being scale. Geriatric Nursing , 17: 262–266.

Jampolsky, L. (2005). Walking Through Walls: Practical Spirituality for an Imprac- tical World . Berkeley, CA: Celestial Arts.

Koerner, J. G. (2011). Healing Presence: The Essence of Nursing (2nd ed.). New York, NY: Springer.

McGuinness, H. (2012). Indian Head Mas- sage (4th ed.). London, UK: Hodder Education.

Newman, R. B., & Miller, R. L. ( 2006). Calm Healing . Berkeley, CA: North Atlantic Books.

Nightingale, F. (1860). Notes on Nursing . New York, NY: D. Appleton.

Ody, P. (2011). The Chinese Medicine Bible: The Definitive Guide to Holistic Healing. New York, NY: Sterling.

O rnish , D. (1999). Love and Survival: The Sci- entific Basis for the Healing Power of Inti- macy . New York, NY: HarperCollins.

Q uinn , J. F. (1989). On healing, whole- ness, and the haelan effect. Nursing and Health Care , 10(10): 553–556.

Quinn, J . F. (1997). Healing: A model for an integrative health care system. Advanced Practice Nursing Quarterly , 3(1): 1–7.

Shames, K. H. (1993). The Nightingale Con- spiracy . Montclair, NJ: Enlightenment Press.

Taylor, E. J. (2002). Spiritual Care: Nursing Theory, Research, and Practice . Upper Saddle River, NJ: Prentice Hall.

Tulku, T. (2007). Tibetan Relaxation . London, UK: Thorsons.

Warber, S. L., Cornelio, M. A., Straughn, J., & Kile, G. (2004). Biofield energy healing from the inside. Journal of

36 Unit 1 • Healing Practices

Alternative and Complementary Medi- cine , 10(6): 1107–1113.

Watson, J. (2007). Theoretical questions and concerns: Response from a caring science framework. Nursing Science Quarterly , 20(1): 13–15.

Weil, A. (1995a). Natural Health, Natural Medicine . Boston, MA: Houghton Mifflin.

Resources

Weil, A. (1995b). Spontaneous Healing . New York, NY: Knopf.

Weil, A. (2005). Mindbody Tool Kit . Boulder, CO: Sounds True.

Zhu, J. W. (2012). Chinese Medicine: Acupuncture, Herbal Medicine, and Therapies. Hauppauge, NY: Nova Science.

American Holistic Medical Association

27629 Chagrin Blvd, Suite 213

Woodmore, OH 44122

www.holisticmedicine.org

American Holistic Nurses Association

323 N. San Francisco St., Suite 201

Flagstaff, AZ 86001

800.278.2462

www.ahna.org

British Complementary Medical Association

P.O. Box 5122

Bournemouth BH8 OWG

0845.345.5977

www.bcma.co.uk

Canadian Holistic Nurses Association

www.chna.ca

3 The Role of Evidence-Based Health Care in Complementary and Alternative Therapies

Leslie Rittenmeyer PsyD, CNS, RN

Science is nothing but perception.

Plato

BACKGROUND

Evidence-based health care encompasses all the health profes- sions, including medicine, nursing, and allied health (Joanna Briggs Institute, n.d.). Evidence-based medicine was influenced by scholars such as David Sackett and A. L. Cochrane, and pre- ceded evidence-based nursing. The Cochrane Collaboration, which has played a leading role in promoting evidence-based practice, arose from a concern by its founder, A. L. Cochrane, that there was little information about the outcomes of health care practices. The emphasis of the Cochrane Collaboration was, and for the most part continues to be, the systematic review of randomized clinical trials (RCTs). Later in the chapter the rela- tionship of complementary and alternative medicine (CAM) to the Cochrane Collaboration will be discussed. Over the years

37

38 Unit 1 • Healing Practices

additional systematic review methodologies beyond RCTs have been devel- oped to take a more pluralistic approach. Philosophically, evidence-based practice means doing what works and doing it the right way to achieve the best possible patient outcomes ( Muir-Gray, 1997 , 18).

Definitions

Sackett, Rosenberg, Gray, Haynes, and Richardson ( 1996 ) provided the classic definition of evidence-based medicine. They described it as an explicit use of the best evidence available in making decisions about the care delivered to individual clients. Evidence-based medicine involves integrating individual clinical exper- tise with the best available external clinical evidence from systematic review.

A number of definitions of evidence-based nursing can be found in the literature. Generally, they all emphasize that evidence-based nursing is a set of tools, resources, and procedures for finding current best available evidence from various sources and applying this evidence to make clinical decisions that promote positive health outcomes or to inform policy. This process takes into account the situation, cultural context, resources, preferences of patients, clinical expertise and judgment, and common sense. The Honor Society of Nursing, Sigma Theta Tau International ( n.d. ), defines evidence-based nurs- ing as the integration of the best available evidence, nursing expertise, and the values and preferences of individuals, families, and communities who are served. DiCenso, Guyatt, and Ciliska ( 2005 ) defined evidence-based nursing as “the integration of best evidence with clinical expertise, and patient values to facilitate clinical decision making” (DiCenso et al., 2005 , p. 4 ).

The Joanna Briggs Institute (JBI), an interdisciplinary, not-for-profit, inter- national research and development agency, provides a comprehensive descrip- tion of evidence-based practice and its relationship to evidence-based nursing:

Simply defined, evidence-based practice is the melding of individ- ual clinical judgment and expertise with the best available external evidence to generate the kind of practice that is most likely to lead to a positive outcome for a client or patient. Evidence-based nurs- ing is nursing practice that is characterized by these attributes. Evidence-based clinical practice takes into account the context in which care takes place; the preferences of the client; and the clinical judgment of the health professional, as well as the best available evidence. ( Joanna Briggs Institute, n.d. )

As you can see all these definitions share some similarities, namely, best available evidence, clinical expertise, patient preference, and context of the situation. All parts of the definition are equally important, although discuss- ing them in depth is beyond the scope of this chapter. For a closer analysis refer to Hopp and Rittenmeyer ( 2012 ).

Several authors ( DiCenso et al., 2005 ; Ingersoll, 2000 ; Melnyk & Fineout- Overholt, 2005 ; Rycroft-Malone, 2004 ) differentiate evidence-based practice from research utilization. Research utilization focuses on the application of

Chapter 3 • The Role of Evidence-Based Health Care 39

individual research findings to planning and implementing patient care, whereas evidence-based practice is an integration of factors such as clinical expertise, clini- cal context, and patient preferences with the best available international evidence identified by a transparent, systematic research process called systematic review.

Systematic Review

A systematic review is the use of explicit, scientifically rigorous, and trans- parent research methods to critically appraise and synthesize the data from more than one research study. A systematic review protocol provides a plan to ensure scientific rigor and to minimize potential bias in the review. See Box 3.1 for the JBI steps in a systematic review protocol.

BOX 3.1

JBI Steps to a Systematic Review Protocol

1. Background: Provide a rationale for the systematic review through initial explora- tion of the research literature.

2. Review Questions/Objectives; Statement of PICO or PICo Questions; In quan- titative reviews, questions should be specific regarding the patient problem or pop- ulation (P), intervention (I), comparison intervention (C), and outcomes (O) (PICO questions) to be investigated. For instance, how effective is vitamin C compared with vitamin D in reducing pain in patients with osteoarthritis? Other types of ques- tions for systematic reviews focus on the meaning of an experience, as opposed to the effectiveness of an intervention. The focus is on the phenomena of interest (PI) and the context (Co) (PICo questions). These types of questions are sometimes called meaningful questions, and this research is usually qualitative in design. For example, what is the experience of receiving a massage after a chemotherapy treatment?

3. Inclusion Criteria: Include types of participants, interventions in quantitative reviews of phenomena of interest, outcomes or context in qualitative reviews.

4. Types of Studies: Choose RCTs or other quantitative designs, or the array of qual- itative designs in qualitative reviews.

5. Search Strategies: Strategies must be transparent; identify a search strategy and the databases to be searched.

6. Assessment of Methodological Quality: Identify the appraisal instruments to be employed for judging the quality of the included studies.

7. Data Collection: Identify the extraction tools that will be used to extract data from the studies.

8. Data Synthesis: State how the data will be synthesized, for example, by meta- analysis or meta-aggregation.

9. Statement of Conflict of Interest

Source: Joanna Briggs Institute.

40 Unit 1 • Healing Practices

Evidence-based nursing, although closely aligned with evidence-based medicine, has differentiated itself by the value the former places on holistic paradigms. This difference is partly reflected in the recognition that in addi- tion to meta-analysis of quantitative studies, evidence-based nursing requires meta-aggregation of qualitative studies ( Jensen & Allen, 1996 ; Sandelowski & Barroso, 2003 ; Walsh & Downe, 2005 ). The latter are particularly important to the discipline of nursing because it is a human science, and a large amount of qualitative research informs its practice.

Controversies Related to Evidence-Based Practice

Evidence-based nursing has not escaped controversy in the nursing literature. Fawcett, Watson, Neuman, Walker, and Fitzpatrick ( 2001 ) and Upton ( 1999 ) expressed concern that the practice of evidence-based nursing is more focused on the science of nursing than the art of nursing. They feared that this would compromise nursing’s holistic roots. Melnyk and Fineout-Overholt ( 2005 ) and Mitchell ( 1999 ) cautioned that the practice of evidence-based nursing could lead to a kind of cookbook nursing with emphasis on only the tech- nical side of practice. Ingersoll ( 2000 ) suggested that ethical concerns are raised when the reimbursement of health care is connected exclusively to a documented body of evidence.

These and other concerns were addressed by DiCenso et al. ( 2005 ), who pointed out that evidence-based practice not only is informed by research studies but also is determined by context, available resources, patient preferences, expert opinion, and feasibility. Rycroft-Malone ( 2004 ) supported this view in her contention that evidence-based practice involves both quantitative and qualitative evidence, clinical expertise, patient experiences, and consideration of local and organizational influences.

The scholarly debate pertaining to evidence-based nursing practice is healthy for the profession, and owing to the expansion of the definition to include patient preference, clinical expertise, and context of care, there appears to be less fear that the practice will diminish the holistic values of the disci- pline of nursing. Rittenmeyer ( 2012 ) contends that as long as one adheres to the expanded definition of evidence-based practice, it is hard to see the con- flict between the aims and structures of theory-guided practice and evidence- based practice.

EVIDENCE-BASED PRACTICE MODELS

The primary rationale for the use of evidence-based practice (EBP) is that it increases nurses’ confidence that medical care and nursing care will lead to better patient outcomes. Another reason is the long lag time between knowl- edge generation and the use of that knowledge in the planning and provision of care by clinicians. The summaries of systematic reviews, such as best prac- tice sheets, provide a more expedient way for clinicians to access knowledge.

Chapter 3 • The Role of Evidence-Based Health Care 41

It is difficult for busy clinicians to keep up when approximately 1,500 articles, 55 new clinical trials, 1,500 books, and more than 7,000 systematic reviews are produced annually.

Models of Practice

Numerous models of evidence-based practice can be found in the litera- ture. The ACE Star Model ( Academic Center for Evidence-Based Nursing, n.d. ) from the University of Texas, and the Iowa Model from the Univer- sity of Iowa ( Iowa Model of Evidence-Based Practice, n.d. ) are examples of these. A discussion of all models of evidence-based practice is beyond the scope of this chapter but can readily be found on their websites. This chap- ter focuses on the Joanna Briggs Institute (JBI) model of evidence-based practice.

The JBI model of evidence-based health care conceptualizes evidence- based practice as “clinical decision-making that considers the best available evidence, in the context in which the care is delivered, client preference and the professional judgment of the health professional” ( Pearson, Wiechula, Court, & Lockwood, 2007 , p. 85 ). Included in the model are four major compo- nents of the evidence-based health care process, namely, health care evidence generation, evidence synthesis, evidence (knowledge) transfer, and evidence utilization ( Pearson et al., 2007 ).

The JBI model depicts health care as a cyclical process that derives its foci from the identification of global health care needs by clinicians and patients or consumers and addresses those needs by generating knowledge and evidence to effectively and appropriately meet those needs “in ways that are feasible and meaningful to specific populations, cultures and set- tings” ( Pearson et al., 2007 , p. 86 ). Lastly, the evidence is then appraised and synthesized and transferred to health care delivery systems and clinicians who utilize and evaluate its impact on health outcomes ( Pearson et al., 2007 ). Figure 3.1 depicts the JBI model.

Barriers to Evidence-Based Practice

Grol and Grimshaw ( 2003 ) and Grol and Wensing ( 2004 ) contended that one of the most consistent findings in health services research is the gap between best practice and actual clinical care. A review of studies in countries such as the United States and the Netherlands indicated that 30% to 40% of patients do not receive care based on the best available scientific evidence. A study by Hannes, Vandersmissen, De Blaesar, Peeters, Goedhuys, & Aertgeerts ( 2007 ) of 53 Flemish nurses identified some of the following barriers to EBP: lack of time and resources, resistance to change, lack of responsibility in the uptake of evidence, and unequal power structures for decision making. Melnyk and Fineout-Overholt ( 2005 ) likewise identified such barriers to EBP in nursing as lack of knowledge, lack of time or resources, and overwhelming clinical responsibilities.

42 Unit 1 • Healing Practices

EVIDENCE-BASED PRACTICE AND COMPLEMENTARY AND ALTERNATIVE THERAPIES

The use of complementary and alternative therapies is becoming increasingly prevalent. Persons choose to pursue complementary treatment for myriad reasons, such as quality-of-life issues, holistic beliefs, unresolved pain, cultural

Disc ours

e

Hea lth c

are

inte rven

tion /act

ivitie s

F A M

E*

Experience Research Methods of utilisation

implementation F A M E*

Evidence Utilisation

Em bed system

organisational

change

Evidence (knowledge)

Transfer

Health Care Evidence

Generation

Evidence Synthesis

Syste ms

Inf orm

ati onPractice Change

Evaluation ofimpact onsystem/processoutcome

Ed uc

at io

n S

ys te

m at

ic R

ev ie

w

Theory

M ethodology

Evidence- based Practice evidence, context, client preference

judgement

Global Health

*F A M E

Feasibi l i ty

Appropr iateness

Meaningfulness

E ffect iveness

FIGURE 3.1 Joanna Briggs Institute of Evidence-Based Practice

Source: From The JBI Model of Evidence-Based Healthcare, by A. Pearson, R. Wiechula, A. Court, and C. Lockwood, 2005, International Journal of Evidence Based Healthcare, 3(8): 209.

Chapter 3 • The Role of Evidence-Based Health Care 43

values, or simply to avoid the invasiveness of biomedical treatments. Some have contended that the use of complementary and alternative therapies has increased because patients are dissatisfied with traditional Western health care. This may be true for some, but data from a U.S. national survey do not support this view. Adults often use and seem to value both. Of 831 respon- dents who saw a medical doctor and used complementary therapies in the previous 12 months, 79% perceived the combination to be superior to either one alone ( Eisenberg et al., 2001 ).

In an update of the work of Eisenberg et al., the National Center for Complementary and Alternative Medicine (NCCAM), a part of the National Institutes of Health (NIH), released the 2007 National Health Interview Sur- vey (NHIS) titled Costs of Complementary and Alternative Medicine (CAM) and Frequency of Visits to CAM Practitioners: United States, 2007 ( Nahin, Barnes, Stussman, & Bloom, 2009 ). The results of this study are found in Box 3.2 . Com- pared with the results of the earlier survey by Eisenberg et al., the data sug- gest that visits to CAM providers decreased (except for acupuncture), but the use of self-care CAM strategies increased.

To relate evidence-based health care to complementary and alternative health care may seem at first glance an uncomfortable fit, but it appears this is no longer true. It is significant that the Cochrane Collaboration has a working group called the Complementary Alternative Medicine Field. The mission of this group is to facilitate the systematic review of existing randomized con- trolled trials (RCTs) to provide information to benefit clinical decision making and the planning of future research in the field of complementary health care. The group also maintains a database of RCTs pertaining to CAM. Manheimer and Berman ( 2008 ) reported that as of 2007, there were 313 completed Cochrane complementary medicine systematic reviews in the Cochrane

BOX 3.2

• In 2007, adults spent $33.09 billion out of pocket on visits to CAM practitioners and purchase of CAM products.

• Nearly two thirds of the total out-of-pocket costs were for self-care purchases of CAM products.

• Approximately one third was spent on visits to CAM practitioners. • Approximately 38.1 million adults made an estimated 354.2 million visits to practi-

tioners of CAM. • About three quarters of both visits to CAM practitioners and total out-of-pocket

costs spent on CAM practitioners were associated with manipulative and body- based therapies.

• About $14.8 billion was spent on the purchase of nonvitamin, nonmineral natural products.

44 Unit 1 • Healing Practices

Collaborative Library and 180 complementary protocols. As of 2013, there were 568 documents relating to complementary and alternative therapies on the Cochrane Collaboration website. An increasing number of systematic reviews in the field of complementary interventions can be found in other sources as well, suggesting an increasing demand by health care practitio- ners for knowledge generated by systematic reviews of complementary and alternative therapies.

Web-Based Resources in Evidence-Based Practice

The following are valuable resources for practitioners seeking information on evidence-based practice:

• About the Cochrane Library www.cochrane.org • Evidence-Based Practice Centers www.ahrq.gov/professionals/clinicians-

providers/ • The Joanna Briggs Institute for Evidence Based Nursing and Midwifery

www.joannabriggs.edu.au/ • The NICHD Cochrane Neonatal Collaborative Review Group (alpha-

betic listing of systematic reviews) www.nichd.nih.gov/cochrane /Pages/cochrane.aspx

• Clinical Evidence (subscription required): clinicalevidence.com

Guidelines

• National Guideline Clearinghouse www.guideline.gov • CDC Recommends: The Prevention Guidelines System www.cdc.gov

/wonder/prevguid.html • Society of Critical Care Medicine www.sccm.org • Institute for Clinical Systems Improvement www.icsi.org/ • National Kidney Foundation Clinical Practice Guidelines www.kidney.

org/professionals/kdoqi/guidelines_commentaries.cfm • NIH Consensus Statements—Index by Date consensus.nih.gov • PDQ (Physician Data Query): NCI’s Comprehensive Cancer Database

www.cancer.gov/ncicancerbulletin/011012/page6 • Registered Nurses Association of Ontario (RNAO) www.rnao.org/ (see

Best Practice Guidelines)

Implementation and Links

• The Hartford Institute for Geriatric Nursing http://hartfordign.org/ • Getting Research into Practice (how to make a change in practice) www

.shef.ac.uk/scharr/ir/units/resprac/index.htm

Chapter 3 • The Role of Evidence-Based Health Care 45

References

Academic Center for Evidence Based Nurs- ing. (n.d.). Explanation of the ACE Star Model of Knowledge Transformation. Retrieved from www.acestar.uthscsa .edu/Learn_model.htm

DiCenso, A., Guyatt, G., & Ciliska, D. (2005). Introduction to evidence based nursing. In A. DiCenso, D. Ciliska, & G. Guyatt (Eds.), Evidence-Based Nursing: A Guide to Clinical Practice (pp. 3 – 19 ). St. Louis, MO: Elsevier.

Fawcett, J., Watson, J., Neuman, B., Walker, P. H., & Fitzpatrick, J. J. (2001). On nursing theories and evidence. Journal of Nursing Scholarship , 33(2): 115–119.

Grol, R., & Grimshaw, J. (2003). From best evidence to best practice: Effective implementation of change. Lancet , 362: 1225–1230.

Grol, R., & Wensing, M. (2004). What drives change? Barriers to and incen- tives for achieving evidence-based practice. Medical Journal of Australia , 180: 57–60.

Hannes, K., Vandersmissen, J., De Blaeser, L., Peeters, G., Goedhuys, J., & Aertgeerts, B. (2007). Barriers to evidence based nurs- ing: A focus group study. Journal of Advanced Nursing, 60(2): 162–171.

Hopp, L., & Rittenmeyer. L. (2012). Intro- duction to Evidence-Based Practice: A Practical Guide for Nursing . Philadelphia, PA: F.A. Davis.

Ingersoll, G. L. (2000). Evidence-based nursing: What it is and what it isn’t. Nursing Outlook , 48: 151–152.

Iowa Model of Evidence Based Practice. (n.d.). Explanation of the model. Retrieved from www.uihealthcare.com/depts /nursing/rqom/evidencebasedpractice /iowamodel.html

Jensen, L., & Allen, M. (1996). Metasyn- thesis of qualitative findings. Qualita- tive Health Research , 6(4): 553–560.

Joanna Briggs Institute. (n.d.). Definition of evidence based practice and nursing. Retrieved from www.joannabriggs .edu.au/

Manheimer, E., & Berman, B. (2008). Cochrane complementary medicine field: About the Cochrane Collabora- tion (fields). Cochrane Collaboration (2): CE000052.

Melnyk, B. M., & Fineout-Overholt, E. (2005). Making the case for evidence- based practice. In B. M. Melnyk & E. Fineout-Overhold (Eds.), Evidence-Based Practice in Nursing and Healthcare: A Guide to Best Practice (pp. 3 – 24 ). Philadelphia, PA: Lippincott Williams & Wilkins.

Mitchell, G. J. (1999). Evidence-based prac- tice: Critique and alternative view. Nurs- ing Science Quarterly , 12(1): 30–35.

Muir-Gray, J. A. (1997). Evidence Based Health Care: How to Make Health Policy and Management Decisions. New York, NY: Churchill Livingstone.

Nahin, R., Barnes, P., Stussman, B., & Bloom, B. (2009). Costs of complementary and alterna- tive medicine (CAM) and frequency of visits to CAM practitioners: United States, 2007. National Health Statistics Report; no. 18. Hyattsville, MD: National Center for Health Statistics.

Pearson, A., Wiechula, R., Court, A., & Lockwood, C. (2007). A re-construction of what constitutes “evidence” in the healthcare professions. Nursing Science Quarterly , 20(1): 85–88.

Rittenmeyer, L. (2012). Why bother with theory. In L. Hopp & L. Rittenmeyer, Introduction to Evidence-Based

46 Unit 1 • Healing Practices

Practice: A Practical Guide for Nursing. Philadelphia, PA: F. A. Davis.

Rycroft-Malone, J. (2004). The PARIHS framework: A framework for guiding the implementation of evidence-based practice. Journal of Nursing Care Quar- terly , 19(4): 297–304.

Sackett, L., Rosenberg, C., Gray, M., Haynes, B., & Richardson, S. (1996). Evidence-based medicine: What it is and what it is not. British Medical Journal , 312: 71–72.

Sandelowski, M., & Barroso, J. (2003). Creating metasummaries of qualitative

findings. Nursing Research , 52(4): 226–233.

Sigma Theta Tau International. (n.d.). Position statement on evidence based nursing. Retrieved from www .nursingsocieity.org/research/main.html

Upton, D. J. (1999). How can we achieve evidence-based practice if we have a the- ory-practice gap in nursing today? Jour- nal of Advanced Nursing , 29(3): 549–555.

Walsh, D., & Downe, S. (2005). Meta- synthesis method for qualitative research: A literature review. Journal of Advanced Nursing , 50(2): 204–211.

Systematized Health Care

Practices Everything on earth has a purpose, every disease an herb to

cure it, and every person a mission. This is the Indian theory of existence.

Mourning Dove

2 U N I T

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4 Traditional Chinese Medicine

A cheerful heart is good medicine, but a downcast spirit dries up the bones.

Proverbs 17:22

Traditional Chinese Medicine (TCM) originated in Chinese culture more than 3,000 years ago and has spread, with variations, throughout other Asian countries, particularly Japan, Korea, Tibet, and Vietnam. As a comprehensive health sys- tem, it has a range of applications, from preventive health care and maintenance to diagnosis and treatment of acute and chronic disorders.

BACKGROUND

Traditional Chinese Medicine has a long and extensive history. Shen Nong, the Fire Emperor, said to have lived from 2698 to 2598 b.c. , is considered the founder of herbal medicine in China. The written history itself is more than 2,500 years old, dating to the text on internal medicine of Huang Di, the Yellow Emperor. Written long before the birth of Hippocrates, the father of Western medicine, Yellow Emperor’s Classic of Medicine covers such princi- ples as yin and yang, the five phases, the effects of the season, and treatments such as acupuncture and moxibustion.

TCM is associated with early Taoists and Buddhists, who observed energy within themselves, in plants and animals, and throughout the cosmos. Based on a belief in the natural order of the universe and the direct correlation between the human body and the cosmos, TCM philosophy stresses the constant search for harmony and balance in an environment of constant change. By the close of the Han era ( a.d. 220), the Chinese had a clear grasp

49

50 Unit 2 • Systematized Health Care Practices

of pathology, preventive medicine, first aid, and dietetics and had devised breathing practices to promote longevity. During the fourth and fifth centuries a.d. , China’s influence spread throughout Asia, and both Taoism and Buddhism had a marked impact on ideas about health. Sun Si Mian ( a.d. 581– 682), a famous physician, established himself as China’s first medical ethicist. He advocated the need for rigorous scholarship, compassion toward patients, and high moral standards in physicians. In the 11th century, TCM began to focus more on social phenomena, especially human relations and ethical behavior. Initially, this orientation resulted in increased scientific medical study and publications. As TCM developed further, people began to take for granted that a breakthrough in one realm of knowledge would eventually solve all problems of human existence. (As in the West, some assume that advances in technology will solve all problems.) Eventually, sociological methods were used to solve medical problems, and clinical and empirical research reached a low point. Fortunately, the core of the scientific system was never obliterated, and the past 50 years have seen a worldwide revival of TCM ( McNamara & Ke, 2012 ; Zhu, 2012 ). In China today, TCM is practiced in hospitals along with Western medicine. Physicians study not only principles of anatomy, histology, biochemistry, bacteriology, and surgery but also acupuncture, acupressure, and herbal medicine. Patients can choose TCM or Western approaches or a combination of these for their particular problem. Inpatient and outpatient care is provided in large, well-equipped hospitals, as well as in private clinics and pharmacies.

PREPARATION

As of 2013, the Council of Colleges of Acupuncture and Oriental Medicine consisted of 53 schools of acupuncture in the United States that had been fully accredited or were candidates for accreditation with the Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM). An accredited graduate-level program consists of 2,625 hours or 146 credits covering Oriental medicine, acupuncture theory, Chinese herbs, and biomedicine theory. Additionally, 1,330 hours of clinical practice are required. Practitioners who already have a master’s degree in acupuncture are eligible for an herb certificate program of 450 hours of didactic instruction and 210 hours of clinical training in the use of Chinese herbs. Forty-three states plus the District of Columbia require passing a national board exam as a prerequisite for licensure. In addition, each state has its own eligibility requirements.

CONCEPTS

The focus of Traditional Chinese Medicine is on the patient rather than on disease, with the goal to promote health and improve the quality of life. A basic understanding of TCM requires recognition of its long-lived tradition, multiple philosophies, and varied practices. It is impossible to separate the individual concepts and the specific treatment approaches from the context of

Chapter 4 • Traditional Chinese Medicine 51

a complete theoretical system. Prevention, diagnosis, and treatment of dis- eases are based on the concepts of qi, yin and yang, the five phases, the five seasons, and the three treasures. Often only isolated fragments of TCM emerge in the West.

Qi

The concept most central to TCM is qi or chi (pronounced “chee”), which is translated as energy. Qi represents an invisible flow of energy that circulates through plants, animals, and people, as well as through the earth and sky. It is what maintains physiologic functions and the health and well-being of the individual. In TCM theory, energy is distributed throughout the body along a network of energy circuits or meridians connecting all parts of the body. The many different types of qi in the body are described according to their source, location, and function. Yin qi supports and nourishes the body, wei qi protects and warms the body, jing qi flows in the meridians, zang qi flows in the organs, and zong qi is responsible for respiration and circulation. Obstructed qi flow in the human body can cause problems ranging from social difficulties to illness. Its effects are specific to each individual—a person gets sick, has problems at work, or fights with family—and depend on each individual’s unique qi. Cer- tain TCM treatments such as meditation, exercise, and acupuncture are ways of enhancing or correcting the flow of qi ( Ody, 2011 ).

Yin and Yang

In Taoist philosophy, wholeness comprises the union of opposites—dark and light, soft and hard, female and male, slow and fast, and so on. These opposite but complementary aspects are called yin and yang . Originally, the terms desig- nated geographic aspects such as the shady and sunny side of a mountain or the southern and northern bank of a river. Currently, the terms are used to character- ize the polar opposites that exist in everything and make up the physical world.

From the health perspective, the basis of well-being is the appropriate balance of yin and yang as they interact in the body. Imbalance of yin and yang is considered to be the cause of illness. Yin is the general category for passivity and is like water, with a tendency to be cold and heavy. Yin uses fluids to moisten and cool the body. It provides for restfulness as people slow down and sleep. Yin is associated more with substance than with energy. Things that are close to the ground are yin or more earthy. Yin is associated with the symptoms of coldness, paleness, low blood pressure, and chronic conditions. People with excess yin tend to catch colds easily and are sedentary and sleepy. Yang is the general category for activity and aggressiveness. It is like fire, with its heating and circulating characteristics. Associated with things higher up or more heavenly, yang is the energy that directs movement and supports its substance. Symptoms such as redness in the face, fever, high blood pressure, and acute conditions are associated with yang. People with excess yang tend to be nervous and agitated and cannot tolerate much heat ( McNamara & Ke, 2012 ). It must be understood that yin and yang cannot exist

52 Unit 2 • Systematized Health Care Practices

independently of each other. Figure 2.1 in Chapter 2 showed the t’ai chi sym- bol of yin and yang. Nothing is either all yin or all yang. They are complemen- tary and depend on each other for their very existence—without night there can be no day, without moisture there can be no dryness, and without cold there can be no heat. It is the interaction of yin and yang that creates the changes that keep the world in motion; summer leads to winter, and night becomes day. Yin and yang are used in both the diagnosis and the treatment of illness. For example, if a person is experiencing too much stress—usually understood as an excess of yang—more yin activities, such as meditation and relaxation, constitute the appropriate treatment.

Five Phases

As they studied the world around them, the Chinese perceived connections between major forces in nature and particular internal organ systems. Seeing similarities between natural elements and the body, early practitioners developed a concept of health care that encompassed both natural elements and body organs. This theory is known as the five phases theory ( wu-hsing ). Five elements—fire, earth, metal, water, and wood—represent movement or energies that succeed one another in a dynamic relationship and in a continuous cycle of birth, life, and death. These elements do not represent static objects, since even mountains and rivers change constantly with time. In the five phases theory, it is not the substances themselves that are important but their interactions in making up the essential life force or qi ( McNamara & Ke, 2012 ; Zhu, 2012 ).

The rhythm of events resembles a circle known as the creation cycle. In this cycle, burning wood feeds fire; from its ashes, fire produces earth; earth in turn gives up its ore, creating metal; from condensation on its surface, metal brings forth water; and water nourishes and creates plants and trees, creating wood. Each element is related to a pair of internal organs. The yin organ is solid and dense, like the liver, while its yang partner is hollow or forms a pocket, like the gallbladder. The proper interaction of the organ partners influences how well the entire body functions. Fire is linked to the circulation of blood, hor- mones, and food. Its partner organs are the heart (yin) and small intestine (yang). Earth is linked to digestion and comprises the spleen/pancreas (yin) and the stomach (yang). Metal is linked to respiration and elimination and is made up of the lungs (yin) and large intestine (yang). Water is linked to elimination and comprises the kidneys (yin) and urinary bladder (yang). Wood is linked to toxic processing and is made up of the liver (yin) and gallbladder (yang). In addition, each organ is related to a time of day of optimal functioning. If a problem occurs during those hours when an organ is most vulnerable, the timing may alert a TCM practitioner of an imbalance in that organ system ( Zhu, 2012 ).

Five Seasons

The four cardinal compass directions—south, west, north, and east—are affiliated with four of the five elements: fire, metal, water, and wood. The fifth element, earth, is depicted in the center. The Chinese place so much

Chapter 4 • Traditional Chinese Medicine 53

importance on the direction south that they put it at the top of their maps and navigate from it in the same way that Westerners use north. Just as south rules the top of the compass, it also represents summer, the “high noon” of the year, and is linked to fire. West, the direction of the setting sun, is associ- ated with autumn and metal, which is used to make tools for harvesting. North is linked to winter and water, the opposite of the element fire, and is seen as a period of dormancy. East, the direction of the rising sun, is associ- ated with spring and with wood, which represents all growing things. The fifth and central element, earth, is related to the late summer season and a time of maturity. Figure 4.1 illustrates the five directions as they correlate to the five seasons and the five elements.

The etiology of disease in TCM is linked to the five phases, five seasons, and five directions. It is believed that if one component is overbearing and excessive, then another becomes weak and debilitated. It is a complex system of checks and balances that is often not easily grasped by those with a West- ern perspective. Diagnosis and treatment of illness depends on understanding the five elements, seasons, and directions and how they interact.

Three Treasures

The Chinese believe that a combination of life force elements makes up the substance and functions of the body, mind, and spirit, and that these three are all one and the same. One way to understand this connection is to think of water and its wet, fluid nature. Compare liquid water with ice, which not only appears different but feels hard and cold. And then consider steam and its hot, gaseous nature. Despite the differences in appearance, the three different

SOUTH

Summer Fire Peak

CENTER

Late summer Earth Maturity

EAST

Spring Wood Growth

WEST

Autumn Metal Tools

NORTH

Winter Water Dormancy

FIGURE 4.1 Five Directions/Seasons/Elements

54 Unit 2 • Systematized Health Care Practices

forms are the same substance. In the same way, body, mind, and spirit can be seen as different expressions of the same individual ( Ody, 2011 ).

The Taoists call body, mind, and spirit the three “vital treasures.” They are jing , meaning basic essence; qi , meaning energy or life force; and shen , mean- ing spirit and mind. The balance of their abundance or deficiency influences the state of health. Jing is the essence with which people are born. It is similar to Western concepts of genes, DNA, and heredity. Essence is the gift from one’s parents; it is the basic cellular material that allows that cell to function. It is the bodily reserve that supports life and must be restored by food and rest.

There are several types of qi: the hereditary qi, which is from the jing; the nutritive qi derived from food; and the cosmic qi from the breathed air. Wei qi is a specialized qi associated with the immune system. Wei qi circulates near the surface of the body and is the first level of protection when a bacterium or virus tries to enter the body. If the circulating wei qi is weak, it can allow a pathogen to enter the body, and illness ensues.

The vital treasure known as shen is the gift from heaven and represents spiritual and mental aspects of life. Shen comprises one’s emotional well- being, thoughts, and beliefs. It is the radiance, or inner glow, that can be per- ceived by others. For people to be healthy, their physical, emotional, mental, and spiritual aspects must be balanced ( Ody, 2011 ).

VIEW OF HEALTH AND ILLNESS

The Chinese regard the body as a system that requires a balance of yin and yang energy to enjoy good health. Each part of the body is also thought of as an individual system that requires its own balance of yin and yang to function properly. A headache is not just an event in the head, and it is more than just a pain. In Traditional Chinese Medicine, a headache is the obstruction of energy related to the overall energy patterns in the body as well as the circum- stances and lifestyle of the sufferer. TCM assumes that a balanced body has a natural ability to resist or cope with agents of disease. Symptoms are caused by an imbalance of yin and yang in some part of the body, and illness can develop if the balance is disturbed for any length of time. Therefore, health is maintained by recognizing an imbalance before it becomes a disease. It is believed that everything needed to restore health already exists in nature, and it is up to the individual, with or without the aid of a health practitioner, to free up energy and restore balance using diet, herbs, acupuncture, and other yin/yang treatments ( Ody, 2011 ; Zhu, 2012 ).

The Chinese believe that all living things—people, the earth, the universe—are connected by cosmic energy. Thus, the balance of qi in an indi- vidual is connected to the balance in the environment; the forces active within the world are the same forces active within the individual body. Simply put, nothing happens without consequence to something else. The concern for bal- ance and harmony is reflected not only in the TCM approach to the individ- ual but also in the view that the balance and well-being of the resources of the

Chapter 4 • Traditional Chinese Medicine 55

natural world and society are vital to the overall health of all who live on the earth. Practitioners never lose sight of the multifaceted relationship between individuals, communities, societies, and nature.

Because the human body is a microcosm of the universe, extremes of climate in the body can create problems, just as extreme environmental condi- tions can wreak havoc on the environment. Sometimes, people experience a “cold” or yin illness caused by too much coldness in the body. For example, the symptoms of a “cold” influenza include a low-grade fever, no sweating, headache, muscle aches, stuffy nose, and a cough with clear white phlegm. Some influenzas are “hot” or yang influenzas caused by too much heat in the body. Symptoms include high fever, sweating, headache, dry or sore throat, thirst, and nasal congestion with sticky or yellow mucus. Too much cold in the body requires “warming” remedies, and too much heat in the body requires “cooling” remedies ( Ody, 2011 ).

DIAGNOSTIC METHODS

The Traditional Chinese Medicine practitioner has four diagnostic methods ( szu-chen ): inspection, auscultation and olfaction, inquiry, and palpation. These methods gather information about the five phases and their related body systems. The practitioner examines how the person eats, sleeps, thinks, works, relaxes, dreams, and imagines. No part of the self is considered a neu- tral bystander when the body is in a state of imbalance.

Inspection

Inspection refers to the visual assessment of the spirit and physical body of patients. Spirit inspection or observation is an assessment of the person’s overall appearance, especially the eyes, the complexion, and the quality of voice. Good spirit, even in the presence of serious illness, indicates a more positive prognosis. Tongue diagnosis is a highly developed system of inspection of the physical body. The tongue is considered to be the visual gateway to the interior of the body. The whole body “lives” on the tongue, rather like a hologram. Different areas of the tongue correspond to the five phases and related organ systems, as depicted in Figure 4.2 . The central area of the tongue is related to the spleen/pancreas and stomach. The very back of the tongue reflects the kidneys and urinary bladder. The sides of the tongue are related to the liver and gallbladder. The very tip of the tongue corresponds to the heart, and surrounding the heart are the lungs in the front third of the tongue. The practitioner inspects the color, shape, markings, and coating of the tongue to gather information about the state of balance in the person’s body. For example, a moist tongue with a thin white coating may signal the presence of a “cold” or yin illness, whereas a dry, yellow, or dark tongue may signal a “hot” or yang illness ( McNamara & Ke, 2012 ).

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Auscultation/Olfaction

The second part of diagnosis, auscultation and olfaction, refers to listening to the quality of speech, breath, and other sounds, as well as being aware of the odors of breath, body, and excreta. Types of sound are associated with the five phases and organ systems. How the person is breathing is a good indication of the status of the organs. Phases and organ systems are associated with specific odors such as sickly sweet, rotten, putrid, rancid, and scorched. Odors can arise from the skin itself or from the ears, nose, genitals, urine, stool, or bodily discharges. The breath may also have a distinctive odor. Usually, the stronger the odor, the more serious the imbalance has become.

Inquiry

The third part of diagnosis, inquiry, is the process of taking a comprehensive health, social, emotional, and spiritual history. The practitioner questions the person not only about the presenting complaint but also about many other factors, including sensations of hot and cold, perspiration, excreta, hearing, thirst, sleep, digestion, emotions, sexual drive, and energy level.

Kidneys/urinary bladder

Spleen/pancreas stomach

Lungs

Heart

Liver/gallbladder

FIGURE 4.2 Tongue Map

Chapter 4 • Traditional Chinese Medicine 57

Palpation

Palpation is the fourth diagnostic method and includes pulse examination, general palpation of the body, and palpation of the acupuncture points. Read- ing the pulses, or pulse diagnosis , can provide key information about the person’s condition. For example, a fast pulse might indicate a problem with an overactive heart or liver; a slow pulse might indicate a sluggish digestive system; pulses described as wide, flat, and soft might indicate a spleen prob- lem; and narrow, forceful pulses might indicate a liver dysfunction. The radial pulse is felt in three positions and two layers on both the right and the left arm. The more superficial, or surface layer, belongs to the yang organs; the deeper layer belongs to the yin organs. The locations of major points used in pulse diagnosis are illustrated in Figure 4.3 . The pulse allows the practitioner to feel the quality of qi and blood at the different locations in the body. Twenty-nine pulse qualities are described according to size, rate, depth, force, and volume. Examples of qualities are surging, scattered, vacuous, slippery, stringlike, and flat ( Ody, 2011 ).

All this diagnostic information is compiled to arrive at a “pattern of dis- harmony,” or bian zheng . A single biomedical disease can be associated with a large number of Chinese diagnostic patterns. A lower urinary tract infection,

(s) Small intestine (d) Heart

(s) Gallbladder (d) Liver

(s) Urinary bladder (d) Kidney yin

(s) Large intestine (d) Lung

(s) Stomach (d) Spleen/pancreas

(s) Kidney yang (d) Pericardium

(s) = Superficial (d) = Deep

Left hand Right hand

FIGURE 4.3 Location of Major Points Used in Pulse Diagnosis

58 Unit 2 • Systematized Health Care Practices

for example, might be related to one of four distinct diagnostic patterns. Each of these patterns would be treated in different ways, as it is said, “one disease, different treatments.” Also, many different biomedical diseases may fall into one pattern, thus the saying, “different diseases, one treatment.”

TREATMENT

Because an individual’s combinations of yin and yang are unique, Traditional Chinese Medicine practitioners must tailor their treatment to each client. The goal of treatment is to reestablish a balanced flow of energy in the person through diet, herbs, massage, acupuncture, qigong, and gua sha. Feng shui, although not considered an actual treatment, is employed to improve health and well-being.

Diet

The simplest and most accessible treatment is diet. Dietary interventions are individualized on the basis of the individual’s pattern of disharmony. Foods are used to rebalance the body’s internal “climate” by bringing warmth to coldness or by cooling off too much heat. The thermal nature of food is described by the way a person feels after ingesting it. For example, after eating watermelon or asparagus, which are cooling foods, one feels physically and emotionally cooler. An internal feeling of warmth comes after eating warming foods such as salmon, lamb, or sweet potatoes. Neutral foods do not create a specific thermal quality and are thus good diet balancers. A diet to maintain health should be varied and include a minimum of seven different fruits and vegetables a day to avoid a cold or a hot imbalance. If a person is ill and the symptoms indicate a hot condition, then the diet should emphasize cooling foods, and vice versa. In addition to the overall daily diet, specific foods are used as medicines to correct hot and cold imbalances ( Zhu, 2012 ). Box 4.1 lists common foods and their thermal effects on the body.

Foods are categorized according to one of six tastes, each having a specific function in the body. Sweet foods are often used to aid digestion and qi, and influence the spleen and stomach. Salty foods affect the kidney and bladder and are often used to “soften” cysts or tumors and may be tried before surgery. Sour foods, such as lemons or tomatoes, are used to dry mucous membranes in the intestinal, urinary, reproductive, or respiratory surfaces. Pungent foods such as garlic and onion are used to aid digestion, stimulate circulation, and promote sweating. Bitter foods, such as greens or tonic water, also help in digestion and are used to regulate the bowels. Astringent foods, such as beans or potatoes, stop the flow of bodily secretions such as tears, saliva, and sweat.

Each food has both yin and yang energies, but often one predominates. Cooling foods and those with bitter and salty flavors are yin. Warming foods are yang, as are foods with pungent and sweet flavors. When people have an excess of yin they may be sluggish, laid back, calm, slightly overweight, and emotionally sensitive. To balance these overly yin tendencies, yang foods are

Chapter 4 • Traditional Chinese Medicine 59

added to the diet to help activate the metabolism and provide more energy. People experiencing an excess in yang may be tense, loud, hyperactive, and aggressive. Adding yin foods to the diet cools their internal tension.

TCM practitioners recommend certain foods for balancing and improv- ing a variety of conditions. Foods can be potent healers, especially when deal- ing with temporary illnesses, but they are never used as a lone treatment for serious or chronic conditions.

Herbs

Herbal medicine ( ahong yao ) is an integral part of TCM. In terms of the complex- ity of diagnosis and treatment, it resembles the practice of Western internal medicine. Herbs may be taken in the form of tea, or the substances may be pow- dered and made into pills, pastes, or tinctures for internal or external use. Just as with food, some herbs are warming (cinnamon) and some are cooling (mint).

With the exception of conditions that require surgery, herbs can be used to treat almost any condition in the practice of TCM. Herbs are often pre- scribed in complex mixtures and tend not to be used as isolated components, for example, as extractions from the parent plant. TCM practitioners believe that the healing benefits of herbs result from the synergistic interactions of all the components of the plant. The same herb can be used for many different disorders. Likewise, the same disorder in different people will be treated with different herbs, depending on the assessment of the individual. Herbs are used in the following ways: antiviral, antibacterial, antifungal, and anticancer. Herbs are also used to treat pain, aid digestion, lower cholesterol, treat colds and flus, increase resistance to disease, enhance immune function, improve

BOX 4.1

Thermal Food Qualities

Cooling

Pork, duck, eggs, clams, crab, millet, barley, wheat, lettuce, celery, broccoli, spinach, tomato, banana, watermelon, asparagus, ice cream, soy sauce

Neutral

Beef, beef liver, rabbit, sardines, yam, rice, corn, rye, potato, beet, turnip, carrot, lemon, apple

Warming

Tuna, turkey, salmon, lamb, venison, chicken, chicken liver, shrimp, trout, oats, cabbage, squash, kale, scallion, celery, ginger, sugar, garlic, pepper

60 Unit 2 • Systematized Health Care Practices

circulation, regulate menstruation, and increase energy ( Zhu, 2012 ). Box 4.2 lists herbs commonly used as tonics in TCM. Chapter 7 covers the use of herbs in greater detail.

Massage

Traditional Chinese massage methods were described in texts as early as 200 b.c. Tui na is the forerunner of all forms of massage therapy that exist today. It differs from other forms of massage in that it is used to treat not only muscu- loskeletal problems but also internal diseases. Tui na practitioners must know

BOX 4.2

Tonic Herbs Frequently Used in Traditional Chinese Medicine

Herb Use

Astragalus Enhances immune function by increasing activity of WBCs; increases production of antibodies and interferon

Dong quai Blood-building tonic that improves circulation, tones the uterus, balances female hormones

Garlic Lowers blood pressure, lowers cholesterol and triglycerides; antiseptic, antifungal

Ginger Warming effect; stimulates digestion, decreases nausea, relieves aches and pains

Gingko Mediates the allergic and inflammatory reaction in asthma; not to be taken with aspirin or other anticoagulants; discontinue before surgery

Ginseng Increases appetite and digestion, tones skin and muscles, restores depleted sexual energy

Siberian ginseng Enhances immune function, increases energy Green tea Lowers cholesterol; anticancer effects, antibacterial effects Ho shou wu Cleans the blood, nourishes hair and teeth, increases energy; pow-

erful sexual tonic Licorice Used as an expectorant in bronchitis and asthma;

anti-inflammatory, antitussive Ligusticum Inhibits bronchospasm through bronchodilation Ma huang Effective for mild asthma; because it contains ephedrine, in excess

it can cause hypertension, tachycardia, palpitations, headache, ner- vousness, and insomnia. Ephedrine products are banned in many countries because of their use in producing methamphetamines.

Onion (quercetin) Inhibits the platelet-activating factor in asthma

Chapter 4 • Traditional Chinese Medicine 61

Traditional Chinese Medicine to make a diagnosis before beginning treat- ment. Tui na is often combined with qigong exercises for building up general health, strength, and stamina. Both energizing and sedating techniques are used to treat and relieve many medical conditions. The following major tech- niques are in use ( Pritchard, 2010 ):

• Ma — rubbing with palm or fingertips • Pai — tapping with palm or fingertips • Tao — strong pinching with thumb and fingertip • An — rapid and rhythmical pressing with thumb, palm, or back of the

clenched hand • Nie — twisting, with both thumbs and tips of the index fingers grasping

and twisting the area being treated • Ning — pinching and lifting in a stationary position • Na — rhythmic compression along energy channels • Tui — pushing, often with slight vibratory effect

Massage increases circulation of blood and lymph to the skin and under- lying muscles, bringing added nutrients and pain relief. Massage can help restore proper movement to injured limbs and joints and help restore a sense of balance. Massage is an effective method of reducing stress and tension that usually leads to a feeling of relaxation. Massage is the treatment modality of first choice for children. Chapter 12 covers massage in greater detail.

Acupuncture

Acupuncture involves stimulating specific anatomic points called hsueh where each meridian passes close to the skin surface. Puncturing the skin with very fine needles is the usual method, but practitioners may also use pressure (shiatsu), friction, suction, heat, or electromagnetic energy to stimulate points. The primary goal of acupuncture is the manipulation of energy flow through- out the body following a thorough assessment by a TCM practitioner. Treat- ment is offered in the context of the total person and with the goal of correcting the flow of qi to restore health. Some Western health care practitioners who have learned the techniques of acupuncture miss the broader context and limit their focus to an injured or painful body part.

Acupuncture is effective in the treatment of acute and chronic pain and motion disabilities. In addition, it is used in respiratory and cardiovascular con- ditions (asthma, COPD, palpitations, hypertension); eye, ear, nose, and throat disorders (conjunctivitis, tinnitus, Ménière’s disease, rhinitis, sore throat); gas- trointestinal problems (gastritis, ulcers, colitis, constipation, irritable bowel syndrome); urogenital conditions (premenstrual syndrome, endometriosis, menopausal symptoms, prostatitis, incontinence, erectile problems); skin disor- ders (eczema, shingles, urticaria); psychiatric problems (anxiety, depression, schizophrenia); and in addictive disorders and withdrawal syndromes. Auricular acupuncture is a complete system of its own and is quite powerful for balancing the hormones and overall energy of the body. Contraindications

62 Unit 2 • Systematized Health Care Practices

to acupuncture are childhood, pregnancy, hemophilia, and acute cardiovascu- lar disorders ( Ody, 2011 ). Chapter 13 covers acupuncture in more detail.

Moxibustion is an application of heat from certain burning substances at acupuncture points on the body. A systematic review of moxibustion to correct breech birth presentation found it to be effective at 33 to 35 weeks of gestation. The Health Ministry of Spain has begun a multicenter, randomized controlled trial of moxibustion and breech birth ( Zhu, 2012 ).

Cupping is the application of suction cups on the skin. The cups create a vacuum on the skin and break up accumulated toxins. The first few applica- tions result in painless circular areas of erythema or ecchymosis. When the toxins are successfully removed from the body, cupping no longer creates these marks ( Zhu, 2012 ).

Qigong

Qigong (pronounced “chee-gong”) is the art and science of using breath, move- ment, self-massage, and meditation to cleanse, strengthen, and circulate vital life energy and blood. In India the comparable practice is called yoga. Both of these traditions of self-healing have been called “moving meditation” or “medi- tation in motion.” T’ai chi, which is familiar to many Americans, is a more phys- ical form of qigong. In China, millions of people from children, to workers, to elders, to patients in the hospital practice qigong daily. The techniques are easy to learn and simple to apply for all people, well or sick. Qigong decreases fatigue and forgetfulness and generates energy by enhancing bodily functions.

It is inevitable that taking a deep breath triggers a sense of relaxation. By adding the intention to relax with the breath, the effect is even greater. Add- ing gentle movements or self-massage to the deep breathing and relaxation generates increased self-healing abilities. The focus on deep and intentional relaxation allows for release of emotional stress, for a sense of tranquility, and for one’s natural spirituality to arise ( Ody, 2011 ).

Gua Sha

Gua sha (pronounced “gwaw saw”) is a TCM technique of smearing oil on the skin and then rubbing it with a flat jade stone, spoon, or other round- edged tool to bring out impurities in the body. Gua means “to rub or scrape.” Sha is the red rash that appears afterward, signifying that the impurities have been expelled through the skin. Most practitioners do gua sha on the arms, back, and chest, where many of the meridians are located. Gua sha is used to treat such problems as fibromyalgia, hypertension, arthritis, muscle aches, and early onset of colds and flu.

Feng Shui

Feng shui (pronounced “fung shway”) is the ancient Chinese system of arranging the environment for living in harmony with one’s surroundings. It began thousands of years ago in China and India as a process of decorating

Chapter 4 • Traditional Chinese Medicine 63

graves and has now gained popularity in many parts of the world. For mod- ern practitioners, feng shui is a design system based on the flow of energy through one’s home and environment. The primary objective is to control and balance surroundings in a way that brings happiness, prosperity, and health. Feng shui is based on the principles of qi, yin and yang, five phases, five sea- sons, and numbers and as such is an adjunct to other healing methods.

Many people are aware of the impact their surroundings have on them and use feng shui principles to improve their lives. Practitioners assess the interaction between the home’s energy field and those of the people who reside there. These combined energy forces are significant factors in why and how we develop certain diseases and can be altered to improve our health status. Feng shui practitioners help people determine placement of furniture, colors, and designs that are comfortable, healthy, and supportive. For exam- ple, the entrance to the home should draw people into its nurturing space. The front door is seen as an opening for qi, and obstructions near the door can block good qi, prosperity, and luck from entering the home. Feng shui describes stairway placement; front and back door alignment; bedroom arrangement; placement of electronic equipment; living room, dining room, kitchen, and bathroom arrangement; use of a fireplace; as well as the choice of art. Mirrors have many curative uses, such as lighting up dark corners, slow- ing down the flow of qi, and deflecting unwanted influences.

Color is a vibration to which people respond both consciously and unconsciously. Red is stimulating and dominant and is associated with warmth and prosperity. Yellow is associated with intellect, decisiveness, and optimism. Green symbolizes growth, fertility, and harmony, while blue is peaceful and soothing. Purple is dignified and spiritual, brown suggests stabil- ity and safety, pink is linked to happiness and romance, and orange encourages communication. White symbolizes new beginnings and purity. Black is myste- rious and independent. The aim of feng shui is to ensure good qi flow, bal- ance, and harmony with one’s surroundings. Feng shui music is designed to help people improve their physical and mental health through naturally bal- ancing the energy in the physical and etheric bodies ( Collins, 2008 ).

RESEARCH

Although extensive research has been done in China through the institutions of Traditional Chinese Medicine, much clinical research has been in the form of reports of observed results of various treatments. Many of these reports have been difficult to translate into Western languages and into the causal and analytic type of research modalities typical of the biomedical model. Research standards throughout the world are subject to cultural influences. Not all cul- tures require their medical practitioners to conduct randomized, double-blind clinical trials. Consequently, the research data are influenced by the location of the study. Research that is meaningful to the scientific communities of China and Japan may not have the same impact on European and North American biomedical communities.

64 Unit 2 • Systematized Health Care Practices

Extensive research has been published on the pharmacology and toxic- ity of many traditional herbs. Researchers in China and Japan have studied the therapeutic value of herbs in the following areas: chronic hepatitis, rheu- matoid arthritis, hypertension, atopic eczema, various immunologic disorders including AIDS, and certain cancers. Herbs are also given to control the side effects of chemotherapy and radiation. It would be useful to repeat these stud- ies using biomedical research criteria. Research on the medical effects of qigong has been continuing since the mid-1980s and is now focusing on qigong as a biophysical rather than a mystical force. Acupuncture is one of the most thoroughly researched and documented TCM practices. Research stud- ies are covered in more detail in the chapters devoted to these specific prac- tices. Research opportunities in the future might include studies regarding manual healing therapies, bioelectricity, magnetic physical interventions, and the use of mind–body interactions for health purposes. For the most up-to- date list of research studies available in the United States, contact the National Center for Complementary and Alternative Medicine at the National Insti- tutes of Health.

RELATED SYSTEMS

Tibet

In Tibetan Buddhism, religion and medicine are never separated from each other. The spiritual goal of Buddhism is to understand the nature of oneself and suffering and to develop compassion and compassionate action in one’s life. Tibetan medicine, a sophisticated system, is based on general medical and philosophical assumptions as well as on each individual’s emotions, atti- tudes, lifestyles, and spiritual beliefs. It is believed that one’s positive actions produce happiness, and one’s negative actions produce suffering. This belief in cause and effect is referred to as karma .

In Tibetan medicine, disease results from two causes. The first cause is spiritual, something brought from past-life karma. Spiritual diseases are mediated by a qualified teacher who uses meditation and yoga to balance body, mind, and spirit. The process of learning how to control one’s mind to function in a balanced mode with one’s body is called dharma .

The second cause of disease involves factors from this life, including sea- sonal changes, personal habits and behaviors, poisons, and negative spirits. Illness is considered to be a lack of internal harmony or balance or a lack of harmony with the larger external environment. The process of diagnosis is similar to that of Traditional Chinese Medicine. Essential components in help- ing people mobilize their resources for self-healing are caring and compas- sion. As Forde ( 2008 ) stated, “The most revered healing method in Tibetan medicine is compassion” (p. 14 ). We in the biomedical field should take care- ful note of that philosophy.

Other treatments include dietary changes, massage, exercise, yoga, med- itation, breath work, moxibustion, and acupuncture. Surgery is used only

Chapter 4 • Traditional Chinese Medicine 65

when absolutely necessary. Herbal medicines are made from a variety of herbs, minerals, fruits, twigs, roots, and animals. As in the Native American tradition, the state of the practitioner’s mind and the method of gathering are important to the medication’s therapeutic outcome. All preparation of medi- cines begins with prayer.

Korea

Chinese medicine arrived in Korea in approximately 200 b.c. The close relation- ship between China and Korea facilitated the exchange of ideas for hundreds of years. In the 10th century a.d. , Korea established its political independence from China, but cultural and medical exchange continued. A contemporary innovative system developed in Korea in 1971 involves hand and finger acu- puncture. Energy channels of the entire body are mapped onto the hands, where they are stimulated using short, fine needles and magnets. This system is rapidly gaining in popularity throughout the world ( Sing, 2012 ).

Japan

The history of medical information exchange dates to the first century a.d. By the eighth century, many Chinese medical texts were translated for use in Japan. Several factors contributed to the unique adaptation of Chinese medicine. The scarcity of herbs led to an emphasis on lower prescription doses in Japan. Palpation, as a part of the diagnostic process, includes palpation of the abdominal energy pathways. An area of specialization in Japanese medicine relegates acupuncture, massage, and herbs to separately licensed practitioners. In Japanese medicine, acupuncture involves the use of somewhat finer gauge needles than those used for Chinese acupuncture and shallower insertion. Shiatsu is a holistic health care model using energy techniques to support well-being and to prevent illness. Treatment is based on the relationship between the client and practitioner, who uses gentle pressure along the meridians to correct energy imbalances.

Europe

The history of Chinese medicine in Europe dates to the middle of the 16th century a.d., when European physicians who traveled and studied in China and Japan wrote texts on acupuncture. In the 1950s and 1960s, two notable English acupuncturists, Dr. Felix Mann and Dr. Sidney Rose-Neil, influenced the development of acupuncture in English-speaking countries ( Ergil, 2011 ).

United States

In 1826, Dr. Franklin Bache became one of the first U.S. physicians to use acu- puncture in his practice. When large numbers of Chinese laborers arrived in the United States, they were accompanied by TCM physicians and herbal merchants. Ah Fong Chuck became the first licensed practitioner of TCM in

66 Unit 2 • Systematized Health Care Practices

the United States in 1901 when he was awarded a medical license in Idaho. With the advent of World War II and the interruption of the herb supply from China, these practices disappeared or retreated into Chinatowns nationwide. In the 1970s, President Nixon reopened communication with China, and the practice of TCM began to gain visibility once again throughout the United States. Now, a clear interest in acupuncture, herbs, and qigong can be found among many North Americans ( Ergil, 2011 ).

INTEGRATED NURSING PRACTICE

For Chinese immigrants, Western medicine is used for acute or life-threatening situations. Traditional Chinese Medicine is their usual health practice. Managing one’s health and illness in the immigrant culture is a family affair rather than an individual process. Family and friends provide health information and share in the decision-making process. This understanding helps nurses provide culturally sensitive care ( Kong & Hsieh, 2012 ).

Although nurses are not educated as TCM practitioners, some principles are common to both nursing and TCM. Nursing and TCM practitioners believe that people are at once mind, body, emotions, and spirit; energy fields become unbalanced as a response to stress; energy fields are constantly inter- acting; people heal themselves; and the client–practitioner relationship is one of partnership.

Caring and compassion are considered to be essential components in helping people mobilize their resources for self-healing in both the practice of nursing and TCM. A critical attitude on the part of the compassionate nurse is one of intent to help and comfort. Even though outcomes of illness are not primarily in the hands of health care practitioners, nurses must still be willing to do their best. In addition to using their valuable technical skills, they must be present in the moment for each client. It means grounding and centering oneself before entering into a healing relationship with another person. It means keeping the focus on the other person rather than being distracted by personal internal dialogue. All levels of nursing practice incorporate princi- ples of caring as a guiding focus for nursing intervention. Some nurses will want to continue their education through in-depth study of the principles and practices of TCM. Requirements and programs of study can be obtained from the Council of Colleges of Acupuncture and Oriental Medicine, the address of which is found in the Resources section.

Before we can care for our clients, we must first learn to value and care for ourselves. Drawing from TCM, self-care means seeking ways to establish and maintain balance and harmony in our lives. Exercise programs might include vigorous exercise such as aerobics, running, or swimming; moderate exercise such as dancing or walking; or gentle movement exercise such as qigong, t’ai chi, or yoga. Touching and being touched are important to our sense of well-being. Self-massage, partner massage, and professional thera- peutic massage contribute to a sense of balance and connection with others. Meditation, prayer, and worship are spiritual aspects of self-care. Breath work

Chapter 4 • Traditional Chinese Medicine 67

is both a physical way to increase relaxation and decrease stress and a spiri- tual way to connect with the universe.

Diet is another area in which TCM can provide some practical guidelines. North Americans seem to fluctuate in their eating habits between overindul- gence in food and starvation diets that neglect the principle of balance. Limit- ing the diet to a few fruits and vegetables may be as harmful as a steady diet of hamburgers. In TCM it is believed that illness can be avoided by eating a var- ied diet as much as possible. For example, a cold or hot imbalance is avoided by eating a minimum of seven different fruits and vegetables each day.

For mild, temporary illnesses one might use a number of diet remedies. The cold type of the common cold and flu previously described as character- ized by low-grade fever, no sweating, headache, muscle aches, stuffy nose, and a cough with clear white phlegm is treated with warming foods such as garlic, ginger, chives, pepper, pumpkin, apple, onion, and lamb. The hot type of the common cold and flu with its symptoms of high fever, sweating, head- ache, dry or sore throat, thirst, nasal congestion, and sticky or yellow mucus responds to cooling foods such as watermelon, eggplant, banana, plums, tomato, and tofu. The cold type of low back pain that is characterized by cold- ness and severe pain in the lower back that gradually worsens over time, is not relieved by lying down, and is aggravated by rainy days is treated with hot foods including garlic, chicken, apple, yam, celery, onion, peach, and mustard greens. The hot type of back pain that includes symptoms such as soreness of the lower back that is relieved by lying down, weakness of the legs, and frequent relapses is treated with cooling foods such as peanuts, ses- ame, soybeans, beef, pineapple, and grapes.

Like many other forms of alternative therapies, TCM regards breath as an important function of life. Restrictions in breathing lead to dysfunction and disease. Forming healthy breathing habits can counter stress and help balance body, mind, emotions, and spirit.

Considering the Evidence

H. Cao, J. Liu, and G. T. Lewith, 2010, Traditional Chinese Medicine for treatment of fibromyalgia: A systematic review of randomized controlled trials, Journal of Alternative and Complementary Medicine, 16: 397–409.

What Was the Type of Research?

A systematic review of randomized controlled trials (RCTs).

What Was the Purpose of the Research?

To synthesize, appraise, and evaluate relevant randomized controlled trials concerning the beneficial and harmful effects in the use of Traditional Chinese Medicine in persons living with fibromyalgia.

(continued)

68 Unit 2 • Systematized Health Care Practices

How Was the Study Done?

The authors used a systematic review methodology to examine published and unpub- lished randomized controlled trials relevant to the purpose of this research. They utilized a comprehensive search strategy using selected keywords and six English and Chinese elec- tronic databases to identify randomized controlled trials focusing on Traditional Chinese Medicine and persons living with fibromyalgia. Two authors independently identified studies, extracted data, and assessed the quality of the studies. Initially, 883 citations were identified and narrowed to 35 studies for retrieval and review. Ultimately, 25 RCTs were included in this review, with a total of 1,516 participants in the selected studies.

What Were the Findings of the Research?

Traditional Chinese Medicine may be effective for treating fibromyalgia. Some side effects were reported in 11 of the randomized controlled trials, but no serious adverse effects related to TCM were identified. Acupuncture, and acupuncture combined with cupping and conventional medication were significantly more effective for reducing pain and the number of tender points in persons living with fibromyalgia than implementing only con- ventional medication as the treatment plan.

What Additional Questions Might I Have?

What would be the effect of Traditional Chinese Medicine used in combination with other complementary and alternative therapies? Could TCM have an effect on the quality of life of persons living with other health challenges? Are additional studies on TCM of good methodological quality currently being conducted to strengthen the evidence?

How Can I Use This Study?

This study has considerable clinical value for nurses caring for persons living with fibromy- algia. Nurses should recognize that Traditional Chinese Medicine may be an appropriate intervention for enhancing the quality of life for those individuals diagnosed with fibromy- algia, but they should be aware that additional research on the effectiveness of TCM is needed to strengthen the evidence.

Source: Contributed by Dolores M. Huffman, RN, PhD.

References

Collins, T. K. (2008). The Western Guide to Feng Shui for Prosperity . Carlsbad, CA: Hay House.

Ergil, K. V. (2011). China’s traditional medicine . In M. S. Micozzi (Ed.), Fun- damentals of Complementary and Alter- native Medicine (4th ed., pp. 373–402). St. Louis, MO: Saunders.

Forde, R. Q. (2008). The Book of Tibetan Medicine , New York, NY: Sterling.

Kong, H., & Hsieh, E. (2012). The social meaning of Traditional Chinese Medicine: Elderly Chinese immigrants’ health practice in the United States. Journal of Immigrant Minority Health. 14: 841–849. doi:10.1007/s10903-011-9558-2

Chapter 4 • Traditional Chinese Medicine 69

McNamara, S., & Ke, S. X. (2012). Tradi- tional Chinese Medicine. Charleston, SC: Create Space.

Ody, P. (2011). The Chinese Medicine Bible: The Definitive Guide to Holistic Healing. New York, NY: Sterling.

Pritchard, S. (2012). Tui Na: A Manual of Chinese Massage Therapy. Philadelphia, PA: Churchill Livingstone.

Sing, P. (2012). East Asian Traditional Medicine Including Traditional Chinese, Japanese, Korean, Mongolian, and Tibetan Medicine. Webster’s Digital Services.

Zhu, J. W. (2012). Chinese Medicine: Acu- puncture, Herbal Medicine and Therapies. Hauppauge, NY: Nova Science.

Resources

Academy of Chinese Culture and Health Science

1601 Clay Street

Oakland, CA 94612

510.763.7787

www.acchs.edu

American Academy of Medical Acupuncture

1970 E. Grand Ave., Suite 330

El Segundo, CA 90245

310.364.0193

www.medicalacupuncture.org

American Association of Acupuncture and Oriental Medicine

P.O. Box 162340

Sacramento, CA 95816

866.455.7999

www.aaaomonline.org

Australian Chinese Medical Association

P.O. Box 2328

Carlingford Court

NSW 2118

61.2.9873.6222

www.acma.org.au

Chinese Medicine and Acupuncture Association of Canada

154 Wellington Street

London, ON N6B 2K8

519.642.1970

www.cmaac.ca

Council of Colleges of Acupuncture and Oriental Medicine

600 Wyndhurst Ave, Suite 112

Baltimore, MD 21210

410.464.6040

www.ccaom.org

70

5 Ayurvedic Medicine

The secret of health for both mind and body is not to mourn for the past, not to worry about the future . . . but to live the

present moment wisely and earnestly.

Siddhartha Gautama Buddha

BACKGROUND

Ayurveda , one of the oldest medical systems in the world, has been practiced for more than 5,000 years in India. It is a holistic and sophisticated system encompassing balance of body, mind, and spirit, as well as balance between people, their envi- ronments, and the larger cosmos. Ayurveda is a Sanskrit word derived from two roots— ayur , which means “life,” and veda , or “knowledge”—and translates literally to the science of life. Ayurveda has been adapted by Hindu, Buddhist, and other religious groups and is undergoing a renaissance both in India and throughout the West.

Ayurveda is an intricate system with a tradition of integrat- ing that which is useful from other systems. This ancient system has adapted to modern science and technology, including bio- medical science and quantum physics. This blending of Ayurveda and conventional medicine has proved very compati- ble ( Jayasundar, 2012 ).

CONCEPTS

Ayurveda asserts a fundamental connection between the micro- cosm and macrocosm. People are a creation of the cosmos and as such are minute representations of the universe, containing within them everything that makes up the surrounding world. One must

Chapter 5 • Ayurvedic Medicine 71

understand the world to understand people and, conversely, must understand people to understand the world. Ayurveda emphasizes the interdependence of the health of the individual and the quality of societal life. Therefore, measures to ensure the collective health of society, such as pollution control and appro- priate living conditions, are supported. Much like in Traditional Chinese Medicine, the focus is on the person rather than on disease ( Pole, 2012 ).

Five Elements

Ayurveda views nature and people as made up of five elements or qualities. These elements are earth, water, fire, air, and space and contain both matter and energy. As they interact, these elements give rise to all that exists. The earth element is dense, heavy, and hard. In the human body, all solid struc- tures and compact tissues are derived from the earth element. The water ele- ment is liquid and soft and exists in many forms in the body, such as plasma, cytoplasm, saliva, nasal secretions, eye secretions, and cerebrospinal fluid. The fire element is hot and light and is believed to regulate body temperature as well as being responsible for digestion, absorption, and assimilation. The solar plexus is the seat of fire in the body. Fire manifests in the brain as the gray mat- ter that allows one to recognize, appreciate, and comprehend the world. The air element is cold, mobile, and rough and in the cosmos is the magnetic field responsible for the movement of the earth, wind, and water. In the body, the air element governs cellular function, the movement of breath, and move- ments of the intestines. Thought, desire, and will are also governed by the air principle. The space element is clear and subtle and makes up most of the body. Space plays a unique role because it allows the existence of sound, which needs space to travel. Sound includes not only audible sound like music but subtler vibrations that resonate in the body ( McIntyre, 2012; Pole, 2012 ).

People are a composite of these five elements, which combine in various ways to govern mind, body, and spirit. Ayurveda sees the body as doshas (vital energies), dhatus (tissues), and malas (waste products). It is the dosha’s job to assist with the creation of all the various tissues of the body and to remove any unnecessary waste products from the body.

Doshas

Doshas , or tridosha, are both structures and energy and are the mediators between body tissues, wastes, and the environment and are responsible for all physiological and psychological processes. The Sanskrit names for the three doshas are Vata, Pitta, and Kapha . As the driver or mover of the entire body, the Vata dosha is the most important. It is composed of the elements of air and space and is involved with all elimination, physical and mental movement, and nervous function. If Vata becomes imbalanced, it can cause the other two doshas to become imbalanced. The Pitta dosha is composed of the elements fire and water, governs enzymes and hormones, and is responsible for diges- tion, body temperature, hunger, thirst, sight, complexion, courage, and men- tal activity. The Kapha dosha, composed of the elements of earth and water, is

72 Unit 2 • Systematized Health Care Practices

the heaviest of the three doshas. It provides the structure, strength, and stabil- ity that the body needs. It is also responsible for lubrication, sexual power, and fertility. Figure 5.1 illustrates the connections between the elements and the doshas.

Body Types

Vata, Pitta, and Kapha are present in every cell, tissue, and organ, but each person is made up of unique ratios of the three doshas. This individual consti- tution is determined by genetics, diet, lifestyle, and emotions. Each dosha gives an indication of physical strengths and limitations. According to Ayurveda, there are 10 body types:

• Single-dosha types. One dosha is predominant: Vata Pitta Kapha

• Two-dosha types. One dosha is predominant, and there is a strong secondary dosha: Vata–Pitta, Pitta–Vata Pitta–Kapha, Kapha–Pitta Kapha–Vata, Vata–Kapha

• Three-dosha type. All three doshas are in equal proportions: Vata–Pitta–Kapha

Knowing one’s body type is the key to balancing one’s life in the way that nature intended. This balance goes beyond physical and mental health and includes personal relationships, work satisfaction, spiritual growth, and

VATA

Functions: nervous system, circulation, elimination, emotions, creativity

WATER

liquid/soft

EARTH

dense/heavy/hard

FIRE

hot/light

SPACE

Clear/subtle

AIR

Cold/mobile/rough

PITTA

Functions: digestion, body temperature, hunger, thirst, confidence, cheerfulness

KAPHA

Functions: lubrication, structure, strength, stamina, compassion

FIGURE 5.1 The Elements and the Doshas

Chapter 5 • Ayurvedic Medicine 73

social harmony. As a general rule, the strongest dosha in one’s constitution has the greatest tendency to increase, making people most susceptible to ill- nesses associated with an increase of that dosha ( Sumantran & Tillu, 2012 ).

Vatas are connected to the air and space, so they are similar to the wind—dry, cool, and capable of fast, variable movement and thought. The basic pattern of the Vata type is “changeable.” Vata people are unpredictable and often start things without finishing them. Stress usually leads to anxiety or fear. They are responsive to sound and touch and dislike loud noise. Bal- anced Vata people are happy, enthusiastic, and energetic. When out of bal- ance, they have a tendency to be impulsive. See Box 5.1 for characteristics of the Vata body type.

BOX 5.1

Learn Your Dosha

Vata Type • Light, thin build • Thin, dry skin • Dark, coarse, curly hair • Irregular hunger and digestion • Difficulty putting on weight • Light, interrupted sleep • Tendency toward constipation • Aversion to cold weather, craving for warmth • Bursts of mental and physical energy • Performs activity quickly • Quick to grasp new information but quick to forget • Tendency for worry, anxiety, fearfulness • Excitability, changing moods • Enthusiasm, vivaciousness • Fast talking

Pitta Type • Medium build • Fair, soft, warm skin • Fine, soft, blond, light brown, or red hair • Sharp hunger and thirst, strong digestion • Cannot skip meals • No problem gaining or losing weight • Aversion to hot weather, craving for coolness • Moderate strength and endurance • Sound but short sleep • Sharp, clear, precise speech • Sharp intellect and good, quick memory

74 Unit 2 • Systematized Health Care Practices

Pittas are aligned with fire and act with fervent determination. The basic pattern of the Pitta type is “intense.” Pitta people are ambitious, out- spoken, bold, orderly, and efficient. They tend to respond to the world visu- ally and enjoy being surrounded by fine objects. Balanced Pitta people are sweet, joyous, and confident. Box 5.1 lists the characteristics of the Pitta body type.

Kaphas are a combination of earth and water and, therefore, move slowly and gracefully. The basic pattern of the Kapha type is “relaxed.” Kapha people are stable, steady people who have a happy, tranquil view of the world. They are graceful people who wake up slowly, eat slowly, and speak slowly. They respond to the world through taste and smell and tend to place a great deal of importance on food. See Box 5.1 for characteristics of the Kapha body type.

Few people are single-dosha types. Most are two-dosha types, with one dosha predominant but not extreme. The dominant dosha gives people their primary reactions to the world, which are then moderated by the second dosha. Those with the two doshas of Vata–Pitta type are quick moving, friendly, and talkative with a sharp intellect. They are not as unpredictable or irregular as the single Vata type. They enjoy challenges, but stress makes them tense and hard driven. People who have a combination of Pitta and Kapha types are stable personalities but have a tendency toward anger and criticism. They have steady energy and good stamina but are less motivated to be active. Those whose doshas are the Kapha–Vata type may have a hard time identifying

• Enterprising character, likes challenges • Busy lifestyle, achiever • Tendency toward anger, irritability under stress, judgmental

Kapha Type • Solid, powerful build • Thick, pale, cold skin • Thick, wavy, lustrous hair • Tendency to obesity, hard to lose weight • Slow digestion, mild hunger • Heavy sleep and for a long period of time • Oily, smooth skin • Aversion to cold, damp weather • Steady energy, great strength and endurance • Graceful in action • Slow to grasp new information but good retentive memory • Good organizer • Affectionate, tolerant, forgiving • Tendency to be greedy and possessive • Tendency to be complacent • Slow speech that may be labored

Chapter 5 • Ayurvedic Medicine 75

themselves, since the Vata and Kapha tend to be opposites. Usually, they have a thin body type but with a relaxed, easygoing manner. They tend to procrastinate but can be quick and efficient when necessary. The three-dosha type tends to have good immunity, lifelong good health, and longevity ( McIntyre, 2012 ).

Tissues/Dhatus

The seven dhatus or tissues are the structures of the body, are responsible for nourishment, and must be retained for health. They are rasa (plasma), rakta (blood cells), mamsa (muscle), meda (adipose), asthi (bone), majja (bone mar- row), and shukra (reproductive tissue). In general, Ayurveda practitioners work to keep these tissues intact and healthy ( McIntyre, 2012 ).

Waste Products/Malas

The malas , or wastes, are the nonretainable substances within the body. Urine, feces, and sweat, for example, need to be released and eliminated as the body rids itself of toxins. Excretion of the malas cleanses; thus people are cautioned against inhibiting the body’s natural functions, including sneezing, yawning, burping, urinating, defecating, and passing gases. Vata is the dosha that causes these urges, and suppression of them disturbs Vata. Ayurveda encour- ages expression of these urges in a way that is not offensive to other people ( McIntyre, 2012 ).

Energy/Prana

Prana , which the Chinese call qi, in Sanskrit means “primary energy,” some- times translated as “breath” or “vital force.” Prana is not only the basic life force but also the original creative power. Prana has many levels of meaning, from the physical breath to the energy of consciousness. The five pranas are categorized according to movement, direction, and body region. The navel is considered the pranic center of the physical body. Prana vayu , forward- moving air, moves inward and regulates the intake of substances into the body. This prana moves energy from the head down to the navel. It is the basic energy that drives the person in life. Apana vayu , air that moves away, moves downward and directs all forms of elimination and reproduction. It controls the movement of energy from the navel down to the root chakra at the base of the spine. Udana vayu , upward-moving air, brings about the trans- formations of life energy. It governs the growth of the body and the release of positive energy. This prana moves energy from the navel up to the head. Samana vayu , balancing air, moves from the periphery to the center and moves energy from the entire body back to the navel. It aids in all types of process- ing—food, oxygen, and emotional and mental experiences. Vyana vayu , out- ward-moving air, moves from the center to the periphery and regulates energy out from the navel through the entire body. It directs the circulation of nutrients throughout the body ( Pole, 2012 ).

76 Unit 2 • Systematized Health Care Practices

VIEW OF HEALTH AND ILLNESS

When the doshas are balanced, individuals experience health on all levels: mental, emotional, physical, spiritual, and environmental. Health is much more than the mere absence of disease. Mentally healthy people have good memory, comprehension, intelligence, and reasoning ability. Emotionally healthy people experience evenly balanced emotional states and a sense of well-being or happiness. Physically healthy people have abundant energy with properly functioning senses, digestion, and elimination. From a spiritual perspective, healthy people have a sense of aliveness and richness in life, are developing in the direction of their full potential, and are in good relation- ships with themselves, with other people, and with the cosmos. Environmen- tally healthy individuals have minimal economic, social, and political stress.

Balancing one’s doshas does not mean trying to achieve an equal portion of Vata, Pitta, and Kapha. One cannot change the ratio of doshas that are pres- ent from conception. Health is the balance of each dosha that is right for that particular individual. Doshas, however, are responsive to people’s habits, such as diet, exercise, and daily routines, which can either deplete or increase the doshas. Although both states of imbalance lead to ill health or disease, increased doshas are more problematic than decreased doshas.

Imbalance in the doshas is the first sign that mind, body, and spirit are not perfectly coordinated. One type, called natural imbalance , is due to time and age. Natural imbalances are typically mild and normally do not cause problems. Each dosha becomes more predominant during certain times of day as energy moves through six cycles in each 24-hour period: Veta predom- inates from 2 to 6, day and night; Kapha during the hours of 6 to 10; and Pitta from 10 until 2. Each dosha also predominates during particular seasons and stages of life. Kapha dominates during childhood and during the spring sea- son, Pitta during summer and middle age, and Vata during fall and the latter part of one’s life.

Unnatural imbalances of the doshas can be caused by a variety of factors, each of which falls into one of three broad categories of disease. Adhyatmika diseases originate within the body and include hereditary and congenital dis- eases. Adhibhautika diseases originate outside the body and include trauma, bacteria, and viruses. Adhidaivika diseases originate from supernatural sources , including those diseases that are otherwise unexplainable, such as illnesses originating from seasonal changes, divine sources, planetary influences, and curses. While some of these causes are beyond individual control, lifestyle and diet are within one’s control. Preventing disease and improving overall health depends on the recognition of dosha imbalance and an understanding of the factors that increase and decrease each of the doshas ( Pole, 2012 ).

Imbalanced Vata shows up as rough skin, weight loss, anxiety, restlessness, insomnia, decreased strength, constipation, arthritis, hypertension, rheumatic disorder, and cardiac arrhythmia. Pitta imbalance includes a yellowish complex- ion, excessive body heat, insufficient sleep, weak digestion, inflammation, inflam- matory bowel disease, skin disease, heartburn, and peptic ulcer. Kapha imbalance

Chapter 5 • Ayurvedic Medicine 77

presents as a pale complexion, coldness, lethargy, excessive sleep, depression, sinusitus, respiratory disease, asthma, and excessive weight gain ( Pole, 2012 ).

Several factors aggravate or increase each of the doshas. Factors that increase Vata are excessive exercise; wakefulness; falling; cold; late autumn and winter; fear or grief; agitation or anger; fasting; and pungent, astringent, or bitter foods. Factors that increase Pitta are anger; fasting; strong sunshine; midsummer and early autumn; and pungent, sour, or salty food. Factors that increase Kapha are sleeping during the daytime; spring and early summer; heavy food; milk products; sugar; and sweet, sour, or salty foods ( Pole, 2012 ).

DIAGNOSTIC METHODS

The first question asked is not “What disease does this person have?” but “Who is this person” The complete process of diagnosis takes into account physical, mental, and spiritual components integrated with the social and environmental worlds in which the person lives. In addition to using X-rays or other biomedical diagnostic tools, Ayurvedic practitioners diagnose by observing people, touching them, taking pulses, and interviewing them.

Pulse Diagnosis

Pulse diagnosis is a highly specialized skill that requires great sensitivity. The process, as illustrated in Figure 5.2 , involves placing the index, middle, and ring fingers of the right hand on the radial arteries of the right hand of men and the

FIGURE 5.2 An Ayurvedic practitioner uses the index, middle, and ring fingers to locate three pulse points that are related to the flow of prana in the body and the three doshas.

Source: Dorling Kindersley Media Library/Andy Crawford

78 Unit 2 • Systematized Health Care Practices

left hand of women. The general feel of the pulse is related to body type. A Vata pulse, felt by the index finger, is irregular or wavering, resembling the move- ment of a snake. A Pitta pulse, felt at the middle finger, feels forceful and throb- bing, resembling the movement of a frog. A Kapha pulse, felt at the ring finger, is said to be gliding, resembling the movement of a swan. A three-dosha pulse resembles the movement of a woodpecker. Ayurvedic doctors may also take pulse readings at other points on the body as well. These points include the brachial artery above the elbow, the femoral artery, and pulse points at the tem- ples, ankles, and top of the feet. This basic form of pulse reading gives the prac- titioner a vital clue to the person’s body type. Pulse diagnosis is remarkably comprehensive. Experienced physicians not only can diagnose present diseases but also can tell what diseases the person has experienced in the past and which they are likely to develop in the future ( McIntyre, 2012).

Tongue Diagnosis

Tongue diagnosis can also reveal the functional status of internal organs. A healthy tongue should be pink, clear, and shiny. A discoloration and sensitivity of a particular area of the tongue, or both, indicate dosha dysfunction. Kapha imbalance is evidenced by a whitish tongue, Pitta imbalance by a yellow-green tongue, and Vata imbalance by a brown to black tongue ( McIntyre, 2012 ).

Urine Diagnosis

Ayurvedic practitioners do urine examinations as another way to understand dosha imbalances. A midstream specimen is collected first thing in the morn- ing. Healthy urine should be clear without much foam. Kapha imbalance gives the urine a cloudy appearance, Pitta imbalance imparts a dark yellow color, and a Vata imbalance presents as pale yellow and oily urine. The prac- titioner also puts a few drops of sesame oil in the urine and examines it in the sunlight. The shape of the drops signifies which dosha is imbalanced: A snakelike shape with wave movement indicates Vata; an umbrella shape with multiple colors, Pitta; and a pearl shape, Kapha. The movement of the oil in the urine indicates the prognosis of the disease. If the drop spreads immedi- ately, the illness is probably easy to cure. If the oil drops to the middle of the urine sample, the illness is more difficult to cure. If the oil sinks to the bottom, the illness may be impossible to cure ( Pole, 2012 ).

Body Observation

The practitioner carefully examines the skin, nails, and lips. Cool, hot, rough, or dry skin indicates imbalance. Imbalance can be visualized in the nails by longitudinal striations, bumps, or a parrot beak at the end of the nail. Dry, rough lips or inflammatory patches on the lips are another sign of imbalance. Coldness, dryness, roughness, and cracking indicate Vata imbalance. Hotness and redness indicate Pitta imbalance. Wetness, whiteness, and coldness indi- cate a Kapha imbalance ( Pole, 2012 ).

Chapter 5 • Ayurvedic Medicine 79

TREATMENT

Specific lifestyle interventions are a major preventive and therapeutic approach in Ayurveda. Each person is prescribed an individualized diet and exercise program depending on dosha type and the nature of the underlying dosha imbalance. Care is taken to not cause new symptoms by suppressing the presenting symptoms. Herbal preparations are added to the diet for pre- ventive or regenerative purposes, as well as for the treatment of specific disor- ders. Yoga, breathing exercises, and meditative techniques are also prescribed by the practitioner ( Murray, 2012 ).

Nutrition

In Ayurveda, a balanced diet is different from the Western balanced diet derived from the basic food groups of meat, dairy, fruit, grains, and vegetables. Ayurveda recognizes six tastes: sweet, sour, salty, pungent, bitter, and astrin- gent. A balanced Ayurveda diet must contain all six tastes at every meal but in different proportions depending on dosha type. The word taste includes not only the perceptions on the tongue but also the immediate effect of the sub- stances within the body. Each of the six tastes is derived from two of the five elements. Sour, salty, and pungent have the fire element and so increase body temperature, dilate body channels, and allow energy and toxins to flow out from the body. Sweet, bitter, and astringent have no fire and thus are cooling, promoting relaxation. Sweet, sour, and salty have the water element and soften tissues, lubricate mucous membranes, and increase water retention ( Pole, 2012 ).

Ayurveda describes the actions of each of the six tastes. Sweet promotes the vitality of body tissues, soothes the five senses, and adds bulk and firm- ness. Used in excess, sweet creates obesity, weak digestion, and a tendency to excessive sleep and heaviness. Sour improves the taste of food, increases digestion, and awakens the mind. In excess, sour wastes muscles and causes a buildup of toxins in the blood. Salty promotes digestion, moisturizes the body, softens all organs, and acts as a laxative and sedative. In excess, salty causes stagnation of blood, wasting of the muscles, wrinkling of the skin, and diges- tive hyperacidity. Pungent cleanses the mouth, opens the vessels, improves blood flow, and cures disorders of excess fluid in the body. In excess, pungent causes fatigue, emaciation, dizziness, and thirst. Bitter , though it does not taste good in itself, restores the sense of taste, detoxifies, relieves thirst, and is antibacterial, germicidal, and antipyretic. In excess, bitter causes wasting of the tissues, weakness, and dryness. Astringent is drying, firming, and sedat- ing. It stops bleeding and aids in healing of wounds. In excess, astringent causes premature aging, constipation, retention of wastes, spasms, and con- vulsions and weakens vitality ( Pole, 2012 ).

Three pairs of gunas, or qualities, are inherent in food: heavy or light, oily or dry, and heating or cooling. The following are examples:

• Heavy: wheat, beef, cheese • Light: barley, chicken, skim milk

80 Unit 2 • Systematized Health Care Practices

• Oily: milk, soybeans, coconut • Dry: honey, lentils, cabbage • Heating: pepper, honey, eggs • Cooling: mint, sugar, milk

It is not necessary to memorize which foods reduce which doshas because any number of books offer long lists of foods matched to the dosha, taste, and guna. Many people seem to know naturally what their bodies need for balance. See Box 5.2 for the relationship between the doshas, tastes, and gunas. To counter an excess of Vata, diet recommendations consist of warm food with moderately heavy textures; salt, sour, and sweet tastes; and added oil. Examples of foods to include are asparagus, carrots, green beans, avoca- dos, bananas, melons, rice, wheat, chicken, seafood, chickpeas, and tofu. To counter an excess of Pitta, diet recommendations are for cool or warm (but not hot) foods with moderately heavy textures and bitter, sweet, and astrin- gent tastes. Examples of foods to include are broccoli, cabbage, lettuce, apples, grapes, raisins, barley, oats, ice cream, chicken, shrimp, chickpeas, and tofu. Coconut, olive, and soy oils are acceptable. For an excess of Kapha, diet

BOX 5.2

Foods in Relation to Doshas

Vata

Balances Aggravates

Salt Hot Pungent Light

Sour Oily Bitter Dry

Sweet Heavy Astringent Cold

Pitta

Balances Aggravates

Bitter Heavy Pungent Hot

Sweet Cold Sour Light

Astringent Dry Salty Oily

Kapha

Balances Aggravates

Pungent Light Sweet Heavy

Bitter Dry Sour Oily

Astringent Hot Salty Cold

Sources: McIntyre (2012) ; Murray (2012) ; Pole (2012) .

Chapter 5 • Ayurvedic Medicine 81

recommendations include warm, light food, cooked without much water; pungent, bitter, and astringent tastes; and a minimum of butter and oil. Examples of foods to include are cauliflower, celery, leafy green vegetables, apricots, pears, dried fruits in general, barley, corn, rye, skim milk, chicken, shrimp, sunflower seeds, and raw honey ( Pole, 2012 ).

Every food can be characterized by taste and guna. In addition to a diet bal- anced in terms of fats, carbohydrates, and proteins, people need variety in salty, sour, sweet, pungent, bitter, and astringent foods. The goal of diet management is to avoid aggravating any of the doshas and keep them calm and balanced.

Herbs

In Ayurveda, natural medicines are primarily herbal but may include animal and mineral ingredients, and even powdered gemstones. Practitioners pre- scribe many thousands of herbs. Like food, herbs are classified according to the six tastes. Herbs, however, are more potent and specific in their action than is food. Some herbs used for preventive and regenerative purposes are readily available. The use of herbs for treating disease must be medically supervised. As in Traditional Chinese Medicine, the entire plant is used. It is believed that the plant contains other chemicals that buffer the active ingredi- ent, thus reducing possible side effects ( Sharma et al., 2007 ).

Like foods, herbs balance doshas. Vata-balancing herbs include ginseng, licorice, Indian Pennywort, bala, and sitopaladi. Aloe vera, comfrey root, Indian gooseberry, and saffron are used to balance Pitta; and elecampane, honey, and sitopaladi balance Kapha. Herbs usually take longer to work than Western medications prescribed by practitioners. Historically, Ayurvedic herbs have had little exposure outside India but are now becoming more familiar with the rapid explosion of interest in herbal medicines in North America. The following are a few of the more common herbs found in health food stores. Sitopladi is a very good herbal formula for colds and flu. Indian Pennywort (brahmi) enhances a person’s ability to focus mentally and learn new material. Guggulu is a powerful purifying agent, well known for lower- ing of blood cholesterol levels. Shilajit, with its antispasmodic qualities, is effective in acute and chronic respiratory illnesses. Bala, or Indian country mallow, is helpful in all types of nervous system disorders and certain types of heart disease. These few examples of herbs give one an idea of how they are used as natural body medicines ( Shukla, Bhatnagar, & Khurana, 2012 ). In some instances, heavy metals such as lead, mercury, and arsenic have been found in Ayurvedic herbal medicines. Thus, people have been cautioned about ordering these herbs from overseas or through the Internet ( WHO Drug Information, 2007 ). Chapter 6 presents herbs in more detail.

Exercise

According to Ayurveda, exercise should conform to one’s dosha type. Kapha people can perform moderately heavy exercise such as aerobics, running, dancing, and weight training. Because of their physical strength, Kaphas excel

82 Unit 2 • Systematized Health Care Practices

at endurance sports. Pitta people, who have more drive than endurance and an intense competitive spirit, should engage in a moderate amount of exer- cise. Brisk walking or jogging, hiking, swimming, and skiing are appropriate. People with a Vata dosha might enjoy jogging, but exercises like stretching, yoga, and t’ai chi are better choices. Such individuals have bursts of energy but tire quickly and may push themselves past their limits. Walking is proba- bly the best exercise for all people, because it calms all dosha types. Ayurveda recommends a brisk half-hour walk every day ( Murray, 2012 ).

For people over the age of 80 or under 10, as well as those who have seri- ous Vata and Pitta imbalances, exercise should be very gentle. Exercise should always leave a person ready for work as opposed to being work itself. Several other exercise precautions must be noted. One should not engage in exercise sooner than half an hour before and 1 to 2 hours after a meal. Exercising in the evening is discouraged because it is better for the body to slow down and prepare for sleep. Exercise is discouraged in wind or cold, since heavy breath- ing of cold, damp air is unhealthy for the respiratory tract. Also discouraged is exercise during the intense heat of the day, since environmental heat causes an even greater rise in body temperature.

The key to exercise is moderation and regularity. Ayurveda suggests that all exercise should be done at half of one’s capacity. That means working out just until sweat appears on the forehead, under the arms, and along the spinal column. This amount of exercise improves digestion, prevents consti- pation, improves circulation, stimulates metabolism, regulates body tempera- ture, and maintains body weight. Exercise keeps one’s senses and mind alert and attentive as well as being effective in inducing relaxation and sleep. Over- exercise, as indicated by panting and heavy sweating, may cause dehydration, muscle aches, breathlessness, and even chest pain. It is believed that overexer- cise eventually contributes to arthritis, sciatica, or heart conditions ( Pole, 2012 ).

Yoga

Yoga, developed in the Ayurvedic tradition, is one of the most effective forms of exercise for the body as well as nourishment for the mind and spirit. Hatha yoga, the most familiar form of yoga in North America, is a combination of body positions, breathing exercises, and mental focus on the present. Stretch- ing helps relax and tone the muscles, improves circulation, improves concen- tration, and helps one regain energy. Yoga is increasingly being recognized for maintaining general health as well as helping people manage chronic dis- orders such as headaches, insomnia, hypertension, and depression. Further information about yoga is found in Chapter 16 .

Breathing

Practicing controlled breathing is a valuable technique that leads to a health- ier lifestyle. Several techniques can be utilized to relax the mind and body. Simple breathing helps people become aware of their breath and often relieves tension. Simple breathing involves closing the eyes and observing the breath,

Chapter 5 • Ayurvedic Medicine 83

becoming more aware of its pattern and changes. Slow, easy breathing is con- tinued for several minutes until a sense of relaxation is achieved. Alternate nostril breathing, pranayama , is another technique that can ease difficulty in breathing by making the respiratory rhythm more regular, which in turn soothes the entire nervous system. Pranayama is helpful prior to meditation because it focuses attention inward. Pranayama is performed while seated with the eyes closed. Figure 5.3 illustrates the position. The index and middle fingers of the right hand are placed on either side of the nose. The thumb closes the right nostril while the person breathes in through the left nostril. The left nostril is then closed with the ring finger, and the right nostril is opened for the out-breath and the next in-breath. The right nostril is then closed, and the out-breath occurs through the left nostril. After several cycles, breathing naturally gets deeper and smoother.

Meditation

An important part of daily life in Ayurveda, meditation is considered a pow- erful tool to help maintain health. Meditation is a moment-to-moment aware- ness that cleanses the body, mind, and spirit. It is finding the quiet in the mind. As the mind is brought into a silent and receptive state, new energy comes into being, which is conducive to a state of health and peace. Further information about meditation is found in Chapter 17 .

Massage

Marma therapy is a massage technique focusing on 107 sensitive points, called marmas , located on the skin. These points are similar to the acupuncture

FIGURE 5.3 Pranayama/Controlled Breathing

84 Unit 2 • Systematized Health Care Practices

points called hsueh in Traditional Chinese Medicine. Marma therapy predates the Chinese approach and is likely the parent to acupuncture and acupres- sure. Marmas are activated through various methods. One is through yoga movements that gently stretch specific marma points. Warm oil dripped on the center of the forehead (shirodhara) on a major marma point can be pro- foundly soothing. A daily self-massage with oil can reach all the marmas on the skin. Once taught, these techniques can be practiced at home. Massage is covered in more detail in Chapter 12 .

Aromatherapy

Aromatherapy is based on olfactory stimuli used to help balance the doshas as each responds to specific signals. Specialized olfactory cells provide instant connection of odors with the brain. The hypothalamus responds through reg- ulation of body functions, the limbic system responds with emotions, and the hippocampus responds with memories, which explains how smells can elicit memories so vividly. In general, Vata is balanced by warm, sweet, and sour aromas such as basil, orange, rose geranium, clove, and other spices. Pitta is balanced by sweet, cool aromas like rose, mint, cinnamon, sandalwood, and jasmine. Kapha is balanced by warm aromas with spicy overtones such as juniper, eucalyptus, camphor, and clove. People whose doshas are out of bal- ance are given specific oils to restore dosha balance. Aromatherapy may be used at any time but is often prescribed at night because it helps induce sleep ( Murray, 2012 ). Aromatherapy is discussed further in Chapter 8 .

Music

India has a long tradition of merging music and medicine. Unlike the distinct tones of most Western music, the tones in Indian music tend to blend together, creating a soothing, unifying sound. As with taste and smell, doshas can be balanced with certain tones and rhythms. The three doshas peak at different times of the day, and traditional Indian music smooths the process of these transitions. Ten minutes of music can be used as a gentle wake-up in the morning, after a meal to settle digestion, just before bedtime to aid sleep, and during the recovery period from an illness. Music therapy is discussed further in Chapter 21 .

Purification

Panchakarma , or purification therapy, involves five procedures, any or all of which can be chosen based on the person’s general condition, the season, and the nature of the disease. The five therapies of panchakarma are experienced over a period of a week and involve purifying the body through the use of sweating, emetics, purgatives, enemas, and nasal inhalations. Commonly administered by an Ayurvedic physician with the help of a number of assis- tants, the benefits of panchakarma are relief from long-standing symptoms, renewed health, and extended longevity ( McIntyre, 2012 ).

Chapter 5 • Ayurvedic Medicine 85

RESEARCH

Many Western researchers believe that they look at reality in an objective way. In contrast, Ayurvedic researchers believe that nothing happens in a vacuum. Everything that happens does so in relationship to what is occurring around it. The principle of research is that knowledge cannot be separated from its context.

The National Center for Complementary and Alternative Medicine (NCCAM) has supported research for a number of years. Current studies are primarily focused on herbal preparations that have undergone systematic reviews ( Agarwal, Abhijnhan, & Raviraj, 2007 ; Singh et al., 2007 ; Sridharan, Mohn, Ramaratnam, & Panneerselvam, 2011 ).

As with Traditional Chinese Medicine, many studies have been diffi- cult to translate into Western languages and into the causal and analytic type of research modalities typical of the biomedical model. Research stan- dards throughout the world are subject to cultural influences. Not all cul- tures require their medical practitioners to conduct randomized, double-blind clinical trials. Consequently, the research data are influenced by the location of the study. Research that is meaningful to the scientific Ayurvedic communities may not have the same impact on Western biomed- ical communities.

INTEGRATED NURSING PRACTICE

Although most nurses have not been educated in Ayurvedic medicine, they can integrate a number of principles into their professional practice. Ayurveda teaches self-discovery and self-understanding; it encourages people to learn how they maintain their health and how and when they become sick; and it advocates lifestyle changes to maximize one’s well-being.

The designation of doshas and dosha imbalance is a highly sophisticated process performed by professional practitioners. Using Box 5.1 as a checklist, individuals can begin to learn their dosha or body type, as follows:

• Make a check mark next to the description that best fits how you have been most of your life. If two descriptions apply to you, check both.

• Consider the qualities carefully. There are no right or wrong answers. Be honest and check how you really are, not how you would like to be.

• Look for lasting trends. For example, if your sleep has been heavy and prolonged most of your life but is now light and fitful, the change is likely due to imbalance rather than dosha type. Check your usual pattern.

• Note whether each dosha has some checks, because everyone’s body type has Vata, Pitta, and Kapha components.

• Total the number of checks for each dosha. The dosha with the greatest number should be your body type. If the highest two dosha scores are close, you are probably a two-dosha type. If all three dosha scores are close, you are a three-dosha type.

86 Unit 2 • Systematized Health Care Practices

Determining their unique blend of doshas allows people to begin to understand how their health is affected by internal and external influences. As people become more familiar with their body, they can observe and expe- rience the effect of what they eat and do each day; how they think and feel; the state of their metabolism, digestion, and elimination; the relationships they engage in; their jobs; and the environment in which they find themselves. Because all these factors are interdependent, problems in one area can cause problems in other areas.

People’s dosha balance can be disrupted in a number of ways. An inap- propriate diet and lifestyle for one’s dosha type will cause a slowly develop- ing excess or deficiency in doshas. If people suffer significant trauma, however, the dosha levels can change immediately and dramatically. Dosha imbalance can also result from an accumulation of toxins or from too many experiences of a particular dosha without enough experiences from the other doshas. Once people understand their baseline dosha type, they can assess imbalances that may contribute to disease. Nurses can remind people that the strongest dosha in their constitution has the greatest tendency to increase. For example, Kapha-type clients have a natural tendency toward those things with Kapha qualities, and thus they increase their Kapha energy. Those indi- viduals whose lifestyle includes a desk job, overeating, not exercising, and sleeping excessively may experience an excess in their Kapha dosha. They may need to consciously add opposite qualities to pacify or balance their Kapha energy, such as decreasing food intake, eating more pungent and bitter vegetables and astringent fruits, and increasing exercise.

Achieving balance of the doshas does not happen quickly—people need to work at it consciously. In some cases, lifestyle changes may be difficult, such as the nature of one’s job, while others may be easier, such as a change in lei- sure activities. Typically, people find that diet, exercise, and leisure activities are the most amenable to change. For example, watching television and using computers increase Vata by stimulating the eyes and ears, and the passive nature of these activities increases Kapha. If a television program makes people angry, or their computer programs will not do what they wish, their Pitta may be stimulated. Limiting the time spent watching television and being selective with programs may help them balance their doshas and move toward a health- ier state. Likewise, if people spend a lot of time at their computer, they need to take frequent breaks, move and stretch their bodies, and rest their eyes.

Individuals whose strongest dosha is Vata need to develop more regu- larity in their daily routines, such as eating regular meals, having an estab- lished bedtime, and slowing down and taking time to think. Because these persons have a tendency to dry skin, they should oil their skin regularly. Peo- ple with Vata doshas are drawn to sensory experiences involving movement, speed, and action, and they may enjoy loud music and computer games. To maintain a healthy balance, Vata-type individuals should make an effort to balance those activities with quiet, creative pursuits such as writing, photogra- phy, or painting. Similarly, because they are attracted to vigorous exercise, they should try to engage in gentle exercise every day. Ayurveda suggests that

Chapter 5 • Ayurvedic Medicine 87

all exercise be done at half of one’s capacity. If people know they are exhausted after a 40-minute aerobics class, then they should do only 20 minutes of the class. People with Vata doshas enjoy spending their vacations sightseeing, touring, and filling their days and nights with many activities and returning home exhausted. A more beneficial vacation would be in a beautiful, sunny, and warm environment where they rest and limit their activities. Vata-type people wear clothes that are mostly dark shades, reflecting their mood.

Pitta-type individuals need to loosen up on setting and achieving goals and learn to enjoy the present moment. They can learn to achieve their ambi- tions without pressuring themselves. They also need to control their tendency to organize themselves and everyone else, because they become easily frus- trated when things do not go as planned. Pitta-type people are stimulated by competitive, mentally challenging situations that may increase aggression or determination to win. They should learn to use constructive criticism rather than confrontation. Engaging in noncompetitive leisure activities such as gar- dening may help prevent an excess of Pitta. Vacations in cooler climates, and water and winter sports will cool their tendency to be warm. Pitta types should avoid overly organizing their vacations and try to enjoy whatever hap- pens. Red clothing overstimulates Pitta and may contribute to a more aggres- sive approach to others. Cool, soft, pale colors help balance the Pitta dosha.

Kapha–type individuals need to vary their daily experiences to avoid becoming stuck in a rut, for example, by making small changes in the daily routine, and getting up early and going to bed late to limit the tendency to sleep too long. Because such people may prefer to sit and do nothing, they should find mentally and physically stimulating activities. Kapha is balanced by vigorous exercise, and Kapha types have good stamina, so they can exer- cise longer than Vata or Pitta types, but they will have to force themselves to do so. Kapha types prefer a vacation lying on a beach doing nothing but soak- ing up the sun. They will find, however, that sightseeing and touring will be more stimulating and balancing. All colors, except greens and dark blues, bal- ance Kapha. Bright, strong colors are exciting and balancing.

Helping people understand their doshas is an ongoing process. As peo- ple observe their mind, body, spirit, and relationships, they learn how they respond to different qualities in everyday activities. After helping clients determine their dosha type, have them review their lifestyles in terms of diet, work, leisure activities, exercise, daily routines, quiet times, sleep, and rela- tionships. By applying the principles of Ayurveda, people can begin making choices about the qualities they wish to incorporate into their lives. Rather than focusing on negatives (what they want to stop doing), have them focus on positives (what they want to start doing). Suggest that they limit their exposure to those qualities they do not want and enjoy those that will aid their well-being. Change begins with small steps and is a gradual process. Some people will want to seek the advice of an Ayurvedic practitioner to individu- alize a lifestyle change program. Remind clients that their mind and body always strive toward health and that every individual needs time, nurturing, routine, and gentle discipline to achieve a more complete level of well-being.

88 Unit 2 • Systematized Health Care Practices

TRY THIS

Massage

Sesame Oil Massage

Use the refined sesame oil sold in health food stores, not the heavy Chinese sesame oil. If you wish, you may use olive oil instead. Warm a quarter cup of oil in the microwave for 10 to 15 seconds, being careful not to overheat it.

Mini-Massage (1–2 minutes)

Use 1 tablespoon of warm oil and rub it into your scalp. Use small, circular motions with the flat of your hand. Using your palm, massage the forehead from side to side, and gen- tly massage your temples using circular motions. Gently rub the outside of the ears. Mas- sage both the front and the back of the neck.

Use a second tablespoon of warm oil and massage both feet using the flat of the hand. Massage each toe with your fingertips. Vigorously massage the soles of your feet. Sit quietly for a few seconds to relax, and then shower or bathe as usual.

Full-Body Massage (5–10 minutes)

Massage the scalp, ears, and neck with 1 tablespoon of warm oil as already described. Using more oil, vigorously massage your arms using long strokes on the long parts,

and circular motions at the joints. Adding oil as necessary, massage the chest, stomach, and lower abdomen using

gentle circular strokes in a clockwise direction. Massage as much of your back and spine as you can reach.

Massage the legs as you did the arms using vigorous movements. With the remaining bit of oil, massage the feet as described earlier. Bathe with

warm water and mild soap.

Source: Chopra (1991) .

References

Agarwal, V., Abhijnhan, A., & Raviraj, P. (2007). Ayurvedic medicine for schizo- phrenia. Cochrane Database of System- atic Reviews , Oct. 17(4): CD006867.

C hopra, D. (1991). Perfect Health . New York, NY: Harmony Books.

Jayasundar, R. (2012). Healthcare the Ayurvedic way. Indian Journal of Medi- cal Ethics, 9(3): 177–179.

McIntyre, A. (2012). The Ayurveda Bible. Richmond Hill, Ontario, Canada: Fire- fly Books.

Murray, A. H. (2012). Ayurveda for Dum- mies. Hoboken, NJ: For Dummies, Wiley.

Pole, S. (2012). Ayurvedic Medicine: The Principles of Traditional Practice. London, UK: Singing Dragon.

Chapter 5 • Ayurvedic Medicine 89

Sharma, H., Chandola, H. M., Singh, G., & Basisht, G. (2007). Utilization of Ayurveda in health care: Part 2— Journal of Alternative and Complementary Medi- cine, 13(9): 1011–1019.

Shukla, S. D., Bhatnagar, M., & Khurana, S. (2012). Critical evaluation of Ayurvedic plants for stimulating intrinsic antioxidant response. Fron- tiers in Neuroscience. doi: 10.3389/ frins.2012.00112

Singh, B. B., Vinjamury, S. P., Der- Martirosian, C., Kubik, E., Mishra, L. C., Shepard, N. P., . . . Madhu, S. G. (2007). Ayurvedic and collateral herbal treatments for hyperlipidemia: A sys- tematic review of randomized con-

trolled trials and quasiexperimental designs. Alternative Therapies in Health and Medicine, 13(4): 22–28.

Sridharan, K., Mohan, R., Ramaratnam, S., & Panneerselvam, D. (2011). Ayurvedic treatments for diabetes mellitus. Cochrane Database of Systematic Reviews , Dec. 7(12): CD008288.

Sumantran, V. N., & Tillu, G. (2012). Can- cer, inflammation, and insights from Ayurveda. Evidence-Based Complemen- tary and Alternative Medicine. doi: 10.1155/2012/306346

WHO Drug Information. (2007). Journal of Alternative and Complementary Medi- cine , 21(2): 91.

Resources

Ayurvedic Herbs—Circle of Health P.O. Box 719 Ashland, OR 97520 541.944.7243 www.ayurveda-herbs.com

Ayurvedic Practitioners Association (UK) 23 Green Ridge Brighton BN1 SLT 01273.500.492

apa.com.uk www.ayurveda-germany.com/ lancaster/

National Ayurvedic Medical Association 620 Cabrillo Avenue Santa Cruz, CA 95065 800.669.8914 www.ayurveda-nama.org

90

6 Native American Healing and Curanderismo

Morning Prayer I thank You for another day. I ask that

You give me the strength to walk worthily this day so that when I lie down at night I

will not be ashamed.

Evening Prayer At the end of each day, face west and say:

Thank you for all the things that happened today, the good as well as

the bad.

Prayers by Bear Heart, Native American Shaman

When it comes time to die, be not like those whose hearts are filled with the fear of death, so when their time comes they weep and pray for a little more time to live their lives over again in a different

way. Sing your death song, and die like a hero going home.

Chief Aupumut, Mohican, 1725

Chapter 6 • Native American Healing and Curanderismo 91

There are more than 556 distinct Native American tribes. Although each Native American Indian–based healing system is unique, the systems share a number of characteristics. This chapter presents the commonali- ties found among tribes. The population of today’s Native American tribes is only a fraction of what it was before Europeans invaded North America, and many customs have been lost forever. Nevertheless, many of the traditions and ceremonies practiced by Native Americans for centuries are still in evi- dence today ( Grandbois & Sanders, 2012 ).

BACKGROUND

Non-Indian people can learn a great deal from the Native American approach to life and traditional healing. To learn, people must be open to the ancient wisdom and understand it in the context of the entire Native American expe- rience. It is not something to be trivialized by simply purchasing medicine objects and trying them out at home. As one Sioux leader said, “First they took our land, now they want our pipes . . . all the wannabees, these New Agers, come with their crystals and want to buy a medicine bag to carry them around in. If you want to learn our ways, come walk the red road with us, but be silent and listen” ( Johnson, 1994 , p. 6 ).

In their earliest encounters, European American physicians devalued the skills of Native healers. This association has, in a way, come full circle. Western medicine is now advancing toward a holistic point of view that Native Americans have been practicing for thousands of years. Today, medi- cine women and men practice in a system that parallels conventional medi- cine. Some of them are traditional, meaning they adhere strictly to the old ways of life and reject any form of biomedicine. Others have acculturated, or adapted to the mainstream culture, and use both Indian medicine and con- ventional medicine. A third group of Native Americans has become assimi- lated and has virtually abandoned all traditional ways in favor of the dominant culture and utilizes only biomedicine ( Shimer, 2004 ).

Most tribal people have one or more types of health care specialists whose treatments frequently overlap. Some Native healers use herbs, some heal with songs, and some practice spiritual rituals. A midwife or a medi- cine woman or man might focus on natural medicines such as herbs and hands-on techniques but also use prayer and ceremony. Shamans , or holy people, emphasize spiritual healing but are often also knowledgeable about natural medicines. Kahunas are people, usually of Hawaiian ancestry, who have developed a level of spirituality that joins them with many of the spirit powers, allowing direct communication about the healing process. Shamans and medicine people are seen as channels the Creator has provided and trained. Some are born into families with medical or ritual skills, while oth- ers discover this path through a dream or vision. Selection is based on signs of devotion, wisdom, humility, and honesty. Once called, the individual seeks training, usually by apprenticing to a medicine person for a number of years. All knowledge comes from the Creator, and the elders are charged

92 Unit 2 • Systematized Health Care Practices

with the responsibility of keeping knowledge about healing foods, herbs, and medicine and passing it on. Trusted with all secrets, rituals, and legends of their people, Native healers are considered to be inspired individuals with great importance to the tribe. Training is complete when the teacher says it is complete and when the candidate has practiced the skills publicly and with success ( Bad Hand, 2002 ). See Chapter 24 for more information about shamans.

CONCEPTS

Spirituality

Spirituality and medicine are inseparable in Native American tradition. Essentially no distinction is made between religious and medical practices. “Making medicine” is an important part of traditional life. It is how people give thanks to the Spirit who helps, guides, nourishes, and clothes them. Medicine is the constant pipeline to the Creator. In Indian tradition, making medicine is a process for achieving a variety of positive outcomes: a good hunt, plentiful crops, connecting with someone, healing someone, a success- ful birthing, and so on. Medicine is the way people keep their balance; it provides them with the opportunity to grow in new and healthier ways ( Barnes, 2012) .

Native Americans believe in a singular living God but also believe that same God may be contacted through many ways, from many cultures. In Native languages, God is given such names as Great Spirit, Creator, Great Being, Great Mystery, Above Being, The One Who Oversees All Things, and He Who Gives Life. Everything is considered a gift from the Creator, and using these gifts is one way to create an atmosphere conducive to addressing the Creator ( Bear Heart, 1996 ).

Gratitude

Gratitude is a central aspect of Native American culture. Every day is a spiri- tual, sacred day as demonstrated in Bear Heart’s prayer at the opening of this chapter. Native Americans give thanks to the Great Power who makes all things possible. They give thanks not only for the good events but also for the bad things that happen throughout the day, because they believe that the more they show their appreciation, the more blessings they will receive.

Native peoples do not own or possess land but rather see themselves as caretakers of the earth for the Great Spirit. The land is considered the Mother, since all things come from her body. Animals, birds, trees, and grass all come from Mother Earth and are powerful living beings, just like human beings. When Native people take something from the earth, such as herbs or even a stone, they always give an offering, usually tobacco, in return and say a prayer that the item taken will be used in a good manner ( Bear Heart, 1996 ; Mackinnon, 2012 ).

Chapter 6 • Native American Healing and Curanderismo 93

Healing

Medicine women and men see themselves as channels through which the Great Power helps others achieve well-being in mind, body, and spirit. The only healer is the One who created all things. Medicine people consider that they have certain knowledge to assemble items to help the sick person heal, and that knowledge has to be dispensed in a certain way, often through ritual or ceremony. Healers receive their knowledge through fasting and asking for guidance from above. During the period of fasting, the Great Being might reveal a chant or the location of a particular herb and give instructions on how to use it for different illnesses ( Bear Heart, 1996 ).

Time is often considered an ally in recovery because it allows fears and problems to fade. Love is a key element in the healing process. The healer enters into the healing relationship with love and compassion, and the two individuals experience a joining or merging as this process unfolds. This merger symbolizes the cementing together of people and the Divine Spirit ( Barnes, 2012 ).

Circle

The circle represents the cycles of life, which have no beginning, no end, and no time element. The Great Spirit causes everything to be round. The sun, earth, and moon are round. The sky is deep like a bowl. Things that grow from the ground like the stem of a plant or plant roots are round. The circle, symbol of infinity and interconnectedness, is seen in the sweat lodge, the bowl of the Sacred Pipe, the Sacred Hoop, and the Medicine Wheel. In addition, the camp is circular, tepees are circular, and people sit in a circle in all ceremonies. When people come together in a circle, a spirit of oneness and a sense of sacredness come upon them.

Medicine Wheel

The Medicine Wheel is both an important conceptual scheme and a major ceremonial observance. The Sacred Hoop makes up the circumference, and the interior of the circle is divided into four quadrants. Each quadrant repre- sents a direction, a totem, an element, a color, a kingdom, a quality, a season, and a gateway to the individual. The four colors—white, black, yellow, and red—represent the races of humanity. See Figure 6.1 for an illustration of the Medicine Wheel.

The four directions of the Medicine Wheel are the basis for the astrologi- cal system. Each person is represented somewhere within that circle, depend- ing on birth date. Table 6.1 gives a brief summary of the Twelve Moons.

The Number 4

The number 4 is significant to Native American people and is incorporated into their daily lives through prayers, ceremonies, and activities. It is believed

94 Unit 2 • Systematized Health Care Practices

to be the number of completeness. Everything that grows from the earth con- sists of four parts: roots, stems, leaves, and fruit. Earth, air, fire, and water are the four life-giving elements. Four types of things take breath: those that crawl, those that fly, those that walk on four legs, and those that walk on two legs. There are four directions, four seasons, and four races of people—white, black, yellow, and red.

VIEW OF HEALTH AND ILLNESS

Health is viewed as a balance or harmony of mind and body. The goal is to be in harmony with all things, which means first being in harmony with oneself. Harmony is thought to neutralize problems and help one’s life become beauti- ful. Good health makes it easier for all people to do their part in the universe, to serve others, and to fulfill their personal life visions.

Life is considered in all its dualities: winter/summer, cold/hot, day/ night, mind/body, spiritual/physical, work/play, and so on. Native people

NORTH

totem—buffalo element—air color—white kingdom—animal quality—knowledge/wisdom season—winter gateway—to mind

SOUTH

totem—mouse element—water color—red kingdom—plant quality—trust, innocence season—summer gateway—to emotions

EAST

totem—eagle element—fire color—yellow kingdom—human quality—illumination, enlightenment season—spring gateway—to spirit

WEST

totem—grizzly bear element—earth color—black kingdom—mineral quality—introspection, intuition, change season—autumn gateway—to body

FIGURE 6.1 The Medicine Wheel

Sources: Hill (2006) ; www.medicinewheel.com ; Rutherford (2008) .

Chapter 6 • Native American Healing and Curanderismo 95

TABLE 6.1 Twelve Moons

Birth Date/Power Animal Characteristics

North December 22–January 19 Snow goose

Snow geese represent the chief at the top of the medicine wheel and have the potential for great power. People in this position have great vision and can send messages over long dis- tances. Often, just thinking of someone will be enough to get the person to call him or her.

January 20–February 18 Otter

People in this moon are as playful as the otter. Otter people like others as well as them- selves and are humanitarian in their views. They excel in communication, intellect, and romance. They may have psychic abilities.

February 19–March 20 Cougar

Others come to cougar people for advice, because they have a natural medicine power and psychic ability. They are deeply sensitive, hesitate to express their true feel- ings, and yearn for spirituality.

East March 21–April 19 Red-tailed hawk

Red-tailed hawk people look at the world with a sense of wonder. They are open to learn- ing new things, enjoy life and adventure, and are passionate about everything they do. Because they are fearless, they may act without thinking.

April 20–May 20 Beaver

Beaver people value hard work and focus on getting the job done. The results of their work can have great impact on people far away. They strive to create and maintain an orderly and beautiful environment.

May 21–June 20 Deer

Deer people often have many ideas and try to accomplish them all. They may have two or three jobs at a time. They have graceful, quick movements. Deer people appreciate the beauty in themselves, others, and the environment.

South June 21–July 22 Flicker (large woodpecker)

People in this position are intuitive and wild in some aspects of being but conservative in oth- ers. They have an ability to both heal and inspire. Flicker people have an excellent sense of humor and a strong desire for self-expression.

July 23–August 22 Sturgeon

Sturgeon people come into the world as teach- ers, with strong leadership abilities. They are always reading and studying to search for the truth. They have an outer shell that protects their inner sweetness from other people.

(continued)

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believe that the two sides of everything deserve equal attention and that both should be nourished with love. A healthy person who is walking in balance is energized and alert, and in the presence of disease will still feel alive and ful- filled ( Sue & Sue, 2012 ).

Traditionally, Native American people lived long, happy, healthy, and balanced lives. They did everything to respect and honor Mother Earth and the Great Spirit. They ate wholesome food and considered all food to be blessed as a gift of life from the Creator. They got up with the sun and went to bed with the moon. Exercise was a natural part of their lives, integrated into daily activ- ities. These good health habits, a sense of joy, and a purpose in life are key fac- tors for living into old age ( Sun Bear, Mulligan, Nuffer, & Wabun, 1989 ).

Illness occurs when balance is disrupted. It is believed that most illness begins in the head, and people must get rid of ideas that predispose them to illness. If the mind is negative, the body will be drained, making it more vul- nerable. Disease is also thought to be caused by “soul loss”—when individu- als stop being generous and become selfish and dishonest. When people open up to the universe, learn what is good for them, and find ways to be happier, they can begin to work toward a longer and healthier life. Many ancient peoples had ways to get rid of this negativity. The Mayan people of Mexico would stand in a stream of flowing water and talk out all their angers,

Birth Date/Power Animal Characteristics

August 23–September 22 Brown bear

Brown bear people have a natural creative curiosity. Their gut feelings tend to be very accurate as long as they don’t overanalyze. They have good sense and make fair deci- sions. They are confident and well balanced.

West September 23–October 23 Raven

Like ravens who fly together, these people tend to stay with the flock. If they can separate and follow their own convictions, they can be great leaders. They understand messages from the heart and are physically affectionate.

October 24–November 21 Snake

Snake people are powerful healers who are able to travel places where others may fear to go. They are often messengers for the spiritual aspects of life. They are inquisitive and able to create change.

November 22—December 21 Elk

Elk people are insightful, independent, determined, and open hearted. They are passionate about justice. They have an abil- ity to perceive the thoughts and feelings of others and may be clairvoyant.

Source: Adapted from Brother Eagle Soaring (2003) .

TABLE 6.1 (Continued)

Chapter 6 • Native American Healing and Curanderismo 97

fears, sorrows, or troubles over the water. The moving water would take all the emotions they poured out of themselves into the current and away from them. The Bear Dance was a way the Indian people of Northern California rid themselves of negativity. A man in a bear costume would dance around a circle of people who would use switches to hit him as they spoke about the things in their lives that were bothering them. When the bear had acquired everyone’s negativities, he went down into a stream, washing them away. Some Native people of the Southwest had dancers armed with swords who went through the village singing, chanting, and rattling, driving out the neg- ative forces as they went. Behind the dancers came people with brooms to sweep away anything that was left over. Most Indian tribes had some way of letting people get rid of negativity so that they could go on and build new positive patterns ( Garrett, 2003 ).

Dreaming is a powerful way for people to learn what is good for them. Dreams are a personal connection to the upper, spiritual realms. Divine guid- ance is thought to come through dreams and visions. In a period of illness, people may actually dream the healing. Dreaming is important in the healing practices of medicine women and men, because treatment information is often provided through dreams. Dream weavers, dream catchers, or dream nets are special medicine objects that allow the good dreams to reach the person through the hole in the center and catch the bad dreams to keep those away from the person.

DIAGNOSTIC METHODS

Healers must diagnose the source of the problem because they want to treat the cause, not just the effect. Much as in Traditional Chinese Medicine and Ayurveda, the diagnostic method takes into account all aspects of one’s inner self, lifestyle, emotions, social setting, and natural surroundings. Heal- ers always consider the total person, whether treating someone for physical illness or emotional problems. They look at the overall picture, determine what is out of balance within the whole, and then pinpoint the trouble spots. Some healers diagnose by going into a trance. While in a trance “hand trem- blers” pass their shaking hands over the body of the person; when the hands stop trembling, the locale of the illness is found, and the cause is usually identified. “Star gazers” also enter trance states to read cause in the stars. “Listeners” do not go into a trance but listen to the person’s story and on that basis identify the cause of the illness ( Struthers, Eschiti, & Patchell, 2004 ; Barnes, 2012 ).

TREATMENT

When people fall ill, they often experience anxiety and fear, which may inca- pacitate them. The healer is not so burdened and is able to supply coherence, calmness, and hope. Power flows through the healer to the patient. Patients’ preferences are always respected in determining their own path toward balance

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and healing. Healers use medicine objects to assist them, and treatments consist of ceremony, touch, herbs, singing, drumming, and sometimes peyote.

Items used to help make medicine are called medicine objects. Medicine objects can be anything that relates to the Great Spirit in a sacred way. The medicine bag contains healing objects, which vary in size and number but typically are such things as feathers, claws, bird or animal bones, an assort- ment of herbs or roots, smudges, or paints. The medicine bag may also con- tain personal items that represent the individual and personal experiences that are sacred to him or to her. Native Americans are protective of their med- icine bags because they carry a part of themselves and are among their most prized companions. The Medicine Wheel is a sacred circle usually built from stones. It is entered for the purpose of healing, giving thanks, praying, or meditating. The Pipe is one of the most sacred medicine objects and is an instrument of prayer.

The Indian art of healing is ceremonial or ritual in nature. Different cere- monies are conducted according to the type of illness or the severity of the person’s condition. Healing ceremonies are led by medicine people or holy people. There is a communal aspect of the ceremony—as many people as pos- sible participate to increase the power of the prayers. The primary purpose is to allow connection with the Great Healer, since physical health often fails without the aid of spiritual means. A secondary benefit is a cleansing of the body, mind, and spirit. A healing session is never a casual encounter. It is arranged through a formalized procedure after discussion by the patient, family, advisers, and healer. Acceptance by the healer is followed by instruc- tions on preliminary actions, which may include fasting, abstinences, prayers, or the preparation of offerings or feasts.

Smudging

Smudging is a cleansing and purifying process using smoke from burning sacred herbs, usually sweet grass, sage, cedar, or tobacco. Sweet grass is used to bless one’s self and one’s home to protect from evil spirits. It is also used to purify sacred prayer instruments. Sage has a variety of uses. It is used in the blessing of one’s home, it is part of the mixture used in the sacred smoking of the Pipe, and it is used in tea to flush out impurities. Cedar is considered the “tree of life” because it withstands the four elements no matter how harsh the seasons. Cedar is used in all sacred ceremonies as well as for its medicinal qualities. Tobacco is considered a gift from the Creator, and its smoke is a visual representation of people’s thoughts and prayers being carried to the Creator. People and all sacred objects are smudged so all can be centered and focused on the healing process. The smoke clears negativity, purifies the energy field of people and places, and is a prayer to the Creator. In addition to its use in healing ceremonies, smudging is used in the morning or evening as part of daily devotion. Smudging is a practice known to many religions; examples include the use of frankincense in Catholic churches and sticks of incense in Buddhist temples ( Barnes, 2012 ; Ewing, 2012 ).

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Sweat Lodge

The sweat lodge or purification ceremony is a ritual to cleanse body, mind, heart, and spirit. It may be held as its own ceremony or in preparation for another ceremony, such as a vision quest. Typically, the sweat lodge is held in a round structure covered with overlapped pieces of tarpaulin or blankets with a small door flap. When the flap is down, the place is nearly dark and almost sealed off from the outer air. Near the lodge is a fire pit, where rocks are heated and then passed into the lodge. Water from a bucket is splashed onto the stones, which creates a dense steam referred to as the Breath of Spirit. Depending on the illness, a variety of herbs are burned on the sweat rocks. Sacred songs and prayers go on for several hours. Everyone in the sweat lodge prays earnestly for the one needing healing, but it is the responsibility of the one being healed to pray that healing energies come to her or to him and to ask the Spirit to give guidance to the medicine person ( Sue & Sue, 2012 ).

The sweat lodge is also a powerful ceremony to keep people healthy, and many view it as the first line of defense in preventing illness. The sweat lodge raises the body’s temperature well above normal, killing heat-sensitive viruses and bacteria. The lodge is also a bringing together of the four elements: earth, air, fire, and water. Through sweating and praying, the body is cleansed of toxins, the mind of negativities, the heart of hatred, and the spirit of doubt. The sweat lodge is as sacred a place as a church or a temple ( Barnes, 2012 ).

Drumming and Chanting

Drumming and chanting are powerful ways to bring oneself in balance with self, others, and the world. Drumming harmonizes people with the heartbeat of Mother Earth. It is a pulse rather than a tempo. As people dance to the pulse of the drum, they dance in harmony with the Creator and with one another. Symbolically, the drum represents all life. The wood was once a tree, and the skin covering the drum was once life. These objects are related to life that has gone on, yet they are helping present lives. Chanting is a form of prayer through music. Holyway chants are used to attract good, to cure, and to repair; ghostway chants are used to remove evil; and lifeway chants are used to treat injuries and accidents ( Drake, 2012 ; Mackinnon, 2012 ).

Sing

A sing is a healing ceremony that lasts from 2 to 9 days and nights. A highly skilled specialist called a singer guides it. Used in healing, sings are attended by as many people in the community as are able to come because just being pres- ent is considered healing. Some songs are only for children and call on spirits who take care of little children. Some spiritual songs take care of adults only. Other songs focus on specific problems, such as the song for small burns that will cool them and keep them from blistering. To learn a single chant can take up to several years. It takes some people 40 years of singing before they master the chants and the accompanying herbal preparations ( Rutherford, 2008 ).

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Pipe Ceremony

The Pipe ceremony takes many different forms depending on how this sacred knowledge was given to the various tribes. The Pipe is one of the most sacred medicine objects and represents the universe to Native American people. The bowl represents the Earth Mother and the female powers of the universe. The stem represents the plant kingdom and the male powers of the universe. When the bowl and stem are joined together, the Pipe is sacred. The tobacco smoked in the Pipe is an instrument of prayer and has come to signify the sacredness of the ritual. As the smoke of the Pipe rises, it creates an atmosphere of prayer by symbolizing prayers going up to the Creator ( Barnes, 2012 ).

Pipes are used for private and group prayers. Prayers are transmitted in the smoke of the burning tobacco. Participants in the Pipe ceremony are as centered and focused as possible, since everything they think and feel is part of the prayers being offered. As in many other ceremonies, the number 4 has special significance. The Pipe is offered to the four directions and is often passed in four ritual repetitions ( Bad Hand, 2002 ).

Sun Dance

The sun dance includes the sweat lodge, the Pipe ceremony, monthly prayer rituals, and a yearly ceremony. During the monthly ceremony, songs are sung to carry the prayers upward, and people come forth to be healed. The yearly 3- to 4-day sun dance usually takes place in July. It is a very detailed and com- plex ceremony. The medicine person prays on behalf of the tribe, the world, and all creation. The dancers, who spend all their time praying to the Creator, move to the drumbeat around a center pole. Because the dancers fast for the entire time, many collapse or “take a fall.” This fall is often followed by a vision, similar to what happens on a vision quest. The sun dance ends with a purification ceremony so that tribe members can reenter the world refreshed and regenerated ( Walsh, 2007 ).

Vision Quest

An extremely powerful ceremony is the vision quest. Traditionally, it is a time of fasting, praying, isolation, and exposure to the elements, all of which contribute to a mystic experience with the goal of understanding self and communicating with the Great Spirit. Individuals ask themselves questions such as How can I best serve the people? How can I best serve Mother Earth? How can I best serve future generations? It is hoped that during the vision quest people find out who they are, what they are supposed to do, and what their life’s goal should be, as well as discover the purpose and meaning of their lives. The vision quest begins with a sweat lodge for purification, after which the person is taken to an isolated place in nature and begins the period of silence and fasting. During the vision quest, the individual focuses only on prayer and vision and in this way is pushed into the spirit world. After the vision quest, the person returns to the sweat lodge, and a Pipe ceremony is performed ( Mackinnon, 2012 ).

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Healing Touch/Acupressure

Native Americans have always considered touch to be therapeutic. The Cre- ator touches patients and transfers power to them through medicine people or shamans who are healing instruments. Touching, an expression of loving care, is essential for the healing process. It cleanses the affected area and relieves pain. The willingness to touch on the part of the healer demonstrates a lack of fear of contamination. Healing touch is a powerful way to remove barriers and create or restore relationships ( Shimer, 2004 ).

Some tribes have used a form of acupressure since ancient times. Com- pared with traditional Chinese practitioners, Native Americans use fewer pressure points, but the process is similar. Prior to using acupressure, medi- cine people warm their hands over a fire so that the Great Being can send healing warmth through them to the patient. It is believed that no harm will be done to a person as long as the pressure is applied slowly and in a relaxed way. Medicine people are taught that acupressure should be performed only with the utmost gentleness and love.

Herbs

Native Americans have long used herbs in maintaining health and treating disease. Botanical remedies are supplemented with ceremony and prayer dur- ing the healing process. The beneficial properties of herbs as medicines often depend on the greenness or ripeness of the plant and the part of the plant to be used, such as roots, barks, twigs, bulbs, rhizomes, fruit seed, tubers, leaves, and flowers. Knowing the best time for cutting and digging each type of plant, for peak effectiveness, is part of the knowledge of the Native healer. Whether it be in summer, winter, spring, or autumn, the timing must be appropriate for each plant. An herb gathered with prayers, cut or dug at the correct time, and prepared properly, will restore a person from illness to health ( Barnes, 2012 ).

Ancient Native people considered nature to be their pharmacy. They did not have aspirin, but they did have willow bark, which contains salicylic acid. The active ingredient in foxglove is digitalis, which was used in a tea to help people with heart problems. Particular molds, similar to those forming the basis of penicillin, were used to treat infections. Purple coneflower (echinacea) is an immune system booster and antibiotic that is held in high esteem by many people today. Goldenseal, which is a good disinfectant that promotes scab formation, is one of the most important Native American medicinal plants. Currently, it is also used as a gargle for sore throat or as a mouth rinse for canker sores, tonsillitis, and infected gums ( Barnes, 2012 ). For further information on herbs, see Chapter 7 .

Peyote

A hallucinogenic herb, peyote has been used by the Indians of North America for a long time. Native people do not use peyote to “get high” but rather to see teaching visions. Using peyote is a sacrament, and it provides a connection to

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the sacred world. Peyote makes people highly sensitive to sight and sound and more aware of what is around and inside them. It is used to heal all kinds of sickness, for clairvoyance, and in the worship of the Great Being. It is believed that the Creator put peyote on earth as a medicine to help people ( Bad Hand, 2002 ; Bear Heart, 1996 ).

Role of Medicine Women and Men

Although they are the primary care providers in many places, the responsi- bilities of medicine women and men go beyond healing illness. They also evaluate advice and treatment given by other health care practitioners. Medi- cine men and women often have a strong influence on the acceptance or rejection of the treatment plans from conventional health care providers. They may also function as tribal social mediators, dispensing traditional wis- dom and suggesting action. Medicine people reaffirm and strengthen tribal identity through the recounting of myth and song. They have an extensive knowledge of their communities and of family relationships and interaction. They are the formulators and teachers of the old religion and creators of the new. Medicine people are figures of authority and awe as instruments of the Creator ( Gonzales, 2012 ).

Navigator Programs

The goal of patient navigator programs is to improve outcomes for indige- nous people with cancer. The Native Sisters Program encourages the use of screening programs for breast cancer prevention and identification. The Walk- ing Forward Program seeks to remove treatment barriers and decrease mor- tality rates. Both programs are grounded in the traditions and knowledge of Native American populations ( Whop et al., 2012 ).

RESEARCH

Formal research into healing ceremonies is almost nonexistent. Native American medicine is a tradition that is subtle and difficult to document and communicate fully outside of its varied traditions and ceremonies. Anecdot- ally, many ailments and diseases—ranging from skin rashes and asthma to heart disease, diabetes, and cancer—have reportedly been cured by medicine people and shamans. A few studies, such as the following, are beginning to be reported in the scientific literature:

• A review of randomized and nonrandomized trials aimed at preventing the use of tobacco in Indigenous youth found only two studies that met the criteria for inclusion. Conclusions cannot currently be drawn on the efficacy of tobacco use prevention in this population ( Carson et al., 2012 ).

• Jewelweed has been used by Native American tribes to counteract the effects of poison ivy dermatitis. Jewelweed extracts were not effective, but jewelweed mash was effective. Soap made with jewelweed was not

Chapter 6 • Native American Healing and Curanderismo 103

more effective than non-jewelweed soap ( Abrams Motz, Bowers, Mull Young, & Kinder, 2012 ).

• A study of adolescents from the First Nations communities in Manitoba found the following variables to be correlated with an increased risk for suicide: being female, being depressed, being abused or having a fear of being abused, substance use, and a hospital stay ( Mota et al., 2012 ).

• The Creek Indians have used the Native American Method (NAM) for pain relief. A randomized, blinded study involved women with dysmenorrhea. The NAM healers moved their hands over the affected part of the body for 4 to 5 minutes. Each participant rated her intensity of pain before and after the intervention—either real or a simulation. NAM produced a significant decrease in the pain level compared with no change for the control (simulation) group ( Westerlund, González Medina, Pérez González, 2012 ).

CURANDERISMO

Curanderismo (pronounced “koo-rahn-dare-EES-mo”), from the Spanish verb curar , “to heal,” is a cultural healing tradition found in Latin America and among many Hispanic Americans in the United States. In Mexico, many beliefs are shared with Native American cultural traditions. Curanderismo, as described here, is most characteristically practiced by Mexican Americans. Although it is a traditional healing system, curanderismo survives by grow- ing, changing, and incorporating Western biomedical beliefs, treatments, and practices. It is also believed, however, that in certain types of illness and heal- ing, Native healers are more accomplished than practitioners of conventional medicine. Some professional nurses are also Native healers. They combine their knowledge of nursing science with the long tradition of curanderismo ( Gonzales, 2012 ).

Natural and Supernatural Illnesses

Illnesses are classified into two types: natural and supernatural. The natural source of illness includes genetic disorders, dysfunction of the body, improper self-care, infection, and psychological conditions. Supernaturally induced ill- nesses are said to be caused either by evil spirits or by a person practicing magic and placing a hex on the victim. Supernatural illnesses, which may resemble natural illness, occur when these negative forces damage a person’s health. It is believed that conventional medical practitioners are unable to intervene with supernatural illnesses ( Burns, 2012 ).

Healers

Curanderos (men) and curanderas (women) believe that they work by virtue of el don, a gift of healing, often believed to be a gift from God. In some areas, becoming a healer is a matter of inheritance; in other areas it is a matter of

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being called. Healers routinely deal with physical ailments as well as with problems of a social, psychological, or spiritual nature. Healers are always one of the people. Their healing awareness comes from living with the people, feeling their pain, knowing their illnesses, and experiencing their suffering ( Sobralske, 2006 ).

Three Levels of Healing

Three levels of care are practiced among curanderos and curanderas, namely, the material level, the spiritual level, and the mental level. Healers have the gift for working at only one of these levels because each requires distinct areas of knowledge, methods of diagnosis, and types of healing. The majority of the healers work at the material level, and most combine shamanic healing, herbal medicine, and first-aid techniques ( Burns, 2012 ).

The material level involves the use of physical or supernatural objects to heal or to change the person’s environment. Physical healers include mid- wives, bone setters, herbalists, and people who treat sprains and tense mus- cles. Objects and rituals are used for their curative powers. Objects include herbs, religious symbols (crucifix, pictures of saints, incense, holy water), and secular items (cards and ribbons). Several types of rituals are used for super- natural cures. One of the most frequently used is a cleansing ritual that includes prayers and invocations designed to remove the negative forces that are causing the illness, and a purification of the environment with incense. At the same time, the patient is given the spiritual strength necessary to achieve recovery.

The spiritual level of healing is similar to shamanic healing rituals. It is believed that spiritual beings who exist in another dimension are inter- ested in making contact with the physical world. These spirit entities come from once-living humans. Spiritual-level healers become a direct link or medium with these spirits. They enter a trance state and make contact with the spirit world. Some spirits have left tasks undone in their physical lives; some wish to help or harm others; and some wish to communicate with their friends and relatives. Healers believe that spirits can manipulate a person’s health by directing positive or negative forces at them from the spiritual realm.

The mental level is the least encountered level of practice. Healers have the ability to transmit, channel, and focus mental vibrations in a way that directly affects a person’s mental or physical condition. If healers are work- ing with physical illness, such as cancer, they channel vibrations to the afflicted area to retard the growth of abnormal cells and accelerate the growth of healthy cells. If healers are working with mental conditions, they send vibrations into the person’s mind to manipulate energies and modify behav- ior. Mental healing can be accomplished in person or over long distances ( Gonzales, 2012 ).

Most research done on curanderismo is traditional anthropological research such as participant observation and interviewing. Many of the home

Chapter 6 • Native American Healing and Curanderismo 105

remedies have been tested for biochemical and therapeutic activities and have demonstrated therapeutic actions that match the healers’ uses. Research regarding herbs is presented in Chapter 7 .

INTEGRATED NURSING PRACTICE

Just as Native American healers see themselves as channels through which the Great Power helps others achieve a sense of wellness, some nurses see God or the Divine Being at work in their professional practice. Although cli- ents may be unaware of this spiritual impetus, these nurses believe that the spiritual dimension provides the energy and momentum for their practice. Other nurses believe that their desire to care for others is what provides direc- tion for their practice. The art of nursing , for many, is in being there, with another person or persons, in a context of caring. As nurses return to their nursing roots in using their hands, heart, and head in creating healing envi- ronments, they approach the Native American ideal of healing practices.

Like Native Americans, nurses have traditionally looked at the total per- son in their care. The context of people’s lives is critically important to the nursing-healing model. In addition, nurses also believe that feelings or energy or caring flows from nurses to clients. People in distress or who are ill are anx- ious and fearful. Nurses who are centered and balanced can share their sense of calmness in the face of crisis. Before entering a client’s home or room, take a moment to center with a couple of deep, cleansing breaths and focus on what you are about to do with this person who is your client.

When you are with the client, touch may be an appropriate intervention. For some people who are suffering or in crisis, a touch on the arm or holding his or her hand may be the most effective nursing intervention you will pro- vide. It is important to remember that touch must always be appropriate and acceptable to the client.

Just as Native American tribes have rituals for cleansing the mind of negative thoughts and feelings that predispose to disease, nurses can help cli- ents modify unhealthy thinking patterns. Negative thinking not only occurs in the brain but also in the body; negative thoughts cause instantaneous chemi- cal changes in every cell. Continuous cellular disruption may contribute to the onset of illness and disease. To counteract negative thinking, some people find it helpful to look at themselves in the mirror and say aloud three good things about themselves. People might say, “I’m a good friend,” “I’m an hon- est person,” “I’m a caring person,” “My hair looks beautiful today,” “I am becoming healthier every day,” and so on. The goal is to say different positive qualities about themselves each day. Keeping a journal about feelings imme- diately after the exercise and feelings throughout the day is helpful in evaluat- ing the impact of positive statements on negative thinking.

Positive affirmations are another way to counteract negative thinking. In this nursing intervention you encourage people to make a list of positive things in their lives or things they would like to have happen. Affirmations

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are always stated as if they were a fact, even when they are still a dream. For example, an ill client might be thinking, “I’m never going to get better. I’m always going to be miserable.” You might suggest that he or she verbalize affirmations such as “I’m feeling better every day. My body is continuing to heal.” Encourage clients to write a list of affirmations over several days and repeat them several times a day. Because people tend to live their lives accord- ing to their expectations, changing expectations from negative to positive can improve the level of wellness.

Although it might not be reasonable to find a stream of flowing water to take away angers, fears, sorrows, or troubles, you can teach people to visualize that process. Direct clients through the relaxation process and have them mentally walk into a stream or actually stand in a shower that is com- fortable in temperature and force of the flow. As they stand in the stream, have them visualize the water washing out all their physical, mental, emo- tional, or relational problems. Similar to the Indian art of healing, this nurs- ing intervention may be beneficial for clients who feel weighted down with their problems or sorrows.

Gratitude is important in Native American culture. As a nurse, you can help others become more grateful for their life experiences. Many people find it extremely beneficial to keep a gratitude journal. At the close of every day, they write at least three things that happened during the day for which they are thankful. They may be thankful for a beautiful sunrise, a smile from a stranger, a hug from a child, an A on an exam, a wonderful dinner, an inti- mate moment with a partner, and so on. Focusing on gratitude is another way to become more in harmony with oneself and is thought to neutralize prob- lems and negative thinking.

A number of substance abuse programs, both Native American and non–Native American, have added drumming groups to their programs. In addition, drumming is being studied in the treatment of soldiers with post- traumatic stress disorder. Drumming enhances hypnotic susceptibility, increases relaxation, improves meditation, and synchronizes brain wave pat- terns. It facilitates an outlet for rage and a way to regain self-control. Drum- ming groups may also enhance recovery by encouraging social support and social networks. As a nurse, you can encourage the study and practice of drumming groups in these types of programs ( Dickerson, Robichaud, Teruya, Nagaran, & Hser, 2012 ).

Most people have objects that are significant to them. Although these objects are not medicine objects in the Native American tradition, they may engender a sense of comfort and perhaps protection. Encourage and support clients to have religious symbols or holy books around them if those items are important to them. Secular items can also be of great comfort, such as pictures of family and friends, get-well cards, poems, and beloved books. Most nurses do not have sweat lodges or sings as part of their healing practices, but many clients have a community of family or friends who may be sending their love and concern or praying for their healing. Actively support those activities that pro- vide love and hope to counteract the fears and doubts that accompany illness.

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Like Native Americans, nurse psychotherapists find the circle to be a beneficial design. Group therapy typically occurs with all the participants sit- ting in a circle, which contributes to the group’s sense of oneness and connect- edness. Circle arrangements foster cooperation rather than competition. It is often helpful to use a circle arrangement for nursing team conferences or interdisciplinary clinical conferences.

Integrated Nursing Practices Related to Herbs are Covered in Chapter 7 , those related to acupressure in Chapter 13 , and those related to dreams in Chapter 19 .

TRY THIS

Positive Thoughts

Often, individuals endure such runs of negative thoughts that they are unaware of the process until they have been “beating themselves up” for 10 to 15 minutes. To become more aware of this habitual process, tap one of your left fingers on a firm surface for every negative thought. When your finger becomes quite sore, you will have another level of awareness of your negativity. Negative thoughts can be countered with positive ones. When you catch yourself thinking and feeling a negative thought, such as how fat your body is or how dumb you are, STOP. Then, look for and substitute a positive thought or feeling in the place of the one you removed, such as how lovely your hair looks or how well you have succeeded at something. Listen to yourself saying the positive phrase out loud. Continue in this way, adding other phrases and wishes for yourself.

References

Abrams Motz, V., Bowers, C. P., Mull Young, L., & Kinder, D. H. (2012). The effectiveness of jewelweed, Impatiens capensis, the related cultivar I. balsamina, and the component lawsone in prevent- ing post poison ivy exposure contact dermatitis. Journal of Ethnopharmacology, 143(1): 314–318.

Bad Hand, H. P. (2002). Native American Healing . Chicago, IL: Keats.

Barnes, O. (2012). The Power of Native American Healing. Charleston, SC: CreateSpace.

Bear Heart. (1996). The Wind Is My Mother . New York, NY: Berkeley Books.

Brother Eagle Soaring. (2003). Retrieved from www.spiritalk.net/naheali4.htm

Burns, C. R. (2012). Health and medicine. Handbook of Texas Online. Texas State Historical Association. Retrieved from http://www.tshaonline.org/hand- book/online/articles/smhzcC

Carson, K. V., Brinn, M. P., Labiszewski, M. A., Peters, M., Chang, A. B., Veale, A., . . . Smith, B. J. (2012). Interventions for tobacco use prevention in indigenous youth. Cochrane Database of Systematic Reviews, Aug. 18 (8): CD009325.

Dickerson, D., Robichaud, F., Teruya, C., Nagaran, K., & Hser, Y. L. (2012). Utilizing

108 Unit 2 • Systematized Health Care Practices

drumming for American Indians/Alaska Natives with substance use disorders. American Journal of Drug and Alcohol Abuse, 38(5): 505–510.

Drake, M. (2012). Shamanic Drumming. Salem, OR: Talking Drum.

Ewing, J. P. (2012). Finding Sanctuary in Nature. Forres, UK: Findhorn Press.

Garrett, J. T. (2003). The Cherokee Herbal . Rochester, VT: Bear.

Gonzales, P. (2012). Red Medicine: Tradi- tional Indigenous Rites of Birthing and Healing. Tucson, AZ: University of Arizona Press.

Grandbois, D. M., & Sanders, G. F. (2012). Resilience and stereotyping: The experi- ences of Native American elders. Jour- nal of Transcultural Nursing. doi: 10.1177/1043659612451614

Johnson, S. (1994). The Book of Elders . San Francisco, CA: HarperSanFrancisco.

Mackinnon, C. (2012). Shamanism and Spir- ituality in Therapeutic Practice. London, UK: Singing Dragon.

Mota, N. M., Elias, B., Tefft, B., Medved, M., Munro, G., & Sareen, J. (2012). Cor- relates of suicidality: Investigation of a representative sample of Manitoba First Nations adolescents. American Journal of Public Health, 102(7): 1353–1361.

Rutherford, L. (2008). The View Through the Medicine Wheel: Shamanic Maps of How the Universe Works . Ropley, Hants, UK: John Hunt.

Shimer, P. (2004). Healing Secrets of the Native Americans . New York, NY: Black Dog & Leventhal.

Sobralske, M. (2006). Machismo sustains health and illness beliefs of Mexican American men. Journal of the American Academy of Nurse Practitioners , 18: 348–350.

Struthers, R., Eschiti, V. S., & Patchell, B. (2004). Traditional indigenous healing: Part 1. Complementary Therapies in Nursing & Midwifery , 10: 141–149.

Sue, D. W., & Sue, D. (2012). Counseling the Culturally Diverse: Theory and Prac- tice . Hoboken, NY: Wiley.

Sun Bear, Mulligan, C., Nufer, P., & Wabun. (1989). Walk in Balance . New York, NY: Simon & Schuster.

Walsh, R. (2007). The World of Shamanism . Woodbury, MN: Llewellyn.

Weatherup, K. (2006). Practical Shaman- ism: A Guide for Walking in Both Worlds . San Diego, CA: Hands Over Heart.

Westerlund, S., González Medina, M. E., & Pérez González, O. (2012). Effect of human electromagnetic fields in relief of minor pain by using a Native American method. Integrative Medicine, 11(1): 39–44.

Whop, L. J., Valery, P. C., Beesley, V. L., Moore, S. P., Lokuge, K., Jacka, C., & Garvey, G. (2012). Navigating the cancer journey: A review of patient navigator programs for Indigenous cancer patients. Asia-Pacific Journal of Clinical Oncology. doi: 10.1111/j.1743- 75632012.01532.x

Resources

Association of American Indian Physicians

1225 Sovereign Row, Suite 103

Oklahoma City, OK 73108

405.946.7072

www.aaip.org

Dance of the Deer Foundation, Center for Shamanic Studies

P.O. Box 699

Soquel, CA 95073

831.475.9560

www.shamanism.com

Chapter 6 • Native American Healing and Curanderismo 109

Feathered Pipe Ranch Foundation

P.O. Box 1682

Helena, MT 59624

406.442.8196

www.featheredpipe.com

National Alaska Native American Indian Nurses Association

www.nanaina.com

National Association of Indian Nurses of America

P.O. Box 190

Elmsford, NY 10523

www.nainanusa.com

The School of Lost Borders

P.O. Box 796

Big Pine, CA 93513

530.305.4414

www.schooloflostborders.com

Singing with the Wheel (compact disc)

West Winds

P.O. Box 16729

Mobile, AL 36616

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Botanical Healing

The Lord hath created medicines out of the earth; and he that is wise will not abhor them.

Ecclesiasticus 38:4

Let your food be your medicine and your medicine your food.

Hippocrates

3 U N I T

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7 Herbs and Nutritional Supplements

Physicians pour drugs, about which they know little, to cure diseases, about which they know less, into humans, about whom

they know nothing.

Voltaire

The Great Spirit is our father, but the earth is our mother. She nourishes us; that which we put into the ground, she

returns to us, and healing plants she gives us likewise.

Big Thunder

Also known as botanical medicine or phytotherapy ( phyto means “plant”), herbal medicine is used by 80% of the world’s population. Herbs are also the most popular com- plementary and alternative (CAM) therapy in the United States, with more than 750 herbs now on the market. According to the National Center for Complementary and Alternative Medicine (NCCAM), Americans spend more than $14.8 billion a year on herbal remedies and dietary supplements. For many conditions, herbs are the treatment of choice because they are milder and have fewer side effects than prescription drugs ( Bardia, Nisly, Zimmerman, Gryzlak, & Wallace, 2007 ). Vitamins, minerals, diet

113

114 Unit 3 • Botanical Healing

supplements, and specialized diets are beyond the scope of this text. Entire books are devoted to each of those topics, to which the reader is referred.

BACKGROUND

Throughout history, almost all societies have used plants for therapeutic pur- poses. For example, the oldest surviving garlic prescription, carved into a clay tablet, dates to 3000 b.c. Over thousands of years, a medical pharmacopoeia developed in every culture, from Asia to the Americas, to Europe and Africa. Over an extensive period of time, Chinese herbalists documented the healing properties of more than 7,000 herbs and thousands of herbal combinations. Saint-John’s-wort has a 2,500-year history of safe and effective use and was prescribed as medicine by Hippocrates (460–377 b.c. ) himself. Galen ( a.d. 129– 200) described 130 herbal antidotes and medicines, and Dioscorides (first cen- tury a.d. ) wrote about the medicinal properties of 500 plants and described how to prepare 1,000 simple remedies. The ancient Egyptians used pepper- mint and spearmint to relax the digestive tract, while Chinese and Ayurvedic doctors used mint to treat colds, coughs, and fevers ( Castleman, 2009 ).

When Europeans came to the Americas, they found that Native Americans had a vast pharmacopoeia of medicinal plants such as birch, blackberry, cone- flower, ginseng, goldenseal, and ginger that had been handed down from gen- eration to generation. Early Jesuit missionaries in Canada discovered American ginseng in the early 1700s and exported it to Asia, where it became a highly revered tonic. The Shakers (Church of the United Society of Believ- ers), who were great friends of Native Americans, were the first to cultivate medicinal plants in mass quantities and became the first reputable pharma- ceutical manufacturers in the United States. Until the Civil War disrupted their efforts, the Shakers sold 354 varieties of therapeutic herbs. During the early 20th century, tincture of echinacea was highly valued for its antibiotic properties until synthetic antibiotics became available. Kava, used to calm the nervous system and decrease anxiety, was even sold during the 1920s in the Sears, Roebuck and Company catalog. Many herbs used in ancient times are still in use today throughout the world. Herbal medicine has generally been more widely accepted outside the United States, where health care providers often combine it with conventional therapy ( Castleman, 2009 ).

In the 1960s, the U.S. Food and Drug Administration (FDA) developed the current regulations regarding medications. At that time, herbal medicine was not very popular and thus was virtually ignored by the FDA. Herbs are viewed as dietary supplements and are controlled by the 1994 Dietary Supplement Health and Education Act. Under this act, dietary supplements cannot make specific medical claims, as can prescription and over-the-counter (OTC) drugs. General statements such as “improves memory” or “promotes regularity” can be used as long as a disclaimer notes that the herb is not approved by the FDA and that the product is not intended to diagnose, treat, cure, or prevent any disease.

Researchers are intensifying their efforts to collect and screen more nat- ural products for their medicinal properties. Gordon Cragg, former chief of

Chapter 7 • Herbs and Nutritional Supplements 115

the Natural Products Branch (NPB) of the National Cancer Institute’s (NCI) Division of Cancer Treatment and Diagnosis, stated, “Nature produces chem- icals that no chemist would ever dream of at the laboratory bench” ( Hallowell, 1997 , p. 19 ). A great variety of some of the most concentrated healing herbs are found in a wide band around the equator. Unfortunately, destruction of these natural plant habitats, especially tropical rain forests, is driving many species to extinction before they can be found and studied.

It is unlikely that most herbal medicines will ever win FDA approval, since the process costs approximately $100 million per drug. Large pharma- ceutical companies are willing to invest this fortune in new drugs that can be patented and sold at high profits. In contrast, obtaining exclusive rights or patents to most herbs, such as garlic or ginseng, is nearly impossible, which takes away the financial incentive to get them approved for medicinal use. The lack of profit, rather than the lack of efficacy of herbs, keeps drug compa- nies from advocating for FDA approval of herbs.

Much of what is known about herbs comes from Germany, where an expert panel called Commission E, set up in 1978, has reviewed all available literature on 650 medicinal herbs, issuing recommendations for their use. The National Center for Complementary and Alternative Medicine is actively involved in researching healing herbs. In addition, NCI is screening plants for compounds active against the AIDS virus and nine major types of cancer. Since 1986 NCI has received samplings of thousands of plants from ethno- botanists throughout the world. Indigenous people have been testing and using healing plants for thousands of years, but only recently have Western researchers sought their knowledge.

CONCEPTS

Synergism

The active chemicals in herbs work synergistically ; that is, the combined action of two or more substances produces a greater effect than the sum of the effects of the individual substances acting alone. Most herbal medicines rely on the complex interplay of many chemicals for their therapeutic action, and many lose their activity when purified and isolated. For example, a num- ber of antimicrobial compounds are found in tea tree oil, but studies indicate that no single compound in the oil is responsible for its remarkable germ- fighting ability; rather, the interaction of at least eight distinct chemicals in the oil seems to produce the effects. This complexity makes it nearly impos- sible for an infectious microbe to build up resistance to tea tree oil. One of the primary problems with conventional antibiotics is the ability of many microbes to develop resistance to them, thus rendering the drugs useless. Antioxidant defenses also operate synergistically. For example, a number of carotenoids working together have higher anticancer properties than does a single carotenoid. Thus beta-carotene supplements may not provide the same protection as eating fruits and vegetables rich in beta-carotene. Other substances in a plant may help the body utilize its benefits as well as buffer

116 Unit 3 • Botanical Healing

any side effects. Including the whole plant in the final product often ensures that some measure of the natural “checks and balances” will be retained ( Castleman, 2009 ; Duke, 2002 ).

Various herbs and other substances may also work synergistically with one another. A rather dramatic example of this effect was observed during the testing of plant samples from the rain forest in Ecuador for chemicals that could be used to treat diabetes. The leaves from the plant were immersed in an alcohol extract and then a water extract. The researchers debated whether to throw a live crab into the extract, just as native healers did. Some believed it might make a difference, while others believed the crab was simply ritualis- tic. Amazingly, the only extract that demonstrated therapeutic effect was the one with the crab in it. It turned out that a component in a crab’s shell is needed to extract the active chemical compound from the plant ( Cray, 1997 ).

Phytonutrients

Phytonutrients are chemicals present in plants that make the plants biologi- cally active and are responsible for giving plants their color, flavor, and nat- ural disease resistance. Phytonutrients are products of photosynthesis or are substances that serve as defense mechanisms against attacks by insects and other predators. These active components of plants usually occur in groups that complement one another’s protective and healing effects. Descriptions of the most important phytonutrients and their uses are found in Table 7.1 .

Antioxidants

Antioxidants are a group of vitamins, minerals, enzymes, and herbs that help protect the body against naturally occurring free radicals, which are molecular species containing an unpaired electron. In the body, free radicals of both oxy- gen and nitrogen are produced during normal metabolic processes, as well as being derived from external sources. Free radicals are unstable and highly reac- tive. They gain stability by either donating or accepting an electron from another molecule, thus creating more free radicals in the process. Because free radicals react so readily with other compounds, they can effect significant changes in the body. Many different factors can lead to the production of free radicals. Internal sources , in addition to metabolic processes, include emotional stress and strenu- ous exercise. External sources include air pollution, cigarette smoke, factory and car exhaust, smog, pesticides, herbicides, food contaminants, chemotherapy, and radiation. All cause the overproduction of free radicals. Oxidative damage can be visualized, for example, on the exposed surface of a cut apple, which turns brown as it oxidizes, that is, reacts with the oxygen in air. Humans, how- ever, cannot “see” the damage being done by free radicals in the body. An excess of free radicals is, in part, responsible for the effects of aging and is impli- cated in cancer and a variety of chronic and degenerative conditions, including arthritis and heart disease ( Atsumi & Tonosaki, 2007 ; Duke & Castleman, 2009 ).

Free radicals are normally kept under control by antioxidant enzymes, which act as scavengers to search out and neutralize dangerous free radicals.

Chapter 7 • Herbs and Nutritional Supplements 117

TABLE 7.1 Phytonutrients

Name Properties Use/Effects

Alkaloids Group of nitrogen-containing compounds; analgesic, local

anesthetic, sedating, antispasmodic, hallucinatory; poisonous to varying degrees

Affect both the nervous and circulatory systems. Most

familiar are atropine, caffeine, cocaine, morphine, nicotine, and quinine.

Bitter principles

Group of chemicals that have an extremely bitter taste

Through a reflex action via taste buds, stimulate appetite and

flow of digestive juices, stimulate liver activity and flow of bile; some act as diuretics. Viewed as overall tonics.

Carbohydrates Main energy source and structural support of plants

In some herbs, such as coltsfoot and marshmallow, the cellulose

combines with other chemicals to form mucilage, a gummy substance that, when ingested by humans, soothes and protects irritated or inflamed internal tissue.

Carotenoids Yellow, orange, or red pigments in photosynthetic plants;

converted to vitamin A in liver

Three most important to humans: Beta-carotene may aid in cancer prevention by neutralizing free

radicals; used in conjunction with topical sunscreens for better prevention of sunburn and skin damage.

Lycopene may prevent prostate cancer and decrease risk of

heart attacks. Lutein may be useful in prevention of macular

degeneration, a leading cause of blindness in the elderly.

Essential oils Vaporize when heated; combinations give plants

their particular smell

Garlic is an antiseptic, thyme is an expectorant; chamomile

relieves gaseous distention and painful intestinal spasms.

Fatty oils Mixture of triglycerides, glycerol, fatty acids

Omega-3 fatty acids are used against cardiovascular disease

and depression; improve cognition.

(continued)

118 Unit 3 • Botanical Healing

Name Properties Use/Effects

Glycosides Complex organic substances; some of the most potent herbal

remedies and among the most toxic substances known

Cardiac glycosides include foxglove and lily of the valley, which

affect cardiac contractions; used to correct arrhythmias.

Mustard glycosides are used externally and have antiseptic

and analgesic effects.

Cyanogenic glycosides release hydrogen cyanide when chewed

or digested, resulting in antispasmodic, purgative, and sedative effects. Found in some nuts, vegetables, and the seeds of some fruits. Hydrogen cyanide, sometimes called prussic acid, is highly poisonous.

Phenolic glycosides include salicylic derivatives found in

willow and other plants; salicylic acid derivative is main ingredient in aspirin; antiseptic, analgesic, and anti-inflammatory effects.

Coumarin glycosides strengthen capillary walls and

act as an anticoagulant.

Anthraquinone glycosides are used as laxatives.

Flavonoid glycosides, known as bioflavonoids or flavonoids,

improve circulation, stimulate bile production, lower cholesterol levels, and strengthen the liver.

Isoflavones Compounds similar to human estrogen; found primarily in

soy products

May prevent hormone-related cancers; lower cholesterol,

relieve menopausal symptoms, prevent osteoporosis by increasing bone density.

Tannins Chemical substances with astringent and antiseptic

properties

Form a protective layer on the skin and mucous membranes and are

useful in treatment of burns and local inflammation; used for eye and mouth infections.

TABLE 7.1 (Continued)

Chapter 7 • Herbs and Nutritional Supplements 119

As people age they produce fewer of these enzymes, and they may benefit from dietary antioxidants such as vitamin C, vitamin E, carotenoids, the min- eral selenium, and the hormone melatonin. Herbs with antioxidant properties include bilberry, ginkgo, grape seed extract, green tea, and flavonoids. Fruits and vegetables are the primary sources of antioxidants.

Plant-Derived Products

Herbal medicines were in use even before pharmaceutical companies came into existence. In many parts of the world, treating illness with herbs is still the only medicine available. Even though only a tiny fraction of plants have been studied for medicinal benefits, conventional physicians use plant-derived products regularly. Fifty percent of all prescription and over-the-counter (OTC) drugs sold in the United States are derived from plants. Examples of herbal remedies that have been synthesized into modern drugs are reserpine from Indian snakeroot, digoxin from foxglove, quinine from Peruvian bark, aspirin from willow tree bark, morphine from opium poppy, cocaine from coca leaves, and atropine from deadly nightshade. Paclitaxel (Taxol, Abraxane) is found in Pacific yew bark and is currently being used in the treatment of early and advanced breast cancer and ovarian tumors. The drug vincristine (Oncovin) has been isolated from the Madagascar periwinkle and has been found to arrest cell division so dramatically that it is being used to treat acute leukemia and Hodgkin’s disease ( Bowden, 2008 ; Koudelka & Turanek, 2012 ).

Safety

Not all plant life is beneficial. Most plant-related poisonings are due to acci- dental consumption of toxic ornamental plants such as jade, holly, poinsettia, schefflera, philodendron, and dieffenbachia rather than herbs. Data compiled by the American Association of Poison Control indicate that medications such as analgesics, sedatives, antipsychotics, antidepressants, cold/cough prepara- tions, and cardiovascular drugs are much more likely to cause adverse reac- tions and fatalities than are herbs ( Bronstein et al., 2011 ).

Although the safety of herbs has not been completely established through an evidence-based approach, it is thought that the vast majority of herbal med- icines present no danger if taken appropriately. Some can, however, cause seri- ous side effects if taken in excess or, for some individuals, if taken over a prolonged period. For example, comfrey , a digestive remedy; coltsfoot , used to treat cough; and kava , used for anxiety, can cause liver damage if taken in large doses. Beta-carotene increases the risk of lung cancer among smokers. Vitamin E supplements increase the incidence of prostate cancer among healthy men. Yohimbe may lower blood pressure and contribute to a heart conduction disor- der that may result in death. Willow bark may result in Reye’s syndrome in children. Ephedra can increase blood pressure and contribute to seizures, myo- cardial infarctions, or strokes (Bronstein et al., 2011 ; Zhang, Xue, & Fong, 2011 ).

Herbs can also interact with drugs, and caution should be used when combining herbs with prescription and OTC medications (see Table 7.2 ).

120 Unit 3 • Botanical Healing

TABLE 7.2 Herb Interactions

Herb/Supplement May Interact with Potential Effects

Black cohosh Hormone replacement medications

May potentiate one another

Capsicum Anticoagulants, aspirin May prolong bleeding time

Theophylline Increases absorption, may cause toxicity

Echinacea Immunosuppressants Reduces effectiveness of immunosuppressants

Antifungals; drugs known to elevate liver enzymes

May cause liver damage

Evening primrose oil

Phenothiazine medications, Wellbutrin

May increase risk of seizures

Feverfew Anticoagulants, aspirin May increase anticoagulant effects

Garlic Anticoagulants, aspirin May increase anticoagulant effects

Hypoglycemics May cause hypoglycemia

Antihypertensives May require increased dose of antihypertensive

HIV medications May increase or decrease effectiveness of medications

Ginger Anticoagulants, aspirin May increase anticoagulant effects

Ginkgo Anticoagulants, aspirin May increase anticoagulant effects

Anticonvulsants May decrease effectiveness of anticonvulsants

Ginseng Oral contraceptives Increases the potency of estrogen in oral contraceptives causing side

effects such as weight gain, breast pain, and vaginal bleeding

MAO inhibitors May result in mania

Caffeine May cause irritability

Glaucoma medications May decrease effectiveness of glaucoma medications

Goldenseal Anticoagulants, aspirin Decreases effectiveness of anticoagulants

Diuretics Increases diuretic effect

General anesthetics May increase hypotensive effect of anesthetic

Licorice Hypoglycemics May interfere with regulation of blood sugar levels

Lanoxin, Lasix, Hygroton, Lozol, Bumex

Licorice depletes potassium; may cause hypokalemia

Chapter 7 • Herbs and Nutritional Supplements 121

(continued)

Herb/Supplement May Interact with Potential Effects

Thyroid replacement medication

May require higher doses of thyroid replacement drugs

Oral contraceptives May cause high blood pressure, fluid retention, hypokalemia

Antihypertensives Decreases effectiveness of antihypertensives

Ma huang Most antihypertensives May increase blood pressure and risk of cardiac arrhythmia

Antidepressants May increase blood pressure and risk of cardiac arrhythmia

Decongestants May increase blood pressure and risk of cardiac arrhythmia

Lanoxin Increases risk of cardiac arrhythmia

Hypoglycemics May interfere with regulation of blood sugar levels

Milk thistle Oral contraceptives Reduces effectiveness of oral contraceptives

Psyllium Laxatives May increase effects

Saint-John’s-wort Oral contraceptives Reduces effectiveness of oral contraceptives

Tetracyclines, sulfa drugs, Feldane, Prilosec, Prevacid

Extreme photosensitivity may occur; increasing risk for severe

sunburn

Antidepressants May potentiate one another, causing severe agitation,

nausea, confusion, and possible cardiac problems

Anticonvulsants

Anticoagulants

May decrease effectiveness of anticonvulsants May increase anticoagulant effect

Dioxin, immunosuppressants, protease inhibitors

May reduce effectiveness of these medications

Theophylline May decrease serum theophylline levels

General anesthetics May prolong effect of anesthesia

Saw palmetto Proscar May potentiate each other, resulting in overdose

Valerian Antianxiety medication, Benadryl, Vistaril,

anticonvulsants

May increase sedative effects

General anesthetics Prolongs anesthesia

122 Unit 3 • Botanical Healing

Herb/Supplement May Interact with Potential Effects

Vitamin A Accutane for acne Toxicity may occur, resulting in severe headaches, dry

eyes and skin, hair loss, and possible liver damage

Vitamin B 6 Carbidopa, levodopa May decrease effectiveness, resulting in breakthrough

symptoms such as tremors

The majority of people who use herbs do not inform their medical providers of this fact. Such lack of communication can lead to herb–drug interactions that might otherwise have been avoided. Any herbs that act as anticoagu- lants or those that potentiate anesthesia must be discontinued before sur- gery if at all possible ( Shaw, Graeme, Pierre, Elizabeth, & Kelvin, 2012 ).

The processing and manufacturing of herbal products varies from coun- try to country, with varying degrees of quality assurance. Contamination with heavy metals, pesticides, herbicides, insects, animals, and/or animal excreta can result in unsafe herbal products. In the United States herbs are sold as dietary supplements and have significantly fewer requirements compared with prescription and OTC drugs. The requirements apply only to how the final product is manufactured, not to suppliers of the herbal ingredients.

TREATMENT

Medicinal herbs are available at health food stores, herb shops, supermarkets, and pharmacies. They can be used as a preventive, a tonic, or a treatment. Herbs can be prepared and used in a number of ways. Extracts or tinctures are made by pressing herbs with a heavy press and soaking them in alcohol or water, which after evaporation yields a concentrated extract. Extracts are gen- erally measured in drops and diluted in a small amount of water for inges- tion. A preparation of the delicate parts of plants—that is, leaves, flowers, and seeds—is called an infusion , a process similar to making tea. Hot water is poured over the herb, steeped for 3 to 5 minutes, and strained before drink- ing. Honey or lemon may be added to taste. Decoction is the preparation of the more resilient parts of plants, such as the bark, roots, and berries. These parts of the herb are usually boiled for 10 to 20 minutes and strained before drinking. A compress is a cloth soaked in a warm or cool herbal solution and applied directly to an injured area. An herbal poultice is made by mixing pow- ered herbs with enough hot water to make a thick paste that is then applied directly to the skin. Poultices are used to reduce swelling, relieve pain, decrease muscle spasms, draw out toxins from the body, increase circulation, and speed healing. Table 7.3 lists some of the more common herbs as well as their action, dosage, and side effects.

TABLE 7.2 (Continued)

Chapter 7 • Herbs and Nutritional Supplements 123

TABLE 7.3 Common Herbs

Name Properties/Use Side Effects/Contraindications

Asian ginseng Improve mental and physical performance; lower blood glucose; improve immune function

Headaches, sleep problems, GI problems People taking medicine to lower blood sugar should use extra caution NOT for people with hypoglycemia

Bilberry Diarrhea; menstrual cramps; varicose veins; venous insufficiency

High doses or extended use of the leaf or extract may lead to possible

toxic effects

Black cohosh Menopause; dysmenorrhea Minimal side effects NOT for people with a liver disorder NOT to be used with hormone replacement therapy NOT to be used with hormone-sensitive breast cancer

Butterbur Antihistamine for allergy symptoms; migraines

Belching, GI issues, asthma, fatigue NOT for children

Chamomile Anxiety, sleeplessness, GI upset, infant colic, mouth ulcers from cancer treat- ment; drug withdrawal

NOT for those with extreme allergy to ragweed.

NOT for pregnant or lactating women

Cranberry Prevent urinary tract infections or H. pylori infections that can lead to stomach ulcers; antioxidant

Use with caution for people taking anticoagulants or medications that affect the liver

Echinacea Prevent colds, flu; stimulate immune system

Few side effects

Evening primrose oil

Eczema; rheumatoid arthritis; breast pain

Well tolerated by most people NOT for pregnant or lactating women

Fenugreek Diabetes; loss of appetite; stimulate milk production in breastfeeding women; skin inflammation

Gas, bloating, diarrhea NOT for pregnant women

Feverfew Migraines; rheumatoid arthritis; psoriasis, allergies; tinnitus; dizziness

No serious side effects NOT for pregnant women

Garlic High cholesterol; slow development of atherosclerosis; hypertension

Nausea, garlicky scent NOT for people with clotting disorders NOT prior to surgery

Ginger Nausea and vomiting of various causes; arthritis

Safe during pregnancy

(continued)

124 Unit 3 • Botanical Healing

Name Properties/Use Side Effects/Contraindications

Ginkgo Dementia; memory impairment; intermittent claudication; tinnitus

Headache, nausea, GI upset NOT for people with clotting disorders NOT prior to surgery

Goldenseal Respiratory tract infections; eye infections; vaginitis; canker sores

Few side effects

Grape seed extract

Hypertension; high cholesterol; poor circulation; vascular fragility; edema; antioxidant

Few side effects

Green tea Cancer; mental alertness; weight loss; high cholesterol

Contains caffeine

Horse chestnut

Venous insufficiency Do NOT use raw or unprocessed plant parts, as they are poisonous

Licorice root Stomach ulcers; bronchitis; sore throat; hepatitis

Use with caution with diuretics, as potassium levels could drop dangerously low; use with caution for people with hypertension

Milk thistle Liver disorders; high cholesterol;

NOT for pregnant or lactating women Use with caution for people with

diabetes or hypoglycemia

Noni Antioxidant; immune stimulating; tumor fighting properties

High in potassium; use with caution for people with renal disease

Red clover Menopause; high cholesterol; osteoporosis; prostate enlargement

Few side effects Unclear if it is safe for pregnant or

lactating women or hormone- sensitive cancers

St. John’s wort Minor depression Photosensitivity, anxiety, dry mouth Sexual problems

NOT for use with other antidepressants

NOT for children NOT for pregnant or lactating women

Saw palmetto Urinary antiseptic; benign prostatic hyperplasia

Few side effects NOT for pregnant or lactating women

Tea tree oil Antifungal, antiseptic; acne; minor wounds and cuts; athlete’s foot; nail infections; herpes; douche for yeast infections

Only for topical use

Valerian Insomnia; menopause; men- strual and intestinal cramps

Excitability, uneasiness, fatigue, headache

TABLE 7.3 (Continued)

Chapter 7 • Herbs and Nutritional Supplements 125

RESEARCH

Most herbal medicines have not been tested as thoroughly as have prescription drugs in the United States, although the National Center for Complementary and Alternative Medicine, the National Cancer Institute, and the Society for Integrative Oncology fund many herbal research trials. South Africa has more than 20,000 plant species, several thousand of which are used by traditional healers. Research teams from the United States are teaming up with the South African Herbal Science and Medicine Institute to study the medicinal proper- ties, safety, and effectiveness of several of these African plants. In contrast, many scientific studies have been conducted outside the United States on a variety of herbal remedies, such as those by Commission E in Germany, men- tioned previously. In the coming years, the pharmacopoeia of useful herbs is likely to expand, since research in the field of herbal medicine is on the rise worldwide.

In 1995, the American Herbal Pharmacopoeia (AHP) was organized as an educational foundation to disseminate information regarding the pharma- cology, actions, indications, dosages, side effects, contraindications, drug interactions, and toxicology of herbs. To date, their information covers 140 medicinal plant species, representing 90% of the herb sales in the United States. The goal of AHP is for health care providers in the United States to integrate herbal medicines into treatment plans, as their contemporaries have done in other countries.

Evidence summaries produced by the Joanna Briggs Institute found the following:

• Treatment of acute ischemic stroke with Ginkgo biloba extract should be guided by clinical judgment until high-quality research is conducted ( Jahan, 2012 ).

• A fixed dose of 1 gram of ginger is recommended for reducing postop- erative nausea and vomiting in patients having gynecologic or lower limb extremity surgery ( Moola, 2012 ).

The Joanna Briggs Institute Clinician Information on Aromatherapy and Herbal Medicine ( Carstens, 2010 ) found the following:

• Herbs may be beneficial in treating a variety of conditions, but caution must be used owing to possible complications and lack of evidence (Grade B).

• Herbal remedies can affect laboratory test results, so good communica- tion among patients, primary care providers, laboratory scientists, and pathologists is important (Grade A).

A sample of randomized clinical trials sponsored by the National Cancer Institute include studies of

• selenium for both prostate cancer prevention and non–small cell lung cancer.

• psilocybin for clinically significant depression or anxiety secondary to cancer.

126 Unit 3 • Botanical Healing

• ginseng for preventing respiratory infection and reducing antibiotic use in patients with chronic lymphocytic leukemia. It is also being studied in people with cancer and the related fatigue.

• green tea for former smokers with chronic obstructive pulmonary dis- ease (COPD).

• grape powder for estrogen levels in postmenopausal women. • valerian for improving sleep in people with cancer. • ginger for nausea related to chemotherapy.

The quality of herbal products can affect study outcomes and the degree to which herbs can be integrated into evidence-based medicine. Quality can be affected by environmental conditions; herb collection practices; handling, storage, and manufacturing conditions; and contamination.

INTEGRATED NURSING PRACTICE

Because herbs are marketed as “natural” or promoted as foods, consumers may assume incorrectly that herbs are safe and without side effects. It is important to remember that natural remedies must be approached with respect. They work because they have strong pharmacological activity. It is important to teach clients that although herbs are generally much safer than prescription drugs, if herbs are abused or overused, they can cause harm.

Although herbs can be quite effective, it is important to caution people about becoming overzealous about their use. If they have a life-threatening illness such as asthma or if they experience chest pain or if they notice more benign symptoms that persist for longer than a few days, they should seek medical attention. While it may be helpful to take echinacea for an incipient cold, any serious ailment should first be diagnosed by a health care practitio- ner. Self-diagnosis and self-care are by nature subject to limits. Conventional medicine is best used in crisis situations, and herbs are best used in noncrisis situations. Professionals can save consumers from treating something that does not exist or failing to treat something that does. Further, health practi- tioners can help individuals evaluate the extent of their progress on the herbal regimen. Consultation is especially important if people are taking other medications; although some herbs can work with prescription drugs, others may not. Some herbs potentiate the effects of drugs, so individuals may need a lower dose of their regular medication. Suddenly stopping a pre- scription can be hazardous to one’s health. Pregnant and lactating women should always consult their primary care practitioner before taking any herbal medicines.

Herbs should be used with caution with children. Children are not “small adults” and may experience side effects that are different from those experienced by adults. Parents or caregivers should consult with the child’s primary care professional before using any herbs with children.

Nurses must be open to exploring and discussing their clients’ use of and questions about herbal medicine. This clinical screening allows evaluation

Chapter 7 • Herbs and Nutritional Supplements 127

of herbal intake against known and potential adverse interactions with pre- scription and over-the-counter (OTC) medications.

As a nurse, you need to educate consumers about potential actions and interactions of herbal remedies. People cannot expect to take an herb for a few days to undo 10 years of poor health habits nor to replace a healthy diet with herbal supplements. If people eat a healthful, varied diet that is high in fresh foods, especially fruits, vegetables, and whole grains, they do not need to take supplements unless they have special needs ( Weil, 1998 ).

Sometimes, walking into a health food store or pharmacy is highly con- fusing. Many people are overwhelmed by the wide assortment of products and brands. As a nurse, you can teach consumers the following basic guide- lines in selecting herbal medicines:

• Store clerks are not experts. They do not have an adequate scientific background to counsel people.

• Go with a name brand. Since the industry is unregulated, it is best to choose products made by large, reputable companies that have been in business for a long time. Many excellent products are produced in Germany and France, where they must meet strict production standards.

• Check the label. Look for the word standardized , which tells you that the product consistently contains a certain percentage of a specific chemical.

• Check to see whether the claims are reasonable. Be wary of promises of instant cures for complicated disorders. If something sounds too good to be true, it probably is.

• Consider the product’s form. A liquid, powder, or solid extract is gener- ally best. Bulk herbs can lose their potency quickly. Many herbal tinc- tures are 50% grain alcohol, which may be a problem for people with a history of alcohol abuse or for those who take drugs that can interact with alcohol.

• Be wary of ultracombination products. If the product has more than six ingredients, it probably contains a small amount of each. A combination of herbs does not necessarily make the product better. If you need ginkgo to boost your memory, it is better to get it full strength than to get a product diluted with ginseng, garlic, and other herbs.

• Take the right dose. Do not take higher doses than the label recommends. Exceeding the recommended dose can lead to toxicity. Most herbal rem- edies are not to be given to children under the age of 1 unless directed by an experienced practitioner. Children ages 1 to 6 are typically given one third the adult dose, while children ages 6 to 12 receive half the adult dose. People over the age of 65 may need a reduced dosage.

• Watch for side effects. If you have any unusual symptoms, such as aller- gies, rashes, heart palpitations, or headaches, stop taking the herb imme- diately and see a health care practitioner.

• Give the product time to work. Evaluate how it makes you feel. After 30 days, ask yourself whether the product has made a difference in your health. If you are not sure, stop taking the herb to gauge the difference.

128 Unit 3 • Botanical Healing

• Inform your primary health care practitioner about the herbal remedies you are taking.

• If you plan on regularly using herbal remedies, invest in a good herbal reference guide to ensure your access to proper information, or consult with the one of the organizations in the resource list. The U.S. Depart- ment of Agriculture provides free access to 80,000 records, developed by Dr. James A. Duke, on herb taxonomy and use of herbs worldwide.

As a nurse, it is also important that you warn consumers about remedies that can be risky. Chaparral, sold as teas and pills to fight cancer and “purify blood,” has been linked to serious liver damage. Dieter’s teas, containing such ingredients as senna, aloe, rhubarb root, buckthorn, cascara, and castor oil act as laxatives that when consumed in excessive amounts can disrupt potassium levels and contribute to cardiac arrhythmias. Ephedra is a cardiac and ner- vous system stimulant that can cause anxiety, psychotic episodes, hyperten- sion, stroke, tachycardia, arrhythmias, and cardiac arrest. The Food and Drug Administration has banned the sale in the United States of supplements con- taining ephedra. The ban does not apply to traditional Chinese herbal remedies that are regulated as conventional foods.

TRY THIS

Herbal Remedies

Peppermint Tea

Used to soothe an upset stomach, aid digestion, relieve menstrual cramps, soothe sore throats, improve alertness.

How to Combine 1 to 2 teaspoons of dried peppermint leaf with 8 ounces of water. Steep 3 to 5 minutes. Strain and drink the tea.

Chamomile

An excellent home remedy for indigestion, heartburn, and infant colic. It also soothes skin and has mild relaxant and sedative properties.

How to For an infusion, use 2–3 heaping teaspoons of dried or 1/3 cup of fresh flowers per cup of boiling water. Steep 10–20 minutes. Strain and drink up to 3 cups a day. Diluted infusions may be given to infants for colic.

For a relaxing herbal bath, fill a cloth bag with a few handfuls of dried or fresh flow- ers and let the water run over it.

Chapter 7 • Herbs and Nutritional Supplements 129

The U.S. public is demanding more information about herbal remedies. In the best of all worlds, consumers would have an educated professional—a nurse, a pharmacist, or a doctor—to help guide them through the process of using herbal remedies. That is the situation in Germany, where health care practitioners and pharmacists must be knowledgeable about natural reme- dies, their approved uses, their potential side effects, and how they should be prescribed. This is not the case in the United States, but it surely will

For allergic skin rashes, tightly pack a jar of flower heads, and cover them with olive oil. Cover and set in a sunny place for 3 weeks. Strain and apply to rashes.

Comfrey

External use only. Promotes the growth of new cells and has a mild anti-inflammatory action. Used in wound and burn treatment.

How to Mix the powdered root with water to make a paste. Apply to the injured area and cover with a clean bandage. Change daily.

Ginger

Decreases nausea, boosts the immune system, lowers blood pressure.

How to Use 2 teaspoons of powdered or grated root per cup of boiling water. Steep 20 minutes, strain, and add juice from half a lemon and honey to taste. Drink hot up to 3 cups a day. Dilute ginger infusion to treat infant colic. If you buy whole root, refrigerate it.

Mint

Relaxes the digestive tract; used to treat colds, coughs, and fevers.

How to For an infusion, use 1 teaspoon of fresh herb or 2 teaspoons of dried leaves per cup of boiling water. Steep 10 minutes, strain, and drink up to 3 cups a day. Peppermint has a sharper taste than spearmint and feels cooler in the mouth.

For a relaxing herbal bath, fill a cloth bag with a few handfuls of dried or fresh leaves and let the water run over it.

Rosemary

Stimulates circulation and relaxes tired and sore muscles.

How to For tired, sore feet, make a footbath by adding 10 drops of essential oil to a basin of hot water large enough to hold both feet. Stir the oil into the water with your hand.

130 Unit 3 • Botanical Healing

change in the near future. Schools of nursing and schools of medicine are including courses on complementary and alternative medicine in their cur- riculum. Pharmacy schools now require their students to take a course in herbal therapy.

As nurse–author Carolyn Kresse Murray ( 1996 ) said, “Part of patient advocacy is making sure you help your patient with all his [her] therapies. Equipping yourself with knowledge about herbal therapies is another way to keep him [her] from harm” (p. 59 ).

Considering the Evidence

C. V. Little, T. Parsons, and S. Logan, 2009, Herbal therapy for treating osteoarthritis, Cochrane Database of Systematic Reviews, (4): CD002947. doi: 10.1002/14651858. CD002947

What Was the Type of Research?

Systematic review of randomized control trials (RCTs)

What Was the Purpose of the Research?

To synthesize, appraise, and evaluate relevant RCTs concerning the effectiveness of herbal therapies in treating osteoarthritis compared with placebo use

How Was the Research Done?

The authors used a systematic review methodology to examine RCTs relevant to the pur- pose of this research. They employed a comprehensive search strategy using selected keywords and 10 electronic databases to identify relevant studies. In addition, the authors hand searched the reference lists from retrieved articles to locate additional studies meet- ing the inclusion criteria. Two reviewers assessed the methodological quality of the stud- ies. Five studies (four different herbal treatments) were identified as meeting the established inclusion criteria for this review.

What Were the Findings of the Research?

There is some evidence to support the use of avocado-soybean unsaponifiables (natural vegetable extract made from avocado and soybean oils) in helping persons living with chronic but stable osteoarthritis of the hip. Owing to the lack of studies, there needs to be additional research related to other herbal remedies for persons living with osteoarthritis.

What Additional Questions Might I Have?

Would avocado-soybean unsaponifiables have a positive effect on other types of arthritic conditions? Are there any side effects associated with the use of avocado-soybean unsa- ponifiables? Are there additional studies of good methodological quality currently being done to investigate the effect of herbs on osteoarthritis?

Chapter 7 • Herbs and Nutritional Supplements 131

References

How Can I Use This Study?

This study has clinical value for nurses caring for persons living with pain associated with osteoarthritis and desiring to enhance their quality of life. Nurses can incorporate the find- ings of this review in educating and promoting the health of persons living with this chal- lenge. Nurses should be aware that additional research of good methodological quality on the effectiveness of herbal treatment for patients with osteoarthritis is needed to strengthen the evidence.

Source: Contributed by Dolores M. Huffman, RN, PhD

Atsumi, T., & Tonosaki, K. (2007). Smell- ing lavender and rosemary increases free radical scavenging activity and decreases cortisol level in saliva. Psy- chiatry Research , 150(1): 89–96.

Bardia, A., Nisly, N. L., Zimmerman, M. B., Gryzlak, B. M., & Wallace, R. B. (2007). Use of herbs among adults based on evidence-based indications: Findings from the National Health Interview Survey. Mayo Clinic Proceed- ings , 82(5): 561–566.

Bowden, J. (2008). The Most Effective Natu- ral Cures on Earth . Beverly, MA: Fair Winds Press.

Bronstein, A. C., Spyker, D. A., Cantilena, L. R., Green, J., Rumack, B. H., & Dart, R. C. (2011). 2010 annual report of the American Association of Poison Con- trol Centers’ national poison data sys- tem (NPDS). Clinical Toxicology , 49: 910–941. doi: 10.3109/15563650.2011.635149

Carstens, J. (2010). Complementary thera- pies (aromatherapy and herbal medi- cine): Clinician information. Joanna Briggs Institute Clinician Information. Retrieved from http://connect.jbiconnectplus.org/ ViewDocument.aspx?0=3771

Castleman, M. (2009). The New Healing Herbs . Emmaus, PA: Rodale Press.

Cray, D. (1997). Money that grows on trees. Time , Fall special issue, 150(19): 21.

Duke, J. A. (2002). The Green Pharmacy Herbal Handbook . New York, NY: St. Martin’s Press.

Duke, J. A., & Castleman, M. (2001). The Green Pharmacy Anti-Aging Prescriptions . Emmaus, PA: Rodale.

Hallowell, C. (1997). The plant hunter. Time , Fall special issue, 150(19): 17–22.

Jahan, N. (2012). Stroke (acute ischaemic): Ginkgo biloba. Joanna Briggs Institute Evidence Summary. Retrieved from http://connect.jbiconnectplus.org/ ViewDocument.aspx?0=6846

Koudelka, S., & Turanek, J. (2012). Liposo- mal paclitaxel for mutations. Journal of Controlled Release. doi: 10.1016/ j.jconrel.2012.09.006

Moola, S. (2012). Postoperative nausea and vomiting: Complementary therapies. Joanna Briggs Institute Evidence Sum- mary. Retrieved from http://connect. jbiconnectplus.org/ViewDocument. aspx?0=7166

Murray, C. K. (1996). Walking the Spiritual Walk . Virginia Beach, VA: A.R.E. Press.

Shaw, D., Graeme, L., Pierre, D., Elizabeth, V. V., & Kelvin, C. (2012). Pharmacovigi- lance of herbal medicine. Journal of Eth- nopharmacology, 140(3): 513–518.

Weil, A. (1998). Ask the experts. Natural Health , (January–February): 24–28.

Zhang, A. L., Xue, C., & Fong, H. H. S. (2011). Integration of herbal medicine into evidence-based clinical practice. In F. F. Benzie and S. Wachtel-Galor (Eds.), Herbal Medicine: Biomolecular and Clinical Aspect (2nd ed., pp. 453–464). Boca Raton, FL: CRC Press.

132 Unit 3 • Botanical Healing

Resources

American Botanical Council

P.O. Box 144345

Austin, TX 78714-4345

512.926.4900

www.abc.herbalgram.org

American Herbalists Guild

P.O. Box 230741

Boston, MA 02123

857.350.3128

www.americanherbalistsguild.com

American Herbal Pharmacopoeia

P.O. Box 66809

Scotts Valley, CA 95067

831.461.6318

www.herbal-ahp.org

British Herbal Medicine Association

P.O. Box 583

Exeter EX1 9GX

44 (0) 845.680.1134

www.bhma.info

Herb Research Foundation

4140 15th St.

Boulder, CO 80304

800.748.2617

www.herbs.org

NAPRALERT (NAtural PRoducts ALERT)

The Program for Collaborative Research in the Pharmaceutical Sciences

College of Pharmacy

University of Illinois at Chicago

833 South Wood St.

Chicago, IL 60612

312.996.9035

www.napralert.org

National Herbalists Association of Australia

4 Cavendish St.

Concord West NSW 2138

02.8765.0071

www.nhaa.org.au

Ontario Herbalists Association

P.O. Box 123, Station D

Etobicoke, ON M9A 4X2

877.642.4372

www.herbalists.on.ca

U.S. Food and Drug Administration

10903 New Hampshire Ave

Silver Spring, MD 20993-0002

888.463.6332

www.fda.gov

Wise Woman Apprentice Program

P.O. Box 64

Woodstock, NY 12498

845.246.8081

www.susunweed.com

133

8 Aromatherapy

Earth laughs in flowers.

Ralph Waldo Emerson

Aromatherapy is the therapeutic use of essential oils of plants to heal the body, mind, and spirit. It is an offshoot of herbal medicine, and its basis of action is the same as that of modern pharmacology. The chemicals found in the essen- tial oils are absorbed into the body, resulting in physiological or psychological benefit. Aromatherapy is used to treat symptoms, so it has neither a theory of health and illness nor a system of diagnosis, in contrast with biomedicine, Traditional Chinese Medicine, and the like.

Scientists have long known that certain scents have the power to evoke strong physical and emotional reactions, but rarely has that knowledge been used in conventional medicine. Healthy humans can smell as many as 10,000 different odors, ranging from the deep fragrance of jasmine to the putrid stench of sewage. Most people, however, do not realize how much the sense of smell affects their daily lives.

Aromatherapy has been forgotten and ignored for many years but is now one of the fastest growing alternative therapies in Europe and the United States. The term aromatherapy has become more than a buzzword since the mid-1980s. In the United States, it is now a generic term in the public domain and, as such, cannot be trademarked by an individual or business.

Aromachology is a term coined by the Sense of Smell Insti- tute to describe the scientific study of fragrances, both natural and synthetic, as applied to psychology and human behavior. A systematic review of 18 studies found that odors can affect mood and behavior in humans ( Herz, 2009 ).

Essential oils come from all over the world—lavender from France, sandalwood and jasmine from India, rose from Turkey

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134 Unit 3 • Botanical Healing

and Bulgaria, geranium from the island of Réunion, eucalyptus and tea tree from Australia, and mint from the United States, to name a few examples. Today, only 3% of essential oils are used in therapy; the remaining 97% are used in the perfume and cosmetic industry. Owing to increased popularity, aromatherapy has become a $1 billion industry.

BACKGROUND

Almost all ancient cultures recognized the value of aromatic plants in main- taining health. Ancient Egyptians used scented oils daily to soften and protect their skin from the harsh, dry climate. They created various fragrances for personal benefit as well as for use in rituals and ceremonies. Fragrances were considered a part of the personal purification necessary to reach a realm of higher spirituality. Oils were dispersed into the air to purify the environment and to protect against evil spirits. Egyptians were the first to perfect embalm- ing with the use of aromatic plants and oils ( Tucker, 2012 ).

Priests and physicians used oils thousands of years before the time of Christ. The Ebers Papyrus, discovered in 1817, dates to 1500 b.c. and mentions more than 800 different formulas of herbal prescriptions and remedies. The Romans diffused oils in their temples and political buildings and bathed in hot tubs scented with oils. Ancient Arabian people studied the chemistry of plants and developed the process of distillation for extraction of essential oils. Throughout Asia perfumes were prized for both medicinal and cosmetic properties. Hundreds of references are made to oils in the Bible such as frank- incense, myrrh, and cinnamon. Many were used as protection against disease and for anointing and healing the sick ( Cline et al., 2008 ). Hippocrates, the father of Western medicine, reportedly said, “The way to health is to have an aromatic bath and scented massage every day” ( Thomas, 2002 , p. 10 ).

In the 12th century, trade routes from the Middle East introduced spices, herbs, and exotic scents to Europe, leading to the compilation of many books on therapeutic plant remedies. In the Americas, shamans also used herbs and aromatics in bathing patients to transform their energy field. Smoke from plants was often blown over patients as part of healing ceremonies ( Schiller, Schiller, & Schiller, 2013 ).

Although oils were used with great effectiveness in ancient times, they were largely forgotten by the Western world until resurrected in the 20th century by a French cosmetic chemist, Maurice-Rene Cattefosse. While working in his laboratory in 1920, he had an accident that resulted in a third-degree burn of his hand and forearm. He plunged his arm into a vat of lavender oil, thinking that it was water. To his surprise, the burning stopped within a few moments. With the continual application of lavender oil over the next few weeks, the burn healed completely without a trace of a scar. This incident was the beginning of Cattefosse’s fascination with the therapeutic properties of essential oils. He carried out experiments using oils to cure burns, to treat wounds, and to prevent gangrene and in 1937 coined the term aromatherapie ( Schiller et al., 2013 ).

Chapter 8 • Aromatherapy 135

PREPARATION

Since the 1980s, numerous schools of massage and aromatherapy have opened in the United Kingdom, France, and Japan. Training in aromatherapy has grown, and courses in it are part of the nursing degree program in some nurs- ing colleges and universities. Aromatherapists practice in a number of set- tings, including private practices, general medical clinics, and hospitals.

Some people in the United States, after a weekend course, call themselves “aromatherapists.” They may know little about plant chemistry and the specific ways in which the oils need to be formulated. Their self-proclaimed title is fine if they use oils only for fragrance and perfume. However, it is inappropriate for individuals with this limited knowledge to use oil formulas for a specific thera- peutic action. Jane Buckle, PhD, RN, ( www.rjbuckle.com ) offers a 45 hour CEU program that is available only to registered nurses (RNs) and licensed Massage Therapists (LMTs). Those who successfully complete the program receive a Certificate in Clinical Aromatherapy. Valerie Cooksley, RN, OCN, FAAIM, and Laraine Kyle Pounds, RN, MSN, who founded the Integrative Institute of Aromatherapy, offer an Integrative Aromatherapy© Certification Program, which consists of 310 contact hours for RNs ( [email protected] ).

Both these programs have been developed in conjunction with and approved by the American Holistic Nurses Association. In addition, the National Association for Holistic Aromatherapy has established certification guidelines and Standards of Training Levels.

CONCEPTS

Essential Oils

Essential oils are volatile liquids that are distilled or cold pressed from plants. Although chemically they are oils and as such do not mix with water, the term oil is somewhat misleading, since essential oils feel like water rather than oil. Varying amounts of essential oil can be extracted from a particular plant, which influences the price of the oil. For example, 1 ounce of jasmine may cost $150, while the same amount of tea tree oil may cost only a few dollars. The orange tree is a good example of a plant from which oils are extracted from various parts. Neroli oil comes from the orange tree blossoms, orange oil from the fruit itself, and petitgrain oil from the leaves of the tree. The following are other examples of plant parts from which oils are derived:

Leaves: eucalyptus, peppermint, petitgrain Flowers: lavender, rose Blossoms: neroli Fruits: lemon, mandarin, orange Grasses: lemongrass Wood: camphor, sandalwood Barks: cinnamon

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Gum: frankincense Bulbs: garlic, onion Dried flower buds: clove

Essential oils are stored in tiny pockets between plant cell walls. As the oil is released, it circulates through the plant and sends messages that help the plant function efficiently. Oils activate and regulate such activities as cellular metabolism, photosynthesis, and cellular respiration. They may also trigger immune responses to assist in coping with stressful changes in the environ- ment and climate. Some oils protect the plant from predators, especially microorganisms, and in so doing are essentially antibacterial, antiviral, and antifungal. Some oils protect the plant by repelling harmful insects, while others attract insects or animals that are useful for propagation ( Clark, 2009 ).

Plant oils are highly concentrated, and it is important to respect their power. One drop of oil is the medical equivalent of 1 ounce of the parent plant material used in herbal medicine. Essential oils are chemically diverse and may contain a mixture of more than 100 organic compounds, including esters, alcohols, aldehydes, ketones, phenols, and acids. Each oil may contain more of some compounds than others, which impart to the oil its particular thera- peutic properties. Table 8.1 lists some of the major chemical components and their therapeutic effects.

Hydrosols

Hydrosols , sometimes called plant waters, are extracted from plants during the process of steam distillation. In addition to the essential oil, a conden- sate water is produced that contains all the components of the plant. In essence, a hydrosol is equivalent to a homeopathic version of the essential oil and is diluted in the same manner (see Chapter 9 for information on dilution) . The use of hydrosols in aromatherapy is quite new but growing, since they are gentle, safe, and highly effective in extremely low dilutions ( Schiller et al., 2013 ).

How Essential Oils Work

The sense of smell is an important part of aromatherapy. Inside the human nose is a small cavity called the vomeronasal organ (VNO), which is lined with a cell type that is unlike any other in the human body. The VNO is far less prominent in people than in animals, which depend more heavily on smell for guidance. Pheromones are chemical substances produced by an animal that cause a specific reaction in another, usually of the same species, through smell. The VNO appears to specialize in detecting pheromones without people’s conscious awareness. In other words, people do not “smell” pheromones in the same way they smell freshly baked apple pies or essential oils. The scent, however, is registered at some brain level, and people respond to it emotion- ally and/or physically ( McGuigan, 2007 ).

Chapter 8 • Aromatherapy 137

In addition to the VNO, the nose contains 5 million smell-sensing cells that allow people to consciously register smells. Each cell has 6 to 12 hairlike receptors (cilia) that hang down into the stream of air rushing into the nose. These olfactory receptors are the only sensory pathways that open directly to

TABLE 8.1 Chemical Compounds of Essential Oils and Their Therapeutic Actions

Chemical Compound Therapeutic Action Examples of Oils

Aldehydes Anti-inflammatory, vasodilators, calm

central nervous system

Citronella, melissa, cinnamon bark,

lemongrass, lemon, lime, verbena

Esters Similar to alcohols; antifungal,

anti-inflammatory, antispasmodic; generally safe; low toxicity

Ylang-ylang, neroli, bergamot, lavender,

clary sage, petitgrain, geranium, citronella

Hydrocarbons Terpenes

Antiseptic, bactericidal, antiviral; may be

expectorant, decongestant, stimulant

Bay, verbena, pine, juniper, tea tree

Ketones Calming, sedative, analgesic, promote

wound healing; not for long-term use; never used in pregnancy

Caraway, dill, spearmint, peppermint, jasmine,

rosemary, sage, fennel

Lactones Calming; potentially photocarcinogenic;

triggered by action of light; never use before sun exposure

Bergamot, orange, mandarin, lemon

Oxygenated hydrocarbons

Alcohols

Antiviral, bactericidal, stimulate immune

system; non–skin irritating; generally safe for children and the elderly

Rose, geranium, citronella, rosewood, coriander, euca-

lyptus

Phenols Antiseptic, bactericidal, stimulate immune

system, stimulate central nervous system; very potent; handle with great care, since these can irri- tate the skin and mucous membranes

Thyme, sage, oregano, clove, cinnamon leaf,

ylang-ylang

Sources: Clark ( 2009 ); Schiller et al. ( 2013 ); Schnaubelt ( 2011 ).

138 Unit 3 • Botanical Healing

the brain. The cilia detect scents, and the nerve cells relay this information directly to the limbic system, triggering memories and influencing behavior. The amygdala of the limbic system, which stores and releases emotional memories, is most sensitive to odor or fragrance. Thus, the sense of smell can evoke powerful memories in a split second and change people’s perceptions and behaviors. Odors are powerful memory stimulants even when they are not actually present. Just thinking or talking about a particular odor can unleash many memories. Olfactory stimulation can trigger negative responses such as intense fear or panic, or can trigger positive feelings with increased release of endorphins and neurotransmitters. Odors stimulate the pituitary gland and hypothalamus and thus affect the production of hor- mones that control appetite, insulin production, body temperature, metabo- lism, stress levels, and sex drive. Unlike vision and hearing, the sense of smell is fully functional at birth. Newborns can recognize their mothers by smell, and this sensory response is an important part of bonding. In adult relationships, the sense of smell has a significant role in sensual and sexual attraction ( Krautwurst, 2008 ).

In addition to activating the central nervous system, inhaled oil mole- cules enter the respiratory system. There the molecules attach to oxygen mol- ecules and circulate throughout the body, bringing with them the potential for activating self-healing processes. The equivalent in conventional medicine is the use of inhalers in the treatment of asthma. Essential oils can be inhaled directly or mixed with a carrier oil. Electrical and fan-assisted equipment or an aromatherapy lightbulb ring may be used to scent a room for therapeutic purposes or to simply make the environment more pleasant. Steam inhalers can be used in the treatment of respiratory infections.

Applied externally, essential oils can calm inflamed or irritated skin, soothe sore muscles, decrease muscular tension, and release muscle spasms. Molecules of essential oils are so tiny they are quickly absorbed through the skin and enter the intercellular fluid and the circulatory system, bringing healing nutrients to the cells. Some oils such as basil, tea tree, and thyme encourage the production of white blood cells, while others such as lavender and eucalyptus fight harmful bacteria, viruses, and fungi. Oils may be applied just about anywhere: neck, face, wrists, over the heart, back, arms, legs, and feet. Massage therapists and acupuncturists often use essential oils in their treatments. Benefits are gained not only from the penetration of the oil through the skin but also from inhalation of the vapor and from direct massage of the skin and muscles. Essential oils do not remain in the body but are excreted in urine, feces, perspiration, and exhalation, usually in 3 to 6 hours ( Schiller et al., 2013 ).

A diffuser is a special air pump designed to disburse the oil as an extremely fine vapor into the atmosphere, where it stays suspended for sev- eral hours. Diffusing releases antiviral, antibacterial, and antiseptic properties. Unlike commercial air fresheners, which mask odors, essential oils clean the air by altering the structure of the molecules that create an unpleasant smell. Essential oils help remove dust particles from the air and, when diffused in

Chapter 8 • Aromatherapy 139

the room, can be an effective air filtration system. Diffusers should be used with caution by people with respiratory problems and or allergies, by children, and by pregnant women.

It is also believed that there is a psychological component to the effect of essential oils. Odors associated with either positive or negative emotional feelings and experiences trigger the same feelings when smelled at a later date. For example, a person may smell bus fumes and instantly recall a bus trip taken as a young child. The olfactory nerve is only two synapses away from the amygdala (involved in emotions) and three synapses away from the hippocampus (involved in memory). Thus, both feeling and memories are an almost instantaneous response to certain odors ( Herz, 2009 ).

TREATMENT

Essential oils influence health on physical, mental, and emotional levels. They have the ability to penetrate cell membranes and transport oxygen and nutri- ents to the cell, and many have antiviral, antibacterial, antifungal, and anti- septic properties. This property of oils may be significant in the future as microbes continue to mutate and develop resistance to known medications. Aromatherapy can be used to

• prompt the body and mind to function more efficiently. • decrease and manage stress. • refresh or recharge oneself. • regulate moods, either by energizing or sedating. • aid restful sleep. • act as a first-aid measure. • reduce weight. • boost the immune system. • minimize the discomforts of illness and speed recovery. • refresh a room environment.

The purity and authenticity of essential oils is critical to their effec- tiveness. Oils that are diluted, adulterated, or synthetic should not be used for aromatherapy. Those identified as commercial-grade essential oils are likely to be diluted or adulterated in some way. Some are diluted with chemical carriers and passed on to the consumer as “pure essential oils.” These are often found in bath and cosmetic shops. Those labeled as “infused oils” are also adulterated. “Nature identical” oils are synthetic petrochemical-based products. They have been developed to closely mimic the smell and composition of essential oils. They are not identical, how- ever, and lack many of the healing components of essential oils. Other names for synthetic oils are aroma-chemicals, perfume oils , and fragrance oils . Manufacturers are not restricted in labeling essential oils. In general, those described with terms such as genuine, authentic , or premium are more likely

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to be pure essential oils. Informed consumers read labels carefully and buy from reputable dealers.

Essential oils are quite potent and can irritate the skin, so they should be diluted with a carrier oil before being used on the skin. Carrier oils con- tain vitamins, proteins, and minerals that provide the body with added nutrients. Some carrier oils can be purchased at supermarkets, while oth- ers may be available only at health food stores. Carrier oils include apricot kernel oil, sunflower oil, soy oil, sweet almond oil, grapeseed oil, sesame

BOX 8.1

Blending Oils According to Effects

Soothing oils: Chamomile Uplifting oils: Black pepper, coriander, jasmine, juniper, eucalyptus, peppermint, tea tree Balancing oils: Cypress, lavender Uplifting and soothing oils: Basil, bergamot, frankincense, ginger, neroli, orange, patchouli, sandalwood Uplifting and stimulating oils: Cedarwood, lemon, lemongrass, myrrh, pine, rose, rosemary, ylang-ylang Uplifting and balancing oils: Clary sage, geranium

Examples of Blends Basil, lavender Bergamot, cypress, jasmine Chamomile, lavender Clary sage, lavender, sandalwood Eucalyptus, chamomile, lavender, bergamot Geranium, bergamot, lemon, lavender Ginger, lavender, orange, neroli Jasmine, rose, lemon, black pepper Juniper, bergamot, geranium, frankincense Lemon, tea tree, ylang-ylang Pine, eucalyptus, lavender Patchouli, bergamot, geranium Peppermint, lavender Sandalwood, ylang-ylang, black pepper, neroli

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oil, avocado oil, jojoba, and wheat-germ oil. The fragrance does not have to be intense to be effective. In fact, the more intense the odor, the less pleasant it becomes.

Blending together two or more pure essential oils can create a synergis- tic effect; that is, the blend can be more powerful than the sum of its parts. The interaction of the oils also adds vibrancy to the blend. Essential oils that com- plement each other are combined. For example, the calming effects of laven- der and bergamot or rosemary work well together. Oils that produce opposite effects, such as a soothing oil and a stimulating oil, should not be blended. It is also important that the blend have a pleasing scent. See Box 8.1 for catego- ries of oils to consider when formulating blends. See books on essential oils for amounts of oils to use.

RESEARCH

The research basis for aromatherapy is in its infancy. Much of the research has been performed on animals and isolated tissue cultures. Few trials have been conducted on humans under clinical conditions. Many of the studies are prac- tice based and anecdotal, and little is known at this time about possible inter- actions with conventional medications or treatments. Nurses are conducting much of the aromatherapy research in conventional health care settings. A number of studies are being done in intensive care settings and in the fields of midwifery, palliative care, and geriatric care. Difficulties with research include chemical inconsistencies across laboratories, the impact of culture on odor perception, individual experiences with odors, and gender differences in sen- sitivity to odors.

The following is a small sample of findings of aromatherapy studies:

• An evidence summary by the Joanna Briggs Institute found that aroma- therapy should be considered as an adjunct therapy to antiemetic drug therapy to prevent postoperative nausea and vomiting (Grade A; Moola, 2012 ).

• An evidence summary by the Joanna Briggs Institute found that there is insufficient evidence to recommend aromatherapy for pain manage- ment in patients with cancer ( Woodward, 2011 ).

• An evidence summary by the Joanna Briggs Institute found that aroma- therapy in conjunction with massage may assist in short-term relief of anxiety ( Carstens, 2010 ).

• A systematic review of studies involving aromatherapy for treatment of hypertension found no convincing evidence of effectiveness ( Hur, Lee, Kim, & Ernst, 2012 ).

• In a randomized double-blind clinical trial on the use of lavender, clary sage, and marjoram for women with primary dysmenorrhea, the partici- pants applied the essential oil massage cream to their lower abdomen. The aromatic oil massage significantly reduced the duration of men- strual pain ( Ou, Hsu, Cai, Lin, & Lin, 2012 ).

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• A pilot study examining the impact of inhalation of a rose and lavender blend indicated significant improvement in anxiety and depression lev- els in high-risk postpartum women ( Conrad & Adams, 2012 ).

INTEGRATED NURSING PRACTICE

Worldwide, nurses are increasingly providing aromatherapy in a variety of health care settings. Essential oils can be combined with carrier oils and used for back rubs and foot rubs to help clients relax and decrease their levels of anxiety. Other essential oils can be used as an adjunct to conventional approaches to boost the production of white blood cells and to utilize their antibacterial or antiviral action. Acute-care and long-term care settings often have unpleasant smells in rooms and hallways. Essential oils such as rose- mary, lemon, tangerine, mandarin, and lemongrass can be diffused into the air to alter the structure of the molecules creating the odor, thus refreshing the environment. Diffusion of essential oils can also help boost the client’s immune system, decrease anxiety and stress, aid restful sleep, and speed recovery. Essential oils can be used to enhance sedation, thereby decreasing the need for nighttime medication.

Nurses can teach people a number of things about the use of essen- tial oils. As a general rule, people should purchase essential oils in natu- ral and health food stores rather than stores selling beauty products and perfumes. Oils should be stored in tightly closed dark vials away from heat, light, or dampness. Essential oils should not be ingested, because even modest amounts can be fatal. They must be kept away from chil- dren and pets. Pregnant women, children, and persons with pulmonary disorders, allergies, or epilepsy should consult a knowledgeable health care practitioner or qualified aromatherapist before using essential oils. Some oils can trigger bronchial spasms, so persons with asthma should consult their primary health care provider before using oils. Oils other than lavender or tea tree oil must always be diluted before being applied to the skin. Individuals who have sensitive skin or allergies should take extra care in massaging the oils into the skin or inhaling the essential oil aromas. People should not rub their eyes if they have any essential oil on their hands. Several oils are photosensitive or phototoxic and can cause severe sunburn if the skin is exposed to the sun within 6 hours after application. These oils include clove, bergamot, angelica, verbena, bitter and sweet orange, lemon, lime, and mandarin. Certain oils can be highly toxic, so their use should be limited to qualified aromatherapists. These oils include boldo leaf, calamus, yellow camphor, horseradish, rue, sas- safras, savin, tansy, wintergreen, wormseed, and wormwood.

Professional aromatherapists use up to 50 oils. Most people can meet their home needs with just 10: chamomile, clove, eucalyptus, geranium, lav- ender, lemon, peppermint, rosemary, tea tree, and thyme. Box 8.2 describes helpful oils you can encourage people to have available at home.

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BOX 8.2

Helpful Oils to Have at Home

Oil Use

Basil Decrease sinus congestion; soothe GI tract, aid digestion; decrease headache; decrease anxiety; decrease menstrual cramps Bergamot Decrease anxiety, decrease depression; urinary antiseptic; acne, disinfectant for wounds, abscesses, boils Cedarwood Decrease respiratory congestion and coughs, expectorant; for pain swelling of arthritis; antifungal for skin rashes Chamomile Soothe muscle aches, sprains, swollen joints; GI antispasmodic; rub on abdomen for colic, indigestion, gas; decrease anxiety,

stress-related headaches; decrease insomnia; can be used with children

Clary sage Induce sleep; increase sense of well-being; massage or warm compress for menstrual cramps; do not use in pregnancy

until onset of labor Coriander Improve digestion, decrease colic, decrease diarrhea; decrease muscle aches and stiffness in joints; decrease mental fatigue,

and increase memory and mental function Cypress Massage or cold compress for rheumatic aches; bruising or varicose veins; respiratory antispasmodic (put couple of drops

on handkerchief or tissue and inhale deeply), decrease coughs, asthma, bronchitis

Elemi Boost immune system; cystitis; speed bone healing (massage in prior to casting); speed healing of cuts, sores, wounds; cool

inflamed skin; sedative Eucalyptus Feels cool to skin and warm to muscles; decrease fever; relieve pain; anti-inflammatory; antiseptic, antiviral, and expectorant for

respiratory system in steam inhalation; boost immune system Frankincense Bronchodilatory, acts on mucus, enabling sputum to be expelled; infected sores; deepen breathing to induce calmness;

incense creates a state conducive to prayer or meditation Geranium Antibacterial; insecticidal; antidepressant; improve yeast infections; first aid on minor cuts and burns Ginger Help ward off colds; calm upset stomach, decrease nausea; soothe sprains, muscle spasms Green apple Reduce headache severity; decrease anxiety; aid in weight reduction program; reduce symptoms of claustrophobia Jasmine Uplifting and stimulating, antidepressant; massage abdomen and lower back for menstrual cramps Juniper Calming, decrease stress; diuretic; muscle aches and pains

(continued )

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TRY THIS Soothing Potions

Rosewater

Instead of using soap, try splashing your face with rosewater, a simple infusion from rose petals containing some of the flowers’ essential oils. Rose oil has mild antiseptic and

Lavender Calming, sedative, for insomnia; massage around temples for headache; inhale to speed recovery from colds, flu; massage

chest to decrease congestion; heal burns Lemongrass Sedative; skin antiseptic for acne Marjoram Insomnia, decrease tension; muscle and joint pain; inhale to clear sinuses and clear congestion; massage abdomen for

menstrual cramps Neroli Gentle sedative for insomnia, panic attacks; massage abdomen for irritable bowel syndrome Orange General tonic; decrease anxiety; GI antispasmodic for colic and indigestion; massage abdomen for constipation; can be used

with children Peppermint Increase alertness; GI antispasmodic for colic and indigestion; massage on temples for headache; decongestant for colds, flu Petitgrain Useful for acne and oily skin; decreases muscle spasms; gentle sedative Rose Antidepressant; increase alertness; compress for eyestrain, headaches; use in massage for PMS Rosemary Stimulating; increase circulation to skin; compress on swollen joints; decrease respiratory congestion; antifungal, antibacterial;

deodorize the air Sandalwood Calm and cool body; decrease inflammation; drops on handkerchief for sore throat, congestion; in bath water for

cystitis; improve chapped dry skin; increase sense of peace in meditation or prayer

Tea tree First-aid kit in a bottle; antifungal, good for athlete’s foot; soothe insect bites, stings, cuts, wounds; in bath for yeast

infection; drops on handkerchief for coughs, congestion Vetiver Stimulate production of red blood cells; increase circulation; induce restful sleep; decrease tension Ylang-ylang Soothe CNS, decrease depression, increase euphoric mood; decrease blood pressure; regulate respiration; calm heart

palpitations

Sources: Harding ( 2013 ); Schiller et al. (2013); Tucker (2012).

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anti-inflammatory action, and it can reduce redness in the skin by constricting the tiny blood vessels. It is also used in aromatherapy to calm the nerves and elevate mood. You can buy rosewater in any natural food store, but you can also make your own. Put a handful of fresh rose petals into a small saucepan, add enough water to cover the petals completely, simmer for 15 minutes, and then remove the pan from the heat. When the mixture is completely cooled, strain away the petals and transfer your rosewater to a clean glass bottle.

Adult Cold Care

2 drops eucalyptus

5 drops geranium

3 drops peppermint

5 drops rosemary

Mix oils together. Use in any of the following ways:

• Put several drops in a diffuser. • Put 2 drops on a tissue and breathe in the aroma. • Put 4 drops in a bath. • Add 8 drops to 2 tablespoons of carrier oil and massage the chest, back, neck,

forehead, nose, and cheekbones.

Natural Sleep Aid

• Put 2 drops of lavender on your pillowcase. • Combine 3 drops chamomile, 4 drops lavender, 3 drops orange, and 5 ounces of

water. Using a spray bottle, spray linens and room air before sleeping.

Body Scrub

• 2 parts small-grain salt or sugar • 1 part oil (olive, coconut, almond, safflower, vegetable, baby) • 5 drops of preferred essential oil • Use on dry skin to exfoliate. Rinse well.

Source: Fitzsimmons & Bousquet ( 1998 ); Hoffman & Fox ( 2006 ); Schiller et al. ( 2013 ).

Considering the Evidence

Y.-L. Lee, B. Wu, H. W. H. Tsang, A. Y. Leung, and W. M. Cheung, 2011, A systematic review on the anxiolytic effects of aromatherapy in people with anxiety symptoms, Journal of Alternative and Complementary Medicine, 17: 101–108.

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What Was the Type of Research? Systematic review of randomized clinical control trials (RCTs)

What Was the Purpose of the Research? To synthesize, appraise, and evaluate relevant RCTs concerning the anxiolytic effects of aromatherapy as an intervention in persons living with anxiety symptoms identified through valid inventories

How Was the Research Done? The authors used a systematic review methodology to examine RCTs relevant to the purpose of this research. They employed a comprehensive search strategy using selected keywords and nine databases and the Handbook of Psychiatry to identify randomized clinical controlled trials focusing on anxiety disorders, anxiety, anxious symptom or anxiolytic effects, aromatherapy aroma, or essential oil. The researchers independently identified RCTs that used aromatherapy as the intervention to decrease anxiety symptoms that were measured by a valid tool. Fifty-two studies were considered relevant for evaluation. Ultimately, 16 RCTs met the inclusion criteria. A total of 25,377 subjects were included in the 16 studies, the majority of whom were female, and ages ranged from 18 to 90. Types of aromatherapies included aromatherapy massage, inhalation, tablet intake, and footbath. Duration of exposure to aromatherapy massage was from 20 minutes to 1 hour, and duration of inhalation ranged from 5 minutes to 60 minutes. Lavender was the most commonly used essential oil used in the studies. All the studies included participants experiencing anxiety secondary to another primary diagnosis. None of the subjects had a primary diagnosis of anxiety disorder.

What Were the Findings of the Research? Fourteen studies suggested positive findings related to the anxiolytic effects of aroma- therapy. The subjects in the treatment group exposed to aromatherapy experienced better outcomes in reducing anxiety than the control group. Seven studies suggested that the benefits of aromatherapy were superior to those of conventional therapy or a placebo. One study reported that an oral lavender oil capsule was as effective as some medications used for generalized anxiety disorders.

What Additional Questions Might I Have? What would be the effect of aromatherapy in combination with other complementary and alternative therapies? Could aromatherapy have an effect on the quality of life in persons living with other health challenges? Does aromatherapy have long-term effects on decreasing anxiety? Are there side effects associated with the oral intake of lavender oil? What is the effectiveness of aromatherapy in persons with a primary diagnosis of anxiety disorder? Are there additional studies currently being done to investigate the effect of anxiolytic effects of aromatherapy to strengthen the evidence?

How Can I Use This Study? This systematic review has considerable clinical value for nurses caring for persons living with anxiety. Nurses should recognize that aromatherapy may be an appropriate, inexpensive, and safe intervention for enhancing the quality of life for those individuals experiencing anxiety.

Source: Contributed by Dolores M. Huffman, RN, PhD.

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References

Carstens, J. (2010). Complementary ther- apies (aromatherapy and herbal med- icine): Clinician information. Joanna Briggs Institute Evidence Summary. Retrieved from http://connect .jbiconnectplus.org/ViewDocument .aspx?0=3771

Clark, S. (2009). Essential Chemistry for Safe Aromatherapy (2nd ed.). Edinburgh, UK: Churchill Livingstone.

Cline, M., Taylor, J. E., Flores, J., Bracken, S., McCall, S., & Ceremuga, T. E. (2008). Investigation of the anxiolytic effects of linalool, a lavender extract, in the male Sprague-Dawley rat. American Association of Nurse Anesthetists Journal , 76(1): 47–52.

Conrad, P., & Adams, C. (2012). The effects of clinical aromatherapy for anxiety and depression in the high risk postpartum woman: A pilot study. Complementary Therapies in Clinical Practice, 18: 164–168. doi: 10.1016/ j.ctcp.2012.05.002

Harding, J. (2013). The Essential Guide to Oils. London, UK: Watkins.

Herz, R. S. (2009). Aromatherapy facts and fictions: A scientific analysis of olfactory effects on mood, physiology and behav- ior. International Journal of Neuroscience. doi: 10.1080/00207450802333953

Hoffman, R., & Fox, B. (2006). Alternative Cures That Really Work . New York, NY: Rodale.

Hur, M.-H., Lee, M. S., Kim, C., & Ernst, E. (2012). Aromatherapy for treat- ment of hypertension: A systematic review. Journal of Evaluation in Clinical Practice, 18: 37–41. doi: 10.1111/j.1365-2753.2010.01521.x

Krautwurst, D. (2008). Human olfactory receptor families and their odorants. Chemistry & Biodiversity , 5(6): 842–852.

McGuigan, M. (2007). Hypothesis: Do homeopathic medicines exert their action in humans and animals via the vomeronasal system? Homeopathy , 96(2): 113–119.

Moola, S. (2012). Postoperative nausea and vomiting: Complementary Therapies. Joanna Briggs Institute Evidence Sum- mary. Retrieved from http://connect .jbiconnectplus.org/ViewDocument .aspx?0=7166

Ou, M.-C., Hsu, T.-F., Lai, A. C., Lin, Y.-T., & Lin, C.-C. (2012). Pain relief assessment by aromatic essential oil massage on outpatients with primary dysmenorrhea: A randomized, double- blind clinical trail. Obstetrics and Gyn- aecology Research, 38: 817–822. doi: 10.1111/j.1447-0756.2011.018002.x

Schiller, D., Schiller, C., & Schiller, J. (2013). The Aromatherapy Encyclopedia . Laguna Beach, CA: Basic Health.

Schnaubelt, K. (2011). The Healing Intelli- gence of Essential Oils. Rochester, VT: Healing Arts Press.

Thomas, D. V. (2002). Aromatherapy: Mythical, magical, or medicinal? Holis- tic Nursing Practice , 17(1): 8–16.

Tucker, L. (2012). Introductory Guide to Aromatherapy (2nd ed.). London, UK: EMS.

Woodard, E. (2011). Cancer patients: Pain management by complementary ther- apies. Joanna Briggs Institute Evidence Summary. Retrieved from http://connect .jbiconnectplus.org/ViewDocument .aspx?0=6654

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Resources

Aromatherapy Registration Council 5940 SW Hood Ave. Portland, OR 97039 503.244.0726 www.aromatherapycouncil.org

Institute of Integrative Aromatherapy P.O. Box 19241 Boulder, CO 80308 303.545.2002 www.aroma-rn.com

International Federation of Aromatherapists 20A The Mall Ealing, London W5 2PJ 44(0).567.2243 www.ifaroma.org

National Association for Holistic Aromatherapy (NAHA) P.O. Box 1868 Banner Elk, NC 28604 828.898.6161 www.naha.org

Smell and Taste Treatment and Research Foundation 845 N. Michigan Ave., Suite 990W Chicago, IL 60611 312.649.5829 www.smellandtaste.org

9 Homeopathy

Miracles do not happen in contradiction of nature, but in contradiction to what we

know about nature.

Saint Augustine

The term homeopathy is derived from the Greek words omoios , meaning “similar,” and pathos , meaning “feeling.” It is a self-healing system, assisted by small doses of remedies or medicines, that is useful in a variety of acute and chronic disor- ders. The practice of homeopathy in the United States has increased tremendously since the 1980s, corresponding to the increase in other forms of alternative medicine. Homeopathic medicine is practiced worldwide, especially in Europe, Latin America, and Asia.

In the United States, the homeopathic drug market has grown into a multimillion-dollar industry. Most of these reme- dies are not regulated by the U.S. Food and Drug Administration (FDA) and are available as over-the-counter medications.

BACKGROUND

As a therapeutic system, homeopathy is approximately two hun- dred years old. It was developed by Samuel Hahnemann (1755– 1843), a German physician and chemist. Homeopathy spread through most of Europe and to the United States, Russia, and Latin America in the 1830s. During epidemics of cholera, typhus, and scarlet fever, homeopathy was significantly more effective than the conventional medical approaches of the times. In 1869, the American Institute of Homeopathy opened free dispensaries for the poor and voted to admit female physicians, unheard of in conventional medicine. By the 1890s, 15% of U.S. physicians were using some homeopathic remedies in their practice, were being

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educated in the 22 homeopathic medical schools, and were practicing in more than 100 homeopathic hospitals ( Feingold, 2008 ).

During and after the Civil War, the practice of medicine began to change with technical achievements such as anesthesia, antisepsis, surgery, microbi- ology, vaccines, and antibiotics. State legislatures began to license physicians and to accredit medical schools. The American Medical Association (AMA) invited homeopaths to become members in exchange for licensing, seeking to create a monopoly against lay healers, midwives, and herbalists. When homeopaths chose not to join forces, the AMA began to persecute homeopa- thy and, in 1914, proposed uniform standards of medical education. The AMA also assumed the power of accreditation, using it to phase out homeopathic colleges. Between the 1920s and 1970s, homeopathic education in the United States was almost nonexistent ( Wauters, 2007 ).

PREPARATION

About half the homeopaths in the United States are physicians. The others are licensed health care practitioners such as nurse practitioners, dentists, naturo- pathic physicians, chiropractors, acupuncturists, and veterinarians. Nonlicensed homeopathic practitioners can “counsel” people, but they cannot state or imply that they can diagnose or treat illnesses. The Council for Homeopathic Certifica- tion administers the certification process, which involves a specified number of hours of training, 3 years of clinical practice, and written and oral examinations. Certification gives one the right to place the designation DHt after one’s name.

CONCEPTS

Law of Similars

Hahnemann proposed the use of the law of similars, which claims that a nat- ural substance that produces a given symptom in a healthy person cures it in a sick person. The substance whose symptom-picture most closely resembles the illness being treated is the one most likely to initiate a curative response for that person—hence the name homeopathy —“similar feeling.”

If taken in large amounts, these natural compounds will produce symp- toms of disease. In the doses used by homeopaths, however, these remedies stimulate a person’s self-healing capacity. As Andrew Weil stated, “The dif- ference between a poison and a medicine is the dose” ( Frye, 1997 , p. 846 ). An example is the use of ipecac, which in large doses causes severe nausea and vomiting. People who are experiencing nausea and vomiting, however, can use a remedy made with ipecac to cure those same symptoms ( Waisse, 2012 ).

Law of Infinitesimals

Natural healing compounds are specially prepared for homeopathic use through a process of serial dilution. The compound is first dissolved in either water or a water/alcohol mixture and is called the “mother tincture.”

Chapter 9 • Homeopathy 151

One drop of the tincture is then mixed with 9 drops of water/alcohol to form a 1:10 dilution, and this dilution process is repeated many times depending on the potency being prepared. At each step of the dilution, the vial is vigorously shaken, a process called succussion, which is an essential step. Thus, the nota- tion 6X on a remedy means that the procedure (diluting and succussing) has been repeated sequentially six times. The concentration of the active substance is then one part in 10 raised to the sixth power (10 6 ), or one part per million. Dilutions of 30X and 200X are common. The homeopathic belief is that the more the substance is diluted, the more potent it becomes as a remedy.

The remedies are diluted beyond the point at which any molecules of the substance can theoretically still be found in the solution. This paradox, that the remedy becomes more potent through dilution, is the reason many biomedical scientists reject homeopathic medicine. Just as the mechanisms of many con- ventional drugs are not fully understood, it is not presently known how homeo- pathic remedies work, but a number of theories have been proposed.

A remedy may be like a hologram. No matter how many times a sub- stance is diluted, a smaller but complete essence of the substance remains. Modern chaos theory supports the observation that major changes occur in living organisms when bodily substances are activated only slightly. The basic assumption of chaos theory is that minute changes can have huge effects. Advances in quantum physics have led some scientists to suggest that the imprinting of electromagnetic energy in the remedies interacts with the body on some level. Gas discharge visualization technology may provide an elec- tromagnetic probe into the properties of homeopathic remedies in the future. Researchers in physical chemistry have proposed the memory-of-water the- ory in which the structure of the water/alcohol solution is altered during the process of dilution and retains its new structure even after the substance is no longer present. It seems likely that remedies work through a bioenergetic or subatomic mechanism that is not yet capable of being understood. The situa- tion may be likened to any number of advances in the understanding of energy such as radio, television, microwave ovens, and cordless telephones that previously were virtually unimaginable ( Griffith, 2012 ; Waisse, 2012 ).

In the 1920s and 1930s, Dr. Bach, a bacteriologist, a pathologist, a homeo- pathic physician, and an intuitive healer, discovered flower essences. He believed that emotions such as anger, hate, or fear negatively affect the immune system, leading to stress, pain, and illness. He experimented with a number of flowers, eventually creating a treatment system involving 38 dif- ferent types of wildflowers. Flowers are placed in a clear glass bowl filled with purified water and placed in direct sunlight, which transfers the energy of the blossom into the water—a process called infusion. Bach’s flower essences are diluted but not as much as homeopathic remedies. The remedies are placed under the tongue or in a glass of liquid four times a day. They are usually safe for even infants and the elderly and are thought to contribute to physical, emotional, mental, and spiritual healing. The best known remedy is the Bach Rescue Remedy, which is used to calm people (and pets) in any stressful situation ( Balch, 2010 ).

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VIEW OF HEALTH AND ILLNESS

Homeopathy is a method for treating the sick rather than a set of hypotheses about the nature of health and illness. However, the underlying assumption is that a vital force—known as qi or prana in other traditions—exists. It is necessary to have adequate nutrition, exercise, rest, good hygiene, and a healthy environment to establish and to maintain homeostasis. In other words, health is the ability of people to adapt their equilibrium in response to internal and external change. Illness is primarily a disturbance of the vital force manifesting as symptoms of distress. Vital force or life energy is the ultimate origin of health and illness alike, ending only with the death of the person ( Griffith, 2012 ).

Symptoms of illness represent a body’s attempts to heal itself. Thus, homeopathy views symptoms as an adaptive reaction that is the best possible response that can be made in the present circumstances. For example, a cough is the body’s attempt to clear the bronchi; inflammation is the body’s effort to wall off and burn out invading foreign bodies; and fever is the body’s way of creating an internal environment that is less conducive to bac- terial or viral growth. Given this perspective, the therapeutic approach is to aid the body’s efforts to adapt to stress or infection. Thus, for someone with a high fever, homeopaths may recommend belladonna, which increases the natural healing response of body heat. The law of similars is a stimulation of immune and defense responses leading to spontaneous resolution of symp- toms as the illness is conquered. In like manner, two of the few conventional therapies that seek to stimulate the body’s own healing reaction, immuniza- tion and allergy treatment, have the homeopathic law of similars as their basis. Other applications in conventional medicine include the use of radia- tion in the treatment of cancer and Ritalin in the treatment of children with hyperactivity disorders. The majority of interventions in biomedicine, how- ever, attempt to oppose symptoms by exerting a greater and opposite force. Medicines are designed to “cure” by suppressing symptoms, such as when aspirin is used in an effort to control or limit fevers. The danger is that, over time, suppressive treatments may actually strengthen disease processes instead of resolving them ( Schmidt, 2012 ).

DIAGNOSTIC METHODS

Homeopathic diagnosis is holistic and detailed; the initial assessment may last several hours. Practitioners assess the whole person, examining every aspect of physical, emotional, and mental life. A multitude of factors are con- sidered, such as nutritional status, emotional imbalance, and environmental stress. It is believed that no part can be isolated from the whole person. The homeopathic interview itself is a powerful healing experience because clients are encouraged to tell their story in its entirety. They are encouraged to speak for as long a time as possible. This process of sharing pain and suffering begins the healing process. During the interview, the practitioner observes

Chapter 9 • Homeopathy 153

everything about the person, including posture, dress, facial expression, tone of voice, rate of speech, and so forth. The physical exam is a head-to-toe assessment with the inclusion of laboratory work as needed to establish a diagnosis. Answers to questions are elicited in an attempt to fully understand the significance of symptoms:

• Subjective symptoms such as pain, vertigo, fatigue, or anger • Localization of symptoms such as one sided, wandering, radiating,

or diffuse • Factors that modify the symptoms, making them better or worse, such

as time of day, hot or cold, weather, diet, or emotional state • Quality of symptoms such as burning, aching, throbbing • Rate of onset or resolution of the symptoms, such as sudden or gradual • Symptoms that appear simultaneously or in sequence

Symptoms are classified into three categories—the general physical symptoms, the local symptoms, and the mental and emotional symptoms. General physical symptoms include such factors as sleep, appetite, energy, tem- perature, or generalized body pain. Local symptoms occur in particular parts of the body, such as swelling in the right elbow or pain in the left leg. Included in local symptoms are those related to a specific organ function, such as short- ness of breath or palpitations. Mental and emotional symptoms include anxiety, irritability, anger, tearfulness, isolation, or suspiciousness. This composite picture of the person is far more important than any isolated laboratory find- ings or abstract disease category in formulating the diagnosis. Homeopathic practitioners do not hesitate to refer to biomedical specialists for conventional drugs or surgery.

TREATMENT

Homeopathy is not a complete system of medicine in itself and should be used in conjunction with biomedicine. As in other complementary and alternative practices, the initial question is always, Who is the person? rather than, What is the disease? This focus ensures an individualized approach to treatment. Each person with the same presenting complaint may be treated with different rem- edies depending on the totality of physical, mental, and emotional symptoms. A person with a sore throat may be prescribed one of six or seven common remedies for sore throats, depending on whether the pain is worse on the right or left side, what time of day it is worse, how thirst and appetite are affected, and the individual’s emotional state ( Feingold, 2008 ).

Homeopathic practitioners see the purpose of treatment as stimulating the individual’s self-healing powers. The science and the art of homeopathy is to find the remedy with the ability to mimic most closely the sick person’s pattern of symptoms. Practitioners use only one remedy at a time, since administering different remedies for different symptoms makes it difficult to know which remedy was effective. Not only are the smallest possible doses used but typically only one dose is given, which allows time for the remedy

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to complete its action without further interference. If necessary, a dose may be repeated or another remedy may be tried. A temporary worsening of the symptoms may occur after receiving the remedy, which is usually mild and short-lived and may be an indication that the correct remedy was chosen ( Waisse, 2012 ).

Homeopathy is used to treat both acute and chronic health problems as well as for health promotion. It cannot cure conditions resulting from structural, long-term organic changes such as cirrhosis, diabetes, chronic obstructive lung disease, advanced neurological diseases, or cancer. In some of these cases, homeopathy can palliate the symptoms and increase the client’s comfort level. Traumatic injuries affect nearly everyone in similar ways, and  thus the remedies are fairly standard. Epidemic infectious diseases also tend to affect most victims in the same way, and individuals are usually treated with the same remedy. Common infectious illnesses such as urinary tract infections, respiratory infections, and ear infections demonstrate more individual symptoms and require more individualization in selecting the remedy. Chronic illness such as ulcerative colitis, rheumatoid arthritis, asthma, and skin disorders are considered to be constitutional. Thus, these disorders require the most skillful assessment, individualized prescription, and follow-up ( Schmidt, 2012 ; Schneider, Schneider, Hanisch, & van Haselen, 2008 ).

The Homeopathic Pharmacopoeia of the United States ( Borneman & Foxman, 1989 ), listing more than 2,000 remedies, is the official standard for preparation and prescription. Most remedies come from plants used in traditional herbal medicine. A few remedies come from animal sources, and others, from natu- rally occurring chemical compounds. Box 9.1 lists examples of remedies. Some, such as mercury and belladonna, would be poisonous in large doses but are safe in the superdilute homeopathic doses. These remedies rank among the safest medicines available ( Waisse, 2012 ). Homeopathic medicines found in most health food stores are called combination medicines or formulas because they contain between three and eight different homeopathic medi- cines mixed together. The various manufacturers choose the medicines most commonly prescribed for specific symptoms and assume that one of them will help cure the ailment of each consumer. Professional homeopaths believe that the remedy individually chosen for the person tends to work more often and more effectively than these combinations.

RESEARCH

As in other areas of medical research, the two questions to be answered are, How does it work? and How well does it work? Many researchers are study- ing the physics of how homeopathic remedies work. It currently seems likely that remedies work through a bioenergetic or subatomic mechanism that is not yet understood or measurable. Research in the areas of quantum physics, physical chemistry, and biochemistry may someday be able to explain how the remedies work.

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One of the difficulties in using the standard randomized, placebo- controlled paradigm for homeopathic remedies is that the treatments are individualized. Unlike with biomedicine, each person with the illness is likely to be prescribed a different remedy based on holistic assessment. In addition, there is no uniform prescribing standard for homeopaths.

A small sampling of studies included the following findings:

• A systematic review of homeopathy for eczema found that the three clinical trails that met the inclusion criteria failed to show that homeopa- thy is an effective treatment for this skin disorder ( Ernst, 2012 ).

• A study of EEG changes in response to olfactory stimulation with two remedies showed some positive correlation, indicating the need for additional neuroimaging research on the physiologic effects of homeo- pathic remedies ( Bell, Howerter, Jackson, Brooks, & Schwartz, 2012 ).

BOX 9.1

Examples of Homeopathic Remedies

Plant Mineral Animal

Herbs: comfrey, eyebright, Metals: copper, gold, Venoms: jellyfish, insects, mullein, yellow dock lead, tin, zinc spiders, mollusks, crustaceans, fish, snakes, amphibians Foods and spices: Salts: calcium sulfate, Secretions: ambergris, cayenne, garlic, sodium chloride, musk, cuttlefish ink mustard, onion potassium carbonate Fragrances, resins, Acids: hydrochloric, Milks residues: amber, nitric, phosphoric, petroleum, charcoal sulfuric creosote Mushrooms, lichens, Elemental substances: Hormones mosses carbon, hydrogen, iodine, phosphorus, sulfur Constituents of earth’s Glandular and tissue crust: silica, aluminum extracts oxide, ores, rocks, lavas, mineral waters Disease products: vaccines, abscesses, tuberculosis, gonorrhea, syphilis

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• An observational, nonrandomized, multicenter study of children with migraine headaches found that homeopathic treatment decreased the frequency, severity, and duration of migraine attacks ( Danno, Colas, Masson, & Bordet, 2013 ).

• A review of current evidence found that homeopathy was not an effec- tive treatment for generalized anxiety or for specific anxiety disorders ( Sarris et al., 2012).

INTEGRATED NURSING PRACTICE

Nurses, like homeopathic practitioners, emphasize listening to clients’ stories of their lives. It is within the context of people’s lives that nurses identify pat- terns of response to illnesses and disorders and formulate nursing diagnoses. Nursing diagnoses and outcome criteria focus attention on adaptations that may help people live healthier lifestyles. The study of mental health nursing in the basic educational program teaches the value of listening and attending to people’s pain as an intervention to help them begin the process of healing. These principles are common to both nursing and homeopathy, illustrating, once again, the broad base of nursing practice. Some nurse practitioners, valu- ing the contributions of homeopathy to well-being, continue their education and achieve licensure to practice homeopathic medicine. Nurses educated in Western approaches are more likely to suppress symptoms in an attempt to “cure” the disease. In many situations, it may be more beneficial to follow the homeopathic approach and view symptoms as the body’s attempt to heal itself. Clients may improve more quickly when non-life-threatening symp- toms are supported rather than suppressed, such as low- to moderate-grade fevers or productive coughs.

People who are interested in homeopathic remedies can find low- potency remedies in health food stores. Higher potency remedies are obtained from homeopathic pharmaceutical companies under the direction of experi- enced homeopathic prescribers. Because remedies are inactivated by direct sunlight and heat, nurses should teach people to store the preparations in a dark, dry place, away from other strong-smelling substances. When taking a remedy, patients should have nothing by mouth for at least 30 minutes before and after the dose. Many homeopaths discourage the use of coffee, mint, cam- phor, and other strongly aromatic substances while undergoing treatment, since such substances may reverse the effects of the remedy. Camphor is a component in chest rubs as well as in many cosmetics, skin creams, and lip balms. If the remedy is in the form of a pellet, it should be held under the tongue and allowed to dissolve slowly. If the remedy is a liquid, it should be held in the mouth for 1 to 2 minutes before swallowing.

Prescription medications, especially those given for potentially life- threatening disorders such as asthma, should not be stopped abruptly when homeopathic care is begun. As the person improves, however, a downward titration of the biomedical prescription may be needed. Acupuncture and

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chiropractic medicine should not be started at the same time as homeopathic remedies, but if already instituted, may be continued ( Griffith, 2012 ).

A number of homeopathic remedies can be used to speed recovery and prevent recurrences of acute conditions such as colds, stomachaches, coughs, and headaches. Although many remedies are used for conditions that subside on their own, remedies can dramatically speed recovery and often prevent recurrences. Because homeopathic medicines are considerably safer than conventional drugs, it often makes sense to use them first and then consider using conventional drugs if the homeopathic remedies work too slowly or not at all. Individuals should read all the information on the label to select the right remedy. If the label states, for example, that the remedy is best used when the symptoms appear suddenly, then that remedy is not likely to be effective for a condition that emerged almost unnoticed over several days. Nurses can teach clients the following three guidelines for the use of homeopathic remedies:

1. The more the better. The more the symptoms match that of the remedy, the more likely it will work.

2. The less the better. The more dilute the remedy, the more powerful it is. 3. It’s working if you feel better within 24 hours. If not, you may have the

wrong remedy and may need a different remedy or may need to see a health care practitioner.

Many people keep homeopathic remedies on hand and ready to use. See “Try This: Top 10 Remedies” for the most popular remedies that help with the majority of common physical problems and emotional difficulties.

TRY THIS

Top 10 Remedies

Bryonia (wild hops): Used for coughs that are worsened by simple breathing; head- aches that are increased by bending over, walking, or even moving the eyes; consti- pation with dry, hard stools.

Allium cepa (onion): Used for colds or respiratory allergies in which symptoms resemble the reaction of a person exposed to the mist produced when an onion is cut: watery eyes, clear nasal discharge, and sneezes, all of which are aggravated by exposure to heat.

Pulsatilla (windflower): Need is based on the type of person, rather than a specific ailment. Helpful for people who are highly emotional, weepy, impressionable, easily influenced, fearful of abandonment, and worried about what others think of them. May also be used for digestive disorders, allergies, earaches, headaches, insomnia, and premenstrual syndrome.

Ignatia (St. Ignatius bean): Used by persons experiencing anxiety or grief. (continued)

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Arsenicum album (arsenic): Used for many conditions, especially when symptoms are worse after midnight, when burning symptoms are predominant, when great thirst occurs, or when the person is high strung and restless.

Belladonna (deadly nightshade): Used for fever or inflammation that begins rapidly, with a red or flushed appearance; the person is hypersensitive to touch or light.

Gelsemium (yellow jessamine): Used for classic flu symptoms accompanied by lack of thirst. Helpful for headaches in the back part of the head.

Nux vomica (poison nut): Useful after overdosing with food or drink, indigestion, constipation, and headaches that are worse at night and on waking.

Aconitum (monkshood): Used for colds, flu, coughs, and sore throats with rapid onset.

Rhus toxicodendron (poison ivy): Helpful for arthritis syndromes, flu, sprains and strains, and sore throats; used by people who feel pain on initial motion that eases with continued motion and who have symptoms that worsen in cold or wet weather.

Sources: Feingold ( 2008 ); Griffith ( 2012 ); Wauters ( 2007 ).

Considering the Evidence

S. Kassab, M. Cummings, S. Berkovitz, R. van Haselen, & P. Fisher, 2009, Homeopathic medicines for adverse effects of cancer treatments, Cochrane Database of Systematic Reviews, Apr. 15 (2): CD004845. doi: 10.1002/14651858.CD004845.pub

TRY THIS

Pet Remedies

Mercurius solubilis: Inflamed gums; swollen nasal bones and a greenish thick discharge

Podophyllum: Diarrhea with gushy feces containing mucus

Baryta carb: Diarrhea in puppies and young dogs

Arsenicum album or allium cepa: Respiratory symptoms with thin, watery nasal and ocular discharge

Sulfur: Red, itchy skin

Lycopodium or thallium acetas: Hair loss secondary to skin disorders

Source: Kachnic ( 2012 ); Macleod ( 2012 ); Madrewar & Glencross ( 2011 ).

Chapter 9 • Homeopathy 159

What Was the Type of Research? Systematic review of randomized clinical control trials (RCTs)

What Was the Purpose of the Research? To synthesize, appraise, and evaluate relevant RCTs concerning the effectiveness and safety of homeopathic medicines used to prevent or treat adverse effects of cancer treatments

How Was the Research Done? The authors used a systematic review methodology to examine published and unpub- lished RCTs relevant to the purpose of this research. They employed a comprehensive search strategy using selected keywords and extensive electronic databases, gray litera- ture sources, and conference proceedings to identify randomized clinical controlled trials focusing on homeopathic medicines and prevention of adverse effects in persons receiv- ing cancer treatments. Reviewers independently identified the studies, appraised, and extracted the data. Eight RCTs meeting the established criteria were included in this review, which included a total of 664 participants. Three studies focused on the adverse effects associated with radiotherapy, three studies concentrated on the adverse effects of chemotherapy, and two studies investigated menopausal symptoms associated with breast cancer treatment.

What Were the Findings of the Research? Preliminary data suggest that topical calendula for prophylaxis of acute dermatitis during radiotherapy may be effective. In addition, TRAUMEEL S mouthwash may be effective in the treatment of chemotherapy-induced stomatitis. However, the reviewers indicated that the studies need to be replicated to strengthen the evidence. There is no convincing evi- dence to date regarding the use of homeopathy medicines to treat menopausal symp- toms in women living with breast cancer.

What Additional Questions Might I Have? Are there any adverse or harmful effects associated with topical calendula and TRAUMEEL S mouthwash use in persons living with cancer and receiving cancer treatments? Are there additional studies currently being done to investigate the effect of homeopathic medicines in persons living with cancer to strengthen the evidence?

How Can I Use This Study? This study has considerable clinical value for nurses caring for persons living with cancer. The findings from this review should help inform nursing practice in supporting and edu- cating patients concerning the use of topical calendula and TRAUMEEL S mouthwash to decrease the incidence of adverse effects associated with cancer treatments such as radia- tion therapy and chemotherapy. Cancer therapy can be a very stressful time, and dimin- ishing the untoward effects of some treatments may serve to enhance the quality of life for persons living with cancer.

Source: Contributed by Dolores M. Huffman, RN, PhD

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References

Balch, P. A. (2012). Prescription for Nutri- tional Healing (5th ed.). New York, NY: Avery.

Bell, I. R., Howerter, A., Jackson, N., Brooks, A. J., & Schwartz, G. E. (2012). Multiweek resting EEG cordance change patterns from repeated olfac- tory activation with two constitution- ally salient homeopathic remedies in healthy young adults. Journal of Alter- native and Complementary Medicine, 18: 445–453. doi: 10.1089/acm.2011.0931

Borneman, J. P., & Foxman, E. L. (1989). Homeopathic Pharmacopoeia of the United States . Southeastern, PA: Homeopathic Pharmacopoeia.

Danno, K., Colas, A., Masson, J. L., & Bordet, M. F. (2013). Homeopathic treatment of migraine in children. Journal of Alternative and Complemen- tary Medicine, 19(2): 119–123. doi: 10.1089/acm.2011.0931

Ernst, E. (2012). Homeopathy for eczema: A systematic review of controlled clin- ical trials. British Journal of Dermatology, 166: 1170–1172. doi: 10.1111.j.1365-2133. 2012.10994.x

Feingold, E. (2008). Homeopathy, Herbal Remedies, & Nutritional Supplements . Albany, NY: Whitston.

Frye, J. (1997). Homeopathy in office practice. Primary Care , 24(4): 845–864.

Griffith, C. (2012). The Practical Handbook of Homeopathy . London, UK: Watkins.

Kachnic, J. (2012). Your Dog’s Golden Years. Denver, CO: Wallingford Vale.

Macleod, G. (2012). Dogs: Homoeopathic Remedies. London, UK: Rider.

Madrewar, B. P., & Glencross, M. (2011). Therapeutics of Veterinary Homeopathy & Repertory. New Delhi, India: B. Jain.

Sarris, J., Moyaln, S., Camfield, D. A., Pase, M. P., Mischoulon, D., Berk, M., .  . . Schweiter, I. (2012). Complemen- tary medicine, exercise, meditation, diet, and lifestyle modification for anxiety disorders: A review of current evidence. Evidence-Based Complemen- tary and Alternative Medicine. doi: 10.1155/2012/809653

Schmidt. J. M. (2012). The biopsychosocial model and its potential for a new theory of homeopathy. Homeopathy, 101: 121–128. doi:10.1016/j.homp2012.02.001

Schneider, C., Schneider, B., Hanisch, J., & van Haselen. (2008). The role of a homeopathic preparation compared with conventional therapy in the treat- ment of injuries: An observational cohort study. Complementary Therapies in Medicine , 16: 22–27.

Waisse, S. (2012). The science of high dilutions in historical context. Home- opathy, 101: 129–137. doi: 10.1016/ j.homp.2012.01.001

Wauters, A. (2007). The Homeopathy Bible . New York, NY: Sterling.

Resources

American Institute of Homeopathy 101 S. Whiting St., Suite 315 Alexandria, VA 22304 888.445.9988 www.homeopathyusa.org

Australian Homoeopathic Association P.O. Box 7108 Toowomba South, QLD 4350 07.4636.5081 www.homeopathyoz.org

Chapter 9 • Homeopathy 161

European Council for Classical Homeopathy School House Market Place Kenninghall, Norfolk NR16 2AH 44.1953.888163 www.homeopathy-ecch.org

Hahnemann Center for Heilkunst 9-4338 Innes Rd. Ottawa ON K4A 3W3 613.692.6950 www.homeopathy.com

Homeopathic Educational Services 2124B Kittredge St. Berkeley, CA 94704 501.649.0294 www.homeopathic.com

The Academy of Veterinary Homeopathy P.O. Box 232282 Leucadia, CA 92023-2282 866.652.1590 www.theavh.org

162

10 Naturopathy

It is more important to know what sort of person has a disease than to know what

sort of disease a person has.

Hippocrates

Naturopathic medicine is not only a system of medicine but also a way of life with emphasis on client responsibility, cli-ent education, health maintenance, and disease prevention. It may be the model health system of the future with the movement toward healthy lifestyles, healthy diets, and preventive health care.

BACKGROUND

The basic precepts of naturopathy are similar to those of ancient medical systems throughout the world. Naturopathy can trace its philosophical roots to the Hippocratic school of medicine around 400 b.c. Hippocrates had a holistic approach to clients and instructed his students to prescribe only wholesome treatments and to avoid causing harm or hurt. Furthermore, Hippocrates thought that the entire universe followed natural laws, and the role of the physician was to understand and support nature’s own cures ( Pizzorno & Murray, 2012 ).

Naturopathic medicine grew out of the 19th-century medical systems of the United States and Europe. Dr. John Scheel of New York City coined the term naturopathy in 1895, although it was Benedict Lust who formalized it in 1902 as both a system of medi- cine and a way of life. By the early 1900s, more than 20 naturo- pathic schools of medicine were operating in the United States. In the 1920s and 1930s, naturopathic journals encouraged a diet high in fiber and low in red meat, the same type of diet promoted by the National Institutes of Health and the National Cancer Institute in the 1990s. With the development of antibiotics and vaccines in the

Chapter 10 • Naturopathy 163

1940s and 1950s, the popularity of naturopathy began to decline as people began to rely on these medical breakthroughs. The 1970s saw a renewal in the importance of nutrition, healthy lifestyles, and environmental cleanup programs. This interest continued to grow into what is now the U.S. interest in complementary and alternative medicine ( Pizzorno & Murray, 2012 ).

PREPARATION

For naturopathic medicine to become recognized as a legitimate health care system required that accredited schools be established and credible research be conducted. Currently there are seven schools in the United States and Canada: Bastyr University in Kenmore, Washington; National College of Naturopathic Medicine in Portland, Oregon; the Southwest College of Naturopathic Medi- cine and Health Science in Tempe, Arizona; University of Bridgeport College of Naturopathic Medicine in Bridgeport, Connecticut; National University of Health Sciences in Lombard, Illinois; Canadian College of Naturopathic Medi- cine in North York, Ontario; and Boucher Institute of Naturopathic Medicine in New Westminster, British Columbia. The Council on Naturopathic Medical Education is the accrediting agency for programs in the United States and Canada. Schools in Australia include Southern Cross University, the Univer- sity of Western Sydney, and Victoria University.

In the United States, state law determines the scope of naturopathic practice, since there is no national licensure for naturopathy. The laws typi- cally allow standard diagnostic procedures, a range of therapies, vaccinations, and limited prescriptive rights. Some states allow the practice of natural child- birth. In states that do not license naturopathic doctors, anyone can call herself or himself a naturopathic doctor after completing some correspondence courses. These individuals may give seminars and advise people on healthy lifestyles, but they are not permitted to diagnose illness or to prescribe treatment. When seeking a naturopathic doctor as a primary care physician, people must ask for verification of graduation from an accredited naturopathic medical school.

The education of naturopathic physicians is extensive and similar to con- ventional medical education. Four years of medical school follow a college degree in a biological science. The first two years of medical school include courses in anatomy, cell biology, nutrition, physiology, pathology, neurosciences, histol- ogy, pharmacology, biostatistics, epidemiology, and public health as well as alternative therapies. Some differences are significant. For example, conventional medical students may have only 4 course hours in nutritional education, while naturopathic medical students have 138 course hours in nutrition. The third and fourth years of medical school are oriented toward clinical experience in diagno- sis and treatment. The profession has redefined itself in terms of current advances in health care and the evolution of scientific knowledge. Today’s naturopathic doctor is an extensively educated primary care physician able to utilize a broad range of conventional and alternative therapies.

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CONCEPTS

Naturopathic medicine holds the same view of human physiology, bodily functions, and disease processes as does conventional medicine. Although many alternative health care professions are defined by the therapies used, naturopathy is defined by basic concepts.

Healing Power of Nature

It is believed that the body innately knows how to maintain health and heal itself. Natural laws of life operate inside and outside the body, and the physi- cian’s job is to support and restore them by using techniques and medicines that are in harmony with the natural processes. These natural methods are geared to strengthen the body’s own healing ability. Faith, hope, and beliefs may be the most significant aspects of any treatment. Many studies have documented the ability of the mind to affect the process of disease, either positively or nega- tively. Physicians consider issues such as, What does it mean, for this person, to be in balance? and What healing powers are available for this person?

First Do No Harm

Iatrogenic illness, an inadvertent complication as a result of medical treatment—either traditional or alternative—is a major health problem in the United States. Adverse drug reactions send thousands of people to hospital emergency departments, and hospital-acquired ( nosocomial ) infections have become a major problem in the United States.

As Hippocrates said, “Above all else, do no harm.” Naturopathic physi- cians prefer noninvasive treatments that minimize the risk of harmful side effects. Questions considered are, Will a delay in treatment be of benefit? and What is the potential for harm with this particular treatment plan?

Find the Cause

Naturopathic physicians look for the underlying causes of disease and try to help patients eliminate them. These causes are often found in people’s lifestyles, habits, and/or diets. Physical, mental, emotional, and spiritual factors are impor- tant in determining cause. Issues considered are, What are the causative factors contributing to “disease” in this person? Of these causative factors, which are avoidable or preventable? What are the limiting factors in this person’s life?

Physician as Teacher

The word doctor comes from the Latin docere , meaning “to teach.” Unlike many conventional medical physicians who have little time to teach, naturo- pathic physicians focus on teaching people how to achieve health and avoid disease by assuming responsibility for themselves and their well-being. Consumers are becoming increasingly aware that good health is dependent to a great extent on treating the body properly. They are seeking health care practitioners who can teach them how to conduct all aspects of their life in a

Chapter 10 • Naturopathy 165

healthy manner. Thus, naturopathic physicians are an appropriate choice for many. These consumers need to ask such questions as, What type of patient education does the physician provide? and In what ways does the physician encourage and support patient responsibility?

VIEW OF HEALTH AND ILLNESS

Naturopathy views health as more than the absence of disease. Health is a dynamic process that allows people to thrive despite various internal and external stresses. Health arises from a complex interaction of physical, mental, emotional, spiritual, dietary, genetic, environmental, lifestyle, and other com- ponents. Health is characterized by positive emotions, thoughts, and actions. Healthy people are energetic and creative as they live goal-directed lives. Health does not come from doctors, pills, or surgery but rather from people’s own efforts to take appropriate care of themselves.

Naturopathic physicians recognize the role of bacteria and viruses in illness but view these as secondary factors. They believe that most disease is the direct result of ignoring natural laws. These violations include eating processed foods, not getting enough exercise and rest, living a fast-paced lifestyle, focusing on negative thoughts and emotions, and being exposed to environmental toxins. Disease-promoting habits lead people away from optimal function toward pro- gressively greater dysfunction in body, mind, and spirit. Naturopathy recog- nizes that death is inevitable but believes progressive disability is often avoidable.

DIAGNOSTIC METHODS

Naturopathic physicians practice as primary care providers. They see people of all ages suffering from all types of disorders and diseases. They make con- ventional medical diagnoses using standard diagnostic procedures such as physical examinations, laboratory tests, and radiology. They also perform a detailed assessment of lifestyle, looking for physical, emotional, dietary, genetic, environmental, and family dynamics contributing to a disorder. Since health or disease is a complex interaction of factors, naturopathic physicians treat the whole person, taking all these elements into account. Careful atten- tion to each person’s individuality and susceptibility to disease is critical to accurate diagnosis. When necessary, naturopathic physicians, like family practice physicians, refer patients to other health care professionals for hospi- talization, surgery, or other specialized care.

TREATMENT

Naturopathic physicians do not provide emergency care, nor do they do major surgery. They rarely prescribe drugs, and they treat clients in private practice and outpatient clinics, not in hospitals. Some physicians practice nat- ural childbirth at home or in a clinic.

The therapeutic approach of the naturopathic doctor is to help people heal themselves and to use opportunities to guide and educate people in developing

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healthier lifestyles. The goal of treatment is the restoration of health and normal body function, rather than the application of a particular therapy. Virtually every natural medical therapy is utilized, most of which are described in this text. Physicians mix and match different approaches, customizing treatment for each person. The least invasive intervention to support the body’s natural healing pro- cesses is a primary consideration. A primary focus is on the return to nature— that is, diet, exercise, and rest. Cleansing and detoxification consists of decreasing the amount and number of toxins entering the body by eating organic whenever possible and avoiding processed foods, sugar, caffeine, and alcohol. A goal is also to increase the elimination of toxins from the body by increasing intake of fluids, fruits, and vegetables, and increasing sweat through exercise or the use of saunas. The colon is cleansed with high-fiber foods, herbs such as aloe vera juice, liquid fasting for short periods of time, and, sometimes, colonic irrigation.

Chemical remedies used by naturopathic physicians include botanicals and homeopathy. Mechanical remedies include physical therapy, spinal manipulation, acupuncture, yoga, and massage. Mental and spiritual reme- dies include prayer, positive thinking, and stress management.

Counseling is an important intervention because mental, emotional, and spiritual factors are part of the holistic approach. Lifestyle modification is cru- cial to the success of naturopathy. While it is relatively easy to tell a person to stop smoking, get more exercise, and reduce stress, such lifestyle changes are often difficult for people to make. The naturopathic physician is educated to assist people in making the needed changes. This process involves helping people acknowledge the need to change habits; identifying reinforcers for unhealthy habits; setting realistic and progressive goals; establishing a sup- port group of family, friends, and others with similar difficulties; and giving people positive recognition for their gains ( Hechtman, 2012 ).

RESEARCH

The American Association of Naturopathic Physicians publishes the Journal of Naturopathic Medicine , which includes articles on original research, research reviews, and news and review articles relating to naturopathic medicine. Naturopathic schools of medicine have active research departments investi- gating a number of healing therapies. Because treatment programs are indi- vidually designed, it is nearly impossible to compare naturopathic medicine with conventional medicine; too many variables are involved. Scientific research in particular therapies has been conducted in China, India, Germany, France, and England. In the United States, substantial scientific information is readily available on the effectiveness of diet and lifestyle in modifying the risk of severe illness such as heart disease and cancer. Hundreds of scientific papers address diet, nutritional supplements, herbs, exercise, and acupuncture. Some of the other natural healing therapies have not been fully investigated from the Western scientific perspective. Currently, there is no adequate scientific basis for naturopathic evidence-based medicine. It may be many years before sci- ence is sophisticated enough to understand some of these therapies.

Chapter 10 • Naturopathy 167

INTEGRATED NURSING PRACTICE

Interestingly, the bond between nursing and naturopathy is demonstrated by the enrollment in U.S. naturopathic colleges of medicine: one third of the stu- dents are nurses who have chosen this path to continue their postbaccalaure- ate education. The profession of nursing, like naturopathy, has traditionally embraced the concept of the healing power of nature and the belief that the locus of restoring health is within each person and cannot be “given” to a cli- ent by health care practitioners. Drugs, herbs, procedures, surgeries, or mind– body techniques may be helpful or necessary but by themselves do not cure disease. People must, and do, rebalance and repair themselves. The profes- sion of nursing was founded on this philosophy and view of life as noted by Florence Nightingale ( 1860 ) in her basic premise that healing is a function of nature that comes from within the individual. She saw the role of the nurse as putting the “patient in the best condition for nature to act on him.”

Nursing has always focused on education of those who have been entrusted to our care. We believe that through education we empower others by providing the knowledge, skills, and support to tap into their inner wisdom and make healthy decisions for themselves. This concept is basic to the practice of nursing and is evidenced in the American Nurses Association’s Standard of Nursing Practice, which includes health teaching as one of the standards. The goal of nurs- ing, as in naturopathy, is one of healing and, if possible, the restoration of health.

Because we nurses spend so much more time with clients than do physi- cians, we are often in a position to prevent or respond quickly to iatrogenic illnesses. To this end, it is critically important that we monitor closely the impact of medications on the recipients. We must know the physiological action, expected effects, side effects, and adverse effects of every medication we administer. We must assess and reassess clients who are receiving medica- tions. Likewise, we must understand procedures and their potential problems for all clients in our care. It is up to each one of us to maintain clinical skills through self-study and continuing education.

TRY THIS

Visualization

Visualization is one of the many interventions used by nurses. This visualization is called “Winched up the Hill.” Whenever you are faced with a hill to ascend, imagine a winch at the top and a cord from it to your solar plexus. Invite the winch to draw you upward, easily, and effortlessly. At first it may make little difference, but keep practicing the visual- ization at every opportunity until you train yourself to tune into this extra source of energy.

Source: Rutherford ( 1996 ).

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References

Hechtman, L. (2012). Clinical Naturopathic Medicine. Philadelphia, PA: Churchill Livingstone.

Nightingale, F. (1860). Notes on Nursing . New York, NY: D. Appleton.

Pizzorno, J. E., & Murray, M. T. (2012). Textbook of Natural Medicine (4th ed.). St. Louis, MO: Elsevier.

Rutherford, L. (1996). Principles of Sha- manism . San Francisco, CA: Thorsons.

Resources

American Association of Naturopathic Physicians

4435 Wisconsin Ave., NW, Suite 403

Washington, DC 20016

866.538.2267

www.naturopathic.org

Australian Naturopathic Practitioners Association

Suite 36/123 Camberwell Rd.

East Hawthorn, VIC 3123

613.9811.9990

www.anpa.asn.au

British Naturopathic and Osteopathic Association

2 Clifton Road

Southbourne, Dorset BH6 3PA

01582.488.455

bnoa.org.uk

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Manual Healing Methods

All things are connected. Whatever befalls the earth

befalls the sons of the earth. Man did not weave the web of life.

He is merely a strand in it. Whatever he does to the web

he does to himself.

Chief Seattle, upon surrendering his tribal lands in 1856

4 U N I T

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11 Chiropractic

It is most necessary to know the nature of the spine. One or more vertebrae may or may not go out of place very much and if they do, they are likely to produce serious

complications and even death, if not properly adjusted. Many diseases are

related to the spine.

Hippocrates

The word chiropractic comes from two Greek words, cheir (hand) and praktikos (practical), which were combined to mean “done by hand.” Chiropractic, by numbers of practi- tioners, is the third largest independent health profession in the United States, following conventional medicine and dentistry. It is also the most frequently used form of complementary medi- cine. Chiropractors are primary health care providers, licensed for both diagnosis and treatment. The practice is limited by pro- cedure (manipulation of the spine) and excludes surgery and pre- scription medications.

BACKGROUND

Manipulation, as a healing technique, was practiced long before chiropractic. Chinese artifacts dating to as early as 2700 b.c. describe manipulation of the spine. In 1500 b.c. , the Greeks gave written instructions on how to manipulate the lumbar spine for back care. Hippocrates (born c. 460 b.c. ), considered the father of Western medicine, used spinal manipulation to reposition verte- brae and cure a variety of dysfunctions. Galen (born c. a.d.  130), a Greek physician, anatomist, and physiologist, also used

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manipulation and reported the cure of a patient’s hand weakness and  numbness through manipulation of the seventh cervical vertebra. Hippocrates and Galen helped form the foundation of Renaissance medicine, during which manipulative healers were known as “bone-setters.” Regarded by some as the father of surgery, Ambroise Paré (born c. a.d. 1517) incorpo- rated manipulation into his treatment of patients. In the centuries that fol- lowed, manipulative techniques were passed down from generation to generation, often within families ( Oddo, 2012 ).

Daniel David Palmer, a self-educated American healer, founded chi- ropractic in 1895. Palmer administered the first chiropractic adjustment to Harvey Lillard, a janitor who had gone deaf 17 years earlier while stooping in a mine. Palmer found what he called a misaligned vertebra, which he manipulated, allowing Lillard to stand up straight, free of back pain, and with his hearing restored. Within 2 years of this discovery, Palmer founded his Chiropractic School and Cure while at the same time developing the underlying concepts. In 1906, a split in the profession occurred that still exists today. Several faculty members, including John Howard, left Palmer College because of significant differences with Palmer’s son, B. J. Palmer. B. J. Palmer believed that spinal subluxation or misalignment of the spinal vertebrae was the cause of all disease, whereas Howard believed that addi- tional causes were generally present. Howard opened his National School of Chiropractic around a broad-based and scientific educational curriculum. To this day, those who follow Palmer’s path are called “straight” chiropractors, while those who follow the Howard model are called “mixer” chiropractors ( Oddo, 2012 ).

PREPARATION

Chiropractors are licensed in all states of the United States as well as in many other countries. The 18 U.S. chiropractic colleges graduate more than 3,000 chiropractors each year. There also are colleges in Canada, Australia, England, Europe, South Africa, and Japan. Chiropractic education requires at least 90 undergraduate credit hours, including many in the basic sciences. Chiropractic college is a 4-year program that includes courses in anatomy, physiology, pathology, and diagnosis, as well as spinal adjusting, nutrition, physical therapy, and rehabilitation. Course work also includes public health and research methods. Educational standards in the United States are supervised by a government-recognized accrediting agency, the Council of Chiropractic Education ( National Center for Complementary and Alternative Medicine [NCCAM], 2012 ).

Chiropractors practice in more than 60 countries and function almost entirely in free-standing private practices. Some continue their education with postdoctoral training in specialty areas such as radiology, orthopedics, neu- rology, behavioral medicine, family practice, occupational health, and sports medicine. The majority of states have mandated health insurance coverage for chiropractic treatment.

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CONCEPTS

Anatomy

The craniosacral system is composed of the brain and spinal cord, the cere- brospinal fluid, the meninges, and the bones of the spine and skull. The adult vertebral column is composed of 7 cervical, 12 thoracic, 5 lumbar, 1 sacral, and 1 coccygeal vertebrae. The vertebrae provide attachment for various muscles and protection for the spinal cord and are separated by interverte- bral disks. Several curves in the vertebral column increase its strength. The spinal cord, housed in the vertebral canal, conducts sensory and motor impulses to and from the brain and controls many reflexes. Thirty-one pairs of spinal nerves originate from the cord: 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 1 coccygeal.

The vertebrae, with the exception of the first and second cervical, are much alike and are composed of a body, an arch, and seven projections called processes (see Figure 11.1 ). The two processes at the top are the supe- rior articular processes, and the two at the bottom are the interior articular processes; these four processes are of particular interest to the chiropractic physician. At the end of each of these processes is a facet, which, like the facet of a diamond, is smooth and capped with cartilage to allow for friction- free movement. The two superior articular processes from each vertebra join with the two inferior articular processes of the vertebra above. The resulting structure is called a facet joint , which is encased in a strong, fibrous joint cap- sule that prevents the joint from coming apart. The other anatomical feature that is of concern to chiropractic is the sacroiliac joint, which is formed where the sacrum attaches to the ilia.

Vertebral body

Transverse process

Disc

Transverse process

Spinous process

Facet of inferior process

FIGURE 11.1 The Vertebrae

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Assumptions

Chiropractic practitioners believe that the body possesses a unique internal wis- dom that continually strives to maintain a state of health within the body. This body wisdom means that every person has an innate healing potential. Access- ing this internal healing system is the goal of the healing arts. In addition, it is believed that a balanced, natural diet and regular exercise are essential to proper bodily function and good health. The assumptions of chiropractic are as follows ( Association of Chiropractic Colleges, 2012 ):

• Structure and function exist in intimate relation with one another. • Structural distortions can cause functional abnormalities. • The vertebral subluxation is a significant form of structural distortion

and leads to a variety of functional abnormalities. • The nervous system plays a prominent role in the restoration and main-

tenance of proper bodily function. • Subluxation influences bodily function primarily through neurologic

means. • Chiropractic adjustment is a specific and definitive method for the cor-

rection of vertebral subluxation.

Chiropractic addresses the application of this knowledge to diagnose and treat structural dysfunctions that affect the nervous system. Since the ner- vous system is highly developed in humans, it influences all other systems in the body, thereby playing a significant role in health and disease.

VIEW OF HEALTH AND ILLNESS

Chiropractic practitioners believe that health is a state of balance, especially of the nervous and musculoskeletal systems. When the spine is fully aligned, nerve energy flows freely to every cell and organ in the body. This free flow of energy nurtures the innate ability of the body to work effectively and coordi- nate normal body functions.

Traditionally, chiropractic viewed illness and disease as caused by mis- alignment of the spinal vertebrae, referred to as vertebral subluxation , leading to irritation and dysfunction of nerves and blood vessels. The disrupted flow of impulses was thought to interfere with normal muscle function, respiration, heartbeat, arterial tone, digestion, and resistance to disease. A more recent theory is that of intervertebral motion dysfunction . This motion theory contends that loss of mobility in the facet joints (see Figure 11.2 ), rather than misalignment, is the key factor in the concept of subluxation. Subluxation can be caused by just about anything—falls, injuries, genetic spinal weaknesses, improper sleeping habits, poor posture, obesity, stress, and occupational hazards ( NCCAM, 2012 ; Chilibeck et al., 2011 ).

Although this “one cause” philosophy has been a central concept in chiropractic history, few chiropractors today would endorse this simplistic formulation of illness. They recognize the existence of bacteria and viruses in

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creating disease, especially in a susceptible person. Susceptibility depends on many factors, one of which is spinal misalignment. Although chiropractic now embraces a multifactoral explanation of disease, the chiropractic treat- ment of choice is spinal adjustment. The biomechanical explanation states that range of motion is improved when fibrous adhesions within joints are broken or small tags from the joint capsule are released through manipulation. The neurophysiologic explanation proposes that mechanoreceptors in the joint are stimulated through manipulation, resulting in a relaxation of the paraspinal muscles ( Chilibeck et al., 2011 ).

DIAGNOSTIC METHODS

Ninety percent of those seeking chiropractic services have neuromusculoskeletal symptoms or disorders, primarily back pain, neck pain, and headaches. The cen- tral focus of chiropractic diagnosis is the determination of when and where spinal manual therapy (SMT) is appropriate. The diagnostic process also deter- mines what type of adjustment would be most appropriate. Unlike practitioners of conventional medicine, who typically assume that the site of a pain is the site of its cause, chiropractors evaluate the site of pain in a regional and whole-body

FIGURE 11.2 Practitioner uses her hands to discover which spinal joints are moving freely and which joints are stiff.

Source: Dorling Kindersley Media Library/Andy Crawford

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context. Joint pain in the upper extremities, for example, can be caused by injury or pathology in the joint but may also originate from cervical spine dysfunction. Similarly, the source of joint pain in the lower extremities can be in the lumbar spine. The chiropractic assumption is that the source of the pain should be sought along the path of the nerves leading to and from the site of the symptoms. This whole-body approach is a hallmark of chiropractic ( Theberge, 2008 ).

The process for assessing a client is much the same as that followed by any other physician or nurse practitioner. The chiropractor may spend as much as 60 to 90 minutes with a new client, examining, explaining the results of the examination, the diagnosis, and the proposed treatment plan. The quality of the relationship is primary to chiropractic.

A detailed history is the first step in chiropractic diagnosis. The chiro- practor asks about the pattern and quality of the pain and its chronology. Is the pain constant or intermittent? Is the pain a dull ache, a nagging sensation, or a burning sensation? What causes the pain to get worse? What causes the pain to get better? The answers to these types of questions are key to the diagnostic process. The physical examination includes postural assessment, range-of- motion studies, inspection and palpation of affected areas, muscle strength testing, and neurologic screening.

A number of back pain risk factors are critical to diagnosis and are con- sistently assessed by the physician. Individual factors contributing to back pain include older age, tallness, obesity, smoking, decreased muscle strength, decreased flexibility, lack of physical conditioning, and multiple pregnancies. Other health conditions are considered, such as osteoporosis, multiple myeloma, osteoarthritis, scoliosis, and ruptured disk. Psychological factors include the person’s levels of anxiety, stress, and pain tolerance. Occupational risk factors for back pain include heavy physical work; frequent bending, twisting, lifting, pushing, pulling; repetitive strain; and injury or accidents. Recreational risk factors include hockey, football, gymnastics, golf, racquetball, bowling, squash, handball, tennis, backpacking, wrestling, skiing, and other high-impact sports. All applicable risk factors are noted during the history ( Attlee, 2012 ).

The chiropractic physician relies heavily on hands-on procedures using palpation to determine both structural and functional problems. These hands- on procedures are complemented by a neurologic physical examination, which is the same as performed by a physician practicing conventional medicine. In the motion palpation exam the chiropractor physically examines the spine, not- ing how it feels as well as how the client says it feels. The client is gently moved into and out of various postures during this part of the exam. Some postures are done standing, while others are done lying down. This process often informs the chiropractor what movements or positions reproduce or aggravate the pain. X-rays to confirm diagnostic findings may or may not be done.

Hypermobility of spinal joints is diagnosed by the sound of a repeated click when a joint is moved through its normal range of motion. This unstable type of subluxation is related to flaccid ligaments and is more problematic than the fixated type of subluxation. Hypermobile joints should not be forcibly

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manipulated, since manipulation can move the joint beyond the safe range of motion and increase the degree of hypermobility. Rather, nearby joints that have become fixated to compensate for the unstable joint can be manipulated, and muscle strength and tone can be increased with exercise ( Attlee, 2012 ).

The chiropractor rules out pathologies that contraindicate SMT. For example, advanced, degenerative joint disease would rule out all forms of SMT that use significant force on the joint. Chiropractic treatment is not appro- priate in the case of spinal infections, fractures, or tumors, which fortunately are fairly rare. In addition, SMT is not done on a woman in late pregnancy or on people whose pain is increased with manipulation. Diagnosis determines appropriate chiropractic treatment, referral for appropriate conventional medical care, or concurrent care.

TREATMENT

Three primary clinical goals guide chiropractic intervention. The first clinical goal is to reduce or eliminate people’s pain. Typically this goal is the client’s primary—and often only—goal. The second clinical goal is to correct the sublux- ation, thereby restoring biomechanical balance to reestablish shock absorption, leverage, and range of motion. In addition, spinal rehabilitative exercises are encouraged to strengthen muscles and ligaments to increase resistance to fur- ther injury. The third clinical goal is to perform preventive maintenance to ensure the problem does not recur. This goal is comparable to the practice of having teeth cleaned periodically to prevent decay. Maintenance intervals vary from person to person depending on lifestyle.

Back pain is a leading cause of disability and the second most common reason (after the common cold) people visit a doctor. Chiropractors have twice the number of visits for back pain as do biomedical physicians. Most chiropractors also treat peripheral joints—elbows, knees, and shoulders. In 1994, a panel for the Agency for Health Care Policy and Research of the U.S. Department of Health and Human Services concluded that spinal manual therapy speeds recovery from acute low back pain and recommended it either in combination with or as a replacement for the use of nonsteroidal anti- inflammatory drugs. At the same time, the panel rejected many methods used for years by conventional medicine, such as bed rest, traction, and various other physical therapy modalities and cautioned against spinal surgery except in the most severe cases ( Theberge, 2008 ). Spinal manipulation is an assisted (chiropractor) passive (client) motion applied to the spinal facet joints or the sacroiliac joints. Chiropractors use their hands to apply pressure in a specific location and direction. The skill lies in the ability to be specific about which joint is being manipulated, which is especially important in the presence of any unstable joints. A chiropractor has 10 to 20 different ways of manipulat- ing every movable joint in the body. Chiropractors also practice soft-tissue manipulation to stretch contracted muscles and decrease muscle spasms.

High-velocity, low-amplitude (HVLA) thrust adjustment is the most common form of manipulation. It is performed by manually moving a joint to

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the end point of its normal range of motion, isolating it by local pressure on bony prominences, and then giving a swift, specific, low-amplitude thrust. Often, a series of these thrusts are applied to the back and neck. When the facet joints are forced apart, a small vacuum is created and then released, which creates a popping sound much like that produced when people crack their knuckles. This manipulation does not cause pain, though people may feel a little discomfort the next day owing to rebalancing of the contracted muscles. This sensation can be compared to muscular soreness at the begin- ning of a weight training program. HVLA is absolutely contraindicated in malig- nancies, bone and joint infections, acute myelopathy, acute fractures and dislocations, acute rheumatoid or rheumatoid-like joint pathology, and unsta- ble joints. Adverse effects with cervical adjustment may be more serious such as disk injury, vertebrobasilar infarction, or vertebral fracture. Other adjust- ing methods include low-velocity thrust adjustment with mechanically assisted drop-piece tables, various light-touch techniques, ultrasound, and electrical muscle stimulation. Some chiropractors use an activator adjusting instrument (AAI) instead of their hands to do the adjustment. This is a low- force, high-speed adjustment that is especially good for children and the elderly ( Huggins, Boras, Gleberzon, Popescu, & Bahry, 2012 ).

Network chiropractic spinal analysis blends chiropractic and energy field principles. This approach assesses two types of subluxations: structural, involving the joint facets; and soft tissue involving tension in the muscles and other soft tissue connected to the spine. Network chiropractors treat the soft- tissue subluxations with energy techniques before correcting the structural subluxations with manipulation. Similar to network chiropractic is Bio-Energic Synchronization Technique (BEST). Chiropractors using BEST look at the part of the body responsible for misalignment of the spine and use energy balancing to treat the malfunction ( Morter Health System, 2012 ).

Craniosacral therapy involves manipulation of the sutures in the skull, resulting in decreased cerebrospinal fluid pressure and increased mobility of the cranial bones. Stimulating nerve endings in the scalp triggers the nervous sys- tem to turn off stress signals. The goal of craniosacral therapy is to reestablish structural stability and improve neurologic function. It is used to treat problems of the brain and spinal cord such as chronic pain, headache, temporomandibular joint (TMJ) syndrome, stroke, epilepsy, cerebral palsy, dizziness, and tinnitus. Craniosacral therapy is rapidly gaining acceptance in Western medicine. In addition to chiropractors, nurses, physicians, dentists, and physical therapists are incorporating craniosacral techniques into their practice ( Attlee, 2012 ).

As holistic practitioners, chiropractors work with many facets of clients’ lifestyles. Chiropractors provide nutrition education, design exercise programs, plan rehabilitation measures, explain correct posture and lifting techniques, and assess and improve activities of daily living. Conditions commonly seen by a chiropractor include the following:

• Lower back syndromes • Midback conditions

Chapter 11 • Chiropractic 179

• Neck syndromes • Headaches • Carpal tunnel syndrome • Sciatica • Muscle spasms • Sports-related injuries • Whiplash and accident-related injuries • Arthritic conditions • Shoulder conditions • Torticolis • Extremity trauma

RESEARCH

Procedures have been researched since the early days of chiropractic, though researchers frequently had difficulty in finding a source for publication. The most significant research in the 1980s and 1990s was done outside the United States. The quality and quantity of chiropractic research in the United States has increased, however, as chiropractors have become more accepted by bio- medical physicians. Professional groups such as the American Back Society, the North American Spine Society, the International Society for the Study of the Lumbar Spine, and the American Public Health Association all accept chi- ropractic physicians as full members.

The National Center for Complementary and Alternative Medicine has established a Developmental Center at the Palmer College of Chiropractic. The purpose of this center is to enhance research and build relationships with institutions of conventional medicine. Two projects there are studying the effect of cervical manipulation in people with hypertension, and the use of manipulation for treating temporomandibular disorders (TMD). The follow- ing is a small sampling of other studies:

• In an unblinded randomized study of isometric strength differences in individuals’ legs, spinal manipulation reduced the strength imbalances, allowing for improved knee and hip flexion ( Chilibeck et al., 2011 ).

• A systematic review investigated the effectiveness of spinal manipula- tion with children experiencing colic or asthma. The subjective and objective outcome measures reported a favorable response. Further studies using better methodologies and larger samples are necessary ( Gleberzon, Arts, Mei, & McManus, 2012 ).

• A systematic review of treatments for cervical radiculopathy found insuf- ficient evidence to make treatment recommendation, and the researchers did not identify contraindicated therapies ( Rodine & Vernon, 2012 ).

• A randomized controlled trial studied the effectiveness of intraoral myofascial therapies for chronic TMD. The treatment group and the treatment group plus “self-care” exercises demonstrated significant dif- ferences in resting, opening, and clenching pain compared with the

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wait-list control group at 6 months and 1 year ( Kalamir, Bonello, Graham, Vitiello, & Pollard, 2012 ).

• A randomized controlled trial studied the effectiveness of spinal manip- ulation, home exercise with advice, and medication for pain in both the short and long term. There was significant improvement with spinal manipulation and home exercise with advice compared with the use of medication both short and long term ( Bronfort et al., 2012 ).

Chiropractic researchers are examining the effectiveness of chiropractic in organic or somatovisceral disorders. With growing medical–chiropractic cooperation and new federal funding of studies, more widely disseminated research findings are anticipated.

INTEGRATED NURSING PRACTICE

Observing a client’s posture and gait is a key component of basic nursing assessment. Normally, a person’s posture should be erect and at ease with the shoulders level and straight. Movements should be smooth and relaxed. A normal walk is rhythmic, in a straight, upright position with the arms swing- ing naturally at each side. General nursing assessment data provided by the client includes the following:

• Description of current mobility, mobility 2 months ago, and mobility 2 years ago

• Description of changes in the ability to walk, sit, or stand • History of injuries and treatments • Description of daily exercise routine • List of sport activities • Description of repetitive movements related to work or other activities

During a nursing assessment, clients are asked to walk across the room and back as the nurse looks for any difficulties with gait or posture that require further evaluation. An older client’s gait may include short, shuffling, uncertain, and sometimes unsteady steps with a decreased arm swing. As people age they often develop slumped shoulders and a more stooped body posture. Pregnant women often experience changes in body posture and gait as their pregnancy advances. The pelvis tips forward, increasing the lumbosa- cral curve, creating a gradual lordosis—an exaggerated lumbar curve in the spine. The enlarging breasts may pull the shoulders forward, contributing to a stooped body posture. As the pelvic joints relax and the weight and size of the fetus increase, the woman’s center of gravity, stance, and gait are altered, contributing to the common complaint of backaches.

As a nurse, you can intervene to help with minor difficulties of gait and posture. Teach people to warm up and stretch before exercising, and cool down and stretch afterward. Many people can participate in low-impact aerobic activity that does not stress muscles and joints, such as walking, swimming, dancing, weight training, and bicycling. Other activities you can encourage are

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yoga, t’ai chi, and qigong, which are presented in other chapters in this text. Help people become aware of problems they are experiencing in posture, and encourage them to walk and sit “straight, tall, and relaxed.” Good standing pos- ture is with one’s feet facing forward, knees slightly flexed, chest up, shoulders back, and chin parallel to the floor. Good sitting posture includes feet flat on the floor, with knees, ankles, and hips at right angles, and chin parallel to the floor.

Nursing practice and chiropractic medicine support the belief that pre- vention of injuries is preferred over treatment of injuries. Many nursing activ- ities such as lifting, transferring, or positioning clients require muscle exertion by the nurse. To reduce the risk of injury to your clients and yourself, practice proper body mechanics. The coordinated motion of the body depends on the integrated functioning of bones, joints, muscles, and the nervous system. You achieve better body balance from a wide base of support created by separating your feet to a comfortable distance. Bending your knees and flexing your hips, thus bringing the center of gravity closer to your support base, will also improve your balance. When you are lifting an object or person, use your legs to lift and your arms to support. Facing the direction of movement and pivot- ing with your feet prevents abnormal twisting of the spine. Balancing activity between arms and legs protects the back from strain.

A referral to chiropractic evaluation and treatment is appropriate for the conditions listed earlier in the chapter. Chiropractors view themselves as con- tributing members of the health care team and refer to conventional physicians for problems outside their scope of practice. Although chiropractors have clear guidelines for referring to conventional practitioners, biomedical professionals have not developed formal guidelines for referring to chiropractors. It is time for communication and cooperation to be broadened between conventional practitioners and chiropractors in an effort to create the most effective health care system for the greatest number of people.

TRY THIS

Energy Boosters

Poor posture robs your body of energy. You may spend many hours of your day walking incorrectly or slumped in a chair, which interrupts the flow of energy and oxygen through your body and spinal cord. Take a moment to sit up or stand straight. Imagine that a cord is attached to the top of your head, pulling it gently toward the sky. This image helps readjust your posture. Feel your head, neck, shoulders, and spine relax as they realign from a constricting position. This imagery, practiced either sitting or standing, will revive you.

Take your shoes off; sit on the floor with your legs stretched out in front of you and your palms facing down at your sides. Point your toes as hard as you can and hold for 5 seconds, then flex your feet as hard as you can and hold for 5 seconds. Repeat 10 times.

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References

Association of Chiropractic Colleges. (2012). www.chirocolleges.org

Attlee, T. (2012). Cranial-Sacral Integration. London, UK: Jessica Kingsley.

Bronfort, G., Evans, R., Anderson, A. V., Svendsen, K. H., Bracha, Y., & Grimm, R. H. (2012). Spinal manipulation, medication, or home exercise with advice for acute and subacute neck pain: A randomized trial. Annals of Internal Medicine, 156 (1 Pt. 1): 1–10.

Chilibeck, P. D., Cornish, S. M., Schulte, A., Jantz, N., Magnus, C. R. A., Schwanbeck. S., & Juurlink, B. H. J. (2011). The effect of spinal manipulation on imbalances in leg strength. Journal of the Canadian Chiro- practic Association, 55(3): 183–192.

Gleberzon, B. J., Arts, J., Mei, A., & McManus, E. L. (2012). Journal of the Canadian Chiro- practic Association, 56(2): 128–141.

Huggins, T., Boras, A. L., Gleberzon, B. J., Popescu, M., & Bahry, L. A. (2012). Clini- cal effectiveness of the activator adjusting instrument in the management of muscu- loskeletal disorders: A systematic review of the literature. Journal of the Canadian Chiropractic Association, 56(1): 49–57.

Kalamir, A., Bonello, R., Graham, P., Vitiello, A. L., & Pollard, H. (2012). Intraoral myofascial therapy for chronic myelogenous temporoman- dibular disorder: A randomized con- trolled trial. Journal of Manipulative and Physiological Therapies, 35(1): 26–37.

Morter Health System. (2012). Retrieved from www.morter.com/morter.php

National Center for Complementary and Alternative Medicine. (2012). Chiro- practic: An introduction. Retrieved from http://nccam.nih.gov/health /chiropractic/

Oddo, T. (2012). The Early History and Phi- losophy of Chiropractic. Charleston, SC: CreateSpace.

Rodine, R. J., & Vernon, H. (2012). Cervi- cal radiculopathy: A systematic review on treatment by spinal manipulation and measurement with the neck dis- ability index. Journal of the Canadian Chiropractic Association, 56(1): 18–28.

Theberge, N. (2008). The integration of chiropractors into health care teams. Sociology of Health and Illness , 30(1): 19–34.

Resources

American Chiropractic Association 1701 Clarendon Blvd. Arlington, VA 22209 703.276.8800 www.acatoday.org

British Chiropractic Association 59 Castle St. Reading, Berkshire RG1 7SN0118 950 5950 www.chiropractic-uk.co.uk

Canadian Chiropractic Association 600-30 St. Patrick St. Toronto, ON M5T 3A3 877.222.9303 http://www.chiropracticcanada.ca/

The Chiropractors’ Association of Australia Suite 2/36 Woodriff St. Penrith, NSW 2750 1800.075.003 chiropractors.asn.au

Federation of Chiropractic Licensing Boards 5401 West 10th St., Suite 101 Greeley, CO 80634-4400 970.356.3500 www.fclb.org

World Chiropractic Alliance 2683 Via de La Valle, Suite G629 Del Mar, CA 92014 800.347.1011 www.worldchiropracticalliance.org

12 Massage

When you stand with your two feet on the ground, you will always keep your

balance.

Tao Te Ching

Massage therapy , the scientific manipulation of the soft tissues of the body, is a healing art, an act of physical caring, and a way of communicating without words. Massage, a hands-on touch therapy, is experiencing an ever- widening U.S. audience. Massage is the most prevalent comple- mentary therapy offered in hospitals in the United States. The goal of massage therapy is to achieve or increase health and well-being and to help the body heal itself. Although massage therapists may hold general views of health and well-being, massage therapy has no specific theoretical framework or diag- nostic system of disease.

Compared with members of other cultures, people in the United States are generally touch phobic and touch deprived. Cross-cultural studies have revealed that people in the United States have one of the lowest rates of casual touch in the world. When psychologist Sidney Jourard observed rates of casual touch among couples in cafés, he reported the highest rates in Puerto Rico (180 times per hour) and Paris (110 times per hour) and one of the lowest rates in the United States (2 times per hour). French par- ents and children touch each other 3 times more frequently than their U.S. counterparts. French teens demonstrate significantly more casual touching of friends than do U.S. adolescents, who are more likely to fiddle with their rings, crack their knuckles, and demonstrate other forms of self-stimulation. Other studies have found that cultures that are more physically affectionate toward infants and children tend to have lower rates of adult violence. In spite of advertising pleas to “reach out and touch someone,” the

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majority of North Americans have precious little physical contact with family members, friends, and coworkers ( Field, 1999 , 2001).

Concerns have escalated about “inappropriate” touch, sexual abuse, and sexual harassment in schools and workplaces in the United States. Touch, unfortunately, has become associated with sex. Some schools have instituted “teach, but don’t touch” policies. It is rare to see teachers put their hands on the shoulder of a child who is crying. Sadly, to protect themselves from being accused of inappropriate touch, many people are not touching at all. While concern for protecting children from those who would touch inappropriately is valid, the implications of a “hands-off” barrier have significant negative effects on growth, development, and emotional well-being.

BACKGROUND

The idea that touch can heal is an old one. Cave paintings in the Pyrenees show that 15,000 years ago people treated injuries with what looks like mas- sage, and references to massage are found in 4,000-year-old Chinese medical texts. In the fourth century b.c. Hippocrates wrote, “The physician must be acquainted with many things and assuredly with rubbing” (the ancient Greek and Roman term for massage). Some of the greatest physicians in his- tory advocated massage, including Celsus (25 b.c. – a.d. 50), Galen (130–200), and Avicenna (980–1037). Ambroise Paré (1517–1590), called by some the father of surgery; William Harvey (1578–1657), who demonstrated the circu- lation of blood; and Herman Boerhaave (1668–1738), who introduced the clinical method of teaching medicine, all utilized massage as a healing tech- nique. Roman gladiators were massaged before entering the arenas, and 18th-century Swedish cavalrymen were rubbed down between battles. In the Middle Ages, Christians viewed massage as the work of the devil, and many therapists were burned at the stake as witches. Remnants of this attitude have continued into the 20th century, as massage is sometimes assumed to be a front for prostitution ( Rose, 2012 ).

The 13th-century German emperor Frederick II was curious to know what language children would speak if they were raised without hearing any words at all. Having stolen a number of newborns from their parents, he gave them to nurses who physically cared for the infants but were forbidden to cuddle or talk to them. All the children died before they could talk, which revealed a critical fact: tactile stimulation can be a matter of life and death. Most recently, a similar situation occurred in the early 1990s in Romania when thousands of infants were stockpiled in orphanages. Some were virtually left alone in their cribs for 2 years and were discovered to be severely impaired as a result of this isolation ( Colt, 1997 ).

Two New York physicians who were trained in Sweden introduced mas- sage into the United States in the mid-19th century. The first massage therapy clinics were opened by Swedish physicians after the Civil War and had among their clients members of Congress and Presidents Harrison and Grant. At first, physicians performed massage, but they eventually delegated the technique to nurses and physical therapists. By the mid-20th century, massage therapy had

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virtually been abandoned by most health care professionals except nurses. For many years, during the time of relatively little technology, it was standard nurs- ing practice to give back rubs after bathing clients, and back rubs were also a routine part of hour-of-sleep care. Advanced medical technology, sophisticated equipment, and the assumption by nurses of more management roles left little time for hands-on nursing care. There was an upsurge of interest in the field in the 1970s when Drs. Dolores Kreiger and Martha Rogers, two nurse pioneers, advocated the art and caring form of touch in nursing practice. Nurses are now returning to their tradition in providing comfort and care through the use of touch and massage. Most communities of Catholic sisters have at least one sister trained in massage therapy, and massage is routinely offered at spiritual retreats. These sisters have come to recognize the power for spiritual renewal from physical contact in their healing ministries. If clients choose, they also pray with them. Going beyond what most massage therapists do, sisters often set aside time after the massage if the client wants to talk about a problem or issue.

In the United States, some insurance companies will pay for massage that has been ordered by a primary health care provider, but it is still considered an alternative or complementary treatment. In many areas of the world massage is an integral part of health systems. In the former Soviet Union, Germany, China, and Japan, massage therapists work along with physicians in the hospital setting as important members of the health care team. Some U.S. hospitals have a massage therapist available for outpatient and inpatient clients.

PREPARATION

Therapists who have 500 or more hours of education from a recognized school are eligible to take the National Certification Examination offered by the National Certification Board of Therapeutic Massage and Bodywork. The International Association of Infant Massage further certifies instructors who take 4 days of training, read course material, and pass a take-home exam. There is also a certification process for those therapists who wish to practice prenatal massage therapy. The Federation of State Massage Therapy Boards facilitates communication among board members, which include 41 state boards and the U.S. Virgin Islands board. The goal of the organization is to improve standards of massage therapy education, licensure, and practice.

CONCEPTS

Skin

In many ways, human beings are wired for touch. The skin is the body’s largest organ, covering almost 20 square feet and accounting for nearly one quarter of the body’s total weight. As many as 5 million touch receptors in the skin— 3,000 in a fingertip—send messages via the spinal cord to the brain. The skin has four main functions: it protects against mechanical and radiation injuries and from invasion by foreign substances; it is a sense organ; it regulates temperature; and it is a metabolic organ. Of all the sensory organs, the skin is

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the most important. People can survive without the senses of sight, sound, smell, and taste but would find it difficult to survive without the functions performed by the skin.

Touch

Touch is a primal need, as necessary for growth and development as food, clothing, or shelter. The sense of touch is the earliest to develop in the human embryo, and at less than 6 weeks of gestation, a light stroking of the face will cause the neck and trunk to bend away from the source of stimulation. Touch continues to function even after seeing and hearing begin to fade with age. Touch can be thought of as a nutrient transmitted through the skin in many different ways: holding, cuddling, nuzzling, caressing, and massage. From the bonding of parent and newborn to holding the hand of a dying loved one, touch is the most intimate and powerful form of communication between peo- ple. It can be aggressive, as the spanking of a child or a punch in the face. It can be tender, as the hug that comforts a crying friend or the touch of a lover.

The importance of the sense of touch is evident in many English expres- sions. Some people have to be “handled” carefully because they are “thin- skinned,” while others are “thick-skinned.” “Touchy” people are overly sensitive or easily angered. Some people are “soft touches,” and others have “the human touch.” Some people “rub” others the wrong way. “Feeling” for another person is a description of empathy. A “touching” experience is something that is deeply felt. As biomedicine continues to make incredible advances in technology, it leaves behind one of the most valuable senses of a human being—that of touch. This sense of isolation may explain, in part, the increasing interest in healing practices, most of which include the experience of touch.

Trigger Points

When a person is injured or bodily systems are malfunctioning, trigger points or pain reflexes appear throughout the body. A trigger point is a “knot” of tensed muscles that when stimulated, triggers a referred pain response in other parts of the body. Some of the trigger points are in the area of the injury or problem, while others are at a distance. Rubbing and exerting pressure on these points have been found to have a positive effect on the healing process ( Granger, 2012 ).

Fascia and Fascial Restrictions

The fascia is the tough connective tissue in the body that is almost like a three- dimensional web from head to foot. If somehow every structure of the body were removed except the fascia, the body would retain its shape. Every mus- cle, bone, organ, nerve, and blood vessel of the body is covered with fascia like a continuous plastic wrapping. Fascia varies in thickness and density and in the amount of collagenous fiber, elastic fiber, and tissue fluid it contains. The function of the fascia is to support cells, muscles, groups of muscles, and organs and act as a shock absorber. At the cellular level, fascia creates the

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interstitial spaces and is important in cellular respiration, elimination, metab- olism, fluid, and lymphatic flow.

Each time a person experiences a trauma, undergoes an inflammatory process, or suffers from poor posture over time, the fascial system becomes restricted, and the individual loses flexibility and spontaneity of motion. As the fascia continues to slowly tighten, an abnormal pressure develops on the nerves, muscles, bones, or organs, resulting in poor cellular efficiency, necro- sis, pain, and dysfunction throughout the body ( Kumka & Bonar, 2012 ).

VIEW OF HEALTH AND ILLNESS

It is believed that massage aids the ability of the body to heal itself, so the aim of massage is to achieve or increase health and well-being. Only now are sci- entists coming to appreciate the importance—and the power—of touch. The Touch Research Institute (TRI) at the University of Miami School of Medicine brings together researchers from Duke, Harvard, the University of Maryland, and other universities to study touch and how it might be used to promote health and treat disease.

Stronger, sustained touch in massage can have an even greater effect than other forms of touch. A skilled massage therapist not only stretches and loosens muscle and connective tissue but also greatly improves blood flow and the movement of lymph fluid throughout the body. Massage speeds the removal of metabolic waste products resulting from exercise or inactivity, allowing more oxygen and nutrients to reach the cells and tissues. The release of muscular tension also helps unblock and balance the overall flow of life energy throughout the body known as qi, ki, prana, or subtle energy. In addi- tion, massage can stimulate the release of endorphins, serotonin, dopamine, and oxytocin. The benefits of massage are described in Box 12.1 .

As an adjunct to medical treatment, massage may be helpful in relieving backaches, headaches, muscle spasm and pain, hypertension, swelling and pain from injuries or after surgery, grand mal epileptic seizures, insomnia, anxiety, and depression. Massage can be a palliative treatment for those with terminal conditions and can help maintain circulation and muscle tone in individuals who are bedridden. Even people in deep comas may show improved heart rates when their hands are held. Most comprehensive cancer treatment programs offer massage as a standard component of care. Massage can reduce agitation in persons with Alzheimer’s disease, and it has been used to relieve stress at disaster sites.

Massage has been used with individuals who have psychiatric disabilities as an adjunct to conventional psychiatric interventions. Clients are given a chair massage, done with the client fully dressed and seated on a massage chair. The head, neck, back, arms, and legs are massaged for 10 to 20 minutes per session.

Some businesses provide chair massage for their employees as part of their wellness programs. The immediate effect is one of feeling better immediately. The longer range effect is an improvement in employee performance and pro- ductivity, as well as feelings of loyalty to the business.

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TREATMENT

Touch is the fundamental medium of massage therapy. It is, however, more than just mechanical manipulation. Touch is a form of communication; thus, one of its most significant benefits is the comfort of human care conveyed by the therapist. Massage communicates gentleness and connection, trust and receiving, and peace and alertness.

The first massage therapy appointment begins with questions about one’s physical condition, medical history, and current aches and pains. The therapist determines what a client hopes to gain from the massage. The client undresses in private and uses a sheet or blanket for draping. The individual decides whether underwear is on or off. The client lies on a cushioned table, and the

BOX 12.1

The Benefits of Massage

Physical Level

• Relieves muscle tension and stiffness • Reduces muscle spasm and tension • Provides relief from pain • Speeds recovery from exertion • Improves joint flexibility and range of motion • Increases ease and efficiency of movement • Improves posture • Stimulates lymphatic circulation, which decreases edema • Improves local circulation, which increases healing of injured tissues • Lowers blood pressure, slows heart rate • Promotes deeper, easier breathing • Eases tension headaches • Improves the health of the skin

Mental Level

• Induces a relaxed state of alertness • Reduces mental stress, thus clearing the mind • Increases capacity for clearer thinking

Emotional Level

• Satisfies the need for caring and nurturing touch • Increases feelings of well-being, decreases mild depression • Enhances self-image • Reduces levels of anxiety • Increases awareness of mind–body connection

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therapist uncovers only that part of the body that is being massaged, using oil or lotion to help the hands move smoothly. It is recommended that clients not eat just before a massage and drink extra water afterward to clear the body of toxins released from deep tissues. At home, clients are encouraged to enjoy a salt bath as another aid in detoxifying the body. A half cup each of sea salt, Epsom salts, and baking soda is added to a tub of warm water for the salt bath.

From hour-long massages in therapists’ offices to 10-minute massages at the workplace, a massage is available for practically every body and budget. Massage therapists offer their services in a wide variety of settings such as private practice clinics, health clubs and fitness centers, chiropractic offices, nursing homes and hospitals, salons and resorts, on site in the workplace, and even in clients’ homes. There are almost as many styles of massage as there are practitioners. Most therapists combine a variety of methods in their work, which allows them to tailor each session to the specific needs of the client. Box 12.2 lists some cautions and risks associated with massage therapy.

Massage is contraindicated in the following conditions:

• Phlebitis/thrombosis • Severe varicose veins • Any acute inflammation of the skin, soft tissue, or joints • Burns • Areas of hemorrhage or heavy tissue damage • Unregulated blood pressure • Unstable blood sugar • Herniated disk • Recent fractures or sprains • Advanced osteoporosis • A bleeding disorder or taking blood-thinning drugs • Some types of cancer

Swedish Massage

Peter Ling of Sweden, who integrated ancient Asian massage with a Western understanding of anatomy and physiology, developed Swedish massage about 150 years ago. It is the most common form of massage in the United States. Swedish massage uses a system of long gliding strokes, as well as kneading and friction techniques on the more superficial layers of the mus- cles, combined with active and passive movements of the joints. It is used primarily for a full-body massage to promote general relaxation, improve cir- culation and range of motion, and relieve muscle tension.

Swedish massage uses five basic strokes. Effleurage , French for “touching,” is the introductory stroke. The therapist uses the whole hand in providing long, gliding strokes to relax the central nervous system and prepare the local area for the other strokes. Petrissage involves grasping muscle groups and lifting them, stretching them away from the bones and then kneading or rolling them. This technique is the closest to imitating exercise because it makes the muscles con- tract. This stroke is used mostly on flaccid muscles that require an increase in

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contractile ability. Petrissage also stimulates the central nervous system and therefore is not used with clients who have cerebrovascular dysfunctions. Friction involves using the fingers and thumbs to press on small areas and move in a cir- cular motion around each area. Vibration involves placing the hands on a muscle group and moving them back and forth quickly in a shaking motion. Tapotement or percussion involves striking the skin with the outside edges of the hands, fin- gers, or cupped palms to stimulate circulation ( Stewart, 2010 ).

Shiatsu Massage

In Japanese, shi means “finger” and atsu means “pressure.” Shiatsu massage is the Japanese adaptation of acupressure. Like Chinese acupuncture and acu- pressure, shiatsu is based on the idea that life energy, ki , flows along invisible pathways called meridians. Health is related to a free flow of energy, and ill- ness is caused by blockages to the flow. Blocked energy can cause physical discomforts, so the aim is to release the blocks associated with the discomfort or disease and rebalance the energy flow. Therapists use their hands, elbows, and even their feet to press for about 30 seconds on each point. Depending on the way it is done, shiatsu can be gentle or quite forceful. Done on a floor mat rather than a massage table, a typical shiatsu session lasts about an hour ( Kalbantner-Wernicke, Hasse, & Fisher, 2012 ).

Sports Massage

Sports massage uses techniques of both Swedish and shiatsu massage but focuses on parts of the body that are likely to be stressed by a particular sport. It takes less time than Swedish or shiatsu and is usually more vigorous. For

BOX 12.2

Cautions/Risks of Massage Therapy

Rarely can cause:

• Internal bleeding • Nerve damage • Temporary paralysis • Allergic reactions to massage oils or lotions

Prenatal Massage—consult health care provider

• High-risk pregnancy • Pregnancy-induced hypertension • Preeclampsia • Previous preterm labor • Can induce labor

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example, runners might need to have their hamstrings worked extensively. This technique also concentrates on reducing or eliminating factors that interfere with human performance such as muscle spasms, tendonitis, and muscle fatigue.

Prior to an athletic event, massage loosens, warms, and readies the muscle for intensive use, especially when combined with stretching. Besides helping prevent injury, massage can improve performance and endurance. Postevent massage relieves pain, prevents stiffness, and returns the muscles to their nor- mal state more rapidly. The use of massage in sports health care is increasing rapidly in both training and competition. Recreational athletes have also dis- covered the benefits of sports massage as a regular part of their workouts.

Trigger Point Massage

Trigger point massage is a type of deep massage in which the fingers are used to release knots and tender spots in muscles. Rubbing and exerting pressure on these points has been found to have a positive effect on the healing process by interrupting the cycle of spasm and pain. Techniques are similar to those used in shiatsu but are based on Western anatomy and physiology. Trigger point massage is typically a technique incorporated into Swedish or sports massage.

Myofascial Release

Myofascial release is a whole-body therapy preceded by a comprehensive evalu- ation and diagnostic workup. The therapist evaluates the fascial system through visual analysis and palpation of tissue and fascial layers. Normal tissue is soft and mobile in all directions. Abnormal tissue may feel hot, hard, sensitive, or some- what stringy or crunchy. When the therapist has determined where the fascial restrictions lie, gentle pressure is applied in the direction of the restriction, which is designed to break up the collagen of the fascia. Myofascial release is effective in strains and sprains, headaches, chronic pain, temporomandibular joint (TMJ) pain, and adhesions. Myofascial release is contraindicated in malignancy, open wounds, cellulitis, febrile state, hematoma, infection, advanced degenerative changes, acute circulatory conditions, and acute rheumatoid arthritis ( Kumka & Bonar, 2012 ).

Rolfing

Developed by the late biochemist Ida P. Rolf, Rolfing (also known as structural integration) is a system of whole-body manipulation in which the Rolfer uses the fingers, knuckles, and elbows to stretch the fascia, which tends to bind up because of injury, bad posture, emotional problems, or genetic weaknesses. The fascia is stretched to release patterns of tension and rigidity and return the body to a state of correct alignment. Whereas other massage therapists work by apply- ing smooth strokes over muscles, Rolfers press deeply into muscle tissue and fascia to release them. Clients are asked to breathe deeply during the session and visualize the muscle lengthening. The current Rolfing method is gentler and far less painful than the original style of treatment. Practitioners use a broad range of touch and pressure from feather-light to deep massage. When performed with the right sensitivity, even deep and heavy pressure may not be painful.

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Thai Massage

Some people call Thai massage “passive yoga” because the receiver is fully clothed, lies on a futon, and is deeply stretched, compressed, and gently rocked. The whole body of the therapist is used to treat the whole body of the receiver. The experience feels like a combination of yoga, shiatsu, and meditation. Point pressure and kneading of the tissues are similar to massage techniques. Yoga techniques involve positioning the client in numerous stretches similar to yoga poses, then gently rocking the person to deepen the stretch and open the joints. The gentle rocking creates an energy flow through the different stretches. Thai massage gives the person the flexibility, inner organ massage, oxygenation of the blood, and quieting of the mind that comes with yoga, but because the receiver is passive, the session becomes meditative. Sometimes the therapist stands on the recipient and gently rolls one foot on and off the body. This com- pression can be gentle to deep and can energize or relax the recipient.

Chinese Massage

Tui na is one of the four main branches of Traditional Chinese Medicine, the others being herbs, acupuncture, and qigong. Tui na is the forerunner of all forms of massage that exist today, but it differs from other types of massage in that it is used to treat specific illnesses as well as musculoskeletal problems. A practitioner of Tui na must be a Traditional Chinese Medicine physician to make an accurate diagnosis before instituting treatment. Tui na is often com- bined with qigong exercises for building up general health and strength. See Chapter 23 for information on qigong.

Bowenwork

Bowenwork is a type of massage that uses gentle hand movements to stretch muscles and fascia to stimulate nerve pathways. Lymph and blood movement is increased, which improves tissue repair of injuries. Bowenwork was first introduced in Australia and has become an accredited, 2-year vocational pro- gram in Victoria, Australia. It is offered as a therapy worldwide ( Hansen & Taylor-Piliae, 2011 ).

Chair Massage

Chair massage is done with the client fully dressed, seated on a portable mas- sage chair. A doughnut-shaped pillow that allows for easy breathing supports the person’s face. The sessions, which last 10 to 20 minutes, involve massage of the head, neck, back, arms, and hands. This type of massage is often provided in the workplace, shopping malls, or airports. The purpose of the massage is to decrease tension, reduce stress, and enhance people’s adaptive capabilities.

Pregnancy Massage

Massage is contraindicated until after the first trimester of pregnancy, because of the danger of miscarriage during that time. During the second and third

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trimesters, massage can ease pain and provide comfort to the pregnant woman. Massage relaxes the woman and reduces the flow of stress hormones to the baby. It also nurtures the woman, which helps her nurture her baby after birth. Pregnancy massage is usually done in a side-lying position with plenty of pillows or cushions for support (see Figure 12.1 ). The massage usually is done to the neck, arms/hands, back, pelvis, and legs/feet. Since not all massage therapists are trained in pregnancy massage, consumers must ask about the experience and/or credentials of a particular therapist.

Infant Massage

Infant massage is gaining in popularity in the United States (see Figure 12.2 ). Researchers have found that infant massage produces weight gains in prema- ture infants, reduces complications in cocaine babies, and helps depressed mothers soothe their babies. In healthy babies, it improves parent–infant bonding, eases painful procedures such as inoculations, reduces pain from teething and constipation, reduces colic, induces sleep, and makes parents feel good ( Field et al., 2008 ).

Self-Massage

Self-massage is a wonderful way for people to better acquaint themselves with their entire body. It is a process in which they learn to be aware of and release tensions and inhibitions, to reclaim parts of themselves that have been neglected, and to accept themselves as they are. Self-massage increases one’s ability to listen to the body and enhance one’s healing journey. Getting to know and appreciate one’s body through touch is an important part of self-acceptance. The more in

FIGURE 12.1 Pregnant Woman Getting a Massage

Source: Getty Images, Inc.; Photodisc/Steve Mason

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touch people are with themselves, the more they come in touch with the reality and experience of the world around them. Heightened awareness of the unity of body, mind, and spirit often leads to an increased perception of the unity of all nature. As it builds self-confidence and self-acceptance, this awareness enables people to respond with more compassion and caring toward others.

Self-massage is done in a warm, comfortable, and quiet environment. Breath work and relaxation techniques are utilized to ground and center one- self before the experience. Self-massage often begins with gazing at oneself naked in a mirror, withholding judgment and criticism. The next step is to stretch like a cat and pay attention to how the body feels. If there is an area that is stiff or tender, the person slowly moves, gently holds, or massages that part. Then the person finds a position that is relaxing and comfortable. With- out a set route or sequence, individual senses guide self-massage. Sometimes one may explore and massage the whole body, and at other times one may feel like spending the whole time on one part, such as the face and head. Self- massage is done slowly and rhythmically with the eyes closed so that all one’s attention can be focused on the sensation ( Tulku, 2007 ).

RESEARCH

During the past half century, numerous reports on clinical trials have been published in health care literature. These reports have documented the benefits of massage therapy for the treatment of pain, inflammation, lymphedema, nau- sea, muscle spasm, various soft-tissue dysfunctions, grand mal seizures, anxiety,

FIGURE 12.2 Baby Boy Having His Back and Side Massaged

Source: Alamy Images/BananaStock

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depression, and insomnia. Randomized, controlled trials are somewhat difficult, since therapists individualize treatment approaches for each client.

• A Joanna Briggs Institute evidence summary found that massage therapy may be offered to people with cancer pain (Grade B; Woodward, 2011 ).

• A Joanna Briggs Institute evidence summary found that • massage therapy may be useful for reducing anxiety and blood pres-

sure (Grade B). • massage therapy may be beneficial for people with subacute and chronic

low-back pain especially when combined with exercise and education. • massage can be recommended for improving quality of life and

immune function for people with HIV/AIDS (Grade B). • massage is recommended for women who are in labor (Grade B). • there is insufficient evidence to recommend massage for mechanical

neck pain and for people with intellectual disability ( Slade, 2012 ). • A Joanna Briggs Institute evidence summary found that massage of

myofascial trigger points is helpful for tension headaches ( Carstens, 2011 ).

The following is a small sample of the current research:

• A systematic review of deep friction massage as a treatment for tendi- nopathy demonstrated some evidence of benefit. Meta-analysis was not possible because of the heterogeneity of the dependent measures ( Joseph, Taft, Moskwa, & Denegar, 2012 ).

• The Ottawa Panel for evidence-based clinical practice guidelines found that massage therapy is effective in providing pain relief in persons with acute and chronic low back pain ( Brosseau, Well, Poitras et al., 2012 ). The same review group found that massage provides short-term relief for persons with subacute and chronic neck pain ( Brosseau, Wells, Tugwell, et al., 2012 ).

• A Cochrane Database systematic review found that massage provided short-term relief for people with mechanical neck disorders but could not make a practice recommendation at this time ( Patel et al., 2012 ).

• A randomized, controlled trial of massage therapists found that giving a therapeutic massage significantly lessened the therapists’ anxiety levels ( Jensen, Ramasamy, Hotek, Roel, & Riffe, 2012 ).

• A single-blind randomized trial compared Thai massage with physical therapy for anxiety and pain levels in patients with scapulocostal syn- drome. The Thai massage group demonstrated significant decrease in both pain and anxiety compared with the control group ( Buttagat, Eungpinichpong, Kaber, Chatchawan, & Arayawichanon, 2012 ).

INTEGRATED NURSING PRACTICE

Massage provides a valuable tactile approach that when combined with verbal approaches, communicates nurses’ care and compassion. Back rubs, lasting 3 to 5 minutes, offer physiological and mechanical benefits to clients in a variety of set- tings. A back rub is usually given after the bath, but you may also find that giving

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one in the evening will help clients relax and fall asleep. Massage the back in a slow, rhythmical, and relaxed manner. Tightness through the shoulder and neck muscles from an uncomfortable resting position can be relieved with friction or petrissage. Gently rubbing the skin over bony areas increases circulation and helps prevent skin breakdown. If you are caring for someone who is in bed a great deal of the time, offer massage each time the person’s position is changed. Observe for areas of redness, especially over the sacrum and the back of the heels, elbows, and knees. Stroking toward the pressure areas encourages capillary dilation.

People, who are self-conscious about full-body or even back massage may accept and benefit from hand and foot massage. Figure 12.3 illustrates

A

B

While holding the client’s hand, place mas- sage oil or lotion on the hand. Gently bend the hand backward and forward to limber the wrist. Grasp each finger and do range- of-motion exercises.

With the client’s elbow resting on the table, hold the hand upright and massage the palm of the hand with the cushions of your thumbs, using circular movements in oppo- site directions.

FIGURE 12.3 Procedure for Hand Massage

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the procedure for a hand massage. These same steps can be adapted for a foot massage. By stimulating the circulation, massage eases stiffness and pain in persons with arthritis and helps drain lymph and decrease fluid retention in persons with dependent edema.

Childbirth nurses and nurse midwives have long advocated massage during pregnancy. A light, natural oil such as tangerine, almond, or safflower is used. Essential oils are not added because they may have ill effects on the fetus. The benefits of massage during pregnancy ( Osborne, 2012 ) are as follows:

• Relaxes. Massage helps reduce tension in the neck and shoulders and, in the later stages of pregnancy, in the lower back.

• Uplifts. Massage minimizes fatigue and improves the flow of energy and induces a general feeling of well-being.

• Improves circulation. Massage may help prevent varicose veins that may accompany pregnancy.

• Stimulates lymphatic drainage. Massage helps reduce fluid retention in the ankles and feet that often occurs during the later stages of pregnancy.

Massage each finger from the base to the tip, along all sur- faces of the finger.

Use your thumbs to massage the wrist and top of the hand, using circular movements. Repeat three times. Repeat the entire procedure on the other hand.

C

D

FIGURE 12.3 (continued)

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• Tones muscles. Massage helps relieve the pain of distended ligaments and decreases the tendency to cramp that may occur toward the fifth month of pregnancy.

• Maintains skin tone. Massage increases the skin’s suppleness and elasticity and may help prevent stretch marks.

Midwives and maternal child nurses incorporate massage during labor and delivery. During contractions, deep massage of the lower back and hips provides counterpressure that many women find helpful. In between contrac- tions, massage of the shoulders, back, hands, and feet increases comfort and relaxation. If contractions are lagging, a light massage of the breasts may stimulate activity. After delivery, gentle heat may be applied to the breasts followed by a firm massage around the breast toward the nipple to assist in milk letdown.

If you practice nursing in newborn nurseries and neonatal intensive care units, you should advocate infant massage and incorporate it as a basic nurs- ing intervention. Most premature and drug-exposed infants given three mas- sages a day are more alert, active, and responsive than nonmassaged infants. Massaged infants are also able to calm themselves, sleep more deeply, and have fewer episodes of apnea.

Whether you are massaging a newborn or teaching parents infant mas- sage, the process lasts for as little as a few minutes or as long as a half hour but should be performed only when a baby is willing. If a baby is crying, hiccupping, or turning the head to the side, the massage should be discontinued and tried another time. The oil for infant massage should be a light-textured, unscented oil such as almond, coconut, or safflower oil. Infants should not be massaged with synthetic, petroleum-based products because they have no nutritional value and are not absorbed into the skin. The following are some gentle massage strokes for infants:

• Foot. Press all over the bottom of the foot using the thumbs. • Leg. Hold the leg like a baseball bat and move the hands up the leg,

squeezing slightly and turning in opposite directions. • Stomach. Make scooping strokes, one hand following the other. • Chest. Begin with both hands at the center and gently push out to the

sides along the rib cage. • Back. With fingers spread apart, “comb” the back from the neck to the

buttocks. • Hand. Roll each finger between your finger and thumb; press gently all

over the palm, using the thumbs. • Face. Make small circles around the jaw using the fingertips.

If you are a hospice nurse, an important part of your care might be massage, which often helps manage pain and symptom distress. As well as integrating it into your routine nursing care, you can easily teach it to family members. Touch is a primal need, even during the process of dying. Being able to communicate caring through massage makes the process a little easier for all concerned.

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TRY THIS

Massage

One-Minute Massage

Revive your hair and your spirits with a simple scalp massage you can do anytime and almost anywhere. With your fingertips, rub the entire scalp using small circular motions. Massage stimulates the scalp oils that bring out the natural shine in hair. It is also an all- over energy booster.

Two-Minute Massage

Mix a tablespoon each of wheat germ, olive oil, and sunflower oil. Rub on your shoulders and neckline. After 2 minutes, rinse and pat dry. Lavish the damp skin with lotion.

Partner Massage

• Set the mood with scented candles and soft music in a dimly lit room. • Lay folded quilts on the floor rather than using your bed, so you can easily move

around your partner. • Remove jewelry to avoid catching hairs as you work. • Comfort your partner by covering her or him with a sheet and placing a pillow

under the knees when lying faceup and under the ankles when lying facedown. • Massage works best when strokes are lubricated. Any vegetable oil will work, but

scented massage oils can add to the sense of relaxation and sensuality. • Begin with both of you breathing slowly and deeply to center and ground yourselves. • Warm the oil by rubbing it between your hands before applying it. • Begin with light strokes and proceed to deeper pressure only after the muscles in

the area have relaxed and warmed up. • Your partner should tell you if any strokes feel uncomfortable: too light, too deep,

or on a tender spot. • Take your time: ideally 2 to 3 minutes per foot, 10 minutes per leg, 15 to 20 minutes

for the back, and 15 minutes for the front including 5 minutes on the face. • Stroke toward the heart instead of against the flow of blood returning to the heart. • Never press directly on the spinal column, just on the muscles on either side of it. • The best massage comes from using your whole body, not just your arms.

Sources: Bligny ( 2011 ); Smith ( 2012 ); Young ( 2012 ).

You may wish to expand your expertise in massage by becoming a mas- sage therapist and combining that practice with your practice of nursing. Con- tact the National Association of Nurse Massage Therapists (see this chapter’s Resources section) for appropriate programs.

200 Unit 4 • Manual Healing Methods

References

Bligny, Y. (2011). Bioharmonic Self-Massage. Rochester, VT: Healing Arts Press.

Brosseau, L., Wells, G. A., Poitras, S., Tugwell, P., Casimiro, L., Novikov, M., ... Cohoon, C. (2012). Ottawa Panel evidence- based clinical practice guidelines on therapeutic massage for low back pain. Journal of Bodywork and Movement Therapies, 16(4): 424–455. doi: 10.1016/ jbmt.2012.04.002

Brosseau, L., Wells, G. A., Tugwell, P., Casimiro, L., Novikov, M., Loew, L., … Cohoon, C. (2012). Ottawa Panel evidence-based clinical practice guide- lines on therapeutic massage for neck pain. Journal of Bodywork and Movement Therapies, 16(3): 300–325. doi: 10.1016/ jbmt.2012.04.001

Buttagat, V., Eungpinichpong, W., Kaber, D., Chatchawan U., & Arayawichanon, P. (2012). Acute effects of traditional Thai massage on electroencephalo- gram in patients with scapulocostal syndrome. Complementary Therapies in Medicine, 20(4): 167–174.

Carstens, J. (2011). Headache (cervico- genic): Massage therapy. Joanna Briggs Institute Evidence Summary. Retrieved from http://connect.jbiconnectplus .org/ViewDocument.aspx?0=5727

Colt, G. H. (1997). The magic of touch. Life , 52–62.

Field, T. M. (1999). American adolescents touch each other less and are more aggressive toward their peers as com- pared with French adolescents. Adoles- cence , 34: 753–758.

Field, T. M. (2001). Touch . Cambridge, MA: MIT Press.

Field, T. M., Diego, M., Hernandez-Reif, M., Dieter, J., Kumar, A., Schanberg, S., & Kuhn, C. (2008). Preterm infant massage therapy research. Infant Behavior & Development, 33 (1): 115–124.

Granger, J. (2012). Neuromuscular Therapy Manual. Baltimore, MD: Lippincott Williams & Wilkins.

Hansen, C., & Taylor-Piliae, R. E. (2011). What is Bowenwork®? A systematic review. Journal of Alternative and Com- plementary Medicine, 17(11): 1001–1006. doi: 10.1089/acm.2010.0023

Jensen, A. M., Ramasamy, A., Hotek, J., Roel, B., & Riffe, D. (2012).The benefits of giving a massage on the mental state of massage therapists: A random- ized, controlled trial. Journal of Alterna- tive and Complementary Medicine , 20(12): 1142–1146.

Joseph, M. F., Taft, K., Moskwa, M., & Denegar, C. R. (2012). Deep friction massage to treat tendinopathy: A sys- tematic review of a classic treatment in the fact of a new paradigm of under- standing. Journal of Sport Rehabilitation, 21(4): 343–353.

Kalbantner-Wernicke, K., Hasse, T., & Fisher. S. (2012). Baby Shiatsu. London, UK: Singing Dragon.

Kumka, M., & Bonar, J. (2012). Fascia: A morphological description and classi- fication system based on a literature review. Journal of the Canadian Chiro- practic Association, 56(3): 179–191.

Osborne, C. (2012). Pre- and Perinatal Mas- sage Therapy (2nd ed.). Baltimore, MD: Lippincott Williams & Wilkins.

Patel, K. C., Gross, A., Graham, N., Goldsmith, C. H., Ezzo, J., Morien, A., & Peloso, P. M. (2012). Massage for mechanical neck dis- orders. Cochrane Database of Systematic Reviews, Sept. 12 (9): CD004871. doi: 10.1002/14651858.CD004871.pub4

Rose, M. K. (2012). Comfort Touch: Massage for the Elderly and the Ill. Baltimore, MD: Lippincott Williams & Wilkins.

Slade, S. (2012). Massage therapy: Vari- ous conditions. Joanna Briggs Institute Evidence Summary. Retrieved from http://connect.jbiconnectplus.org /ViewDocument.aspx?0=6747

Stewart, N. (2010). The Complete Body Mas- sage Course . London, UK: Collins & Brown.

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Resources

American Massage Therapy Association 500 Davis St., Suite 900 Evanston, IL 60201-4695 877.905.2700 www.amtamassage.org

American Oriental Bodywork Therapy Association 1010 Haddonfield-Berlin Rd., Suite 408 Voorhees, NJ 08043-3514 856.782.1616 www.aobta.org

Association of Bodywork & Massage Professionals 25188 Genesee Trail Road, Suite 200 Golden, CO 80401 800.458.2267 www.abmp.com

Australian Association of Massage Therapists Level 6, 85 Queen St. Melbourne, VIC 3000 aamt.com.au

British Federation of Massage Practitioners 78 Meadow St. Preston, Lancashire PR1 1TS 01772.881063 www.jolanta.co.uk

Federation of State Massage Therapy Boards

7111 West 151st St., Suite 356 Overland Park, KS 66224 913.681.0380 www.fsmtb.org

International Association of Infant Massage Unit 10, Marlborough Business Centre South Woodford, London E18 1AD 020.8989.9597 www.iaim.org.uk

National Association of Nurse Massage Therapists 28 Lowry Drive P.O. Box 232 West Milton, OH 45383 800.262.4017 www.nanmt.org

Rolf Institute of Structural Integration 5055 Chaparral Ct., Suite 103 Boulder, CO 80301 800.530.8875 www.rolf.org

Touch Research Institute University of Miami School of Medicine P.O. Box 016820 Miami, FL 33101 305.243.6781 www.miami.edu/touch-research

Tulku, T. (2007). Tibetan Relaxation . London, UK: Dharma Publishing

Woodward, E. (2011). Cancer patients: Pain management by complementary thera-

pies. Joanna Briggs Institute Evidence Summary. Retrieved from http://connect .jbiconnectplus.org/ViewDocument .aspx?0=6654

202

13 Pressure Point Therapies

Let parents then bequeath to their children not riches but the spirit of

reverence.

Plato

Acupuncture, acupressure, Jin Shin Jyutsu, Jin Shin Do, and reflexology are different forms of the same practice of stim-ulating points on the body to balance the body’s life energy. Jin Shin Jyutsu, Jin Shin Do, and reflexology are forms of acupres- sure, and in this chapter the term acupressure includes all the forms. Acupuncture and acupressure are based on the theory that apply- ing pressure or stimulation to specific points on the body, known as acupuncture points , can relieve pain, cure certain illnesses, and promote wellness. Acupuncture uses needles, whereas acupres- sure uses finger pressure. Although the older of the two tech- niques, acupressure is not as powerful and could be considered the over-the-counter version of acupuncture. Acupressure is easy to learn and convenient for self-care, whereas acupuncture requires training to use the needles. Frequently, these practices are part of a holistic approach to wellness and are combined with diet, herbs, massage, mind–body techniques, and spiritual therapies. Used with great success on humans for thousands of years, acupuncture and acupressure are now available for cats, dogs, and horses through veterinarians trained in Traditional Chinese Medicine.

BACKGROUND

Acupuncture and acupressure started in China several thousand years ago. The practice spread to Korea around 300 a.d. and to Japan and Europe in the 17th century. In the late 19th century,

Chapter 13 • Pressure Point Therapies 203

a Canadian physician, Sir William Osler, became interested in acupressure techniques, but they remained largely unknown in North America until the 1970s. Accompanying President Richard Nixon on his trip to China in 1972, James Reston, a reporter for the New York Times , wrote about his experience with acupuncture for relief of pain following abdominal surgery in China. This article began the upsurge of interest in these therapies in the United States. At the present time, acupuncture and acupressure are practiced widely in Asia, the former Soviet Union, and Europe and are gaining in popularity in North America ( Hunts, 2012 ).

Jin Shin Jyutsu (pronounced “jin-shin, jit-soo”) and Jin Shin Do are Japanese phrases meaning “the way of the compassionate spirit.” They are ancient practices that fell into relative obscurity until they were dramatically revived in the early 1900s by Master Jiro Murai in Japan. Dying from a termi- nal illness, he turned in desperation to Jin Shin Jyutsu and meditation. Within a week, he was completely well. He spent the remaining 50 years of his life researching and sharing his knowledge of this healing art, which he referred to as the art of happiness, the art of longevity, and the art of benevolence. After World War II, a Japanese American, Mary Burmeister, studied with Master Murai for many years and eventually returned to the United States with the “gift” of Jin Shin Jyutsu and Jin Shin Do. Today, thousands of stu- dents throughout the United States and around the world study and practice Jin Shin Jyutsu and Jin Shin Do ( Waldeck, 2011 ).

Reflexology , an associated ancient practice, limits the use of acupressure points, or reflexes, to the feet, hands, and ears. William Fitzgerald, an Ameri- can physician, introduced reflexology to the West in 1913. He noted that there was less postoperative pain when pressure was applied to people’s feet and hands just before surgery. In spite of Fitzgerald’s work, it was the efforts of Eunice Ingham, a physical therapist, who expanded and refined Fitzgerald’s observations and found that reflexology not only reduced pain but provided other health benefits as well. Ingham mapped the specific reflex zones on the feet, hands, and ears that reflexologists use today. This work gave her the dis- tinction of being the founder of modern reflexology in the West ( Keet, 2009 ).

PREPARATION

The United States has 53 schools and colleges of acupuncture approved by the Council of Colleges of Acupuncture and Oriental Medicine. The graduate-level program of 2,625 hours or 146 credits covers Oriental medicine, acupuncture theory, Chinese herbs, and biomedicine theory and includes 1,330 hours of clin- ical practice. The master’s-level program for practitioners seeking licensure only as an acupuncturist is a minimum of 3 years and 1,905 hours or 105 credits. There is also an herb certificate program of 450 hours of didactic instruction and 210 hours of clinical training in the use of Chinese herbs for those practitioners who already have a master’s degree in acupuncture. Forty-three states plus the District of Columbia require passing a national board exam as a prerequisite for licensure. In addition, each state has its own eligibility requirements.

204 Unit 4 • Manual Healing Methods

An estimated 7,000 to 8,000 U.S. doctors now include acupuncture in their practice. Most are family physicians, anesthesiologists, orthopedists, and pain specialists. Few physicians are certified by the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM), but most are certified by the American Academy of Medical Acupuncture (AAMA) instead. Even though acupuncture is used in China to treat many conditions, in the United States, conventional physicians have taken the technique out of context, basing it more on a biomedical model of diagnosis and treatment. Nationally, an estimated 15,000 nonmedical professionals practice acupuncture, including nurses, naturopathic physicians, and chiropractors.

Professionals using acupressure are usually physical therapists or massage therapists with special training in this field. Some nurses are trained in acupres- sure and use it to help clients sleep and to reduce levels of anxiety. Midwives may use acupressure techniques to promote relaxation during labor and reduce breast engorgement after delivery. No specific license or certification is needed to prac- tice any of the forms of acupressure, although practitioners of reflexology have the option to become certified by the American Reflexology Certification Board.

CONCEPTS

Meridians

Acupuncture, acupressure, Jin Shin Jyutsu, Jin Shin Do, and reflexology are treatments rooted in the traditional Eastern philosophy that qi , or life energy, flows through the body along pathways known as meridians . Like major power lines, the meridians connect all parts of the body. As vital energy flows through the meridians it forms tiny whirlpools close to the skin’s surface at places called hsueh , which means “cave” or “hollow.” In Traditional Chinese Medicine, these are acupuncture points; in India, marma points. These pres- sure points function somewhat like gates to moderate the flow of qi. Acupunc- ture needles inserted into these points or pressure on these points releases blocked energy and improves the circulation of qi in the body ( Jevon, 2012 ).

In addition to the major meridians, the body has 360 to 365 classic points through which qi can be accessed. Most practitioners, however, focus on 150 points. The points themselves are metaphors for a person’s journey through life, with names such as “Spirit Gate,” “Great Esteem,” “Joining the Valleys,” and “Inner Frontier Gate.” Meridians are associated with internal organs after which they are named: stomach, spleen, heart, small intestine, bladder, kid- neys, gallbladder, liver, lungs, and large intestine. The triple-warmer meridian is associated with the thyroid and adrenal glands, the governing meridian with the spine, and the central meridian with the brain. Chapters 2 and 4 present more detailed information regarding energy and meridians.

Microsystems

The meridians converge at many points in the body, called microsystems , that are reflexes to distant parts of the body. These microsystems are small,

Chapter 13 • Pressure Point Therapies 205

Head

4 4

1 1 2 2

3 3 Neck

Cervical Spine

Thoracic

Lumbar

Spine

Spine

Sacrum & Coccyx

5

8 7

6 9

14 14

13

17 19

12 11 10

13

17 18

20

5

8

6

15 16

19 18

20

9

1. Head and brain 11. Liver 2. Pituitary and pineal glands 12. Gallbladder 3. Throat and thyroid gland 13. Kidney 4. Sinus 14. Adrenal gland 5. Eyes and ears 15. Spleen 6. Shoulder 16. Pancreas 7. Heart 17. Small intestine 8. Lungs and thymus gland 18. Large intestine 9. Diaphragm and solar plexus 19. Bladder

10. Stomach 20. Sacrum and sciatic nerve

local representations of the whole body and are located on the feet, hands, and ears. In other words, each individual part of the body has an associ- ated reflex on the ear, the hand, and the foot. The reflexes are symmetric in that organs on the right side of the body are reflected in the right foot, and the left organs are reflected in the left foot. The reflexes also corre- spond in descending order: the brain reflexes are in the tips of the toes, the eyes and ears under the toes, the shoulders and lungs on the ball of the foot, the stomach and pancreas on the instep, the intestines and colon toward the heel, and the hips on the heel. See Figures 13.1A , B , and C for reflexology maps.

FIGURE 13.1A Foot Reflexology Points

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Head Eyes Ears Sinus Neck

Neck 2 1 2

4

3 5

2 11 9

6 7

12

10

13 Prostate

Uterus

Pineal

Neck

8

Shoulders

Head Eyes Ears Sinus Neck

Lower back

Testes

Ovaries

Middle back

1. Heart (left hand) and thymus gland

2. Lungs 3. Liver (right hand)

and shoulders 4. Solar plexus 5. Pancreas 6. Kidneys and

adrenals 7. Stomach 8. Large intestine 9. Small intestine

10. Bladder 11. Appendix 12. Thyroid 13. Sacrum and pelvis

21 15

20

5

4

3

2

19

18

17

1

16

7 6

11

8

9 12 13

10

14

7

1. Endocrine glands and hormones 2. Head and brain 3. Neck 4. Upper and middle back 5. Lower back 6. Heart and thymus gland 7. Lungs 8. Stomach 9. Small intestine

10. Large intestine 11. Spleen 12. Liver 13. Kidney 14. Bladder 15. Nervous system and spirit 16. Eyes and face 17. Shoulders 18. Arm and elbow 19. Hand 20. Leg and knee 21. Foot

FIGURE 13.1B Hand Reflexology Points

FIGURE 13.1C Ear Reflexology Points

Chapter 13 • Pressure Point Therapies 207

Mind–Body Connections

In the pressure point tradition, the mind, body, spirit, and emotions are never separated. Thus, the heart is not just a blood pump, but it also influences one’s capacity for joy, one’s sense of purpose in life, and one’s connectedness with others. The kidneys filter fluids, but they also manage one’s capacity for fear, one’s will and motivation, and one’s faith in life. The lungs breathe in air and breathe out waste products, but they also regulate one’s capacity to grieve, as well as one’s acknowledgment of self and others. The liver cleanses the body, and it also influences one’s feeling of anger as well as that of vision and cre- ativity. The stomach has a part in digestion of food and influences one’s ability to be thoughtful, kind, and nurturing as well. These are just a few of the mind– body connections recognized by pressure point practitioners ( Zhu, 2012 ).

VIEW OF HEALTH AND ILLNESS

Health is viewed as a state of harmony, or balance, of the opposing forces of nature, both internal and environmental. The body requires balanced yin and yang energy to function properly and to utilize its natural ability to resist dis- ease. It is believed that everything needed to maintain and restore health already exists in nature and that pressure point therapies free up energy and restore balance, thus enabling individuals to maintain or regain their health.

Symptoms are caused by an imbalance of yin and yang in some part of the body, leading to excesses or deficiencies of life energy throughout the body. When the flow of energy becomes blocked or congested, people experi- ence discomfort or pain on a physical level, may feel frustrated or irritable on an emotional level, and may experience a sense of vulnerability or lack of pur- pose in life on a spiritual level. When the flow of energy is interrupted, the area cannot nourish or cleanse. If not corrected, these blocks and imbalances in energy channels can result in disease and eventually illness.

The goal of care is to recognize and manage the disruption before illness or disease occurs. Qi can be thrown out of balance in a number of ways, including genetic vulnerability, accident or trauma, diet, lifestyle, emotional upset, spiritual distress, climate, or noxious agents. Pressure point practitio- ners bring balance to the body’s energies, which promotes optimal health and well-being and facilitates people’s own healing capacities.

DIAGNOSTIC METHODS

The initial consultation involves a holistic assessment because no part of the self is considered a neutral bystander when the body is in a state of imbalance. A detailed medical history is an important part of the diagnostic process. Special attention is paid to the connection between body, mind, emotions, and spirit.

Palpation is the major diagnostic method of pressure point therapies within the context of Traditional Chinese Medicine. Reading the pulses provides a remarkable amount of information about the person’s condition.

208 Unit 4 • Manual Healing Methods

Imbalances in the body can be detected through palpating microsystems on the feet, hands, and ears. If something feels unusual in the microsystems, the corresponding organ is examined in more detail. Chapter 4 discusses the diagnostic process of Traditional Chinese Medicine in greater detail.

TREATMENT

Pressure point therapies consider symptoms to be an expression of the condition of the person as a whole. Thus, sessions focus not only on relieving pain and dis- comfort but also on responding to disruptions before they develop into illnesses.

Acupuncture

To restore the flow of energy, acupuncturists insert sterile, hair-thin needles at points along the meridians. The needles are rotated, twirled, or accompanied by a weak electrical current and are often left in several minutes or longer. Acupuncturists also may apply heat or use finger pressure to alter the flow of qi. Clients feel little, if any, pain. Some people experience sensations of warmth, tingling, heaviness, or a dull ache.

Western medical explanations of evidence now indicate that, in addition to restoring the flow of energy within the meridians, acupuncture reduces pain by triggering the release of endogenous opioids. Many of the analgesic effects of acupuncture can be partially or completely blocked by the use of opioid antagonists such as naloxone. Acupuncture also stimulates the ner- vous system to release adrenocorticotropic hormone (ACTH), a chemical that aids in fighting inflammation; prostaglandins, which help wounds heal more quickly; and other substances that may promote nerve regeneration. Anti- emetic effects apparently stem from the increase in endorphins and ACTH, which inhibits the chemoreceptor trigger zone and the vomiting center in the brain. Acupuncture also calms the upper gastrointestinal tract. Research has found that acupuncture is effective for nausea from morning sickness, motion sickness, postoperative nausea, and chemotherapy-induced nausea. Unlike drugs and surgery, acupuncture has virtually no side effects ( Jingyi, 2012 ).

Jin Shin Jyutsu and Jin Shin Do

Jin Shin Jyutsu and Jin Shin Do can be applied as self-help and also by a trained practitioner, who places the fingertips over clothing on designated pressure points to harmonize and restore the energy flow. Rather than doing something to the body, Jin Shin encourages the body to “let go,” which is seen as the path to awakening one’s awareness of harmony within the self and the universe.

A session generally lasts about an hour with the client lying on a table fully clothed. The practitioner’s hands act as “jumper cables” to “kick start” the correct flow of energy. A spot on the shoulder may be held at the same time as a spot on the knee. The practitioner uses special sequences of hand positions to stimulate the circulation of energy. The touch is gentle, is steady, and never involves force. It is generally pain free; any tenderness in a particular area is

Chapter 13 • Pressure Point Therapies 209

caused by a blockage and tends to dissipate as the area is held. Some people may feel hot or cold or feel a sensation in another part of the body than the one where the practitioner is working. Most people experience a sense of deep relaxation with Jin Shin Jyutsu and Jin Shin Do ( Waldeck, 2011 ).

Reflexology

Most commonly, reflexologists manipulate the reflex zones on the feet, but the hands or ears may also be manipulated. A session usually lasts about 45 minutes with the client sitting comfortably in a chair and the practitioner using thumb and fingers in small, creeping movements over the sole of the foot. This manipu- lation prompts the nervous system to speed up the body’s response to an afflicted area by stimulating the flushing of toxins from the area.

Uses

Pressure point therapies are widely used around the world to treat many con- ditions, including addiction, allergies, bronchitis, cerebral palsy, depression, diabetes, hemorrhoids, hepatitis, herpes, infertility, irritable bowel syndrome, nausea, premenstrual syndrome, stroke, and ulcers. In the United States, reduc- tion of pain is a major therapeutic use, including pain from dental work, tem- poromandibular joint (TMJ) syndrome, migraine headaches, osteoarthritis, low back pain, sciatica, carpal tunnel syndrome, and sports injuries. Acupuncture can provide symptomatic relief from the pain of bursitis and is much safer than anti-inflammatory drugs and injections of steroids ( Cross, 2012 ; Jevon, 2012 ).

Contraindications

Pressure point therapy is not appropriate for every ailment. It is not indicated for an acute or infectious illness or fever or if surgery is needed. Foot injuries need to heal before reflexology is used on the foot. If someone has a pace- maker, practitioners avoid stimulating the left chest zone. If someone has gall- stones or kidney stones, the gallbladder and kidney points are avoided. If the person is pregnant, uterine points are avoided.

RESEARCH

In 1997, the National Institutes of Health (NIH) assembled a panel of experts in a scientific court known officially as a consensus conference. A panel of 12 experts was drawn from a variety of backgrounds, including biomedical research scientists, physicians, and others. The panel’s task was to listen to as much evidence as the acupuncture/pressure point research community could present in the first half of the 3-day conference. The panel’s conclusions included the following statement: “There is sufficient evidence of acupunc- ture’s value to expand its use into conventional medicine and to encourage further studies of its physiology and clinical value” ( NIH, 1998 ). The panel determined that acupuncture was clearly effective for nausea and vomiting in

210 Unit 4 • Manual Healing Methods

pregnancy, motion sickness, chemotherapy, and anesthesia, and for postoper- ative pain from dental surgery. The panel also noted “other situations such as addiction, stroke rehabilitation, headache, menstrual cramps, tennis elbow, fibromyalgia, myofascial pain, osteoarthritis, low back pain, carpal tunnel syn- drome, and asthma where acupuncture may be useful as an adjunct treatment or an acceptable alternative or be included in a comprehensive management program” ( NIH, 1998 ). This panel focused only on data collected by means of randomized controlled clinical trials and therefore did not review data on technique, cost benefit, patient preference, or practitioner education.

• A Joanna Briggs Institute evidence summary ( Moola, 2012 ) found that • in people undergoing surgery acupressure, acustimulation, and acu-

puncture reduces postoperative nausea and vomiting (Grade B). • perioperative acupuncture is recommended to reduce nausea and

vomiting in children having an adenoidectomy or tonsillectomy (Grade B).

• A Joanna Briggs Institute evidence summary found that owing to low methodological quality of current research, there is insufficient evidence that acupuncture reduces cancer pain in adults ( Woodard, 2011 ).

The following is a small sample of recent research results:

• A Cochrane Database systematic review found that there was insuffi- cient evidence that acupuncture can lessen the symptoms of depression ( Smith, Hay, & MacPherson, 2010 ).

• A randomized controlled clinical trial found that acupuncture was effec- tive in reducing menopausal symptoms compared with sham acupunc- ture ( Sunay, Ozdiken, Arslan, Seven, & Aral, 2011 ).

• A review of the literature found evidence that acupuncture provided some relief to a number of women with primary dysmenorrhea, but it was not clear how acupuncture compared with conventional treatments ( Cunningham & Tan, 2011 ).

• A randomized controlled trial found that foot reflexology improved the quality of sleep in postpartum women ( Li, Chen, Li, Gau, & Huang, 2011 ).

• A randomized controlled trial found that among patients with advanced- stage breast cancer the reflexology group had significant improvement in physical functioning and reduced dyspnea compared with the control group. No differences were found in the health-related quality of life, depressive symptoms, state anxiety, pain, and nausea ( Wyatt, Sikorskii, Rahbar, Victorson, & You, 2012 ).

INTEGRATED NURSING PRACTICE

If you are interested in incorporating pressure point therapies into your nurs- ing practice, you may want to attend a weekend or weeklong program on reflexology, Jin Shin Jyutsu, or Jin Shin Do. Even without further education, you can incorporate hand, foot, or ear massages into your practice. This type

Chapter 13 • Pressure Point Therapies 211

of massage is easy to learn and nonintrusive. The procedure for a hand mas- sage is shown in Figure 12.3 in the chapter on massage therapy. These proce- dures can be modified for an ear massage. The hands, feet, and ears are fairly small. If you simply massage them, focusing on any tender spots you find, you are bound to send qi or energy to all parts of the body. Few people object to this type of massage. Even if the recipient has no particular physical com- plaints, this type of massage is wonderfully relaxing.

You can teach clients about a number of pressure points as you advocate self-help. Box 13.1 describes this process for nausea, headaches, hiccups, and carpal tunnel syndrome. To ease tension and restore energy, try this pressure point: Hold your left palm in front of you, fingers together. The fleshy spot between your thumb and index finger is a key pressure point. Using your right thumb, massage this spot in a circular motion for a slow count of 15. Then, switch hands and repeat the process. You can also teach clients several finger holds to improve their general level of well-being. Explain that they should gently hold the appropriate finger on either hand while imagining the negative emotions melting away and physical symptoms easing.

BOX 13.1

Self-Help: Pressure Points

The following are several examples of how you can use pressure points to relieve discomfort or pain. Once you think you have located one of the appropriate points, probe the area with a fingertip or pencil eraser in a tight circular motion in the general location. Points often feel tender, sore, or tingling. Press the point for 1 minute, then stop for a few seconds, and press again. Work the point for 5 to 20 minutes. If you are experienc- ing a headache, hiccups, or symptoms of carpal tunnel syndrome, experiment for yourself and find which points work best for you. Remember, only some of the points need to be worked to achieve relief. There is only one point for nausea.

Nausea

Point Hold your hand open, palm up. This point is 2 inches toward the elbow from the wrist crease and is centered in the groove between

the two large tendons. Using the thumb and a finger, press firmly on this point on both sides of the wrist. Wrist bands can also be purchased that apply pressure to the correct spot. This procedure is safe during pregnancy and also helps with other types of nausea.

Headache

Point 1 Hold your hand open, palm down, and find the point in the center of the fleshy webbing between the thumb and index finger.

(continued)

212 Unit 4 • Manual Healing Methods

Point 2 Find the point on the top of the foot in the valley between the big toe and second toe.

Point 3 This point is at the base of the back of the skull in the hollow above the two large vertical neck muscles.

Point 4 This point is in the hollow above the inner eyes, where the bridge of the nose meets the ridge of the eyebrows.

Point 5 Find the point between the eyebrows in the indentation where the bridge of the nose meets the forehead.

Point 6 This point is two finger-widths above the webbing of the fourth and fifth toes in the groove between the bones.

Hiccups

Point 1 Find the point in the indentation behind each earlobe. Point 2 This point is located at the base of the throat in the center of the

collarbone. Point 3 Find this point on the center of the breastbone three thumb-widths

up from the base of the bone. Point 4 This point is located three finger-widths below the base of the

breastbone in the pit of the abdomen. If you are healthy, do not press this point for more than 2 minutes. If you are not healthy, do not press this point at all.

Carpal Tunnel Syndrome

Point 1 Find the point in the middle of the inner side of the forearm, two and a half finger-widths below the wrist crease.

Point 2 This point is located in the middle of the inside of the wrist crease. Point 3 Find the point on the outside of the forearm, midway between the

radius and ulna, two and a half finger-widths below the wrist crease.

Sources: Forem & Shimer (1999) ; Keet (2009) ; Wills (2009) .

• Thumb. Corresponds to worrying, depression, anxiety. Physical symp- toms may include stomachaches, headaches, skin problems, and ner- vousness.

• Index finger. Corresponds to fear, mental confusion, frustration. Physi- cal symptoms are digestive problems and muscle problems such as backaches.

• Middle finger. Corresponds to anger, irritability, indecisiveness. Phys- ical symptoms are eye or vision problems, fatigue, and circulation problems.

• Ring finger. Corresponds to sadness, fear of rejection, grief, negativity. Physical symptoms are digestive, breathing, or serious skin problems.

• Little finger. Corresponds to insecurity, effort, overdoing it, nervous- ness. Physical symptoms are sore throat and bone or nerve problems.

Chapter 13 • Pressure Point Therapies 213

Clients can be taught acupressure for relief of nausea from a variety of causes. The pericardium 6 point is located in the midline of the inner wrist between two and three finger-widths up toward the elbow from the crease where the hand joins the wrist. People can stimulate this point using their own finger or apply an acupressure wristband to the point.

TRY THIS

Foot Massage

When your feet ache, your whole body suffers. Here are instructions for a 10- to 15- minute foot massage to relax and soothe your feet and perhaps your entire body.

• Sit in a comfortable, quiet place where you will not be disturbed. You may want to have soothing music in the background.

• Pour a small amount of nongreasy lotion or massage oil into your hands and rub them together.

• Begin massaging one foot, stroking each toe in an up-and-down motion. Then, mas- sage the entire foot using kneading, wringing motions until the lotion is absorbed.

• Holding your foot firmly in one hand, press the thumb of the other hand (slightly bent) on the sole of the foot near the heel. Apply even pressure with the thumb and “walk it” forward, little by little. Press one spot, move forward, press again, move forward, and so on.

• When you get to the toes, go back to the heel and trace another line from heel to toe. Continue this process until the entire sole of the foot has been worked.

• Repeat the entire process with the other foot.

Sources: Cross (2012) ; Rose (2009) ; Tanner (2012) .

Considering the Evidence

K. Linde, G. Allais, B. Brinkhaus, E. Manheimer, A. Vickers, & A. R. White, 2009, Acupunc- ture for tension-type headache, Cochrane Database of Systematic Reviews, Jan. 21 (1): CD007587. doi: 10.1002/14651858.C

What Was the Type of Research? Systematic review of randomized clinical control trials (RCTs)

What Was the Purpose of the Research? To synthesize, appraise, and evaluate relevant RCTs on the effectiveness of an acupunc- ture intervention with clients experiencing episodic or chronic tension-type headaches.

(continued)

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A control group received standard care only or treatment of acute headache, a sham acupuncture intervention, or another intervention.

How Was the Research Done? The authors used a systematic review methodology to examine published and unpub- lished RCTs relevant to the purpose of this research. They employed a comprehensive search strategy using selected keywords and electronic databases to identify randomized clinical controlled trials focusing on the purpose of the review. Two reviewers identified the studies, appraised, extracted the data, and assessed risk of bias and quality of the acupuncture intervention. Eleven studies of methodological quality were identified as meeting the established inclusion criteria for this review. A total of 2,317 patients with tension-type headache were included in this review.

What Were the Findings of the Research? Acupuncture could be considered a nonpharmacologic intervention to give short-term relief (3 months) to patients experiencing frequent episodic or chronic tension-type head- aches. Acupuncture resulted in a small but significant decrease in tension-type headaches compared with sham therapy.

What Additional Questions Might I Have? Are there any adverse or harmful effects associated with acupuncture in persons living with tension headaches? What would be the effect of acupuncture in combination with other complementary and alternative therapies in this client population? Could acupunc- ture have long-term effects for persons experiencing tension-type headaches?

How Can I Use This Study? This study has considerable clinical value for nurses caring for persons living with tension head- aches. Health care providers should recognize and support patients’ decisions to incorporate acupuncture in enhancing their quality of life. Nurses should be aware that previous research lacked support for acupuncture for tension-type headaches owing to an insufficient number of studies. However, additional clinical trials have found acupuncture to be an effective inter- vention, so nurses can have more confidence in this complementary and alternative therapy.

Source: Contributed by Dolores M. Huffman, RN, PhD

References

Cross, J. R. (2012). Light Touch Reflexther- apy. Bloomington, IN: AuthorHouse.

Cunningham, S., & Tan, D. (2011). Dys- menorrhoea and acupuncture: A review of the literature. Nursing Stan- dard, 25(44): 39–47.

Forem, J., & Shimer, S. (1999). Healing with Pressure Point Therapy . Upper Saddle River, NJ: Prentice Hall.

Hunts, L. (2012). History of Acupuncture. Charleston, SC: CreateSpace.

Jevon, D. (2012). Acupressure. East Sussex, UK: Gazelle Distribution Trade.

Jingyi, Z. (2012). Acupuncture Patterns & Practice. Seattle, WA: Eastland Press.

Keet, L. (2009). The Reflexology Bible: The Definitive Guide to Pressure Point Heal- ing . New York, NY: Sterling.

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Li, C.-Y., Chen, S.-C., Li, C.-Y., Gau, M.-L., & Huang, C.-M. (2011). Randomised controlled trial of the effectiveness of using foot reflexology to improve qual- ity of sleep amongst Taiwanese postpar- tum women. Midwifery, 27(2): 181–186. doi: 10.1016/j.midw.2009.04.005

Moola, S. (2012). Postoperative nausea and vomiting: Complementary thera- pies. Joanna Briggs Institute Evidence Summary. Retrieved from http:// connect.jbiconnectplus.org/View Document.aspx?0=7166

National Institutes of Health. (1998). NIH consensus conference: Acupuncture. Journal of the American Medical Associa- tion , 280: 1518–1524.

Rose, M. (2009). Comfort Touch: Massage for the Elderly and the Ill . Hagerstown, MD: Lippincott Williams & Wilkins.

Smith, C. A., Hay, P. P. J., & MacPherson, H. (2010). Acupuncture for depression. Cochrane Database of Systematic Reviews. doi: 10.1002/14651858.CD004046.pub3

Sunay, D., Ozdiken, M., Arsian, H., Seven, A., & Aral, Y. (2011). The effect of acupuncture on postmenopausal

symptoms and reproductive hor- mones: A sham controlled clinical trial. Acupuncture Medicine, 29: 27–31. doi: 10.1136/aim.2010.003285

Tanner, R. (2012). Foot Massage. Leicester, UK: Lorenz Books.

Waldeck, F. (2011). Jin Shin Jyutsu. Munich, Germany: Creative-Story.

Wills, P. (2009). Easy Reflexology . Courte- nay, BC: Connections.

Woodward, E. (2011). Cancer patients: Pain management by complementary therapies. Joanna Briggs Institute Evi- dence Summary. Retrieved from http://connect.jbiconnectplus.org /ViewDocument.aspx?0=6654

Wyatt, G., Sikorskii, A., Rahbar, M H., Victorson, D., & You, M. (2012). Health- related quality-of-life outcomes: A reflexology trial with patients with advanced-stage breast cancer. Oncology Nursing Forum, 39(6): 568–577. doi: 10.1188./12.ONF.568–577

Zhu, J. W. (2012). Chinese Medicine: Acupuncture, Herbal Medicine and Therapies. Hauppauge, NY: Nova Science.

Resources

American Association of Acupuncture and Oriental Medicine 1925 W. County Rd B2 Roseville, MN 55113 651.631.0204 www.aaaom.edu

American Academy of Medical Acupuncture 1970 E. Grand Ave., Suite 330 El Segundo, CA 90245 310.364.0193 www.medicalacupuncture.org

Australian Acupuncture & Chinese Medicine Association P.O. Box 1635 Coorparoo DC, QLD 4151 61.(0)7.3324.2599 www.acupuncture.org.au

British Acupuncture Council 63 Jeddo Rd. London W12 9HQ 020.8735.0400 www.acupuncture.org.uk

Canadian Acupressure Institute Inc. 256 Linden Ave. Victoria, BC V8W 4E5 877.909.2244 www.acupressureshiatsuschool.com

Council of Colleges of Acupuncture and Oriental Medicine 600 Wyndhurst Ave., Suite 112 Baltimore, MD 21210 410.464.6040

Jin Shin Foundation for Bodymind Acupressure P.O. Box 416

216 Unit 4 • Manual Healing Methods

Idyllwild, CA 92549 951.659.5707 www.jinshindo.org

National Commission for the Certification of Acupuncture and Oriental Medicine

76 South Laura St., Suite 1290 Jacksonville, FL 32202 904.598.1005 www.nccaom.org

14 Hand-Mediated Biofield Therapies

Sheila O’Brien Lewis, BScN, MHSc,

When health is absent . . . Wisdom cannot reveal itself Art cannot become manifest Strength cannot be exerted

Wealth is useless And reason is powerless.

Herophilos

A wide variety of alternative, complementary, and integra-tive healing practices are emerging in popularity and are designed to balance the body’s biofield, or energy field, and increase the flow of energy. The National Center for Comple- mentary and Alternative Medicine ( NCCAM, 2012 ) defines bio- field therapy/energy healing therapy as “the channeling of healing energy through the hands of a practitioner into the client’s body to restore a normal energy balance and, therefore, health. Energy healing therapy has been used to treat a wide variety of ailments and health problems and is often used in conjunction with other alternative and conventional medical treatments.”

People and cultures all over the world have identified and given various names to the concept of biofield, as seen in Box  14.1 . Practices related to biofield therapies have been utilized cross- culturally for millennia, but it is only recently that programs of related research have emerged in the Western Hemisphere. In the 1980s, scientists in the emerging field of psychoneuroimmunology (PNI), or mind–body medicine, began to study energy medicine.

217

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Among them were Herbert Benson, MD, and Joan Borysenko, PhD, who dis- covered and studied the body’s innate “relaxation response” as it relates to self-healing. Many of the PNI researchers were influenced by Eastern tradi- tions that view the mind, body, spirit, and health as one, and energy as some- thing that people can deliberately nurture within themselves. Today, the field of mind–body medicine is well established and recognized, with scientific breakthroughs occurring regularly.

Three prominent therapies using the hands to balance and support the biofield and impact the healing process are Therapeutic Touch (TT), Healing Touch (HT), and Reiki . All three approaches could simply be defined as the use of the hands on or near the body with the intention to support and facilitate self-healing in a heart-centered and intentional way to balance and support

BOX 14.1

Some Equivalent Terms for Biofield

Ankh Ancient Egypt Animal Magnetism Mesmer Arunquiltha Aborigine (Aus) Bioenergy United States/United Kingdom Biomagnetism United States/United Kingdom Gana South America Ki Japan Life Force General Usage Mana e Polynesia Manitou Algonquian M’gbe Hiru Pygmy Mulungu Ghana Mumia Paracelsus Ntoro Ashanti Ntu Bantu Oki Huron Orenda Iroquois Pneuma Ancient Greece Prana India Qi (ch’i) China Subtle Energy United States/United Kingdom Sila Inuit Tane Hawaii Ton Dakota Wakan Lakota

Source: Adapted from National Institutes of Health. (n.d.) , p. 2 .

Chapter 14 • Hand-Mediated Biofield Therapies 219

the energy field. Actually, the word touch is a misnomer, especially in TT and HT, because the practitioner need not touch the recipient to achieve the desired effects during a healing session. All these therapies require informed consent from the client, and when touch is used, the client is always fully clothed. Prac- titioners use their hands with gentle, light, or near-body touch to clear, bal- ance, energize, and support another’s energy system. These therapies are modern interpretations of several ancient healing practices, traditionally known as the “laying on of hands.” TT, HT, and Reiki, however, must not be confused with faith healing because the context in which they are practiced is not religious but scientific, and some clients may experience them spiritually.

The goals of these hand-mediated therapies are to facilitate self-healing and well-being. Relaxation and stress reduction may result as well. All three are forms of treatment and are not designed to diagnose physical conditions but are to be used in conjunction with other therapies. This means that these therapies are not meant to replace conventional surgery, medicine, or drugs in treating organic disease.

BACKGROUND

Healing Touch is an international multilevel educational program that is taught through the Healing Touch Program. Healing Touch (HT) was devel- oped by Janet Mentgen, BSN, RN, HNC, CHTP/I, a Colorado nurse, who began practicing and teaching medically based energy therapy in 1980. In 1989, her five-course sequence in HT became the first certified program offered by the American Holistic Nurses Association (AHNA). “Healing Touch is a nurturing and heart-centered energy healing therapy. Gentle touch assists in balancing physical, mental, emotional and spiritual well-being. The goal in HT is to restore harmony and balance, to support the body’s natural healing ability. It is safe for all ages and works in harmony and collaboration with standard medical care” ( Healing Touch International, Inc., 2012 , p. 2 ).

Therapeutic Touch (TT) was developed by Dolores Krieger, PhD, RN, Pro- fessor Emeritus, New York University, who launched the TT movement in 1970 after studying with Dora Kunz, a past president of the Theosophical Society of America and a natural healer. TT refers to the Krieger-Kunz method of Therapeutic Touch ( Kreiger, 1979 ; Kunz, 1991 ), which was originally developed as an energy field interaction between nurse and client. In addition, nursing scholars such as Carpenito-Moyet ( 2006 ) have defined and further developed human energy field theory through the nursing diagnosis of “energy field disturbance” as a “state in which a disruption of the flow of energy surrounding a person’s being results in a disharmony of the body, mind, and/or spirit” (p. 289 ). “TT is a contemporary interpretation of several ancient healing practices. It is an intentionally directed process of energy exchange during which the practitioner uses the hands as a focus to facilitate the re-balancing of another’s energy field in support of healing. Therapeutic Touch is a holistic process and works to restore balance and order in all aspects of the individual: body, mind, and spirit” ( Therapeutic Touch Interna- tional Association, n.d. , p. 1).

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Reiki (pronounced “ray-kee”) originated in Japan. Reiki “is composed of two syllables: rei , which means universal energy, the energy that permeates the entire universe, and ki , the life energy of all living creatures” ( Birocco et al., 2012 , p. 290 ). The origin of Reiki can be traced to an ancient Tibetan/Buddhist practice rediscovered by Dr. Mikao Usui, a Japanese physician and monk ( NCCAM, 2008 ). He first used Reiki on himself and his family and then began to share his knowledge with the public. Chujiro Hayashi, who was a student of Usui’s, further developed this healing practice, and Hawayo Takata, a Japanese American student of Hayashi’s, introduced Reiki to Western cul- tures between 1930 and 1940 ( Birocco et al., 2012 ; NCCAM, 2008 ). Reiki is practiced in more than 800 hospitals in the United State. In addition, a Reiki education program for BSN nursing students has successfully been integrated at the University of Maine, Augusta ( Clark, 2013 ).

All hand-mediated biofield therapies reflect the unitary transforma- tive perspective, which encourages each person to relate with others and his or her world as unitary “pan-dimensional” beings in a pan-dimensional universe ( Newman, 1997 ; Rogers, 1992 ; Watson, 1999 ). Within this world- view, a unitary human being (human field) “is an irreducible, indivisible, pan-dimensional energy field identified by pattern and manifesting char- acteristics that are specific to the whole and which cannot be predicted from knowledge of the parts” ( Rogers, 1992 , p. 29 ). The kaleidoscopic role of nursing within this perspective is to view the client as expert. Caring– healing relationships are based on an ethic of caring consciousness, pres- ence, mutual process, pattern recognition and appreciation, and exploration of meaning ( Newman, Smith, Dexheimer Pharris, & Jones, 2008 ). Healing Touch, Therapeutic Touch, and Reiki reflect this unitary transformative stance, with Reiki reflecting Usui’s philosophy, which is also “based on the idea that there is a universal (or source) energy that supports the body’s innate healing abilities” ( NCCAM, 2008 , para. 9). In addition, each of these practices has at its core a commitment to a moral-ethical way of being and belonging.

PREPARATION

Nurses who prepare to practice hand-mediated biofield therapies take time to assess and further develop their caring–healing way of being–belonging– doing with others. As a reflective nursing practice, learning may involve study/reflective practice, such as mindfulness meditation, centering and grounding work, listening and communicating with the intent to understand others at a deeper level, considering ways to create sacred space, and connect- ing with nature as healer. Nurses who seek certification as Healing Touch (HT) practitioners from the Healing Touch Program practice a variety of bio- field techniques to assist the client to self-heal. They also reflect on their own development through reflective practice and activities, such as journaling and reading books about techniques, healing traditions, self-healing, and possible theoretical explanations. The preparation may take two or more years of study

Chapter 14 • Hand-Mediated Biofield Therapies 221

as practitioners meet requirements for each of the five levels prior to certifica- tion. Most programs strongly emphasize development of nurses as healers by considering the relationship they have with clients and with themselves, with a focus on “being mindful of the intention to deliver the best nursing care for the body, mind, spirit and emotional well-being of the patient and using ver- bal and nonverbal communication that reflects a nurse who is caring, calm, and receptive” ( Mentgen, 2001 , p. 148 ).

A Qualified Therapeutic Touch (TT) Practitioner must complete the basic TT program, which is a minimum of 12 hours, and the intermediate TT program, which is a minimum of 14 hours. The programs are followed by mentor guidance for 1 year. Therapeutic Touch can be learned by almost any- one who is motivated by compassion and committed to helping others. Fam- ily members can be taught how to use it effectively with their loved ones.

Both HT and TT were developed by nurses, and all nurses, regardless of clinical specialty, can use HT and TT in any setting. These are independent nursing interventions, so they do not require a physician’s order, but they do require client consent. Like many other nursing practices, these interventions may also require Policy and Practice approval within the Nursing Council/ Program of each institution.

Reiki is usually learned from a Reiki Master and is a spiritual practice. There are two degrees in Reiki healing, as well as a Master degree that pre- pares one to teach others. Most people can complete the first degree in a week- end course. The content includes historical information; the concept of energy healing; attunements to enhance the flow of Reiki energy within the person; understanding of a Reiki session, including the practitioner–client relation- ship; hand positions used in healing; and ethical considerations for practice. The second degree, also completed over a weekend, includes learning how to do distant healing and further enhancement of one’s physical, mental, emo- tional, and spiritual healing abilities. The Master degree involves a training mentorship with a Master Reiki practitioner and through Reiki sharing and Reiki practice groups or both. The American Holistic Nurses Association often approves Reiki programs for continuing education units, and such training is encouraged for all practitioners.

CONCEPTS

By any name—qi, ki, prana, subtle energy—a life force energy is universally recognized in biofield therapies as the core of life and the driving force in healing. The belief is that all living beings are complex networks of interwo- ven vibratory energy systems composed of an energy field (aura), energy cen- ters (chakras), and energy tracts (meridians) and that energy centers control the energy flow into and out of the body. It is at this level of the subtle energy system that both health and illness originate. Many of the most sophisticated instruments widely used in conventional medicine for diagnosis and treat- ment are energy medicine devices. Electrocardiography (ECG), electroen- cephalography (EEG), and electromyography (EMG) all measure heart, brain,

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and muscle activity (respectively), by measuring electric potentials on the sur- face of living tissue, while ultrasound instruments use high-frequency sound waves beyond the range of human hearing, and magnetic resonance imaging instruments use a magnetic field and radio-frequency waves to image various aspects of the body. People can detect a far greater spectrum of energies than can scientific measuring devices.

Energy field theory is based in part on laws of quantum physics. As expressed by McCormack ( 2009 ): “Drawing from quantum physics and field theory, all living things generate vibratory fields, which are intercon- nected by mathematical laws” (p. 45 ). William Collinge, author of Subtle Energy ( 1998 ), believes that many phenomena that are dismissed as coinci- dences are examples of extrasensory perception, déjà vu, and precognition that are part of a subtle perceptual system outside usual perception. He believes that everyone has the ability to sense energies that are not detect- able technologically but that many Western individuals reject their intuitive experiences because of a belief that anything that cannot be measured does not exist. It is this energy field that skilled biofield practitioners can literally feel and modulate.

Researchers and proponents of biofield therapies believe that conscious caring–healing intent is necessary, as well as a conscious use of self as a link between the universal life energy and the other individual. Prior to the actual intervention, practitioners focus completely on the well-being of the recipient in an act of unconditional love and compassion. Compassion, basic to all nursing intervention, involves both intention and action. Practitioners of biofield thera- pies always set their intention in mind first before entering and intervening in others’ energy fields ( Shealy, 2011 ).

People are open systems, so the transfer of energy is a natural, con- tinuous event. Therefore, it is conceivable that one person could transfer energy to another through conscious intent. When two people with an intent to heal are close to one another, their energy fields may overlap, and there may be a repatterning process. As they intermingle, each energy field influences the other through a process of resonance/coparticipation. In intentional healing situations, some practitioners believe that they regulate their own internal energy frequencies, thus supporting recipients as they draw on the healers’ resources and energy patterns. Many other practi- tioners (this author included) believe that the practitioner and client/ environment are in mutual process, connecting with universal life-force energy as the client accesses his or her own self-healing processes. This view is based on the assumption that each client has the innate power to self-heal and to restore his or her own state of balance and harmony. It has been found that in an intentional healing situation, with or without physi- cal contact, a state of coherence and synchrony develops between the brain waves of the healer and the recipient, and they literally become unified in one energetic field. Thus, the client and the practitioner experience a mutual patterning process that involves resonance of the biofield and change ( Shealy, 2011 ).

Chapter 14 • Hand-Mediated Biofield Therapies 223

VIEW OF HEALTH AND ILLNESS

Within individuals, energy flows like a river. If it encounters no obstructions, it is smooth, gliding, and barely perceptible. People whose energy flows smoothly usually report good health and a feeling of peace with themselves and with others. Health, then, is defined as an abundance of qi and a balance or harmony of body, mind, and spirit. In addition, healthy people experience equilibrium between their own energy systems and those of the environment. If obstructions or imbalance in energy occur, such as trauma, pain, rage, sad- ness, or any physical, mental, emotional, or spiritual problem, the balanced stream of energy is disrupted, and illness or disease may result.

The locus of healing is within each person and cannot be “given” to a cli- ent by a biofield therapist. People must, and do, heal themselves. Healing environments are created when nurses enter into a caring relationship with clients. The nurse’s caring presence provides opportunities for a spirit-to-spirit connection in which the nurse becomes a resource for nurturing the wholeness that always exists within each that client. As recipients become engaged in the healing process, they often develop new insights or meaning, and the nurse acts as midwife to the unfolding process related to these patterns.

TREATMENT

Each of the biofield therapies discussed in this chapter utilizes the following treatment practices:

1. Creation of a caring–healing environment (e.g., promoting and support- ing a quiet, safe, private, dignified environment with consideration of heating, ventilation, lighting, tidiness, and cleanliness of the environ- ment; promoting the person’s comfort with appropriate positioning and attention to specific needs for order, beauty, and peace).

2. Centering before beginning the biofield practice. Centering is a general term for any method that people use to quiet themselves physically, mentally, and emotionally. Centering can be achieved by many methods, such as deep breathing, visualization, and focusing, which allow the practitioner to relax and focus on the intent of the healing session. Being centered allows healers to operate intuitively, with awareness, and to channel energy throughout their bodies. Box 14.2 describes one centering method.

3. An interview with the client prior to caring–healing practice of Healing Touch, Reiki, or Therapeutic Touch.

4. The client may choose to sit or lie down, always fully clothed. 5. Assessment: Steps in the biofield caring–healing process include initial

and ongoing assessment of the energy field. Once centered, nurses use their hands to assess the recipient’s energy field. Some nurses are able to feel the energy field when they first learn their biofield therapy, while others require months of practice to experience the sensations. People describe different sensations commonly characterized as heat, cold, tin- gling, buzzing, emptiness, or pressure. The energy field is assessed for

224 Unit 4 • Manual Healing Methods

bilateral similarities or differences in the flow of energy. A healthy energy field is symmetric with a smooth, flowing texture. Practitioners often combine both physical and nonphysical contact during the course of treatment. Clients do not have to believe in the efficacy of the biofield therapy to receive benefit. The one absolutely essential ingredient in each of these biofield therapies is the goodwill and compassion of the practitioner (see Figure 14.1 ).

6. The practitioner chooses specific healing interventions based on the inter- view findings, assessment of the energy field, and specific needs of each client. These specific techniques are carried out with a caring–healing presence and active listening process.

7. Completion and grounding: The practitioner reassesses the biofield of the client prior to “grounding” or helping the client become aware. Often, the nurse does this by gently holding the tops of both feet and shoulders for a minute or two. Another way is to brush down the arms and legs toward the ground until clients start moving their hands and feet and reconnect completely with their body. Verbal cues such as “Feel your fingers and toes and gently move them” may also be helpful.

8. Feedback, documentation, and planning: Discharge planning begins with the first visit. The practitioner listens to what the client wishes to

BOX 14.2

How to Center

• Sit or stand comfortably and close your eyes, or focus on one spot on the floor. • Breathe in and out, slowly and deeply, concentrating on how the breath feels as it

goes in and out. • Breathe in relaxation and peace while breathing out stress and tension. • Imagine a fairly large tree; really sense the tree as it sounds, as it smells, and accord-

ing to the season. • Get close to the tree and put your hands on the tree; lean up against the tree and

put your full weight on the tree. • Look up through the branches and feel the sun shining down; feel the sun traveling

down through the tree and coming in through your head, down through your body, and out your legs.

• Focus once again on your breathing and know that you can come back to this place at any time.

• With practice and experience, you will be able to center yourself within one or two deep breaths.

Source: Therapeutic Touch video courses by Janet Quinn, PhD, RN.

Chapter 14 • Hand-Mediated Biofield Therapies 225

share about his or her experience and answers any questions the client may have. Counseling and education or both are provided in a mutual process that is based on client goals and the knowledge and skills of the nurse. Examples of areas for dialogue can include but are not limited to stress management, lifestyle, nutrition, quality of life, and self-care processes such as journaling, meditation, or exercise and yoga or both, along with other resources that the client finds helpful (i.e., need for referral to other practitioners such as psychotherapist, massage thera- pist, or physician). Planning may include setting time for future visits with the nurse or teaching the client and family or both a specific bio- field technique. The total number of visits with the nurse is based on the client’s responses to the biofield therapy. Documentation begins with the initial client interview and continues throughout the visit.

Therapeutic Touch (TT), Healing Touch (HT), and Reiki are used only as forms of treatment, not to diagnose physical conditions. They work in con- junction with other medical or therapeutic techniques to promote healing and to relieve side effects of conventional therapies. Indications include irritability and anxiety; lethargy, fatigue, and depression; premenstrual syndrome; nau- sea and vomiting; chemotherapy and radiation sickness; wound and bone healing; and acute musculoskeletal problems such as sprains and muscle spasms. These healing practices are often effective in many types of pain. Side effects of biofield therapies are temporary lightheadedness and/or a tempo- rary sensation of heat. Very gentle treatments are used for infants, the elderly, and those experiencing a critical illness. The primary contraindication to TT, HT, and Reiki is that a person does not want it, which falls under the doctrine of informed consent ( Hover-Kramer, 2011 ).

FIGURE 14.1 No Touch Energy Transfer

Source: Getty Images, Inc.-Stone Allstock/Julie Toy

226 Unit 4 • Manual Healing Methods

Practitioners believe that when they work with an individual’s energy fields, they are dealing with that person as a whole, and healing may occur at many levels. Recipients may experience emotional and spiritual growth, as well as physical improvement, but in some cases the therapy may not seem to work at all. Even when these methods do not help people resolve a particular problem, the session is soothing and relaxing.

RESEARCH

A Joanna Briggs Institute evidence summary found that Reiki may have posi- tive effects on well-being (Grade B). Clinical judgment should be exercised, and patient preference should be considered when deciding on Reiki and Therapeutic Touch (TT) for older adults (Grade B; Charlton, 2012 ).

The following is a small sample of current studies:

• A Cochrane systematic review of randomized controlled trials (RCTs) and controlled clinical trials by So, Jiang, and Qin ( 2008) sought to evalu- ate the “effectiveness of touch therapies (including HT, TT and Reiki) on relieving both acute and chronic pain” as well as to “determine any adverse effect of touch therapies” (para. 2). The authors found that “results of trials conducted by more experienced practitioners appeared to yield greater effects in pain reduction. It is also apparent that these trials yielding greater effects were from the Reiki studies. . . . Touch ther- apies may have a modest effect on pain relief. More studies on HT and Reiki in relieving pain are needed” (para. 6, 7).

• A Cochrane systematic review found no strong evidence that TT pro- motes healing of acute wounds ( O’Mathuna & Ashford, 2012 ).

• A quasiexperimental study found that TT was significantly effective for managing state anxiety, regulating vital signs, and decreasing the inci- dence of cardiac dysrhythmia in a sample of women undergoing cardiac catheterization compared with the control group ( Zolfaghari, Eybpoosh, & Hazrati, 2012 ).

• A randomized controlled trial with returning military personnel suffer- ing from posttraumatic stress disorder (PTSD) found that HT with Guided Imagery significantly reduced PTSD symptoms and showed sig- nificant improvements in mental quality of life ( Jain et al., 2012 ).

• A systematic review of HT studies found that there is a need for random- ized clinical trials before recommendations can be made ( Anderson & Taylor, 2012 ).

INTEGRATED NURSING PRACTICE

Hand-mediated biofield therapies of Therapeutic Touch (TT), Healing Touch (HT), and Reiki have been pioneered by nurses and are easily learned by nurses. That this has been recognized for many years is evidenced by the approved nursing diagnosis of disturbed energy field. Although many nurs- ing curricula currently include some components of biofield therapies, most

Chapter 14 • Hand-Mediated Biofield Therapies 227

nurses did not formerly receive information about the use of hand-mediated biofield therapies in nursing school. Nurses who have not been taught any of these therapies may want to participate in courses that are shown on the web- sites for Healing Touch, Therapeutic Touch, and/or Reiki (see Resources list).

TT, HT, and Reiki can be used in almost any clinical setting, including hospitals, nursing homes, home health care, hospice, and private practice. These hand-mediated therapies are used in Lamaze classes, labor rooms, new- born nurseries, neonatal intensive care units, pediatric units, medical surgical units, recovery rooms, palliative care, and behavioral medicine. TT, HT, and Reiki are helpful for people with a variety of health needs. In the current health care environment, individuals with acute and chronic disorders are rapidly dis- charged back to the community. Family and friends are often overwhelmed by caregiver responsibilities. Often, they feel helpless in the face of their loved one’s obvious suffering or pain. Teaching caregivers one or more biofield modalities can be a powerful nursing intervention that counteracts this sense of helplessness. As caregivers discover that biofield therapies can minimize the experience of pain and increase the sense of relaxation, they often feel they have something “worthwhile” to offer. In addition, the use of biofield therapies can be helpful to the caregiver, who is most likely exhausted from trying to carry on the normal daily routine, as well as caring for the sick or injured person. Because one of the steps of biofield therapies is centering, the process demands that caregivers take a few minutes for themselves as they concentrate on their well- being and sense of peace. As caregivers increase their self-awareness, they are quicker to recognize tension and stress in their bodies, which should encourage them to develop stress management skills. TT, HT, and Reiki produce a sense of well-being and relaxation in both the nurse and the recipient. For some nurses, it is the first time they have been given permission to be quiet, take a breath, and center during working hours. When a nurse walks into a client’s room or home in a peaceful state of mind, that gentleness, that kindness permeates the environment. Recipients react positively to the treatments but also to the indi- vidual attention from nurses as they build relationships with clients, offer non- invasive nurturing touch, and reduce clients’ stress and anxiety ( Watson, 2011 ). Practicing one or more of the biofield therapies is one of the ways nurses create caring relationships and caring-healing environments.

TRY THIS

Experience Your Energy Field

• Vigorously rub your hands together for 20–30 seconds. • Hold your palms together, parallel but not touching. • Slowly separate them a couple of inches.

(continued)

228 Unit 4 • Manual Healing Methods

• Slowly bring them close together again. • Repeat this process several more times, each time separating your palms by an addi-

tional 2 inches until they are 8 inches apart. • You should be able to detect your energy field as you bring your palms together;

you may feel a sense of bounciness, sponginess, or elasticity; some people describe it as the feeling of two magnets repelling each other.

References

National Institutes of Health. (n.d). Ad Hoc Advisory Committee to the Office of Alternative Medicine. Biofield therapeutics. The sub-section from alterna- tive medicine: Expanding medical horizons. A report to the National Institutes of Health on alternative medical systems and practices in the United States (pp. 1–20). Retrieved from http://www.shentherapy.info /images/biofield%20therapeutics.pdf

Anderson, J. G., & Taylor, A. G. (2012). Effects of Healing Touch in clinical practice: A systematic review of ran- domized clinical trials. Journal of Holistic Nursing, 29(3): 221–228. doi: 10.1177/0898010110393353

Birocco, N., Guillame, C., Storto, S., Ritorto, G., Catino, C., Gir, N., . . . Ciuffreda, L. (2012). The effects of Reiki therapy on pain and anxiety in patients attending a day oncology and infusion services unit. American Journal of Hospice and Palliative Medicines, 29(4), 290–294.

Carpenito-Moyet, L. J. (Ed.). (2006) Nursing diagnosis: Application to clinical practice (11th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.

Charlton, K. (2012). Reiki and Therapeutic Touch: Dementia and older adults. Joanna Briggs Institute Evidence Sum- mary. Retrieved from http://connect .jbiconnectplus.org/ViewDocument .aspx?0=6296s

Clark, C. (2013). An integral nursing edu- cation experience: Outcomes from a BSN Reiki course. Holistic Nursing Practice, 27(1): 13–21.

Collinge, W. (1998). Subtle Energy. New York, NY: Warner Books.

Healing Touch International, Inc. (2012). Healing and our path of infinite potential: Part 4: Shadow and light. HTI’s Perspectives in Healing, (4th quarter): 1–36.

Hover-Kramer, D. (2011). Healing Touch: Essential Medicine for Yourself and Oth- ers. Boulder, CO: Sounds True.

Jain, S., McMahon, G. F., Hasen, P., Kozub, M. P., Porter, V., King, R., & Guarneri, E. M. (2012). Military Medicine, 177(9): 1015–1021.

Kreiger, D. (1979). The Therapeutic Touch: How to Use Your Hands to Help or to Heal . New York, NY: Prentice Hall.

Kunz, D. (1991). The Personal Aura . Wheaton, IL: Quest.

McCormack, G. L. (2009). Using a non- contact therapeutic touch to manage post-surgical pain in the elderly. Occu- pational Therapy International, 16(1): 44–56.

Mentgen, J. (2001). Healing touch. Nurs- ing Clinics of North America , 36(1): 143–157.

National Center for Complementary and Alternative Medicine. (2008). An Introduction to Reiki. NCCAM Publi- cation No. D315. Retrieved from http://nccam.nih.gov/health/reiki /introduction.htm?nav=gsa

National Center for Complementary and Alternative Medicine. (2012). Energy medicine: An overview. NCCAM Publication No. D235. Retrieved

Chapter 14 • Hand-Mediated Biofield Therapies 229

from http://nccam.nih.gov/health/ backgrounds/energymed.htm

Newman, M. A. (1997). Evolution of theory of health as expanding consciousness. Nursing Science Quarterly , 7: 153–157.

Newman, M. A., Smith, M. C., Dexheimer Pharris, M., & Jones, D. (2008). The focus of the discipline revisited. Advances in Nursing Science, 31(1): E16–E27.

O’Mathuna, D. P., & Ashford, R. L. (2012). Therapeutic Touch for healing acute wounds. Cochrane Database of System- atic Reviews, June 13 (6): CD002766. doi: 10.1002/14651858.CD002766.pub2

Rogers, M. E. (1992). Nursing science and the space age. Nursing Science Quar- terly , 5(1): 27–34.

Shealy, C. N. (2011). Energy Medicine: Practical Application and Scientific Proof. Virginia Beach, VA: A.R.E. Press.

So, P. S., Jiang, J. Y., & Qin, Y. (2008). Touch therapies for pain relief in adults.

Cochrane Database of Systematic Reviews, Oct. 8 (4): CD006535. doi: 10.1002/ 14651858.CD006535.pub2

Therapeutic Touch International Associa- tion. (n.d). Who we are. Retrieved from http://therapeutic-touch.org/

Watson, J. (1999). Postmodern Nursing and Beyond . Edinburgh, UK: Churchill Livingstone.

Watson, J. (2011). Human Caring Science: A Theory of Nursing (2nd ed.). Sudbury, MA: Jones & Bartlett.

Zolfaghari, M., Eybpoosh, S., & Hazrati, M. (2012). Effects of Therapeutic Touch on anxiety, vital signs, and cardiac dys- rhythmia in a sample of Iranian women undergoing cardiac catheterization: A quasiexperimental study. Journal of Holistic Nursing, 30(4): 225–234. doi: 10.1177/0898010112453325

Resources American Holistic Nurses Association

100 SE 9th St., Suite 31 Topeka, KS 66612 800.278.2462 www.ahna.org

Canadian Holistic Nurses Association www.chna.ca

Canadian Reiki Association P.O. Box 54570 7155 Kingsway Burnaby, BC V5E 4J6 www.reiki.ca

Healing Touch Canada RR2 Warsaw, ON K0L 3A0 705.652.0506 www.healingtouchcanada.net

Healing Touch Program 20822 Cactus Loop, Suite 300 San Antonio, TX 78258 210.497.5529 http://www.healingtouchprogram .com/

International Center for Reiki Training 21421 Hilltop St., Suite 28 Southfield, MI 48033 800.332.8112 www.reiki.org

Therapeutic Touch International Association P.O. Box 130 Delmar, NY 12054 518.325.1185 www.therapeutic-touch.org

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15 Combined Physical and Biofield Therapy

The art of medicine consists in amusing

the patient while nature cures the disease.

Voltaire

Applied kinesiology , described in this chapter, is a combi-nation of physical and biofield interventions. Applied kinesiology is both a diagnostic method and treatment modality using energy, acupuncture meridians, as well as lym- phatic, neurovascular, and muscle systems.

BACKGROUND

George Goodheart and Alan G. Beardell, American chiropractic physicians, developed applied kinesiology in the 1960s. In the 1970s, John Thie, also a chiropractor, took their work, simplified it for the general public, and called this modified approach “Touch for Health.”

PREPARATION

Health care professionals may go on to study applied kinesiol- ogy only after completing their basic professional education. Chiropractors, nurses, osteopaths, naturopaths, dentists, and physicians practice applied kinesiology. Interested profession- als take the training in a postgraduate setting, usually in week- end classes. Prerequisites include anatomy and physiology,

Chapter 15 • Combined Physical and Biofield Therapy 231

interpersonal communication, and nutrition. The basic course takes more than 100 hours of classroom study and numerous hours of practice in the clinical setting, after which students can test for basic proficiency. Another 200 hours of clinical hours under the guidance of a mentor are undertaken to reach the next step, in which a diplomate written and oral exam is taken. Organized courses in applied kinesiology are taught in Europe, Canada, the United States, and Australia. There is no licensure per se; providers of applied kinesiology practice on their professional license.

CONCEPTS

As in many alternative practices, the concept of energy is at the heart of applied kinesiology. The belief is in a life force of subtle energy that surrounds and permeates all living things, often referred to as a biofield . It is currently unclear whether the biofield is electromagnetic or a field in physics other than one already known. The present hypotheses are that the biofield is a form of bioelectricity, biomagnetism, or bioelectromagnetism. The exact nature has not yet been established ( Smith, 2011 ).

Meridians

Practitioners of applied kinesiology work closely with the meridian system and pressure points. Meridians are a network of energy circuits that run verti- cally through the body. Each meridian passes close to the skin’s surface at places called pressure points . Since each meridian is associated with an internal organ, the points offer surface access to the internal organ system. Each of the 14 meridians has related specific neurovascular points and neurolymphatic points ( Thie & Thie, 2012 ).

Neurovascular Points

Neurovascular points are located mainly on the head. A few seconds after placing one’s fingers on these points, a slight pulse can be felt at a steady rate of 70 to 74 beats per minute. This pulse is not related to the heartbeat but is believed to be the primitive pulsation of the microscopic capillary bed in the skin.

Neurolymphatic Points

The lymphatic system in the body flows in only one direction and acts as a drainage system for the body. It produces antibodies, makes white blood cells, and transports fats, proteins, and other substances to the blood system. Neurolymphatic reflexes, located mainly on the chest and back, regulate the energy to the lymphatic system. These reflex points act like switches that get turned off when the system is overloaded. They are usually tender spots, and those that are the sorest are in greatest need of massage.

232 Unit 4 • Manual Healing Methods

VIEW OF HEALTH AND ILLNESS

Well-being and health are determined by the nature of the flow of energy within and outside the body. When energy flows smoothly without signifi- cant blockage or fixation, the person experiences health in an ongoing and dynamic way. Disease and pain occur when energy is blocked, fixed, or unbal- anced. When someone’s physical body, thoughts, and emotions are out of alignment with the energy necessary to meet a life challenge, an energy imbal- ance results. Within the applied kinesiology framework, one of the signs of an imbalance is a weakening of the muscles and a change in the posture. If these minor problems are not corrected, the imbalances may develop into physical, mental, and emotional discomfort or pain. Pain and discomfort are seen as signals to people to learn, change, and realign their lives.

Diagnostic Methods

An applied kinesiology exam depends on knowledge of functional neurol- ogy, anatomy, physiology, biomechanics, and biochemistry. It is combined with standard procedures, laboratory findings, X-rays, and history taking. Generally, problems can be related to a chemical imbalance, a structural imbalance, mental stress, or any combination of these states. General exami- nation procedures are used to assess the health of the client and are fol- lowed by specific examination procedures such as testing reflexes or assessing balance ( Rosner & Cuthbert, 2012 ).

Every muscle in the body is related to a specific organ or gland through sharing lymphatic vessels or meridians. Because organs and glands have few pain and sensory fibers, people are largely unaware of energetic imbalances in these parts. Unbalanced organs or glands, however, refer pain externally to the corresponding surface meridians and muscles, indicating the cause of the problem. For example, the deltoid muscle in the shoulder shares a relation- ship with the lungs. If a person has abnormal lung function, such as bron- chitis, pneumonia, congestion, or the flu, the problem may exhibit as a weakness in one or both deltoid muscles. When the lung problem is cleared up, the deltoid muscle returns to a normal state ( Thie & Thie, 2012 ).

Manual muscle testing augments the other examination procedures. Goodheart and Beardall designed specific methods for testing the function of the 576 muscles of the body. Muscle weaknesses are often so subtle that phys- ical therapists would consider the muscle strength to be within normal limits. No more than 15% difference should be discernible between the right and left sides. The testing positions are intended to isolate the muscle from the group with which it normally works, making it less strong than if it were used in the usual way. Small children, the elderly, and the frail will not be as strong as a healthy adult. It is more difficult to test a person who has great strength, such as an athlete, because the weakness cannot be distinguished by the tester ( Thie & Thie, 2012 ).

A number of causes result in weak muscles, including immobility, lack of exercise, poor posture, gland/organ dysfunction, dysfunction of the nerve sup- ply, impairment of lymphatic drainage, decreased blood supply, blockage of

Chapter 15 • Combined Physical and Biofield Therapy 233

meridians, and chemical imbalance. Testing of individual muscles combined with knowledge of the basic mechanics and physiologic functioning of the body provides practitioners with information necessary to formulate a diagnosis.

TREATMENT

Applied kinesiology practitioners believe that the body, mind, emotions, and spirit are interdependent; that people are responsible for their own health; and that they can take simple steps to improve and maintain their level of wellness. The practitioner’s role is to facilitate and support clients’ self-healing capabilities.

Applied kinesiology uses various methods to strengthen those muscles and related organs that were found to be weak during the diagnostic phase. Improvement in the flow of energy can be measured by increased muscle strength, which is assumed to lead to an increase in energy to the corre- sponding organs.

Neurovascular holding points are located mainly on the head. The practi- tioner makes simple contact with the pads of the fingers for anywhere from 20 seconds to 10 minutes, depending on the severity of the problem. This method appears to improve the blood circulation to both the muscle and the related organ, and the weak muscle will have increased strength when retested.

Neurolymphatic points are located mainly on the chest and back. Practitio- ners work on the points that are related to a specific weakened muscle by a deep massage of the points for 20 to 30 seconds. This massage is believed to turn on the blocked reflexes, allowing the lymph flow to return to normal. The weak muscle will have improved strength when retested. Figure 15.1 illustrates the neurolymphatic points for the lungs.

Second

First

FIGURE 15.1 Lung Meridian and Neurolymphatic Holding Points

234 Unit 4 • Manual Healing Methods

Meridians are traced in the designated direction on both sides of the body. Practitioners use the flat of their hands to give better coverage. Meridians can be traced over clothing without actually touching the client. Tracing the merid- ian adds the practitioner’s flow of energy to the recipient’s energy in a blocked meridian and may restore the normal flow of energy. Figure 15.1 also illus- trates the lung meridian.

Acupressure points are held on the same side of the body as the muscle that is weak. The first arm and leg points are held at the same time, one with each hand. Light pressure is maintained for about 30 seconds or until a pulse is felt in the leg. The hands are then moved to the second acupressure points and held, again, until a pulse is felt in the leg. Figure 15.2 illustrates the pressure points for the lungs.

Adherents of applied kinesiology believe that nutrition plays a major role in health and well-being. Kinesiology assesses people’s nutritional

Lung meridian

Neurolymphatic holding points

FIGURE 15.2 Pressure Points for the Lungs

Chapter 15 • Combined Physical and Biofield Therapy 235

status, including food intolerances, vitamin and mineral deficiencies, and other chemical sensitivities. Exercise is an important part of this therapy. Applied kinesiology practitioners encourage clients to walk for exercise. Walking is one of the few exercises that benefit all parts of the body. All the muscles are used when people walk with their arms swinging.

Applied kinesiology can relieve pain, stress, and muscular disorders. It is used to detect allergies, nutritional deficiencies, back or neck pain, fatigue, headache, tension, and the common cold and is believed to have some benefit for those with learning disorders.

RESEARCH

The efficacy of applied kinesiology has not yet been established in published, peer-reviewed research. Replication has been difficult because muscle testing varies in terms of duration of the test and the amount of force used by the practitioner. A review of the literature found insufficient evidence for accu- racy in diagnosis and effectiveness of treatment ( Conable & Rosner, 2011 ; Hall, Lewith, Brien, & Little, 2008 ).

INTEGRATED NURSING PRACTICE

Nurses need advanced study to apply the specific techniques of applied kine- siology. Practitioners in applied kinesiology may actively intervene or make suggested changes to address food allergies, chemical imbalances, or nutri- tional deficiencies as determined by clinical assessment. If appropriate, they may encourage clients to take care of their physical body with moderate exer- cise such as walking or swimming and good nutrition.

TRY THIS

Emotional First Aid

The next time you are upset, try this procedure to decrease your stress.

• Either hold the frontal eminences on your forehead with the first two fingers of your hands—the right and left at the same time—or place the palm of your hand flat on your forehead.

• While applying light pressure, in your mind review exactly what you are thinking and how you are feeling about the problem. Continue holding these points and going over what is bothering you for a few minutes or until you feel the emotions becoming less strong.

• Let your hands go and look around you. Mentally review the issue again. If stressful feelings are still there or have changed to other stressful feelings (fear changed to

(continued )

236 Unit 4 • Manual Healing Methods

TRY THIS

Redirecting the Flow of Energy

Sit facing a partner, and placing both hands in the air, move your hands close to your partner’s hands without touching. Experiment with distances until you can feel the energy pulsating between your hands. Imagine that your partner’s energy is coming into your left hand from your partner’s right hand, and your energy is flowing from your right hand into your partner’s left hand. Imagine the circular circuit between the two of you as the energy flows up the left arm, across the heart, and down the right arm. Imagine how connected you feel at this given moment.

anger, for example), go back and begin the process again. After a further few min- utes, release the pressure and check your feelings about the situation again.

• It is hoped that your mind will feel clearer, and the same emotions will no longer have the same stressful impact.

Considering the Evidence

S. Jain & P. J. Mills, 2010, Biofield therapies: Helpful or full of hype? A best evidence syn- thesis, International Journal of Behavioral Medicine , 17: 1–16.

What Was the Type of Research? A systematic review

What Was the Purpose of the Research? To synthesize, appraise, and evaluate relevant RCTs and other study designs aimed at incorporating distant healing or intercessory prayer; studies that integrated other modali- ties with biofield-based modalities in a way that the interventions could not be separated; animal, plant, and in vitro studies; clinical studies with group assignment but no random- ization to groups; purely descriptive studies; and dissertations.

How Was the Study Done? The authors used a systematic review methodology to examine quantitative studies rele- vant to the purpose of this research according to the QUORUM checklist guidelines. They employed a search strategy using selected keywords and four electronic databases to identify relevant studies. Initially, 576 publications were identified. Sixty-six studies were

Chapter 15 • Combined Physical and Biofield Therapy 237

References

Conable, K. M., & Rosner, A. L. (2011). A narrative review of manual muscle testing and implications for muscle testing research. Journal of Chiropractic Medicine, 10(3): 157–165. doi: 10.1016/ j.jcm.2011.04.001

Hall, S., Lewith, G., Brien, S., & Little, P. (2008). A review of the literature in applied and specialized kinesiology. Forschende Komplementärmedizin, 15(1): 40–46.

Rosner, A. L., & Cuthbert, S. C. (2012). Applied kinesiology: Distinctions in its definition and interpretation. Jour- nal of Bodywork and Movement Thera- pies, 16(4): 464–487. doi: 10.1016/ j.jbmt.2012.04.008

Smith, K. (2011). Shamanism for the Age of Science: Awakening the Energy Body . Rochester, VT: Bear.

Thie, J., & Thie, M. (2012). Touch for Health. Camarillo, CA: DeVorss.

identified as meeting the established inclusion criteria for this review. (Fifty-two were between-subjects RCTs, and 14 were within-subject repeated measures designs.)

What Were the Findings of the Research? Biofield therapies show strong evidence for reducing pain intensity in populations of peo- ple in pain, and moderate evidence for decreasing pain intensity in persons who are hos- pitalized and living with cancer. The findings indicated that there is moderate evidence for decreasing untoward behavioral symptoms in persons living with dementia, and moderate evidence for lessening anxiety in hospitalized patients. Evidence is unclear related to the effect of biofield therapies on fatigue and quality of life for persons living with cancer, diminishing anxiety in persons living with cardiovascular disease, and comprehensive pain outcomes and effect in clients with pain.

What Additional Questions Might I Have? Would additional studies of good methodological quality suggest the use of biofield ther- apies for persons living with fatigue, cancer, and cardiovascular disease? Are there any adverse or harmful effects associated with biofield therapies? What would be the effect of biofield therapies in combination with other complementary and alternative therapies for persons with a variety of health challenges? Could implementation of biofield therapies have long-term effects?

How Can I Use This Study? Nurses should consider the value of biofield therapies in caring for patients experiencing pain and anxiety owing to a variety of health problems. Nurses should be aware that addi- tional research of good methodological quality on the effectiveness of biofield therapies for patients experiencing health challenges is needed and may serve to strengthen the evidence regarding implementation.

Source: Contributed by Dolores M. Huffman, RN, PhD

238 Unit 4 • Manual Healing Methods

Resources The Kinesiology Federation (UK)

P.O. Box 269 Gosport, PO12 9FG 084.5260.1094 www.kinesiologyfederation.org

Touch for Health Kinesiology Association 4917 Waters Edge Drive, Suite 125 Raleigh, NC 27606 800.466.8342 www.tfhka.org

Mind–Body Techniques

A man’s spirit can sustain his broken body, but when spirit dies, what hope is left?

Proverbs 18:14

5 U N I T

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16 Yoga

Meditation is the dissolution of thoughts in Eternal awareness or Pure

consciousness without objectification, knowing without thinking, merging

finitude in infinity.

Voltaire

Yoga , part of Ayurvedic medicine, has been practiced for thousands of years in India, where it is a way of life that includes ethical models for behavior and mental and phys- ical exercises aimed at producing spiritual enlightenment. Although yoga developed from Hinduism, it is not a religion but rather a journey of the body, mind, and spirit on a path toward unity. It is a method for life that can complement and enhance any system of religion, or it can be practiced completely apart from religion.

The Western approach to yoga tends to be more fitness ori- ented, whereas the Eastern approach to yoga is to prepare people for the experience of self-realization. Most Westerners begin yoga with the goal of managing their stress, learning to relax, and increasing their vitality and well-being. After learning yoga, many become more interested in the underlying principles of physical fitness and keeping the mind focused, calm, and clear. Yoga is meant to prepare the body and mind for a useful, dedicated life.

BACKGROUND

The word yoga means to direct and concentrate one’s attention and comes from the Sanskrit word yuj , meaning “to yoke” or “to join.” Yoga was first described by Patanjali, an Indian sage who, thousands of years ago, wrote the Yoga Sutra , which recorded information that had been passed down orally for

241

242 Unit 5 • Mind–Body Techniques

many years. This text has helped define and shape the modern practice of yoga. Yoga first came to the United States in the 1890s, when Swami Vivekananda became a popular teacher and guide. In the 1960s, the Maharishi Mahesh Yogi, the developer of Transcendental Meditation, became a popular figure for the U.S. “hippie generation,” and interest in it has continued to grow since then ( Smith, Hall, & Gibbs, 2013 ).

The various methods of yoga all have the same goal: to attain a state of pure bliss and oneness with the universe. Raja yoga emphasizes control of the intellect to attain enlightenment, accomplished through meditation, concentra- tion, and breath control. Kriya yoga is the practice of quieting the mind through scriptural study, breath control, mantras, and meditation. Karma yoga focuses on service to all beings as the path to enlightenment. Bhakti yoga emphasizes devotion to the divine. Inana yoga ’s goal is wisdom and the direct knowledge of the divine. Tantra yoga involves the study of sacred writings and rituals. Mantra yoga is the study of sacred sounds. Kundalini yoga is the study of energy movement along the spine. Iyengar yoga , a form of hatha yoga, strives for perfec- tion in the postures using props such as belts or ropes. Silver yoga and chair yoga are designed to accommodate those with reduced body flexibility such as older people or those with physical challenges. Restorative yoga is usually done in a lying or sitting position, which causes less physical strain. Props such as blan- kets, pillows, towels, balls, or straps support the poses and provide a gentle prolonged stretch. When combined with physical therapy the benefits are improved strength, flexibility, and range of motion for individuals recovering from illness or injury or for those experiencing physical or emotional stress ( Ramacharaka, 2012 ; Smith et al., 2013 ).

Although these many branches of yoga exist, this chapter focuses on hatha yoga as the form of yoga most frequently practiced by Westerners. In this particular type of yoga, the path to enlightenment is through control over the physical body as the key to control of the mind and freedom of the spirit. Physical exercises, breath control, and meditation tone and strengthen the whole person—body, mind, and spirit.

PREPARATION

No national licensure or standard certification is required for yoga instruc- tors. Becoming a yoga instructor or yoga therapist requires much more per- sonal dedication than that demanded by many other alternative therapy practices. To be admitted to most training programs, prospective yoga instruc- tors must have been practicing yoga daily for 6 months to a year; must abstain from drugs, alcohol, and tobacco; and must follow a vegetarian diet.

CONCEPTS

Classical yoga incorporates eight limbs or paths that provide structure for one’s daily life. These physical and psychological practices are believed to contribute to a higher level of personal development. The outer aspect of yoga consists of

Chapter 16 • Yoga 243

right living (abstinence and personal discipline), right care of the body (body control), and enhancement of vital energy (breath control). Yoga also has an inner dimension that emphasizes its key purpose. Detachment, concentration, and meditation together form a single process toward the development of pure consciousness ( Smith et al., 2013 ). Box 16.1 lists the eight limbs of yoga.

Abstinences

Abstinences concern what not to do in life. The first abstinence pertains to nonviolence. Nonviolence means not only not physically hurting others but also having nonviolent words and nonviolent thoughts. Truthfulness, the sec- ond abstinence, results in personal integrity and strength of character. Non- stealing, the third abstinence, includes not stealing others’ material belongings as well as not taking credit for things one has not done, not stealing the center of attention, and so forth. The fourth abstinence, chastity or nonlust, means holding people in high esteem and loving and respecting others. The fifth abstinence is nongreed, which means living simply and viewing possessions as tools to use in life. Nongreed leads to the avoidance of jealousy and envy ( Gupta & Fox, 2012 ).

BOX 16.1

The Eight Limbs of Yoga: Guidelines for Living

1. Abstinences (yamas) Nonviolence (ahimsa) Truthfulness (satya) Nonstealing (asteya) Chastity or nonlust (brahmacharya) Nongreed (aparigraha)

2. Personal Disciplines (niyamas) Purity (shauca) Contentment ( samtosa) Self-discipline (tapas) Self-study (svadhyaya) Centering on the divine (ishvara-pranidhana)

3. Body Control (asanas) 4. Breath Control (pranayama) 5. Detachment (pratyahara) 6. Concentration (dharana) 7. Meditation (dhyana) 8. Pure Consciousness (samadhi)

244 Unit 5 • Mind–Body Techniques

Personal Disciplines

Personal disciplines concern what to do in life. Purity, the first discipline, is achieved through the practice of the five abstinences. The abstinences clear away negative ways of being, leading one straight to purity. Purity also relates to cleanliness and respect for all life. Contentment, the second discipline, means finding happiness with who one is and with what one has. The third discipline, self-discipline, means being able to make a commitment and adhere to it. The fourth discipline, self-study, means studying oneself through introspection. Centering on the divine, the fifth discipline involves devotion. These disciplines work with any religion because individuals are encouraged to focus on how the divine is in them, part of them, and all around them ( Gupta & Fox, 2012 ).

Body Control

Body control, an important part of hatha yoga, is attained through a number of poses or asanas . These body positions are what most Western people think of when they hear the word yoga (see Figure 16.1 ). These poses help people learn to control their bodies, making them stronger, more flexible, better func- tioning, and more resistant to disease and other problems. Poses are also meant to facilitate meditation. The poses are frequently classified into the

FIGURE 16.1 Woman Bent Over with Her Arms Stretched Over Her Head

Source: Dorling Kindersley Media Library/Dorling Kindersley

Chapter 16 • Yoga 245

following groups: standing poses, inverted poses, twists, backward-bending poses, forward bends, and poses for restoration. Another way of classifying poses is according to balance, strength, flexibility, and relaxation. The belief in nonviolence also applies to the poses, which means that physical exercise is never done to the point of pain because pain is indicative of doing violence to the body ( Lysycia, 2013 .)

Breath Control

Breath control teaches people to direct energy or prana for optimal physical and mental benefit. When air is inhaled, so is vital energy that flows into the body to nourish and enliven. The purpose of balancing the breath is to make respiratory rhythm more regular, which in turn has a soothing effect on the entire nervous system. It is the best antecedent to meditation because it focuses attention inward and reduces scattered thinking ( Babooa, 2012 ).

Detachment

The practice of detachment is related to the senses. It is the withdrawal of the senses from everything that stimulates them. The goal of detachment is to gain mastery over external influences. This detachment can occur dur- ing breathing exercises, during meditation, and while doing the poses. The process of detachment can also be an effective technique for pain control ( Babooa, 2012 ).

Concentration

Teaching the mind to focus on one thing instead of many is the goal of concen- tration. Concentration means sustaining attention while quieting the mind and relaxing the breathing. Frequently, people focus on one object such as a candle flame, the figure of a circle, or a single sound. The purpose is to learn to push away many thoughts that usually float around in one’s mind. Concen- tration works directly on the body, allowing each yoga pose to accomplish the maximum possible benefit ( Kabat-Zinn, 2011 ).

Meditation

Breath control, detachment, and concentration lead to the state of meditation. Meditation occurs when people become absorbed into the object on which they are concentrating. At this point, nothing else exists. It is through the process of meditation that individuals are able to clear their minds of clutter and thus think more quickly and see things more clearly in daily life ( Kabat-Zinn, 2011 ). Meditation is covered as a separate topic in Chapter 17 .

Pure Consciousness

The other seven limbs of yoga lead to pure consciousness, which means a total merging with the object of meditation and thus becoming one with the universe.

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Generally speaking, pure consciousness is “mind without thought.” Many religions throughout history include pure consciousness as part of their tradition. Christianity refers to it as “pure love,” and Judaism, as the “divine nothingness” or “the naught.” It is more than a mental or emotional experience. Physically, breathing slows drastically, the heart rate drops, and EEGs demonstrate unique patterns unlike those in any of the other three common states of consciousness—waking, sleeping, and dreaming. Pure consciousness is an ideal state, a state of pure bliss that is elusive for most people. A few rare and diligent yogis have been able to maintain this state for extended periods of time. Most others get occasional glimpses of it while meditating ( Kabat-Zinn, 2011 ).

VIEW OF HEALTH AND ILLNESS

In yoga, health is related to the five sheaths of existence . The first sheath is the physical body; the second is the vital body, life force, or prana; the third sheath is the mind, including thoughts and emotions; the fourth sheath is the higher intellect; and the fifth sheath is bliss, filled with positive energy and inner peace. It is believed that imbalances in any of these sheaths can result in illness. For example, intense anger, a disturbance in the third sheath, disrupts one’s breathing pattern, which leads to an imbalance in prana or life force. The disrupted breathing allows the invasion of a virus, leading to a disruption in the first sheath, manifesting as a cold. Living one’s life in moderation is thought to keep all five sheaths in balance, which contributes to health and well-being ( Smith et al., 2013 ).

Yogic thought places food or ahara on three levels. The first is the physical food that nourishes the body. The second is impressions or the sensations of sound, touch, sight, taste, and smell that nourish the mind. The third level is associations or the people who nourish the soul. Health and well-being are withdrawal from wrong food, wrong impressions, and wrong associations while simultaneously opening up to the right food, right impressions, and right associations. Just as a healthy body resists tox- ins and pathogens, a healthy mind resists the negative influences around it ( Smith et al., 2013 ).

The yogic perspective of health and illness is related to internal and external balance. Although it is recognized that viruses, bacteria, genetics, and accidents can cause illness, disorders can also be brought on by

• insufficient prana, or life force. • blocked prana. • inappropriate diet. • lack of cleanliness. • unhappiness. • pessimism and negativity.

Healthy habits, maintenance of the body, peacefulness of mind, and calmness of spirit protect people from ill health. Yoga is a great preventive medicine. It helps the body cleanse itself of toxins by removing obstacles to the proper flow of the lymphatic system. Lymph is pumped through the body

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by movement—musculoskeletal movement, respiratory movement, circula- tory movement, gastrointestinal movement, and so forth, all of which are part of yoga. Yoga also increases the flow of vital energy throughout the body by opening up and increasing the flexibility of body joints, considered to be minor chakras. Yoga poses and breathing techniques allow energy and lymph to flow freely throughout the entire body, resulting in a body that works bet- ter, feels better, and fights disease more effectively. Health, from a yogic per- spective, can be described as the body easeful, the mind peaceful, and the life useful ( Gupta & Fox, 2012 ).

TREATMENT

Individuals can do as much or as little yoga as they wish. Some start with all three practices—poses, breath control, and meditation. Others start with the poses and may or may not develop interest in breathing and meditation.

As practiced in the United States, a typical yoga session lasts 20 minutes to an hour. Some spend 30 minutes doing poses and another 30 minutes doing breathing practices and meditation. Others spend the majority of the time doing poses and end with a short meditation or relaxation procedure. Some people practice one to three times a week in a class, while others practice daily at home. Yoga should not be done within 1 to 2 hours after a heavy meal for sake of abdominal comfort when doing the poses. Caffeine and other stimu- lants should be avoided because they may interfere with the goal of relax- ation. Yoga should never be done under the influence of alcohol or recreational drugs because they may decrease concentration, coordination, and strength, thus increasing the risk of physical injury. Yoga is best done in comfortable, loose clothing using a nonslippery surface such as a rug, mat, or blanket. Because it is important that the process have one’s full attention, the room should be void of all extraneous noise, even soft background music.

Yoga is tailored to the individual and can be done with great benefit at the beginner level as well as at the most advanced level. Participants must remember that yoga is not a competitive sport, and thus a person’s level does not matter. If people are stiff and out of shape, sick, or weak, sets of easy exer- cises help loosen the joints and stimulate circulation. If practiced regularly, these simple exercises alone make a great difference in people’s health and well-being.

Poses can be slow and careful or more vigorous. Beginning poses are used to relax tension in the muscles and joints and center the mind. Attention is paid to how the body feels and what it is doing. Every movement is made gently and slowly. Strain or force is to be avoided because yoga is a nonvio- lent approach that is done comfortably. Strength training is isometric because the muscles are tensed in opposition to each other. After assuming a pose, one holds it for as long as can be done comfortably, usually about six breaths. Each pose in a well-structured workout includes a pose and its opposite, such as a forward bend and a backward bend, so the body stays physically balanced. Breathing should be easy, fluid, and continuous and used to facili- tate the poses ( Lysycia, 2013 ).

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Every yoga session should end with a few minutes of complete and total relaxation. This period is an important part of bringing the mind and body together to maximize the benefits. Some people end the session with chanting to reach a deeper state of relaxation. The instructor ends the session with the word namaste: “The divine in me bows to the divine in you.”

Yoga offers a number of health benefits. The physical and psychological benefits include the following:

• Increases flexibility of muscles and joints • Improves range of motion • Tones and strengthens muscles • Improves endurance • Increases circulation • Lowers blood pressure • Increases lymph circulation • Improves digestion and elimination • Promotes deeper breathing • Increases brain endorphins, enkephalins, and serotonin • Increases mental acuity • Augments alpha and theta brain wave activity • Promotes relaxation • Manages stress ( Li & Goldsmith, 2012 ; National Center for Complemen-

tary and Alternative Medicine [NCCAM], 2013 ).

Yoga is not a cure-all for disease. It can help, however, to relieve symp- toms, decrease pain, and improve the quality of life. It helps prevent disease by reinforcing lifestyle changes such as positive health habits and attitudes. Overall, yoga is safe. If individuals have a weak link—whether it is the lower back, knees, or shoulders, they are at higher risk of injury and need to be more careful when doing yoga. The two main causes of yoga-related injuries are unqualified teachers and overzealous students. Poorly trained instructors teach improper form. Overzealous students see yoga as a competition and push themselves beyond their physical limits.

RESEARCH

The National Institutes of Health (NIH) has three current clinical trials in progress: evaluation of yoga for sleep disturbances in posttraumatic stress disorder (PTSD, efficacy of yoga for treatment-resistant PTSD, and develop- ment of a translational tool to study yoga therapy. The Joanna Briggs Institute has published two evidence summaries regarding yoga:

• The evidence summary for yoga as a treatment for people with epilepsy found no clear research results. Thus, the recommendation for the use of yoga in the treatment of people with epilepsy should be based on clini- cal judgment ( Rathnayake, 2011a ).

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• The evidence summary for yoga as one type of exercise for older adults who suffer from sleep problems found that yoga is recommended to improve the sleep status of older adults ( Rathnayake, 2011b ).

The following is a small selection of current reported research:

• A systematic review of yoga for musculoskeletal disorders found that yoga was equal to or superior to exercise or usual care in decreasing pain and decreasing pain medication use. More studies with larger sam- ples and precise descriptions of the yoga intervention are needed for more vigorous evidence ( McCaffrey & Park, 2012 ).

• Eighty-four pregnant women living with depression were randomly assigned to yoga, massage therapy, or standard prenatal care control groups. Both therapy groups had a greater improvement in depression, anxiety, and somatic symptoms compared with the control group. The yoga and massage therapy groups also had longer gestational ages and higher birth weights than the control group ( Field, Diego, Hernandez- Reif, et al., 2012 ).

• Ninety-two pregnant women living with depression were randomly assigned at 22 weeks’ gestation to yoga or to a social support control group. The yoga group reported a more rapid improvement in depres- sion, anxiety, and somatic symptoms, but at the end of the treatment period both groups demonstrated the same degree of improvement ( Field, Diego, Delgado, & Medina, 2012 ).

• A randomized controlled single-blind study of 80 people with chronic low back pain found that those in a yoga program as opposed to those in a physical therapy control group had significantly better improvement in pain, anxiety, depression, and spinal mobility ( Tekur, Nagarathna, Chametcha, Hankey, & Nagendra, 2012 ).

• Thirty people with simple fractures were randomly assigned to a yoga group or to a control group. Twenty-one days postfracture, the yoga group had significant improvement in pain reduction and tenderness and a sig- nificant increase in fracture line density compared with the control group ( Oswal, Nagarathna, Ebnezar, & Nagendra, 2011 ).

INTEGRATED NURSING PRACTICE

The regular practice of yoga builds and tones muscles, increases flexibility, improves endurance, and promotes a state of relaxation. The physiologic responses are the opposite of the fight-or-flight stress response. Stretching and deep breathing bring on a profound sense of relaxation. Gentle stretching and range-of-motion joint exercises decrease muscle tension and joint stiffness. The mindful focus on awareness of self, breath, and energy minimizes anxiety associated with stress. Just getting the body down on the floor tends to clear the mind, perhaps because being on the floor is so unusual that it changes people’s attitudes toward and awareness of the body ( Kabat-Zinn, 2011 ).

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Hatha yoga is designed by and for healthy, flexible people. Even when experiencing a serious illness, however, most people can work on breath con- trol even if they do not feel up to doing the poses. The breathing exercises and relaxation response nourish the body, quiet the mind, and contribute to a more balanced state. Individuals should be encouraged to check with their primary care practitioner if they have recently had surgery, have a debilitat- ing physical handicap, or have cancer, diabetes, epilepsy, heart disease, high blood pressure, HIV, multiple sclerosis, or any other serious condition. Yoga, combined with a low-fat diet and moderate aerobic exercise, can significantly reduce blockages in coronary arteries ( Ornish, 2008 ). Other studies have shown yoga to be effective in treating arthritis, diabetes, mood disorders, asthma, hypertension, menstrual cramps, back pain, and chronic fatigue.

Yoga can benefit people of any age, from children to older adults. Chil- dren take naturally to yoga and usually find it to be much fun. Getting the whole family involved is one way to maintain the routine. Some adults find yoga complements their aerobic routine, while others engage in yoga as a great nonaerobic conditioner. It is possible to learn yoga from books or com- pact disks (see the Resources section at the end of this chapter), but it is easier to learn from a teacher. Yoga classes are available in many places, such as health clubs, community centers, universities, and hospitals.

As a nurse, you can encourage people to utilize yoga as a way to start on the path of taking responsibility for their well-being. Consistent practice of yoga changes people’s attitudes about their body and their beliefs about what they can do to take care of themselves, both of which are crucial to well-being. For some, the physical exercise may be a way to attain a specific goal such as improving flexibility, improving muscle tone, or losing weight. Others have no specific goal other than the exercise itself and becoming aware of their self, breath, and energy. The relaxation that accompanies yoga can stimulate self- healing and contribute to a sense of inner peace.

Almost anyone can be taught the Mountain Pose, which is a standing position of postural awareness. When this pose is practiced well, the body is prepared for almost all daily movement: standing, sitting, walking, and run- ning. Like the mountain poised between heaven and earth, this pose estab- lishes grounding through the legs and feet and encourages the lift of the spine. Instruct people to stand sideways near a full-length mirror so they can check their alignment, which may feel strange at first (see Figure 16.2 ). Once people are in alignment, they should notice their physical sensations. Is weight bal- anced evenly between the feet? Are the legs firm but not tight? Are shoulders relaxed? Does the spinal cord feel light and the head feel balanced on the torso? Is breathing comfortable and easy? Encourage people to practice the Mountain Pose several times a day. Standing well reduces strain on the joints, ligaments, and muscles, especially those of the spinal column and lower extremities. It also aids respiration, digestion, and elimination. The Mountain Pose conveys a sense of poise and self-esteem.

Benefits from any fitness program, including yoga, can occur only with continued practice. Try some of these suggestions to help people develop a regular pattern:

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• Encourage clients to make time for yoga practice every day, to give themselves permission to take care of themselves and take time to relax. They may find that doing a few poses before bedtime or early in the morning works best. Even if they practice for only 5 minutes, a daily practice is the foundation on which to build.

• To maintain their practice, many people find it helpful to go to a yoga class at least once a week. The support of practicing with others and the infor- mation they get from teachers help strengthen their commitment to yoga.

• Suggest that they create a dedicated yoga space. They may have to tem- porarily push things aside to have enough space for their practice. Or they may simply choose a place to spread their yoga mat on the floor. Having a regular space for practice helps people focus on the poses without being distracted by their surroundings.

• Have people start with the poses they like. If they like a pose, they will do it even if it is difficult. You may suggest that they take one pose they like from each class and practice it at least once a day, which takes only a few moments. They can then gradually begin to combine the poses to form their own yoga session.

FIGURE 16.2 Mountain Pose (Tadasana)

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One of the many applications of yoga is in pregnancy and childbirth. In fact, many of the techniques taught in childbirth classes, such as focus, relax- ation, and systematic breathing, have their roots in yoga. The gentle stretch- ing of the poses helps ease the muscle aches of pregnancy and strengthens the muscles that will be used during delivery. The breathing techniques may lessen the shortness of breath that often accompanies advanced pregnancy.

Yoga practiced while pregnant is slightly different from regular yoga in that some poses are contraindicated. These poses are the extreme stretching positions and any position that puts pressure on the uterus. Full forward bends will probably be uncomfortable for both woman and baby. Because her center of balance has shifted completely, she must be careful with balance poses. A pregnant woman should never lie on the stomach for any pose. After the 20th week, she should lie on her left side rather than her back. If any pose feels uncomfortable, the woman should stop at once. If a pregnant woman experi- ences dizziness, sudden swelling, extreme shortness of breath, or vaginal bleed- ing, she should see her midwife or doctor immediately ( Lee & Attwood, 2013 ).

With midwife or doctor approval, most women can usually start gentle yoga poses 2 weeks after delivery or a few weeks later if they have had a cesarean section. They should start with a few poses and gradually work back to their regular routine. If their postpartum bleeding gets heavier or brighter red, they must stop and call their midwife or doctor. Filling their body with energy through breathing exercises may promote self-healing after childbirth.

As people learn yoga, they will find that each sequence of poses helps them focus on something specific; for example, one sequence can improve bal- ance, while another may release anger and negative feelings; some sequences will tone internal organs, increase lung capacity, or build upper-body strength. People choose the sequences that are right for them. It is most important to remind people that it is not a matter of being a beginning, intermediate, or advanced student but rather that they keep practicing, doing as much as they can whenever they can. Yoga moves at their pace, in the time they have.

TRY THIS

Heart Breathing

• Sit comfortably and close your eyes. • Simply notice your breathing without trying to change it. Pay attention to your in-

breath and your out-breath. • Now imagine that the breath is pouring into your heart with each inhalation and

flowing out of your heart with each exhalation. Just feel the breath flowing in and out of your heart. Imagine the breath is pure love.

• Do this breath awareness for 5 to 10 minutes. • Now let your attention return to your environment, slowly open your eyes, get up,

and move on. • Think about the feeling throughout the day.

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Considering the Evidence

C. C. Streeter, T. H. Whitfield, L. Owen, T. Rein, S. K. Karri, A. Yakhkind, R. Perimutter, A. Prescot, P. F. Renshaw, D. A. Ciraulo, and J. E. Jensen, 2010, Effects of yoga versus walking on mood, anxiety, and brain GABA levels: A randomized controlled MRS study, Journal of Alternative and Complementary Medicine, 16: 1145–1152.

What Was the Type of Research? Primary research

What Was the Purpose of the Research? To investigate whether changes in mood, anxiety, and GABA (gamma-aminobutyric acid) levels in the brain are specific to yoga or related to physical activity

How Was the Research Done? The authors used a randomized control study design to assign healthy subjects with no sig- nificant medical or psychiatric health problems to yoga ( n = 19) only or to a metabolically matched walking program ( n = 15) only for 60 minutes, 3 times a week over a 12-week period. Mood and anxiety were measured at specific intervals and before each magnetic resonance spectroscopy (MRS) scan. Three scans were taken at specific times during the 12-week period. Participants were 18–45 years of age with no reported Axis I diagnosis.

What Were the Findings of the Research? The group assigned to the yoga intervention reported greater improvement in mood and experienced less anxiety than the walking group. There was a positive correlation between improved mood and decreased anxiety and GABA levels. Those individuals assigned to yoga only had a positive correlation between changes in the mood scales and in changes in their GABA levels.

What Additional Questions Might I Have? Are there any adverse or harmful effects associated with yoga as an intervention in per- sons living with health problems? What would be the effect of yoga used in combination with other complementary and alternative therapies? Would the results be significantly different with an older adult sample or a larger sample? How can GABA levels be safely increased in the brain? Can yoga be considered a therapy for persons with increased anxiety or mood changes?

How Can I Use This Study? This study has considerable clinical value for nurses caring for persons experiencing changes in mood and increased anxiety. Nurses should recognize and encourage yoga to elevate mood and decrease anxiety. Nurses should be aware that this is the first reported study identifying that increased GABA levels are associated with improved mood and decreased anxiety. Further study is warranted to strengthen the evidence related to this phenomenon.

Source: Contributed by Dolores M. Huffman, RN, PhD

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References

Babooa, S. K. (2012). Your Window to Silence and Peace: Gems of Yogic Medita- tion. Bloomington, IN: iUniverse.

Field, T., Diego, M., Delgado, J., & Medina, L. (2012). Yoga and social support reduce prenatal depression, anxiety, and cortisol. Journal of Yoga & Physical Therapy, 2. doi: 10.4172/2157- 7595.1000124

Field, T., Diego, M., Hernandez-Reif, M., Medina, L., Delgado, J., & Hernandez, A. (2012). Yoga and massage therapy reduce prenatal depression and pre- maturity. Journal of Bodywork and Movement Therapies, 16(2): 204–209.

Gupta, Y., & Fox, K. (2012). Yoga and Long Life. Whitefish, MT: Literary Licensing.

Kabat-Zinn, J. (2011). Mindfulness for Beginners. Boulder, CO: Sounds True.

Lee, T., & Attwood, M. (2013). Pregnancy Yoga. New York, NY: Duncan Baird.

Li, A. W., & Goldsmith, C. A. W. (2012). The effects of yoga on anxiety and stress. Alternative Medicine Review, 17(1): 21–35.

Lysycia, J. M. (2013). Yoga: The Essential Positions. Edison, NJ: Chartwell Books.

McCaffrey, R., & Park, J. (2012). The ben- efits of yoga for musculoskeletal disor- ders: A systematic review. Journal of Yoga & Physical Therapy, 2(5). doi: 10.4172/2157-7595.1000122

National Center for Complementary and Alternative Medicine. 2013. Yoga for health. Retrieved from http://nccam .nih.gov/health/yoga/introduction .htm#hed4

Ornish, D. (2008). The Spectrum: A Scien- tifically Proven Program to Feel Better, Live Longer, Lose Weight, and Gain Health . New York, NY: Ballantine Books.

Oswal, P., Nagarathna, R., Ebnezar, J., & Nagendra, H. R. (2011). The effect of add-on yogic prana energization technique (YPET) on healing of fresh fractures: A randomized control study. Journal of Alternative and Com- plementary Medicine, 17(3): 253–258. doi: 10.1089/acm.2010.0001

Ramacharaka, Y. (2012). Raja Yoga. New Orleans, LA: Cornerstone.

Rathnayake, T. (2011a). Epilepsy: Yoga. Joanna Briggs Institute Evi- dence Summary. Retrieved from http://connect.jbiconnectplus.org /ViewDocument.aspx?0=5129

Rathnayake, T. (2011b). Sleep Problems (Adults 60+): Physical Exercise. Joanna Briggs Institute Evidence Summary. Retrieved from http://connect . jbiconnectplus.org/ViewDocument .aspx?0=5639

Smith, J., Hall, D., & Gibbs, B. (2013). The Complete Guide to Yoga. Lanham, MD: Southwater.

Tekur, P., Nagarathna, R., Chametcha, S., Hankey, A., & Nagendra, H. R. (2012). A comprehensive yoga programs improves pain, anxiety and depres- sion in chronic low back pain patients more than exercise: An RCT. Comple- mentary Therapies in Medicine, 20(3): 107–118.

Resources

American Yoga Association P.O. Box 19986 Sarasota, FL 34276 941.927.4977 www.americanyogaassociation.org

The Canadian Yoga Institute 403.394.9642 www.yogacanada.org

Center for Mindfulness in Medicine, Health Care, and Society

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University of Massachusetts Medical School 55 Lake Ave. North Worcester, MA 01655 508.856.2656 www.umassmed.edu/cfm

The British Wheel of Yoga 25 Jermyn St. Sleaford, Lincolnshire NG34 7RU 01529.306.851 www.bwy.org.uk

Yoga Australia Suite 208, 566 St. Kilda Rd. Melbourne 3004 VIC 1300.881.451 www.yogaaustralia

Yoga Research and Education Center 759 South State St., #24 Ukiah, CA 95482 www.yrec.org

256

17 Meditation

The Wise Man believes profoundly in silence—the sign of a perfect equilibrium. Silence is the absolute poise or balance of

body, mind and spirit.

Ohiyesa

Meditation is a general term for a wide range of practices that involve relaxing the body and stilling the mind. The root word, meditari , means “to consider,” or one could say, “to pay attention to something.” Medha , the Sanskrit derivation means “wisdom.” The founder and director of the Stress Reduction Clinic at the University of Massachusetts Medical Center, Jon Kabat-Zinn ( 1994 ) stated, “Meditation is simply about being yourself and knowing something about who that is. It is about coming to realize that you are on a path whether you like it or not, namely, the path that is your life. . . . Meditation is the pro- cess by which we go about deepening our attention and aware- ness, refining them, and putting them to greater practical use in our lives” (pp. xvi – xvii ).

In 1975, Dr. Herbert Benson wrote the book The Relaxation Response , which drew the attention of Western health care practitioners to the physical and psychological benefits of relaxation. As Benson pointed out, the components of relax- ation are quite simple: a quiet space, a comfortable position, a receptive attitude, and a focus of attention. The relaxation response involves physiologic and psychologic effects that appear common to many forms of focused attention in addi- tion to meditation: prayer, yoga, biofeedback, and the presug- gestion phase of hypnosis. These practices are covered in other chapters in this text. Benson ( 1975 ) described meditation as a process that anyone can use to calm down, cope with stress, and, for those with spiritual inclinations, feel as one with God

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or the universe. Meditation can be practiced individually or in groups and is easy to learn. It requires no change in belief system and is compatible with most religious practices.

BACKGROUND

Most meditative practices have come to the West from Eastern practices, partic- ularly those of India, China, Japan, and Tibet. Meditative techniques, however, can be found in most cultures of the world where prayer, meditation, ritual, or contemplation are all initiated by shifting into a relaxed state. Nearly all major religions include some form of meditative practice. Christianity, Judaism, Buddhism, and Islam all use repetitive prayers, chants, or movements as part of their worship rituals. Although religious practices in the West are not typically labeled “meditative,” they in fact are. The Catholic practice of using rosary beads while saying the “Hail Mary” is a familiar example. The repetition of the words combined with the movement of the beads induces a state of relaxation and a quieting of the mind.

Until recently, the primary purpose of meditation has been spiritual or religious. Since the 1970s, it has been explored as a way of reducing stress on both body and mind. Many conventional health care practitioners recom- mend it for widely diverse situations, from undergoing natural childbirth to managing hypertension to controlling pain. For many years, nurses have taught clients progressive relaxation in a wide variety of clinical settings.

PREPARATION

Practicing meditation does not require a teacher, and many people learn the process through instructions from books, recordings, or compact disks. Some people, however, find that the structure of a meditation class is helpful. Many varieties of teachers and classes are available. Currently no certification process is available for a meditation teacher. The general standard is some years of daily meditation practice before one teaches others. Both Christian and Buddhist tra- ditions offer regular classes and retreats designed to teach meditative practices and the process of being a spiritual being in a material world. In the Hindu tradition, people learn meditation from a guru who is a spiritual teacher or guide. Whatever the tradition, teachers encourage self-responsibility and the practice of mindfulness in everyday life ( davidji, 2012 ).

CONCEPTS

Meditative State

Meditation is about being aware of who one is in the here-and-now rather than about feeling a particular way. It means letting go of any expectations of the process and simply observing what happens as it unfolds. People are sometimes concerned that they do not have the skills to meditate. As

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Dr. Jon Kabat-Zinn (1994) stated, “Thinking you are unable to meditate is a little like thinking you are unable to breathe, or to concentrate or relax. Pretty much everybody can breathe easily. And under the right circum- stances, pretty much anybody can concentrate, anybody can relax” (p. 33 ). All forms of meditation require regular, daily practice over a period of time to experience the many benefits.

Attention and Concentration

Basic to all meditative techniques is the intentional focus of attention on one thought, word, sound, image, or physical sensation for a sustained period of time. The mind is fully alert but not focused on the external world or events. The normal rapid series of thoughts and feelings is replaced with inner aware- ness and attention. Rather than allowing the mind to jump between the past and the future, a person focuses attention in the present reality. It is impossible to make the mind empty, but it is possible to focus on one thing, which helps the mind let go of the tendency to worry, plan, think, analyze, remember, or solve problems. A passive, nonjudgmental attitude is necessary during meditation. When thoughts intrude, they are noticed and then let go as the attention returns to the original focus.

In some types of meditation, the focus is on the breath, the primary pur- pose being to calm the mind and body. It is a process of keeping the attention on the breath while breathing deeply, slowly, and regularly. The awareness is on the breath moving in and the breath moving out and allowing all other thoughts, feelings, or sensations to pass by as this focus is maintained. Through regular meditation practice, it becomes a habit to breathe more consciously and deeply throughout the day, so that in the long term, the breath becomes a calming force in daily life ( Seaward, 2013 ).

Some people use a mantra as their focus of attention. A mantra is a sound or sounds that resonate in the body and evoke certain energies. Mantras, such as OM, soothe the mind and awaken the senses. Another beginning mantra is OM SHANTI SHANTI SHANTI. Shanti means peace, and when repeated three times, it balances the body, mind, and spirit.

A mandala meditation uses an object to focus the mind through sight. A  mandala is typically a circular geometric design that draws the eye to the center and is meant to suggest the circular patterns in the universe, such as solar systems. Mandalas appear as labyrinths in the floors of some cathedrals in Europe. In a labyrinth only one path leads to the center and back out. The faithful follow the course of the labyrinth into the center as penitence or in spiritual contemplation. Labyrinths and mandalas have recently become popular in the United States among some Christian religious groups who are renewing the contemplative aspects of their faith. Using mantras and mandalas together is an effective focus for meditation ( Buchanan, 2007 ).

Figure 17.1 is the mandala in the floor of Chartres Cathedral in France. Using a pencil, trace the walking path to the center and then back to the outer world.

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Meditation is both simple and difficult—simple because it is nothing more than maintaining focused attention, yet difficult because of the habitual, lifelong pattern of letting the mind wander wherever it wants. With extended practice, the mind tends to become better and better at staying focused. The stability and calmness that come with focused attention are the foundation of meditation.

VIEW OF HEALTH AND ILLNESS

Many disorders or diseases are aggravated or caused by stress. They are labeled as disorders of arousal, in which the limbic system of the brain has become overstimulated. In addition, overactivity of both the sympathetic nervous system and the adrenal glands is related to stress. It is thought that excessive limbic activity may inhibit immune function, which may account for the association of chronic stress and increased susceptibility to infection.

FIGURE 17.1 Mandala in the Floor of Chartres Cathedral

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A relaxed state is the opposite of the aroused state of fight or flight. The fight-or-flight reflex increases blood pressure, heart rate, breathing, metabo- lism, and blood flow to the muscles. The response triggered by all the relaxing practices does the opposite and results in a lower blood pressure and slower heart rate, breathing, metabolism, and blood flow. Relaxation and meditation also decrease the production of adrenergic catecholamines, thereby decreasing limbic activity. Since a person’s state of mind and emotional, attitudinal, and intellectual components initiate activities in the nervous system, individuals can consciously choose to trigger the benefits of meditation.

TREATMENT

The relaxation response can be evoked by any number of techniques, includ- ing progressive relaxation, meditation, prayer, jogging, swimming, Lamaze breathing exercises, yoga, t’ai chi, and qigong. The beauty of these techniques is their simplicity. They allow the mind to have a focus while enhancing one’s vitality and well-being.

The varieties of meditation have many different names. Some are religious practices, and some are not. Some are complicated, while some are simple. Each type of meditative practice involves a form of mental focusing and the adoption of a nonjudgmental attitude toward intruding thoughts. All types appear to produce similar physical and psychological changes. People beginning the prac- tice of meditation should look around for a form that seems comfortable, that suits them, and that does not conflict with their belief system ( davidji, 2012 ).

Transcendental Meditation was developed by the Indian leader Maharishi Mahesh Yogi in an effort to make the ancient practice of meditation more attainable to Westerners. TM is a sound-focused form of meditation and is simple and easy to learn. To prevent distracting thoughts, a person is given a mantra (a word or sound) to repeat silently over and over again while sitting in a comfortable position. When thoughts other than the mantra come to mind, the person is to notice them and then gently return the focus to the mantra. It is expected that people will practice TM for 20 minutes, once or twice a day. The trademarked Transcendental Meditation is a commercial enterprise that is a fairly expensive undertaking. Classes are typically found in Ayurvedic schools and health care centers. Local centers may be found on the Internet at www.tm.org .

The essence of Buddhist meditation is training the mind in compassion and in wisdom. The goal is to develop compassion for all living things. Medi- tation begins with a time of contemplation, which typically includes points such as these:

• Just as I wish to be free from suffering and experience only happiness, so do all other beings.

• I am no different from any other being; we are all equal. • My happiness and suffering are insignificant when compared with the

happiness and suffering of all other living beings. ( davidji, 2012 )

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The next step is a process of meditating on any determinations that might have been made during contemplation. The practice is concluded by dedicating one’s life and purpose to the welfare of all living beings. It is believed that many of the daily problems people experience will disappear, because most of them arise from regarding oneself as more important than others.

Mindfulness, an ancient Buddhist practice, is both a philosophy and a meditation practice. Its primary principle is “being in the moment.” Most often people go through daily routines with little awareness or attention. People read while they eat, exercise while watching TV, or cook while talking to their children, and the nuances of these experiences are lost. This situation might be called living mindlessly by ignoring present moments. Mindfulness is the opposite of living on “automatic pilot.” It is the art of conscious living by focusing full attention on the activity at hand. While it may be simple to prac- tice mindfulness, it is not necessarily easy. Habitual unawareness is persistent, and mindfulness requires effort and discipline. Thus, to eat a peach mindfully would involve being actively aware of every sensation, every smell, and every taste, noticing its texture, color, and weight and how it feels on the tongue. This technique can be practiced with any activity ( Kabat-Zinn, 1994 ).

Mindfulness meditation is a daily practice that encourages living in the moment. It begins by sitting quietly with eyes closed and focusing on breathing. The flow of thought during the meditation is observed as thoughts come and go. The key to mindfulness meditation is the ability to accept rather than judge the wandering thoughts, bringing attention back to the breathing as needed.

Mindfulness-based stress reduction (MBSR) is a structured 8-week ther- apy program utilizing mindfulness medication, yoga, and group discussion. Mindfulness-based relapse prevention (MBRP) is a program focused on breathing and physical sensations as a way of coping with triggers to sub- stance abuse relapse ( Josefsson & Broberg, 2011 ).

Tibetan meditation is a breath-focused form of meditation. The person simply focuses attention on each in-breath and out-breath. When thoughts about anything other than the breath intrude, the person notes them by silently saying “thinking” and then returns attention to the breath. It is recog- nized that thought cannot be completely halted and that thoughts are a natu- ral process and are simply to be noted in a nonjudgmental way.

Forms of moving meditation include the Chinese martial art t’ai chi, the Japanese martial art Aikido, the Indian practice of yoga, and the walking meditation in Zen Buddhism. Instead of focusing on a word or on breathing, movement meditations use physical sensations as the focus of concentration. In walking meditation, for example, attention is given to the feeling of each step as it is taken. Intruding thoughts are simply noticed, and attention is returned to the step. Research has found that focused walking, in contrast with unfocused walking, is associated with reduced anxiety and fewer nega- tive thoughts. In rhythmic meditation participants pay attention to their hand and body movements while their eyes are open ( Rinpoche, 2013 ).

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If practiced regularly, even 15 minutes twice a day, meditation produces widespread positive effects on physical and psychological functioning. The autonomic nervous system responds with a decrease in heart rate, lower blood pressure, decreased respiratory rate and oxygen consumption, and a lower arousal threshold. People who meditate say they have clearer minds and sharper thoughts. The brain seems to clear itself so that new ideas and beliefs become available. This clearer mind may be accompanied by a cognitive restructuring in which people interpret life events in a more positive, more real- istic fashion. Meditation’s residual effects—improved stress-coping abilities— are a protection against daily stress and anxiety. All other self-healing methods are improved with the practice of meditation ( Khong, 2013 ).

Some adverse effects of meditation are possible. Relaxation exercises should not be practiced while driving or operating potentially dangerous machinery. Some people have been stressed so long that they are unfamiliar with deep relaxation and therefore feel threatened by it. In meditation, people are taught to accept nonjudgmentally whatever thoughts occur. Sometimes, however, extremely upsetting thoughts arise, and it is impossible to remain nonjudgmental, which could lead to disparaging thoughts about one’s abilities. The adverse effects for more experienced meditators are temporary fear, anxi- ety, confusion, depression, and self-doubt. For an unknown reason, these kinds of thoughts are more likely to arise during the first 10 minutes of meditation.

RESEARCH

Since the 1960s a large body of research has been documented regarding med- itation and the relaxation response. There is support for the effectiveness of meditation in dealing with a number of chronic physical disorders, reducing stress, and improving well-being and quality of life ( Edenfield & Saeed, 2012 ). The following is a small sample of the research:

• A Cochrane systematic review of relaxation therapies, including medita- tion, in regard to preterm labor and preterm birth found that these thera- pies reduced stress and anxiety but had no effect on preterm labor and birth ( Khianman, Pattanittum, Thinkhamrop, & Lumbiganon, 2012 ).

• A systematic review and meta-analysis found that mindfulness inter- ventions were effective in reducing the symptoms of anxiety and comor- bid depression. More research is necessary to determine whether mindfulness is more or less effective than current treatments of choice ( Vøllestad, Nielsen, & Nielsen, 2012 ).

• A systematic review and meta-analysis of meditation in the treatment of anxiety disorders found that meditation reduced symptoms of anxiety but did not improve clinically diagnosed anxiety disorders ( Chen et al., 2012 ).

• A systematic review of mind–body therapies, including meditation, found that they improved the symptoms of fatigue and thus improved the quality of life. There were no harmful effects ( Senders, Wahbeh, Spain, & Shinto, 2012 ).

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• A randomized controlled trial studied Transcendental Meditation with health education in the secondary prevention of cardiovascular disease in Blacks. The TM group demonstrated lower blood pressure and psy- chosocial stress, which significantly reduced the risk for mortality, myocardial infarction, and stroke in Blacks with coronary heart disease compared with those who received health education alone ( Schneider et al., 2012 ).

• Antiretroviral therapy (ART) for HIV has many side effects. A random- ized, wait-list controlled trial found that mindfulness-based stress reduc- tion significantly reduced the frequency of side effects and reduced the stress associated with those side effects at 3 and 6 months postintervention ( Duncan et al., 2012 ).

INTEGRATED NURSING PRACTICE

Progressive relaxation and meditation are used in a wide variety of clinical settings such as rehabilitation facilities, cardiac care units, postoperative units, stress management centers, behavioral counseling settings, and centers dedicated to health and wellness promotion. Thousands of hospitals, clinics, private practitioners, and universities offer training in meditation. In addi- tion, recordings, compact disks, and books make meditation more accessible to people with busy schedules. Many individuals practice meditation to reduce stress, anxiety, anger, and other negative emotions. But increasingly, nurses are prescribing meditation as part of the treatment for a large and growing number of medical conditions.

Mindfulness-based stress reduction (MBSR) programs have been devel- oped by Jon Kabat-Zinn at the University of Massachusetts Medical Center and are taught by nurses and other health care professionals worldwide. People participate for many reasons, including job, family, or financial stress; chronic pain and illness; anxiety and panic; sleep disturbances; fatigue; hypertension; and headaches. A number of midwifery practices include MBSR as a comple- ment to childbirth education and parenting classes. The course schedule consists of eight weekly classes and one daylong class.

Progressive relaxation is a way of decreasing muscular tension. The relaxation response can be elicited by teaching clients two common techniques: progressive relaxation and body scan. Both focus on reducing muscle tone in the major muscle groups and take about 7 to 10 minutes. If possible, help the client find a quiet place with a comfortable temperature to do the exercise, which can be done in any comfortable position. People typically do the exer- cise lying on their back and begin with a focus on the breath, breathing gently, slowly, and deeply. Next, instruct the client to tense a muscle group as tight as possible, hold the tension for several seconds, and then consciously relax it to shift awareness to different parts of the body in turn. Have the client repeat this sequence for each of the major muscle groups in the body, usually begin- ning at the toes and slowly working up the body. Progressive relaxation is designed to help people with chronic tension experience the difference

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between a muscle that is tense and one that is relaxed. In the body scan exer- cise, clients are instructed to focus their attention on body parts, one at a time, often beginning at the feet and moving toward the head, and to consciously relax each part. Box 17.1 provides directions for the body scan technique.

You can also teach clients to anchor the relaxation response with a sen- sory stimulus, such as an aroma of lavender or rose, or a touch, such as press- ing two fingers together. The sensory anchor should be established within 30 seconds of the relaxation exercise. After performing progressive relaxation using the sensory anchor for 2 weeks, the individual should be able to instan- taneously relax by reexperiencing the particular sensory trigger, be it an aroma or a physical sensation.

Meditation is the next step following the mastery of progressive relax- ation and body scan. Explain the two basic steps to clients: the repetition of a word, sound, prayer, phrase, or muscular activity and the disregard of every- day thoughts that interfere with the process. The word or phrase is silently repeated with each in-breath and out-breath. Some people choose to use one word for the in-breath and another for the out-breath. Some meditators choose an object of personal significance on which to focus. Every detail of the object is studied, including gradations of shape, color, texture, and so on. Flowers, candle flames, or religious statues are common choices.

Before sitting down to meditate, it is helpful to make sure that the area is clean and uncluttered, which helps keep the mind clear and fresh. No props are required for meditation, although some people may choose to include incense, candles, or religious symbols in their meditative practice. Beginners often start with 5 to 10 minutes of meditation and increase the time gradually. It is most important that time be scheduled each day, and many people find

BOX 17.1

Body Scan Meditation

• Lie on your back with your legs uncrossed, your arms at your sides, palms up, and your eyes closed.

• Focus on your breathing; breathe in peace and breathe out tension. • As you begin to feel relaxed, direct your attention to your feet, paying attention

to any sensations. Let your feet relax, and feel the warmth spread throughout your feet.

• Then, move your focus to your ankles. Follow the same procedure as you move up your lower legs, knees, thighs, hips, and so on all around the body.

• Pay particular attention to any areas that are painful or are the focus of any medical condition, such as the lungs or heart.

• Finish the body scan by paying particular attention to the neck and head. Experience the warmth of the relaxation.

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that meditating first thing in the morning, before the busy day begins, works well. Other people prefer to meditate in the evening. The key is to find a time when one is unlikely to be disturbed. It is best to wait about 2 hours after a big meal, during which time the blood flow is diverted from the brain to the gut, which makes falling asleep during meditation more likely.

All sitting meditative practices begin with finding a comfortable but erect position. The posture itself is a meditation. Slumping reflects low energy and passivity, while a ramrod-straight posture reflects tension and effort. It is easiest to meditate if the spine is straight and the body posture is symmetrical. Some people sit on the floor cross-legged using a firm cushion under their backside to support the spine. Others sit in a chair with a straight back, with both feet on the ground. The face relaxes, shoulders drop, and head, neck, and back move into easy alignment. The eyes may be either open or closed. Hands may be resting in the lap or held with palms together. It is believed that having the palms together with the fingertips touching com- pletes a circuit of energy extending from the heart down the arms and through the chakras in the center of the palm of each hand as well as the chakras in the fingertips. People often experiment with various ways of posi- tioning their hands during meditation until they determine which position is best for them ( Kabat-Zinn, 2011 ).

Once people are adept at meditation, they can be taught to use minis . Minis are abbreviated versions of meditation. Instruct clients to breathe deeply, releasing tension, while saying the chosen focus word, sound, phrase, or prayer. Minis are very helpful in the midst of busy, stressful times ( Benson, 1997 ).

One type of meditation is a breathing awareness meditation. In this form, the person concentrates on the sensation of the breath as it enters the nose and fills the chest and abdomen, and then as it passes out of the body. Alternatively, one can imagine the breath coming in from the toes, up the legs, through the belly, and into the chest and out the same pathway. It is helpful to imagine healing and relaxation flowing into the body with each in-breath, and stress or pain leaving the body with each out-breath. When thoughts arise, they are noticed and then let go as attention is brought back to the breathing.

Another breathing awareness practice you can teach clients is a simple technique used in Zen meditation. Instruct clients to sit in a comfortable position with the spine straight. Ask them to gently close their eyes while breathing naturally and easily. To begin the exercise, have them count “1” to themselves as they exhale. On the next exhale, count to 2, and so on, up to counting to 5. Then, instruct them to begin a new cycle, counting “1” on the next exhale. Remind clients never to count higher than to 5, and to count only on the exhale. They will know their attention has wandered when they find themselves up to 8 or 10. When this occurs, have them gently refocus and restart on the count of 1. This form of meditation should be done for about 10 minutes ( Weil, 1995 ).

Any repetitive behavior can be used as a meditative focus. One of the most universally used practices is walking meditation. In walking meditation,

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one is not walking to get to any particular place. Having no place to go makes it easier to be present in the moment. This meditation is often practiced at some place in nature, on a track, on a walking mandala, or even pushing a shopping cart through a supermarket. It can be practiced at any pace, from very slow to very brisk. The practice is to take each step as it comes and to be fully present with it. One notices the movements of each foot, how it lifts, moves forward in space, and then descends again. Just as in other forms of meditation, when thoughts intrude, they are let go, and awareness is returned to the physical sensations of walking.

An excellent book for nurses is Sherry Kahn’s text, The Nurse’s Meditative Journal ( 1996 ). This book provides step-by-step instruction in meditation and journal writing as an aid in self-exploration and growth. A nurse’s ability to focus in the midst of chaos, and understand in the midst of confusion, can bring comfort to clients and inspire professional peers to find these same qualities within themselves.

There are as many ways to meditate as there are people. When people say they have tried meditation and cannot do it, they just have not found the right practice for them. One person may want to sit, one to do repetitive prayers, one to swim or run, one to walk, and one to do yoga or t’ai chi. Clients should be encouraged to explore a variety of techniques and develop the habit of meditation on a daily basis.

TRY THIS

Loving–Kindness Meditation

Begin by focusing on your breathing, and take a few slow, easy breaths. Feel yourself relaxed. Imagine a white light above you and slightly in front of you, pouring a waterfall of love and light over you. Let the light enter the top of your head and wash through you. See yourself totally enclosed in a cocoon of white light, and repeat these loving–kindness blessings for yourself, with all the respect and love that you would have for your only child:

May I be at peace. May my heart remain open. May I awaken to the light of my own true nature. May I be healed. May I be a source of healing for all beings.

Next, bring one or more loved ones to mind. See them in as much detail as possible. Imagine the white light shining down on them and surrounding them. Then bless them:

May you be at peace. May your heart remain open. May you awaken to the light of your own true nature. May you be healed. May you be a source of healing for all beings.

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References

Next, think of a person or persons whom you hold in judgment or with whom you are angry and to whom you are ready to begin extending forgiveness. Place them in the white light and see the light washing away all their negativity, just as it did for you and your loved ones. Bless them:

May you be at peace. May your heart remain open. May you awaken to the light of your own true nature. May you be healed. May you be a source of healing for all beings.

See our beautiful planet as it appears from outer space, a delicate jewel spinning in space. Imagine the green earth, the blue seas, the birds, the animals, the fish. Earth is a realm of opposites—of day and night, good and evil, sickness and health, riches and poverty, female and male. Hold the earth as you offer these blessings:

May there be peace on earth. May the hearts of all people be open to themselves and to each other. May all people awaken to the light of their own true nature. May all creation be blessed and be a blessing to all that is.

Sources: Borysenko & Borysenko ( 1994 ); Collinge ( 1998 ); Kabat-Zinn ( 1994 ).

Benson, H. (1975). The Relaxation Response . New York, NY: Morrow.

Benson, H. (1997). Timeless Healing . New York, NY: Fireside Books.

Borysenko, J., & Borysenko, M. (1994). The Power of the Mind to Heal . Carlsbad, CA: Hay House.

Buchanan, J. (2007). Labyrinths for the Spirit. London, UK: Gaia Books.

Chen, K. W., Berger, C. C., Manheimer, E., Forde, D., Magidson, J., Dachman, L., & Lejuez, C. W. (2012). Meditative therapies for reducing anxiety: A sys- tematic review and meta-analysis of randomized controlled trials. Depres- sion and Anxiety, 29(7): 545–562. doi: 10.1002/da.21964

Collinge, W. (1998). Subtle Energy . New York, NY: Warner Books.

davidji. (2012). Secrets of Meditation. Carlsbad, CA: Hay House.

Duncan, L. G., Moskowitz, J. T., Neilands, T. B., Dilworth, S. E., Hecht, F. M., &

Johnson, M. O. (2012). Mindfulness- based stress reduction for HIV treatment side effects: A randomized, wait-list controlled trial. Journal of Pain and Symp- tom Management, 43(2): 161–171.

Edenfield, T. M., & Saeed, S. A. (2012). An update on mindfulness meditation as a self-help treatment for anxiety and depression. Psychology Research and Behavior Management, 5: 131–141. doi: 10.2147/PRBM.S34937

Josefsson, T., & Broberg, A. (2011). Medi- tators and non-meditators on sus- tained and executive attentional performance. Mental Health, Religion, & Culture, 14(3), 291–309. doi: 10.1080/ 13674670903578621

Kabat-Zinn, J. (1994). Wherever You Go, There You Are: Mindfulness Meditation in Everyday Life . New York, NY: Hyperion.

Kabat-Zinn, J. (2011). Mindfulness for Beginners. Boulder, CO: Sounds True.

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Kahn, S. (1996). The Nurse’s Meditative Journal . Albany, NY: Delmar.

Khianman, B., Pattanittum, P., Thinkhamrop, J., & Lumbiganon, P. (2012). Relaxation therapy for preventing and treating pre- term labour. Cochrane Database of System- atic Reviews, Aug. 15 (8): CD007426.pub2. doi: 10.1002/14651858

Khong, S. C. (2013). Deep Relaxation. Berkeley, CA: Parallax Press.

Rinpoche, S. M. (2013). Running with the Mind of Meditation. New York, NY: Three Rivers Press.

Seaward, B. L. (2013). Essentials of Manag- ing Stress (3rd ed.). Burlington, MA: Jones & Bartlett.

Schneider, R. H., Grim, C. E., Rainforth, M. V., Kotchen, T., Nidich, S. I., Gaylord- King, C., . . . Alexander, C. N. (2012). Stress reduction in the secondary prevention of cardiovascular disease:

Randomized, controlled trial of tran- scendental meditation and health education in blacks. Circulation: Cardio- vascular Quality and Outcomes, 5(6): 750– 758. doi: 10.1161/CIRCOUTCOMES. 112.967406

Senders, A., Wahbeh, H., Spain, R., & Shinto, L. (2012). Mind-body medicine for multiple sclerosis: A systematic review. Autoimmune Diseases. doi: 10.1155/2012/567324

Vøllestad, J., Nielsen, M. B., & Nielsen, G. H. (2012). Mindfulness- and acceptance- based interventions for anxiety disor- ders: A systematic review and meta- analysis. British Journal of Clinical Psychology, 51(3): 239–260. doi: 10.1111/ j.2044-8260.2011.02024.x

Weil, A. (1995). Natural Health, Natural Med- icine . Boston, MA: Houghton Mifflin.

Resources

American Chronic Pain Association P.O. Box 850 Rocklin, CA 95677 800.533.3231 www.theacpa.org

American Meditation Institute P.O. Box 430 60 Garner Rd. Averill Park, NY 12018 518.674.8714 www.americanmeditation.org

Australian School of Meditation & Yoga www.asm.org.au

Canadian Meditation Institute 2039-26 Ave. 5W Calgary, AB T2T IE5 403.802.0852 www.canadianmeditation.org

Jon Kabat-Zinn Audiobook: Guided Mindfulness Meditation Series 3 Boulder, CO press.soundstrue.com/

Labyrinth Society P.O. Box 736 Trumansburg, NY 14886 877.446.4520 labryinthsociety.org

Maharishi Medical Centers in the United States www.maharishi-medical.com

Mind–Body Medical Institute 151 Merrimac St., 4th floor Boston, MA 02414 617.643.6090 www.massgeneral.org/bhi

Upaya Zen Center 1404 Cerro Gordo Road Santa Fe, NM 87501 505.986.8518 www.upaya.org

18 Hypnotherapy and Guided Imagery

Tension is who you think you should be. Relaxation is who you are.

Ancient Chinese proverb

Cultivate the inner self: its power becomes real.

Lao-Tzu

Hypnotherapy is the application of hypnosis in a wide variety of medical and psychological disorders. Hypno-sis is a state of attentive and focused concentration during which people are highly responsive to suggestion. Guided imagery , a state of focused concentration, is a similar process that encourages changes in attitudes, behavior, and physiological reactions. Many people consider guided imagery to be a form of hypnosis.

Hypnotherapists and guided imagery therapists help peo- ple learn methods to take advantage of the mind–body–spirit connection through the medium of relaxation and imagination. The basic difference between meditation and hypnosis or guided imagery is that in meditation, one empties one’s mind of images, whereas in hypnosis or guided imagery, one creates vivid mental images.

BACKGROUND

Around the world, shamans and traditional healers have used the power of suggested mental images for thousands of years.

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Hypnotic trances have been used in a variety of healing practices and religious rituals such as holding sweat lodge ceremonies, drumming, and chanting. Inducing trance states and using therapeutic suggestion were cen- tral practices of the early Greek healing temples. People in the 14th century thought illness was related to evil spirits, and evil spirits were often treated with imagery and hypnotic techniques. During the Renaissance (14th to 16th centuries), it was believed that dysfunctional imagination was the root of all pathology. It was even believed that the mother’s imaginings dur- ing pregnancy could alter the growth and development of her fetus ( Nash & Barnier, 2012 ).

Hypnotherapy originated in the late 18th century in Europe with Austrian physician Franz Anton Mesmer, who is considered the father of hypnosis. He is remembered for the term mesmerize , which described a pro- cess of inducing a trance through a series of passes he made with his hands and/or magnets over people. He worked with psychic and electromagnetic energies that he called animal magnetism . The medical community eventually discredited him despite his considerable success in treating a variety of ailments. In the mid-19th century, James Braid, an English physician, success- fully used hypnosis in pain control and as an anesthetic in surgery. Even after witnessing live demonstrations of a patient undergoing painless surgery, his colleagues dismissed him as a fake. Not long afterward, the discovery of chloroform led to the near abandonment of hypnotic anesthesia.

In the late 19th and early 20th centuries, Émile Coué, a French physi- cian, formulated the laws of suggestion , discussed later in this chapter and used to this day by hypnotherapists. He also discovered that giving positive suggestions when prescribing medication proved to be a more effective cure than prescribing medication alone. Sigmund Freud at first found hypnosis extremely effective in treating hysteria, and then, troubled by the sudden emergence of powerful emotions in his patients, he abandoned it in favor of psychoanalysis. Carl Jung did not actively use hypnosis, but he encouraged his patients to use active imagination to change old memories. He often used the concept of the inner guide in his healing work. Milton Erickson, an American psychologist and psychiatrist, is considered the father of modern hypnotherapy. He demonstrated how traumatic amnesia and psychoso- matic symptoms can be resolved with hypnotherapy and was influential in the official acceptance of hypnotherapy by the American Medical Associa- tion in 1958 ( Nash & Barnier, 2012 ).

Guided imagery is a process of using ideas, feelings, physical responses, and all the senses to relax, maintain health, and heal the body and mind. Since the 1970s, many books have been written on the use of guided imagery to improve health, expand thinking, and achieve life goals. Some are directed toward children and adolescents, some toward adults, and some toward peo- ple in old age. Motor imagery became popular in sports medicine and train- ing in the later part of the 20th century. The same brain regions that are activated during physical movement are also activated when the same move- ment is simply imagined. Accordingly, motor imaging was incorporated into

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rehabilitation programs and activities in nursing homes ( Schuster, Butler, Andrews, Kischka, & Ettlin, 2012 ).

PREPARATION

At present, no laws limit the use of hypnosis to clinical practitioners. Although anyone can hypnotize other people, hypnotherapy is best practiced by a health care professional. Nurses, physicians, dentists, psychologists, occupational therapists, social workers, and counselors are eligible to take approved professional training in hypnotherapy. The American Society of Clinical Hypnosis and the American Council of Hypnotist Examiners share in the education and accreditation of individuals who meet professional requirements. Therapists are required to follow the code of ethics established by these bodies. In addition to successfully passing an examination, certified hypnotherapists complete 200 hours of instruction, and certified clinical hypnotherapists complete 300 hours of instruction. Most practitioners do not identify themselves as hypnotists but as nurses, doctors, dentists, and others who use hypnosis as one of several modes of intervention.

The American Holistic Nurses Association and Beyond Ordinary Nurs- ing offer a Nurses’ Certificate Program in Imagery. The program consists of 84 hours of in-depth, hands-on training over a period of 9 to 12 months, to provide nurses with experience in relaxation and therapeutic imagery skills. These skills are used to reduce stress and anxiety; promote healing; decrease pain and symptoms; minimize side effects; manage chronic illness; prepare for procedures, surgery, or childbirth; respond to end-of-life issues; and access inner wisdom and resources. An overview of the program content is found in Box 18.1 .

BOX 18.1

Program Content for Nurses’ Certificate Program in Imagery

• Core concepts in integrative medicine, psychoneuroimmunology, and holistic healing

• Principles and theory of the guided imagery process • Stress management strategies and self-care as an integral aspect of professional

practice • A variety of breathing and relaxation techniques • Eight distinct integrative imagery techniques in the practicum

This program is approved for 108 continuing education hours by the American Holistic Nurses Association.

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CONCEPTS

Trance

To understand hypnotic trance, one must understand the functional difference between the conscious and the subconscious mind. The conscious mind contains the short-term memory and the intellect. It functions like a computer, always analyzing, criticizing, and discriminating one’s thoughts and perceptions. The language of the intellect is logic and reason. The subconscious mind contains emotions, creativity, imagination, intuition, long-term memory, and control of body functions. It also contains the habit center, where persistent habits such as nail biting or test anxiety are located. The subconscious does not respond to reason and facts, as does the intellect. The language of the subconscious is imagery and metaphor. During times of emotional turmoil or sudden trauma, people often become aware of the subconscious mind’s power over body func- tions and intellect when they are unable to eat, sleep, or talk, and cannot think clearly. After years of ignoring feelings or “stuffing” them into the subcon- scious, in a hypnotic trance, people can access the subconscious mind, which allows them to tap into their creativity, access buried memories, change habits, unmask erroneous beliefs, repair self-esteem, and restore health.

A trance state is a form of heightened concentration. People in trance are aware of what is going on around them but choose not to focus on it and can return to normal awareness whenever they choose. The majority of people will tend to remember most of what happens in a controlled hypnotherapy or guided imagery session. Trance is not a form of sleep or stupor, as is easily determined by observing the range of activities possible by people in a hypnotic trance.

There are three levels or stages of trance. The first is a superficial trance in which people are very aware of their surroundings and may accept suggestions such as eating less or quitting smoking but do not necessarily carry them out. The second level, known as alpha trance , is significantly deeper. Heart rate, blood pressure, and respiration become slow. Hypnotic suggestions at this level are more effective. The third level, called somnambulism , is the level most beneficial to health and well-being. It is at this level that posthypnotic suggestions are most effective, and people can remember past events with clarity ( Heap, 2012 ).

People naturally flow in and out of hypnotic trances. When driving a familiar route, people may slip into a trance. They can arrive at a destination and not be exactly sure about how they got there. During the trance they drive appropriately, stop at stop signs, obey traffic laws, and so on, but have no conscious awareness of doing these things. Another example of hypnotic trance can be observed during movie watching. People enter the theater hav- ing set aside a specific period of time wherein they can enjoy themselves. The process of settling into theater seats relaxes moviegoers and puts them in a receptive frame of mind. The lights go down to reduce the distractions from the outside world, and the big screen becomes the most noticeable aspect of the perceptual world. Within moments, the audience is transported to another place and time. If the movie is frightening, many people experience a racing heart, rapid breathing, and muscle tension—yet they are well-aware that no

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physical danger exists. They are responding to images and sounds alone. Movies operate by mental mechanisms similar to those of hypnosis. First, par- ticipants decide to let go of normal concerns and open the mind to a new experience. Then, certain procedures relax the beta level of brain activity. Next, through the thoughtful use of metaphor and imagery, deeper levels of consciousness are reached. Finally, new images and perceptions can be intro- jected (Hamilton, March 1, 2001, personal communication).

A trance is characterized by muscle relaxation, predominating alpha brain waves, feelings of well-being, diminished ability to vocalize, and an ability to accept new ideas if they do not conflict with personal values. The perception of time is often distorted; 30 minutes may seem like 5. Feelings are more accessible while one is entranced, as well as memories from long ago. As one’s awareness phases in and out, parts of the session may not be consciously remembered but are retained in the subconscious. People in trance describe their arms and legs as feeling heavy like lead or light and tingly, almost numb. Some experience slight twitches as the nervous system relaxes, and respira- tion shifts to abdominal breathing. Coming out of the trance, people awaken with very pleasant, almost euphoric feelings of well-being.

Laws and Principles of Suggestion

The first law of suggestion , as formulated by Coué, is that of concentrated attention . When people focus their attention repeatedly on a goal or idea, that event tends to be realized. Consequently, practitioners repeat hypnotic sug- gestions three or four times during a session. The law of dominant affect states that stronger emotions tend to take precedence over weaker ones. An effective hypnotherapist, after assessing the client’s emotional state, connects the hyp- notic suggestion to the dominant emotions. The carrot principle is applied when the practitioner interjects comments about the person’s goals with the hypnotic suggestions, thus linking motivation to the suggestions. The princi- ple of positive suggestion is applied to help people override existing attitudes ( Heap, 2012 ). Dr. Coué was known for encouraging his patients to say to themselves 20 to 30 times each night before going to sleep, “Every day in every way, I am getting better and better.” If someone is seeking hypnosis in an effort to lose weight, the suggestion is not, “You will not be hungry,” which is unlikely and a negative rather than a positive statement. Rather, the posi- tive suggestion might be, “You will be surprised to find how comfortable you will be. You treat your body with kindness and respect.”

Memories

It is true that under hypnosis people often recall past forgotten events. It is also true that people under hypnosis often “remember” things quite vividly that never actually happened but that have great personal significance nonetheless. These might be called fantasized life events. In a deep trance state, memories and fantasies may be intense, and the two may be indistinguishable. People are able to remember great detail of actual events and are also uniquely capable of

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making up details and experiencing them as if they were remembered. Recog- nizing the potential difficulties arising from what some call “false memory syn- drome,” several states in the United States now limit legal testimony to that obtained prior to any systematic hypnotic treatment. In 1985, the American Med- ical Association cautioned against the systematic use of hypnosis for memory recall for both its unreliability and its potential to create vivid false memories.

Imagery

Imagery is a two-way communication between the conscious and the uncon- scious mind and involves the whole body and all its senses. Most individuals image frequently throughout the day, and worry is the most common form of imagery that affects health. In their imagination, people react to current stress- ors and anticipated dangers. Their body becomes aroused and tense, and the fight-or-flight mechanism is activated. Guided imagery can help people learn how to stop troublesome thoughts and focus on images that help them relax and decrease the negative impact of stressors.

In guided imagery, the images may be created by the therapist based on the needs and desires of the client. Clients can also create the images as a way to understand the meaning of symptoms or to access inner resources. Imagery stimulates changes in many body functions such as heart rate, blood pressure, respiratory patterns, brain wave rhythms and patterns, electrical characteris- tics of the skin, local blood flow and temperature, gastrointestinal motility and secretions, sexual arousal, and levels of various hormones and neurotransmit- ters. The exercise in Box 18.2 is a helpful demonstration of the power of imag- ery and allows one to experience the physical response to imaging.

BOX 18.2

Sensory Imagery

• Relax and take some easy, deep breaths. • Focus on letting the tension go out of your body. • Imagine holding a juicy, yellow lemon. Feel its coolness, its texture, and its weight in

your hand. • Imagine cutting the lemon in half. Notice the cut surfaces—the bright yellow outer

layer, the whiteness of the inner peel, and the pale yellow of the pulp. • Cut one of the halves in two and pick up the freshly cut lemon quarter and imagine

smelling the lemony scent. • Now imagine biting into the lemon and sucking its sour juice into your mouth. • What happened when you imagined biting into the lemon? Did you salivate or gri-

mace? Did you have any other physical reaction?

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TREATMENT

Hypnotherapists do not “put” people into trances. They arrange circumstances to increase the likelihood that people will shift themselves into a trance state. About 20% of the population have a high capacity for trance; these people may go under hypnosis deeply. Another 20% percent have a slight capacity for trance, are easily distracted, and may not respond to hypnotherapy at all. Peo- ple who cannot be hypnotized include those with organic brain disease, those with low IQs, and those who do not want to be hypnotized. The remaining 60% of the population fall somewhere between these extremes ( Lewis, 2013 ).

Some people seeking hypnotherapy or guided imagery ask whether the use of audio recordings would offer equal benefit. The answer to that ques- tion depends on several factors, including the nature and depth of the prob- lem one wants to resolve. General self-hypnosis recordings will give only general results. Personalized audio recordings, created by a therapist using the person’s own images, are more effective. Working with an experienced practitioner is most effective because the procedure is individualized accord- ing to the client’s expectations and preferences.

The first and most important step in hypnotherapy is establishing a rela- tionship with the client. It is a cooperative venture, and if the suggestions are to be effective, the therapist and client must work together. The relationship is one in which clients permit themselves to be as receptive as possible, and the therapist commits to working for the clients’ well-being. People who benefit most from hypnotherapy are those who understand that hypnosis is not a sur- render of control; it is only an advanced form of relaxation. The therapist gets to know clients, develops treatment plans, explains the hypnotic process, dis- pels myths and fears, answers questions, encourages positive attitudes about hypnosis, and with people’s permission, trains them in self-inductive proce- dures. This process is as applicable for a short-term case of test anxiety as it is for a lengthy terminal illness. A measure of trust is needed to start the process and develop the relationship.

The induction phase is generally a period of relaxation or focus on the breathing that disengages people from other concerns and helps them focus their attention. In other words, the induction phase is similar to meditation and elicits the same physiological response. The induction starts with “easy” suggestions, such as focusing on breathing and closing the eyes. Directions are given to relax physically and mentally and to focus on the therapist’s voice and words.

Training in induction may take one or two sessions. When the client is comfortable with entering the trance experience, the hypnotic suggestion begins. Based on the assessment process, the practitioner suggests an image known to be pleasurable to the client and related to the desired outcome. Hypnotic communications contain cues and explicit instructions for focusing attention and imagining in line with the aims of suggestions. The imagery is intensified by incorporating the five senses: The person is asked not only to visualize the scene but to smell the scents, touch things in the environment,

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hear the surrounding sounds, and even taste anything appropriate. The client is asked to focus attention on as many details about the situation as possible and is walked through the session focusing on the desired events. The sugges- tions of the hypnotherapist are translated by the client into ideas. These ideas then lead to corresponding behaviors in the nontrance state ( Robertson, 2013 ).

Trance removal is that time when clients are given suggestions that will return them to a nontrance state. The hypnotherapist, for example, may count to 10, asking clients to open their eyes at the count of 5, and to be fully alert at 10. Clients most commonly report that they feel relaxed during the session but may not be certain that they were hypnotized, since they could hear every word the therapist said. Many hypnotherapists provide guided audio record- ings for their clients so they can practice the therapy at home.

Hypnosis cannot make people do anything against their will. If they really do not want to change, hypnosis will be a waste of time and money. If, for example, a person seeks hypnotherapy to stop smoking at a spouse’s insis- tence but is poorly motivated, hypnotherapy will not be effective. Occasion- ally, clients may demand that the hypnotherapist perform some magical incantation and remove 30 pounds or make the person never smoke again. This demand is the equivalent of insisting that their primary care provider cure them of hypertension while refusing to change their diet or follow a rec- ommended medication schedule.

In some medical facilities, hypnosis and imagery are now routinely used with a variety of conditions, usually in conjunction with other forms of medical, surgical, psychiatric, or psychological treatment. They can be used with nonmedical clients as well, working through problems of living, situa- tions of performance anxiety, and in changing bad habits. Depending on the complexity and seriousness of the complaint, treatment typically runs from 2 to 10 sessions.

Jeanne Achterberg ( 2008 ), well known for her use of imagery in the treat- ment of cancer, believes that imagery is as essential as radiation and chemo- therapy and must not be thought of as a “last alternative.” She believes that imagery plays an important role in the biochemical healing process. She hypothesizes that images produced in the mind are converted to biochemical messages that somehow initiate a path of cancer-cell destruction or organ-cell reconstruction. Possibly, this healing process inhibits the nervous and endo- crine systems from secreting stress hormones. Of course, it is difficult to prove definitively that imagery is a direct cause of healing when it occurs, because imagery is never the sole treatment used.

Hypnotherapy and guided imagery can be used to help people gain self-control, improve self-esteem, and become more autonomous. People who are imprisoned by negative beliefs see themselves as hopeless, helpless vic- tims. With guided imagery, they can learn how to substitute positive, empow- ering messages. Hypnosis and imagery can also be used as a mental rehearsal for procedures, treatments, or surgery. Clients are shown how to use their own images about the healing process, or, alternatively, they are guided through a series of images intended to distract them from painful procedures

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or anxiety-producing situations. The practitioner may have them imagine themselves in a state of good health or well-being, or having successfully achieved goals.

Virtual reality environments are a recent modification of guided imag- ery. With the use of head-mounted displays, people are immersed into a vir- tual world. This process is effective in reducing pain and anxiety from treatments or disease. Increasingly, interactive tools are providing successful distractions that allow people to cope more effectively with their treatment protocol ( Wiederhold & Wiederhold, 2007 ).

People, especially children, are often able to rid themselves of warts by visualizing their disappearance in one way or another. Hypnosis and imagery are often used as a clinical treatment for Reynaud’s disease, a condition in which the capillaries of the extremities constrict, with the result that hands and feet are cold and painful. When they learn to “think warm,” people may find that the circulation to their hands and feet improves, resulting in less pain. Similarly, hand-warming frequently cuts down on both the incidence and severity of migraine headaches. The use of hypnosis in promoting feel- ings of comfort, distraction, and dissociation through imagery in those with chronic pain has been well established. Clients are often able to change their perceptual experience of pain by substituting numbness, a sense of pressure, or other sensation for an unwanted pain. In 1995, a National Institutes of Health (NIH) panel endorsed hypnosis as a useful adjunct to conventional treatments. Current clinical studies at NIH include hypnosis for overactive bladder, ulcerative colitis, hot flashes, posttraumatic stress disorder (PTSD), and sleep disturbance.

Contraindications for hypnosis and imagery include poor motivation, such as “My husband sent me so I would lose weight,” or an unwillingness even to try the treatment because of extreme fear or compelling religious objections. The procedure is unsuitable for people with active psychosis or somatic delusions. It is generally considered that these individuals are often bombarded with too many images already and are thus unable to differenti- ate between voluntary and involuntary images.

RESEARCH

One of the difficulties in conducting research on hypnotherapy is that it is not simply a single form of treatment. Hypnosis does not represent one standard set of suggestions, which may account for the large number of studies that favor anecdotal, rather than controlled, evidence. For hypnosis to be most effective in a clinical setting, hypnotic suggestions are best for- mulated on the basis of the individual person’s interests, style, motivation, and receptivity to hypnosis. It is not like administering a drug, for which doses are standardized. In hypnosis, the personal and subjective matter a great deal. A Joanna Briggs Institute evidence summary found that there is insufficient evidence to recommend hypnotherapy as a specific treatment for smoking cessation ( Le, 2012 ).

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Numerous studies indicate that mental imagery can bring about signifi- cant physiological and biochemical changes. Some of these findings are from well-controlled studies, while others are reports of single cases or small studies that have not been replicated. Nevertheless, the overriding conclusion points to a relationship between imagery of body change and actual body change.

The following is a small sample of current studies in imagery and hypnotherapy:

• A survey of women in the HypnoBirthing group found that their labor was shorter, their cesarean section rates were lower, and they used less pain medication than did women in the general population ( Phillips- Moore, 2012 ).

• Patients with cancer having bone marrow aspirations were randomized into hypnosis intervention or a control group. The hypnosis group expe- rienced less anxiety, but the difference in pain scores between the two groups was not statistically significant ( Snow et al., 2012 ).

• A pilot project provided a 15-minute scripted hypnotic experience in the pre-op holding area for patients undergoing breast cancer surgery. Post-op the intervention group experienced less anxiety worry, nervousness, sadness, irritability, and distress compared with the control group. Both the control and intervention groups experienced the same amount of pain and nausea post-op ( Lew, Kravits, Garberoglio, & Williams, 2011 ).

• A systematic review of guided imagery for nonmusculoskeletal pain found that the evidence is encouraging but inconclusive at this time ( Posadzki, Lewandowski, Terry, Ernst, & Stearns, 2012 ).

• A review of the literature of guided imagery as a treatment option for fatigue found inconsistent results. It was concluded that further research is warranted using systematic, well-designed methodologies ( Menzies & Jallo, 2012 ).

• A randomized controlled trial for returning military personnel with posttraumatic stress disorder (PTSD) found that the group treated with guided imagery and healing touch had a significant reduction of PTSD symptoms compared with the group that received the usual treatment ( Jain et al., 2012 ).

• A randomized controlled trial of patients with inflammatory bowel dis- ease found that those receiving guided imagery with relaxation training had statistically significant improvement in symptoms compared with the wait-list control group ( Mizrahi et al., 2012 ).

INTEGRATED NURSING PRACTICE

As a nurse, you can employ guided imagery for personal and professional development. On a regular basis, take time to envision what kind of nurse you would like to be. Envision yourself as healthy, alert, balanced, compassionate, and competent in the clinical arena. You can also use imagery to learn new procedures or techniques. After learning the goals, steps, and processes of a

Chapter 18 • Hypnotherapy and Guided Imagery 279

new activity, you can envision yourself doing the procedure safely and skill- fully several times as you integrate knowledge with psychomotor skills. This “rehearsal” is a powerful tool for improving your technical nursing practice.

Some people fear that hypnosis and guided imagery may cause them to lose control of their minds to an outside force. This fear, most likely, results from hypnosis demonstrations performed onstage. Volunteers may seem to be under the control of the stage hypnotist. In volunteering, they know they will be expected to do silly things in front of an audience, and it is a chance for those with extrovert tendencies to perform, have fun, and be a star. The volunteers are often truly hypnotized and doing exactly what they want to do—giving themselves permission to be outrageous. They would not, however, do some- thing against their moral beliefs ( Lewis, 2013 ). Box 18.3 lists the myths and realities of hypnotherapy.

The reality of therapy is quite the opposite because the individual is always under self-control. When clients learn a technique like imagery, it is entirely within their control for use when, how, and where they want. It is a tool they can use whenever they feel particularly anxious, upset, or uncom- fortable. That type of empowering, in itself, is healing because people feel bet- ter and do better when they have a sense of mastery over what is happening to them.

Hypnosis is used in many different clinical settings. Hypnosis is effec- tive in surgery; in childbirth; and in the management of cancer, stress, weight

BOX 18.3

Hypnotherapy: Myths and Realities

Myth Reality

People are asleep during hypnosis. People are awake and aware throughout the entire process and are highly selective about where they focus their attention. Hypnotized people have lost control All hypnosis is self-hypnosis, since people and are under someone’s power. cannot be hypnotized against their will. Hypnotized people are fully able to stop the process at any time. People can be influenced to tell secrets. Because the subconscious offers only information it deems appropriate and ready to contribute, people cannot be forced to reveal any secrets they would not disclose in a fully alert state. People might get “stuck” in a Because individuals control the situation, hypnotic trance. they can end the hypnotic trance at any time.

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loss, smoking withdrawal, and posttraumatic stress disorder. Some people use hypnosis to improve self-confidence and in spiritual growth.

Many kinds of imagery work well with clients. Feeling-state imagery is designed simply to help clients change their mood in a general way. The ther- apist can suggest to individuals that they let their imaginations take them to a favorite place, real or imagined. For example, some may imagine themselves at a beach and floating gently on the water while feeling peaceful and relaxed. Others may imagine themselves as a young child sitting on the lap of a beloved grandparent. Clients can use this kind of imagery to move from a feeling state of tension and fear to one of peace and calm.

With end-state imagery clients imagine themselves already in the situa- tion or circumstances that they wish to attain. It may be seeing themselves as healthy, strong, and free from disease. Others may imagine themselves as suc- cessful, happy, and well loved.

Symptoms of disease are often thought to result from blocked energy. Energetic imagery involves imagining the life force energy, or qi, flowing smoothly and easily throughout the body. Clients can be taught to imagine that they are pulling up energy from the earth through the soles of their feet to replenish the body’s energy.

Cellular imagery relates to imagining events at the cellular level. For example, clients may be taught to imagine their natural killer cells surround- ing and attacking cancer cells. Cellular imagery is usually specific and focused on exactly what needs to be fixed. Imagery does not have to be visual. Some people “hear” their imagery, others “feel” it, and some “taste” or “smell” it. Some people might choose to put a hand over the affected area and send heal- ing images to the cells in that area.

Similar to cellular imagery, physiologic imagery involves the entire body. Thus, clients might be directed to imagine that their blood vessels are relaxed and wider in an effort to lower their blood pressure. People with back pain might imagine that all the muscles in their back are relaxing and softening. Peo- ple with diabetes might put their hands over the abdomen and imagine insulin moving out of the pancreas to connect with hungry cells throughout the body.

Psychological imagery involves people’s perception of themselves. For example, individuals who feel overly responsible may feel as though they have the weight of the world on their shoulders. Those who feel abandoned may feel the pain as heartache. In guiding the imagery, the therapist may direct clients to focus on their sensation, put their hands on the hurting places, and breathe into the pain. Psychological imagery can also be interactive. When conflict is the issue, people might imagine a dialogue with the adversary that may bring a fresh perspective and new solutions to problems.

The goal of spiritual imagery is to make contact with God or the Divine or to gain entrance into a larger world. Clients may use spiritual imagery to find guidance or inspiration. Some clients find it comforting to imagine that they are being held in the hands of God, where they are perfectly safe.

Eight characteristics help make imagery effective as a healing tool, espe- cially with regard to cancer:

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• Images must be personal. Images created by others appear to be less effective in the healing process.

• Images must feel right to the person and be congruent with who they are and their values. For example, combative or warlike images are not appropriate for those who see themselves as gentle and conciliatory.

• Imagery works best in a permissive, unforced atmosphere. An attitude of allowing the imagery to happen seems to be most effective.

• Images must be energetic and physical. People do best when they allow themselves to feel the sensations of their images.

• Images must be anatomically correct and accurate. The type of imagery must be chosen according to the nature of the disease and the body part and system affected.

• Skill at using imagery increases with practice, and response to imagery intensifies with use. It is suggested that clients use imagery in 5- to 20-minute blocks of time, once or twice a day.

• Imagery should have an end-stage component. Clients should be encour- aged to see the imagery as a mission accomplished.

• People receiving medical treatment concurrently should include it in the imagery. Clients who incorporate their chemotherapy or radiation treat- ment do better than those who ignore these medical procedures in their imagery. ( Achterberg, 2008 ; Naparstek, 1994 ; Lyons, 2012 )

Prior to beginning guided imagery, you should assess a client’s belief system, desired outcome, and basic understanding of the pathophysiology involved, as well as his or her understanding of the effects of medications, treatments, or surgery. This information is necessary to formulate appro- priate script content. Establish a quiet, safe environment free of unwanted distractions. Prior to the induction phase, take a few moments to center yourself. Let your mind and body release tension and tightness. Focus on letting your vocal cords relax to enhance a calming pitch, volume, and tone to your voice. Ask clients to assume a comfortable position, reclining if possible, and to close their eyes. Guide them through a progressive relaxation or body scan as described in Chapter 17 . Instruct them to go to a safe, comfortable place—an actual location or one conjured up in the imagination. Ask them to use all their senses to explore this place—what they see, hear, smell, taste, or feel. For example, you might ask them to identify the time of day or year, what flowers or trees they smell, the taste of any food that is around, and birds, train whistles, or any other sounds they hear.

Next, have clients focus on the problem at hand (e.g., the diagnosis of cancer, being HIV positive, wound or bone healing, or improved organ function). At this point begin your script, directing them toward their previ- ously discussed goals. You might say something like the following: “Imag- ine the broken edges of your bone. Now, bring lots of red blood cells to the area for extra nutrition and oxygen. Imagine new cells being formed and the bone edges growing together.” After this type of individualized script, you

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should include an end-stage script, such as the following: “Imagine that your broken leg is totally healed now. You have returned to your favorite ski hill. See yourself skiing down the slope. Your leg is strong and healthy and pain free.”

After this phase of guided imagery, talk with clients about the mean- ing of what occurred during the session, and reinforce the positive aspects of the experience. Some nurses make recordings of the individualized session to which clients may choose to listen as they practice on their own every day.

Gawain ( 2002 ) has developed an exercise from which most people can benefit. This “pink bubble” technique can be performed once or regularly over a period of time. It is best to practice the technique in the morning on awakening and/or in the evening right before sleep, as follows:

• Assume a comfortable position, breathe slowly, and go through a pro- gressive relaxation or body scan procedure.

• Imagine something you would like to have or would like to have happened.

• Imagine that it has already happened. Picture the object or the situation as clearly as possible, with yourself in the picture.

• Surround this image with a pink bubble. • Let go of the bubble and watch the bubble float off into the universe. See

it becoming one with the higher power of the universe.

Guided imagery can be used in many different clinical settings to move toward the following outcomes:

• Induce a state of physiologic relaxation • Reduce stress • Control habits: smoking, overeating, nail biting • Reduce pain • Reduce anxiety (and test anxiety) • Understand symptoms • Stimulate healing responses • Increase tolerance of nursing and medical procedures • Enhance motivation and self-care • Find meaning in illness • Resolve conflicts • Enhance self-esteem and self-confidence • Increase problem-solving ability • Access positive inner resources

Shames ( 1996 ) described numerous ways in which nurses can incorpo- rate the use of imagery with nursing procedures. She suggested that people receiving intravenous fluids envision the fluid flushing out cellular toxins while simultaneously nourishing the cells. People taking antibiotics can be taught to imagine the medication attacking and destroying bacteria. Indi- viduals experiencing illness or distress can be instructed to take a deep

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breath and send healing oxygen and a sense of peace to the lungs. On the out-breath, they can image all the toxins or tension leaving the body and disappearing into the air. When a specific organ or part of the body is dis- rupted, people can bring their awareness to that part and imagine healing resources migrating there to nourish and support the function. Individuals experiencing pain can envision the pain flowing out of the body through the feet and fingertips. Some imagine the capillaries and veins expanding to become large pipes, carrying the pain out. Similarly, people can imagine the soothing effects of pain medication on the affected area and feel the soften- ing and relaxing of the body as the pain lessens. Shames’s book Creative Imagery in Nursing is a wonderful resource and provides many suggestions for clinical application of guided imagery. This technique allows nurses to use their creativity, intuition, and imagination as they support others on their healing journeys.

TRY THIS

Renovating Your Day

This exercise is designed for empowering yourself with your thoughts by transforming negative thoughts and events through visualization. Do this every day for a week, prior to bedtime. Mentally go through your day and decide what you could have changed that would have brought better results. Then, imagine that change occurring. For example, if someone said something negative to you, imagine that they said something more positive. If you did not like your test score, visualize the grade as a better one.

TRY THIS

Shrinking Antagonistic Forces

If you are angry with or intimidated by another person, shrink that person and put him or her in the palm of your open hand. Conduct a dialogue with that person, but have that person speak in a different voice, such as a high, squeaky, or cartoon voice. See that person getting smaller and smaller until the person disappears or you blow him or her off into space.

Source: Harding, M. (October 14, 2003, personal communication).

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References

Achterberg, J. (2008). Intentional Healing: Consciousness and Connection for Health and Well-Being . [CD]. Louisville, CO: Sounds True.

Gawain, S. (2002). Creative Visualization (2nd ed.). Novato, CA: New World Library.

Heap, M. (2012). Hypnotherapy: A Hand- book (2nd ed.). Berkshire, UK: Open University Press.

Jain, S., McMahon, G. F., Hasen, P., Kozub, M. P., Porter, V., King, R., & Guarneri, E. M. (2012). Healing touch with guided imagery for PTSD in returning active duty military: A ran- domized controlled trial. Military Med- icine, 177(9): 1015–1021.

Le, V. (2012). Smoking cessation: Hypno- therapy. Joanna Briggs Institute Evi- dence Summary. Retrieved from http://connect.jbiconnectplus.org /ViewDocument.aspx?0=6866

Lew, M. W., Kravits, K., Garberoglio, C., & Williams, A. C. (2011). Use of preopera- tive hypnosis to reduce postoperative pain and anesthesia-related side effects. International Journal of Clinical and Experimental Hypnosis, 59(4): 406–423. doi: 10.1080/00207144.2011.594737

Lewis, S. D. (2013). The Hypnosis Treat- ment Option. Chicago, IL: Copper Ridge Press.

Lyons, T. (2012). Dreams and Guided Imag- ery. Bloomington, IN: Balboa Press.

Menzies, V., & Jallo, N. (2012). Guided imagery as a treatment option for fatigue. Journal of Holistic Nursing, 29(4): 279–286. doi: 10.11770898010111412187

Mizrahi, M. C., Reicher-Atir, R., Levy, S., Haramati, S., Wengrower, D., Israeli, E., & Goldin, E. (2012). Effects of guided imagery with relaxation training on anxiety and quality of life

among patients with inflammatory bowel disease Psychology, Health & Medicine, 27(12): 1463–1479. doi: 10.1080/08870446.2012.691169

Naparstek, B. (1994). Staying Well with Guided Imagery . New York, NY: Warner Books.

Nash, M., & Barnier, A. (2012). The Oxford Handbook of Hypnosis . Oxford, UK: Oxford University Press.

Phillips-Moore, J. (2012). Birthing out- comes from an Australian Hypno- Birthing programme. British Journal of Midwifery, 20(8): 558–564.

Posadzki, P., Lewandowski, W., Terry, R., Ernst, E., & Stearns, A. (2012). Guided imagery for non-musculoskeletal pain: A systematic review of randomized clinical trials. Pain and Symptom Man- agement, 44(1): 95–104.

Robertson, D. (2013). The Practice of Cognitive-Behavioral Hypnotherapy. London, UK: Karnac Books.

Schuster, C., Butler, J., Andrews, B., Kischka, U., & Ettlin, T. (2012). Com- parison of embedded and added motor imagery training in patients after stroke: Results of a randomized controlled pilot trial. Trials, 13:11. doi: 10.1186/1745-6215-13-11

Shames, K. H. (1996). Creative Imagery in Nursing . Albany, NY: Delmar.

Snow, A., Dorfman, D., Warbet, R., Cammarata, M., Eisenman, S., Zilberfein, F., … Navada, S. (2012). A randomized trial of hypnosis for relief of pain and anxiety in adult cancer patients undergoing bone marrow procedures. Psychosocial Oncology, 30(3): 281–293.

Wiederhold, M. D., & Wiederhold, B. K. (2007). Virtual reality and interactive simulation for pain distraction. Pain Medicine , 8(53): 182–188.

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Resources Academy for Guided Imagery

30765 Pacific Coast Hwy, #355 Malibu, CA 90265 800.726.2070 www.acadgi.com

American Council of Hypnotist Examiners 700 S. Central Ave. Glendale, CA 91204 818.242.1159 www.hypnotistexaminers.org/

American Society of Clinical Hypnosis 140 N. Bloomingdale Rd. Bloomingdale, IL 60108 630.980.4740 www.asch.net

Australian Hypnotherapists’ Association www.ahahypnotherapy.org.au

Beyond Ordinary Nursing 205 De Anza Blvd., #201 San Mateo, CA 94402 650.570.6157 www.integrativeimagery.com

Canada Society of Clinical Hypnosis 2036 West 15th Ave. Vancouver, BC V6J 2L5 604.688.1714 www.hypnosis.bc.ca

HypnoBirthing Programme www.hypnobirthing.com

Simonton Cancer Center P.O. Box 6607 Malibu, CA 90264 800.459.3424 www.simontoncenter.com

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Dreamwork

Sometimes dreams are wiser than waking.

Black Elk

Dreams are today’s answers to tomorrow’s questions

Edgar Cayce

In some ways, a great deal is known about dreaming because it has been important to people for all time and across all cul-tures. In the 20th and 21st centuries, the biology of the brain has been explored and increasingly understood. While this basic knowledge provides some facts underlying dreaming, it does not explain what dreaming is. Thus, in a sense, little is known about dreaming, and scientists cannot yet agree on the basic nature of dreaming. Some believe dreams are nothing more than random firing of neurons during sleep. Others believe dreams are symbolic stories or metaphors people tell themselves that represent personal and social mythology. The contemporary psychobiologic view of the dream process blends both the neuroscientific findings with psychoanalytic thought and believes that dreaming is one of the ways that people reflect on and make sense of their waking-life events. In other words, the mind exploits the brain’s physiologic state of dreaming, to work on current life problems ( Reiser, 2001 ).

BACKGROUND

Virtually every culture has believed dreams carry important messages. To the ancient Greeks, dreams were great healers. People who were sick slept in special healing temples in hopes of receiving therapeutic dreams from the gods. The Talmud, the

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Hebrew sacred book of practical wisdom, states clearly that the Jews gave great importance both to the dream and to the dream interpreter. Muhammad began writing the Quran after an angel visited him in a dream. Tibetan Bud- dhists saw no distinction between dreaming and waking and considered all of life a dream.

Plato saw dreams as a release for fervent inner forces. Hippocrates thought dreams were windows on illness, and that normal dream content indicated a state of wellness and bizarre content a state of illness. Aristotle believed that the beginning of illness could be felt in dreams before actual symptoms appeared.

The most famous book on dream interpretation, Oneirocritica , was writ- ten by Artemidorus of Daldis, a professional diviner who lived in the second century. The dreams recorded by him are remarkably similar to contempo- rary ones. Genghis Khan is reported to have envisioned his battle plans in his dreams, while Hannibal attributed the origin of his battle plan to attack Rome over the Alps with elephants to a dream.

During the late Middle Ages, dreams began to fall into disfavor with Christians despite the fact that throughout the Bible, God spoke directly to peo- ple through dreams and visions. St. Frances of Assisi founded the Franciscan Order as a dream directive from Jesus Christ.

In the United States, the traditional Iroquois were (and are) a people of dreams. Children were taught that dreams were the most important source of practical and spiritual guidance. The people of an Iroquois village began each day with dream-sharing. The entire village became involved in dreamwork, especially if a dream seemed to contain a warning of death or disease. “Big” dreams were thought to come about in one of two ways. During sleep, the dreamer would have an out-of-body experience and travel to many places, past, present, and future. Alternatively, the dreamer could receive a visit from a spiritual being. Dreams were considered to be central to healing by provid- ing insight into the causes of illness, often before physical symptoms appeared. Dreams continue to be important tools for many traditional healers in the Native American population ( Buhner, 2006 ).

In 1900, Sigmund Freud wrote The Interpretation of Dreams and pro- posed that dreaming might represent a unique avenue by which unconscious motivation could be explored. Freud’s theory was that dreams were dis- guised wish fulfillments of infantile sexual needs, which were repressed by censors in the waking mind. Freud’s protégé, Carl Jung, believed that humans were spiritual rather than instinctual and saw dreams as a compen- satory mechanism whose function was to restore psychological balance. Jung said that the conscious and the unconscious minds speak entirely different languages. The conscious mind is analytical, critical, and rational, whereas the unconscious mind thinks in metaphor, simile, symbols, and intuition ( Marszalek & Myers, 2006 ).

Dr. Nathaniel Kleitman is considered to be the father of modern scien- tific dream research. In 1957, he and Eugene Aserinsky identified rapid eye movement (REM), demonstrating the activity of the brain during sleep. This

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active sleep stage has consequently been called REM sleep. Today hundreds of sleep clinics operate in the United States, and sleep disorders constitute the second most common health complaint after the common cold ( Cushway & Sewell, 2012 ).

PREPARATION

In a society that discounted dreams, Sigmund Freud introduced the concept of therapeutic dreamwork. He and his followers, however, began to associ- ate dreams with illness rather than wellness and reserved dream interpreta- tion for professionals who were deemed the only people competent to understand the latent content of dreams. This approach said, in effect, that individuals were not experts about their own dreams. In contrast, Carl Jung ( 1965 ) stated that he “avoided all theoretical points of view and simply helped the patients to understand the dream-images by themselves, without application of rules and theories. . . . That is how dreams are intended” ( Jung, 1965 , pp. 170 – 171 ). Many contemporary therapists believe that dreams belong to individuals, and they are the final authority on the meaning of their own dreams. This viewpoint is not intended to minimize the fact that the meaning of many dreams is obscure and that other people may be able to help unlock hidden meaning.

Among indigenous peoples, shamans are recognized as dream counsel- ors but not as “experts” in the Western sense. They are often called to their vocation by dreams. Shamans have a special relationship with the dream- world and through dreams are able to look into the future, communicate with spirits, and clarify the meaning of others’ dreams ( Ewing, 2011 ).

CONCEPTS

Biology of Dreaming

Sleep can be divided into two distinct kinds: a quiet phase and an active phase. Changes in brain waves, eye movements, muscle tone, and the pres- ence of dreams are used to define the two states. The quiet phase is divided into three substages. Stage 1 is the transitional state between drowsy wakeful- ness and light sleep. It is characterized by slow, drifting eye movements and vivid, brief dream images. Falling dreams typically occur during this stage and are often accompanied by muscle spasms of the arms, legs, or the whole body that seem to happen just as one hits the ground in the dream. These sud- den contractions—myoclonic jerks—are common in many mammals. Stage 2 is genuine sleep and is characterized by unique patterns called sleep spindles , which are waxing and waning brain waves. After 20 to 30 minutes, people sink into Stage 3 , delta sleep, named after the regular, slow brain waves that are characteristic of this stage of quiet sleep. Delta sleep lasts about 30 to 40 minutes, during which the muscles are relaxed, although most people make major postural adjustments every 5 to 20 minutes. The dreaming that

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occurs during delta sleep is more poorly recalled, less vivid and visual, less emotional, and more pleasant than REM sleep dreaming. The sleep pattern then retraces the same stages in reverse order.

About 90 minutes after the onset of sleep, several abrupt physiological changes occur as the sleeper enters REM sleep, or the active phase, for the first time of the night. It is the sleep phase of vivid, memorable dreaming. Brain waves become desynchronized in a fast activity pattern that is similar to, but not identical with, that of the waking state. An accompanying profound loss of muscle tone throughout the body causes a general paralysis except for the muscles of the eyes, middle ear ossicles, and respiration. Sometimes, people awaken partially from REM sleep before the paralysis fades away, so that their body is still paralyzed, though they are otherwise awake. Sleep paraly- sis, as this state is called, can occur as people are falling asleep (rarely) or wak- ing up (more frequently). Although the sensation may be terrifying, especially at the first occurrence, sleep paralysis is harmless.

The medial prefrontal cortex, anterior cingulated cortex, limbic region, basal forebrain, and occipital-temporal region become more active in REM sleep compared with non-REM sleep. At this time breathing may accelerate to a panting pace, and the rhythm of the heart may speed up or slow down. Typically, men have erections and women experience vaginal lubrication dur- ing every REM cycle, regardless of dream content. It is not unusual for men to ejaculate and women to experience orgasm during REM sleep. ( Domhoff, 2011 ; Hobson & Friston, 2012 ).

During a typical night’s sleep, the average adult alternates between peri- ods of REM sleep and quiet sleep at regular intervals four to six times each night. After the first REM period, the intervals between REM periods decrease throughout the night, while the length of each REM period increases. REM sleep is both the deepest and lightest stage of sleep. It is the stage when people are least likely to be aroused by environmental stimuli, and it is also the stage when people are most likely to awaken spontaneously. Interestingly, during REM sleep, everyone experiences “symptoms” of mental illness. Box 19.1 describes what happens during sleep.

REM sleep is a primary means of brain development and maturation. Infants born 10 weeks prematurely spend 80% of their total sleep time in REM sleep, and those born 2 to 4 weeks prematurely spend 60% to 65% in REM sleep. Full-term newborns spend about half their sleeping time in REM sleep, which decreases to 30% to 35% by the age of 2. REM sleep stabilizes at about 25% percent by 10 years of age and shows little change until people are in their 70s or 80s, when it decreases to about 18%. The significance of the changing levels of REM sleep is unclear, but it may simply reflect maturation levels of the parts of the brain controlling non-REM sleep ( Klemm, 2011 ).

Dreaming and REM sleep are not the same. People also have dreams in non-REM sleep. In addition, some individuals do not dream during REM sleep, notably, young children and people with certain kinds of brain injuries. Dreaming, as we know it, probably starts around age 3, with the development of language. Children under the age of 7 or 8 experience dreams in only

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20% percent of their REM sleep, compared with normal adults, who experi- ence 80% to 90% dream time during REM sleep ( Klemm, 2011 ).

REM sleep is important to memory. Brain activity in the hippocampus during REM sleep consolidates experiences into long-term memory, as evi- denced by experiments interrupting either REM sleep or non-REM sleep 60 times a night. When REM sleep is interrupted, there is a complete block of learning, while interruption of non-REM sleep appears to have no effect on learning. Thus, it is believed that REM sleep is critical for organizing the pieces for long-term memory. The amygdala, where emotions are encoded and retrieved, is the source of emotional content of dreams ( Hobson & Friston, 2012 ).

Deprivation of REM sleep does not lead to psychosis, bizarre behavior, or anxiety, as was once feared. Interference with REM sleep may come from alcohol, sedatives, caffeine, drugs, anxiety, or depression. People with major depression dream considerably less than average and have limited dream recall. A sign that the depression is lifting is an increase in REM sleep and the

BOX 19.1

How the Brain Goes Out of Its Mind

Every 80 to 90 minutes, during REM sleep, we become completely psychotic.

Experience Psychiatric Label

We see things that are not there. Hallucinations We believe things that could not Delusions, magical thinking possibly be true. We become confused about times, Disorientation places, and persons. Scenes simply appear, and thoughts Attention deficit come and go. We think we are awake even though Lack of insight we are doing and seeing impossible things. We invent implausible narratives. Confabulation, loose association We forget almost everything on Amnesia awakening.

This nocturnal madness is not only normal but probably essential to our health. Deprived of REM sleep, we become anxious and irritable and have trouble concentrating. Under- standing this normal delirium may help you become more empathetic with the person experiencing those same symptoms while awake.

Sources: Hobson (1996) ; Barrick ( 2001 ).

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reporting of more dreams. The most important effect of REM deprivation is a dramatic shift in subsequent sleep patterns. Reduction of REM sleep for sev- eral nights is followed by earlier onset and longer and more frequent periods of REM sleep. The longer the deprivation of REM sleep, the larger and longer the REM rebound. This compensatory mechanism suggests that REM sleep is physiologically necessary ( Klemm, 2011 ).

Functions of Dreaming

Dreaming is a process of making broad connections. Dreams connect with recent experiences, old memories, and imagination. Dreaming makes connec- tions not made during the waking state. The waking state tends to be guided by a specific task or goal, whereas dreaming tends to wander and form unique combinations. For example, people who are awake and thinking of a house may recall a specific house in which they lived in the past. People who are dreaming and thinking of a house may see a generic house or a combination of several houses or even a hotel. During dreaming, thoughts and memories are consoli- dated, and the bizarre twists and images of dreams often represent the processing and reclassifying of old information. Dream symbols bring together ordinary awareness and deeper levels of knowing. Images mean different things to different people. As Moss ( 1996 ) stated, “A dream of teeth falling out might evoke fears of death or job loss in one person, the memory of a boyhood fistfight in another, and the need for a routine dental checkup to a third. A snake might warn of a sneak attack, arouse sexual fears or energies, or signal potential for healing or transformation” ( Moss, 1996 , p. 79 ). The dominant emotion of the dreamer guides the dreaming process to choose images in the memory related to that emotional concern. Dreams can be viewed as explanatory metaphors for the emotional state of the dreamer. “I leave my children in a house somewhere, and then I can’t find them” may be a metaphorical description for the emotional state of guilt. If no single dominant emotion is present at the time, dreams may seem confused and almost random ( Moss, 2007 ).

Jung believed that dreams are a remarkable way to reveal insights and solutions to deal with everyday problems encountered during the awake state. Generally, the language of dreams is anything but obvious, and for this reason it is easy to ignore the messages. What is bizarre to the conscious, ratio- nal mind is not so to the unconscious, which is rich in symbols. People who work on remembering and understanding their dreams often report that dreams provide insights to overcoming and resolving problems and moving ahead ( Cushway & Sewell, 2012 ).

While some dreams seem to be sequences of disconnected images, ideas, feelings, and sensations, others are storylike sequences that are dra- matic and intricately detailed. They may have plots as coherent, funny, and profound as the best stories and plays. Some dreams last longer than one night, and the dream series is concluded the following night or may run for as long as a TV soap opera. It is known that dream content and process are similar to waking thought and behavior. That is, if individuals are outgoing

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and active, or introspective and quiet, in their waking moments, then they are usually the same in their dream lives ( Cushway & Sewell, 2012 ).

Types of Dreams

Dreams offer nightly gauges of the dreamer’s physical, emotional, and spiri- tual health. When disease begins to develop, dreams often provide warnings of specific problems before physical symptoms are apparent. The warning may be in the form of a broken heart, an exploding head, or limbs falling off. Such early diagnosis dreams are entirely natural and are reminders of how illness is related to one’s entire being. It may be that when people are awake they tune out body messages, and when they are asleep their internal sensa- tions get through more easily to the unconscious mind, which sends a mes- sage in a dream. Dreams may also give advice on preventive measures and ways to provide for one’s well-being. Dreams frequently suggest specific courses of treatment for different problems. These suggestions may involve lifestyle changes, conventional medical treatments, alternative therapies, or counseling that addresses the hidden sources of disease. People may neglect the warnings, but the unconscious is highly inventive in rescripting the mes- sage in ways that make it increasingly harder to ignore ( Moss, 2007 ).

Nightmares are terrifying dreams with complex imagery and story lines that are usually vividly recalled. The most common scripts of nightmares include being chased by a monster, being naked in public, falling through space, losing something precious, and being unprepared for an important exam. Nightmares are especially terrifying, because in dreams, anything is possible. Most typically, the dreamer is alone with no chance for escape.

Because REM sleep becomes more physiologically intense as sleep contin- ues, most nightmares occur in the early morning hours. Some factors that seem to contribute to nightmare frequency are fever, stress, and troubled relation- ships. Traumatic events can trigger a long-lasting series of recurrent nightmares. Alcohol, drugs, and some medications that suppress REM sleep also can cause an increase in nightmares. The person sleeps soundly for the first 5 or 6 hours, with little dreaming. When the effect of the substance has worn off, the brain makes up for the lost REM time. As a result, dreams are more intense than usual for the last few hours of sleep. Levodopa ( l -dopa), used in the treatment of Parkinson’s disease, and beta blockers, used in the treatment of cardiovascu- lar disorders, seem to increase nightmares by increasing the activity during REM sleep ( Rhudy, Davis, Williams, McCabe, & Byrd, 2008 ).

Night terrors awaken people with a scream as if they had just had a nightmare. Unlike a nightmare, however, the person frequently cannot remem- ber anything except being afraid. Night terrors usually occur during non-REM sleep and are most common between the ages of 2 and 6 years. Although the cause is unknown, the incidence among adults increases with such factors as stress, lack of sleep, and alcohol and drug use ( Cushway & Sewell, 2012 ).

Rapid eye movement sleep behavior disorder (RBD) has only recently been described in the literature. In this disorder people do not experience sleep

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paralysis, which allows them to act out the dream. Since these individuals often report action-filled and violent dreams, the acting out may cause self-injury or harm to others. People with Parkinson’s disease are at higher risk for RBD ( Chou, Moro-De-Casillas, Amick, Borek, & Friedman, 2007 ; Stores, 2008 ).

Traumatic dreams are a major symptom of posttraumatic stress disorder (PTSD). People exposed to extremely dangerous and life-threatening situations such as war, terrorist attacks, physical or sexual assault, hostage situations, or natural disasters may develop PTSD. Traumatic dreams occur in all stages of sleep and tend to return the victim to the traumatic event in all its emotional hor- ror. As the experience is gradually resolved, there is a decrease in frequency and an alteration in dream content. New stressors may reactivate the traumatic dream.

Recurrent dreams usually begin in childhood or adolescence, often at a time of significant stress. The emotional tone of recurrent dreams is negative 60% to 70% of the time, but the content of the dream does not directly reflect the original stress. Typical dreams include being attacked or chased by ani- mals, monster, burglars, or natural forces. The dream often disappears when the original stressor or problem is resolved.

Lucid dreaming, is being aware that one is dreaming during the experi- ence. People in this unusual state of consciousness are simultaneously aware of their bodies lying on a bed, aware of the content of their dreams, and aware of watching themselves dreaming. When lucid dreaming occurs, the eye move- ments are more deliberate, and there is increased activity in the frontal regions of the brain compared with non-lucid REM sleep. Lucid dreaming may be trig- gered by various things, such as doing something impossible in the dream like flying or walking on water. Likewise, auditory signals such as a doorbell or a siren may startle people into becoming aware they are dreaming. Individuals who wish to explore and use dreams constructively in their lives can learn techniques to increase their conscious dreaming time. Lucid dreaming has also been used successfully in the treatment of nightmares ( Dresler et al., 2012 ).

Precognition is knowing about an event before it actually occurs. Precog- nitive dreaming involves seeing people and situations from the future and is an event in which individuals are not bound by space–time. As people learn to recall their dreams and record them in a dream journal, they often begin to recognize and work with precognitive material in their dreams. Precognitive dreams may indicate what may happen if certain courses of action are pur- sued, or they may reveal a precise event that cannot be altered ( Moss, 2007 ).

TREATMENT

Until recently, Western societies have discouraged dreamwork and dream- sharing. When dreams are recalled, the significance is often minimized. Peo- ple tend to remember only bits and pieces from dreams and often jumble together parts from several dreams into a single confused story. By the time individuals are fully awake they have forgotten 90%, if not more, of their nighttime adventures. Thus, the remembered dream is often different from the fuller dream experience.

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By paying closer attention to dreams, people often gain greater access to their inner lives. Some of the world’s most successful business executives never make a decision until they have a chance to let it pass through their minds dur- ing sleep, allowing solutions to come during dreams. The first step in making sense of a dream is to own it. It belongs solely to the dreamer and is a personal story. Although many books have been written about dream symbols, they are best understood by the dreamer. Dreaming about a horse may be a symbol of comfort and security because the person always had a horse when she was growing up. A horse for another person may be a symbol of terror because he was kicked by a horse as a young child. Yet another person may see a horse as a symbol of a challenge, since she has wanted to learn to ride for some time. Thus, dream dictionaries do not have the answers to people’s dream symbols; they are personal images taken from one’s life representing one’s unique experiences.

Journaling helps mobilize intuition as people begin to understand their personal symbols. Because the dream journal is intensely personal, it should be kept private unless the dreamer chooses to share it with others. The entries should be dated so they can be correlated with significant life events in the present or future, and recurring themes, places, and situations should be noted. Giving dreams titles or headlines like a newspaper headline often reveals a dream message that may otherwise be overlooked. People are encouraged to go back over their journals at regular intervals to note connec- tions between dreams and waking events.

In the midst of nightmares, people who realize they are dreaming fre- quently choose to wake up. Many therapists believe, however, that the essen- tial issue is to discover what elements from the past, mixed with current events, are creating the nightmare. Insight into the source of the nightmare can help people face and overcome the terror while remaining in the dream. Nightmares can be transformed into more pleasant experiences. People are encouraged to remember that nothing in their dreams can hurt them.

Conscious dreaming, as a form of mental imagery, has the potential to aid in the promotion of health and in the healing process. Evidence supports the idea that the vividness of mental imagery determines how strongly it affects physiology. Dreams are the most vivid form of mental imagery most people experience and, therefore, they are also likely to be a source of highly effective healing imagery ( Bulkeley, 2003 ).

Dreams can be immensely useful in gaining self-knowledge. Psycholo- gist Ernest Rossi proposed that an important function of dreaming is integra- tion of split-off parts of one’s personality. According to Rossi ( 1985 ):

In dreams we witness something more than mere wishes; we experience dramas reflecting our psychological state and the process of change taking place in it. Dreams are a laboratory for experimenting with changes in our psychic life. . . . This con- structive or synthetic approach to dreams can be clearly stated: Dreaming is an endogenous process of psychological growth, change, and transformation. (p. 142 )

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RESEARCH

Persons who conduct dream research are often accused of working from biased or otherwise inadequate samples. Some question whether people who remember dreams are different from other people. Others surmise that people do not report their dreams honestly. Many studies of high and low dream recallers demonstrate only small differences between them on a variety of personality and cognitive tests. High recallers differ primarily in their interest in dreams and their motivation to recall them. In many studies, subjects pro- vide dream reports anonymously, which reduces the tendency to misreport. Most people consider dreams as something that happens to them, so they do not view the dreams as reflecting on their self-image and are thus quite will- ing to report whatever they experience ( Domhoff & Schneider, 2008 ).

There are four sources of dream reports: the sleep laboratory, the psy- chotherapy relationship, personal dream journals, and reports written on anonymous forms in group settings. Sleep laboratories awaken individuals during REM and non-REM periods, which allows for the maximum recall of dreams. The process, however, is time consuming and expensive. Psychother- apy is a long-standing source of dream reports. The clients, however, consti- tute a small and unrepresentative sample of the population. Dream journals are personal documents of dreams but may have gaps or omissions. Some individuals are not willing to provide their journals for scientific analysis. The easiest way to get large samples of dreams is in the classroom, meetings, con- ferences, waiting rooms, and so on. People are simply asked to provide their gender, age, and the last dream they remember having.

Four general methods are used to analyze dream content: free associa- tions, finding metaphoric meaning, searching for repeated themes, and quanti- tative analysis. Free association, that is, having clients say whatever comes into their minds about each part of the dream, often reveals the day-to-day waking events incorporated into the dream. In psychotherapy, people may look for metaphors, often based on their own past life experiences. Researchers may also look for repeated themes in a dream series. Usually these themes are unique to each dreamer, which makes it impossible to generalize to other people. The major task in quantitative content analysis is the creation of care- fully defined categories that lead to the same results when used by different researchers. Nominal scales simply record the presence or absence of a characteristic in a dream report. For example, there could be a general category of aggression and then each type of aggression can be assigned separate categories. Hall and Van de Castle ( 1966 ) developed the most comprehensive and widely used empirical system of content analysis. They cataloged more than 10,000 dreams from normal people and found that approximately 64% were associated with sadness, apprehension, or anger. Only 18% were happy or exciting, and only 1% percent of dreams involved sexual feelings or acts. DreamBank, a website at the University of California, Santa Cruz, has more than 22,000 dream reports available for research regarding dream content ( Domhoff & Schneider, 2008 ).

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INTEGRATED NURSING PRACTICE

Dreams are the doorway into the unconscious, which is also a domain of healing. Just as guided imagery can be used to direct people’s attention to specific areas or organs of the body, so can dreams become a healing tool. You can teach the fol- lowing series of steps to clients who are interested in cultivating healing dreams:

• A half hour before bedtime, find a quiet place. • Pay attention to the sounds and sensations of the outside environment

as nature begins to settle down to rest. • Spend a few minutes journaling the experiences and feelings you had

during the day. • Review your accomplishments of the day. • Think for a moment of loving yourself and others with whom you inter-

acted today. • If you had conflict with others, put those thoughts and feelings away for

now. • Imagine yourself as part of the universe, and feel a connection with all

living things. • Allow one issue of present concern to come to your conscious awareness. • Ask for answers, solutions, or healing as you sleep and dream. • On awakening, remember what you wanted to learn from your dreams,

and let the answers come to your awareness. ( Keegan, 1994 )

A similar process is called dream incubation, which is a somewhat more deliberate format. Examples of the types of requests to make of dreams include these: How can I heal myself? Which path shall I choose? How can I solve (state problem)? How can I improve my relationship with (name)? How can I make (state project) a success? Should I do (state proposed action)? What shall I do now? Teach clients the following steps for dream incubation:

• Choose an important matter that you wish to explore. • Write a short, simple question for which you need an answer. • Meditate on the question for a few minutes. Repeat the question several

times, followed by “I give thanks for the answer, which will be in a dream that I remember.”

• Envision yourself awakening, remembering, and receiving an answer. • Write the question again. • Place the paper with the question on it beneath your pillow. • On awakening, follow the guideline in the “Try This” box on improving

dream recall near the end of the chapter. • Watch for extra information that may come later during the day. • Do not give up if success is not immediate.

Help clients understand that they need not seek professional help for bad dreams unless they frequently disrupt their sleep. Other distress signals include regular bouts of fatigue or depression on waking or consistently feeling worse than when they went to bed. Remind people that nothing in their dreams

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can hurt them. Suggestions for reframing nightmare themes are presented in Box 19.2 . Alternatively, nightmares can be managed through a process called dream reentry, which is practiced in the waking state. People begin by selecting the nightmare to relive, then come up with alternative ways of acting in the nightmare to transform the events into a more enjoyable experience. They relive the nightmare in imagination, incorporating the new action, and continue with the dream until they see the result of their new behavior ( Mellick, 2001 ).

BOX 19.2

Reframing Nightmares

Being Chased

Response: Stop running and face the chaser, which may cause it to disappear. If not, try to dialogue and reconcile with the person or animal. Alternatively, ask the adversary itself what you are running away from.

Being Attacked

Response: Demonstrate your readiness to defend yourself, rather than giving in or running away. Then, try to dialogue with the attacker in a soothing manner. Alternatively, enlist friendly and cooperative dream characters to help overcome the threatening character.

Falling

Response: Rather than waking up, go with it, relax, and land gently. Think about landing in a pleasant and interesting place. Alternatively, transform falling into flying.

Trapped or Paralyzed Response: Relax and tell yourself you are dreaming. Go along with images or things that happen to the body, because none of it can be harmful in reality. Adopt an attitude of interest and curiosity about what happens.

Being Unprepared for an Exam or Speech Response: Leave the exam room or the lecture hall. Alternatively, answer the text ques- tions creatively or give a spontaneous talk on any topic of interest. The key is to transform the experience into one that is fun.

Being Naked in Public Response: Remember, modesty is a public convention, and dreams are private experi- ences. Have fun with the idea. Try having everyone else in the dream remove their clothing also.

Sources: Barrick ( 2001 ); Browne ( 2002 ); Bulkeley ( 2003 ).

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Spiritual care, in many settings, includes listening to clients’ dreams. During times of transition, growth, or suffering, spiritual issues or struggles often occur and may be found in dreams as people wrestle with what is most important in their lives. Nurses have a unique opportunity to listen attentively to clients and help them work through this process. Sharing dreams with another person or with a group can provide a variety of insights into the many levels of the dream. Dream sharing also builds a sense of community as people discover they have a great deal in common. Nurses who are sensitive and empathic and have good listening, communi- cation, and group skills can facilitate a dream-sharing group ( Bulkeley & Bulkley, 2006 ).

To allow each member of the group to have time to work on a dream at every session, the number of participants will have to be limited to six or eight. Members should be asked to make a commitment to attend regular ses- sions over a set time, usually for no less than 6 weeks. A typical group session is 2 to 3 hours. Dream sharing requires mutual trust and respect. Individuals who are going to share their innermost thoughts must have the assurance that they are in a place where they are protected and supported. The dream is always honored as a topic worthy of attention and thought.

Even without a full understanding of what dreams signify, we can use their stories to know ourselves better. For many people—and you can be one of them—dreams really do come true.

TRY THIS

Improving Dream Recall

1. Clearly declare to yourself the intention to remember your dreams when you lie down to sleep.

2. Have your tools, notebook, and pen or tape recorder at your bedside. 3. If you awaken during the night while dreaming, record your dream immediately.

Use a penlight to see if you do not wish to disturb a partner. If you tell yourself that you can go back to sleep and catch the dreams later, you will probably find you are wrong.

4. When you awaken in the morning, at first lie quietly before getting out of bed. Then, write whatever you remember, even if it is only one word or scene.

5. If you wake up with no dream memories, move your body back into the position you were in as you began to awaken, and you will be more likely to recall your most recent dream.

6. Don’t censor your dreams, and don’t try to interpret them right away. Bizarre, weird, or trivial dreams may become important later.

(continued)

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7. Pay attention to your feelings. They are often your best guide to the dream’s mean- ing and urgency.

8. Keep a journal for a month of the dreams you do remember. Look for important ideas or themes running through the dreams.

9. The more you practice these skills, the more dreams you will remember.

References

Barrick, M. C. (2001). Dreams . Corwin Springs, MT: Summit University Press.

Buhner, S. H. (2006). Sacred Plant Medi- cine . Rochester, VT: Bear.

Bulkeley, K. (2003). Dreams of Healing . New York, NY: Paulist Press.

Bulkeley, K., & Bulkley, P. (2006). Dream- ing Beyond Death: A Guide to Pre-Death Dreams and Visions . Boston, MA: Beacon Press.

Chou, K. L., Moro-De-Casillas, M. L., Amick, M. M., Borek, L. L., & Friedman, J. H. (2007). Testosterone not associated with violent dreams or REM sleep behavior disorder in men with Parkinson’s. Movement Disorders , 22(3): 411–414.

Cushway, D. J., & Sewell, R. (2012). Ther- apy with Dreams and Nightmares: The- ory, Research, & Practice (2nd ed.). Los Angeles, CA: Sage.

Domhoff, G. W. (2011). The neural sub- strate for dreaming: Is it a subsystem of the default network? Consciousness and Cognition, 20(4): 1163–1174. doi: 10.1016/j.concog.2011.03.001

Domhoff, G. W., & Schneider, A. (2008). Studying dream content using the archive and search engine on DreamBank.net. Consciousness and Cognition , 17(4): 1248–1256.

Dresler, M., Wehrle, R., Spoormaker, V. I., Koch, S. P., Holsboer, F., Steiger, A., . . . Czisch, M. (2012). Neural correlates of dream lucidity obtained from contrast- ing lucid versus non-lucid REM sleep. Sleep, 35(7): 1017–1020. doi: 10.5665/ sleep.1974

Ewing, J. P. (2011). Dreams of the Reiki Shaman. Forres, UK: Findhorn Press.

Hall, C. S., & Van de Castle, R. L. (1966). The Content Analysis of Dreams. New York, NY: Appleton-Century-Crofts.

Hobson, J. A. (1996). How the brain goes out of its mind. Harvard Mental Health Letter , 12(8): 3–5.

Hobson, J. A., & Friston, K. J. (2012). Wak- ing and dreaming consciousness: Neurobiological and functional con- siderations. Progress in Neurobiology, 98(1): 82–98. doi: 10.1016/j.pneurbio. 2012.05.003

Jung, C. G. (1965). (A. Jaffe, Ed.; R. Winston & C. Winston, Trans.). Memories, Dreams, Reflections . New York, NY: Vintage Books.

Keegan, L. (1994). The Nurse as Healer . Albany, NY: Delmar.

Klemm, W. R. (2011). Why does REM sleep occur? A wake-up hypothesis. Frontiers in Systems Neuroscience , 5: 1–12. doi: 10.3389/fnsys.2011.00073

Kramer, M., & Barasch, M. I. (2000). Dreamspeak. Psychology Today, 33(5): 56–61.

Marszalek, J. F., & Myers, J. E. (2006). Dream interpretation: A developmen- tal counseling and therapy approach. Journal of Mental Health Counseling , 28(1): 18–37.

Mellick, J. (2001). The Art of Dreaming . New York, NY: Gramercy Books.

Moss, R. (1996). Conscious Dreaming: A Spiritual Path for Everyday Life . New York, NY: Crown Trade Paperbacks.

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Moss, R. (2007). The Three “Only” Things: Tapping the Power of Dreams, Coincidence, and Imagination . Novato, CA: New World Library.

Reiser, M. F. (2001). The dream in con- temporary psychiatry. American Jour- nal of Psychiatry , 158(3): 351–359.

Rossi, E. (1985). Dreams and the Growth of Personality (2nd ed.). New York, NY: Brunner/Mazel.

Rhudy, J. L., Davis, J. L., Williams, A. E., McCabe, K. M., & Byrd, P. M. (2008).

Physiological-emotional reactivity to nightmare-related imagery in trauma- exposed persons with chronic night- mares. Behavioral Sleep Medicine, 6(3): 158–177.

Stores, G. (2008). Rapid eye movement sleep behavior disorder in children and adolescents. Developmental Medicine and Child Neurology , 50(10): 728–732.

Resources

International Association for the Study of Dreams 1672 University Ave. Berkeley, CA 94703 209.724.0889 www.asdreams.org

DreamGate www.dreamgate.com

Dream Network Australia www.dreamnetworkaustralia.com.au

European Association for the Study of Dreams

ONIROS Chitri Mont Sabot 58190 Neuffontaines, France 33.03.86.24.86.41 www.oniros.fr/home

The Lucidity Institute 2155 Spencer St. Napa, CA 94559 707.254.7829 www.lucidity.com

20 Intuition

Wherever the art of medicine is loved, there is also a love of humanity.

Hippocrates

Intuition comes from the Latin word intueri , which means to look within. Intuition is described as something people see, hear, or feel rather than think; a powerful form of inner wis- dom; an awareness of something without conscious attention or reasoning; or knowledge from an expanded state of awareness. Some people describe it as knowing immediately without think- ing. Words and phrases associated with intuition are hunches, instinct, gut feeling, sixth sense, a flash of insight, “It suddenly hit me,” “Something just clicked into place,” “It just feels right,” and “I don’t know why, but something tells me I should do this.”

BACKGROUND

Intuition is as old as humankind. Scientists, inventors, and artists have credited intuition with their ability to accomplish great things. Archimedes, one of the three greatest mathematicians of all time (born 287 b.c. ), was reported to have shouted “Eureka” when he discovered his famous flotation principle. Hippocrates, the father of medicine, wrote about the value of intuition, which he called “instinct.” He warned that “cold reason” could obscure one’s inner vision. Albert Einstein credited intuition for many of his own inspirations. Thomas Edison used the symbols of his dreams to intuit scientific breakthroughs. Jonas Salk, who discov- ered the polio vaccine, wrote an entire book on intuition, main- taining that creativity was the result of the interaction of intuition and reasoning.

The late Edgar Cayce (1877–1945) was one of the most ver- satile and credible psychics, or medical intuitives, the world has

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ever known. Cayce, a photographer and devout religious person, was, in a sense, the father of holistic medicine. In the early 20th century, he emphasized the importance of attitudes, emotions, diet, and exercise in health and illness. He believed the treatment of illness should be physical, mental, and spiritual. Daily, for more than 40 years of his adult life, Cayce would lie down on a couch and enter a self-induced meditative state. Then, provided with the name and location of a person anywhere in the world, he would speak in a normal voice and give information about the state of the person’s mind and body and prescribe ways to generate physical and mental health. These ses- sions came to be called “readings,” and there are over 14,000 of them on file. A copy of the reading was always sent to the individuals for their own informa- tion and use.

There are currently several well-known medical intuitives. Judith Orloff, MD, is a board-certified psychiatrist, a professor of psychiatry at UCLA, and an author and lecturer on the interrelationship of medicine, intuition, and spiritual- ity. Her book Second Sight ( 1996 ) is a memoir about coming to terms with her intuitive abilities. Mona Lisa Schulz, MD, PhD, is a neuropsychiatrist and neu- roscientist who has worked for many years as a medical intuitive. Caroline Myss, PhD, is a writer, researcher, and medical intuitive who works closely with Norman Shealy, MD, founder of the American Holistic Medical Association.

PREPARATION

The level of training and abilities varies greatly from one medical intuitive to another. Because the practice of medical intuition is not regulated, anyone can claim the title, and the education and experience vary considerably. Indica- tions that an intuitive is not legitimate include claims of the only true way to heal, resistance to collaboration with primary health care providers, giving advice or telling the client what to do, or the charging of exorbitant fees.

Courses in medical and intuitive counseling may be taken at Holos Uni- versity Graduate Seminary. The American Board of Scientific Medical Intu- ition (ABSMI) tests and certifies people who are proficient in Medical Intuition and Counseling Intuition. The Medical Intuition process is a 5-day exam dur- ing which the applicant completes an Intuitive Medical Analysis on eight dif- ferent individuals. For the Counseling Intuitive certification process the applicant must submit 25 case summaries signed by the clients. The appli- cants then conduct a counseling session with a client while being observed by an ABSMI board member.

CONCEPTS

Right and Left Brain

The cerebrum makes up 80% of the weight of the brain. The cerebrum is divided into two hemispheres, right and left. Each of the hemispheres has separate and unique functions, yet if one hemisphere is damaged, the other

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hemisphere seems to be able to take on some of its function. The corpus callosum is composed of 200 million nerve fibers that connect the left and right hemispheres, and it relays sensory information between the two brains.

The left brain contains most language functions and interprets, analyzes, sorts, and retrieves information necessary to problem solve and plan. It is rational and focused on the external world. It is often referred to as the mascu- line half of the brain.

The right brain is the emotional, visual, and intuitive part of the brain. The emotional aspect of language is located here. Its focus is on feelings and the state of the internal body. It is often referred to as the feminine half of the brain.

Women have faster and greater access to the right hemisphere because they have a wider corpus callosum than men. As a general rule, most women tend to process information with the right brain, the left brain, and the body all working together. They are also able to communicate their intuition as it comes to them. Men are more likely to process information with their left brain. The left brain, as the rational, logical, and intellectual part of a person, is highly regarded in Western society. The emotional, intuitive right brain is considered inferior. In fact, the left brain often acts as a censor and denies the validity of intuition ( Duggan, 2007 ).

Intuitive healing calls on both hemispheres of the brain. It respects the intelligence of the left brain and calls on the intuitive wisdom of the right brain. Health and illness issues are best identified and decisions are best made when the rational and intuitive brains work together.

Problem Solving

It is important to most individuals that they make good decisions. Intuition can help people make everyday decisions and improve their problem-solving skills. Sometimes, people simply get a gut feeling about a particular course of action. More often, however, intuition is the result of a four-step process. The first step involves preparation and analysis . People use their left brain to collect facts and information and study the situation. The second step is incubation . During this phase, the problem is put on the “back burner” by letting the left brain move on to another subject. People often increase right brain activity during this phase by listening to music, meditating, or engaging in movement such as dancing, t’ai chi, or yoga. The third step in insight . The intuitive answer may arrive in the form of images, verbal messages, physical sensations, emo- tions, environmental cues, or just a pervasive sense of knowing. The fourth and last step is validation . Once the insight is a conscious thought, the left brain checks to see whether the intuitive message answers the question or solves the problem ( Nyatanga & de Vocht, 2008 ; Pretz, 2008 ).

Intuition and Dreams

Intuition is the language of dreams. The right brain and the body are better able to communicate at night when the left brain is quiet. Dreams offer nightly

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gauges on the dreamer’s physical, emotional, and spiritual health. When dis- ease begins to develop, dreams often provide warnings of specific problems before physical symptoms are apparent. Body cells may send chemical signals to a part of the brain. The warning may be in the form of dreams of a broken heart, an exploding head, or limbs falling off. Such early diagnosis dreams are entirely natural and are reminders of how illness is related to one’s entire being. It may be that when people are awake they tune out body messages, and when they are asleep their internal sensations get through more easily to the intuitive mind, which sends a message in a dream. Intuition in the form of dreams may also give advice on preventive measures and ways to provide for one’s well-being. Dreams frequently suggest specific courses of treatment for different problems. These suggestions may involve lifestyle changes, conven- tional medical treatments, alternative therapies, or counseling that addresses the hidden sources of disease. People may neglect the warnings, but intuition is highly inventive in rescripting the message in ways that make it increas- ingly harder to ignore ( Orloff, 2009 ).

TREATMENT

It would be comforting to believe that primary health care providers easily make medical diagnoses and treatment decisions. However, even with the technological advances of modern science, misdiagnoses are made, and treat- ments may cause more problems than the disease itself. Many health care practitioners rely on their intuition to enhance their scientific understanding. More than 5,000 medical tests are currently in use. How would practitioners know which ones to order if they did not use intuition as well as their knowl- edge and deductive reasoning? Thus, medical intuition is an essential tool for every biomedical and alternative health care provider.

Medical Intuitives

A medical intuitive is someone who has skill and/or training in reading the human energy system. Some practitioners are born with this ability, and some learn it through training and practice. Medical intuition is not a healing modality but rather a tool to provide information about what is going on in a person’s body, mind, and spirit.

Medical intuitives may or may not meet their clients in person, but they will work only with the client’s explicit consent. The intuitive makes it clear that it is not a physician–patient relationship, and there will be no diagnoses or treatment prescriptions. The intuitive will instead tell the person about problematic energetic and emotional factors they detect and may suggest hav- ing certain areas checked out by a regular health care provider. Medical intu- ition is an empowering tool when clients use the information to make changes for the better in their health and lives.

Medical intuition presupposes that body, mind, and spirit are one unified reality and is based on the belief that the body is animated by an integrated

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energy called the life force. The life force sustains the physical body, but it is also a spiritual entity that is linked to a higher being or infinite source of energy. When the energy flows freely throughout the body, a person experiences opti- mal health and vitality. When the life force is blocked or weakened, organs, tis- sues, and cells are deprived of the energy they need to function at their full potential, and illness or disease results.

After quieting or grounding their own energy, medical intuitives tune in to their client’s mind–body–spirit energy. They pay attention to the energy without censoring, questioning, or analyzing. Some intuitives are clairvoyant , which means that intuition comes to them visually, and they see pictures of the inner parts of the body. They are able to see energy or qi as it flows through the body and are able to detect where this energy has become blocked. Some intu- itives are clairsentient , which means that they are able to feel the energy or emotions in the body. They may experience actual sensations in their own bodies or they may scan clients’ bodies seeking out changes in the energy field of the body. Some intuitives are clairaudient , which means that they receive intuitive information through sound. This may be random and dissociated words or a sentence or even an in-depth conversation ( Shealy, 2010 ).

In a sense, biomedical health care providers work from the outside in and look at the symptoms of the physical body. Medical intuitives work from the inside out and are more interested in spiritual, emotional, and psychologi- cal issues that create the environment for illness and disease to occur. Many medical intuitives work with (or are) medical doctors.

Self-Healing

Some individuals believe that curing their illness or disease is something that must be done to them or for them. They have lost their intuitive understand- ing of what is not functioning properly and why, and they often ignore symp- toms or numb their pain. They have little understanding of how they set the internal scene for their illness or disease. With this mind-set, people become disconnected from their ability to heal themselves and feel like victims of their own body processes.

People interested in self-healing recognize that dysfunction and disease are ways the body communicates. All people have the ability to intuit what their bodies are saying. They can learn to trust and use their inner intelligence to tell them what is right and wrong, what’s good and should be strength- ened, and what’s unhealthy and needs to be changed. Intuition may tell a person when to exercise, when to rest, or when to see a biomedical health care provider. Self-healers also understand that intuitions do not heal in and of themselves. To heal, the persons must act on the intuitive information.

Thoughts trigger biochemical responses, and biochemical responses trigger thoughts. Thoughts, words, and beliefs are the link between people’s inner experiences and the directions their lives take. Many individuals have long-standing negative tapes playing in their heads much of the time. This negative self-talk includes statements such as these: I’m bad; I’m fat and

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ugly; No one likes me; I have no control; I’m no good; It’s hopeless; I’m never going to feel better; I’m always sick; I’m all alone in this life; The world is a dangerous place; I might as well give up; and so on. The unconscious mind “hears” these thoughts and words and begins to treat them as reality. Thus, one’s expectations become a self-fulfilling prophecy, and people become driven by negativity ( Orloff, 2009 ).

In contrast, positive attitudes are a part of self-healing and foster growth and adaptive change. Positive beliefs set the stage for healing to occur. Posi- tive self-talk includes statements such as these: My body is a holy vessel; I have the ability to heal myself; I like and respect my body; My body, emo- tions, and spirit are all one; I am well loved; I am good to other people; I enjoy being healthy; I listen to my intuition; My body knows what it needs to get well; and so on. The unconscious takes these positive attitudes seriously, and they become a self-fulfilling prophecy for health and well-being ( Orloff, 2009 ). An old Navajo saying illustrates this process: “If you want to see what your body will look like tomorrow, look at your thoughts today.”

Another facet of self-healing is body scanning , or learning to decode subtle body messages before there is pain or disease. Most people can learn to discern imbalances long before these can be medically verified. Body scan- ning begins with meditation. When people have a quieter conscious mind they can more easily recognize messages coming from the body, emotions, and subconscious mind. Meditation is the amplifier of intuition. Once the mind is quiet, open, and waiting, the individual scans the entire body.

During this process the person notes any areas that are hot or cold, and any sensations of tingling, buzzing, quivering, aching, tightness, or numb- ness. With practice, people can learn to understand the unique language their body uses to communicate needs and problems. With this intuitive understanding, people can take steps to create a healthier and happier life ( Orloff, 2009 ).

RESEARCH

Although there are some compelling anecdotes about medical intuition, research into the phenomenon is in its infancy. Within biomedicine there are “master” diagnosticians who can assess a patient’s condition and prognosis with extremely subtle cues, and healers in many cultures claim to make assess- ments by intuition. It will be interesting to see whether medical intuition, which is subjective and metaphysical, will in the future be understood from an objective, scientific viewpoint.

There are a number of studies on intuition in nursing practice, and tools have been developed to measure intuition in both experienced and novice nurses. These qualitative studies began in the mid-1980s and continue today ( Green, 2012 ). Nursing intuition does not lend itself to randomized blinded stud- ies. According to Effken ( 2007 , p. 188 ): “The value of intuition for clinical practice has been well documented; but because it cannot easily be measured, it can be denigrated in today’s evidence-based research and practice environment.”

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INTEGRATED NURSING PRACTICE

Intuition in Patient Care

Nursing practice is based on more than scientific understanding; it is also inspired by intuition. Experienced nurses are able to talk about their intuitive sense and give examples of it from their own practice but are often discour- aged by a work environment that emphasizes linear deductive reasoning ( Pretz & Folse, 2011 ).

Mona Lisa Schulz, a physician and medical intuitive, states that one of the most intuitive groups of people she knows are nurses in intensive care units. A patient may appear objectively stable, but the nurse who is caring for him will insist that he is about to “go bad” or go into a crisis state. When asked how the nurse knows, the reply is usually, “I just know.” It might be a smell, a slight tinge of color, a touch, or some other subtle cue that alerts the nurse. When science and medical knowledge say one thing, and a nurse’s gut feeling says something else, it is important to look at the situation again ( Schulz, 1998 ).

Patricia Benner has studied nurses and intuition for some time. She describes the intuitive process of nurses as “skilled pattern recognition.” Benner believes that nursing intuition is based on previously acquired knowl- edge, memory, and experience. She has also found that intuitive nurses do not always trust what they are experiencing when they cannot provide the “proof” that others demand of them. Benner suggested that nurses and others might more readily accept intuition if it is called skilled pattern recognition instead ( Benner & Tanner, 1987 ).

Catherine Green ( 2012 ) described nursing intuition as follows:

It is composed of four distinct aspects that include: (1) embodied knowledge rather like that knowledge we have when we have learned to ride a bicycle; (2) well-trained sensory perceptions atten- tive to subtle details of complex, often rapidly changing situations; (3) a significant store of pertinent conceptual knowledge; and (4) a history of habitual actions intentionally directed towards achiev- ing the best outcomes for our patients. (p. 99 )

McCutcheon and Pincombe ( 2001 ) believe that nursing intuition is based on “a complex interaction of attributes, including experience, expertise and knowledge, along with personality, environment, acceptance of intuition as a valid ‘behavior’ and the presence or absence of a nurse/client relationship” (p. 345 ). Their study acknowledges that nurses acting on intuition can posi- tively affect client care and that ignoring intuition can have a negative impact on that care.

Nyatanga and de Vocht ( 2008 ) and Gobet and Chassy ( 2008 ) believe that simple decisions are better processed by the conscious mind, while complex decisions are better processed by the unconscious mind. It is thought that the unconscious mind is able to detect familiar patterns, since more information is stored as unconscious thought. Pretz and Folse ( 2011 , p. 287 ) believe that

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“experienced clinicians can identify relevant information and quickly detect subtle changes or unanticipated patient response to a treatment. . . . Even before objective evidence is available, nurses can use intuition to anticipate changes in patients’ conditions, potentially improving the quality of care and patient outcomes.”

Intuitive Leadership

Business executives have understood for some time that intuition is an impor- tant part of successful leadership. Just as businesses are doing, nurse manag- ers can turn to experts in the field of intuition to shape decisions, assess professional relationships, and decide on courses of action. Respecting intu- ition is part of the environment in which innovation and new ideas naturally emerge. Intuitive leaders are able to look past their preconceptions and assumptions long enough to anticipate new possibilities. This creativity can result in new ideas for nursing research, new systems of care, and new health care products. As individuals are able to broaden their awareness and see new options, they will also see improved professional relationships and team- work. Greater innovation and workable strategies mean more motivated employees and decreased nursing “burnout.”

TRY THIS

Positive Affirmations

Positive affirmations are a way of purposefully changing your inner reality. They are always stated in the present tense, as if they have already occurred. For a week think about and jot down changes you would like to see in your life. Formulate several affirmations for each of these changes. For example, if you are struggling and would like your financial situation to improve, you might develop these affirmations: I have all the money I need and want; I am financially secure; money comes in as I need it; I pay my bills easily; I am very comfortable about money. Affirmations about your career might include the follow- ing: I am an excellent nurse; I make sound and wise decisions; I care about my clients; my clients respond to my care of them; I am respected by other professionals; I really like being a nurse.

• Write out affirmations in a number of areas such as career, health, parenting, and personal relationships.

• Make a tape recording of your affirmations, pausing several seconds after each one.

• Several times a day, when driving or during some other quiet time, play your affir- mation tape. After each taped affirmation, repeat the affirmation aloud.

• Pay attention to how things begin to change in your life. Remember, the thoughts you have become the reality of your life. Make that a positive process.

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TRY THIS

Practice Intuition

Intuitive abilities improve with attention and practice. Try the following:

• Think of something specific to which you would like an answer. • Do a relaxation exercise or move into a meditative state. • Allow any answers to come into your awareness. • Don’t make any judgments about any of the answers or question where they came

from. • Jot down the answers to consider and review when you return to a normal state of

consciousness. • If you received no answers, try a different question or seek an inner guide or teacher

to help you find the answer.

References

Benner, P., & Tanner, C. (1987). How expert nurses use intuition. American Journal of Nursing , 87(1): 23–31.

Duggan, W. (2007). Strategic Intuition . New York, NY: Columbia University Press.

Effken, J. A. (2007). The informational basis for nursing intuition: Philosophi- cal underpinnings. Nursing Philosophy , 8: 187–200.

Gobet, F., & Chassy, P. (2008). Towards an alternative to Benner’s theory of expert intuition in nursing. International Jour- nal of Nursing Studies , 45: 129–139.

Green C. (2012). Nursing intuition: A valid form of knowledge. Nursing Phi- losophy. 13: 98–111.

McCutcheon, H. H. I., & Pincombe, J. (2001). Intuition: An important tool in the practice of nursing. Journal of Advanced Nursing , 35(5): 342–348.

Nyatanga, B., & de Vocht, H. (2008). Intu- ition in clinical decision-making: A psychological penumbra. International

Journal of Palliative Nursing , 14(10): 492–496.

Orloff, J. (1996). Second Sight. New York, NY: Three Rivers Press.

Orloff, J. (2009). Emotional Freedom: Liber- ate Yourself from Negative Emotions and Transform Your Life . Prospect, KY: Har- mony House.

Pretz, J. E. (2008). Intuition versus analy- sis: Strategy and experience in com- plex everyday problem solving. Memory & Cognition , 36(3): 554–566.

Pretz, J. E., & Folse, V. N. (2011). Nursing experience and preference for intu- ition in decision making. Journal of Clinical Nursing, 20: 2878–2889. doi:10.1111/j/1365-2702.2011.03705.x

Schulz, M. L. (1998). Awakening Intuition . New York, NY: Three Rivers Press.

Shealy, C. N. (2010). Medical Intuition. Vir- ginia Beach, VA: 4th Dimension Press.

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Resources

American Board of Scientific Medical Intuition 5607 S. 222nd Rd. Fair Grove, MO 65648 888.242.6105 www.absmi.com

Holos University Graduate Seminary P.O. Box 297

Bolivar, MO 65613 888.272.6109 www.holosuniveristy.org

International Association of Medical Intuitives www.medical-intuitives.net

21 Music as a Therapeutic Tool

Leslie Rittenmeyer PsyD, CNS, RN

Music washed away from the soul the dust of everyday life.

Berthold Auerbach

Music gives soul to the universe, wings to the mind, flight to the imagination, a

charm to sadness, and life to everything.

Attributed to Plato

INTRODUCTION

The focus of this chapter is to explore the use of music as a thera- peutic tool to complement clinical practice. The reader should be aware that there is an academic discipline called music therapy. Music therapy is the clinical and evidence-based use of music interventions to accomplish individualized goals within a thera- peutic relationship by a credentialed professional who has com- pleted an approved music therapy program ( American Music Therapy Association, n.d. ). Music is used to promote wellness or improve the quality of life for those with disabilities or illness. For more information on music therapy the reader is referred to Defining Music Therapy (2nd ed.), by Kenneth Bruscia.

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BACKGROUND

It is generally believed that the utilization of music for healing dates to ancient times. The I Ching, Chinese Book of Wisdom, one of the oldest books in Chinese culture, references music as a powerful healing force. Thousands of years ago humans were playing primitive instruments, and most known primitive soci- eties had some form of music. The Greek philosopher Pythagoras believed that music contributed to health, and he prescribed music to restore harmony ( White, 2001 ). In the mid-1800s Florence Nightingale ( 1859/1992 ) acknowl- edged the benefits of music in aiding the healing process in soldiers wounded during the Crimean War. She observed that wind instruments with continu- ous sound seemed to have a beneficial effect, whereas those instruments that did not produce continuous sound had the opposite effect. During World Wars I and II music was used in the Veterans Administration hospitals as a way to address traumatic war injuries. Doctors and nurses began to notice the effect music had on veterans’ psychological, physiological, cognitive, and emotional state. Music was first used in the general hospital in the first half of the 1990s by health care practitioners in conjunction with anesthesia and anal- gesia. Many concentration camp survivors also used music as a survival tool. ( Frankl, 1963 )

CONCEPTS

Music and the Brain

Ways in which the brain processes music and the effect of music on the brain are of great interest, particularly in the field of neuroscience. The publication of the work Pourquoi Mozart ( 1991 ) by the French researcher Tomatis piqued interest in something called the Mozart effect. Tomatis was particularly interested in the physiological effects of music on healing and believed that the music of Mozart had the greatest effect. A seminal study by Rauscher, Shaw, and Ky ( 1993 ) demonstrated that 10 minutes of listen- ing to a Mozart sonata improved the spatiotemporal intelligence, that is, the ability to mentally manipulate objects in three-dimensional space. Results also showed that college students’ IQ scores improved by 8 to 9 points, which started a popular notion that listening to music made people smarter. Unfortunately, this was not quite so. The improvement was not permanent (nor did the researchers claim it was) and, in fact, lasted only about 10 to 15 minutes. Despite the controversy surrounding this theory, the term “Mozart effect” has been popularized to reflect the healing power of music in general.

Although the perception of music by the brain is not fully understood, it seems that there is not a single area of the brain that can be called the “music center.” More than likely, listening to and perceiving music is a comprehen- sive experience. Sacks ( 2007 ) posited that musical powers are made possible because the brain uses systems that have already been developed for other purposes. He stated, “This might go with the fact that there is no single music

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center in the human brain, but the involvement of a dozen scattered networks throughout the brain” ( Sacks, 2007 , p. xi ). Some scientists believe that the brain is hardwired for music, and others believe that this is not so. Pinker ( 1997 ) is one of the neuroscientists who believe there is no evolutionary basis for supposing that music, or any of the arts, is adaptive and hardwired in the brain. In essence, he bases this belief on the notion that if music vanished tomorrow, from an adaptive perspective, nothing would change biologically. Other scientists, such as Levintin ( 2006 ), disagree and point to the universal- ity of music in cultures and the apparent ability of infants to perceive music early on.

In considering the role of the brain, Levintin (2006) identifies the cumulative experience of perceiving music. The motor cortex allows for movement such as foot tapping, dancing, and playing an instrument; the sensory cortex allows for tactile feedback; the auditory cortex allows for the perception and analysis of tones and sounds; the prefrontal cortex allows for the creation of expectations and satisfaction of expectations; the visual cortex allows for reading music and looking at others’ and one’s own move- ments; the hippocampus allows for memory for music and musical experi- ences; the amygdala allows for the emotional reaction to music; and lastly, the cerebellum allows for movement and the emotional reaction to music. It is unclear exactly how music affects the brain and healing, but it is fairly certain that it does, as supported by both scientific and anecdotal evidence ( Sacks, 2007 ).

Quality of Life

In addition to affecting the brain, music therapy is also capable of affecting individual quality of life. Quality of life is a broad concept that can be defined contextually; that is, quality of life for a person dying of cancer might be defined differently than for a person dealing with an anxiety disorder. And someone experiencing severe chronic pain might define quality of life differ- ently than someone recovering from a hurtful divorce. Victor Frankl ( 1963 ) contended that quality of life is tied to a person’s perception of meaning. The quest for meaning is fundamental to the human condition, and individuals are brought in touch with a sense of meaning when they reflect on that which they have created, loved, believed in, or left as a legacy.

RESEARCH

Although more research is needed on the effectiveness of music intervention, there is some evidence identifying several benefits of music in the promotion of health and healing.

• A Best Practice information sheet from the Joanna Briggs Institute ( 2009 ) made the following recommendations: • Use of music in the preprocedural period may reduce anxiety and

decrease the amount of needed sedative medications. (Grade A)

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• The use of music may reduce surgical or procedural pain but should not be used as the primary pain intervention. (Grade A)

• Music may be an adjunctive intervention in the management of physi- ologically presented anxiety. (Grade B)

• There was not sufficient evidence to recommend the use of music for the perception of well-being, the reduction of side effects of analgesic drugs, and the physiological parameters of anxiety.

• A systematic review of music therapy in the palliative setting found that patients’ overall quality of life was improved, that pain and symptoms were reduced, and that mood and social interaction were improved ( Leow, 2011 ). • In a systematic review of music therapy for depression, Maratos,

Gold, Wang, & Crawford ( 2008 ) reported that music therapy is an acceptable form of therapy for people with depression and seems to help treatment.

• A randomized controlled trial on the effects of music on depression levels found that the music group experienced a cumulative reduction in depression scores over 8 weeks and a statistically significant reduc- tion in depression levels over time compared with the nonmusic control group (Chan, Wong, Onishi, & Thayala, 2011).

• A quasiexperimental pretest–posttest design was used with one music therapy group and one control group for patients having abdominal surgery. Blood pressure, heart rate, and respiratory rate were recorded on the day of surgery and the first, second, and third days post-op. The respiratory rate and systolic blood pressure were significantly reduced in the music therapy group compared with the control group ( Vaajoki, Kankkunen, Pietila, & Vehvilainen-Julkunen, 2011 ).

• A controlled study that measured the effects of music therapy on the psychological health of women during pregnancy found that a pre- scribed 2-week regimen of music therapy reduced the women’s levels of anxiety, depression, and stress ( Chang, Chen, & Huang, 2008 ).

• A meta-analysis of music therapy in a neonatal intensive care unit found that live music provided the greatest benefit for preterm infants ( Standley, 2012 ).

• Kukarni, Johnson, Kettles, and Kasthuri ( 2012 ) studied the effects of music on sedation, pain, and anxiety during radiologic procedures. They reported that sedation requirements were significantly reduced when self-selected music was played, thereby increasing safety during the procedures. The authors also found that music contributed posi- tively to the overall patient experience. There was no effect on baseline anxiety levels.

• A qualitative study explored the impact of active participation in music therapy for persons living with cancer. Some of the benefits described included relaxation, a sense of being uplifted, connectedness

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to others, and evocation of particular memories ( McClean, Bunt, & Daykin, 2012 ).

• A randomized controlled trial studied the impact of music therapy (group 1) and verbal relaxation (group 2) on chemotherapy-induced anxiety. The control group (group 3) received usual care. Both music and verbal relaxation groups experienced a reduction in anxiety compared with the control group. Patients with high state anxiety had a greater drop in anxiety compared with those in the normal state anxiety subsample ( Lin, Hsieh, Hsu, Fetzer & Hsu, 2011 ).

• A quasiexperimental study looked at mean arterial pressure (MAP), heart rate, anxiety, and pain in women undergoing a mastectomy. Participants were randomly assigned to a control group or a music intervention group. The study found that the levels of MAP, anxiety, and pain were significantly lowered in the intervention group com- pared with the control group ( Binns-Turner, Wilson, Pryor, Boyd, & Prickett, 2011 ).

INTEGRATED NURSING PRACTICE

Using music as an intervention is a client preference. Although the practice of music therapy takes specialized credentials, music can be used more gen- erally as a complementary nursing intervention. For instance, teaching stress reduction is a common health promotion activity, and music is a very effec- tive tool for reducing stress. Teaching clients how to perform progressive relaxation accompanied by their favorite music often reinforces the relax- ation response. Some clients like to meditate, and meditating to music is effective for some. Relaxation coupled with music helps decrease the wear and tear that results when the sympathetic nervous system is stimulated by stress or when people experience anxiety or anger. Thus, music can be used to decrease the deleterious effects of any situation that is stressful or anxiety producing.

Music can also be used as a nonpharmacologic intervention for pain management. It is known that muscle tension increases the pain response, so helping clients relax to music can decrease muscle tension and thereby reduce pain. The same principle can be applied with women in labor. Deep breath- ing, progressive relaxation, and imaging enhanced by music can be very effec- tive in creating a positive birthing experience.

Music can also be used while caring for the older population. Many times music helps people remember positive things about their life. Reminis- cence is a developmental exercise that is healthy. The use of music is also very soothing and calming. Doing gentle exercise enhanced by music encourages increased mobility and strength.

Singing bowls are standing bells that are played by rubbing a wooden, plastic, or leather-wrapped mallet around the rim of the bowl to produce a continuous “singing” sound. A warm bell tone can be produced by striking

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the bowl with a soft mallet. Singing bowls are used worldwide for meditation, relaxation, and pain reduction. The vibrations lower heart and respiratory rates and relax brain wave patterns.

In 1973, Theresa Schroeder-Sheker was instrumental in creating the music intervention she called music-thanatology (Cox & Roberts, 2013). Thana- tology , the scientific study of death, derives from Thanatos, the personification of peaceful death in Greek mythology. Music-thanatology is a subspecialty of palliative medicine; it is not for entertainment or distraction. Rather, it is pre- scriptive harp and voice music with its focus on the physical and spiritual care of persons with a terminal diagnosis or who are actively dying. The goal is to provide a sacred space for being with the person who is transitioning from life to death ( Black, 2012 ).

The certified harpist conducts a vigil (a period of attentive interaction) with the client (and family) in a hospital, hospice setting, nursing home, or in a person’s own home. The vigil alternates between music and silence, designed for each person according to an ongoing assessment of individual needs and symptoms. The purpose is to provide comfort and support by calming and settling, as well as reducing pain ( Cox & Roberts, 2013 ). As Black ( 2012 ) describes it:

Music thanatology is based on the premise that dying is a part of a larger spiritual process that affords the opportunity for growth and healing of the inner life without curing the physical body, and as such, it is part of the life cycle that can celebrate and reflect the beauty and reverence of the life lived. (p. 123 )

Music-thanatology training is a 2-year nondegree program offered at Chalice of Repose Project. The curriculum includes courses in anatomy and physiology, end-of-life physical challenges, as well as physical, emotional, and spiritual assessment. The students also study liberal arts and spirituality. They have intense music education in both voice and harp. Following the didactic courses, students serve an internship, write a thesis, and must suc- cessfully complete comprehensive exams. A master’s degree in music- thanatology is a new program being offered by Chalice of Repose both as distance learning and at St. Catherine University in Minneapolis-St. Paul. The excellent book The Harp and the Ferryman ( Cox & Roberts, 2013 ) brings this remarkable process to life and is a “must read” for every nurse.

TRY THIS

Music for Stress Reduction

• Keep a “bag of tricks” with you no matter the environment in which you work. What is in your bag will depend on your job, but always keep a small compact disk (CD) player with an array of CDs for stress reduction and relaxation. Then,

Chapter 21 • Music as a Therapeutic Tool 317

you will be prepared when you encounter a clinical situation that calls for the use of music. Also keep a set of earphones for situations in which the music might disturb others.

• Ask clients who seem anxious whether they would like to listen to some relaxation music. Teach them how to deep breathe slowly while listening to the music. The music and the deep breathing decrease sympathetic nervous system stimulation, thereby decreasing the physiological arousal that is prevalent in anxiety.

• Use music to counteract stress. Choose and play some of your favorite music that comforts or calms you. Find a comfortable position either sitting or lying down. As you listen to the music, focus on your breathing, and let the music lead you to a relaxed state. Focus on how peaceful and calm you feel.

• Experiment with various types of music. You may want to purchase Dr. Andrew Weil’s Mindbody Tool Kit , which is available at bookstores. Nilsson ( 2008 , p. 803 ) in a systematic review on the pain- and anxiety-reducing effects of music made the following recommendations for music interventions in clinical practice: • Slow and fl owing music, approximately 60–80 beats per minute • Nonlyrical • Maximum volume level of 60 decibels • Client’s own choice, with guidance • Suitable equipment chosen for the specifi c situation • Minimum duration of 30 minutes • Measurement, follow-up, and documentation

References

American Music Therapy Association. (n.d.). Official definition and descrip- tion of music therapy. Retrieved from www.musictherapy.org

Binns-Turner, P. G., Wilson, L. L., Pryor, E. R., Boyd, G. L., & Prickett, C. A. (2011). Perioperative music and its effects on anxiety, hemodynamics and pain in women undergoing mastec- tomy. AANA Journal, Special Research Edition, 79(4): S21–S27.

Black, B. P. (2012). Music as a therapeu- tic resource in end-of-life care. Jour- nal of Hospice and Palliative Nursing, 14(2): 118–125. doi: 10.1097/NJH. 0b013e31824765a2

Chan, M. F., Wong, Z. Y., Onishi, H., & Thayala, N. V. (2012). Effects of music on depression in older people: A ran- domized controlled trial. Journal of

Clinical Nursing, 21: 776–783. doi: 10.1111/j.1365-2702.2011.03954.x

Chang, M., Chen, C., & Huang, K. (2008). Effects of music therapy on psycho- logical health of women during preg- nancy. Journal of Clinical Nursing , 17(19): 2580–2587.

Cox, H., & Roberts, P. (2013). The Harp and the Ferryman. Melbourne, Australia: Michelle Anderson.

Frankl, V. E. (1963). Man’s Search for Meaning . New York, NY: Pocket Books.

Joanna Briggs Institute. (2009). Best Prac- tice: Music as an intervention in hospi- tals. 13(3): 13–16.

Kulkarni, S., Johnson, P. C., Kettles, S., & Kasthuri, R. (2012). Music during inter- ventional radiological procedures, effect on sedation, pain and anxiety: A

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randomized control trial. British Jour- nal of Radiology , 85(1016): 1059–1063.

Levitin, D. J. (2006). This Is Your Brain on Music . New York, NY: Dutton.

Leow, M. Q.-H. (2011). Music therapy in the palliative setting: A systematic review. Singapore Nursing Journal, 38(4): 14–21.

Lin, M.-F., Hsieh, Y.-J., Hsu, Y.-Y., Fetzer, S., & Hsu, M.-C. (2011). A randomized controlled trial of the effect of music therapy and verbal relaxation on chemotherapy-induced anxiety. Jour- nal of Clinical Nursing, 20: 988–999. doi: 10.1111/j.1365-2702.2010.03525.x

Maratos, A. S., Gold, C., Wang, X., & Crawford, M. J. (2008). Music therapy for depression. Cochrane Database of Systematic Reviews , Jan. 23 (1): CD004517. doi: 10.1002/14651858. CD004517.pub2

McClean, S., Bunt, L., & Daykin, N. (2012). The healing and spiritual prop- erties of music therapy at a cancer care center. Journal of Alternative and Com- plementary Medicine, 18(4): 402–407. doi: 10.1089/acm.2010.0715

Nightingale, F. (1992). Notes on Nursing: What It Is and What It Is Not (commem- orative edition). Philadelphia, PA: Lippincott. (Original work published 1859)

Nilsson, U. (2008). The anxiety- and pain- reducing effects of music interven- tions: A systematic review. AORN Journal , 88(4): 780–807.

Pinker, S. (1997). How the Mind Works . New York, NY: W.W. Norton

Rauscher, F. H., Shaw, G. L., & Ky, K. N. (1993). Music and spatial task perfor- mance. Nature , 365: 611.

Sacks, O. (2007). Musicophilia: Tales of Music and the Brain . New York, NY: Vintage Books, Random House.

Standley, J. (2012). Music therapy research in the NICU: An updated meta-analysis. Neonatal Network, 31(5): 311–316. doi: 10.1891/0730-0832.31.5.311

Tomatis, A. A. (1991). Pourquoi Mozart . Paris, France: Editions Fixot.

Vaajoki, A., Kankkunen, P., Pietila, A.-M., & Vehvilainen-Julkunen, K. (2011). Music as a nursing intervention: Effects of music listening on blood pressure, heart rate, and respiratory rate in abdominal surgery patients. Nursing and Health Sciences, 13: 412–418.

White, J. M. (2001). Music as intervention: A notable endeavor to improve patient outcomes. Nursing Clinics of North America, 36(1): 83–92.

Resources

American Music Therapy Association 8455 Colesville Rd., Suite 1000 Silver Spring, MD 20910 301.589.3300 www.musictherapy.org

Brain Music Therapy Center 330 West 58th St., Suite 202 New York, NY 10019 212.581.0821 www.brainmusictreatment.com

Chalice of Repose Project P.O. Box 169 Mt. Angel, OR 97362 503.845.6089 [email protected]

Institute of Music in Medicine (Australia) P.O. Box 1480 Geelong, VIC 3220 www.imim.com.au

Chapter 21 • Music as a Therapeutic Tool 319

Lane Community College Music-Thanatology Training Program 4000 E. 30th Ave. Eugene, OR 97405 541.463.3000

Music-Thanatology Association International www.MTAI.org

Society for the Arts in Healthcare 2647 Connecticut Ave. NW, Suite 200 Washington, DC 20008 202.299.9770 www.thesah.org

320

22 Biofeedback

If you are distressed by anything external, the pain is not due to the thing itself but to your own estimate of it; and this you

have the power to revoke at any moment.

Marcus Aurelius

Biofeedback is a method for learned control of physiologic responses of the body. It is a relaxation technique that uses electronic equipment to amplify the electrochemical energy produced by body responses. Normally out of conscious awareness, biofeedback provides perceptible information that individuals can use to gain voluntary control over various physiologic processes.

BACKGROUND

The experimental data to support the feasibility of learned control first appeared in the 1950s. In 1961, experimental psychologist Neal Miller proposed that the autonomic nervous system was trainable, contrary to beliefs about human physiology at the time. As psychologists and physiologists continued this research, it became clear that dramatic gains could be achieved by using bio- feedback information to assist people living with specific condi- tions, including headaches, ulcers, hypertension, and many other stress-related illnesses. The result of this work was the creation of biofeedback therapy, now widely used by both conventional and alternative practitioners. With the advent of computers, the technology has become more powerful ( Larsen, 2012 ).

PREPARATION

Biofeedback does not belong to any particular field of health care but is used in many disciplines, including nursing, psychology,

Chapter 22 • Biofeedback 321

social work, chiropractic, medicine, dentistry, physical therapy, rehabilitation, psychiatry, respiratory therapy, occupational therapy, physician assisting, exercise physiology, and sports medicine. Since 1981, all biofeedback thera- pists must have certification from the Biofeedback Certification International Alliance (BCIA). Applicants must hold a bachelor’s degree or higher in one of the approved health care fields. Certification requires 48 hours in didactic bio- feedback education and 100 hours in clinical experience. BCIA also offers specialty certificates in EEG biofeedback (36 hours of didactic information and 220 hours of clinical training) and pelvic muscle dysfunction biofeedback (28 hours of didactic information and 100 hours of clinical training). When applicants meet the requirements, they are allowed to sit for a qualifying examination that consists of both written and practical assessment. The BCIA provides international directories of certified practitioners.

CONCEPTS

The nervous system has two major components: voluntary and involuntary or autonomic. In normal circumstances, the voluntary component is under a person’s control. If someone decides to stand, the brain sends a message to the appropriate muscle groups, and the person stands. In contrast, the autonomic nervous system functions without conscious thought. Although individuals may be able to change their rate of respiration, for example, they are not able to consciously stop breathing indefinitely.

People continuously receive biofeedback from their body. When they do not eat, they feel hungry. When they run, they get winded. When they experi- ence stress, their muscles tense. Other types of biofeedback are more difficult to discern. With the use of technology, however, people can learn to adjust their thought processes to control body processes such as blood pressure, temperature, muscle tension, bronchial dilation, gastrointestinal functioning, and brain wave activity. The concept is simple: If individuals can develop sen- sory awareness of an involuntary function, they can learn to sense it. For example, if skin temperature in the hands is converted into an audible signal, the beeps give one’s ears and brain feedback. As people learn to dilate the arteries in their hands, thus raising skin temperature, the beeps speed up, pro- viding instant feedback on what is occurring in the body. Biofeedback teaches people what it feels like to be relaxed internally so they can re-create the feeling whenever they choose ( Larsen, 2012 ).

TREATMENT

Biofeedback instruments are highly sensitive electronic devices that monitor physiologic processes. Signals from the body are amplified by the instruments and converted into usable information. The instruments may have meters, tones, or a computer display that presents the information to the trainee.

Temperature or thermal feedback is a primary tool for general relax- ation training and treatment of specific vascular diseases. Blood flow in the

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hands responds to stress and relaxation, and clients learn to relax by watching the rise and fall of finger temperature. Thermal feedback may be used to decrease generalized muscle tension in people with temporomandibular joint (TMJ) syndrome. Migraine headaches may be alleviated by simply raising the temperature in the hands.

Electrodermal response (EDR) or galvanic skin response (GSR) feed- back devices measure sweat gland activity of the fingertips or palm. This response is highly sensitive to emotions and thoughts and is used in general relaxation training to help people reduce the impact of significant stressors and anxiety and to treat excessive sweating.

Electromyography (EMG) feedback measures muscle tension with sensors placed on the skin over appropriate muscles. EMG feedback is used for general relaxation training and insomnia due to overactivation of the autonomic nervous system. Biofeedback readings of the masseter mus- cle are used to treat TMJ. EMG biofeedback is able to detect muscle imbal- ances, allowing individuals to reeducate the involved muscles. Some people experiencing muscle spasms and back pain benefit from EMG biofeedback. People with spinal cord injuries may use biofeedback to strengthen muscles and provide the sensation of movement. An EMG device has been developed to treat kyphosis, a curvature of the spine. In addition, this type of biofeedback is the primary tool for treatment of ten- sion headache and pain reduction.

Respiratory resistance [R os ] biofeedback measures the rate, volume, and rhythm of respiration and is useful in treating both asthma and the hyper- ventilation of anxiety and panic attacks. Gastrointestinal biofeedback is helpful in treating irritable bowel syndrome, colitis, heartburn, functional dyspepsia, and Crohn’s disease. Cardiovascular (EKG) feedback is available through portable heart rate monitors to augment a person’s ability to control heart rate. In addition to being used by persons with cardiac disease, many professional athletes use this system to aid their training.

Pelvic muscle dysfunction biofeedback is used for people with chronic constipation related to pelvic dysfunction. It can also successfully treat incon- tinence. Sensors measure and report the activity of the internal and external rectal sphincters for the treatment of fecal incontinence and the activity of the detrusor muscle for the treatment of urinary incontinence. Pelvic floor biofeedback is also used to treat sexual problems such as vaginismus, vulvo- dynia, or postpartum pelvic changes.

Electroencephalograph (EEG) biofeedback, also called neurofeedback , records information about brain wave activity from sensors placed on the scalp. Changes in brain waves reflect changes in attention as well as in states of arousal from sleep to alert wakefulness. This type of feedback is used for mind quieting, attention control, short-term memory improvement, mood swings, posttraumatic stress disorder, and alcohol and drug addiction. Neu- rofeedback is helpful in cases of insomnia related to mental or emotional problems. People with brain injuries may experience improvement of symp- toms with this type of biofeedback.

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After the desired mode of treatment is determined for the specific disor- der, electrodes are attached to the person in the area to be monitored. These electrodes feed the information to a computer that registers the results either with a sound tone that varies in pitch or speed or on a visual monitor. EEG measurements produce a kind of video game of brain waves. The human brain produces different brain waves during various states of consciousness. Beta waves are associated with normal or waking consciousness, alpha waves are produced in an altered or relaxed state of consciousness, and theta and delta waves are associated with unconscious and sleeping states. When the client produces waves associated with concentration, the game speeds up. The game slows down when brain waves associated with daydreaming are produced. This type of computer system can make learning control of body processes more interactive and fun, especially for children.

Smartphone features are being integrated with biofeedback technologies. There are apps to track heart rate, brain waves, skin nerve impulses, blood pressure, muscle contractions, sleep patterns, and blood oxygenation perfu- sion index. Increasing health literacy and tracking physical processes are critical components in fostering health and wellness.

A biofeedback therapist leads the client in mental exercises to help the per- son reach the desired result, such as muscle relaxation or contraction or the pro- duction of more alpha brain waves. Through trial and error, trainees eventually learn how to control the inner mechanism involved. Training typically requires 8 to 10 sessions, although people with long-term or severe disorders may require more. Clients are expected to practice the skill 15 to 20 minutes a day through- out the training period to incorporate what they have learned into their lives.

A contraindication for biofeedback is that it may increase stress for some individuals who feel overwhelmed by cues and who are unable to change these cues to their desired effect. Frequent connection and focus on the machine may overstimulate the brain. The brain needs “down time” during which the default mode network stimulation allows for the development of the concept of self and for learning and memory consolidation. These unstructured mental times are a key component to mental well-being.

RESEARCH

The following is a sample of research on the effectiveness of biofeedback in a number of conditions:

• A randomized controlled trial investigated whether electromyographic biofeedback would be of benefit to people in rehab following anterior cruciate ligament (ACL) reconstruction. At 6 weeks the biofeedback group showed significant improvement in passive knee extension compared with the control group ( Christanell, Hoser, Huber, Fink, & Luomajoki (2012 ).

• A randomized controlled trial investigated postural balance and muscle strength in community-dwelling older adults. The biofeedback group had Nintendo Wii training, and the control group used therapeutic

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insoles. The biofeedback group had significant improvement in leg muscle strength compared with the control group. Postural balance was not improved with biofeedback ( Jorgensen, Laessoe, Hendriksen, Nielsen, & Aagaard, 2012 ).

• A randomized controlled trial involving individuals with autism spectrum disorder (ASD) investigated the effects of EEG biofeedback on ASD symptoms. The participants were randomly assigned to EEG biofeedback, skin conductance (SC) biofeedback (control), or a wait- list group (control). Of the EEG-biofeedback group, 54% were identi- fied as EEG-regulators, as they were able to significantly reduce delta or theta power or both during their session. These regulators had no significant reduction in symptoms of ASD, but they showed signifi- cant improvement in cognitive flexibility compared with the control groups ( Kouijzer, van Schie, Gerrits, Buitelaar, & de Moor, 2012 ).

• A randomized controlled pilot study investigated adding biofeedback to the training of pelvic floor muscles for treatment of stress urinary incon- tinence. The biofeedback group demonstrated significant improvement in pelvic floor muscle function, reduced urinary symptoms, and improved quality of life ( Fitz et al., 2012 ).

INTEGRATED NURSING PRACTICE

Certified biofeedback therapists, many of whom are nurses, help interpret signals from monitoring devices while leading the client through physical and mental exercises to achieve the desired change in the body function being measured. As a nurse without specific training, your primary inter- vention is to provide information about biofeedback to appropriate clients. You can explain the types of monitoring devices and the conditions for which they are typically effective. In addition, you can help individuals find certified therapists. Explain that biofeedback creates a greater awareness of specific body parts and their functions. With training, clients can regulate these functions. Biofeedback helps people relieve or eliminate symptoms, provides an internal locus of control, and helps them reduce their own health care costs.

TRY THIS

Mind Control of Muscular Strength

• Face your partner. Put your right hand on your partner’s shoulder, palm up. • Clench your right fist, and hold your arm straight.

Chapter 22 • Biofeedback 325

• Have your partner grasp your elbow with both hands and pull down while you resist. The pull needs to be gradual until you both get a sense of how much force is needed to bend your arm.

• Imagine you are a fire engine or pump. You are rooted to the earth and are draw- ing water up, and it is pushing through your arm and out your fingers at high speed with tremendous force—such force that nothing can bend your arm.

• Then, place your arm again on your partner’s shoulder, this time with the fingers outstretched, holding onto the feeling and the image of the pump pushing water through your arm with great force.

• Ask your partner once more to apply gradual force to bend your arm. You will need to apply a little muscle power, but will find you can relax and hold steady with much less effort than before.

Source: Rutherford ( 1996 ).

References

Christanell, F., Hoser, C., Huber, R., Fink, C., & Luomajoki, H. (2012). The influence of electromyographic bio- feedback therapy on knee extension following anterior cruciate ligament reconstruction: A randomized con- trolled trial. Sports Medicine, Arthros- copy, Rehabil itation Therapy & Technology, 4(1): 41.

Fitz, F. F., Resende, A. P., Stupp, L., Costa, T. F., Sartori, M. G., Girao, M. J., & Castro, R. A. (2012). Effect of adding biofeedback to the training of the pelvic floor muscles to treatment of stress uri- nary incontinence. Revista Brasileìra di Ginecologia e Obstetricia, 34(11): 505–510.

Jorgensen, M. G., Laessoe, U., Hendriksen, C., Nielsen, O. B., & Aagaard, P. (2012). Efficacy of Nintendo Wii training on

mechanical leg muscle function and postural balance in community- dwelling older adults: A randomized controlled trial. Journals of Gerontology Series A: Biological Sciences and Medical Sciences. Advance online publication. doi: 10.1093/gerona/gls222

Kouijzer, M. E., van Schie, H. T., Gerrits, B. J., Buitelaar, J. K., & de Moor, J. M. (2012). Is EEG-biofeedback an effec- tive treatment in autism spectrum disorders? A randomized controlled trial. Applied Psychophysiology and Biofeedback , 38(1): 17–28.

Larsen, S. (2012). The Neurofeedback Solution. Rochester, VT: Healing Arts Press.

Rutherford, L. (1996). Principles of Sha- manism . San Francisco, CA: Thorsons.

Resources Association for Applied

Psychophysiology and Biofeedback 10200 West 44th Ave., Suite 304 Wheat Ridge, CO 80033–2840

303.422.8436 www.aapb.org/

Biofeedback Certification International Alliance

326 Unit 5 • Mind–Body Techniques

10200 West 44th Ave., Suite 310 Wheat Ridge, CO 80033-2840 866.908.8713 www.bcia.org/

Biofeedback Foundation of Europe 10 John St. London WC1N 2EB

44 (0) 1753.56.1111 www.bfe.org/

EEG Spectrum International 18017 Chatsworth St., Suite 254 Granada Hills, CA 91344 818.886.2585 www.eegspectrum.com

23 Movement-Oriented Therapies

Walking is man’s best medicine.

Hippocrates

A number of therapies focus on movement, body aware-ness, and breathing, and their purpose is to maintain health as well as to correct specific problems. This chapter presents two Eastern movement-oriented therapies—qigong and t’ai chi—and three Western movement-oriented therapies—the Alexander Technique, the Feldenkrais Method, and the Trager Approach. Common to these various approaches is the retraining of one’s body to improve coordination and balance, to release and change postural faults, and to relieve structural and functional stress. A major principle is that awareness has to be experienced rather than taught verbally, which may then lead to more effec- tive use of one’s whole self.

Qigong, also spelled Chi Kung, Chi Gong , and Chi Gung , and pronounced “chee-gong” is a Chinese discipline consisting of breathing and mental exercises that may be combined with mod- est arm movements. Qigong is one of the four pillars of Tradi- tional Chinese Medicine, the others being acupuncture, massage, and herbal medicine (see Chapter 4 ). Qi is the term for “vital energy” and “life force,” and gong means “work” or “discipline.” Qigong can be translated as “mastery of qi,” “cultivation of energy,” “air energy,” “breath work,” and “energy work.” People discover how to generate more energy and conserve what they have to maintain health or treat illness ( Bastian, 2013 ).

T’ai chi, sometimes spelled taiji , is pronounced “teye-chee.” T’ai chi arose out of qigong and is a discipline that combines physical fitness, meditation, and self-defense. Literally translated, it means “great ultimate fist” and is sometimes translated as

327

328 Unit 5 • Mind–Body Techniques

“supreme boxing” or “root of all motion.” Although it is considered a martial art, t’ai chi is mainly practiced today as a health discipline ( Bunnag, 2013 ).

The Alexander Technique is a method for improving postural and move- ment dysfunction that can lead to pain and disease. It is designed to reduce and eliminate body misuse in daily activities, especially with respect to the head, neck, and shoulders. The Feldenkrais Method uses gentle movement and directed attention to improve movement and enhance functioning. The physics of body movement are combined with an awareness of the way people learn to move, behave, and interact. The Trager Approach uses light, rhythmic rocking and shaking movements that loosen joints, ease movement, and release chronic patterns of tension. All three of these Western approaches are consid- ered to be educational in nature as opposed to medical interventions.

BACKGROUND

Written records on qigong go back 4,000 years. For almost all that time, this practice remained a closely guarded family secret, available only to the elite classes in China. This discipline was handed down covertly and was not revealed until the beginning of the 12th century. In the late 1970s, the Chinese government funded several scientific studies of qigong, which had been banned during the Cultural Revolution as superstitious practice. When a sci- entific basis was established, the government added qigong to the list of treatment methods offered in Traditional Chinese Medicine hospitals. T’ai chi, a modern offshoot of qigong, began in the 14th century. Some forms are practiced to enhance health, others are used for self-defense, and some are practiced as a competitive sport. T’ai chi gained popularity in the United States in the 1960s as people explored alternatives to conventional medicine. Some experts estimate that more than 800 million people practice qigong or t’ai chi internationally—nearly 20% of the world’s population ( Wayne & Kaptchuk, 2008 ).

The Alexander Technique was developed more than a century ago by F. M. Alexander, an Australian actor who had lost his voice while performing. He carefully watched himself while speaking and observed that undue mus- cular tension accounted for his vocal problem. He sought a way to eliminate that restriction, and the technique he developed focused on correcting the mis- use of the neuromuscular activity of the head, neck, and spine. The Alexander Technique is taught in the curriculum of music conservatories, theater schools, and universities throughout the world as a foundation for improved health and creative exploration. It is also a useful tool for helping all individuals maximize their movement potential ( Brennan, 2012 ).

The Feldenkrais Method was developed by Moshé Feldenkrais (1904–1984), a Russian-born Israeli physicist, mechanical engineer, and judo expert. After suffering crippling knee injuries, Feldenkrais used his own body as his labora- tory and taught himself to walk again. In the process, he developed a system for accessing the power of the central nervous system to improve human functioning ( Wildman, 2006 ).

Chapter 23 • Movement-Oriented Therapies 329

Milton Trager developed the Trager Approach in the early 1930s, based on his experience as a boxing trainer. He spent the next 50 years— first as a lay practitioner and later as a physician—expanding and refining his discovery. The Trager Approach is a method of movement reeducation designed to produce positive, pleasurable feelings and tissue changes by means of sensorimotor feedback loops between the mind and the muscles ( Mairi, 2011 ).

PREPARATION

For most people, qigong and t’ai chi are personal disciplines. Most practitio- ners spend 30 to 60 minutes a day doing the exercises. With more intensive practice over many years, some become masters. A t’ai chi master is generally one who has exceptional skill in doing the form or in using the principles in boxing and in life. A qigong master is one who has developed the ability to emit healing energy and has achieved proven success in healing with qi. Masters may also have qualities that are generally considered supernatural in the areas of special insight and spiritual transcendence. Rarely, if ever, will a true master call herself or himself a master. Rather, they say that “the practice is the teacher” and that “the qi is the teacher.”

It is difficult to learn qigong or t’ai chi from a book, audio recording, or video. While simple forms may be grasped this way, the more complex forms are nearly impossible to learn without a teacher’s guidance. In the Chinese tradition, one chooses and remains devoted to a teacher. The teacher– disciple relationship is revered as the only path to advanced skill. The honor and reverence that is bestowed on the teacher is part of the belief system that empowers the disciple.

The North American Society of Teachers of the Alexander Technique (NASTAT) is the certifying body for practitioners. A NASTAT-certified teacher must complete a 1,600-hour training program over a minimum of 3 years. The emphasis of the training is on observation and modification of human movement patterns to identify and eliminate sources of movement dysfunction.

All Feldenkrais practitioners must complete 800 to 1,000 hours of train- ing over a period of 3 to 4 years. The main purpose of the training is for prac- titioners to develop a deep understanding of movement, to become aware of their own movement, to become skillful observers of movement in others, and to be able to teach other people to increase their awareness and improve their skills of movement.

The Trager Institute provides training and certifies Trager practitioners. The practitioner training program consists of 226 supervised hours, while the senior practitioner program entails 500 supervised hours. Students learn the relationship between various groups of muscles and organs that produce patterns of posture and movement. The focus is on the mechanics of movement, the kinesthetic interaction, and principles of neu- ropatterning underlying movement.

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CONCEPTS

Wide Applicability

Almost anyone can participate in movement-oriented therapies. These therapies can be learned by the young and the old, by people physically challenged or phys- ically fit, and by those in good health and those recovering from long-term injury or illness. In China, 80-, 90-, and 100-year-old people get up every morning before dawn to practice qigong or t’ai chi in parks ( Figure 23.1 ), even in the middle of winter. These Eastern practices can be done alone, in pairs, or in large groups.

Qi

Qi is the invisible flow of energy that maintains physiologic function and the health and well-being of individuals. Imbalance of the flow of energy can be treated in a variety of ways, including by practicing qigong and t’ai chi. The principles underlying these movement-oriented therapies are the same as those used in acupuncture (see Chapter 13 ). The “forms,” or sequences of movements, are specifically designed to stimulate pressure points all along the body and to encourage deep, rhythmic breathing, which fills the body with life-giving qi. The ultimate goal is to strengthen the flow of qi through the body to promote health and well-being. When qi is flowing in balance, the body stays healthy and resistant to disease and can activate its own healing efforts.

FIGURE 23.1 Men and Women Practicing T’ai Chi Outdoors in Leshan, China.

Source: Dorling Kindersley Media Library/Ken Robertson

Chapter 23 • Movement-Oriented Therapies 331

Qigong and t’ai chi consist of soft, slow, continuous movements that are circular in nature. When practiced by a master, the movements are so slow and fluid that the person appears to be swimming in air. The softness of move- ments develops energy without nervousness. The slowness of movements requires attentive control that quiets the mind and develops one’s powers of awareness and concentration. The continuous circular nature of the move- ments develops strength and endurance. Yin and yang refer to the balance of forces in the universe. T’ai chi movements are designed to express these forces in balanced form by pairs of opposites. For example, a motion that ultimately involves turning to the right often begins with a small movement to the left. In qigong, students learn to sense their qi and follow it as it moves around the body. As they become more skillful, students learn to strengthen their qi and direct it to specific areas of the body that are weak or ailing ( Liao, 2012 ).

Movement Patterns

The human body is as a remarkable instrument, capable of responding with flexibility and resilience. But as the years pass, people often develop habitual reactions, beliefs, and movement patterns that cause physical and mental strain. These habits are typically expressed by tight muscles, collapsed pos- ture, or lack of mobility. When muscles are working overtime, people eventu- ally feel tight, tense, heavy, or tired. The sources of these problems are many—injury, illness, or stress. Lifelong misuse of muscles arises from sitting, standing, or walking incorrectly or too much sitting and too little walking. For example, years of walking incorrectly can create back or knee problems. A knee replacement is only a temporary solution because the real problem lies not in the knee but in the way the person moves from the hip. Movement- oriented practitioners believe the only lasting remedy is in reeducating the body to walk correctly to avoid injuring the knee. Likewise, back problems can be eliminated by learning appropriate ways of moving ( Brennan, 2012 ),

Sensory-movement activities are used to increase people’s sense of postural awareness, free them from habitual patterns, and restore the proper use of mus- cles. Practitioners lead students through movements to enable them to discover a more fluid range of motion. As people develop new, alternative ways of moving, they experience positive sensory feelings and learn what it is like to be freer and lighter. The goal is to teach people how to move with minimum effort and maxi- mum efficiency through increased consciousness of how their bodies work.

TREATMENT

Qigong is an easy and nontiring exercise that contains sets of moves designed to gather qi. Most people spend 30 minutes a day doing the exercises and another 30 minutes in meditation. Some forms are quite complex. For example, Wild Goose Qigong has two sections with 64 movements in each section. Although it is difficult to learn, Wild Goose Qigong is exceptionally beautiful. In China, the goose is considered to be a marvelous creature that flies high into the clouds to

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gather cosmic energy and information and bring it to earth. Guo Lin Gong, a walking form of qigong, is practiced in China particularly by people with cancer. Improvements have been documented in a wide range of conditions such as stroke, hypertension, spinal cord injuries, multiple sclerosis, joint dis- ease, cerebral palsy, headaches, and many forms of cancer ( Zhang, 2008 ).

Yang, the most popular form of t’ai chi, was developed in the early 20th cen- tury by Yang Cheng Fu. It comprises 108 separate motions that can take 6 to 12 months to learn. When the movements are strung together, the result is a cross between slow-motion shadow boxing and dancing. Each movement has a name, such as “repulse the monkey,” “the snake creeps down,” “the white crane spreads its wings,” or “parting the wild horse’s mane,” which describes what it looks like or what purpose it serves. For example, when one is trying to concentrate, monkey thoughts are distractions. As the monkey is pushed away, the person is not allow- ing distractions to take attention away from the process of the moment. T’ai chi also incorporates breathing exercises for improving and strengthening the flow of qi. One form involves reversed breathing, which is contracting the stomach with the in-breath and expanding the stomach with the out-breath. The benefits of t’ai chi are seen in conditions such as hypertension, osteoporosis, and arthritis. T’ai chi can decrease stress and fatigue, improve mood, and increase energy. It is benefi- cial to cardiorespiratory function, balance, and flexibility ( Liao, 2012 ).

Water t’ai chi is a combination of the principles of water exercise using t’ai chi movements. It is performed upright in chest-deep water, which allows the arms to be totally submerged and the body to be adequately stabilized. Water provides about 12 times the resistance of air, so the body naturally moves more slowly in the water. The exercises improve strength, flexibility, balance, coordination, and posture.

The Alexander Technique includes simple movements that improve bal- ance, posture, and coordination and relieve pain. During a session, the client goes through a series of standing and seated exercises while the practitioner applies light pressure to points of contraction in the body. The techniques help people learn how to use their body with less tension and more aware- ness. The recommended course is 30 lessons, depending on the client’s participation and initial level of functioning ( Brennan, 2012 ).

The Feldenkrais Method consists of two parts: awareness through move- ment and functional integration. They are convenient labels for doing essen- tially the same thing in different ways. Awareness through movement is more like conventional exercises in format, with the teacher guiding a group class verbally rather than using personal manipulation. The lessons consist of com- fortable, easy movements that gradually increase in range and complexity designed for all levels of movement ability. Functional integration is a hands- on lesson that usually lasts 45 minutes to an hour and is performed with the client fully clothed and standing, sitting, or lying on a table. The practitioner touches and moves the client in gentle, noninvasive ways. The intent of this touch is to explore the person’s responses to touch and movement and then to suggest alternative ways of moving.

Feldenkrais exercises are small, gentle movements, such as pelvic tilts— slowly and deliberately lifting the spine from the coccyx to the waist, one vertebra

Chapter 23 • Movement-Oriented Therapies 333

at a time. To be effective, the movements must be effortless. If exercise becomes painful, no learning takes place because the brain is too focused on how to stop doing the painful activity. Feldenkrais exercises are said to improve flexibility, posture, range of motion, relaxation, ease of movement, physical performance, vitality, and well-being. They are also said to relieve joint pain, stress, muscle tension, low back pain, neck and shoulder pain, jaw pain, and headaches.

The Trager Approach is a process of using motion in muscles and joints to produce particular sensory feelings. These feelings are relayed to the central nervous system, and then, through the process of feedback loops, the feelings trigger changes in the tissues. A Trager session takes 60 to 90 minutes with the client wearing a swimming suit and lying on a well-padded table. The practi- tioner touches in such a gentle rhythmic way that the person actually experi- ences the possibility of being able to move each part of the body freely and effortlessly. Because active participation of the client is discouraged, the pas- sive body can freely learn new movements. Trager practitioners work in a meditative state they call “hook-up.” This state allows the practitioner to con- nect deeply with the client in an unforced way, to remain continually aware of the slightest responses, and to work efficiently without fatigue ( Mairi, 2011 ).

Following this session, the student is given instruction in the use of mentastics , a system of simple, effortless movement sequences designed to maintain and even enhance the sense of lightness, freedom, and flexibility that was instilled during the treatment session. Mentastics, Dr. Trager’s coined term for “mental gymnastics,” is a powerful means of reinforcing pos- itive changes. The Trager Approach is said to decrease various types of chronic pain, headaches, and temporomandibular joint pain, improve muscle spasms, and aid in recovery from stroke and spinal cord injuries.

RESEARCH

A Joanna Briggs Institute evidence summary recommends that t’ai chi be used to improve the sleep status of older adults ( Rathnayake, 2011 ). Another JBI evi- dence summary states there is not enough evidence to recommend the use of the Feldenkrais Method for mobility and balance in older adults and that clinician judgment and client preference should be the determining factors ( Kunde, 2012 ).

The following is a small sample of current studies:

• A systematic review found that t’ai chi has positive effects for individu- als with a range of chronic medical conditions ( Fetherston & Wei, 2011 ).

• A randomized controlled trial studied the effect of t’ai chi exercise in decreasing fears of falling among community-dwelling older adults. Participants were randomized into three groups: control, cognitive- behavioral, and cognitive-behavioral with t’ai chi. Those in the cogni- tive-behavioral with t’ai chi group had significantly lower fear-of-falling scores as well as higher mobility and improved quality of life ( Huang, Yang, & Liu, 2011 ).

• A Cochrane systematic review found that no randomized controlled trials of the Alexander Technique to improve symptoms of chronic asthma met the selection criteria. Further research was recommended ( Dennis & Cates, 2012 ).

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• A systematic review of the impact of t’ai chi on persons with coronary heart disease found that t’ai chi may help prevent and even reverse the progression of cardiac disease ( Dalusung-Angosta, 2011 ).

INTEGRATED NURSING PRACTICE

Like most other moderate physical activities practiced on a daily basis, t’ai chi and qigong can improve balance, stability, agility, flexibility, stamina, and muscle tone. They are good exercise for people who are already in shape, but they can also be adapted for older adults, children, or people with injury or illness. The movements are gentle and put less stress on the body than do other exercises. The breathing exercises are a form of meditation that quiets the mind and reduces the negative effects of stress.

If you and others are healthy and wish to maintain your health, learning t’ai chi or qigong is highly recommended. Experienced practitioners spend at least 20 and up to 60 minutes in daily practice. As a nurse, you can encourage your clients to consider practicing one of these forms. To increase health, it is important that clients build up stamina over a period of time. Clients who are seriously ill may be able to do only the simple breath practice as they focus on absorbing healing qi from the environment. When they can manage it, they add simple hand gestures to the breathing. As they continue to improve, they sit in a chair and do the hand motions, moving to a standing position when they feel able. Finally, they do the walking form.

When starting t’ai chi and qigong, it is best to begin with simple exercises. You can teach people a few basic principles of standing and moving so they can begin to feel what it is like to inhabit their body with awareness. Getting the body into alignment is a most important part of these movement thera- pies. Instruct your clients to stand with their feet shoulder-width apart, but- tocks tucked in, spine straight, shoulder relaxed, knees unlocked, and the head straight and resting lightly on top of the spine as if a string from the top of the head were gently suspending the body from above. As they are stand- ing in this position, have them pay attention to their own breathing, inhaling deeply and exhaling completely. Also in this position, have your clients locate their tan t’ien (pronounced “don-tee-en”), which is the body’s center of gravity and stability, located about 1-1/2 inches below the navel and toward the center of the body. T’ai chi and qigong teach individuals to find and maintain their center through movement, whereas in meditation and yoga, they center themselves in stillness. The tan t’ien is considered to be the source of energy, and as they practice, your clients will find that all the movements begin to flow more easily as they learn to move from the tan t’ien.

Two movements in t’ai chi common to various sequences are the t’ai chi fist and the t’ai chi ball. The fist is formed by imagining a robin’s egg in the center of each palm and then slowly curling one finger at a time around the egg, beginning with the little finger and ending with the thumb resting lightly on top. Throughout all the forms, frequent references are made to “picking up

Chapter 23 • Movement-Oriented Therapies 335

the ball.” Have clients visualize forming a ball out of the air and picking it up and moving with it. The ball is designed to help movements flow more easily.

The tree or the horse-riding stance contributes to a sense of rootedness and stability in the body. For this posture, instruct your clients to separate their legs wider than their shoulders and bend their knees so that their thighs are parallel to the floor, thus lowering the center of gravity closer to the earth. The top part of the body feels light, while the lower half feels heavy. At first, the position may feel strenuous, because the muscles in the legs have not been used in this way. With practice, people enjoy the feeling of stability it gives them. Next, direct your clients to bring their arms up as if embracing an invis- ible person, joining their fingertips in front of them. Direct them to slowly turn from side to side, letting their waist initiate the movement. Their legs should feel “soft,” so that they follow the movement led by the waist. Their gaze should travel slowly across an imagined horizon.

T’ai chi and qigong are popular, and lessons are available in most towns and cities. They are taught in health clubs, schools, YMCAs, community cen- ters, hospitals, clinics, and other facilities. Explain to your clients that it is use- ful, in most cases, to begin with a teacher. They can ask around to find a teacher whom others like, or they can observe a class or participate in a trial class. Some people try several teachers or forms before they find the one that meets their personal preferences. Encourage clients to find general forms they like and will do regularly. If possible, they should try to find a place to learn that is convenient. If it is too far, it may become difficult for people to continue in the practice. As t’ai chi and qigong have become more popular, people can be found practicing in parks. In some cases, individuals prefer to have time alone in nature. Often, however, people are happy to have others join them, and frequently, informal groups form. These groups may develop socially as people get to know one another and socialize after the practice.

The claims for the Alexander Technique, the Feldenkrais Method, and the Trager Approach focus more on enhancing well-being than on healing illness. They are designed to relieve muscle tension, increase relaxation, reduce stress, and alter poor habits of posture and movement in those who are healthy. Refer clients to the appropriate associations to locate certified teachers of these techniques.

TRY THIS

Feel Your Qi

• Stand with your feet shoulder-width apart, your knees slightly bent, your spine upright, and your shoulders relaxed. Breathe easily.

• Start to flex or bounce gently at the knees. (continued)

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TRY THIS

Wave Hands Like Clouds (Water T’ai Chi)

• Stand in chest-deep water with your feet several inches apart. • Lift your arms to shoulder level. • Step laterally with the right foot. • Circle both arms under and out of the water—the right arm clockwise and the left

arm counterclockwise. • Repeat four times. • Step laterally with the left foot. • Repeat the arm sequence four times.

References

Bastian, S. (2013). Qi Gong. Somerset, UK: Green Magic.

Bertschinter, R. (2012). Everyday Qigong Practice. London, UK: Singing Dragon.

Bunnag, T. (2013). Cloud Hands: The Essence of T’ai Chi Ch’uan. Hong Kong, China: Orchid Press.

Brennan, R. (2012). Change Your Posture, Change Your Life. London, UK: Watkins.

Dalusung-Angosta, A. (2011). The impact of Tai Chi exercise on coronary heart

disease: A systematic review. Journal of the American Academy of Nurse Practi- tioners, 23: 376–381. doi: 10.1111/ j.1745-7599.2011.00597.x

Dennis, J. A., & Cates, C. J. (2012). Alexander technique for chronic asthma. Cochrane Database of Systematic Reviews , Sept. 12 (9): CD000995.pub2. doi: 10.1002/14651858

Fetherston, C. M., & Wei, L. (2011). The benefits of tai chi as a self- management

• Still bouncing, shift your weight back and forth from your right to your left leg. • Keep your breathing relaxed and deep. • Begin to snap all your fingers, flipping each one past your thumb. • Then, still bouncing and finger-snapping, twist at your waist, to the right, then to

the left. • While you are doing all this, make your exhale a sigh of relief. Do five of these sighs

in a slow, relaxed manner. • Then, stop and close your eyes and turn your attention inward. Feel the buzzing,

humming, or tingling sensation that is in your hands, legs, and body. This is qi. You are literally feeling the activity of the profound medicine you have produced within yourself.

Source: Jahnke ( 2002 ).

Chapter 23 • Movement-Oriented Therapies 337

Resources

American Society for the Alexander Technique P.O. Box 2307 Dayton, OH 45401-2307 800.473.0620 www.amsatonline.org/

East West Academy of Healing Arts 117 Topaz Way San Francisco, CA 94131 415.285.9401 www.eastwestqi.com

Feldenkrais Method of Somatic Education 5436 N. Albina Ave.

Portland, OR 97217 800.775.2118 www.feldenkrais.com

Tai Chi Australia P.O. Box 59 Glen Iris, VIC 3146 61.3.9889.9999 www.taichiaustralia.com

Taoist Tai Chi Society of Canada 588 East 15th Ave. Vancouver BC V5T 2R5 604.681.6609 www.taoist.bc.ca

strategy to improve health in people with chronic conditions. Journal of Nursing and Healthcare of Chronic Illness, 3: 155–164. doi:10.1111/ j.1752-9824.2011.01089.x

Huang, T.-T., Yang L.-H., & Liu, C.-Y. (2011). Reducing the fear of falling among community-dwelling elderly adults through cognitive-behavioural strategies and intense Tai Chi exercise: A randomized controlled trial. Journal of Advanced Nursing, 67(5): 961–971. doi: 10.111/j.1365-2648.2010.05553.x

Jahnke, R. (2002). The Healing Promise of Qi. New York, NY: Contemporary Books.

Kunde, L. (2012). Feldenkrais Method. Joanna Briggs Institute Evidence Summary. Retrieved from http:// connect.jbiconnectplus.org/View- Document.aspx?0=6331

Liao, W. (2012). Restoring Your Life Energy, Boston, MA: Shambhala.

Mairi, A. (2011). Pathway to Presence: The Trager Approach as a Way of Life. Victoria, BC: Aware Now.

Rathnayake, T. (2011). Sleep problems (adults 60+): Physical exercise. Joanna Briggs Institute Evidence Summary. Retrieved from http:// connect.jbiconnectplus.org/View- Document.aspx?0=5639

Wayne, P. M., & Kaptchuk, T. J. (2008). Qigong: Where did it come from? Where does it fit in science? What are the advances? Journal of Alternative and Complementary Medicine , 12(4): 351–353.

Wildman, F. (2006). Feldenkrais: The Busy Person’s Guide to Easier Movement (3rd ed.). Berkeley, CA: The Intelligent Body Press.

Zhang, T. C. (2008). Earth Qi Gong for Women . Berkeley, CA: BlueSnake Books.

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Spiritual Therapies

Regard heaven as your father, Earth as your mother,

And all things as your brothers and sisters.

Native American proverb

6 U N I T

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24 Shamans

Few people even scratch the surface, much less exhaust the contemplation of their

own experience.

Randolph Bourne

Shaman (pronounced “SHAH-min”) is a word from the Tungus people of Siberia. This term has been adopted widely by anthropologists to refer to those known in the West as “medicine men,” “witch doctors,” “witches,” “magi- cians,” and “seers.” Not every kind of medicine person or witch doctor, however, is a shaman. A shaman is a woman or man who enters an altered state of consciousness, at will, to contact and utilize another type of reality to acquire knowledge and power and to help other people. Shamans use ancient techniques to achieve and maintain well-being and healing for themselves and members of their communities, serving as a link between the worlds of matter and spirit. Shamanism is not a belief system. Rather, it is a broad umbrella covering ancient, indigenous, and holistic healing practices worldwide. Shamanism is a living spiri- tual system and as such continues to evolve as culture and knowledge change over time ( Mackinnon, 2012 ). For further information on Native American healers, see Chapter 6 .

BACKGROUND

The origins of shamanism date to at least 40,000 to 50,000 years ago, to Stone Age times, making it the oldest of all healing thera- pies. Worldwide, evidence from ancient cave drawings and similar records supports the conclusions that indigenous peoples shared a similar understanding of how the universe works, how to maintain health and strength, how to cope with serious illness, and how to deal with the trauma of death. One of the most

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remarkable aspects of shamanism is that concepts and treatment methods are similar in widely separated and remote parts of the planet among peoples isolated from one another. Anthropologists have studied shamanism in North, Central, and South America; Africa; Australia; Indonesia; Malaysia; Bali; Tibet; Korea; Siberia; and across Europe and have found that shamans functioned fundamentally in much the same way and with similar tech- niques worldwide. The basic uniformity suggests that, through trial and error, people arrived at the same conclusions ( Mackinnon, 2012 ).

Today, shamanism survives in less developed regions of the world in spite of the advent of Western scientific medicine. There is no equivalent health professional in Western medicine, and the scope of the shaman as a healer extends beyond the capacities and expertise of physicians. The field of holistic medicine is reclaiming many techniques long practiced in shamanism, such as visualization, altered state of consciousness, hypnotherapy, meditation, positive attitude, and stress reduction. Shamanic healing is rapidly gaining popularity among urban Americans as people turn back to the old cultures for help and guidance in finding a better balance with nature and with themselves. Shamanic practice and biomedical treatment are not in conflict. Contemporary shamans are perfectly willing to have their patients see a conventional physi- cian, because the primary goal is wellness. Any kind of technological treatment or medication that will contribute to the strength of the patient is welcomed ( Mackinnon, 2012 ).

PREPARATION

People discover in a wide variety of ways that their purpose in life is to become a shaman. Often, potential healers have prophetic dreams about their future calling. The dream may even include details about locating a teacher and how long the training period will be. In some cases, individuals are led to shamanism through personal and private mystical experiences, while others come from the ranks of cured patients.

The journey from apprentice to shaman is illustrated in the following example of Native American shamans. The first step is “embracing personal history.” This process includes working through old traumas, fears, anger, hate, abandonment, betrayals, and wounds. The purpose is to heal the emotions so that one is no longer controlled by them but, rather, is consciously guided by feelings. The second step is “facing death and making death an ally.” This step means examining one’s attitudes and beliefs to “put to death” any that are inac- curate or outdated. It includes remembering that bodies are temporary and will one day be claimed by death. It also means moving beyond personal history and recognizing that all people are part of a family, village, tribe, city, country, and ultimately all humanity. The third step is “stopping the world,” which involves clearing the mind of its mental garbage. The fourth step is “controlling the dream and finding new vision and purpose.” It is the time to quest for vision and seek direct connection with the dream world and its spiritual teach- ers. The vision quest is part of many old-world cultures and is a time when one

Chapter 24 • Shamans 343

fasts and prays in a sacred place, often on a mountaintop, for up to 4 days and nights. The person prays for a vision and thus a reconnection with the Creator and Creation. Following the vision quest, the person is expected to make life changes that were called for. The fifth and final step is taking full responsibility for all one’s actions without guilt or shame. Apprentice shamans follow this path of transformation as they become healers and helpers in service to other people ( Mackinnon, 2012 ).

Shamanic initiation is experiential and often gradual. Shamans must learn how to achieve the shamanic state of consciousness, must become famil- iar with their own guardian spirits, and must successfully help others as a shaman. After learning the basic principles and methods, new shamans extend their knowledge and power by shamanic journeying. The few shamans who become true masters of knowledge, power, and healing must have many years of shamanic experience.

CONCEPTS

Environment

For the shaman, everything exists as part of an infinite web of life. Plants, stones, and the earth herself are all perceptive beings; they are all consciously aware and have a story to tell. In the shamanistic tradition, people communi- cate intimately and lovingly with “all their relations,” as the Lakota would say, talking not just with other people but also with animals, plants, and all the elements of the environment, including rocks and water. From the shaman’s viewpoint, one’s surroundings are not “environment” but family. The shaman has a deep respect for all forms of life and a great awareness of dependence on the environment. Shamans believe their powers are the powers of the animals, of the plants, of the sun, of the basic energies of the universe. They are expected to live in harmony with nature and to provide strength in daily life and help save others from illness and death ( Mackinnon, 2012 ).

Power

In shamanism, the preservation of one’s personal power is fundamental to well-being. Specific shamanic methods restore and maintain personal power and use it to help others who are weak, ill, or injured. In shamanism, the word medicine means “vital force” or “energy.” People’s medicine is their power, their knowledge, and their expression of their life energy.

Many shamans keep power objects—their medicine—in a medicine bun- dle. This bundle is normally kept wrapped up and is unrolled publicly only on ritual occasions. The objects inside are highly personal, and, as with other matters of power, one does not boast of them because to do so might result in loss of power. Almost any small object can be included, but the quartz crystal is highly prized among the shamans of North and South America, Australia, Southeast Asia, and elsewhere. Quartz crystals are six-sided stones that are usually transparent to milky white and, in a sense, appear to be “solidified light.”

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The quartz crystal is considered the strongest power object and is viewed as a spirit helper. For thousands of years, shamans have used their quartz crystals for power in seeing and divination. Interestingly, in modern physics, the quartz crystal is also involved in the manipulation of power. Its remarkable electronic properties made it a basic component in early radio transmitters and receivers. Later, quartz crystals became basic components for modern electronic hardware such as computers and timepieces ( Cohen, 2007 ).

State of Consciousness

The ordinary state of consciousness (OSC) is a consensus of what reality is. This OSC, also called “ordinary reality” or simply “reality,” is determined by every society and learned by individuals from childhood. Reality, then, is composed of predetermined expectations. For example, in Western societies, people are not surprised when they insert a card in a machine and money comes out. Another characteristic of Western ordinary reality is that it can be measured and quantified. As Candace Pert ( 1997 ) stated, “Measurement! It is the very foundation of the modern scientific method, the means by which the material world is admitted into existence. Unless we can measure something, science won’t concede it exists, which is why science refuses to deal with such ‘nonthings’ as the emotions, the mind, the soul, or the spirit” (p. 21 ).

Nonordinary realities are other levels of consciousness. They can be experienced during dreaming or induced by drugs, fasting, sleep deprivation, or environmental factors. In Western society, this level of consciousness is often viewed as psychosis rather than another legitimate reality.

Shamans move, at will and with serious intention, between an ordinary state of consciousness and a shamanic state of consciousness (SSC). The SSC is an altered state of consciousness that may vary from a light to a deep trance. Shamans journey back and forth between these realities for the specific pur- pose of healing or aiding the community in some manner. Shamans operate in nonordinary reality or SSC only a small portion of the time and then only as needed to perform shamanic tasks. During this trance state, shamans’ souls are believed to leave their bodies and either ascend to the upper world or descend to the lower world. Unlike the altered state of consciousness during dreaming, the SSC is a conscious waking state, and at any time, shamans can will themselves out of it, back into the OSC. The experience is like a waking dream in which shamans can control their actions and direct their adventures. Unlike a mind-altering drug experience, the SSC experience is not dependent on a chemically determined length of time, nor does it risk the possibility of being locked into a “bad trip” ( Mackinnon, 2012 ).

Shamanic Cosmology

Shamanic cultures throughout the world have a three-tiered cosmology or way of viewing the universe. The middle world is the world of OSC or ordinary reality. It is the world of matter and the world in which people live their daily lives. The lower world and the upper world are SSC worlds, nonordinary

Chapter 24 • Shamans 345

reality, or worlds of the spirit, not to be confused with heaven and hell. These worlds are just as real as the ordinary reality of the middle world.

The lower world is the world of power animals . These archetypical ener- gies take the form of animal guides who have knowledge and wisdom to share and help people navigate through life. Power animals tend to provide practical help and guidance. The capability of power animals to speak to humans is an indication of their power. The belief that shamans can shape- shift into the form of their power animal is common to many cultures. Sharing the identity of one’s power animal varies among shamans. Some speak pub- licly about them, while others fear that disclosing the animal’s identity may cause it to leave the person. Many cultures believe that every person is born with a particular animal spirit that is to be their guide throughout life. A simi- lar belief in Western cultures is that of guardian angels watching over people, especially children ( Ingerman & Wesselman, 2010 ; Rutherford, 2008 ).

The upper world is the world of spirit guides, who are beings that look more like people and are more familiar to most individuals. It is in the upper world that people meet their guardian angels. The help from spirit guides tends to be more general and philosophical in comparison with the practical help from the lower world. These worlds are complementary and equal, and neither is superior to the other.

Power animals and spirit guides teach people how to empower them- selves, improve their lives, and even heal themselves. One does not have to be a shaman to make contact with one’s personal power animal and spirit guide. The most traditional method of accessing this nonordinary reality is the sha- manic journey.

Imagination

Most indigenous people make little distinction between what Westerners call imagination and reality. Imagination is just as real and just as concrete as ordinary reality. In fact, most of the material things of the “real” world were someone’s imagination first. Automobiles, televisions, and computers originated in the imaginary realm. In fact, logic and reason have always been preceded by imagi- nation. Western people often ask whether the power animals and guardian spirits are real or imagined. If the information that is received from power ani- mals and guardian spirits empowers people, improves their lives, and helps them heal, the question does not apply. Power animals and guardian spirits are real because people’s lives are changed ( Sandore, 1997 ).

VIEW OF HEALTH AND ILLNESS

In the shamanic worldview, the ability to maintain good health is a matter of power. If the body is “power-full,” it resists the intrusion of external, harm- ful forces. No room is available for disease and illness in a power-filled body. Being power-full is like having a protective force field surrounding the body. Possession of guardian spirit power is also fundamental to health.

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From a shamanic point of view, illnesses usually are intrusions that break the force field of power-fullness. In some ways, this concept is not too different from the biomedical concept of infection. Serious illness and other misfortunes are usually only possible when people are “dis-spirited,” meaning they have lost their power and their guardian spirits. This loss results in an inability to fight off unwanted intrusions. Illness is viewed as a separation—from one’s power, from one’s guardians, from nature, from community, and from the Great Spirit. Even Western everyday language reflects this view when people say, “I’m having a low-energy day,” or “I wasn’t myself last night.”

Severe trauma can result in soul loss, a natural survival mechanism. It is believed that a part of one’s self or soul goes into hiding to ensure that the individual will survive the extreme stress. Western psychiatrists refer to this phenomenon as dissociation . Some people believe that soul loss occurs when people stop being generous and become selfish and dishonest. Sometimes, people’s souls remain lost until they go through a process of soul retrieval. Symptoms of soul loss are an inability to focus and concentrate, a lack of connection to one’s emotions, a feeling of being “spaced out” and not really present, a feeling of being an observer of life, or chronic depression. Soul retrieval, much like the process of psychotherapy, brings buried memories and emotions back to the surface ( Mackinnon, 2012 ).

The Hmong believe there are two treatments of illness. Natural causes of illness are treated with herbs and massage. Supernatural causes of illness are more serious, and treatment consists of a shaman journeying to the spirit world. Hmong people living in the West are often willing to use Western medicine for acute illnesses ( Baker, Dang, Ly, & Diaz, 2010 ).

TREATMENT

The goal of treatment is integration and wholeness. Shamans use a wide variety of interventions including ceremonies, stories, rhythms, sounds, movements, meditation, and herbs and plant medicine. More detailed infor- mation on treatment modalities utilized by Native American shamans is found in Chapter 6 .

Shamans may be called on to help those who have become ill or those who have lost their power, their spirit guides, or even their souls. In such cases, shamans use the shamanic journey to recover that which was lost. Shamans also journey to gather information to help and guide individuals or groups, to solve problems, and to answer questions. Shamans, by offering their total commitment to a patient for as long as several days, develop intense relationships that underscore the importance of caring as well as curing in the shamanic healing tradition. In old cultures, shamans would do the journeying for patients, but in today’s world, anyone can experience a shamanic journey. Through this process people meet and talk with their power animals and spirit guides and restore their own power and self-healing ( Ingerman & Weselman, 2010 ; Mackinnon, 2012 ).

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Basic tools for entering the shamanic state of consciousness prior to the shamanic journey are the drum, which provides lower vibrations, and the rattle, which provides higher vibrations. A drumbeat at a steady 200 to 280 beats per minute serves as a focus for concentration and quiets the chattering mind. The tempo of the drumbeat corresponds to theta brain waves associ- ated with the hypnotic state, facilitating the move into nonordinary reality. It is a remarkably safe practice for most people because one can return to an ordinary state of consciousness at any time. Some people add dancing or chanting to the drumbeat as another way to reach this altered state of con- sciousness ( Mackinnon, 2012 ).

Some shamans use teacher plants as a catalyst to the shamanic journey. Among the many teacher plants worldwide are peyote, San Pedro cactus, aya- huasca, psilocybin, and red-and-white mushrooms. Shamans consider these plants to be gifts to be used with care and awareness. Their use is never intended to be recreational but rather as part of a sacred ceremony ( Cohen, 2007 ).

Sometimes, communities share in a group healing ceremony. It is believed that each individual’s contribution will benefit the group as a whole. The pow-wow is a group ceremony that may be familiar to many. The partici- pants sit in a circle and pass a talking stick around. The person who holds the talking stick speaks her or his heart while others carefully listen. This process continues until all have said everything they needed to say ( Mackinnon, 2012 ).

Another example of a group healing ceremony is found among the indig- enous people of Hawaii, who come together and experience a forgiveness ritual before the shaman begins the healing work. Family and community members convey concern for the patient by their participation in the ritual. This process underscores the belief that no one lives in isolation but is connected to and affected by other people. When people join in a show of community support, new levels of healing are possible ( Ingerman & Wesselman, 2010 ).

Hawaiian medical practices are experiencing a resurgence, and researchers are studying the healing modalities, training patterns, cultural attributes, and the use of Hawaiian medicines. The three significant modalities are massage (ho’olomilomi), herbal medicine (la’au lapa’au), and conflict resolution (ho’oponopono). The majority of the practitioners are skilled in more than one healing modality. All treatment sessions begin and end with spiritual blessings to initiate the healing process. Health is considered to be a state of harmony between people, nature, and the gods ( Ingerman & Wesselman, 2010 ).

RESEARCH

Clinical evidence of results from shamanic healing is anecdotal, and most published studies have been done by social scientists, folklorists, and histori- ans. In another sense, the ancient methods of shamanism have been tested immeasurably longer than those of biomedicine. The similarities between sha- mans and scientists include an awareness of the complexity of the universe and the vast array of knowledge still to be uncovered and understood. As Harner (1990 ) described the similarity:

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Both shamans and scientists personally pursue research into the mysteries of the universe, and both believe that the underlying causal processes of that universe are hidden from ordinary view. And neither master shamans nor master scientists allow the dogma of ecclesiastical and political authorities to interfere with their explorations. It was no accident that Galileo was accused of witch- craft [shamanism]. (p. 45 )

Research has demonstrated that drumming produces changes in the brain. The beat of the drum contains many sound frequencies that transmit impulses along the nerve pathways in the central nervous system. As men- tioned previously, the rhythmic auditory stimulation of drumming increases the production of theta waves, the brain waves of the trance state. Studies have found that shamanic drumming produces frequencies in the theta wave range of 4 to 7 cycles per second ( Mackinnon, 2012 ).

INTEGRATED NURSING PRACTICE

Albert Schweitzer reportedly once observed, “The witch doctor succeeds for the same reason all the rest of us [doctors] succeed. Each patient carries his own doctor inside him. They come to us not knowing this truth. We are at our best when we give the doctor who resides within each patient a chance to go to work” ( Harner, 1990 , p. 135 ). This belief is almost identical with Florence Nightingale’s basic premise that healing is a function of nature that comes from within the individual.

Currently, Dr. O. Carl Simonton and Stephanie Matthews-Simonton combine the techniques of shamanism with biomedicine in their well-known work treating people with cancer. As part of their treatment, clients are taught to relax and visualize themselves on a walking journey until they meet an “inner guide,” which is a person or animal. The client then asks the guide for help in getting well. The process is similar to a shamanic journey and the meeting of a power animal.

Contemporary shamans work among today’s Native American, Hmong, and other indigenous cultures. Their repertoire of curative powers now includes some modern and biomedical practices, and they may collaborate with conventional health care practitioners. Today, many shamans share their knowledge about healing with others, which has contributed to a recent renewal of interest in this oldest of healing therapies. Lectures, retreats, and weekend meetings, where shamans teach the principles of living in balance with nature, are now available to the general public ( Mackinnon, 2012 ).

As nurses, we must remember that we all have our own worldview. Until we recognize this ethnocentrism (our way is the best way), we are likely to impose this view on our clients. We must not only raise our awareness of other worldviews but also respect and honor worldviews that are different from ours.

In sharing information with clients, you can explain that shamanism offers a chance for contemplation. Guides offer more in the way of introspection and

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insight than physical cure. A shamanic journey may increase self-understanding, provide guidance for living, and produce a spiritual rejuvenation—all of which are important for the healing process.

In old cultures, shamans would do the journeying while an apprentice or helper drummed. In today’s world, it is more appropriate to learn to jour- ney for oneself and restore one’s own power. Personal power is believed to be basic to health and well-being. Some clients may wish to meet in drumming circles every 1 or 2 weeks, while others will prefer to work alone. Drumming tapes have been designed and produced for shamanic journeying. As in any other field of learning, it may be more effective initially to work with a profes- sional during a workshop or retreat.

The shamanic journey begins with the drum. Among all the instruments used in healing, the drum produces some of the most powerful effects. Human bodies are multidimensional rhythm machines with everything pulsing in synchrony. Drumming can influence how strongly and harmoniously life moves within and around every person. Drumming has been used in organi- zations ranging from therapy groups and 12-step programs to rehabilitation centers. The following exercise presents an overview of the shamanic journey that you may want to experience for yourself.

In the shamanic tradition, healing is not just for the individual but also for the community. In shamanism, ultimately no distinction is made between help- ing others and helping oneself. By helping others one becomes more powerful, self-fulfilled, and joyful. The broader purpose is the helping of humankind. The desire to help others is what draws many people into the profession of nursing.

The North American Nursing Diagnosis Association identifies the diag- noses “potential for enhanced community coping” and “ineffective community coping.” It is expected that nurses will apply the nursing process with individ- ual clients, families, groups, and communities. Perhaps someday a modern version of the shaman will work side by side with nurses. Such cooperation is already starting to take place where native shamans live, as on some North American Indian reservations and in some places in Australia. Equally exciting is the idea that nurses will be trained in shamanic techniques and health main- tenance so they can combine both approaches in their practice.

(continued)

TRY THIS

Shamanic Journey

• Find a private, secure place where you will not be disturbed. • Assume a comfortable position, either sitting or lying down. You may want to cover

your eyes to block out room light. • Set the intent of your journey: Decide if you want to go to the upper world or

lower, and form the intent to meet your guardian spirit or your power animal.

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• Turn on a drumming tape. Let your body relax; let it sink down into Mother Earth. Take a few deep, slow breaths. Let the drumbeat become part of you; feel it reso- nate through your body.

• In your mind, bring yourself to a place in nature that is special for you, one that holds personal meaning. It might be a tree you climbed as a child, the lake you swam in on summer vacations, the place you now walk your dog. Imagine that place and go there in your mind. Feel the energy of that place.

• If you are going to the lower world, find a place where you can enter the earth, such as a hollowed out tree stump, an animal den, a cave, or whatever else you want to imagine. When you enter the earth, you will be in a long cave. Take your time and follow it. Eventually it will open up into the lower world. Walk around and enjoy the beauty of the lower world. Explore. Soon you will come in contact with power animals. Introduce yourself. Dialogue with the animal, and ask what infor- mation the animal has for you.

• If you are going to the upper world, find a way to get up into the sky. You may climb a mountain or a tall beanstalk, use a hot-air balloon, or even shape-shift into the form of an eagle, and fly up. Eventually, you will come to the interface between the middle world and the upper world. Find a way through this interface, which is something like a membrane. The upper world is an ethereal, light, crystalline place. Explore. Soon you will meet your guardian spirit. Introduce yourself. Dialogue with the spirit, and ask what information the spirit has for you.

• Eventually, the journey has to end. It can end when you decide to end it, when no more information remains to be gained, or when the drumbeat changes, signaling an end. Return home by the same path you took to get there.

• Allow the information to sink into your consciousness. It is best if you write the information in a notebook, in a concrete form you will remember. The shamanic journey is much like a dream—it will leave you quickly. Writing it down is a method to keep the information you gained during the journey.

Source: Richard Sandore, MD (personal communication, 1998).

References

Baker, D. L., Dang, M. T., Ly, M. Y., & Diaz, R. (2010). Perceptions of barri- ers to immunization among parents of Hmong origin in California. American Journal of Public Health, 100(5): 839–845. doi: 10.2105/ AJPH.2009.17.5935

Cohen, K. (2007). Honoring the Medicine: The Essential Guide to Native American Healing . New York, NY: Random House.

Harner, M. (1990). The Way of the Shaman . San Francisco, CA: Harper.

Ingerman, S., & Wesselman, H. (2010). Awakening to the Spirit World. Boulder, CO: Sounds True.

Mackinnon, C. (2012). Shamanism and Spirituality in Therapeutic Practice. London, UK: Singing Dragon.

Pert, C. (1997). Molecules of Emotion . New York, NY: Scribner.

Rutherford, L. (2008). The View Through the Medicine Wheel . Winchester, UK: O Books.

Sandore, R. (1997). Introduction to the Sha- manic Journey . Prone Stone Recording. Soaring Spirit.

Chapter 24 • Shamans 351

Resources

Dance of the Deer Foundation Center for Shamanic Studies P.O. Box 699 Soquel, CA 95073 831.475.9560 www.shamanism.com

Eagle’s Wing Center for Contemporary Shamanism BM Box 7475 London WCIN 3XX 011 44 1435 810233 www.shamanism.co.uk

The Foundation for Shamanic Studies P.O. Box 1939 Mill Valley, CA 94942 415.897.6416 www.shamanism.org

Four Winds Society P.O. Box 680675 Park City, UT 84068 888.437.40787 www.thefourwinds.com

Institute for Contemporary Shamanic Studies 125-720 King St. W. Box 438 Toronto, ON M5V 3S5 416.603.4912 www.icss.org

25 Faith and Prayer

Prayer indeed is good, but while calling on the gods a man should himself lend a

hand.

Hippocrates

Health care sciences have begun to demonstrate that spiri-tuality, faith, and religious commitment may play a role in promoting health and reducing illness. Nurse clini- cians and researchers, as well as others, are becoming more inter- ested in the connection between religious faith and survival. Increasingly, people are beginning to recognize that faith is good medicine.

Spirituality is that part of individuals that deals with rela- tionships and values and addresses questions of purpose and meaning in life. Spirituality unites people and is inclusive in nature, not exclusive. It is not loyal to one group, continent, or religion. Although spirituality is not a religion, being involved in a particu- lar religion is a way some people enhance their spirituality. Yet, people can be very spiritual and not religious. Spirituality involves individuals, family, friends, and community. Individual aspects are the development of moral values and beliefs about the meaning and purpose of life and death. The development of spirituality pro- vides a grounding sense of identity and contributes to self-esteem. Spiritual aspects relating to family and friends include the search for meaning through relationships and the feeling of being connected with others and with an external power, often identified as God or a Supreme Being. Community aspects of spirituality can be under- stood as a common humanity and a belief in the fundamental sacredness and unity of all life. It is that which motivates people toward truth and a sense of fairness and justice toward all mem- bers of society. Spiritual health is expressed through humor, com- passion, faith, forgiveness, courage, and creativity. Spirituality

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enables people to develop healthy relationships based on acceptance, respect, and compassion.

Religion can be described in a number of ways. The definition chosen for this text is one developed by Mickley, Carson, and Soeken ( 1995 ), three nursing researchers. They believe that religion develops and changes over time and is composed of people’s beliefs, attitudes, and patterns of behav- ior that relate to the supernatural—God, the Divine One, the Great Spirit, Creator, and so forth. Religion usually includes a group of people who hold similar beliefs, have sacred texts, share religious symbols, and participate in shared traditions or rituals. Many people may say they are spiritual but not religious, while most religious people also identify themselves as spiritual ( Carson & Koenig, 2008 ; Young & Koopsen, 2011 ).

Faith refers to one’s beliefs and expectations about life, oneself, and others. In a religious context, faith refers to a belief in a Supreme Being who listens and responds to people and who cares about their well-being. In a spiritual context, faith is thought of as the power to accept the nature of life as it is and live in the present moment. It is a sense of letting go of the need to control while trusting and waiting for the moment when answers come ( Carson & Koenig, 2008 ).

Prayer is most often defined simply as a form of communication and fel- lowship with the Deity or Creator. The universality of prayer is evidenced in all cultures’ having some form of prayer. The Hindus speak of the thousand names of God, and surely there are a hundred ways to pray. Imagine a circle or wheel with many spokes leading to the center or Supreme Being. Each spoke is a different religion with different prayers, but they all lead to the center. Prayer has been and continues to be used in times of difficulty and illness, even in the most secular societies. Prayer for self and prayer for others are the most fre- quently used forms of alternative therapies ( Young & Koopsen, 2011 ).

A common image of prayer in the United States is something like this: “Prayer is talking aloud to yourself, to a white, male, cosmic parent figure, who prefers to be addressed in English” ( Dossey, 1997 , p. 10 ). This cultural view of prayer fails to encompass how prayer is regarded by many other people throughout the world. For some, prayer is more a state of being than of doing; for others, prayer is silence rather than words; for some, prayer is a thought or a desire of the heart; others pray to a female Goddess or a Divine Being who looks like they do. Buddhists do not believe in a personal God as creator and ruler of the world, yet prayers offered to the universe are central to the Buddhist tradition. Prayer may be simply being still and know- ing that God is God. Prayer is part of many religious traditions and rituals and may be individual or communal, public or private ( Young & Koopsen, 2011 ). Larry Dossey (1997) provides a broad definition of prayer: “Prayer is communication with the Absolute. This definition is inclusive, not exclu- sive; it affirms religious tolerance; and it invites people to define for them- selves what ‘communication’ is, and who or what ‘the Absolute’ may be” (p.  11 ). According to a Sufi saying, prayer is when you talk to God, and meditation is when God talks to you. In this definition, meditation is thought

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of as passive and receptive, and prayer as active and engaging. The bound- aries between meditation and prayer, however, are often blurred.

BACKGROUND

Until approximately two hundred years ago, medicine and religion were so thoroughly united that healers and priests were often the same individuals. The first hospitals were founded in monasteries by physicians who were usu- ally monks. Today, many cultures throughout the world continue to regard their healers as a source for guidance in matters of faith and wellness. In the West, religion and medicine were fused until the end of the Middle Ages in the mid-1400s. Philosophers such as Descartes (1596–1650), Locke (1632–1704), and Hume (1711–1776) promoted the scientific basis of knowledge, believing that truth could be realized only through the examination of empirical data and the rational, scientific method. Centuries later, Western societies continue to experience the consequences of this split between religion and medicine. Western physicians are educated to think primarily in terms of what can be empirically proven in the laboratory. Discussions of spirituality and religion are considered by many physicians to be “off limits,” with such discussion relegated to spiritual or religious leaders. In the past, when arguments arose between religion and medicine, religion usually did not fare well. As nurses such as M. Dossey, Carson, Burkhardt, Nagai-Jacobson, Taylor, Winslow, Treloar, Koerner, Goertz, and Holt-Ashley and physicians such as B. M. Dossey, Matthews, Koenig, and Benson research and write more about the blending of religion and health care, the practice of their professions will evolve to, once again, include the forgotten “faith factor” in health care.

In some situations, religion may have a negative impact on people’s lives. Religious participation can lead to more, not fewer, problems when unscrupulous leaders coerce or manipulate others to give up all personal autonomy. Problems also occur when religion fosters excessive guilt or shame or encourages people to avoid dealing with life’s problems. Some religious groups urge their members to avoid all conventional medical care, which can lead to life-threatening situations ( Wachholtz & Pearce, 2009 ).

CONCEPTS

Universality of Faith

Throughout history and around the world, people have called on a Divine Being to sustain them. People are nourished by life-affirming beliefs and phi- losophies. They meditate and say prayers that elicit physiologic calm and a sense of peacefulness, both of which contribute to longer survival. Benson ( 1997 ) believes that a genetic blueprint makes believing in the Great Mystery part of people’s nature. Through the process of natural selection, mutating genes retain the impulses of faith, hope, and love, and faith is a natural physio- logic reaction to the threats to mortality that everyone faces. Benson ( 1997 ) went

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on to say that “according to my investigations, it does not matter which God you worship, nor which theology you adopt as your own. Spiritual life, in gen- eral, is very healthy” (p. 212 ).

Spiritual Crises

Serious illness presents a spiritual crisis. As long as people are well, they maintain their autonomy and their ability to function at home, work, or school. Their feelings of self-worth are supported as they find meaning and purpose in their many activities. Once serious illness occurs, some of these things change. Ill people may have to depend on others for personal care, and they may experience other radical lifestyle changes. Body concept changes may threaten self-esteem. In these situations, most people are forced to reeval- uate life’s meaning and purpose. Religious people draw heavily on their resources of faith to see them through difficult situations like serious illness. Positive religious coping involves such beliefs as “God will care for me.” One research study asked 345 patients with advanced cancer which of the two interventions they would prefer: (1) interventions to extend life even though that would mean more pain or (2) interventions to relieve pain even though it would mean they would not live as long. There was a positive correlation between greater use of positive religious coping and wanting more aggressive end-of-life care near the time of death ( Phelps et al., 2009 ).

Twelve Remedies

Numerous studies demonstrate that religious involvement promotes health. It appears at this time that a number of religious “ingredients” promote health and well-being. Although some may be found in nonreligious settings, they are more commonly found operating together in religious organizations. Matthews and Clark ( 1998 ) termed these “religious remedies,” a listing of which appears in Box 25.1 .

The first remedy is the relaxation response, which can be evoked with meditation and prayer ( Matthews & Clark, 1998 ). The relaxation response buf- fers stress by clearing the mind and freeing the body from everyday tension. Practiced regularly, the relaxation response decreases heart rate, lowers meta- bolic rate, decreases respirations, and slows brain waves. In addition, it enhances measures of immunity. Benson ( 1997 ) found that when religious beliefs were added to relaxation response activities, worries and fears were significantly reduced compared with the relaxation response alone. Most worship services provide time for silent prayer or meditation and help people take time out from busy schedules. With regular practice of the relaxation response, people report experiencing an increase in spirituality. They often describe the presence of an energy, a power, or God, that is beyond themselves. Those who feel this pres- ence often experience the greatest medical benefits ( Benson, 1997 ).

The second remedy is one of healthful living ( Matthews & Clark, 1998 ). Some religious groups actively promote a healthy lifestyle as part of their doctrine. Religious prescriptions may include dietary moderation, rules about

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sexual behavior, and regulations regarding hygiene as well as avoidance of tobacco, alcohol, and drugs.

Remedy three is the aesthetics of worship, which taps into a univer- sal appreciation for beauty. Visual symbols of faith are reassuring and calming images. Stained-glass windows, beautiful architecture, and floral arrangements all provide an experience of harmony and balance. Sacred music uses audible beauty to communicate the splendor of God. The smell of incense may evoke a deep sense of peace and quietude ( Matthews & Clark, 1998 ).

The fourth remedy is whole-being worship. Christians who sing familiar hymns, Jews who sing “Torah Ora” when the Torah scroll is presented, and Buddhists who chant their prayers all participate in whole-being worship through music. This combination of physical activity (singing), cognitive activity (reading the words), and spiritual activity (prayer through song) evokes a sense of peace. Movements such as kneel- ing, standing, bowing heads, folding hands, or even dancing engage peo- ple on all levels of being. As people worship with body, mind, and spirit, they undergo a unifying experience that is as good for them as it feels ( Matthews & Clark, 1998 ).

Remedy number five is confession and absolution. Harboring guilty feelings can literally make people sick. In many religions, people are encour- aged to confess their sins and repent, after which they are given assurance of forgiveness and absolution. This process allows individuals to review their

BOX 25.1

Religious Remedies

1. Relaxation response 2. Healthful living 3. Aesthetics of worship 4. Whole-being worship 5. Confession and absolution 6. Support network 7. Shared beliefs 8. Ritual 9. Purpose in life 10. Turning over to a Higher Power 11. Positive expectations 12. Love for self and others

Source: Matthews & Clark (1998).

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mistakes, share their personal pain, learn from their errors, and move on rather than becoming preoccupied with personal shortcomings ( Matthews & Clark, 1998 ).

The sixth remedy is one’s support network —those family members and friends who offer practical help, emotional support, and spiritual encourage- ment in times of need. People are social beings whose health often deterio- rates when they become isolated and lonely. Lack of human companionship has been linked to depression of the immune system and a lowered produc- tion of endorphins, the neurotransmitter that produces feeling of well-being. Religious organizations often provide many opportunities for social interac- tion, from religious services to sacred study groups; to youth, women’s, and men’s groups; and to community outreach groups. Koenig ( 2008 ) describes some of the benefits of group interaction: it offers a sense of partnership, helps with coping, creates a sense of community and safety, encourages a coopera- tive approach to problem solving, helps change behaviors and thoughts, sup- ports taking control, and encourages personal action.

Remedy seven is shared beliefs. Most people prefer to associate with individuals who share similar beliefs and points of view. Great things can be achieved when groups are unified around common values. Religious tra- ditions are opportunities for people to share common beliefs. Individuals who feel they are part of a group find they are not alone and gain strength from the power of shared beliefs. Participation in regular worship not only helps people feel connected and helps them rise above their differences, but it also is an antidote to the alienation often prevalent in Western society ( Matthews & Clark, 1998 ).

The eighth remedy is ritual. Ceremony and ritual are ways of creating sacred space and time, when normal ways of relating are put aside, and peo- ple can listen and pray with an open heart to their Divine Being. Religious ritual is a powerful healing mechanism that has soothing and calming effects. Rituals provide people a link with tradition and give them a sense of security ( Matthews & Clark, 1998 ). As Benson ( 1997 ) stated:

There is something very influential about invoking a ritual that you may first have practiced in childhood, about regenerating the neural pathways that were formed in your youthful experience of faith. . . . Even if you experience the ritual from an entirely differ- ent perspective of maturity and life history, the words you read, the songs you sing, and the prayers you invoke will soothe you in the same way they did in what was perhaps a simpler time in your life. (p. 177 )

The ninth remedy is that of finding a purpose in life ( Matthews & Clark, 1998 ). Victor Frankl ( 1984 ) described people’s search for meaning as being the primary motivation in their lives. This search for meaning becomes more intense during periods of illness as people struggle with age- old questions such as, Why me? Why now? Did I do something to deserve

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this? Religion and worship attendance provide a framework of meaning, a sense of purpose in life, and a meaningful interpretation for difficult times. People who are dying often seem to arrive at a sense of life’s purpose. As they tell it, the purpose of life is to grow in wisdom and to learn to love bet- ter. They discover that health is not an end but rather a means. In other words, health enables people to serve a purpose in life, but health is not the purpose of life.

Remedy 10 is turning one’s life over to the Great Mystery or God. It is an acknowledgment that no one has total control over her or his life. Religion provides an avenue for asking for guidance, intervention, and strength. Faith in a God who is loving and caring provides comfort for those going through difficult times. Worship services often leave people feeling less burdened and anxious, as well as more peaceful ( Matthews & Clark, 1998 ).

The 11th remedy is that of positive expectations. During a time of illness or distress, religion often provides a sense of hope and the strength to endure that which has happened. The expectancy of help from the Divine Source works in the same way as does the expectancy of help from a medication, pro- cedure, or caregiver. Various holy writings promise health and healing to the faithful, and researchers are beginning to document the effect of this expecta- tion on the outcome of disease ( Matthews & Clark, 1998 ). Gregg Braden ( 2008 ) wrote about the role of belief in both creating illness and healing from illness on personal, community, and worldwide levels.

The 12th, and last, remedy is love for self and others. All religions focus on loving God and other people. This love includes helping others— strangers as well as family and friends ( Matthews & Clark, 1998 ). When people love and help others, they often experience better health than those who do not.

These 12 religious remedies can be found outside of religious organi- zations. Frequent religious participation, however, provides many of these remedies in one context. Research is demonstrating that religious participa- tion is an important factor in the prevention of disease, achievement of well- being, healing from illness, and extension of life span. One mystery that remains, however, is why some people are cured and others are not. One can be very spiritual and still get sick and die. It must be remembered that religious participation and spirituality are no guarantee for physical health. Failure to recognize this basic reality can result in inappropriate self-blame ( Matthews & Clark, 1998 ).

How Prayer Works

No one knows how praying for others works. Skeptics say it cannot happen because no accepted scientific theory explains it. In the development of theo- ries, however, empirical facts often lead to the development of an explanatory theory. For example, it was well known that penicillin worked before anyone discovered how it worked. The debate has now shifted from whether prayer works to how prayer works.

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Larry Dossey ( 1993 ), Joellen Goertz Koerner ( 2011 ), and Gregg Braden ( 2008 ) have proposed that prayer is “nonlocal,” an idea derived from the field of quantum physics. The word local means that something is present in the here and now; each of us exists here and not somewhere else, and now and not at some other time. The word nonlocal means that something is not confined by place or time. All the major theistic (belief in a personal God as creator) religions agree on the nonlocal nature of God; that He or She is everywhere, is not con- fined by space and location, and exists throughout time. According to the con- cept of nonlocality, consciousness cannot be localized or confined to one’s brain or body, nor can it be confined to the present moment. Consciousness is basic to the universe, perhaps similar to matter and energy. According to this theory, neither energy nor information travels from one mind to another, because the two minds are not separate but rather interconnected and omniscient. Dossey, Koerner, and Braden have proposed that consciousness-mediated events such as prayer, telepathy, precognition, and clairvoyance may become explainable with continuing developments in quantum physics. Like any other new theory, the nonlocal theory raises more questions than it answers. Evidence exists that prayer works, even though the exact mechanism is unknown at this time.

TREATMENT

Some people seek nurses, doctors, counselors, and therapists who focus on spir- itual concerns as well as physical and emotional concerns. This focus is espe- cially helpful for those who are dealing with issues related to meaning and purpose in life. Alternatively, people may seek the help of religious leaders who include healing practices in their religious practice. Faith healing has not been scientifically proven but remains a popular option for many. Some people go to specific places for healing. The Catholic Church has documented 36 “miracles” at Lourdes, for example. A variety of spiritually focused healing groups are also available. People with addictive disorders benefit from 12-step programs, which rely on both group support and the specific invocation of a Higher Power.

Two different types of prayer are directed and nondirected. In directed prayer, the praying person asks for a specific outcome, such as for the cancer to go away or for the baby to be born healthy. In contrast, in nondirected prayer, no specific outcome is asked. The praying person simply asks for the best thing to occur in a given situation. Studies show that both approaches are effective in promoting health.

Prayer can also be described according to form. Colloquial prayer is an informal talk with God, as if one were talking to a good friend. Petitional prayer or intercessory prayer is asking God for things for oneself or others. The focus is on what God can provide. Intercessory prayer is simply praying for someone else. Ritual prayer is the use of formal prayers or rituals such as prayers from a prayer book or from the Jewish siddur, or the Catholic practice of saying the rosary. Meditative prayer, also known as contemplative prayer, is similar to meditation and is a process of focusing the mind on an aspect of God for a period of time.

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RESEARCH

It is difficult to compare studies on faith and prayer when researchers do not agree on conceptual models with operational definitions. Different opinions exist on what should be included in the research studies. This is a hurdle that must be overcome before a systematic review is possible.

The following is a small sample of studies related to spirituality, reli- gious practice, and prayer:

• A study of intercessory prayer added to normal cancer treatment ran- domized 999 participants to either an intervention group or a control group. An external group was asked to offer Christian intercessory prayer for those in the study group. The people praying were given nonidentify- ing details about the recipients. The intervention group showed signifi- cantly greater improvements in spiritual, emotional, and functional well-being compared with the control group ( Olver & Dutney, 2012 ).

• A 1-year follow-up was completed on women with depression and anxiety who had undergone 6 weekly 1-hour person-to-person prayer sessions. Evaluations at 1 year showed significantly less depression and anxiety, more optimism, and greater levels of spiritual experience than did the baseline (preprayer) measures ( Boelens, Reeves, Replogle, & Koenig, 2012 ).

• A qualitative study exploring the meaning of spirituality was done with 19 Jordanian Muslim men living with coronary artery disease. The data provided four themes. The subjects said that faith facilitated their accep- tance of illness and enhanced their coping strategies; that seeking medical treatment did not conflict with their belief in fate; that spirituality enhanced their inner strength, hope, and acceptance of self-responsibility; and that their faith helped them find meaning and purpose in their lives ( Nabolsi & Carson, 2011 ).

• A study examined changes in religious faith among homeless people enrolled in a supported housing program. A total of 582 clients were separated into three groups based on whether they reported a decrease, an increase, or no change in their religiosity scores at 1-year follow-up. Those who gained faith reported doing more volunteer work, being more engaged in community activities, and having a higher quality of life than those who lost faith. Subjects who reported a large gain in faith had better mental health ratings than those who reported a large loss in faith ( Tsai & Rosenheck, 2011 ).

INTEGRATED NURSING PRACTICE

Every serious illness is a spiritual crisis because it is a confrontation with one’s own mortality. Every nurse, regardless of personal belief, must recognize that religion or spirituality or both are often an essential part of the lives of those entrusted to her or his care. To avoid these issues is to fail to truly be a nurse healer because the nurse’s task is to address the physical, psychological, and spiritual needs of clients.

Chapter 25 • Faith and Prayer 361

As a nurse, you can incorporate faith and prayer issues in your care of clients, regardless of your own personal religious beliefs or worldviews. When you remember that people are spiritual beings, you will be more alert to spiritual concerns. It is important that you promote an atmosphere that accepts and encourages many forms of spiritual expression.

The International Code of Ethics for Nurses, the ANA Code of Ethics, and the Joint Commission on Accreditation of Healthcare Organizations all state that nurses must assess clients’ spiritual needs. Why is it, then, that some nurses do not incorporate faith and prayer into their professional practice? Some nurses are unaware of the research data regarding the faith factor. That situa- tion is beginning to change as schools of nursing develop courses to teach stu- dents about the faith–health connection. Some nurses have been told specifically that they are not to mix nursing and faith. This recommendation was made out of a concern that nurses might blur the professional–personal boundaries and cause harm to their clients. Some nurses believe they do not have enough time, while others are unfamiliar with spiritual assessment tools. As research contin- ues to be documented, nurses are reexamining the relationship between nurs- ing and faith ( Balboni et al., 2011 ; Dunn, Handley, & Dunkin, 2009 ). Taylor, Mamier, Bahjri, Anton, and Petersen ( 2009 ) examined a self-study program designed to help nurses learn to speak with patients regarding religion and spirituality. They found significant differences in pre- and posttest responses.

Faith and prayer can be explored effectively with people of most age groups. The depth and focus of the conversation will vary based on the cog- nitive and developmental ability of the individual or family. Health mainte- nance visits provide an opportunity to explore spiritual beliefs and practices in the context of an overall assessment of lifestyle, risks, and resources. Doors can be opened in a nonthreatening, nonurgent fashion, and the topic can be validated for future discussion. See Chapter 2 for a list of nursing spirituality assessment tools. In the face of major illness, terminal disease, or dying, the discussion of faith and prayer is even more relevant. Clearly though, discussion of this topic should not be restricted to these types of cli- ent encounters. Box 25.2 provides an example of a nursing assessment regarding faith and prayer.

Respecting people’s beliefs and experiences also means that nurses do not force spiritual issues on clients, push religion on them, or attempt to con- vert them to a particular faith. Prayer should never be imposed on patients or used as a substitute for high-quality nursing care. Nor should prayer be used as an invocation of magic. Doing so violates the trust that is basic to the nurse– client relationship. Promoting the benefits of faith and prayer includes respect- ing clients’ choices about doctrine, denomination, beliefs, and traditions ( Carson & Koenig, 2008 ; Young & Koopsen, 2011 ).

Of course, some nurses and physicians do incorporate faith and prayer into their care. Dr. Alijani, a faculty member at Georgetown University Medical School and a well-known surgeon, believes that faith plays a significant role in his patient’s well-being. He sees prayer as the literal lifeline between health and spirituality: “Just as my body needs water, carbohydrates, protein, and

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lipids, my mind needs Allah, and the only way to receive Allah is to pray” ( Matthews & Clark, 1998 , p. 73 ).

Health care practitioners are not meant to replace clergy; the roles are distinct. Although many clients may want their spiritual needs addressed by nurses and physicians, others do not, preferring to have these issues addressed by clergy. The practitioner needs to take into account, however, where and how the client’s belief enters into the healing process. Nor should health care practitioners be forced against their wishes into participating in clients’ reli- gious practices. In the best of worlds, health care professionals and clergy work closely together to provide meaningful holistic care.

Although intercessory prayer is guided by beliefs, experiences, and faith traditions, you can provide clients with some basic guidelines on how to incorpo- rate the benefits of intercessory prayer into their lives ( Matthews & Clark, 1998 ):

• If you are ill, ask specifically for people’s prayers for healing. It may involve clergy, members of a congregation, adding your name to a prayer list, or asking family and friends to pray for you on a regular basis.

• Pray for your own healing. • Seek out healing services. Many churches and synagogues offer

opportunities to participate in a prayer service or healing service. • Pray persistently. Keep praying regardless of apparent results. Continuing

prayer is an expression of faith and hope. • Pray for others who are suffering.

BOX 25.2

Faith and Prayer Assessment

Do you consider yourself a spiritual or religious person? What does your faith mean to you? Has it changed during your illness? What is the importance of this faith in your daily life? Do your beliefs influence the way you think about your health or look at your illness? How important is your religious identification? Do you belong to an organized

group? Tell me about your religious practices, such as worship, prayer, or meditation. How important is prayer for you now? What type of prayer would feel comfortable to you now? What aspects of your faith would you like me to keep in mind as I care for you? Would you like to discuss religious implications of your care?

Sources: Burkhardt & Nagai-Jacobson ( 2002 ); Taylor (2003); Winslow & Winslow ( 2003 ).

Chapter 25 • Faith and Prayer 363

As a nurse, you can also teach yourself and others to take time out to count blessings and say “thanks” for the good things in life. Paying attention to what you already have and what is going right helps alleviate stress, anxi- ety, and depression. An act of gratitude often restores a sense of balance and perspective. You can make the following suggestions:

• Remember to say “thank you.” Make it a habit whenever someone helps you out, gives you a compliment, or gives you a gift.

• Create rituals of thanks, for example, saying grace before meals or daily prayers. Practice them until they become a habit.

• Every night before you go to bed, make a list of five things for which you are grateful. It will help take the focus off the stresses in your life.

• Take the time to give back. Look for opportunities to help others and recycle the good fortune you have in your life.

• Once a day, strike a grateful pose, for example, kneeling in prayer or standing with your arms extended joyfully to the sky.

• Take 10 minutes each day to be grateful. Go outside into nature, medi- tate, or pray. Whatever you do, take the time to appreciate all that you have right now.

As nurses, you must educate yourselves about the clinical relevance of faith and prayer for your clients. The time has come to give more than lip ser- vice to the spiritual aspects of nursing care. It is important that you let your clients know that you will do everything you can do scientifically but that sci- ence and technology have their limitations. Perhaps it is appropriate also to let them know that you may pray for guidance in providing competent and compassionate care.

References

Balboni, M. J., Babar, A., Dillinter, J., Phelps, A. C., George, E., Block, S. D., . . . Balboni, T. A. (2011). “It depends”: Viewpoints of patients, physicians, and nurses on patient-practitioner prayer in the set- ting of advanced cancer. Journal of Pain & Symptom Management, 41(5): 836–847.

Benson, H. (1997). Timeless Healing . New York, NY: Fireside Books.

Boelens, P., Reeves, R., Replogle, W., & Koenig, H. (2012). The effect of prayer on depression and anxiety: Mainte- nance of positive influence one year after prayer intervention. International Journal of Psychiatry in Medicine, 43(1): 85–98.

Braden, G. (2008). The Spontaneous Healing of Belief . Carlsbad, CA: Hay House.

Burkhardt, M. A., & Nagai-Jacobson, M. G. (2002). Spirituality: Living Our Connec- tions . Albany, NY: Delmar.

Carson, V. B., & Koenig, H. G. (2008). Spiritual Dimensions of Nursing Practice . West Conshohocken, PA: Templeton Foundation Press.

Collinge, W. (1998). Subtle Energy . New York, NY: Warner Books.

Dossey, L. (1993). Healing Words: The Power of Prayer and the Practice of Medi- cine . San Francisco, CA: Harper.

Dossey, L. (1997). The return of prayer. Alternative Therapies , 3(6): 10–17, 113–120.

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Dunn, L. L., Handley, M. C., & Dunkin, J. W. (2009). The provision of spiri- tual care by registered nurses on a maternal—infant unit. Journal of Holistic Nursing , 27(1): 19–28.

Frankl, V. (1984). Man’s Search for Meaning . New York, NY: Simon & Schuster.

Koenig, H. G. (2008). Medicine, Religion, and Health . West Conshohocken, PA: Templeton Foundation Press.

Koerner, J. G. (2011). Healing Presence: The Essence of Nursing (2nd ed.). New York, NY: Springer.

Matthews, D. A., & Clark, C. (1998). The Faith Factor: Proof of the Healing Power of Prayer . New York, NY: Viking.

Mickley, J. R., Carson, V., & Soeken, K. L. (1995). Religion and adult mental health. Issues in Mental Health Nursing , 16: 345–360.

Nabolsi, M. M., & Carson, A. M. (2011). Spirituality, illness and personal respon- sibility: The experience of Jordanian Muslim men with coronary artery disease. Scandinavian Journal of Caring Sciences, 4: 716–724. doi: 10.1111/j.1471- 6712.2011.00882.x

Olver, I. N., & Dutney, A. (2012). A ran- domized, blinded study of the impact of intercessory prayer on spiritual well- being in patients with cancer. Alterna- tive Therapies in Health & Medicine, 18(5): 18–27.

Phelps, A. C., Maciejewski, P. K., Nilsson, M., Balboni, T. A., Wright, A. A., Paulk, M. E., . . . Prigerson, H. G. (2009). Reli- gious coping and use of intensive life- prolonging care near death in patients with advanced cancer. Journal of the American Medical Association , 301(11): 1140–1147.

Taylor, E. J., Mamier, I., Bahjri, K., Anton, T., & Petersen, F. (2009). Efficacy of a self-study program to teach spiritual care. Journal of Clinical Nursing , 18(8): 1131–1140.

Tsai, J., & Rosenheck, R. A. (2011). Reli- giosity among adults who are chroni- cally homeless: Association with clinical and psychosocial outcomes. Psychiatric Services, 61(10): 1222–1224.

Wachholtz, A. B., & Pargament, K. I. (2008). Migraines and meditation: Does spirituality matter? Journal of Behavioral Medicine , 31(4): 351–366.

Wachholtz, A. B., & Pearce, M. J. (2009). Does spirituality as a coping mecha- nism help or hinder coping with chronic pain? Current Pain and Head- ache Reports , 13(2): 127–132.

Winslow, G. R., & Winslow, B. W. (2003). Examining the ethics of praying with patients. Holistic Nursing Practice , 17(4): 170–177.

Young, C., & Koopsen, C. (2011). Spiritu- ality, Health, and Healing (2nd ed.). Sudbury, MA: Jones & Bartlett.

Anglican Fellowship in Prayer 1106 Mansfield Ave. Indiana, PA 15701 724.463.6436 www.afp.org

Australian Islamic College of Sydney 33 Headcom St. Mount Druitt, NSW 2770 61.2.9677.2613 www.aics.nsw.edu.au

Resources

Buddhist Association of Canada 1330 Bloor St. W. Toronto ON M6H 1P2 416.537.1342 www.buddhismcanada.com

The Healing Trust 21 York Rd. Northampton, UK NN1 5QG 011.44.1604.603247 www.thehealingtrust.org.uk

Chapter 25 • Faith and Prayer 365

The Interface Between Medicine and Religion John Templeton Foundation 300 Conshohocken State Rd., Suite 500 West Conshohocken, PA 19428 610.941.2828 www.templeton.org

National Center for Jewish Healing 135 West 50th St. New York, NY 10020 888.523.2769 www.jbfcs.org/NCJH

Shalem Institute for Spiritual Formation 3025 Fourth St. NE, Suite 22 Washington, DC 20017 301.897.7334 www.shalem.org

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Other Therapies

Respect means listening until everyone has been heard and understood; only then is there a possibility of “Balance and

Harmony,” the goal of Indian Spirituality.

Dave Chief, Grandfather of Red Dog

7 U N I T

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26 Bioelectromagnetics

You, yourself, as much as anybody in the entire universe, deserve your love and

affection.

Buddha

Bioelectromagnetics is the emerging science that studies how living organisms interact with electromagnetic fields. Electromagnetism , a form of energy, underlies all biochemis- try. Quantum physics has demonstrated that what people see as solid matter—be that a person or an object—is actually 99.9999% empty space filled with energy. Everything is, in fact, energy vibrating at different rates ( Braden, 2008 ).

BACKGROUND

In the 18th century, Luigi Galvani, an Italian physician, conducted experiments on frog muscle to demonstrate that bioelectricity exists within living tissue. Shortly thereafter, Alessandro Volta, a physi- cist, found that animal tissue was not needed to produce a current and went on to invent the electric battery in 1800. Michael Faraday, a British chemist, became the greatest experimentalist in electricity and magnetism of the 19th century; he produced the first electric motor and succeeded in showing that a magnet could induce elec- tricity. This early work led to several devices for the diagnosis and treatment of disease, including many that are in use today.

In the late 1950s in Japan, doctors began to see a new syndrome of low energy, insomnia, and generalized aches and pains. After extensive research it was discovered that these com- plaints came from people who spent large amounts of time in metal buildings and were thus shielded from the earth’s natural magnetic field. The disorder was labeled “magnetic field defi- ciency syndrome,” and symptoms were alleviated by the external

369

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application of magnetic fields to the patients’ body. Today, magnetic healing continues to be a significant part of mainstream medicine in Japan. Similarly, early Russian cosmonauts who spent more than a year in space were amazed to find that they had lost nearly 80% percent of their bone density. As a result, spacecrafts were designed to include strong artificial magnetic fields on board to avoid this problem. Both these examples illustrate that magnetic fields are essential to good health and well-being ( Collinge, 1998 ; Trivieri, 2002 ).

CONCEPTS

Geomagnetic Field

Every atom and cell of the body is a small magnetic field that radiates into space, decreasing in strength with distance and ultimately becoming lost in the jumble of other magnetic fields. Like the human body, the earth radiates an energy field, called the geomagnetic field. This field originates in convec- tion currents in the earth’s liquid outer core and radiates beyond the atmo- sphere, stimulating and protecting all life on earth. Migrating birds or fish returning to their spawning grounds navigate over great distances with the help of magnetic field receptors in their brain. It is believed that they tune in to the magnetic field of the earth to determine location and direction. Animals are attuned to the geomagnetic field and can sense subtle changes in it. For example, dogs, horses, and cattle often become agitated just before an earth- quake ( Smith, 2008 ).

The lines of force of a magnetic field can penetrate the body as if it were air. A strong magnet held on one side of the hand can easily deflect a compass needle on the other side of the same hand. As the magnetic field penetrates the body, it can interact with electric and electromagnetic fields within the body.

Endogenous Magnetic Fields

Endogenous magnetic fields are those produced within the body. This electri- cal activity demonstrates patterns that provide medically useful information. For example, electrocardiography (EKG) and electroencephalography (EEG) measure heart and brain activity, respectively, by measuring electric potentials on the surface of living tissue. New technologies in instruments under devel- opment that are extremely sensitive have opened new lines of research.

Like other kinds of magnetic fields, the human energy field is the stron- gest at its source and fades with distance. Another name for this energy field is aura, and it is the field that surrounds the body as far as the outstretched arms and from head to toe. See Chapter 2 for more detailed information on auras. The human energy field is both an information center and a highly sen- sitive perceptual system that transmits and receives messages as people inter- act with their surrounding environment. Patterns of circulation of energy within the body include the meridian system and the chakras. Virtually every alternative healing therapy has a way of interpreting these subtle energy fields ( Braden, 2008 ).

Chapter 26 • Bioelectromagnetics 371

Recent research has uncovered a form of endogenous radiation, an extremely low-level light known as biophoton emission. It is believed that biophoton emission may be important in gene expression, membrane trans- port, and bioregulation. Externally applied energy fields may alter biophoton emission to the benefit or detriment of the organism. This, as well as other endogenous fields of the body, may prove to be involved in energetic thera- pies such as Therapeutic Touch ( Hossu & Rupert, 2006 ).

Exogenous Magnetic Fields

Exogenous magnetic fields are those produced by sources outside the body and can be classified as either artificial or natural. Artificial exogenous fields are created by such things as power lines, transformers, appliances, radio transmitters, and medical devices. The frequencies of some of these exoge- nous fields can also create problems for people. For example, the frequency of household current in the United States is 60 cycles per second, or 60 hertz, compared with brain frequencies of 8 to 22 cycles per second while awake and as low as 2 cycles per second while sleeping. The more electrical devices in the bedroom, the more likely the interference with the brain’s natural frequencies, resulting in disturbed sleep and fatigue. As long as televisions and computers are plugged in, they produce electromagnetic fields, even when turned off. It would be best, therefore, to unplug all electrical devices in the bedroom prior to sleep ( Yang et al., 2008 ).

The earth’s geomagnetic field is one example of a natural exogenous field. Another example is the field produced by moving water. When people are at beaches, on riverbanks, beside waterfalls, or even walking outside after a powerful rainstorm, they often experience feelings of relaxation and peace. While these feelings may be attributed to the psychological cues from these environments, they also have an energetic basis. When water moves or flows, it releases negative ions into the air. When people are surrounded by negative ions, they seem to balance their energy fields. As Collinge (1998) stated, “It is as if the metaphors of ‘cleansing’ and ‘washing away’ that we associate with moving waters have a real basis in their impact on the field of emotional energy that surrounds and penetrates our body” (p. 93 ).

Ionizing and Nonionizing Fields

Electromagnetic fields can also be classified as ionizing or nonionizing. A field is an ionizing electromagnetic field if its energy is high enough to dis- lodge electrons from an atom or molecule. Gamma rays and X-rays are two types of ionizing radiation that can penetrate the body and cause damage on prolonged exposure. Nonionizing electromagnetic fields may have non- harmful and even beneficial effects on biological tissue. This effect is the basis for bioelectromagnetic (BEM) field application and research.

The actual mechanism by which BEM produces biological effects is under intense study. It is likely that BEM affects the cell membrane, perhaps at the receptors where neurotransmitters and neurohormones bind. Alteration in the

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binding process then alters internal cellular processes. Interestingly, some spe- cific frequencies of BEM affect specific target tissues, just as drugs affect specific tissues. Magnetic fields are also believed to stimulate cellular metabolism and oxygenate tissues, which relieves inflammation and facilitates cellular repair.

TREATMENT

Magnetic field therapy works on the principle that every animal, plant, and mineral has an electromagnetic field that enables organic beings and inor- ganic objects to communicate and interact as part of a single, unified energy system. Static magnetic fields are produced by natural or artificial magnets, and pulsating magnetic fields are produced by electrical devices. These mag- netic fields are able to penetrate the body and affect the functioning of cells, tissues, organs, and systems. These therapies work best in combination with other healing modalities and are considered to be adjunct treatments to con- ventional medicine. They should not be used by themselves for any major disease or medical condition ( Eden, 2008 ).

Nonionizing bioelectromagnetic (BEM) medical applications are classi- fied into two types, thermal or nonthermal. Thermal, or heat, applications include radio-frequency (RF) hyperthermia, laser and RF surgery, and RF dia- thermy. The most important BEM modalities in alternative medicine are the nonthermal applications. Nonthermal means that the application does not cause any significant gross heating of tissue. An example is microwave reso- nance therapy, in which the mechanism of action is thought to be modifica- tion of the cell membrane. The major alternative healing applications of nonthermal, nonionizing electromagnetic fields are bone repair, nerve stimu- lation, wound healing, the treatment of osteoarthritis, electroacupuncture, tis- sue regeneration, immune system stimulation, and neuroendocrine modulations ( Hennig & Speck, 2011 ). Box 26.1 describes these applications.

BOX 26.1

Applications of Nonthermal, Nonionizing Electromagnetic Fields

Transcutaneous electrical Used for pain relief nerve stimulation (TENS) Transcranial electrostimulation Used to reduce symptoms of depression, anxiety, (TCES) and insomnia; may be effective in drug depen-

dence

Repetitive transcranial magnetic Used in place of electroconvulsive therapy in cer- stimulation (rTMS) tain types of mood disorders; used in diagnostic

nerve conduction studies Pulsed electromagnetic fields Used to stimulate bone growth; fractures (PEMFs)

Chapter 26 • Bioelectromagnetics 373

Magnetic resonance imaging provides close-up views of tissues and their biologic processes. MRI helps researchers better understand disease pre- vention, detection, and treatment. Continued success with MRI has led to more individualized treatment choices ( Mertz, 2013 ).

A Low-Energy Neurofeedback System (LENS) has been developed to treat a number of conditions ranging from autism spectrum disorder to head- aches to traumatic brain injuries. The purpose of the system is to help the brain adapt to imbalances caused by physical or emotional trauma. A low- power electromagnetic field is used to provide feedback and to stimulate brain-wave activity ( Larsen, 2012 ).

Being immersed in a field of negative ions seems to balance people’s energy and relieve pain. Physicians specializing in orthopedics and sports medicine have been recommending magnets since 1993. Athletic performance is enhanced, and risk of serious injury is decreased when magnets are used to warm up muscles and joints. People wear magnets on their wrists, elbows, and knees for joint pain or on their heads for headaches. Magnets are used to speed the healing of wounds. Though not recognized as medical devices by the U.S. Food and Drug Administration, magnets have been widely used in Asia for years. The magnets used are about 5 to 10 times as strong as refrigera- tor door magnets and cost between $15 and $35 a pair depending on the size.

A few contraindications for magnetic therapy need to be observed. Until further research is conducted, pregnant women should not wear magnets over the abdominal area. Magnets should not be used by persons wearing pacemakers, defibrillators, aneurysm clips in the brain, cochlear (inner ear) implants, or other implanted electrical devices. Magnets decrease the sticki- ness of platelets, which contributes to increased bleeding. For that reason, they should not be used by people on anticoagulants or who have an actively

Electromyography Used to diagnose and treat carpal tunnel syndrome and other movement disorders Magnetoencephalography Used in psychiatry and in development of new (MEG) medications; more accurate and precise than EEG Electroretinography Used to noninvasively monitor rapid eye movement (REM) sleep Magnetic resonance imaging Used to identify structural abnormalities (MRI) in three dimensions Magnetic molecular energizing Used to improve oxygen carrying capacity, assimila- (MME) tion of nutrients, manufacture of enzymes, metabolic waste removal, and reduction of free radicals Vagus nerve stimulation (VNS) Used for hard-to-treat seizure disorders; depression Power spectral analysis (PSA) Used to monitor the amplitude and latency of brain electrical discharges

374 Unit 7 • Other Therapies

bleeding or open wound. Magnets should not be used with a freshly torn muscle that is still bleeding internally. In this situation, it is best to wait 3 to 5 days after the injury, or 10 to 14 days if the tear is severe, before using mag- nets to aid the healing process.

RESEARCH

Little research has been conducted in the United States regarding the clinical effects of magnets. In Europe and Russia, however, where magnetism is well regarded, hundreds of scientific studies have been documented. The follow- ing is a small sample of current studies:

• A randomized sham-controlled double-blind study using low-frequency repetitive transcranial magnetic stimulation (rTMS) in patients with upper extremity hemiparesis following a stroke found no statistical sig- nificance in hand function between the experimental and the control group ( Seniów et al., 2012 ).

• A randomized blind placebo-controlled trial studied the effects of Bio-Electro-Magnetic-Energy-Regulation (BEMER) on patients experiencing multiple sclerosis fatigue. The study consisted of two 8-minute daily BEMER treatments for 12 weeks. Compared with the placebo group, the patients receiving BEMER demonstrated a statistically significant improvement in their fatigue severity scale ( Piatkowski, Kern, & Ziemssen, 2009 ).

• A pilot study on pregnant women experiencing major depressive disor- der examined treatment with transcranial magnetic stimulation (TMS). Seven of the 10 subjects experienced a decrease in their depression symptoms. No adverse pregnancy or fetal outcomes were observed. For pregnant women who do not wish to take medication, this may be a promising treatment ( Kim et al., 2011 ).

INTEGRATED NURSING PRACTICE

Awareness of magnetic healing is gaining credibility in the United States and is being applied by increasing numbers of conventional as well as alternative health care practitioners as an adjunct therapy. Increasing numbers of people are wearing small magnets during the day for pain relief, greater energy, and healing. Treatments can last from just a few minutes to overnight and, depend- ing on the situation and severity, may be applied several times a day for days or weeks at a time.

Explain to clients that the effectiveness of magnetic treatment depends on the number of magnets used and their strength, thickness, and spacing. Magnets vary in strength, and the magnetic flux density or field strength of those used for healing purposes is generally between 1,000 and 5,000 gauss (G). (The tesla is the preferred international unit of measurement: 1 tesla (T) equals 10,000 G.) In comparison, the magnetic field strength at the surface of the earth is approximately 0.5 G. The thicker the magnet, the greater the

Chapter 26 • Bioelectromagnetics 375

depth of penetration, but increasing thickness makes the magnet more uncomfortable to wear. Most people wear magnets that are between 1/4 and 3/8 inch thick. In general, the magnet should be larger than the size of the area being treated. Clients who are treating finger joints for arthritis will use a small magnet, while those who are treating the lower back will apply a much larger magnet.

When teaching clients about magnetic therapy, you can explain that the most common use is in the treatment of pain, with reports of successful treat- ment in arthritis, rheumatism, fibromyalgia, back pain, headaches, muscle sprains and strains, joint pain, tendonitis, shoulder pain, carpal tunnel syn- drome, and torn ligaments.

Magnetic therapy may be one of the most effective methods for achiev- ing relief from arthritis, especially in the hands and feet. People with carpal tunnel syndrome can apply magnets to the front and back of the wrist to help control symptoms. Individuals diagnosed with fibromyalgia can sleep on a magnetic mattress pad and use a magnetic pillow. They may also use magnets over the painful areas during the day. Magnetic insoles increase circulation and help conditions such as numbness, burning, aches, restlessness, and leg cramps. A client with phantom pain following an amputation may be able to use magnets to improve the flow of blood in the stump and cause the phan- tom pain to disappear. People with asthma and bronchitis may find that wear- ing a strong neodymium magnet over the chest and at an equal level on the back will help return breathing to a normal state. For minor burns, people can place a magnet over the site of injury to speed the healing and reduce the pain ( Keet & Keet, 2007 ).

It is currently unclear whether you should suggest that clients wear the magnets full time or intermittently. This recommendation will need to be determined through further research. At this time, you can encourage clients to experiment with time periods that seem most effective. As scientific and clinical understanding increases, you will be able to provide more informa- tion about how to manipulate magnets for the best effects.

TRY THIS

Absorbing Earth Energy

Find a grassy, open area that is in its relatively natural state. You may or may not choose to use a blanket. Lie facedown with your arms and legs extended in a spread-eagle fashion. Notice that all your chakras are in direct contact with the earth. Visualize an exchange of energy as you release to the earth, with each out-breath, any stress or nega- tivity you have been carrying. With each in-breath, imagine that your chakras are receiving fresh, balanced, healing energy from the earth. Do this relaxation breathing for at least 20 minutes. You should feel yourself in a pleasant and refreshed state.

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References

TRY THIS

Going to the Mountains

If you live near hills or mountains, go to the highest natural point you can reach. High places are concentrations of energy and seem to lift one above normal conflicting ener- gies. Looking below, get a sense of the differences in the two energetic environments. You may feel clear, focused energy on the higher point while sensing a mixture of many different energies in the area below. After a while you should experience clearer thinking and a sense of inspiration.

Source: Collinge ( 1998 ).

Braden, G. (2008). The Spontaneous Healing of Belief . Carlsbad, CA: Hay House.

C ollinge , W. (1998). Subtle Energy . New York, NY: Warner Books.

Eden, D. (2008). Energy Medicine for Women . London, UK: Penguin Group.

Hennig, J., & Speck, O. (2011). High-Field MR Imaging. New York, NY: Springer.

Hossu, M., & Rupert, R. (2006). Quantum events of biophoton emission associ- ated with complementary and alterna- tive medicine therapies. Journal of Alternative and Complementary Medi- cine , 12(2): 119–124.

Keet, L., & Keet, M. (2007). Hand Reflexol- ogy , London, UK: Hamlyn.

Kim, D. R., Epperson, N., Paré, E., Gonzalez, J. M., Parry, S., Thase, M. E., . . . O’Reardon, J. P. (2011). An open label pilot study of transcranial magnetic stimulation for pregnant women with major depressive disorder. Journal of Women’s Health, 20(2): 255–261. doi: 10.1089/jwh.2010.2353

Larsen, S. (2012). The Neurofeedback Solu- tion. Rochester, VT: Healing Arts Press.

Mertz, L. (2013). Medical imaging: Just what the doctor (and the researcher) ordered:

New applications for medical imaging technology. Institute of Electrical and Electronics Engineers Pulse, 4(1): 12–17. doi: 10.1109/MPUL.2012.2228803

Piatkowski, J., Kern, S., & Ziemssen, T. (2009). Effect of BEMER magnetic field therapy on the level of fatigue in patients with multiple sclerosis: A randomized, double-blind controlled trial. Journal of Alternative and Comple- mentary Medicine, 15(5): 507–511. doi:  10.1089/acm.2008.0501

Seniów, J., Bilik, M., Leśniak, M., Waldowski, K., Iwa ń ski, S., & Członkowska, A. (2012). Transcranial magnetic stimulation combined with physiotherapy in rehabilitation of poststroke hemiparesis: A random- ized, double-blind, placebo-controlled study. Neurorehabilitation & Neural Repair, 26(9): 1072–1079. doi: org/10. 1177/1545968312445635

Smith, K. (2008). Awakening the Energy Body . Rochester, VT: Bear.

Trivieri, L. (2002). Alternative Medicine: The Definitive Guide . Berkeley, CA: Celestial Arts.

Yang, Y., Jin, X., Yan, C., Tian, Y., Tang, J., & Shen, X. (2008). Case-only study of

Chapter 26 • Bioelectromagnetics 377

Resources

interactions between DNA repair genes (hMLH1, APEX1, MGMT, XRCC1 and XPD) and low-frequency

electromagnetic fields in childhood acute leukemia. Leukemia & Lymphoma , 49(12): 2344–2350.

Advanced Magnetic Research Institute International 6925 Speedway Blvd., Unit C-110 Las Vegas, NV 89115 1.800.265.1119 www.amri-intl.com

Institute for Magnetic Resonance Research Level 3, Block 3 Royal North Shore Hospital St. Leonards, NSW 2065 61 2 9926 6073 www.education.net/au/Institute-for- magnetic-resonance-research

27 Animal-Assisted Therapy

Treat the earth well: it was not given to you by your parents, it was loaned to you by your children. We do not inherit the Earth from our Ancestors, we borrow it

from our Children.

Ancient Indian proverb

A nimal-assisted therapy (AAT) is defined as the use of specifically selected animals as a treatment modality in health and human service settings. AAT has been steadily gaining in popularity in the United States and has been shown to be a successful intervention for people with a variety of physical or psychologic conditions. Despite reluctance and skepticism on the part of many administrators of health care facilities, nurses have often advocated the use of animals as a therapeutic inter- vention. One of the earliest recorded observations of a connection between animals and health was made by Florence Nightingale ( 1969 ) in 1860 when she noted “a small pet is often an excellent companion for the sick, for long chronic cases especially” (p. 103 ). She further suggested that when possible, patients should partici- pate in the care of the animal, because this activity was helpful to their recovery. Long banned from health care facilities, dogs, cats, and other pets are gradually being welcomed with open arms.

BACKGROUND

In 900 b.c. , Homer wrote about Asklepios, the Greek god of healing whose healing power was transmitted through sacred dogs. In the ninth century, people in Gheel, Belgium, began using

378

Chapter 27 • Animal-Assisted Therapy 379

animals to care for people with disabilities. Theirs was the first recorded therapeutic farm animal program for patients. The York Retreat in England, founded in 1792 for the treatment of people with mental illness, used small animals such as rabbits and poultry in their treatment plan. The goal was to decrease the use of restraints and medications by helping residents learn self- control through animals that relied on them for care. Bethel, a residential treatment center for people with epilepsy, founded in 1867 in Germany, utilized pets as an important part of the treatment program. This pet program is still in place today and has expanded to include farm animals and a wild game park. In the United States in the 1940s, injured World War II soldiers were encouraged to work with the hogs, cattle, and horses on the farm of the Army Air Corps Convalescent Hospital in New York. Since that time, animals have been used in many medical specialties, from pediatrics to geriatrics; in varied U.S. clinical settings, from acute care facilities, chronic care homes, group accommodations, private homes, to schools and correctional facilities; and in prevention and healing, nationwide ( Fine, 2010 ).

PREPARATION

In the 1990s, Pet Partners (formerly the Delta Society) developed the first program for animal-assisted therapy. Rainbow Animal Assisted Therapy focuses on children with special needs. The goals include improving physical skills such as reaching for or grasping objects or brushing a dog, and cognitive skills such as reading aloud to or giving commands to a dog.

Therapy dogs and cats are specifically selected for temperament, companionability, and interaction. Temperament is the animal’s natural or instinctive behavior and is important in terms of the way the animal will react when stressed. A good therapy pet is calm, tolerant, and friendly. The second major criterion is that the animal has a person who is willing to volunteer time and energy to share the pet with others. Dogs must be obedience trained prior to participating in the program. A dog or cat must be at least 1 year old before enrolling in the training and visiting program to ensure that the pet has been effectively socialized and is comfortable interacting with numerous people in a crowded setting. In addition, the animal’s immune system is more stabilized by this age. A veterinarian must verify the animal’s health, and all inocula- tions must be current. AAT-registering organizations require that a dog and its handler pass several tests prior to registration. In general, dogs have to demonstrate basic obedience skills and must be indifferent to crowds and distractions and unfazed by exuberant or clumsy handling, including ear tugging and “bear hugging.” In addition, they must have a high tolerance for unfamiliar or loud noises and peculiar smells. In addition to the familiar dogs and cats in pet therapy, other animals may include parrots, cockatoos, guinea pigs, rabbits, pot-bellied pigs, dwarf goats, llamas, donkeys, and horses. Ther- apeutic riding horses must have a gentle, tolerant temperament; be well bal- anced and well muscled; and move with even strides. In recent years, dolphin-assisted therapy has become very popular, and a number of these

380 Unit 7 • Other Therapies

programs exist worldwide. The cost is significantly higher for dolphins than for other AAT programs.

CONCEPTS

Companion Animals

Many people think of their animals as surrogate children. And these are children who rarely, if ever, disappoint their parents. Pets, especially dogs, often seem to understand what their owners are feeling. For some people, a pet is a reason to get up in the morning. It is something to nurture, touch, and stroke. For stress relief, it apparently does not matter much whether the pet is a Labrador, a tomcat, or a canary. What is most important is the person’s relationship with the pet.

The contributions companion animals make to the emotional well-being of people include providing unconditional love and opportunities for affec- tion; functioning as a confidant, playmate, and companion; and assisting in the establishment of trust, responsibility, and empathy toward others. Studies of children with pets indicate that the unconditional love and acceptance conveyed in the child–animal relationship may validate a child’s sense of self- worth. In addition, older school-age children often turn to companion animals in times of stress for reassurance. Children often perceive their companion animals as play partners, most often during middle childhood than during adolescence or early childhood ( Dietz, Davis, & Pennings, 2012 ).

Children with interactive pets such as dogs and cats are more attached to their companion animals than are children with other types of pets such as hamsters, fish, and turtles. Emotional bonds are more likely to be formed with animals that are able to respond in an outwardly loving and affectionate way. Behaviors such as tail wagging, barking, and purring often elicit affectionate responses in human caregivers. In North America and Europe, families with children, especially school-age children, are more likely to own companion animals than are families without children. Multiple-pet ownership is also common. Pet ownership remains higher in rural versus urban areas, and in houses versus apartments. Still, across a variety of settings, the majority of children in Western countries are living with companion animals.

Therapy Animals

The characteristics that make many pets cherished family members— unconditional affection, responsiveness, and companionability—also make pets effective in therapy. In this age of high technologic health care, it is sometimes easy to forget the importance of unconditional affection. Ani- mals pay little attention to age or physical ability but accept people as they are. It is insignificant if the person has no hair, is in a wheelchair, or is hal- lucinating. The underlying concept that supports the use of animals for therapeutic reasons is the bonding experience it provides. Frail or depressed older adults often brighten up and adopt a more positive outlook when they are in the presence of an animal “therapist.”

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Many health care professionals are finding that loneliness may be as serious as cancer and heart disease for older adults. Older people who stay active, find substitutes for work, and build new relationships as partners and friends die have been found to be the most satisfied with life. Not all older adults, however, have options for remaining active and forming new friendships. Visiting with animals can help people feel less lonely and less depressed. Animals can provide a welcome change from routine or a distrac- tion from disability or pain. People often talk to the animals and share with them their thoughts, feelings, and memories. When people talk to people, their blood pressure tends to go up because of concern about how one is being evaluated or judged. With animals, who are always eager to please and unconditionally accepting, people’s blood pressure levels tend to go down ( Reed, Ferrer, & Villegas, 2012 ).

Animals also make it easier for two strangers to talk. They give people a common interest, provide a focus for conversation, and broaden the circle of friends. When animals visit long-term care facilities, residents laugh and mingle more than when the animals are not around. Animals also help stimu- late socialization by providing an opportunity to share stories of animals the residents may have had in the past. Many people like to stroke the animal while talking about the pets that shared their lives.

TREATMENT

Animal-Assisted Therapy

Animal-assisted therapy is the use of specifically selected animals as a treatment modality in health and human service settings. In AAT, an accred- ited professional guides the human–animal interaction toward specific, individualized therapeutic goals. In one treatment session, a variety of goals can be addressed: physical goals such as range of motion, balance, and mobility; cognitive goals such as improved memory or verbal expression; emotional goals such as increased self-esteem and motivation; and social goals such as building rapport and improved socialization skills. Linda Hume, LPN, AAT specialist, has developed a program of animal facilitation in occupational and physical therapy at Northeast Rehabilitation Hospital in Salem, New Hampshire. The following are a few of the goals and activities she has identified for AAT in her clinical setting:

• Increased upper extremity range of motion: Throw an object for dog to retrieve; use leash to maneuver dog; pet, stroke, brush animal

• Mobility: Ambulate with dog • Improved coordination: Throw an object for dog to retrieve (releasing);

reach for object dog has retrieved • Improved memory: Ask client to recall dog’s name, breed, age, and so

forth; command dog to sit and remember to release dog from command • Increased language production: Use commands with dog; simply talk to

or about animal

382 Unit 7 • Other Therapies

• Object identification: Direct dog to retrieve specific familiar items by appropriate name—ball, spoon, pen, cup

• Attention/concentration: Attend to dog, task, and therapist ( Hume, 2002 ).

Therapeutic horseback riding , or hippotherapy, is defined as all rehabilita- tive uses of horses. The term derives from the Greek word hippo, meaning “horse.” In hippopsychotherapy , the riding is designed to support the psy- chotherapeutic treatment plan. Goals include increased self-confidence, improved self-esteem, refined social competence, the experience of pleasure, and the ability to establish a relationship with the horse. Remedial educational riding is used to further the educational and behavioral goals for school-age children with learning problems. The horse is used as a strong motivator for accomplishing specific treatment goals. Physical hippotherapy is the use of the rhythmic movement of the horse to increase sensory processing and improve posture, balance, and mobility in people with movement dysfunctions. The transfer of movement from the horse to the client is designed primarily to achieve physical goals but may also affect psychological, cognitive, behavioral, and communication outcomes. Clients benefiting from hippotherapy include, but are not limited to, adults and children with cerebral palsy, multiple sclerosis, orthopedic problems, post- traumatic spasticity, strokes, scoliosis, genetic syndromes, autism spec- trum disorder, and developmental delays ( Encheff, Armstrong, Masterson, Fox, & Gribble, 2012 ).

Dolphin assisted therapy (DAT) programs worldwide are used to lessen symptoms of a wide range of conditions such as depression, Down syndrome, autistic spectrum disorders, speech disorders, cerebral palsy, and traumatic brain injury. However, there is currently no evidence that DAT provides greater benefit than other animal-assisted therapies ( Salgueiro et al., 2012 ).

The National Animal Assisted Crisis Response organization provides dog and handler teams to help victims of crisis situations or disasters, such as the F4 tornado in Henryville and Marysville, IN; Hurricane Sandy; and the Sandy Hook Elementary School shooting. Some victims talk to the comfort dogs, while others just want to pet or hug the dogs.

Animal-Assisted Activities

A less formal approach, animal-assisted activities (AAAs) , includes moti- vational, educational, and recreational approaches. The goal is to provide “meeting and greeting” human–animal interactions to enhance the quality of life, rather than a specific treatment plan. AAA is used in many types of facilities with a wide variety of animals. AAA visits to sheltered homeless families has been effective. Most shelters do not allow families to bring their pets, and seeing the visiting animal can be therapeutic, especially for children. AAA visits give homeless children a chance to participate in every- day experiences they may not have had recently, such as walking a dog or playing fetch.

Chapter 27 • Animal-Assisted Therapy 383

Pet Visits

A family pet visit is an arrangement for a pet to visit the owner in a health care setting. The concept of pet visits as therapy for hospitalized people is not new, especially in facilities with rehabilitation, oncology, and mental health units. The pet that visits may belong to a pet therapy program or may be the client’s own pet. It is believed that allowing a pet to visit can be a healing experience for patients, family members, and even the pet. Pets are even allowed to visit in ICU settings, with the approval of the nurses, provided there are no medical contraindications.

Resident Animals

Resident animals live at health care facilities. Species include fish, birds, ham- sters, gerbils, guinea pigs, rabbits, cats, and dogs. The staff is responsible for the complete health and well-being of the animals, and residents are included in providing routine daily care. Grooming and brushing a resident dog, for example, are good therapies for the hands. Some staffs report that full-time pets become so perceptive that they gravitate to the rooms of people who are the most isolated or depressed. Those residents who have regular visits are more receptive to treatment, have a greater incentive to recover, and have an increased will to live.

Green Care

Green care is a total environmental approach using plants, gardens, and animals as therapeutic tools for individuals with physical or emotional prob- lems. The intervention takes place on farms where clients assist in the care of animals and participate in other types of farm work. The program has been implemented in several European countries with positive results ( Berget, Ekeberg, & Braastad, 2008 ).

Service Animals

Service animals are individually trained to do work or perform tasks for a person with a physical or emotional disability. Because they are not considered a “pet,” they may legally go anywhere that a person with disabilities goes. Some service animals are trained to “alert” the person that a specific event is going to occur in the near future and is able to notify the human partner of this impending event. Other service animals are trained to “respond,” that is, to act in a predetermined manner when a specific event occurs ( Fine, 2010 ).

Most people are familiar with guide dogs for those with visual impair- ment. Other disability service animals can be trained to pull a wheelchair, open doors, retrieve dropped objects as small as a dime, turn light switches on and off, carry items in a backpack, and bark to alert for help. Hearing animals alert owners to important sounds that need a response such as smoke, fire, and clock alarms; telephones; baby crying; sirens; and knocks at the door. Seizure response animals , usually dogs or cats, are able to alert people to the onset of

384 Unit 7 • Other Therapies

their owner’s seizures and can be trained to stay with the person or get help. They also help the person become reoriented and mobile after the seizures. Diabetic service animals alert their owners to episodes of hypoglycemia before there are symptoms, giving those persons time to monitor and correct their glucose level. When breathing machines malfunction, respiratory service dogs can be trained to nose the phone receiver out of its cradle and hit the speed- dial buttons, all of which are programmed to 911. Psychiatric service animals alert and/or respond to human partners experiencing panic attacks, social phobias, agoraphobia, posttraumatic stress disorder, dissociative amnesia, and depersonalization disorder. Any person who has a physical or mental impairment that substantially limits a major life activity might be a candidate for a service dog ( Fine, 2010 ).

Training service dogs is an expensive and time-consuming project. The dog spends the first year of life with a foster family who is responsible for socialization and basic obedience training. Next, 5 to 6 months of intensive training is followed by 6 months of in-home training with the new owner. The expense of training an animal is usually more than $10,000. The benefit, of course, is that people can lead more independent and fulfilling lives.

Screening Dogs

Researchers at Cambridge University hope to receive funding to test their theory that a dog’s sense of smell could provide a better early warning system for some cancers than modern science. While people have about 5 million smell-sensing cells, dogs have about 220 million such cells. It is estimated that dogs are 1,000 to 100,000 times more sensitive to smells than humans. Screen- ing dogs are being trained to detect prostate cancer by smelling urine, lung cancer by smelling breath, and skin cancer by smelling the entire body. It is thought that cancer patients have a different odor that is detectable to trained dogs. It will be interesting to follow the development of this canine diagnosis or “dognosis” in the future ( Balseiro & Correia, 2006 ; Wells, 2012 ).

Dogs in the Correctional Setting

Canine Assistants, an organization that trains service dogs, has an at-risk youth program for juvenile male offenders, ages 13 to 18 years. The program is jointly sponsored with the West Florida Wilderness Institute and Camp Sierra Blanca in New Mexico. It is a residential program with an average stay of 6 months. The young men work with service puppies and dogs under the supervision of experienced trainers. The goal is to learn responsibility, patience, and goal setting. Statistics demonstrate increased self-esteem, improved school grades, and a decreased recidivism rate for those involved in the program.

In correctional institutes all across Ohio, puppies and prisoners are team- ing up in an unusual program. A nonprofit organization called Pilot Dogs, Inc., places service puppies under the care of prisoners until the pups are ready for formal training as service dogs. Since the inception of the program

Chapter 27 • Animal-Assisted Therapy 385

in 1992, hundreds of dogs have been placed in prisons. Inmates are chosen based on their records of good behavior and experience with dogs. No violent offenders are permitted to raise the dogs. The puppies sleep in crates in the cells with their partners and accompany them on their daily activities, includ- ing trips to the dining hall, where the puppies learn to be well behaved around people and become accustomed to the noise and crowds they will be faced with later. The prisoner is responsible for the care and well-being of the dog and for housebreaking, leash-training, and putting the dog through a basic obedience course. After spending about 12 months at the correctional facility, the puppies are removed and placed in an intensive training program.

A major advantage for the dogs is having human contact 24 hours a day, which is less likely to occur in regular foster homes. The chosen prisoners have the pleasure and delight of having a puppy to give love to and receive love in return. They also have the satisfaction of seeing the benefits of their training as the puppy progresses. At the Purdy Treatment Center, a maximum security prison for women in Gig Harbor, Washington, selected inmates learn to train and groom dogs from the local Humane Society. They socialize the stray dogs for home adoption. In addition they run a grooming and boarding service for dogs in the community. Many other states, as well as prisons in Australia, England, and Scotland, have adopted the Ohio model ( Furst, 2006 ; Turner, 2007 ).

RESEARCH

To date, much of the literature on the therapeutic use of animals in health care is anecdotal, but scientific research is beginning to appear. Most of the studies recommend further investigations because they show associations but not causal relationships. The following is a small sample of the literature:

• Some children have insecure or disorganized attachment patterns, which lessens their ability to use social supports when experiencing stressful situations. Forty-seven male children were randomly assigned to one of three groups: a friendly therapy dog, a friendly human, or a toy dog. Stress levels of the children were measured by salivary cortisol 5 times during the stressful study time. The physiologic response was signifi- cantly lower in the children with the therapy dog than in the children in the other two groups ( Beetz, Julius, Turner, & Kotrchal, 2012 ).

• Eleven children with neurologic and ambulation disorders participated in a 10-week hippotherapy program. Improvements in pelvic and hip joint positioning and a more normalized vertical trunk position may indicate improved postural control with hippotherapy intervention ( Encheff, Armstrong, Masterson, Fox, & Gribble, 2012 ).

• Twenty-seven people with multiple sclerosis were divided into two groups for therapy: therapeutic horseback riding or traditional physio- therapy. The group that received therapeutic horseback riding showed significant improvement in mobility assessment and gait parameters ( Muñoz-Lasa et al., 2011 ).

386 Unit 7 • Other Therapies

• A systematic review found that animal-assisted therapy is particularly effective in increasing positive behaviors in children with social disabili- ties and decreasing pain levels in chronic conditions ( Reed et al., 2012 ).

One of the largest organizations devoted to animal-assisted therapy is Pet Partners, with 1,500 members, 20% of whom are health care professionals. The objectives of Pet Partners are to promote study and research relating to human–animal interactions, to increase the awareness of the significance of these interactions among health care professionals, and to assess the role of the effect of human–pet bonds on the mental and physical well-being of peo- ple. Pets and People, a nonprofit volunteer agency founded in 1994, supports the research endeavors of graduate nursing students from the University of Southern Mississippi and Louisiana State University. Rainbow Animal Assisted therapy focuses primarily on children with special needs and is active in hospitals and health care facilities, residential centers, schools and libraries, parks, and camps.

INTEGRATED NURSING PRACTICE

An important nursing role is that of advocate. Nurse advocates serve as links between clients and other health care professionals of the community. In that role nurses in a wide variety of clinical settings can explore and encourage the thera- peutic use of animals. The many benefits of human–animal interaction include attachment, bonding, caring, pain management, stress management, motivation, communication, improved self-esteem, cardiovascular benefits, and improved coordination and balance. Disinterest on the part of health care professionals has been the major obstacle to growth in the field of animal-assisted therapy.

To set up an AAT program, you must begin by approaching the facility’s administration with a well-organized plan. This plan should include the fol- lowing aspects:

• Theory and research background • Goals and outcomes • Clearly written policy and procedures • Staff education about the proposed program • A plan for volunteer recruitment and training • A plan for testing and training of potential therapy animals • A plan for implementing the program • A plan for evaluating the program

You can anticipate some opposition to the initiation of an AAT program. One of the biggest concerns is the potential for transmission of infectious diseases. Although the risk is low, several zoonoses, or animal-transmitted infections, can occur. Seek the assistance of a veterinarian to identify the risks for specific types of infections and measures to prevent them. Infection risk can be reduced by making sure each animal is clean, vaccinated, and healthy; keeping the animal out of the areas where food is prepared and

Chapter 27 • Animal-Assisted Therapy 387

served; and having residents wash their hands after the animal visits. Products can be sprayed on the animal’s fur to reduce the risk of an allergic reaction ( Friedmann & Son, 2009 ).

“No pets” policies may not be applied to service animals. Hospitals, medical offices, laboratories, imaging services, day care centers, schools, restaurants, and others are covered under the Americans with Disabilities Act. The ADA requires that places of public accommodation modify their policies and practices to permit the use of a service animal by a person with a disability, unless doing so would create a direct threat to the safety of others or the facility. There is no legal requirement that a service animal wear special equipment or tags. Facilities are advised to accept the verbal reassurance of the person that he or she has a disability and that the animal is a service animal. Requiring “proof” is prohibited by the ADA.

If you are a pet owner, you can consider becoming a pet therapy volun- teer. Many long-term care facilities encourage regular visits from people with trained and screened animals. Increasingly, these pets are also welcome at hospitals, cancer clinics, and hospices. This type of personal involvement in animal-assisted therapy can be wonderfully rewarding.

Very new to the use of animals in health care are the Mexican hairless breed known as Xolos (pronounced “show-low”). These dogs cuddle up to their owners and radiate the same amount of heat as a heating pad, which seems to work wonders for people with arthritis or fibromyalgia. The body temperature of Xolos is the same as that of all dogs, 102°F, but the lack of hair means that body heat is transferred directly to the surface the dog is touching. A nonprofit group, Xolos for Chronic Pain Relief, matches dogs with pain sufferers.

As a nurse you have wonderful opportunities to incorporate AAT in your work with people infected with HIV/AIDS. In the past, these individu- als were told to give up their pets for fear that their compromised immune system would place them at high risk for zoonotic infections. The reality is that people are more likely to contract zoonotic infections from contaminated food, water, soil, or even other people than from pets. You may need to explain to some clients that HIV infects only humans and other primates and therefore cannot be spread from or to dogs, cats, birds, or even fish. With this understanding, you can become an advocate for the physical, emotional, and psychological benefits of pet companionship for those with HIV/AIDS.

With proper care and understanding and a healthy pet, the potential health risks of pet companionship are minimal and the benefits may far outweigh the risks. People living with HIV often deal with feelings of isolation, rejection, and lack of purpose. Companion animals offer such individuals purpose, a feeling of being needed, a way to increase socialization, and a constant source of uncondi- tional affection. Clients selecting a new pet should consider one whose tempera- ment, energy level, and environmental needs match their own. An older pet may be more appropriate than a young one. Box 27.1 describes the teaching you should do with any clients who are ill or immunosuppressed as a result of a disorder, chemotherapy, or organ transplants. The precautions are designed to protect people from acquiring secondary infections.

388 Unit 7 • Other Therapies

A number of communities provide services to enable people who are ill to keep their pets. Volunteers provide dog-walking services for people physi- cally unable to walk their dogs, deliver pet food and supplies, clean litter boxes and birdcages, provide in-home care for cats whose owners must go to the hospital, and foster care for dogs in the same situation. You could volun- teer your time and energy to this type of program, or if your community has no such program, you could establish one.

BOX 27.1

Client Teaching: Pet Owners Experiencing Illness

Veterinary Care

• Have your veterinarian examine your pet initially and then at least once a year. • Keep your pet up to date on annual shots and rabies vaccination. • Seek veterinary care immediately for sick pets. • Have your veterinarian check street animals that are “adopted” before bringing

them into your home.

Pet Care

• Keep your pet clean and well groomed with short, blunt toenails. • Keep the pet’s living and feeding areas clean. • Keep your cat’s litter box out of the kitchen; use a litter box liner and change it

daily. • Always walk your pet on a leash, and minimize the pet’s contact with other animals

and garbage. • Keep cats indoors and prevent them from hunting birds and rodents. • Feed your pet only commercially prepared pet foods; never feed raw meat or unpas-

teurized milk. • Do not allow birds to fly free in your home; avoid their droppings.

General Hygiene

• Wash your hands frequently, especially before eating, smoking, or attending to open wounds.

• Keep your cat off all kitchen surfaces. If that is not possible, be sure to wipe down, with a gentle disinfectant, any surface on which food may be placed.

• Do not allow your dog or cat to drink out of the toilet, because it is a place of many germs.

• Try to avoid contact with your pet’s bodily fluids. Wear gloves and a face mask for cleaning a litter box, aquarium, or birdcage.

Sources: POWARS, New York, NY; PAWS, San Francisco, CA; Pet Partners, Bellevue, WA; Action AIDS, Philadelphia, PA.

Chapter 27 • Animal-Assisted Therapy 389

TRY THIS

Interacting With Your Pet

When you are feeling tense or anxious and if you have a dog or a cat to which you are attached, try the following:

• Note your physical and emotional signs of tension: Are your hands clenched? Body trembling? Are you restless? Unable to relax? Mouth dry? Stomach upset? Breath- ing rapidly? Unable to concentrate? Worrying?

• Do something with your pet for at least 20 minutes: play, groom, or talk. • Conduct another self-assessment. What, if anything, has changed?

If you have a dog or a cat to which you are attached, try this:

• Have a friend take your pulse and blood pressure. • Gently play with your pet, stroke, pet, and talk to your animal for 15 minutes. • Have your friend take your pulse and blood pressure again and compare the results

with those taken prior to the interaction.

Animal contact contributes to self-concept, social interaction, a decrease in loneliness and anxiety, and in general contributes to physical, psychologic, and spiritual well-being. Nurses can and should be at the forefront of design- ing and supporting more humane approaches to those in their care.

Considering the Evidence

D. A. Marcus, C. D. Bernstein, J. M. Constantin, F. A. Kunkel, P. Breuer, and R. B. Hanlon, 2012, Animal-assisted therapy at an outpatient pain management clinic, Pain Medicine, 13: 45–57.

What Was the Type of Research? Primary research

What Was the Purpose of the Research? To investigate the effects of spending waiting time in an outpatient pain management facility with a therapy dog compared with spending time in the outpatient waiting room

How Was the Study Done? The authors identified the design of the study as open label. Participants completed a screen- ing survey that included demographic data and self-reported pain, fatigue, and emotional

(continued)

390 Unit 7 • Other Therapies

distress. After completing the screening survey, participants could choose to spend time with a certified therapy dog instead of waiting in the outpatient waiting area. The sample who spent time with the therapy dog consisted of 235 patients, 34 family members and friends, and 26 staff personnel, compared with 83 patients, 6 family members and friends, and 7 staff personnel who were assigned to the waiting room. Both sets of participants completed another survey after the waiting period to describe their experience.

What Were the Findings of the Research? Pain, mood, and other measures of distress experienced by patients living with pain sig- nificantly improved after the visit with the therapy dog, but similar results were not found with the patients assigned to the waiting room only. Family, friends, and staff members also showed significant improvements after the therapy dog visits. Unprompted remarks by the study participants during and after the therapy dog visits were positive in nature.

What Additional Questions Might I Have? Did the fact that the study participants could self-select to engage with the therapy dog influence the outcome? Did their favorable response to being with the therapy dog indicate they had a preconceived favorable impression of pets and thus were more likely to benefit from the experience? Could the same results be achieved with other therapy animals? Were there any long-term effects related to this encounter with the dog ther- apy? Would similar results be obtained if the number of treatment and control group subjects were comparable?

How Can I Use This Study? This study has clinical value for persons who are experiencing lengthy wait times for medical visits or procedures and have access to therapy animals. Animal-assisted therapy might lessen the stress associated with waiting for medical care and enhance the mood of patients and their perception of the health care they are receiving. Nurses need to be cognizant of the value of the research as a possible adjunct strategy for relieving chronic pain.

Source: Contributed by Dolores M. Huffman, RN, PhD

References

Balseiro, S. C., & Correia, H. R. (2006). Is olfactory detection of human cancer by dogs based on major histocompatibility complex–dependent odor components? Medical Hypotheses , 66(2): 270–272.

Beetz, A., Julius, H., Turner, D., & Kotrschal, K. (2012). Effects of social support by a dog on stress modulation in male children with insecure attach- ment. Frontiers in Psychology, 3: 1–8. doi: 0.3389/fpsyo.2012.00352

Berget, B., Ekeberg, O., & Braastad, B. O. (2008). Attitudes to animal-assisted ther- apy with farm animals among health staff and farmers. Journal of Psychiatric and Mental Health Nursing , 15: 576–581.

Dietz, T. J., Davis, D., & Pennings, J. (2012). Evaluating animal-assisted therapy in group treatment for child sexual abuse. Journal of Child Sexual Abuse, 21(6): 665–683. doi: 10.1080/ 10538712.2012.726700

Chapter 27 • Animal-Assisted Therapy 391

Encheff, J. L., Armstrong, C., Masterson, M., Fox, C., & Gribble, P. (2012). Hippo- therapy effects on trunk, pelvic, and hip motion during ambulation in children with neurological impairments. Pediatric Physical Therapy, 24(3): 242–250. doi: 10.1097/PEP.0b013e31825c1dc3

Fine, A. H. (2010). Handbook on Animal- Assisted Therapy (3rd ed.). London, UK: Academic Press.

Friedmann, E., & Son, H. (2009). The human-companion animal bond. Vet- erinary Clinics of North America: Small Animal Practice , 39(2): 293–326.

Furst, G. (2006). Prison-based animal pro- grams: A national survey. Prison Jour- nal , 86(4): 407–430.

Hume, L. (2002). Animal facilitation in occupational and physical therapy sessions. Retrieved from www. n o r t h e a s t r e h a b . c o m/f e a t u r e s /animal-facilitated-therapy

Marcus, D. A., Bernstein, C. D., Constantin, J. M., Kunkel, F. A., Breuer, P., & Hanlon, R. B. (2012). Animal-assisted therapy at an outpatient pain manage- ment clinic. Pain Medicine, 13(1), 45–57. doi: 10.1111/j.1526-4637.2011.01294.x

Muñoz-Lasa, S., Ferriero, G., Valero, R., Gomez-Muñiz, F., Rabini, A., &

Varela, E. (2011). Effect of therapeutic horseback riding on balance and gait of people with multiple sclerosis. Gior- nale Italiano di Medicina del Lavoro ed Ergonomia, 33(4): 462–467.

Nightingale, F. (1969). Notes on Nursing . New York, NY: Dover.

Reed, R., Ferrer, L., & Villegas, N. (2012). Natural healers: A review of animal assisted therapy and activities as com- plementary treatment for chronic con- ditions. Revista Latino-Americana de Enfermagem, 20(3): 612–618. doi: org. S0104-11692012000300025

Salgueiro, E., Nunes, L., Barros, A., Maroco, J., Salgueiro, A. I., & Santos, M. E. (2012). Effects of a dolphin inter- action program on children with autism spectrum disorders: An explor- atory research. BMC Research Notes, 5:199. doi: 10.1186/1756-0500-5-199

Turner, W. E. (2007). The experiences of offenders in a prison canine program. Federal Probation , 71(1): 38–43.

Wells, D. L. (2012) Dogs as a diagnostic tool for ill health in humans. Alterna- tive Therapies in Health and Medicine, 18(2): 12–17.

Resources

Australian Network for the Development of Animal Assisted Therapies ANDAAT Foundation P.O. Box 162 Caulfield South VIC 3162 0417 363 136 www.andaat.org.au

Canine Assistants 3160 Francis Rd. Milton, GA 30004 800.771.7221 www.canineassistants.org

Equine Assisted Growth and Learning Association (EAGALA) P.O. Box 993

Santaquin, UT 84655 877.858.4600 www.eagala.org

Federation of Horses in Education and Therapy International P.O. Box 134 Damariscotta, ME 04543 www.frdi.net

Invisible Disabilities Association P.O. Box 4067 Parker, CO 80134 www.invisibledisabilities.org

Pet Partners 875 124th Ave., NE, Suite 101 Bellevue, WA 98005

392 Unit 7 • Other Therapies

425.679.5500 www.petpartners.org

Puppies Behind Bars 263 West 38th St., 4th Floor New York, NY 10018 212.680.9562 www.puppiesbehindbars.com

Rainbow Animal Assisted Therapy 6042 West Oakton St. Morton Grove, IL 60053 773.283.1129 www.rainbowaat.org

St. John Ambulance Therapy Dog Program Suite 400, 1900 City Park Drive Ottawa, ON K1J 1A3 613.236.7461 www.sja.ca/Canada /CommunityServices/Programs /Pages/TherapyDogsServices.aspx

Therapet P.O. Box 130118 Tyler, TX 75713 903.535.2125 www.therapet.com

Therapy Dogs International 88 Bartley Rd. Flanders, NJ 07836 973.252.9800 www.tdi-dog.org

Warrior Canine Connection 23222 Georgia Ave. Brookville, MD 20833 301.260.1111 warriorcanineconnection.org

APPENDIX

Alternative Therapies for Common Health Problems

This appendix provides information relating to the management of minor health problems. These types of problems often respond well to alternative therapies and lifestyle modification. If in doubt about the seriousness of symptoms, see your health care practitioner. A number of suggestions are given for various problems. Select one that seems to be the most appropriate for your situation, and keep notes on what seems to work and what does not. Modify these suggestions according to your individual needs.

ABRASIONS, SCRAPES

• Aromatherapy: After washing with soap and water, apply 1–3 drops of lavender or tea tree oil to the wound; reapply oil twice a day until healed.

• To disinfect, pour 3% hydrogen peroxide into the wound and let it foam up.

• Apply the skin of a freshly peeled banana to the affected area, or cut a thin slice of raw potato and tape it over the affected area.

• Herbs: Sprinkle goldenseal powder in the wound. Crushed garlic mixed with honey makes a soothing salve: spread on a piece of clean gauze and cover the injured area.

ACNE

• Aromatherapy: Bergamot, cedarwood, chamomile, clary sage, lemon grass, melissa, patchouli, rosemary, sandalwood, tea tree, thyme, and ylang-ylang can be made into a facial mask, compress, or topical cream. Tea tree and lavender oils can be applied directly to blemishes.

• Herbs: arnica, borage, calendula skin products, tea tree oil • Supplements: vitamin A, vitamin B 6 , zinc, or evening primrose oil

AIDS

• Acupuncture • Herbs: curcumin, extract of boxwood plant, echinacea, licorice, golden-

seal, garlic, Chinese bitter melon • Hyperbaric oxygen • Massage • Supplements: iron; vitamins C, E, and B; beta-carotene; glutamine;

selenium

393

394 Appendix

ALCOHOL ABUSE

• Acupuncture • Antioxidants: selenium, zinc, vitamins C and E • Bach flower essence, chrysanthemum, milkweed • Herbs: milk thistle, kudzu, oatstraw, skullcap; evening primrose oil for

withdrawal • Meditation • Megavitamin therapy: B vitamins • Therapeutic Touch, Healing Touch • Yoga

ALLERGIES

• Applied kinesiology • Herbs: Stinging nettles to alleviate runny nose and sneezing. Teas made

from chamomile, elder, or yarrow flowers can reduce reactions. • Homeopathy: allium cepa (onion); windflower; for swelling in the face:

1 tablet of apis every 15 minutes—maximum 6 doses • Supplements: Vitamin C to decrease histamine production. • Water: Important to keep well hydrated; 64–96 ounces of water a day

ALZHEIMER’S DISEASE (DEMENTIA)

• Reflexology • Supplements: zinc, selenium, evening primrose oil, fish oil, coenzyme

Q10; vitamins B 6 , C, and E • Music

AMPUTATIONS: PHANTOM PAIN

• Magnets: Improve blood flow to stump and cause phantom pain to disappear

• Massage

ANXIETY

• Acupressure: Press center of inside wrist 1 inch above crease toward elbow. • Animal-assisted therapy • Aromatherapy: basil, bergamot, chamomile; frankincense deepens

breathing to induce calmness; green apple, juniper, lemon balm, orange, neroli for panic attacks

• Biofeedback • Flower essences: aspen, mimulus, red chestnut • Herbs: valerian, passionflower, lemon balm, chamomile, ylang-ylang • Homeopathy: St. Ignatius bean, arsenic, Rescue Remedy • Massage

Appendix 395

• Meditation • Reiki • Relaxation techniques • Therapeutic Touch, Healing Touch • Performance anxiety: hypnosis, guided imagery, Alexander Technique

ARTHRITIS

• Aromatherapy: cedarwood, coriander, cypress massage or cold compress, compress of rosemary to swollen joints, ginger and orange oil massage

• Acupuncture • Alexander Technique: to relieve muscular tension and uneven weight

bearing • Bioelectromagnetics • Chiropractic • Exercise (non-weight-bearing) in water or moderate exercise as tolerated • Feldenkrais Method • Herbs: devil’s claw, boswellia, SAMe, evening primrose oil; ginger;

feverfew, capsaicin cream applied topically, glucosamine (1500 mg) and  chondroitin (1200 mg) to help restore joint integrity; natural anti-inflammatories such as willowbark, turmeric, and ginger

• Homeopathy: poison ivy • Ice joints and then rub in analgesic oils. • Magnets: Place over an inflamed area on a regular basis. • Reflexology: Work all joints of the hands and feet for pain relief and

mobility of corresponding body joints. • Rolfing • Supplements: thiamine, vitamins B 6 and B 12 , calcium, magnesium, glu-

cosamine, chondroitin; green tea, avocado-soybean unsaponifiables • Therapeutic Touch • Yoga: Practice slowly, seeing how far the affected joints can be moved

without pain. Do not exercise joints when they are inflamed.

ASTHMA

• Acupuncture • Alexander Technique: teaches a more relaxed way of breathing and ena-

bles an individual to manage an asthma attack • Aromatherapy: Put several drops of cypress on a handkerchief and

inhale deeply. Put frankincense on a pillow at night to slow and deepen the breathing.

• Biofeedback • Breathing exercises • Hypnosis • Herbs: holy basil, elecampine, country mallow, malabar nut, bayberry.

Mix 3 parts tincture of lobelia with 1 part tincture of capsicum. Take

396 Appendix

20 drops in water at the start of an asthmatic attack. Repeat every 30 minutes for a total of 3 or 4 doses.

• Homeopathy: arsenicum album, 1 tablet 3 times daily for maximum of 1 week

• Meditation • Reflexology: During an asthma attack, work the reflexes for the dia-

phragm and lungs on the balls of the feet. • Water: Drink plenty of water to keep the respiratory tract secretions fluid. • Yoga: Focus on expansive postures and breathing practices designed to

increase the length of the exhalation.

ATHLETE’S FOOT

• Acupressure: Do full foot or hand acupressure massage sessions twice a week to stimulate the immune and endocrine systems. Do not press on areas of broken, sore, or cracked skin.

• Aromatherapy: cedarwood, lemon balm, rosemary. Mix 2 drops of lav- ender oil and 1 drop of tea tree oil, and apply between toes.

• Herbs: bitter orange. Apply black walnut tincture directly to fungus patches, and drink a tea of green crushed walnut hulls for fungus anywhere in body.

• Naturopathy: kyolic garlic tablets. Dust your feet and shoes with garlic powder.

• Supplements: Take B-complex vitamins, 50–100 mg, 3 times a day, with meals. Dust vitamin C powder directly onto affected area. Zinc may help clear the skin and boost the immune system.

ATTENTION DEFICIT HYPERACTIVITY DISORDER

• Aromatherapy: lavender, rosemary, valerian • Change diet from “junk foods” high in artificial flavors, preservatives,

and sucrose to nutrient-dense foods • Herbs: chamomile • Homeopathy • Massage • Meditation • Neurofeedback • Supplements: B vitamins, iron, magnesium, omega-3 fatty acids • Yoga

BACK PAIN

• Acupuncture • Alexander Technique: teaches a more balanced use of body, since mus-

cular imbalance often contributes to back pain • Applied kinesiology • Biofeedback

Appendix 397

• Chiropractic • Equine-assisted therapy • Herbs: valerian, nutmeg, gotu kola. To ease local discomfort, soak a

compress in 1/2 cup hot water containing 1 tsp. camp bark and 1 tsp. cinnamon tinctures.

• Homeopathy: arnica, 4 tablets as soon as possible after an injury, repeated every hour for the first day while awake; second day: 4 tablets every 2 hours; third day: 4 tablets 4 times a day

• Hydrotherapy: For acute back pain, use an ice pack on affected area for 20 minutes every 1–2 hours.

• Magnets: Place small magnets over area of muscle spasm in back. • Massage with warm oil. • Reflexology: Work the spinal reflexes, especially the tender points, on

the medial longitudinal arches of the feet (the bony ridges on the inside). • Sleep on back with pillows under knees or on side with pillow between

bent knees. • Yoga: Lie down with legs bent, feet flat on floor, exhale fully and slowly for

at least 12 breaths. Long-term yoga practice can strengthen back muscles.

BALANCE PROBLEMS

• Alexander Technique • Equine-assisted therapy • Qigong • T’ai chi

BEE STINGS/INSECT BITES

• Aromatherapy: tea tree, basil, bergamot, lavender, thyme, ylang-ylang • Add enough water to baking soda or meat tenderizer to make a paste

and apply it to the sting. • Cover affected area with a small amount of mashed fresh papaya. • Herbs: Apply fresh aloe vera sap directly to the bite. If bite becomes

infected, bathe with marigold or echinacea tea. Apply a fresh slice of onion to both bee and wasp stings. A mixture of honey and crushed gar- lic makes a soothing ointment.

• Homeopathy: apis, 1 tablet every 30 minutes; maximum of 6 doses for burning and swelling

BONES (BROKEN)

• Aromatherapy: Massage in elemi oil prior to casting. • Bioelectromagnetics: Place magnets into the dressings over fractures. • Healing Touch • Reiki • Therapeutic Touch

398 Appendix

BRUISES

• Aromatherapy: cypress. Combine 1 drop of chamomile with 2 tsp. of ice- cold water. Soak a cotton pad in this mixture and apply to the affected area.

• Herbs: witch hazel (topical), arnica tablets, or massage tincture of arnica into bruised area; 200–400 mg of bromelain 3 times a day on an empty stomach

• Homeopathy: aconite, 1 or 2 doses only over 15 minutes immediately for the “shock” of the injury

• Hydrotherapy: cold compresses for first 12 hours with occasional breaks to prevent excessive chilling

• Supplements: 2,000 mg vitamin C, 3 times a day, for people who bruise easily. Drink pineapple juice, because enzymes speed the rate at which the blood causing the bruise is resorbed.

BURNS (MINOR)

• Aromatherapy: For pain relief: chamomile, eucalyptus, geranium, laven- der. To reduce inflammation: chamomile, clary sage, geranium, laven- der, myrrh, tea tree. To regenerate skin: chamomile, clary sage, eucalyptus, geranium, myrrh, rose, tea tree

• Herbs: aloe vera sap, calendula lotion, or raw honey • Hydrotherapy: Immediately immerse the affected part in cool water for

5–10 minutes with a brief break during the first 20 minutes after the injury. • Magnets: Place over site of injury to control pain and speed healing.

CANCER

• Acupuncture to treat side effects and symptoms • Antioxidants: vitamins A, C, and E; coenzyme Q10 • Faith and prayer • Herbs: betulinic acid from birch trees, thuja tincture, bromelain, gotu

kola, essiac, green or black tea, maitake mushroom, selenium • Imagery • Massage • Meditation • Qigong • Shark cartilage: works best against solid tumors, especially ovarian and

prostate tumors • Shark liver oil may help people tolerate chemotherapy and radiation. • Supplements: reishi mushroom • Yoga

CANKER SORES

• Herbs: licorice root gel, echinacea tincture, butternut, comfrey. Gargle with a mixture of 1 cup of warm water with 1/4 tsp. of salt and 1/2 tsp. of goldenseal powder.

Appendix 399

• Supplements: vitamin A (25,000–50,000 IU daily) prevents infection from spreading. B-complex (50–100 IU 3 times a day); vitamin E (400– 800 IU daily); selenium (200 mcg daily); acidophilus, 4 capsules, 4–6 times a day

CARPAL TUNNEL SYNDROME

• Acupressure: Firmly press (for 2 minutes) on point on inside surface of forearm about 1 inch up from wrist fold. Also press on point on outside surface of forearm one third of way up between wrist fold and elbow.

• Chiropractic • Herbs: ginger compress • Hydrotherapy: contrast applications • Magnets: Place over the front and back of the wrist to control symptoms • Massage • Pressure point therapies

CHEST CONGESTION

• Aromatherapy: cedarwood, steam inhalation of eucalyptus, frankin- cense. Massage chest with lavender. Inhale marjoram, peppermint, eucalyptus, or rosemary. Place drops of tea tree oil on handkerchief.

• Herbs: tea made with peppermint and yarrow (1/2 tsp. each). Mix sage or eucalyptus leaves in a bowl of steaming water and inhale with a towel draped over the head.

CHOLESTEROL (HIGH)

• Herbs: garlic, ginger, green tea, Indian gooseberry, soy, artichoke leaf extract

• Meditation • Supplements: Profibe (grapefruit fiber), oatmeal • Yoga

CHRONIC FATIGUE SYNDROME

• Acupuncture • Herbs: acute phase—echinacea, goldenseal, licorice; chronic phase—

goldenseal, astragalus, Siberian ginseng • Supplements: beta-carotene, vitamin C, zinc

CIRCULATION (POOR)

• Aromatherapy: rosemary (increases circulation to skin), vetiver • Biofeedback: increases circulation to specific areas of the body • Exercise

400 Appendix

• Herbs: ginkgo, garlic, cayenne, hawthorn, bilberry • Hypnosis • Imagery • Magnets • Massage • Therapeutic Touch • Yoga

COLD SORES

• Aromatherapy: Apply tea tree oil at onset and continue until cleared. • Herbs: echinacea or goldenseal, l -lysine. Lemon-balm tea shows signifi-

cant antiviral activity against herpes simplex. • Hydrotherapy: For early stages, apply ice—on the sore for 10 minutes,

off for 5 minutes. • Supplements: vitamins C, B-complex, E

COLIC

• Aromatherapy: chamomile (rubbed on abdomen), coriander, orange, peppermint

• Chiropractic • Massage abdomen. Massage bottom of feet with warmed sesame oil.

COMMON COLD

• Acupressure: if sinuses become blocked or painful • Aromatherapy: Inhale lavender, eucalyptus, or peppermint oil in steam

vaporizer to speed recovery and lessen stuffiness. Add 3 drops lemon oil, 2 drops each of thyme and tea tree oil, and 1 drop eucalyptus into hot bath.

• Herbs: tea from fresh ginger and brown sugar; echinacea at the first sign of a cold; astragalus, garlic, goldenseal, eyebright, elecampane

• Homeopathy: allium cepa (onion), monkshood or aconite, or natrum muriaticum

• Reflexology: Work the fingers and thumbs, the webs between the fin- gers, the pads beneath the fingers, and the spaces on the back of the hands for the reflexes of the head, lungs, and upper lymphatics.

• Supplements: vitamins A and C, zinc lozenges; selenium for 3 days to help resist a cold

CONSTIPATION

• Aromatherapy: Massage abdomen in a clockwise direction with orange, black pepper, ginger, or marjoram mixed in a carrier oil.

• Biofeedback of pelvic floor muscles

Appendix 401

• Exercise, especially activities that work the abdominal muscles such as rowing, swimming, walking, or sit-ups

• Herbs: dandelion root, chicory root, angelica root, cascara sagrada, senna. Psyllium can be used for several days; long-term use can be damaging.

• Homeopathy: bryonia (wild hops) or nux vomica • Reflexology: areas for the colon on the soles of both feet • Water: Drink 6–8 glasses daily. • Yoga: Twisting postures and forward bends are often helpful.

CORNS

• Aromatherapy: Mix 2 drops each of orange, lemon, and lavender oils in a basin of warm water and soak feet for at least 15 minutes per day.

• Hydrotherapy: hot Epsom salts foot bath, then rub corns with fresh lemon juice

• Reflexology: around and directly on the corns

COUGH

• Aromatherapy: cedarwood. Place several drops of cypress or tea tree oil on handkerchief and inhale deeply. Add 3 drops eucalyptus and 2 drops thyme oil to 2 tsp. vegetable oil. Massage into neck and chest. Do steam inhalation using sandalwood, benzoin, eucalyptus, frankincense, or peppermint.

• Herbs: licorice, wild cherry bark, thyme; tincture of mullein in warm water 3 times a day; horehound

• Homeopathy: bryonia (wild hops), monkshood, rumex, stannum • Reflexology: Work the lung and diaphragm reflexes on and beneath

balls of feet and webs between big toes and second toes.

DEPRESSION

• Acupuncture • Animal-assisted therapy • Aromatherapy: bergamot, geranium, jasmine, lemon balm, rose, ylang-

ylang. Add 15 drops geranium, 10 drops of bergamot, and 5 drops of lavender to bath.

• Exercise • Flower essences: gentian, hornbeam, mustard, gorse, sweet chestnut • Herbs: Saint-John’s-wort, SAMe, valerian • Homeopathy: Rescue Remedy • Hypnotherapy • Meditation • Neurofeedback • Reiki • Supplements: B vitamins, omega-3 • T’ai chi

402 Appendix

• Therapeutic Touch • Transcranial magnetic stimulation • Yoga

DIABETES

• Aromatherapy: Using a carrier oil, rub juniper or cedar oil over spleen and pancreas area.

• Biofeedback • Exercise • Herbs: blueberry leaf tea, 2 cups a day on a regular basis; 100–200 mg of

coenzyme Q10 every day for at least 3 months to stabilize blood sugar; gymnesly, green tea, ginger, ginseng, goldenseal

• Supplements: vitamins B 6 , C, and E; chromium; magnesium; essential fatty acids; flaxseed oil

• Yoga

DIARRHEA

• Aromatherapy: Gently massage abdomen with coriander, chamomile, neroli, lavender, or peppermint in carrier oil.

• Herbs: 2 tsp. of your choice of one of the following: black pepper, cham- omile, coriander, rosemary, sandalwood, or thyme per cup of boiling water to make tea

• Homeopathy: podophyllum—1 tablet hourly until improved, then every 4 hours—for a maximum of 5 days

• Supplements: zinc • Replace lost fluids.

DRUG ADDICTION

• Bach flower essence: California poppy, morning glory, chrysanthemum • Biofeedback • Herbs: chamomile and ginseng (cocaine withdrawal); valerian (benzodi-

azepine withdrawal)

EAR INFECTIONS

• Acupressure: Massage just behind the tip of the mastoid bone at the bot- tom of the back of the ear to relieve pain.

• Aromatherapy: Put a drop of lavender on cotton and put it in the ear. Use a chamomile tea bag that has been infused for a few minutes and place it on the side of the face or over the ear while the tea bag is still warm.

• Chiropractic • Craniosacral manipulation

Appendix 403

• Ear candles • Herbs: warm mullein oil drops in ear • Homeopathy: pulsatilla, belladonna, or aconite • Reflexology: Work all fingers and toes, paying close attention to the

webs between the fingers and toes, especially between the third, fourth, and fifth digits.

ECZEMA

• Aromatherapy: bergamot, chamomile, lavender, melissa, neroli, euca- lyptus, geranium, juniper

• Flower essences: Rescue Remedy, crab apple • Herbs: evening primrose oil applied directly • Hydrotherapy: heat compresses once a day

EMOTIONAL DISTRESS

• Aromatherapy: chamomile, frankincense (deepens breathing to induce calmness), marjoram

• Breathing exercises • Gratitude exercises • Positive affirmations

ENERGY IMBALANCE

• Applied kinesiology • Magnets • Pressure point therapies • Reiki • Shiatsu massage • Thai massage • Therapeutic Touch

FATIGUE

• Aromatherapy: Peppermint, rose, rosemary, and basil stimulate the brain. Lemongrass and rosemary are best for physical fatigue. Use these oils in the bath, in massage oils, in vaporizers, or on a handkerchief. Do not use peppermint or rosemary at night because they are too stimulating. Rose- mary should not be used by people with hypertension or epilepsy.

• Herbs: ginseng, especially for people over the age of 40 • Qigong • Reflexology: a brisk complete foot treatment for more energy, or a slow

complete foot treatment to induce sleep • Supplements: zinc, coenzyme Q10 • Yoga: Start with relaxation and gentle movements on your back, pro-

gressing to kneeling, standing, and/or seated postures.

404 Appendix

FEET (TIRED)

• Aromatherapy: Mix 2 drops each of rosemary, sage, and peppermint oils in basin of hot water and soak feet for at least 15 minutes. Rosemary (20 drops), sage (15 drops), and peppermint (10 drops) mixed in oil base can be applied directly to feet.

• Massage • Reflexology: Massage entire foot.

FEVER

• Aromatherapy: Tea tree and juniper encourage the body to sweat. Lav- ender and peppermint are cooling. Chamomile is soothing and calming, and can be used either in a bath or in cool water to sponge the body.

• Herbs: white willow. To a large mug of boiling water, add juice of 1 lemon, 2 tsp. honey, 1 tsp. grated ginger, 1/2 tsp. cinnamon, 1/2 tsp. nutmeg, and 1 tsp. brandy or whisky.

• Homeopathy: belladonna, aconite, ferrum phosphoricum, gelsemium

FIBROMYALGIA

• Acupuncture • Biofeedback • Herbs: topical capsaicin; 1 tsp. 3 times a day of equal parts of echinacea,

black cohosh, devil’s claw, licorice, dandelion, and celery • Hypnotherapy • Magnets: Magnets can be placed over painful areas during the day. • Massage • Supplements: magnesium, malic acid, vitamins E and C, fish oil, sele-

nium, zinc, SAMe

FLUID RETENTION (EDEMA)

• Herbs: dandelion leaf (diuretic and replaces potassium) • Massage feet and ankles. • Reflexology: lymph system, kidneys, adrenals points on the feet • Elevate legs

HEADACHE (TENSION)

• Acupressure: Press pressure points between eyebrows or at bottom of web between thumb and first finger.

• Alexander Technique: helps improve posture to avoid buildup of ten- sion in neck and shoulders

• Aromatherapy: basil, chamomile; massage lavender, peppermint, or eucalyptus around temples; rose compress to eyes

• Chiropractic

Appendix 405

• Herbs: ginseng, chamomile, turmeric, valerian, willow bark; 1/2 tsp. each of betony and skullcap made into tea

• Homeopathy: bryonia (wild hops), windflower, yellow jasmine, nux vomica • Neurofeedback • Pulsating electromagnetic fields • Relaxation techniques • Therapeutic Touch • Yoga

HEART DISEASE

• Animal-assisted therapy • Aromatherapy: to strengthen the heart muscle—garlic, lavender, pep-

permint, marjoram, rose, rosemary • Biofeedback • Exercise • Herbs: garlic, ginger; 1–2 capsules of hawthorn 4 times a day for mild angina • Meditation • Supplements: vitamins E, C, B 6 , and B 12; l -carnitine; coenzyme Q10 to

improve utilization of oxygen at cellular level, beta-carotene, selenium, magnesium, calcium, fish oil, plant sterols/stanols, black, green, oolong, white tea

• T’ai chi, qigong

HEAT RASH

• Herbs: Sprinkle arrowroot powder on affected area. Place 1/2 cup of freshly grated ginger into a quart of boiling water, remove from heat immediately, and steep for 5 minutes, then cool and sponge ginger water onto affected areas and let it dry.

HEMORRHOIDS

• Aromatherapy: Massage geranium, chamomile, or lavender oil, mixed with a carrier oil, into the rectal area as needed.

• Herbs: Apply aloe vera gel to relieve itching. Use compresses of witch hazel to clean area after bowel movement.

• Homeopathy: aesculus, aloe, or hamamelis • Hydrotherapy: Sit in warm bath for 15 minutes several times a day.

HICCUPS

• Acupressure: Place your middle and index fingers behind each earlobe. Apply light to firm pressure on the neck for 2 minutes as you concen- trate on breathing slowly and deeply.

• Reflexology: diaphragm and stomach points on the feet

406 Appendix

HYPERTENSION

• Animal-assisted therapy • Aromatherapy: ylang-ylang, clary sage, lavender, marjoram • Biofeedback • Chiropractic • Exercise • Herbs: garlic, hawthorn, olive leaf extract, maitake mushroom, reishi

mushroom, evening primrose oil, ginger, goldenseal • Hypnotherapy • Massage • Meditation • Qigong • Supplements: vitamin C, magnesium, flaxseed oil; calcium for pregnancy-

induced hypertension • T’ai chi • Yoga

IMMUNE ENHANCEMENT

• Aromatherapy: elemi, eucalyptus • Herbs: echinacea, goldenseal, astragalus • Massage • Qigong • Supplements: vitamins E and C, beta-carotene, garlic

INDIGESTION

• Aromatherapy: Use basil, chamomile, coriander, ginger, or peppermint as a tea or in massage oil or warm compress over stomach area.

• Herbs: chamomile, peppermint, ginger as a tea; for heaviness after a meal, chew on cardamom or fennel seeds

• Homeopathy: windflower; nux vomica—1 tablet hourly for 6 doses, then 3 times a day—for a maximum of 1 week

INFECTION (BACTERIAL)

• Aromatherapy: calendula, geranium, rosemary, tea tree, lavender, euca- lyptus, thyme, niaouli, bergamot. These oils work by attacking the organisms themselves, by killing airborne germs, and by strengthening the immune system.

• Herbs: echinacea at first sign of infection; echinacea may be combined with goldenseal; garlic in capsules

• Supplements: medicinal honey—manuka from New Zealand or medi- honey from Australia

Appendix 407

INFECTION (FUNGAL)

• Aromatherapy: calendula, lemon balm, rosemary • Herbs: garlic, tea tree oil (topical)

INFECTION (VIRAL)

• Aromatherapy: eucalyptus, lemon balm • Herbs: goldenseal, echinacea, garlic, tea tree oil (topical) • Supplements: zinc, selenium

INFERTILITY

• Meditation for unexplained infertility • Supplements: zinc for men • Acupuncture immediately after in vitro fertilization

INFLAMMATION

• Aromatherapy: benzoin, birch, chamomile, clary sage, elemi, fennel, geranium, helichrysum, jasmine, myrrh, patchouli, rose, sandalwood

• Bee venom may slow down the body’s inflammatory response by inhib- iting the amount of free radicals or by stimulating the adrenal glands to release cortisol.

• Homeopathy: belladonna • Hydrotherapy: applications of heat and cold • Magnets

INSOMNIA

• Acupuncture • Aromatherapy: chamomile, which can also be used with children; clary

sage, lavender, marjoram, neroli, or vetiver in bath or a pillow or as a room fragrance

• Exercise: not later than early evening • Herbs: valerian, lemon balm, catnip, hops, passionflower, skullcap teas

(If taste is unpleasant, add sugar, honey, or lemon.) • Homeopathy: windflower, nux vomica, arsenicum album • Hydrotherapy: warm baths • Light therapy—full-spectrum lights for 30 minutes a day • Magnets: Use magnetic pillow or pad for sedating effect. • Meditation • Neurofeedback • Supplements: melatonin

408 Appendix

IRRITABLE BOWEL SYNDROME

• Biofeedback • Exercise • Herbs: eneric-coated peppermint oil, ginger, chamomile, valerian, rose-

mary, lemon balm • Hypnotherapy • Meditation • Yoga

JET LAG

• Herbs: melatonin • Drink fluids and avoid alcohol. Do in-flight stretches.

LIVER DISEASE

• Herbs: milk thistle, dandelion root tea • Hydrotherapy: Take steam baths or saunas frequently to help body

eliminate toxins.

MACULAR DEGENERATION

• Herbs: gingko, bilberry, blackberry, cranberry, raspberry • Supplements: antioxidants, zinc, fish oil • Vitamin C and E, copper

MEMORY PROBLEMS

• Aromatherapy: basil, black pepper, coriander, ginger, peppermint, rose- mary, thyme

• Exercise • Supplements: vitamin B 6, green tea

MENOPAUSE

• Aromatherapy: geranium, rose, chamomile, yuzu, sandalwood, laven- der, bergamot, fennel in bath or in body creams

• Herbs: black cohosh (estrogen enhancer, hot flashes), chasteberry (hor- mone balancing), Saint-John’s-wort (mood swings), motherwort (palpita- tions and hot flashes), skullcap (anxiety), dong quai (estrogen enhancer), wild yam as tea; Chinese tonic of He Shou Wu, red clover, licorice

• Homeopathy: pulsatilla (mood changes), sulfur (hot flashes) • Hypnotherapy • Meditation • Supplements: vitamin E, soy protein, calcium, magnesium, flaxseed,

evening primrose oil

Appendix 409

MENSTRUAL DISCOMFORT

• Aromatherapy: basil. Massage abdomen and lower back with lavender, clary sage, and rose mixed in carrier oil.

• Herbs: tea of agnus-castus with rosemary for premenstrual water retention; black haw for cramps—4 tsp. in glass of warm water, repeat after 4 hours if necessary; Chinese tonic of dong quai, dandelion leaf for water retention

• Homeopathy: viburnum, magnesium phosphate, sepia, lachesis • Hydrotherapy: warm compresses • Reflexology: Massage uterine reflexes below inside ankle bones and

ovarian reflexes beneath outside ankle bones. • Supplements: calcium and manganese; fish oil, parsley, celery, and dan-

delion leaves are all mild diuretics • Yoga stretches; more relaxation and breathing exercises

MIGRAINE HEADACHES

• Aromatherapy: green apple (inhalant), lavender, melissa, or peppermint can be put on a facecloth with cool water and used as a compress on the forehead or back of the neck.

• Herbs: feverfew (prophylaxis), ginkgo • Homeopathy: iris, sanguinaria, glonoine • Hypnotherapy • Neurofeedback • Pressure point therapies • Pulsating electromagnetic fields • Spiritual meditation

MUSCLE SORENESS

• Aromatherapy: chamomile, juniper • Herbs: Rub in wintergreen oil or capsicum cream. • Hydrotherapy: spa • Massage • Movement therapy: t’ai chi, qigong, Feldenkrais • Yoga

NAUSEA

• Acupressure: wristband—small weights that exert pressure on a specific pressure point on the wrist

• Aromatherapy: ginger, lavender, peppermint used as a compress and as teas

• Healing Touch • Herbs: ginger • Homeopathy: ipecacuanha, sepia, clossypium

410 Appendix

• Imagery • Reiki • Therapeutic Touch

OSTEOPOROSIS

• Exercise: weight bearing unless advanced stage of disease • Herbs: a tea of stinging nettles, alfalfa, or sage, horsetail, dandelion root • Supplements: calcium, vitamins D and C, magnesium, natural hormone

therapy, soy

PAIN

• Acupuncture • Alexander Technique • Biofeedback • Chiropractic • Herbs: feverfew, devil’s claw • Hydrotherapy: hot water packs, cold applications • Hypnotherapy • Guided imagery • Magnets • Pressure point therapies • Reiki • Sports massage • Therapeutic Touch • Trager Approach • Trigger point massage

PHYSICAL DISABILITIES

• Balance difficulties—t’ai chi, yoga, equine-assisted therapy

POISON IVY AND POISON OAK

• Rinse the exposed area with soap and cold water. Mix baking soda with water to form a paste and apply it to skin. Once the paste has hardened, remove with cool water and apply a thin layer of honey to the area.

• Aloe. For itching and discomfort, grind 1 cup raw, whole oats to a fine powder and add to tepid bath—soak for 20–30 minutes.

• Homeopathy: Rhus tox

PREGNANCY

Although not a health care problem, it is included here for relief of some of the discomfort.

Appendix 411

Morning Sickness • Acupressure: wristband—small weights that exert pressure on a specific

pressure point on the wrist • Herbs: peppermint, catnip, ginger, chamomile, cinnamon, red raspberry

leaf teas

Labor • Acupuncture and moxibustion for breech presentation • Aromatherapy: Blend of clary sage, rose, and ylang-ylang can be used

for massage. Deep massage of lower back and hips during contractions— between contractions, massage shoulders, back, hands, and feet; if con- tractions are lagging, a light massage of the breasts may stimulate activity.

• Herbs: red raspberry tea, black cohosh tea, blue cohosh, bethroot • Hydrotherapy: water birth • Hypnotherapy

Postpartum • Herbs: lavender oil or aloe for perineal discomfort; cabbage leaves,

mother’s milk, alfalfa to encourage lactation • Reflexology to encourage lactation

PREMENSTRUAL SYNDROME

• Acupuncture • Aromatherapy: Massage or warm bath with rose oil, clary sage, ylang-ylang,

lavender, lemongrass, sandalwood, jasmine, bergamot. One will have to decide, by trial and error, which of these oils best suits the individual.

• Deep breathing exercises for a least 20 minutes a day • Exercise • Herbs: vitex, black cohosh extract, agnus-castus, chasteberry, Helonias,

evening primrose oil, Chinese tonic of dong quai • Homeopathy: windflower, pulsatilla, lachesis • Massage • Meditation • Reflexology: Massage uterine reflexes below inside ankle bones and

ovarian reflexes beneath outside ankle bones. • Supplements: vitamins A, E, B 1 , B 2 , and B 6 ; 2–3 g capsules of combined

fish oil and evening primrose oil, magnesium, zinc, calcium

PROSTATE ENLARGEMENT (BENIGN)

• Herbs: saw palmetto, pygeum africanum, stinging nettle root tea • Supplements: vitamins C, E, and B 3; zinc; manganese. Add soy foods to

diet.

412 Appendix

PSORIASIS

• Aromatherapy: bergamot (heal skin plaques), lavender (itching), melissa or geranium (irritated skin), jasmine (dry skin)

• Diet: Include foods with zinc, beta-carotene, vitamin D, and omega-3 fatty acids. Avoid liver and other organ meats, which aggravate psoriasis.

• Flower essences: Rescue Remedy cream, crab apple • Herbs: evening primrose oil, echinacea, licorice, milk thistle. Apply aloe

vera extract topically 3 times a day. Do not cover. • Homeopathy: sepai, arsenicum iodatum, petroleum • Add 2 drops calendula oil and 1 drop lavender oil to 2 tsp. almond oil,

and then massage area with mixture. • Sunshine on the skin is helpful.

RINGWORM

• Aromatherapy: rosemary, tea tree oil, lavender, geranium, peppermint, thyme

• Herbs: Apply a paste made of equal parts of myrrh powder and goldenseal powder mixed with a little water. A thin slice of garlic bandaged directly over the skin lesion and left for several days has a powerful antifungal effect.

• Homeopathy: sepia, arsenicum album, graphites

SCIATICA

• Acupuncture • Applied kinesiology • Chiropractic • Herbs: willow bark, black cohosh, chamomile, fenugreek, juniper ber-

ries, parsley, rosemary, skullcap • Homeopathy: colocynth, viscum album, lachesis, rhus tox, aconite, bel-

ladonna • Hydrotherapy: warm water jets • Reflexology: hip, sciatic, knee, lower spine, shoulder points on feet

SEXUAL DYSFUNCTION

• Acupuncture • Herbs: ginkgo for erectile problems; ashwaganda • Hypnotherapy • Imagery

SHINGLES

• Aromatherapy: eucalyptus, tea tree oil, lavender, chamomile, bergamot. Smooth the oil gently over the affected areas and down either side of the

Appendix 413

spine; if body is too painful to touch, add oils to a water spray or use in a bath.

• Flower essences: Rescue Remedy, crab apple • Herbs: echinacea, Saint-John’s-wort tea. Apply aloe vera gel to blistering

area. • Hydrotherapy: body-temperature bath for 30 minutes

SINUS PROBLEMS

• Acupuncture • Aromatherapy: Put basil, marjoram, or eucalyptus on handkerchief, or

use with a vaporizer. • Herbs: ephedra, goldenseal, yarrow, coltsfoot. Make a tea using 2 tsp. of

herb per cup. Use herbs in cream or oil, and massage the sinus areas. • Homeopathy: hydrastis, kali bichromicum, arsenicum album, silicea • Hydrotherapy: hot and cold compresses, steam inhalation, nasal lavage • Reflexology: Massage the sinus reflexes on the tips of the fingers and toes.

SKIN (DRY)

• Aromatherapy: Mix 2 drops each of sandalwood, rose, and geranium oil with 1 tsp. of almond oil. Use as a topical evening moisturizer. Other oils good for dry skin include jasmine, orange, and ylang-ylang used in a moisturizer or in a bath.

SORE THROAT

• Aromatherapy: Take several drops of sandalwood on handkerchief, or mix with carrier oil and massage into throat area. Then, wrap something warm around the throat.

• Herbs: Gargle with 1 cup of warm water with 1/4 to 1 tsp. of salt and 1/2 tsp. of goldenseal powder.

• Homeopathy: monkshood, poison ivy, belladonna • Hydrotherapy: contrast applications to neck and throat; heat compresses • Reflexology: Massage the throat reflexes around the “neck” of the big

toes and thumbs.

SPRAIN AND STRAINS

• Aromatherapy: chamomile, ginger, lavender as massage to area • Herbs: Mix 1/4 cup each of dry mustard powder and flour with warm

water to make a thick paste, spread the paste onto cheesecloth or gauze, roll it up, and apply to the strained area.

• Homeopathy: poison ivy • Hydrotherapy: cold compresses to reduce swelling first 24 hours; then

warm compresses to increase circulation

414 Appendix

• Magnets: Cover area with magnetic pad and secure with an Ace band- age. Put it on for 12 hours, then take it off for 12 hours.

• Myofascial release • Pressure point therapies • Reiki • Therapeutic Touch

STRESS

• Acupuncture • Aromatherapy: juniper, lavender, vetiver, ylang-ylang. Use jasmine in

massage oil or put in bath. • Breathing exercises; alternate nostril breathing (pranayama) • Exercise • Herbs: chamomile tea, passionflower, valerian, ginseng • Humor and laughter • Massage • Meditation • Music therapy • Progressive relaxation • Qigong • Yoga: Focus on slow movements and long exhalations.

SUNBURN

• Aromatherapy: Spray or rub with lavender and chamomile. • Herbs: Soak a soft cloth in cooled black or green tea and spread over the

burned area. Leave on 15–30 minutes. Apply aloe vera sap to area. • Hydrotherapy: cold compresses. Soak in a bath of tepid water and bak-

ing soda (1 pound) for 20–30 minutes; later that day or next, take a tepid bath with 1 or 2 cups of milk added.

• Grated potato applied directly to the skin will decrease pain and prevent blistering; wrap in place with a clean cloth.

SURGERY

• Hypnotherapy and visualization before surgery • Magnets: Place magnets over the incision site for 24 to 48 hours before

surgery to improve postoperative recovery. Place magnets over wound after surgery.

• Meditation before and after surgery

TENSION

• Aromatherapy: hot bath or massage using one of the following oils— bergamot, rose, cedarwood, chamomile, geranium, lavender, melissa, orange, or sandalwood

• Feldenkrais Method

Appendix 415

• Herbs: valerian, passionflower, chamomile, ginseng as teas • Massage • Meditation • Reiki • Therapeutic Touch

TINNITUS

• Acupuncture • Herb: gingko • Homeopathy: salicylicum acidum, chenopodium, cinchona officinalis • Supplement: vitamin B 12

URINARY INCONTINENCE

• Biofeedback of pelvic floor muscles

URINARY TRACT INFECTION

• Aromatherapy: bergamot, sandalwood, lavender, or juniper in bath water

• Herbs: uva ursi, goldenseal; saw palmetto for men • Homeopathy: pulsatilla, sepia, nux vomica • Hydrotherapy: contrast sitz baths • Supplements: unsweetened cranberry juice (300 mL daily); vitamins A

and C • Urinate after sexual activity. • Drink plenty of water.

WARTS

• Aromatherapy: 1 drop each of lemon, thyme, and tea tree oil mixed in a base oil and swabbed 2 times a day.

• Duct tape: Cover the warts with duct tape and leave undisturbed for several days.

• Hypnotherapy • Imagery • Supplements: vitamins A, C, B-complex, and E; zinc; l -cysteine

WEIGHT CONTROL

• Aromatherapy: green apple, fennel, juniper, rosemary, bitter orange • Exercise • Herb: evening primrose oil • Supplements: 2.5 g of vitamin B 5 4 times a day; calcium, chromium, con-

jugated linoleic acid (CLA) • Yoga

416 Appendix

WOUNDS

• Aromatherapy: To disinfect: bergamot, chamomile, clary sage, jasmine, juniper, lavender, rose, tea tree. To relieve pain: bergamot, chamomile, geranium, jasmine, lavender, rosemary. To stop bleeding: cypress, gera- nium, rose. To reduce inflammation: chamomile, geranium, heli- chrysum, jasmine, patchouli. To promote formation of scar tissue: bergamot, chamomile, helichrysum, jasmine

• Bioelectromagnetics • Herbs: echinacea, goldenseal • Homeopathy: calendula, hypericum, ledum • Hydrotherapy: warm-water irrigation • Unprocessed honey may help disinfect wounds, sores, and actively pro-

mote wound healing.

INDEX

Abrasions/scrapes, 293 Abstinences, 243 Academy for Guided Imagery, 285 Academy of Chinese Culture and Health Science, 69 Academy of Veterinary Homeopathy, 161 Achterberg, J., 276 Acne, 393 Aconitum (monkshood), 158 Activator adjusting instrument, 178 Active sleep stage, 288 Acupressure, 101 , 202 – 216

points, 202 pregnancy and, 210 , 211

Acupuncture, 61 – 62 , 202 – 216 , 372 Traditional Chinese Medicine, 61–62, 202, 203 , 204 ,

207 , 208 Addiction, 209 , 322 , 349 , 372 Adhibhautika diseases, 76 Adhidaivika diseases, 76 Adhyatmika diseases, 76 Advanced Magnetic Research Institute

International, 377 Advanced practice nurses, 16 Adverse drugs reactions (ADRs), 127 , 164 Aesthetics of worship, 356 Agency for Health Care Policy and Research of

the U.S. Department of Health and Human Services, 177

AIDS, 263 , 281 , 387 , 393 Aikido, 261 Air element, 71 , 99 Alcohol abuse, 394 . See also Addiction Aldehydes, 137 Alexander, F. M., 328 Alexander Technique, 327 – 337

benefits of, 332 defined, 328 educational institutions and licensing

(preparation), 329 research, 333 – 334 treatment, 332

Alijani, Dr., 361 – 362 Alkaloids, 117 Allergies, 209 , 235 , 394 Allium cepa (onion), 157 , 158 Almond oil, 140 , 145 Aloe, 81 , 128 Altered state of consciousness, 342 , 343 , 344 , 347 Alternative medicine, ix

consumer interest, reasons for, 12 – 14 , 42 – 43 consumer warnings, 10 defined, 4 , 5 evidence-based practice, 10 , 16 illness defined in, 8 meaning of health, 9 not experimental, 12

Alternative medicine view of health, 7 – 9 Alternative therapies: concepts

balance, 19 – 20 breath, 29 – 30 , 261 , 265 common attributes, 7 energy, 22 – 29 integrated nursing practice, 30 – 34

spirituality, 21 – 22 See also Balance; Energy

Alternative therapies for common health problems, 393 – 416. See also specific health problems

Alzheimer’s disease, 187 , 237 , 394 . See also Dementia Amber, 155 American Academy of Medical Acupuncture,

69 , 215 American Association of Acupuncture and Oriental

Medicine, 69 , 215 American Association of Homeopathy, 160 American Association for Integrative Medicine, 18 American Association of Naturopathic Physicians,

166 , 168 American Association of Poison Control Centers, 119 American Board of Scientific Intuition, 302 , 310 American Botanical Council, 132 American Chiropractic Association, 182 American Chronic Pain Association, 268 American Council of Hypnotist Examiners, 271 , 285 Americans with Disabilities Act

Service animals, 387 American Herbalists Guild, 132 American Herbal Pharmacopoeia, 125 , 132 American Holistic Health Association, 18 American Holistic Medical Association, 36, 302 American Holistic Nurses Association, 36 , 135 , 291 ,

221 , 229 , 271 American Institute of Homeopathy, 160 American Massage Therapy Association, 201 American Medical Association (AMA), 150 , 270 , 274 American Meditation Institute, 268 American Music Therapy Association, 319 American Nurses Association, 167 , 361

Code of Ethics, 361 American Nurses Association’s Standard of Nursing

Practice, 167 American Oriental Bodywork Therapy Association, 201 American Reflexology Certification Board, 204 American Society for the Alexander Technique, 337 American Society of Clinical Hypnosis (ASCH),

271 , 285 American Yoga Association, 255 Amputations/phantom pain, 375 , 394 Anatomy, spine, 173 Angelican Fellowship in Prayer, Inc., 365 Angels. See Guardian angels Animal-Assisted Activities (AAA), 382 Animal-Assisted Therapy, 378 – 392

background, 378 – 379 concepts, 380 – 381 defined, 378 , 379 educational institutions and licensing

(preparation), 379 – 380 goals of, 381 HIV/AIDS and, 387 integrated nursing practice, 386 – 389 research, 385 – 386 setting up, 386 – 387 treatment, 381 – 385 See also Animal-Assisted Activities; Companion

animals; Pet visits; Resident animals; Service animals; Therapy animals

417

Animals. See Power animals Anterior cruciate ligament repair, 323 Antioxidants, 116 Anton, 361 Anxiety, 73 , 156 , 141 , 142 , 187 , 204 , 210 , 212 , 225 , 226 ,

250 , 253 , 262 , 263 , 276 , 277 , 282 , 290 , 313 , 314 , 315 , 360 , 372 , 389 , 394 – 395

Apparatus for meridian identification (AMI), 28 Applied kinesiology, 230 – 238

background, 230 concepts, 231 educational institutions and licensing

(preparation), 230 – 231 emotional first aid, 235 – 236 exercise and, 235 health and illness, view of, 232 integrated nursing practice, 235 – 236 nutrition and, 234 – 235 research, 235 treatment with, 233 – 235

Apricot oil, 140 Archimedes, 301 Aromachology, 133 Aromatherapy, 135 – 148

background, 134 concepts, 135 – 139 defined, 133 educational institutions and licensing

(preparation), 135 integrated nursing practice, 142 research, 141 – 142 treatment, 139 See also Essential oils

Aromatherapy Registration Council, 148 Arsenicum album (arsenic), 158 Arthritis, 154 , 158 , 179 , 209 , 210 , 250 , 332 , 372 , 375 ,

387 , 395 Asanas, 243 Aserinsky, E., 287 Aspirin, 152 Association of American Indian Physicians, 108 Association for Applied Psychophysiology and

Biofeedback, 325 Association of Bodywork & Massage Professionals,

201 Asthma, 60 , 61 , 126 , 138 , 142 , 154 , 156 , 179 , 209 , 250 ,

333 , 375 , 395 – 396 Astragalus, 60 Astral body, 27 Astrology, Native American, 95 – 96 Athlete’s foot, 396 Attention and concentration, 258 , 273 Attention Deficit Hyperactivity Disorder, 396 Aura, 27 – 27 , 370 Auric field, layers of, 27 – 28 Auscultation, 56 Australian Acupuncture and Chinese Medicine

Association, 215 Australian Association of Massage Therapists, 201 Australian Chinese Medical Association, 69 Australian Homeopathic Association, 160 Australian Hypnotherapists Association, 285 Australian Islamic College of Sydney, 365 Australian National Institute of Complementary

Medicine, 18 Australian Naturopathic Practitioners Association,

168 Australian Network for the Development of Animal

Assisted Therapies, 391

418 Index

Australian School of Meditation & Yoga, 268 Autism, 20 , 324 , 373 , 382 Avocado-soybean unsaponifiables, 130 Avicenna, 184 Ayahuasca, 347 Ayurvedic herbs, 81

Circle of Health, 89 Ayurvedic medicine, 70 – 89 , 230 , 241

background, 70 concepts, 70 – 75 diagnostic methods, 77 – 78 emphasis of, 70 health/illness, view of, 76 – 77 integrated nursing practice, 85 – 87 research, 85 treatment, 79 – 84 See also Aromatherapy; Body observation; Body

types; Breathing; Doshas; Energy/prana; Exercise; Five elements; Herbs; Massage; Meditation; Music; Nutrition; Pulse diagnosis; Purification; Tissues/dhatus; Tongue diagnosis; Urine diagnosis; Waste products/malas

Ayurvedic Practitioners Association UK, 89 Baby Massage. See Infant massage Bach Flower Remedies, 151 Back pain, 67, 175, 177, 178, 187, 209, 235, 249, 280,

322 , 331 , 333 , 375 , 396 – 397 Back rub, 196 Bahjri, 361 Bala, 81 Balance, 6 , 19 – 20 , 54 , 72 , 76 , 105 , 174 , 202 , 217 , 218 ,

219 , 222 , 223 , 232 , 246 , 323 – 324 , 327 , 332 , 333 , 373 , 381 , 382

circadian rhythms, 20 defined, 19 infradian rhythms, 20 musical rhythms, 21 – 22 Traditional Chinese Medicine, 58 , 61 , 63 , 64 , 67 Ultradian rhythms, 20

Balance problems, 246 , 250 , 252 , 323 – 324 , 327 , 348 , 332 , 333 , 397

Baryta carb, 158 Basil, 84 , 135 , 140 , 143 Bastyr University, 163 Baths, salt, 189 Bay, 137 Bear Dance, 97 Bear Heart, 90 Beardell, A. G., 230 , 232 Bee stings/insect bites, 397 Belladonna (deadly nightshade), 158 Benson, H. (Dr.), 218 , 256 , 354 , 355 , 357 Bergamot, 137 , 142 Best Practice sheets, 40 BEST therapy, 178 Beta-carotene, 115 Bethel (Germany), 379 Beyond Ordinary Nursing, 271 , 285 Bhakti yoga, 242 Bian zheng (pattern of disharmony), 57 Bilberry, 119 , 123 Bioelectromagnetic approaches, 5 Bioelectromagnetics (BEM), 369 – 377

background, 369 – 370 concepts, 370 – 372 defined, 369 integrated nursing practice, 374 – 376 research, 374 treatment, 372 – 374

Index 419

See also Endogenus magnetic fields; Exogenous magnetic fields; Geomagnetic fields; Ionizing/ nonionizing fields

Biofeedback, 320 – 326 background, 320 cardiovascular, 322 concepts, 321 defined, 320 educational institutions and licensing

(preparation), 320 – 321 electrodermal response, 322 electroencephalograph, 322 , 323 electromyography, 322 gastrointestinal, 321 integrated nursing practice, 324 – 325 nervous system and, 321 pelvic muscle dysfunction, 322 research, 323 – 324 respiratory resistance, 322 thermal, 322 treatment, 321 – 323

Biofeedback Certification International Alliance, 321 , 326

Biofeedback Foundation of Europe, 325 Biofield (energy field), 217, 218, 220, 221, 222 , 223 ,

224 , 225 , 226 , 227 , 231 , 305 Biofield and physical therapies. See Combined

physical and biofield therapies Biofield therapies. See Hand-mediated biofield

therapies Biomedical view of health, 4 – 5 Biomedicine, ix, 3 – 5 , 31 , 91 , 152 , 153 , 155 , 186 , 305 ,

306 , 342 , 348 person, view of, 5 shamanism and, 342 , 348 See also Conventional medicine

Biophoton emission, 371 Birch, 114 Bitter principles, 117 Blackberry, 114 Black cohosh, 123 Black pepper, 140 Blood pressure. See Hypertension Body control, 244 – 245 , 332 – 333 Body observation, 78 Body, power-filled, 345 Body scan, 264 , 306 Body types (Ayurveda), 72 – 75 Boerhaave, H., 184 Boldo leaf, 142 Bones (broken), 177 , 178 , 225 , 226 , 247 , 278 , 281 – 282 ,

372 , 397 Borysenko, J., 218 Botanical healing. See Herbs and nutritional

supplements; Homeopathy; Naturopathy Botanical medicine. See Herbs and nutritional

supplements Boucher Institute of Naturopathic

Medicine, 163 Braden, G., 358 , 359 Braid, J., 270 Brain, 136, 138, 288, 302–303, 321, 323 Brain development, 289 Brain injury, 289 , 322 , 373 , 382 Brain Music Therapy Center, 319 Brain waves, 20 , 23 , 222 , 273 , 274 , 288 , 289 , 321 , 322 ,

323 , 348 , 355 , 373 Breath, 29 – 30 , 56 , 62 , 64 , 66 , 271 , 272 , 273 , 274 , 275 ,

280 , 282 , 283

Breath control, 82 – 83 , 245 , 330 , 332 , 334 Breath of Spirit, 29 , 99 Breathing

in Ayurveda, 82 – 83 healthy, 30 , 67 , 245 , 327 , 330 , 332 , 334

Brenner, P., 307 British Acupuncture Council, 215 British Chiropractic Association, 182 British Complementary Medical Association, 36 British Federation of Massage Practitioners, 201 British Herbal Medicine Association, 132 British Naturopathic and Osteopathic Association, 168 British Wheel of Yoga, 255 Bronchial dilation, 321 Bronchitis, 143 , 209 , 375 Bruscia, K., 311 Bruises, 398 Bryonia (wild hops), 157 Buckle, J., 135 Buckthorn, 128 Buddists, 49 , 50 , 64 , 70 , 257 , 353 , 356 Buddhist Association of Canada, 365 Buddhist meditation, 260 – 261 , 266 – 267 Burkhardt, M.A., 354 Burmeister, M., 203 Burns, 134 , 143 , 144 , 189 , 375 , 398 Bursitis, 209 Butterbur, 123 Calamus, 142 Calcium, 155 California Institute for Human Science, 28 Camphor, 84 , 135 , 156 Canada Society of Clinical Hypnosis, 285 Canadian Acupressure Institute Inc., 215 Canadian Association of Naturopathic Doctors, 168 Canadian Chiropractic Association, 182 Canadian College of Naturopathic

Medicine, 163 Canadian Holistic Nurses Association, 36 , 229 Canadian Meditation Institute, 268 Canadian Reiki Association, 229 Canadian Yoga Institute, 255 Cancer, 159 , 166 , 187 , 210 , 226 , 250 , 276 , 278 , 314 , 332 ,

348 , 355 , 360 , 381 , 398 Canker sores, 398 – 39 9 Canine Assistants, 384 , 391 Caraway, 137 Carbohydrates, 117 Carbon, 155 Cardiac catherization, 226 Cardiovascular conditions, 61 , 166 , 237 , 250 , 263 , 322 ,

332 , 334 , 360 , 381 Cardiovascular (EKG) feedback, 322 Caring, 64 , 66 , 196 , 220 , 222 , 226

defined, 16 – 17 Caring for self, 16 – 17 , 305 – 306 Caring-healing paradigm, 16 – 17 Caritas process, 15 Carotenoids, 115 , 117 , 119 Carpal tunnel syndrome, 178 , 211 , 212 , 373 , 375 , 399 Carrot principle, 273 Carson, V., 353 , 354 Cascara, 128 Castor oil, 128 Cattefosse, Maurice-Rene, 134 Causal body, 28 Cayce, E., 301 – 302 Cayenne, 155 Cedar, 98

420 Index

Cedarwood, 140 , 143 Celestial body, 28 Cellular imagery, 280 Celsius, 184 Centers for Disease Control prevention guidelines, 44 Center for Mindfulness in Medicine, Health Care,

and Society, 254 Centering, 29 , 105 , 223 , 224 , 281 Cerebral palsy, 178 , 209 , 332 , 382 Certified Clinical Aromatherapy Practitioners, 135 Chair massage, 187 , 188 , 193 Chakras, 24 – 27 , 28 , 29 , 221

characteristics of, 25 – 26 purpose, function, frequency, 25 – 26 purpose in working with, 26

Chalice of Repose Project, 316 , 319 Chamomile, 123 , 128 , Chanting, 21 , 99 , 248 , 270 , 347 Chaos theory, 151 Chaparral, 128 Charcoal, 155 Chest congestion, 399 Chi (qi), 23 – 24 , 28 , 29 , 51 , 52 , 54 , 57 , 63 , 75 , 152 , 190 , 214 ,

207 , 208 , 211 , 221 , 270 , 305 , 327 , 334 Chinese Medicine and Acupuncture Association of

Canada, 69 Chinese Medicine, Traditional, 49 – 69 , 202 , 203 , 204 ,

207 , 208 , 327 , 328 background, 49 – 50 concepts, 50 – 54 diagnostic methods, 55 – 58 health/illness, view of, 54 – 55 integrated nursing practice, 66 – 67 massage, 60 related systems, 64 – 66 research, 63 – 64 treatment, 58 – 63 See also Acupuncture; Diagnostic methods in

Traditional Chinese Medicine; Diet; Five phases; Five seasons; Herbs; Massage; Qi; Qigong; T’ai Chi, Three treasures; Yin and yang

Chiropractic, 171 – 182 adverse effects, 178 assumptions, 174 background, 171 – 172 concepts, 173 – 174 contraindications, 178 diagnostic methods, 175 – 177 educational institutions and licensing

(preparation), 172 goals, 177 health/illness, view of, 174 – 175 integrated nursing practice, 180 – 182 pregnancy, healing and, 177 , 180 research, 179 – 180 treatment, 177 – 179

Chiropractors, 150 conditions requiring, 179

Chiropractors Association of Australia, 182 Cholesterol (high), 399 Christian, 356 Chronic fatigue syndrome, 399 Cinnamon, 134 , 135 , 137 Circadian rhythms, 20 Circle, 93 , 106 Circulation (poor), 187 , 188 , 189 , 190 , 196 , 197 , 250 ,

375 , 399 – 400 Citronella, 137 Clairaudient, 305

Clairsentient, 305 Clairvoyant, 305 Clark, C., 355 Clary sage, 137 , 141 Cleansing, 166 , 371 Clinical information sheets, 125 Clove, 136 , 137 , 142 Coca leaves, 119 Cochrane Database, 43 , 196 Cochrane Collaboration, 37 , 43 – 44 Cochrane Library, 44 Cochrane Systematic Review, 196 , 210 , 213 – 214 , 226 ,

262 , 333 – 334 Cognitive-behavioral stress reduction, 261 , 263 Cold sores, 400 Colic, 179 , 400 Colitis, 154 , 277 , 322 Collinge, W., 371 Colloquial prayer, 359 Colors for healing, 63 Coltsfoot, 119 Combined physical and biofield therapies, 230 – 238

background, 230 concepts, 231 diagnostic methods, 232 – 233 educational institutions and licensing

(preparation), 230 – 231 health/illness, view of, 232 integrated nursing practice, 235 – 236 research, 235 treatment, 233 – 235 See also Applied kinesiology; Meridians;

Neurolymphatic points; Neurovascular points Comfrey, 81 , 119 , 128 , 155 Commission E, 115 Common cold, 157 , 158 , 235 , 246 , 400 Community aspects of spirituality, 352 Community coping, 347 , 349 Companion animals, 380 Compassion, 33 , 50 , 64 , 66 , 196 , 222 , 227 , 259 , 352 Complementary medicine, 5. See also Alternative

medicine Compresses, 122 Concentrated attention, law of, 273 Concentration, 242 , 243 , 245 , 247 , 258 Coneflower, 114 . See also Echinacea Confession and absolution, 356 , 357 , 359 Conflict resolution, 282 , 347 Conscious dreaming. See Lucid dreaming Conscious mind, 272 Consciousness

pure, 243 , 245 , 246 Constipation, 157 , 158 , 194 , 322 , 400 – 401 Consumers, alternative therapies used by, ix, 12 – 14 ,

164 , 165 Contemplative prayer, 359 Conventional and alternative medicine, assumptions

of, compared origin of disease, 5

Conventional medicine, 4 – 7 , 8 , 9 , 10 cure as basis for, 31 defined, 4 health, view of, 5 reductionist approach, 5 single factors cause and reverse illness

assumption, 8 See also Biomedicine

Cooksley, V., 135 Coordination, 327

Index 421

Copper, 155 Coriander, 137 , 140 , 143 Corns, 401 Cosmology of shamanism, 344 – 345 Coue, E., 270 , 273 Cough, 152 , 156 , 157 , 158 , 401 Council of Chiropractic Education, 172 Council of Colleges of Acupuncture and Oriental

Medicine, 50 , 69 , 203 , 215 Cousins, N., 32 Council for Homeopathic Certification, 150 Council on Naturopathic Medical Education, 163 Cox, H. 316 Crainosacral system, 173 Craniosacral therapy, 178 Cranberry, 123 Creation cycle, 52 Creative Imagery in Nursing, 283 Creosote, 155 Crustaceans, 155 Crisis response dogs, 382 Crises, in faith, 355 , 360 Crohn’s disease, 322 Crystals, 343 – 344 Cupping, 62 Curanderismo, 103 – 105

defined, 103 healing levels in, 104 – 105 natural illnesses, 103 supernatural illnesses, 103

Curative process, 8 , 9 Cure versus heal models, 30 – 32 Cuttlefish ink, 155 Cypress, 140 , 143 Dance of the Deer Foundation, Center for Shamanic

Studies, 108 , 351 Darwin’s survival of the fittest, 8 Deadly nightshade, 119 , 158 Decoction, 122 Delta sleep, 288 – 289 Delta Society. See Pet Partners Dementia, 239 . See also Alzheimer’s disease Depression, 20 , 21 , 77 , 82 , 142 , 187 , 209 , 210 , 225 , 249 ,

262 , 290 – 291 , 314 , 346 , 360 , 372 , 373 , 374 , 380 , 382 , 401 – 402

Descartes, Rene, 4 , 354 Detachment, 245 Dharma, 64 , 245 Dhatus/tissues (Ayurvedic medicine), 75 Diabetes, 209 , 250 , 402 Diagnostic methods

Applied kinesiology, 232 – 233 Ayurvedic medicine, 77 – 78 Chiropractic, 175 – 177 combined physical and biofield therapies, 232 – 233 homeopathy, 152 – 153 Native American healing, 97 naturopathy, 165 pressure point therapies, 207 – 208 Traditional Chinese Medicine, 55 – 58

Diarrhea, 402 Diet, 4 , 12 , 50 , 54 , 58 – 59 , 67 , 79 – 81 , 152 , 162 , 164 ,

165 , 166 , 174 , 178 , 234 – 235 , 246 , 249 , 355. See also nutrition

Dietary Supplement Health and Education Act (1994), 114

Diffuser, 138 – 139 Dill, 137 Dioscorides, 114

Directed prayer, 359 Disease

etiology of, in Ayurvedic Medicine, 76 – 77 etiology of, in Traditional Chinese Medicine, 54 – 55 origin of, 8 See also Health and illness; and specific diseases

Dolphin-assisted therapy, 379 – 380 , 382 Dominant effect, law of, 273 Dong quai (tang kuei), 60 Doshas, 71 – 72 , 73

balance, achieving, 86 – 87 balance, disruption of, 71 balanced and unbalanced, 71 foods in relation to, 80 learning one’s own, 73 – 74 teaching people about, 86 – 87

Dossey, B. M., 354 Dossey, L., 354 , 359 Double-blind studies. See Randomized controlled

trials Down syndrome, 382 Dream Bank, 295 Dream Gate, 300 Dream incubation, 296 Dream Network Australia, 300 Dream recall, 290 , 295 , 296 , 298 – 299 Dream reentry, 297 Dream-sharing protocol, 298 Dream work, 286 – 300

background, 286 – 288 concepts, 288 – 291 educational institutions and licensing

(preparation), 288 integrated nursing practice, 296 – 299 recall, 290 , 295 , 296 , 298 – 299 research, 295 treatment, 293 – 294 See also Dreaming; Dreams

Dreaming biology of, 288 – 290 conscious, 294 functions of, 291 – 292 lucid, 293 night terrors, 292 precognition, 293 recurrent dreams, 292 , 293 traumatic dreams, 293

Dreams cultivating healing, 296 intuition, 294 Native American, 97 , 287 types of, 292 – 293

Dream reports, 295 sources, 295 analyzing content, 295

Drug addiction, 402 . See also Addiction Drumming, 21 , 99 , 270 , 347 , 348 , 349 Duke, James A., 128 Dying, 315 – 316 , 358 Dysmenorrhea. See Menstrual discomfort Dyspnea, 210 Eagle’s Wing Centre for Contemporary

Shamanism, 351 Ear infections, 154 , 402 – 403 Early diagnosis dreams, 292 , 304 Earth element, 71 , 99 East-West Academy of Healing Arts, 337 Ebers Papyrus, 134 Echinacea, 101 , 114 , 123 , 126

422 Index

Eczema, 123 , 155 , 403 Edison, T., 301 EEG Spectrum International, 326 Effleurage, 190 Eight limbs of yoga, 242 – 246 Einstein, Albert, 6 , 22 , 301

theory of relativity changes view of world, 6 El don, 103 Electrodermal response (EDR), 322 Electroencephalograph (EEG), 322 , 323 Electromagnetic energy, 151 , 370 – 372 Electromagnetism, 369 Electromyography (EMG), 322 , 373 Electroretinography, 373 Elemi, 143 Emotional body, 27 Emotional distress, 152 , 403 Emotional health, 3 , 6 , 9 , 151 , 152 , 153 , 157 , 272 , 273 ,

276 , 342 End-state imagery, 280 Endogenous magnetic fields, 22 – 29 , 370 – 371 Energetic imagery, 280 Energy, 5 – 6 , 22 , 75 , 217 , 221 – 222 , 223 , 224 , 225 , 226 ,

227 , 230 , 231 , 232 , 233 , 234 , 236 , 242 , 243 , 245 , 246 , 247 , 249 , 250 , 252 , 304 , 305

aura, 27 – 28 , 221 , 370 chakras, 24 – 27 , 221 , 370 energy concentration, 29 grounding and centering, 29 , 223 , 224 , 281 , 305 imbalance of, 207 , 208 , 223 , 232 , 306 meridians, 28 – 29 , 221 , 231 , 370 See also Energy field

Energy flow, 23 , 28 , 217 , 219 , 221 , 223 , 224 , 230 , 231 , 232 , 233 , 234 , 236 , 305 , 330

Energy imbalance, 207 , 208 , 223 , 232 , 246 , 306 , 403 Environment in shamanism, 343 Environmental health, 3 , 6 , 8 , 9 , 10 , 11 , 15 , 71 , 76 , 77 Ephedra, 119 , 128 Epilepsy, 178 , 250 , 373 Equine Assisted Growth and Learning

Association, 391 Erickson, M., 270 Essential oils, 117 , 135 – 148

blending, 140 cautions about, 136 chemical compounds and therapeutic actions

of, 137 described, 135 how they work, 136 – 137 nature identical, 139 potions, 144 pure, 139 treatment with, 139 – 141 use of, guidelines for, 142

Etheric body, 27 Etheric template body, 27 Esthers, 137 Ethnocentrism, ix–x, 348 Eucalyptus, 84 , 135 , 137 , 138 , 142 , 145 Europe, Chinese medicine and, 65 European Association for the Study of Dreams, 300 European Council for Classical

Homeopathy, 160 Evening primrose oil, 123 Evidence-based medicine, 38 Evidence-based nursing practice

barriers, 41 – 42 best practice sheets, 40 clinical decision making, 38 , 41 , 43

clinical information, 125 Cochran, 37 Cochrane Collaboration, 37 , 43 – 44 Cochrane Library, 44 Cochrane Systematic Review, 196 , 210 , 213 – 214 ,

226 , 262 , 333 – 334 complementary and alternative therapies, 42 – 44 context, 38 , 39 , 40 , 41 , 42 controversies, 40 definitions, 38 , 41

Evidence, 38 , 39 , 40 , 41 Evidence summaries, 125 , 141 , 195 , 210 , 226 , 248 , 249 ,

277 , 333 feasibility, 40 , 42 global health care needs, 41 Joanna Briggs Institute (JBI), 38, 41, 42, 44, 125,

141, 195, 210 , 226 , 248 , 249 , 277 , 333 meditation, 263 – 276 models, 40 Ottawa Panel Clinical Practice Guidelines, 195 – 196 patient outcomes, 38 , 39 , 40 , 41 patient preference, 38 , 39 , 40 , 41 research utilization, 38 – 39 resources, 44 Sackett, D., 37 Sigma Theta Tau, 38 systematic review steps, 39 Web-based resources, 44

Evidence summaries, 125 , 141 , 195 , 210 , 226 , 248 , 249 , 277 , 333

Exercise, 302 , 305 , 309 , 315 applied kinesiology, 232 , 235 Ayurvedic medicine, 81 – 82 chiropractic, 174 , 178 hand-mediated therapies, 225 homeopathy, 152 naturopathy, 165 , 166 yoga, 241 , 242 , 245 , 247 , 249 , 250 , 252

Exogenous magnetic fields, 371 artificial, 371 natural, 371

Extracts, 122 Eyebright, 1 , 155 Eye, ear, nose, and throat disorders, 61 Faith, universality of, 354 – 355 Faith and prayer, 352 – 365

background, 354 concepts, 354 – 359 integrated nursing practice, 360 – 364 research, 360 treatment, 359 See also Crises; Prayer; Religious remedies;

Universality of faith Faith and prayer assessment, 361 False memory syndrome, 274 Fantasized life events, 273 Faraday, M., 369 Fascia and fascial restrictions, 186 – 187 , 191 Fatigue, 225 , 235 , 250 , 262 , 278 , 403 Fatty oils, 117 Feathered Pipe Ranch Foundation, 109 Federation of Chiropractic Licensing

Boards, 182 Federation of Horses in Education and Therapy

International, 391 Federation of State Massage Therapy Boards,

185 , 201 Feeling-state imagery, 280 Feet (tired), 404

Index 423

Feldenkrais Method of Somatic Education, 337 Feldenkrais Method, 327 – 337

defined, 328 educational institutions and licensing

(preparation), 329 research, 333 – 334 treatment, 332 – 333

Feldenkrais, M., 328 Feng shui, 63 – 65 Fennel, 137 Fenugreek, 123 Fever, 152 , 156 , 158 , Feverfew, 123 Fibromyalgia, 210 , 375 , 387 , 404 Fire element, 71 , 74 , 79 , 99 Fitzgerald, W., 203 Five elements (Ayurvedic medicine), 71 Five phases, (Chinese medicine), 52 Five Phases Theory (wu-hsing), 52 Five seasons, 52 – 53 Five Sheaths of Existence, 246 Flavonoids, 119 Flower remedies, 151 Flu, 158 Fluid retention, 404 Focus words or prayers, 258 , 260 , 264 , 265 Food

doshas in relation to, 79 – 81 thermal qualities, 79 – 81 yoga, 246 , 249 See also Nutrition

Food and Drug Administration, 114 , 128 , 132 regulation of medications, 114

Foods, six tastes, 58 Foot massage, 205 , 213 Foundation for Shamanic Studies, The, 351 Four Winds Society, 351 Foxglove, 101 Fractures. See Bones, broken Frankincense, 134 , 136 Frankl, V., 313 , 357 Free radicals, 116 , 119 Freud, Sigmund, 270 , 287 , 288 Friction, 189 , 190 , 195 , 196 Galen, 114 , 171 – 172 , 184 Galvani, 39 Galvanic skin response (GSR), 322 Garlic, 114 , 115 , 117 , 120 , 123 , 127 , 136 Gas discharge visualization, 151 Gastroesophageal reflux, 322 Gastrointestinal biofeedback, 322 Gastrointestinal disorders, 320 , 321 , 322 Gawain, S., 282 Gelsemium (yellow jessamine), 158 Geomagnetic field, 370 – 372 Geranium, 134 , 139 , 142 , 145 Germany, site of herbal studies, xxxx, 125 , 127.

See also Commission E Ghostway chants, 99 Ginger, 59 , 60 , 67 , 118 , 124 , 125 , 140 , 143 Ginkgo, 60 , 119 , 120 , 124 , 125 , 127 Ginseng, Asian, 60 , 81 , 114 , 115 , 120 , 126 , 127 Glycosides, 118 Goertz, 354 Gold, 155 Goldenseal, 101 , 114 , 120 , 124 Goodheart, G., 230 , 232 Grape seed extract, 118 , 124 Gratitude, 363

Gratitude, central to Native American spirituality, 92 , 106

Green apple, 143 Green care, 383 Green, C., 307 Green tea, 60 , 119 , 124 , 126 Grounding, 29 , 305 Group healing ceremony, 347 Guardian angels, 22 , 345 , 346 , 348 Guardian spirits, 345 , 346 , 348 Gua sha, 62 Guggulu, 81 Guided imagery, 269 – 285

clients, working with, 278 – 283 defined, 269 See also Imagery; Hypnotherapy and guided

imagery Guides. See Spirit guides Gunas, 79 , 80

doshas, tastes, and, 79 Guo Lin Gong, 332 Hahnemann Center for Heilkunst, 161 Hahnemann, Samuel, 149 , 150 Hall, C. S., 295 Hand massage, 206 Hand-mediated biofield therapies, 217 – 229

background, 219 – 220 concepts, 221 – 222 contraindications, 225 educational institutions and licensing

(preparation), 220 – 221 health/illness, view of, 223 integrated nursing practice, 226 – 228 research, 226 side effects, 225 treatment, 223 – 226

Hand tremblers, 103 Harner, M., 347 – 348 Harp and the Ferryman, The, 316 Harpist, 316 Harvey, W., 184 Hatha Yoga, 79 , 82 , 84 , 242 , 249

See also Yoga Hawayo Takata, 220 Headache, 54 , 55 , 60 , 67 , 143 , 144 , 156 , 175 , 179 , 187 ,

211 , 212 , 213 – 214 , 235 , 263 , 277 , 320 , 322 , 332 , 333 , 373 , 375 , 404 – 405

Heal versus cure models, 31 – 32 Healing

community ceremonies, 349 defined, 31 , 32 holistic, 3 , 4 , 6 , 7 , 11 , 15 , 16 humanistic perspective, 3 integrative, 3 Native American, 93 , 341 – 351

Healing ceremonies, Native American, 98 – 100 Healing environments, 33 Healing, integrative. See Integrative healing Healing levels in curanderismo, 104 – 105 Healing practices . See Alternative therapies;

Integrative healing Healing touch, 101 Healing Touch (HT), 217 – 229

educational institutions and licensing, 220 – 221 research, 226 treatment, 223 – 226 use of, by nurses, 226 – 228

Healing Touch Canada, 229 Healing Touch Program, 220 , 229

424 Index

Healing Trust, The, 365 Health

defined, 9 , 76 – 77 , 152 , 165 , 207 , 223 , 246 , 341 Five Sheaths of Existence, 246 meaning of, 9

Health/illness applied kinesiology, 232 Ayurvedic medicine, 76 – 77 chiropractic view of, 174 – 175 hand-mediated biofield therapies, 223 homeopathy, 152 intuition, 302 , 303 massage therapy, 187 – 188 meditation, 259 – 260 Native American healing, 94 – 97 naturopathic view of, 165 pressure point therapies, 207 shamanism, 345 – 346 Traditional Chinese Medicine, 54 – 55 yoga, 146 – 147

Health promotion, 10 Healthful living, ix, 164 , 165 , 355 , 356 Healthy People 2020, 10 Heart breathing exercise, 252 Heartburn, 322 Heart disease, 405 . See also Cardiovascular conditions Heat applications, 372 Heat rash, 405 Heisenberg uncertainty principle, 11 Hemorrhoids, 209 , 405 Herb Research Foundation, 132 Herbal remedies, 123 – 124 Herbs,

Ayurvedic medicine, 81 homeopathy, 155 Native American healing, 101 naturopathy, 166 , 167 preparation of, 122 Traditional Chinese Medicine, 59 – 60 See also Specific herbs

Herbs and nutritional supplements, 113 – 132 background, 114 – 115 concepts, 115 – 122 dosage, 125 , 127 education of patients by nurses, 127 guidelines in selecting, 127 – 128 integrated nursing practice, 126 – 128 research, 125 – 126 side effects, 125 treatment, 122 See also Antioxidants; Herbal remedies; Herbs;

Phytonutrients; Plant-derived products; Plant-related poisonings; Synergism

Hiccups, 405 High-velocity, low-amplitude (HVLA) thrust

adjustment, 177 – 178 Hindu, 70 , 241 , 257 , 353 Hippocrates, 6, 49, 114, 134, 164, 171–172, 184,

301, 327 Hippotherapy, 379 , 382 , 385 HIV, 195 , 250 , 263 , 281 . See also AIDS Hmong, 346 Ho shou wu, 60 Holistic approach in research, 11 Holistic healing, 3 Holistic medicine, 341 , 342 Holos University, 302 , 310 Holt-Ashley, M., 354 Holyway chants, 99

Homeless, 360 , 382 Homeopathic Educational Services, 161 Homeopathic Pharmacopoeia of the United States, The ,

154 Homeopathic remedies, 150 – 158

prescription medications and, 156 use of, guidelines for, 156 – 157

Homeopathy, 149 – 161 background, 149 – 150 concepts, 150 – 151 diagnostic methods, 152 – 153 educational institutions and licensing

(preparation), 150 health/illness, view of, 152 integrated nursing practice, 156 – 157 popularity of, 149 research, 154 symptoms, classification of, 153 treatment, 153 See also Homeopathic remedies; Law of

Infinitesimals; Law of Similars Homer, 378 Honey, 80 , 81 Horse chestnut, 124 Horseradish, 142 Hospice, 227 , 387 Hot flashes, 277 Howard, J., 172 Hsueh, 61 , 84 , Huang Di (the Yellow Emperor), 49 Humanistic perspective of healing, 3 Hume, L., 354 , 381 Hydrocarbons, 137 Hydrolsols, 136 Hypermobile joints, 176 – 177 Hypertension, 76 , 82 , 141 , 179 , 187 , 250 , 257 , 263 , 280 ,

320 , 321 , 332 , 381 , 406 HypnoBirthing Program, 285 Hypnosis, 269 – 285

contraindications, 277 defined, 269

Hypnotherapy, 6 , 16 , 269 – 285 background, 269 – 271 concepts, 272 contraindications, 277 defined, 269 educational institutions and licensing

(preparation), 271 evidence-based nursing, 277 integrated nursing practice, 278 – 283 myths and realities, 279 research, 277 – 278 steps in, 278 treatment, 275 – 277 versus stage hypnosis, 279 , 281

Hypnotic state, 269 , 270 , 272 , 275 Hypnotic suggestion, 275 – 276 Hypnotic trances and movie watching compared, 272 Iatrogenic illnesses, 164 I Ching, Chinese Book of Wisdom, 312 Ignatia (St. Ignatius bean), 157 Illnesses. See Health and illness; and specific illnesses Imagery, 269 – 285

cellular, 280 characteristics of, 280 – 281 desired outcomes, 282 end-state, 280 energic, 280 feeling-state, 280

Index 425

physiological, 280 psychological, 280 sensory, 274 spiritual, 280

Imagination, 269 , 272 , 274 , 291 , 345 Immune enhancement, 406 Inana Yoga, 242 Incontinence, 322 , 324 Indian Country mallow, 81 Indian gooseberry, 81 Indian Penny wort, 81 Indian snakeroot, 119 Indigestion, 322 , 406 Induction phase of hypnotherapy, 275 , 281 Infant massage, 194 , 198 Infection, 406 – 407 Infertility, 209 , 407 Inflammation, 152 , 158 , 189 , 195 , 407 Inflammatory bowel disease, 278 Infradian rhythms, 20 Infusion, 122 , 151 Ingham, E., 203 Inquiry, 56 Insomnia, 187 , 249 , 277 , 279 , 322 , 333 , 372 , 407 Inspection, 55 – 56 Institute for Clinical Systems Improvement, 44 Institute for Contemporary Shamanic Studies, 3 , 351 Institute of Integrated Aromatherapy, 148 Institute for Magnetic Resonance Research, 377 Institute of Music in Medicine (Australia), 319 Integrated nursing practice, x–xi, 14 – 17

alternative therapies, 30 – 34 Animal-Assisted Therapy, 386 – 389 Applied Kinesiology, 235 – 236 aromatherapy, 142 Ayurvedic medicine, 85 – 87 bioelectromagnetics, 374 – 376 biofeedback, 324 – 325 caution patients about risky remedies, 126 chiropractic, 180 – 182 clinical relevance of faith, 360 – 364 counting blessings, advising patients about, 363 dream work, 296 – 299 emotional first aid, 235 – 236 faith and prayer, 360 – 364 flow of energy, redirecting, 236 hand-mediated biofield therapies, 226 – 228 herbs and nutritional supplements, 126 – 127 homeopathy, 156 – 157 hypnotherapy, guided imagery, 278 – 283 intuition, 307 – 309 magnetic healing, 374 – 376 massage therapy, 196 – 198 meditation, 263 – 267 movement-oriented therapies, 334 – 336 music, 315 – 318 Native American healing, 97 – 102 naturopathy, 167 nursing assessment, herbs, 126 nursing assessment regarding faith and prayer, 361 prayer, benefits of, to patients, 355 , 357 , 361 , 362 pressure point therapies, 210 – 213 Shamans, 348 – 350 Traditional Chinese Medicine, 66 – 67 understanding doshas, 71 – 72 , 73 yoga, 249 – 252

Integrative healing/medicine alternative medicine, 3 assumptions, 7 – 9

background, 7 consumers, 12 – 14 conventional medicine, 4 – 6 integrated nursing practice, 14 – 17 research, 10 – 13

Integrative Institute of Aromatherapy, 135 Interactions: herbs and drugs, 120 – 122 Intercessory prayer, 359 , 360 , 362 Interface Between Medicine and Religion, The,

365 International Association of Infant Massage, 185 , 201 International Association of Medical Intuitives, 310 International Association for the Study of Dreams, 300 International Center for Reike Training, 229 International Code of Ethics for Nurses, 361 International Federation of Aromatherapists,

148 Interpretation of Dreams, The, 287 Interview, 152 , 226 Intervertebral motion dysfunction, 174 Intuition, 301 – 310

background, 301 concepts, 302 – 304 counseling, 302 dreams, 303 – 304 educational institutions and licensing

(preparation), 302 integrated nursing practice, 307 – 309 leadership, 308 medical, 302 , 304 patient care, 307 – 308 practice, 307 – 309 problem solving, 303 readings, 302 research, 306 treatment, 304 – 306

Ionizing/nonionizing fields, 371 – 372 Ipecac, 150 Iroquois, 287 Irritable bowel syndrome, 209 , 322 , 408 Islam, 257 , 287 Isoflavones, 118 Invisible Disabilities Assocation, 391 Iyengar yoga, 242 Japan, Chinese medicine and, 65 Jasmine, 81 , 133 , 135 Jet lag, 20 , 408 Jewelweed, 101 Jews, 356 , 365 Jin Shin Do, 202 , 203 , 204 , 208 – 209 Jin Shin Foundation for Bodymind Acupressure,

215 – 216 Jin Shin Jyutsu, 202 , 203 , 204 , 208 – 209 Jiro Murai (Master), 203 Joanna Briggs Institute (JBI), 38 , 39 , 41 , 42 , 44 , 141 ,

195 , 210 , 226 , 248 , 249 , 277 , 333 Joint Commission on Accreditation of Healthcare

Organizations, 361 Jourard, S., 183 Journal of Naturopathic Medicine, 166 Journaling, 294 , 296 Jung, C., 270 , 287 , 288 , 291 Juniper, 81 , 137 , 140 , 143 Kabat-Zinn, J., 256 , 258 , 263 , 268 Kahn, S., 266 Kahunas, 91 Kapha, 71 – 75

aromatherapy, 84 balancing herbs, 81

426 Index

Kapha (Continued) body type, 74 excess, countering, 86 – 87 exercise and, 81 – 82 factors increasing, 86 – 87 food, 80 imbalanced, 74 increase, 86 – 87 maintenance of, 86 – 87 pulse, 77 – 78

Karma, 64 Karma yoga, 242 Kava, 114 , 119 Keegan, L., 15 Ketones, 137 Ki, 24 , 190 , 221 Kinesiology. See Applied kinesiology Kinesiology Federation, 238 Kleitman, N. (Dr.), 287 Knee pain, 331 Koenig, H. G., 354 Koerner, 33 , 354 , 359 Korea, Chinese medicine and, 65 Kreiger, Delores (Dr.), 185 , 219 Krieger-Kunz Method of Therapeutic Touch, 219 Kriya yoga, 242 Kundalini yoga, 242 Kunz, D., 219 Kyphosis, 322 Labor, 198 , 227 , 249 , 262 , 278 , 315 , 411 Labyrinth, 258 , 259 Labyrinth Society, 268 Lactones, 137 Lane Community College, 319 Lavender, 133 , 134 , 135 , 137 , 138 , 141 , 142 , 145 Law of Infinitesimals, 150 – 151 Law of Similars, 150 Laws of suggestion. See Suggestion, laws of Leadership and intuition, 308 Learning disabilities, 290 Lemon, 135 , 142 Lemon grass, 135 , 137 , 142 Levintin, D. J., 313 Licorice, 60 , 81 , 124 Life force, 6 , 7 , 8 , 9 , 52 , 53 , 54 , 152 , 218 , 221 , 222 , 305 , 327 Lifeway chants, 99 Ligusticum, 60 Lime, 137 , 142 Ling, P., 189 Listeners, 97 Liver disease, 408 Locke, 354 Loneliness, among older people, 381 , 389 Long-term care facilities, 387 Love for self and others, 356 , 358 Lovingkindness meditation, 266 – 267 Low energy neurofeedback system (LENS), 373 Low-velocity thrust adjustment, 178 Lucid dreaming, 293 Lucidity Institute, The, 300 Lung, 23 Lust, B., 162 Lycopene, 158 Lycopodium, 158 Lymphedema, 195 Macular degeneration, 408 Madagascar periwinkle, 119 Magnetic field, 369 , 370 Magnetic healing, 370 – 372

contraindications, 373 pregnancy and, 373

Magnetic molecular energizing (MME), 373 Magnetic resonance imaging (MRI), 373 Magnetoencephalography (MEG), 373 Maharishi Medical Centers in the United States, 268 Maharishi Mahesh Yogi, 242 , 260 Ma huang, 60 , 121 Malas/waste products (Ayurvedic medicine), 75 Mana, 22 Mandala meditation, 258 , 261 Mandarin, 135 , 137 , 142 Manic. See Bipolar disorder Mamier, I., 361 Manipulation (chiropractic), 177 Mantra, 258 , 260 Mantra Yoga, 242 Manual healing methods. See Chiropractic;

Combined physical and biofield therapies; Hand-mediated biofield therapies; Massage; Pressure point therapies

Manual muscle testing, 232 Marjoram, 141 Marma points, 204 Marma therapy, 83 – 84 Massage, 4 , 16 , 135 , 138 , 141 , 143 , 144 , 145 , 146 ,

188 – 195 , 347 Ayurveda, 83 – 84 background, 184 – 185 benefits of, 188 chair, 187 , 193 Chinese, 60 – 61 concepts, 185 – 187 contraindications, 189 defined, 183 educational institutions and licensing

(preparation), 185 foot, 196 hand, 196 , 197 health/illness, view of, 187 – 188 infant, 194 , 198 integrated nursing practice, 196 – 198 myofascial release, 191 one-minute, 199 partner, 199 pregnancy and, 193 , 196 , 198 psychiatric setting, 187 research, 195 – 196 rolfing, 192 self-, 194 – 195 Shiatsu, 190 – 191 sports, 191 Swedish, 189 – 190 , 191 techniques, 190 Thai, 192 Traditional Chinese Medicine, 60 – 61 , 192 treatment, 188 – 195 trigger point, 191 two-minute, 199 See also Backrub; Fascia and Facial Restrictions;

Skin; Touch; Trigger points Material level of healing, 104 Matthews, D. A., 354 , 355 Matthews-Simonton, S., 348 Mayan people, 96 McCutcheon, H. H. I., 307 Medical intuitives, 301 – 302 , 304 – 305 , 307

Clairaudient, 305 Clairsentient, 305

Index 427

Clairvoyant, 305 Medicine. See Alternative medicine, Biomedicine,

Integrated medicine Medicine, making, 92 Medicine bag, 98 Medicine objects, 98 Medicine Wheel, 93 , 98 Medicine women and men, 102 Meditation, 13 , 16 , 21 , 22 , 27 , 247 , 256 – 268 , 269 , 296 ,

306 , 315 , 327 , 342 , 346 , 353 – 354 , 356 adverse effects of, 262 awareness of breathing, 258 , 265 Ayurveda, 83 background, 257 body scan, 264 Buddhist, 260 – 261 , 266 – 267 concepts, 257 – 259 defined, 256 health/illness, view of, 259 – 260 integrated nursing practice, 263 – 267 lovingkindness, 266 – 267 mandala, 258 mantra, 258 , 260 mindfulness, 261 minis, 265 moving, 62 , 265 – 266 progressive relaxation, 263 – 264 research, 262 – 263 rhythmic, 261 steps, 264 Tibetan, 261 Transcendental, 260 , 263 treatment, 260 – 262 walking, 265 – 266 See also Attention and concentration; Meditative state

Meditative prayer, 359 Meditative state, 257 – 258 Melatonin, 119 Melissa, 137 Memories, 273 – 274 , 290 Memory problems, 408 Memory of water theory, 151 Menopause, 210 , 408 Menstrual discomfort, 142 , 145 , 210 , 225 , 250 , 409 Mental body, 27 Mental health, 20 , 72 Mental level of healing, 104 Mentastics, 333 Mentgen, J., 219 Mercurius solubilis, 158 Meridians, 28 – 29 , 51 , 62 , 65 , 190 , 204 , 208 , 231 , 234 , 370 Mesmer, F. A., 270 Mesmerize, 270 Mexican hairless dogs, 387 Mickley, J. R., 353 Microsystems, 204 – 206 Midwives, 204 , 252 , 263 Migraine headaches, 409 . See also Headaches Milk thistle, 124 Miller, N., 320 Mindbody tool kit, 20 , 36 Mind–body connections, 207 Mind–Body Medical Institute, 268 Mind–body medicine, 217. See also Biofeedback;

Dream work; Guided imagery; Hypnotherapy; Meditation; Movement-oriented therapies; Yoga

Mindfulness, 261 Mindfulness-based cognitive therapy, 261 , 263

Mindfulness-based relapse prevention, 261 Mindfulness-based stress reduction,

261 , 263 Mindfulness meditation, 261 Mint, 81 , 128 , 134 Monkshood, 158 Moons, Native American astrology, 95 – 96 Morning sickness, 161 . See also Nausea Moss, R., 291 Mother tincture, 150 – 151 Mountain Pose, 250 – 251 Movement-oriented therapies, 327 – 337

applicability, 330 background, 328 – 329 concepts, 330 – 331 educational institutions and licensing

(preparation), 329 integrated nursing practice, 334 – 336 research, 333 – 334 treatment, 331 – 333 See also Alexander Technique; Feldenkrais

Method; Qigong; T’ai Chi; Trager Approach Movement patterns, 331 Moving meditation, 62 , 265 – 266 Moxibustion, 62 , 64 Mozart effect, 312 Multiple sclerosis, 332 , 374 , 382 , 385 Murray, C. K., 130 Muscle misuse, 331 Muscle soreness, 409 Muscle tension, 315 , 321 , 328 , 331 , 333 , 335 Muscle testing, manual, 232 Music, 356

Ayurveda, 84 Feng shui, 63 healing, 20 Mindbody Tool Kit, 20 , 36 Sound Body, Sound Mind, 20 music-thanatology, 315 therapy, 20 , 84

Music as a therapeutic tool, 311 – 319 background, 312 brain, 312 – 313 concepts, 312 – 313 definition, 311 music-thanatology, 315 nursing practice, 315 – 316 quality of life, 313 research, 313 – 315 singing bowls, 315

Muslim, 360 Myofascial release, 191

contraindications, 191 Myrrh, 134 Myss, C., 302 Nagai-Jacobson, M. G., 354 NAPRALERT, 132 National Animal Assisted Crisis Response, 382 National Alaska Native American Nurses

Association, 104 National Animal Assisted Crisis Response, 382 National Association for Holistic Aromatherapy

(NAHA), 135 , 148 National Association of Indian Nurses of America,

109 National Association of Nurse Massage Therapists,

198 , 201 National Ayurvedic Medical Association, 89 National Cancer Institute (NCI), 115 , 162

428 Index

National Center for Complementary and Alternative Medicine (NCCAM), 5 , 10 , 11 – 12 , 18 , 217 , 220

National Center for Jewish Healing, 365 National Certification Board of Therapeutic Massage

and Bodywork, 185 National College of Naturopathic Medicine, 163 National Commission for the Certification of

Acupuncture and Oriental Medicine (NCCAOM), 216

National Guidelines Clearing House, 44 National Herbalists Association of Australia, 132 National Institutes of Health, 5 , 11 , 18 , 162 , 209 , 277

consensus statements, 44 statement on acupuncture, 209

National Kidney Foundation Clinical Practice Guidelines, 44

National School of Chiropractic, 172 National University of Health Sciences, 163 Native American healing, 90 – 109 , 287 , 341 – 351

background, 91 – 92 concepts, 92 – 94 diagnostic methods, 97 health/illness, view of, 94 – 97 integrated nursing practice, 105 – 107 research, 102 – 103 treatment, 94 – 102 See also Acupressure; Chanting; Circle; Drumming;

Healing; Healing touch; Herbs; Number four; Peyote; Pipe Ceremony; Shamans; Sing; Smudging; Spirituality; Sweatlodge; Vision Quest

Nature, healing power of, 162 , 164 , 166 , 167 Naturopathic physicians, focus of, 164 , 166 Naturopathy, 5 , 162 – 168

background, 162 – 163 concepts, 164 diagnostic methods, 165 educational institutions and licensing

(preparation), 163 health/illness, view of, 165 integrated nursing practice, 167 research, 166 treatment, 165 – 166 See also Iatrogenic illness; Nature, healing power

Nausea, 121 , 123 , 124 , 125 , 126 , 141 , 150 , 209 , 210 , 211 , 225 , 409 – 410 , 411

Navigator Programs, 102 Neck pain, 175 , 179 NCLEX-RN exam, 15 Near-death experiences and angels, 22 Negative thinking, 105 – 106 , 273 , 274 , 276 , 283 ,

305 – 306 Neroli, 135 , 137 Nervous system

biofeedback and, 321 Network chiropractic spinal analysis, 178 Neurofeedback, 322 , 323 Neurolymphatic points, 231 , 233 Neurovascular points, 231 , 233 Newton, Isaac (Sir), 4 Nightingale, Florence, 15 , 31 , 167 , 312 , 348 , 378 Nie, 61 Nightmares, 292 , 294 , 297

reframing, 297 Night terrors, 292 Ning, 61 Nocebo, 32 Nondirected prayer, 359 Noni, 124

Nonionizing BEM medical applications, 371 – 372 Nonordinary realities, 344 , 345 North American Nursing Diagnostic Association, 349 North American Society of Teachers of the

Alexander Technique (NASTST), 329 Nose, functioning of, 136 – 137 Number Four, Native American, 93 – 94 Nurse-healers

caritas process, 15 doshas, teaching about, 85 – 87 self-care, 16 – 17 , 278 – 279 , 363 See also Integrated nursing practice

Nurse psychotherapists, 106 Nurses, xi

chiropractic, patients and, 180 guided imagery and, 278 – 283 hospice, 227 meditation, patients and, 263 – 267 position of, to respond and monitor medications, 167 self-care, 16 – 17 , 66 similarities with Native American healers, 105 – 107 Therapeutic Touch, 217 – 229

Nurses’ Certificate Program in Imagery, 271 Nurse’s Mediation Journal, The, 266 Nursing

art of, 15 , 105 combining conventional and alternative practices,

15–16 creating healing environments, 33 educating patients about pressure point therapies,

210 – 213 incorporating pressure point therapies into

practice, 210 – 213 intuition, 307 – 309 leadership, 308 principles in common with Traditional Chinese

Medicine, 66 See also Integrated nursing practice

Nursing students, 361 , 386 Nutritional supplements. See Herbs and nutritional

supplements Nutrition

applied kinesiology, 234 – 235 Ayurvedic medicine, 79 – 81 homeopthy, 152 naturopathy, 163 , 166 See also Diet

Nux vomica (poison nut), 158 Objects, significant, 98 Oki, 23 Olfaction, 56 Olfactory stimulation, 138 Omega-3 fatty acid, 117 Oncovin, 119 One-minute massage, 199 Onion, 136 , 155 Ontario Herbalists Association, 132 Opium poppy, 119 Orange, 84 , 135 , 137 , 142 , 145 Ordinary reality, 344 , 347 Ordinary State of Consciousness (OSC), 344 Oregano, 23 , 137 Orloff, J. (Dr.), 302 Ornish, D., 27 Osler, William (Sir), 203 Osteoarthritis. See Arthritis Osteopathy, 5 Osteoporosis, 332 , 370 , 410 Ottawa Panel Clinical Practice Guidelines, 195 – 196

Index 429

Pacific yew bark, 119 Paclitaxel, 119 Pai, 61 Pain, 60 , 61 , 67 , 68 , 141 , 175 , 177 , 178 , 179 , 209 , 210 ,

225 , 226 , 235 , 237 , 257 , 263 , 264 , 265 , 277 , 282 , 314 , 315 , 316 , 322 , 331 , 333 , 372 , 373 , 374 , 381 , 385 , 389 , 390 , 410

Palmer, B. J., 172 Palmer Chiropractic School and Cure, 172 Palmer, D. D., 172 Palpation, 57 , 177 Panchakarma, in Ayurveda, 84 Pare, A., 172 , 184 Partner massage, 199 Passive yoga, 192 Patanjali, 241 Patchouli, 140 Patient outcomes, 38 , 39 , 40 , 41 Patient preferences, 38 , 39 , 40 , 41 Patient Protection and Affordable Care Act, 10 Pelvic muscle dysfunction, 321 , 322 , 324 Peppermint, 135 , 137 , 142 , 145 Percussion, 190 Personal disciplines, 244 Personal power, 343 – 344 , 345 , 346 , 349 Pert, C., 344 Peruvian bark, 119 Pet owners experiencing illness, 388 Pet Partners, 391 Pet visits, 383 Petersen, F., 361 Petitgrain, 135 , 137 Petitional prayer, 359 Petrissage, 190 Pets and People, 386 Peyote, 98 , 101 – 102 , 347 Phantom pain, 375 , 394 Phenols, 137 Physical and biofield therapies. See Combined

physical and biofield therapies Physical disabilities, 410 Physician Data Query, 44 Physics, quantum, 359 , 369 Physiological imagery, 280 Phytonutrients, 116 Phytotherapy. See Herbs and nutritional

supplements Pilot Dogs, Inc., 384 – 385 Pincombe, J., 307 Pine, 137 Pink bubble technique, 282 Pinker, S., 313 Pipe Ceremony, 100 Pitta, 71, 72, 76, 78

aromatherapy, 84 balancing herbs, 81 body type, 73 excess, countering, 86 – 87 exercise and, 82 factors increasing, 86 – 87 food, 80 imbalanced, 74 increase, 86 – 87 maintenance of, 86 – 87 pulse, 77 – 78

Placebo, 31 , 32 Placebo effect, 31 Plant-derived products, 119 Plant-related poisonings, 119 – 122

Pneuma, 23 Podophyllum, 158 Poison ivy, 158 , 410 Poison nut, 158 Poses, yoga, 242 , 244 , 245 , 247 , 250 , 251 , 252 Positive affirmations, 105 – 106 , 276 , 306 , 308 Positive attitude, 306 Positive expectations, 306 Positive suggestion, 270 Positive thoughts, 105 – 106 , 306 , 308 Postpartum, 142 , 180 , 210 , 252 , 322 , 411 Posttraumatic stress disorder, 226 , 248 , 277 , 278 , 279 ,

293 , 322 Posture, 323 – 324 , 327 , 328 , 331 , 332 , 333 , 335 , 382 Potions, in aromatherapy, 144 Poultice, 122 Pounds, 135 Pourquoi Mozart, 312 Power animals, 345 , 346 Power objects, 343 Prana, 23 , 24 , 29 , 75 , 152 , 187 , 218 , 221 , 246 Pranayama, 82 – 83 , 245 Prayer, 4 , 16 , 21 , 22 , 23 , 91 , 92 , 93 , 98 , 100 , 101 , 104 ,

352 – 365 defined, 352 how it works, 358 – 359 kinds of, 359 See also Faith and prayer

Prayers, 353 , 356 , 360 , 361 , 362 Precognition, 359 Pregnancy, 410 – 411

acupressure, 210 , 211 aromatherapy, 142 chiropractic healing, 180 ginger, 123 herbs, 123 , 124 , 126 labor, 411 Law of Similars, 150 magnetic healing, 374 massage, 193 , 198 meditation, 262 moxibustion, 62 , 64 music, 314 nausea, 411 postpartum, 411 posture and gait, 180 pressure point therapies, 210 , 211 yoga, 249 , 252

Premature infants, 194 , 198 , 262 REM sleep, 287 – 288 , 289 – 291 , 292 , 295

Premenstrual syndrome, 210 , 225 , 411 Pressure point therapies, 202 – 216

background, 202 – 203 concepts, 204 – 207 contraindications, 209 diagnostic methods, 207 – 208 educational institutions and licensing

(preparation), 203 – 204 health/illness, view of, 207 integrated nursing practice, 210 – 213 pregnancy and, 210 , 211 research, 209 – 210 self-help applications, 211 – 212 treatment, 208 uses, 209 See also Acupuncture; Jin Shin Do; Jin Shin Jyutsu;

Meridians; Microsystems; Mind–body connections; Reflexology

Prisoners raising service dogs, 384 – 385

430 Index

Progressive relaxation, 281 , 315 Prostate enlargement (benign), 411 Psilocybin mushrooms, 347 Psoriasis, 412 Psychiatric disorders, 61 , 225 , 276 , 372 , 373 , 384 Psychiatric service dogs, 384 Psychological imagery, 280 Psychoneuroimmunology (PNI), 217 Psyllium, 121 PubMed, 12 Pulsatilla (windflower), 157 Pulsating magnetic fields, 372 Pulse diagnosis, 57 , 77 – 78 Pulsed electromagnetic fields (PEMFs), 372 Pure consciousness, 245 , 246 Purification

Ayurveda, 84 Native American, 100

Purpose in life, 356 , 357 – 358 Puppies Behind Bars, 392 Pythagoras, 312 Qi (chi), 21 , 24 , 28 , 29 , 51 , 52 , 54 , 57 , 63 , 75 , 152 , 190 ,

204 , 207 , 208 , 211 , 221 , 231 , 305 , 327 , 334 Qigong, 58 , 61 , 62 , 64 , 66 , 192 , 260 , 327 – 337

defined, 62 , 327 educational institutions and licensing

(preparation), 329 Guo Lin Gong, 332 research, 333 – 334 Traditional Chinese Medicine, 58 , 61 , 62 , 64 , 66 ,

327 , 328 treatment, 331 – 332 Wild Goose, 331

Qualitative research, 10 – 11 , 39 , 40 , 45 , 46 Quality of life, 313 Quantitative research, 10 – 11 , 39 , 40 Quartz crystals, 343 – 344 Qua sha, 62 Quinn, J. F., 32 Randomized controlled trials, 11, 37, 43, 102, 103,

125–126, 130, 141, 145–146, 158–159, 179, 180, 196, 210, 213–214, 226, 236–237, 249, 253 , 263 , 278 , 314 , 315 , 323 , 324 , 333 , 374 , 385

Rainbow Animal Assisted Therapy, 392 Raja Yoga, 242 Rapid eye movement (REM), 287 – 288 , 289 – 291 , 292 ,

295. See also REM sleep Rapid eye movement sleep behavior disorder,

292 – 293 Reality, 344 Recurrent dreams, 293 Red clover, 124 Red and white mushrooms, 347 Reductionist approach of conventional medicine,

4 , 15 Reflexology, 202 , 203 , 204 , 209

maps, 205 – 206 Registered Nurses Association of Ontario, 44 Reiki, 217 – 229

educational institutions and licensing (preparation), 220 – 221

treatment, 223 – 226 use of, by nurses, 226 – 229

Relaxation process, 52 , 61 , 62 , 106 , 260 , 263 , 264 , 273 , 275 , 278 , 281 , 282 , 320

Relaxation response, 260 , 269 , 272 , 274 , 321 , 322 , 323 , 333 , 335 , 355 , 356

Relaxation Response, The, 218 , 256 Religion, 20 , 352 – 365

Religious remedies, 355 – 358 aesthetics of worship, 356 confession and absolution, 356 – 357 healthful living, 355 – 356 love for self and others, 356 , 358 positive expectations, 356 , 358 purpose in life, 356 , 357 – 358 relaxation response, 355 , 356 ritual, 356 , 357 shared beliefs, 356 , 357 support network, 356 , 357 turning life over to God, 356 , 358 whole-being worship, 356

REM sleep, 287 – 288 , 289 – 291 , 292 , 295 brain development, 289 deprivation, 290 – 291 memory, 290

Repetitive transcranial magnetic stimulation (rTMS), 372

Rescue remedy, 151 Research

animal-assisted therapy, 385 – 386 aromatherapy, 141 – 142 Ayurvedic research results, 85 bioelectromagnetic, 374 biofeedback, 323 – 324 chiropractic, 179 – 180 combined physical and biofield, 235 dream work, 295 evidence-based nursing practice, 44 faith and prayer, 360 hand-mediated therapies, 226 herbs, 125 – 126 homeopathy, 155 – 156 hypnosis, 277 – 278 intuition, 306 limitations of scientific, 11 , 15 massage, 195 – 196 meditation, 262 – 263 movement, 333 – 334 music, 313 – 315 Native American healing, 97 – 102 naturopathic medicine, 166 pressure point, 209 – 210 qualitative, 10 – 11 , 39 , 40 , 45 , 46 quantitative, 10 – 11 , 39 , 40 shamans, 347 – 348 Traditional Chinese Medicine, 63 – 64 Yoga, 248 – 249 See also Randomized controlled trials;

Placebo effect Research utilization, 38 – 39 Resident animals, 383 Respiratory conditions, 61 , 154 , 157 , 158 Respiratory resistance [R(os)], 322 Reston, J., 203 Reynaud’s disease, 277 Rhus toxicodendron (poison ivy), 158 Rhythms

circadian, 20 infradian rhythms, 20 musical, 20 – 21 ultradian rthythms, 20

Ringworm, 412 Ritual, 356 , 357 Ritual prayer, 359 Roberts, P., 316 Rogers, Martha (Dr.), 185 Rolf, Ida P., 192

Index 431

Rolf Institute, 201 Rolfing, 192 Rose, 84 , 133 , 135 , 137 , 142 , 144 Rosemary, 137 , 142 , 145 Rose geranium, 84 Rosewater, 144 Rosewood, 137 Rossi, E. L., 294 Ruach, 29 Rue, 142 Sackett, D., 37 Sacks, O., 312 – 313 Sacred Hoop, 93 Sacred Pipe, 93 , 98 , 100 Sacred space, 316 Saffron, 81 Safety

prescription medications, 126 herbs, 126 homeopathic remedies, 157

Sage, 101 , 137 Salk, J., 301 Salt bath, 189 San Pedro cactus, 347 Sandalwood, 84 , 133 , 135 Sassafras, 142 Savin, 142 Saw palmetto, 124 Scheel, J. (Dr.), 162 Schulz, Mona Lisa (Dr.), 302 , 307 School of Lost Borders, The, 109 Schroeder-Sheker, T., 315 Schweitzer, Albert, 348 Sciatica, 179 , 412 Scoliosis, 382 Screening dogs, 384 Second Sight, 302 Seizures, 178 , 187 Selenium, 119 , 125 Self-care, pressure point therapies and, 210 – 213 Self-care practices for nurse-healers. See Nurse-

healers Self-esteem, 276 , 355 Self-healing and intuition, 305 – 306 Self-massage, 194 – 195 Senna, 128 Sensory imagery, 274 Service animals, 383 – 384 Sexual dysfunction, 412 Shakers (Church of the United Society of Believers),

114 Shalem Institute for Spritual Formation, 365 Shamanic journey, 343 , 346 , 348 , 349 , 350

steps for, 349 – 350 Shamanic State of Consciousness (SSC), 344 Shamanism

biomedicine, 342 , 348 community healing ceremonies, 347 , 349 cosmology of, 344 – 345 health/illness, view of, 345 – 346 imagination, 345 journey to help others, 344 origins of, 341 personal power, 345 , 346 soul loss and retrieval, 346 states of consciousness in, 344 See also Drumming; Personal power; Power

animals; Spirit guides; Teacher plants Shamans, 91 , 134 , 269 , 288 , 341 – 351

background, 341 becoming, steps in, 342 – 343 concepts, 343 – 345 contemporary, 342 , 348 defined, 341 educational institutions and licensing

(preparation), 342 – 343 environment as family, 343 health/illness, view of, 345 – 346 integrated nursing practice, 348 – 350 research, 347 – 348 treatment, 346 – 347

Shames, K. H., 33 , 282 Shared beliefs, 356 , 357 Shealy, N., 302 Shen, 54 Shen Nong, 49 Shiatsu, 61 , 65 Shiatsu massage, 190 – 191 Shilajit, 81 Shingles, 412 – 413 Siberian ginseng, 60 Sigma Theta Tau, 38 Simonton Cancer Center, 285 Simonton, O. C., 348 Sing, 99 Singing bowls, 315 Singing with the Wheel, 109 Sinus problems, 413 Sitopladi, 81 Skilled pattern recognition, 307 Skin, 185 – 186 Skin disorders, 61 Skin (dry), 413 – 414 Sleep and healing, 371 , 375 Sleep paralysis, 289 Sleep spindles, 289 Smell, 136 – 137 Smell and Taste Treatment and Research

Foundation, 133 , 148 Smoking cessation, 277 Smudging, 98 Societal health, 71 Society of Critical Care Medicine

Guidelines, 44 Socrates, 6 Soeken, K. L., 353 Somnambulism, 272 Sore throat, 153 , 158 , Soul loss (dissociation), 96 Soul retrieval, 346 Sound therapy, 20 South African Herbal Science and Medicine

Institute, 125 Southern Cross University, 163 Southwest College of Naturopathic Medicine and

Health Science, 163 Space element, 71 Spearmint, 137 Spinal cord injuries, 322 , 332 Spinal manipulation, 177 Spinal manual therapy (SMT), 177 Spinal vertebrae, misalignment of, 173 Spirit guides, 345 , 356 , 348 Spirit inspection, 55 Spiritual assessment, 33 , 315 , 316 Spiritual guides, 22 Spiritual health, 3 , 6 , 9 , 10 , 21 , 33 , 304 , 305 , 306 , 352 Spiritual imagery, 280

432 Index

Spiritual level of healing, 4 , 21 , 33 , 104 , 304 , 305 , 306

Spiritual therapies. See Faith and prayer; Shamans Spirituality, 21 – 22 , 352 – 365

Native American healing, 97 – 102 Sports massage, 191 Sprains and strains, 225 Squaw tea, 101 St. Ignatius bean, 157 St. John Ambulance Therapy Dog Program, 392 St. John’s wort, 124 Star gazers, 97 Static magnetic fields, 372 Stress, 151 , 152 , 227 , 257 , 259 – 260 , 262 , 263 , 265 , 314 ,

320 , 321 , 322 , 323 , 327 , 331 , 332 , 333 , 335 Stress reduction, 166 , 219 , 224 , 225 , 227 , 249 , 256 ,

261 – 262 , 263 – 264 , 315 , 342 , 414 Structural integration, 192 Subconscious mind, 272 Subluxation, 172 , 174 , 176 , 177 , 178 Subtle energy, 22 , 23 , 28 , 221 , 231 , 370 Succussion, 151 Suffering, 21 , 22 , 33 , 64 , 152 Suggestion, laws and principles of, 270 , 273 Suicide, 103 Sulfur, 158 Sun Dance, 100 Sun Si Mian, 50 Sunburn, 414 Support network, 356 , 357 Surgery, 279 , 313 , 314 , 315 , 414 Surgery and herbs, 122 Sweating, 322 Sweatlodge, 99 – 100 , 270 Swedish massage, 189 – 190 , 191 Sweet grass, 101 Symptoms, classification of, in homeopathy, 153 Symptoms, view of, 5 , 7 , 8 , 152 Synergy, in essential oils, 141 Systematic review, 39 , 68 , 85 , 130 , 141 , 145 – 146 ,

155 , 158 – 159 , 179 , 195 , 196 , 226 , 236 – 237 , 249 , 262 , 278 , 314 , 333 , 334 , 386

Systematized health care practices. See Ayurvedic medicine; Curanderismo; Native American healing; Traditional Chinese Medicine

T’ai Chi, 260 , 261 , 266 , 327 – 337 defined, 327 educational institutions and licensing, 329 research, 333 – 334 Traditional Chinese medicine, 327 , 328 treatment, 331 – 332 water T’ai Chi, 332 Yang, 332

Tan dien, 29 T’ai Chi Australia, 337 Tangerine, 142 Tannins, 118 Tansy, 142 Tan T’ien, 29 , 334 Tantra Yoga, 242 Tao, 61 Taoists, 49 , 50 , 51 , 54 Taoist Tai Chi Society of Canada, 337 Tapotement, 190 Tastes

actions of, 79 in Ayurveda, 79 six, in food, 79

Taxol, 119

Taylor, E. J., 354 , 361 Tea tree oil, 124 , 135 , 137 , 138 , 142 Teacher plants, 347 Temperature (thermal) feedback, 321 – 322 Temporomandibular joint sydrome (TMJ), 178 , 179 ,

191 , 209 , 322 Tendinopathy, 195 Tension, 321 , 322 , 414 – 415 Thai massage, 192 Thanatology, 315 Thanatos, 315 Theory of relativity, changes view of

world, 6 Therapet, 392 Therapeutic dream work, 288 Therapeutic Touch (TT), 217 – 229 , 371

caregivers need for, 227 educational institutions and licensing

(preparation), 220 – 221 effectiveness of, 226 treatments, 223 – 226 use of, by nurses, 226 – 228

Therapeutic Touch International Association, 229 Therapy animals, 380–381

temperament, 379 Therapy Dogs International, 392 Thie, J., 230 Three (vital) treasures, 54 Thyme, 137 , 138 , 142 Tibet, Chinese medicine and, 64 – 65 Tibetan meditation, 261 Tinctures, 122

See also Mother tincture Tinnitus, 415 Tissues/dhatus (Ayurvedic medicine), 75 Tobacco, 100 Tomatis, 312 Ton, 23 Tongue diagnosis, 56 , 78 Touch, 101 , 183 , 184 , 185 , 186 , 187 , 188 , 194 , 219 ,

226 , 227. See also Healing Touch and Therapeutic Touch

Touch for Health, 217 – 229 Touch for Health Kinesiology Association, 238 Touch Research Insititute, 187 , 201 Traditional medicine, 4 Traditional Chinese Medicine, 30 , 49 – 69 , 81 , 84 , 114 ,

202 , 203 , 204 , 207 , 208 See also Chinese Medicine, Traditional

Trager Approach, 327 – 337 defined, 328 educational institutions and licensing

(preparation), 329 mentastics, 333 research, 333 – 334 treatment, 333

Trager Institute, The, 329 Trager, M., 329 Trance, 269 , 270 , 272 – 273 , 274 , 275 . See also Hypnotic

trances Trance removal, 276 Transcendental Meditation, 260 , 263 Transcranial electrostimulation (TCES), 372 Transcranial magnetic stimulation (TMS), 372 Transcultaneous electrical nerve stimulation

(TENS), 372 Traumatic brain injury, 289 , 373 , 382 Traumatic dreams, 293 Treloar, L. L., 354

Index 433

Trigger point massage, 191 Trigger points, 186 Triple warmer, 204 Tui na, 60 , 61 Turning life over to God, 356 , 358 Twelve Remedies. See Religious remedies Two-minute massage, 199 Ulcerative colitis, 154, 277 Ulcers, 209 , 320 Ultradian rhythms, 20 Unbalanced organs or glands, 232 – 233 Unconscious mind, 274 , 306 United States, Chinese medicine and, 65 – 66 U.S. Food and Drug Administration,

132 , 149 Universality of faith, 354 – 355 University of Bridgeport, 163 University of Massachusetts Medical School, 255 University of Western Sydney, 163 Upaya Zen Center, 268 Urinary incontinence, 415 Urinary tract infection, 154 , 415 Urine diagnosis, 78 Urogenital conditions, 277 Usui, Dr., 220 Vaginismus, 322 Vagus nerve stimulation (VNS), 373 Valerian, 124 , 126 van de Castle, R. L., 295 Vata, 71, 72, 75, 76, 78

aromatherapy, 84 balancing herbs, 81 body type, 73 excess, countering, 86 – 87 exercise and, 82 factors increasing, 86 – 87 food, 80 imbalanced, 73 increase, 86 – 87 maintenance of, 86 – 87 pulse, 78

Verbena, 137 , 142 Vertebral column, 173 Veterinarians, acupuncture and acupressure and, 202 Vertigo, 178 Vetiver, 144 Vibration, 190 Victoria University, 168 Vincristine, 119 Virgil, 316 Virtual reality environments, 277 Vision Quest, 100 , 342 – 343 Visualization, 13, 15, 167 , 283 , 342 , 348 Vitamin A, 122 , 393 , 398 , 399 , 400 , 411 , 415 Vitamin B, 122 , 393 , 395 , 396 , 400 , 401 , 402 , 405 ,

411 , 415 Vitamin C, 119 , 393 , 394 , 396 , 398 , 399 , 400 , 402 , 404 ,

405 , 406 , 408 , 410 , 411 , 415 Vitamin D, 410 , 412 Vitamin E, 119 , 393 , 394 , 398 , 399 , 400 , 402 , 404 , 405 ,

406 , 408 , 411 , 415 Vivekananda, Swami, 242 Volta, 369 Vomero nasal organ (VMO), 136 – 137 Vomiting. See Nausea Vulvodynia, 322 Walking meditation, 265 , 266 , 331 , 334

Warrior Canine Connection, 392 Warts, 277 , 415 Waste products/malas (Ayurvedic medicine), 75 Water and energy, 371 Water element, 71 , 99 Water t’ai chi, 332 Watson, Jean, 16 Weight control, 139 , 143 , 279 , 415 Weil, Andrew, 7 , 20 , 150 Whiplash, 179 White House Commission on Complementary and

Alternative Medicine Policy, 12 Whole-being worship, 356 Wild hops, 157 Willow tree bark, 101 , 119 Windflower, 157 Winslow, B. W., 354 Winslow, G. R., 354 Wintergreen, 142 Wise Woman Apprentice Program, 132 World Chiropractic Alliance, 182 Wormseed, 142 Wormwood, 142 Wounds, 225 , 226 , 372 , 373 , 416 Xolos, 387 Xolos for Chronic Pain Relief, 387 Yang, T’ai Chi, 332 Yang Cheng Fu, 332 Yellow champhor, 142 Yellow dock, 155 Yellow Emperor’s Inner Classic, 40 Yellow jessamine, 158 Yin and yang, 23 – 24 , 51 – 52 , 54 , 55 , 57 , 58 , 59 , 63 ,

207 , 331 Ylang ylang, 137 , 140 , 144 Yoga, 16, 82, 241–255, 256 , 260 , 261 , 266

abstinences, 243 background, 241 – 242 benefits of, 248 body control, 244 – 245 breath control, 245 concentration, 245 concepts, 242 – 246 defined, 214 detachment, 245 health/illness, view of, 246 – 247 integrated nursing practice, 249 – 252 iyengar, 242 limbs or paths of, 242 – 246 meditation, 245 Mountain Pose, 250 – 251 personal disciplines, 244 pregnancy and childbirth, 249 , 252 , 271 , 279 pure consciousness, 245 – 246 research, 248 restorative, 242 silver yoga program, 242 treatment, 247 – 248 See also Abstinances; Body control; Breath control;

Concentration; Detachment; Meditation; Personal disciplines; Pure consciousness

Yoga Australia, 255 Yoga Research and Education Center, 255 Yohimbe, 119 York Retreat, 379 Zen meditation, 261 , 265 Zoonoses, 387