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National Association of Naturopathic Physicians --
Outline for Study of Services of Practitioners
Performing Health Services in Independent Practice

Part II: The Discipline

A. DEFINITION

The Dictionary of Occupational Titles, U.S. Department of Labor, Washington, D.C., defines naturopathy as follows: Doctor, Naturopathic (medical service), 0-52-21. Naturopathic. A healer. Diagnoses and treats patients to stimulate and restore natural bodily processes and functions, using a system of practice that employs physical, mechanical, chemical, and psychological methods; utilizes dietetics, exercise, manipulation, chemical substances naturally found in or produced by living bodies, and the healing properties of air, light, water, heat, and electricity. Provides for care of bodily functions, processes, or traumas, and treats nervous or muscular tensions, abnormalities of tissues, organs, muscles, joints, bones, and skin, pressure on nerves, blood vessels, and lymphatics, and assists patient in making adjustments of a mental and emotional nature. Naturopathy excludes the use of major surgery, X-ray, and radium for therapeutic purposes and the use of drugs with the exception of those substances which are assimilable, contain elements or compounds which are components of bodily tissues and are useable by body processes for maintenance of life.

Webster's Seventh New Collegiate Dictionary (G. & C. Merriam Company, 1W5), on page 563, defines naturopathy as: a system of treatment of disease emphasizing assistance to nature and including the use of natural medicinal substances and physical means (as manipulation and electrical treatment).

In his book "Basic Naturopathy" (1948, American Naturopathic Association, Inc.), Harry Riley Spitler, N.D., M.D., Ph.D., uses this definition: Naturopathy is a complete system of practice, making use of nature's agencies, forces, and processes, and products for therapeutic purposes, exclusive of major surgery.

The definition adopted by N.A.N.P. is this: Naturopathy (naturopathic medicine) -- A system of treatment of human disease which emphasizes assisting nature. It embraces minor surgery and the use of nature's agents, forces, processes, and products, and introduces them to the human body by any means that will produce health-yielding results.

B. THE SCIENTIFIC BASIS OF NATUROPATHY

1. Historical development

One aspect of Naturopathy dates to the pre-Christian Egyptians -- to their use of massage and manipulation of the body, its muscles, its tissues: the beginning of mechanotherapy. The Old Testament refers to subsequent Israelite rules governing diet hygiene. Me steam and vapor baths (early hydrotherapy) of middle Europe in the Middle Ages still obtain as does the use of cold and hot baths perfected by early Romans and Athenians.

The herbal, botanical side of naturopathy dates most clearly to the Chinese of 5,000 years ago, the discoverers of therapeutic value in ginseng, cascara. and other roots, flowers, and botanical substances.

Naturopathic education dates to the Athenian teachings of Easculapius during the 13th century B.C. Of the 300 "healing centers" in Greece which followed, 200-300 years B.C., one (at Kos) nurtured Hippocrates, father of modern medicine.

In 1050 A.D. the first "university of hygiene" was founded at Salerno, Italy: the initial book of health rules it produced went through 240 editions.

As the 12th century opened, universities were founded in Bologna. Montpellier, and Oxford. Paracelsus began experiments with the body's dependency upon sulphur, mercury, and salt, and with the concept of internal medication . . . giving birth to the theory of iatro-chemistry, the forerunner of contemporary pharmacology.

It could 'be held that naturopathy as a formal profession and discipline was recognized and legalized when the "Herbalist Charter" of King Henry VIII was enacted by England's Parliament. That document read in part: Be it ordained. established, and enacted, by authority of this present Parliament, That all Time from henceforth it shall be lawful to every Person being the King's subject, having Knowledge and Experience of the Nature of Herbs, Roots, and Waters or of the Operation of the same, by Speculation or Practice, within any part of the Realm of England, or within any other of the King's Dominations, to practice, use, and minister in and to any outward Sore, Uncome Wound, Aspotemations, outward Swelling or Disease, Any Herb or Herbs, Ointments, Baths, Pultess, and Emplaisters, according to their cunning, Experience, and Knowledge in any of the Diseases, Sores, and Maladies beforesald, and all other like to the same, or Drinks for the Stone, Strangury, or Agues, without suit, vexation, trouble, penalty, or loss of their goods. . . .

Hydrotherapy, as an adjunct of natural healing, gained initial European prominence through the movement begun by Priessnitz at his institute in Grafenberg, Silesia in 1829. At first, lay patients, and later physicians, sought his teaching and help with such practical procedures as plunge, hot and cold packs, sitz baths, and compresses.

But hydrotherapy is only one of the many therapeutic techniques employed by naturopathy. Rickli delved into sunlight and air cures following Priessnitz' lead, beginning in 1848. Berg began research into vegetarian diet; Finsen, into ultraviolet treatment; Cone, into psychology; Schroch into warm moisture, dry diet, and fasting ... all precursor scientists to the formal regimen of today's naturopathy.

The groundwork for naturopathy per se was laid by Hippocrates, when he wrote in a treatise on "Epidemic Diseases" -- "Nature is the healer of all disease. Let foods be your Medicine and your Medicine your Foods."

The 19th century . . . from 1859 to 1900 particularly . . . fleshed-out Hippocrates' basic thesis. Man after man added to the body of knowledge concerning natural healing: Christian was the food scientist; Buckley was the first American physician to recognize the value of diet in treating cancer patients; Wilstatter, a German chemist, was first to study the healing properties of chlorophyll in treating anemia.

The 20th century practitioner who tied all the foregoing body of knowledge together, into the formal concepts of contemporary naturopathy, was Benedict Lust, born and educated in Germany, who introduced naturopathic healing to the United States in 1892, with the founding of his Yungborn Health Institution in New Jersey. . . . at the same time that Dr. Still propounded the philosophy of osteopathy and Dr. Palmer Inaugurated the practice of chiropractic.

Naturopathy's pioneers, in addition to Lust, Included Kellogg, founder of the Battle Creek Sanitarium, and Hahnemann, founder of homeopathy.

2. Scientific theories and principles

Naturopathy (naturopathic medicine) is the technique of treatment of human disease which emphasizes assisting nature. It can embrace minor surgery and the use of nature's agencies, forces, processes, and products, introducing them to the human body by any means that will produce health-yielding results.

Naturopathy is based upon the tendency of the body to maintain a balance and to heal itself. The purpose of naturopathic medicine is to further this process by using natural remedies . . . as distinct from "orthodox" medicine (allopathy and osteopathy), which seeks to combat disease by using remedies which are chosen to destroy the causative agent or which produce effects different from those produced by the disease treated (from the definition of "allopathy" -- Webster's Seventh New College Dictionary: 1965, p. 24).

Naturopathy places priority upon these conditions as the basis for ill health: (1) lowered vitality; (2) abnormal composition of blood and lymph; (3) maladjustment of muscles, ligaments, bones, and neurotropic disturbances; (4) accumulation of waste matter and poison in the system; (5) germs, bacteria, and parasites which invade the body and flourish because of toxic states which may provide optimum conditions for their flourishing; (6) consideration of hereditary influences; and (7) psychological disturbances.

In applying naturopathic principles to healing, the practitioner may administer one or more of specified physiological, mechanical, nutritional, manual. phytotherapeutic, or animal devices or substances. The practitioners end aim is to remove obstacles to the body's normal functioning, applying natural forces to restore its recuperative facilities. Only those preparations and doses which act in harmony with the body economy are utilized, to alter perverse functions, cleanse body of its catabolic wastes, and promote its anabolic processes.

3. Supportive studies and research

Bibliographies containing reference works used in teaching undergraduate practitioners-to-be, and utilized, postgraduate, by practicing naturopathic physicians, are appended hereto, from the Library of Congress and from the National Library of Medicine in Bethesda, Maryland.

In sum, the texts on these appended bibliographies comprise the primary body of formal knowledge which governs the practice of naturopathy -- the results of research emanating from or pertinent to this profession, and case studies which confirm the validity of the naturopathic mode of practice.

C. THE PRACTICE OF NATUROPATHY

1. Role of diagnosis

Diagnosis (as defined by Gould and as accepted by naturopathy) is the determination of the nature of a disease by --

Diagnosis is, necessarily, each physician's prelude to prescription and/or treatment, as it is with all naturopathic physicians, albeit that diagnosis from verbal (orally-given) symptoms, is unacceptable. Naturopathy's forebearers may have set today's standards for diagnosis as a mandatory prelude to treatment. The chemist of George Washington's era, Carl Wilhelm Scheele, discarded from his apothecary shop the previously (and automatically) applied "iron from the nails of the coffins of criminals," etc., as essential medications." Further symptoms alone are but one phase of diagnosis, for symptoms are to naturopathy, as Hippocrates wrote, "Partly symptoms of defense and partly symptoms of failure."

a. Interview

Techniques for patient interviews are generally consistent throughout naturopathic practice. Sample questionnaire forms for completion by physician and/or patient are appended. The personal interview Is the naturopathic physician's first phase of diagnosis -- observation, visual detection of obvious abnormalities of a physical or psychological character, aural detection of physiological (speech) or psychological abnormalities, etc.

During the interview, the naturopathic physician examines extensively for subjective symptoms which are revealed through conversation, and seeks maximum objective or subjective information following the diagnostic outline in 1. above.

b. Physical examination

Guidelines in the diagnostic outline of 1. above apply to physical examination of the patient as well as to aural-written notions.

Initial physical examinations, for new patients, are comprehensive, regardless of the nature of the patient's complaint -- to establish history and ascertain with some exactitude the current status of the patient's body. Manual and visual examination of the body -- its limbs, muscles, orifices, is routine.

The naturopath applies to his physical examinations of patients the principles in which he has been trained -- osteology, Roentgenology, dermatology, syndesmology, myology, neurology, topographical anatomy, ophthalmology, angiology. physiology, otalaryngology, clinical psychology, pediatrics, proctology, gynecology, obstetrics, etc.

Aside from data collected on a patient's questionnaire, the physical examination probes functions of the neuron and muscle fibers and their interdependence in myoneural action; physio-chemical phenomena associated in the process of osmosis, diffusion, and their bearing on such functions as pulmonary and cellular respiration, absorption, and secretion; the physiology of the heart, blood, and lymph; the excretory functions of the kidney (see following d.), skin, and lungs; the endocrine system and its role in the metabolic process; the function of the cerebrospinal and autonomous nervous systems; the physiology of the male and female generative systems.

c. Diagnostic aids

The naturopath's armamentarium includes every accepted diagnostic instrument: Sphygmomanometer; stethoscope, electro-cardiograph; endo-cardiograph; thermometer; speculums; proctoscopes; sigmoidoscopes; instruments for testing reflexes, aural receptivity, and for testing pressure of the eyeball; scales; X-ray fluoroscopes -- the gamut of modern medicine's diagnostic equipment. (Note: naturopathic physicians utilize X-ray for diagnostic purposes, not for therapy.)

d. Laboratory tests

The naturopathic physician is schooled in inorganic chemistry, bio-chemistry, biology, zoology, histology, microscopic anatomy, splanchology, embryology, bacteriology, pathology, toxicology, trophology, endocrinology, etc.

He is trained in laboratory diagnosis, conducting his own tests or utilizing state health department or private laboratories for studies and evaluation. (A Rumple report form utilized by Oregon's Public Health Laboratory in reporting test results to naturopaths is appended.) The naturopath applies physiological and pathological chemistry to his analyses: micro-biology and micro-bacteriology, serology, and bio-chemistry.

All of the bodies' tissues, fluids and excretions are subject to examination during the course of laboratory testing as part of naturopathic diagnosis: urine, sputum, feces, epidermal abnormalities, gastric fluids, etc.

Blood testing, aside from Its role as part of any general physical examination, is also conducted by the naturopath for the specific purpose of detecting venereal disease or as a concomitant and pre- and post-natal care and the prophylaxis of or informational reporting on new-born infants. Serology is an essential part of naturopaths' geriatric and gerontological practice.

2. Treatment methods

Obviously, treatment will vary with the condition which necessitates it. Generally speaking, naturopathy utilizes nature's agencies, forces, processes, and products, which may be applied to the body by using physiotherapy, mechanotherapy, or hydrotherapy. Botanical agents and biological remedies may be prescribed, for external application or internal consumption, and nutritional counseling may figure in treatment.

lontophoresis is employed frequently to ionize certain remedies in the treatment of disease when it is deemed inadvisable to prescribe internal medication.

Naturopathy's overriding dictate . . . when the practitioner's decision to apply prophylactic or physiological therapeusis is being formulated . . . is that nature is a sensitive agent possessing the faculty of making her own cures.

The techniques applicable to naturopathic treatment of disease and illness are the same techniques applicable to treatment by an allopath, with greater emphasis upon hydrotherapy, massage, manipulation, or electrotherapy in necessary instances, and with greater utilization of medications in their natural or botanical form than in their chemically-created or derived form.

To draw a simple comparison, naturopathic gynecology and obstetrics parallel allopathic gynecology and obstetrics. Naturopathy's osteopathic treatment embraces the identical principles of clinical visceral neurology and orthopedics (minor surgery) as those guiding the osteopath. Similarly, naturopathy's uses of Roentgenology and radiology are no more radical than those of allopathy.

Naturopathy does, in general, rely less heavily on radical alteration of bodily functions and chemistry than do other healing arts. Naturopathy's primary stresses include light therapy (helio, light, ultra-violet, infra-red, chrome, etc.); electrotherapy (galvanic, faradic, sinusoidal, diathermic etc.); vigrotherapy (oscillations, concussions, vibration, spondylotherapy); remedial exercise (kinesiotherapy, medical gymnastics, body mechanics, active and passive exercise): manipulations (osseus and soft tissue, mobilization and immobilization techniques, spinal therapy, manipulative and orificial surgery); vasomotor control, mechanical therapy (utilizing supporters, prosthetics, belts, casts, pneumatotherapy, zone therapy, orthopedic devices); crymotherapy; blochemic therapy (nutritional -- correcting deficiencies and employing corrective or hygienic nutrition, phytotherapy-using naturopathic botanicals, herbal, and vegetable materials as listed in "Naturae Medicina"; the use of tissue minerals and cell salts -- Schuessler, vitamins, endocrines, etc; vaportherapy; colon therapy -- irrigating agents and other products for the treatment pathoses of this region; autotherapies; climatotherapy.

3. Patient records

Refer to appended, sample patient interview (narrative case history) questionnaires and laboratory reports. Each practitioner maintains his own form of on-going record for detailing a patient's medical history or progress.

D. CONTRIBUTIONS OF NATUROPATHY TO THE HEALTH FIELD

1. New knowledge

See the appended bibliography of works utilized as references by this profession. These lists include works which are the product of naturopathic case studies or research.

Naturopathy's contribution to the formal, published body of medical research is limited because almost all of its practitioners are individuals, without the benefit of teaching hospitals, numerous clinics, or other study centers in which pure research-endowed privately or by government -- can be conducted. Naturopathy's research is confined primarily to monographs printed in its professional publications or delivered orally at its conventions and other educational meetings.

Many naturopathic physicians feel that their profession's principles are still untried by the larger body of allopathic medicine, hence various naturopathic principles which are centuries old could still be considered "new" to the contemporary practitioner who has yet to utilize them in the late 20th century.

2. New techniques

Essentially, the answer to D. 1. above applies to this question, save that naturopathic undergraduate and postgraduate teaching and seminar curricula embrace every new concept, technique, medication, and instrument which becomes known to the healing arts generally (and which is within legal limitations upon naturopathic practice).

3. New approaches to health

Here it can be held without contradiction that naturopathy has led the way in the fields of nutrition, dietetics, metabolic chemistry, and in some areas of hydro- and physiotherapy. For example, long established naturopathic principles were given national esteem 25 years ago through the "Sister Kenny treatment" for poliomyelitis. Naturopathy's manipulative techniques have been substantially emulated by chiropractic. Naturopaths and their 19th-century forebears were the first to recognize validity in the hypnosis thesis of Paracelsus, Cagliostro, von Helmont, Mesmer, and Braid. Naturopaths, in Freud's professional infancy, were already attuned to the value of psychotherapy.

Less dramatic than citing the naturopathic origins of new "truths" in 20th century healing, but nonetheless illustrative of naturopathy's ever-modern approach to health, is a recitation of some of the current curricula at its National College of Naturopathic Medicine: applied psychology, suggestotherapy, autosuggestion, therapeutic hypnotism, occupational therapeutics, psychosomatic therapy -- are examples of naturopathy's academic currency.

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