INTRODUCTION:

Changes in science and medicine have provided the knowledge and technology to
successfully alter the course of many illnesses. Despite the success of allopathic medicine many
conditions such as arthritis, chronic back pain, headache, allergies etc have been difficult to treat,
and more clients are exploring alternative methods to relive their symptom distress.

The number of clients seeking unconventional treatments has risen considerably. In part this
increase is due to:

 The perception that the treatments offered by the medical profession do not provide relief
for a variety of common illnesses,
 The increasing interest of clients in becoming more educated about their health and the
need to take a more active role in their treatment,
 The increased number of research articles,
 The attraction to a holistic approach to health care that incorporates the mind, body and
spirit.

ALTERNATIVE MEDICINE THERAPIES IN HEALTH CARE:

Unconventional therapies are referred to as either complementary or alternative medicine
(CAM) therapies. Complementary therapies are those therapies in addition to conventional
treatment recommended by the person’s health care provider. As the name implies, complement
therapies complement conventional treatments. Complementary therapies include relaxation,
exercise, massage, reflexology, prayer, biofeedback, creative therapies includes art, music, or
dance therapy, meditation osteopathy and herbalism.

An example of a complementary therapy is using aromatherapy to help lessen a clients

discomfort following surgery.

Alternative therapies include the same interventions as complementary therapies but

frequently become the primary treatment that replaces allopathic medical care. Both
complementary and alternative therapies vary in degree to which they are compatible with
allopathic medicine.

An example of alternative therapy is using a special diet to treat cancer instead of undergoing
surgery, radiation, chemotherapy that has been recommended by a practitioner such as an
oncologist.

Because of the increased interest and use of CAM, many institutions, including
mainstream medical schools have established training programs that incorporate CAM
philosophy and content in to the curriculum. Some are developing integrative medical programs
that allow health care consumers the opportunity to be treated by a team of providers consisting
of both allopathic and complementary practitioners.

NATIONAL CENTER FOR COMPLEMENTARY AND ALTERNATIVE

MEDICINE:
Health care professionals have raised important questions about the effectiveness and
safety of complementary and alternative approaches in the face of their increased use by
consumers. In response to this need, the National Center For Complementary And Alternative
Medicine (NCCAM) as part of the National Institute of Health (NIH) was established. The goals
of NCCAM are to;

∞ Conduct and support basic and applied research and research training on complementary
and alternative approaches and
∞ Disseminate scientifically based information on complementary and alternative research,
practice and findings to health care providers and consumers.

In collaboration with NCCAM, Cochrane Collaboration established a focus area on

complementary and alternative approaches, providing a valuable source.

CLASSIFICATION:
NCCAM has proposed a classification system for complementary and alternative
therapies that include 5 major categories with few types of approaches also;

o Alternative medical system.

o Mind and body interventions.
o Biologic based therapies.
o Manipulative and body based methods and
o Energy therapies.

Alternative Medical Systems –Built Upon Complete Systems of Theory and Practice:

 Acupuncture: A traditional Chinese method of producing analgesia or altering the

function of a body system by inserting thin needles along a series of lines or channels
called meridians. Direct needle manipulation of energetic meridians influences deeper
internal organs by redirecting qi.
 Ayurveda: Traditional Hindu System of medicine practiced in India. A combination of
remedies such as herbs, purgative, rubbing oil street disease.
 Homeopathic Medicine: System of medical treatments based on the theory that certain
diseases can be cured by giving small doses of substances that in a healthy person would
produce symptoms like those of the disease. Prescribed substances called remedies are
made from naturally occurring plant, animal, or mineral substances.
  Latin American Practices: Curanderismo medical system which includes a humeral
model for classifying food, activity, drugs and illnesses and a series of folk illnesses.
 Native American Practices: Therapies include sweating and purging, herbal remedies
and shamanic healing (healer makes contact with spirits to ask their direction in bringing
healing to people.
 Naturopathic Medicine: System of therapeutics based on natural food light warmth
massage fresh air regular exercise and avoidance of medication. Recognizes inherent
healing ability of the body.
 Traditional Chinese Medicine: Set of systemic techniques and methods including
acupuncture, herbal medicines, massage, and acupressure etc. Fundamental concepts
from Taoism, Confucianism, and Buddhism.

Biologically Based Therapies-Use substances found in nature such as herbs foods and vitamins:

 The “Zone”: dietary program that requires eating of protein, carbohydrate, and fat in a
ratio 30:40:30. Used to balance insulin and other hormones for optimal health.
 Macrobiotic Diet: Predominantly a vegan diet (no animal products except fish),initially
used in the management of cancers. Emphasis placed on whole cereal grain, vegetables,
and unprocessed foods.
 Orthomolecular Medicine (megavitamin): Increased intake of nutrients such as vitmin c
and beta carotene. Diet treats cancer, schizophrenia, autism, and certain chronic diseases
such as coronary artery diseases.
 European phytomedicines: Products developed under strict quality control in
sophisticated pharmaceutical factories, packaged professionally in tablets or capsules.
Herbs have a wide variety of uses. Examples of well studied herbal medicines include
bilberry, milk thistle.
 Traditional Chinese Herbal Remedies: Herbs considered the backbone of medicine.
 Ayurvedic Herbs: Traditional Hindu System of herbs used for over 2000years.

Manipulative and Body based Methods –Based on manipulation and or movement of one or
more parts of the body:

 Acupressure: Therapeutic technique of applying digital pressure in a specified way on

designated points on the body to relive pain, produce analgesia or regulate a body
function.
 Chiropractic medicine: System of therapy that involves manipulation of the spinal
column and includes physiotherapy and diet therapy.
 Feldenkrais method: Alternative therapy based on establishment of good self image
through awareness and correction of body movements. Techniques integrates the
understanding of the physics of the body movement pattern with an awareness of the way
people learn o move behave and interact.
  Tai chi: Technique that incorporates breath movement and meditation to cleanse
strengthen and circulate vital life energy and blood. Therapy stimulates the immune
system and maintains internal and external balance.
 Massage therapy: Manipulation of soft tissue through stroking rubbing or kneading to
increase circulation improve muscle tone and relaxation.
 Simple touch: Touching the client in an appropriate and gentle ways to make connection
display acceptance and give appreciation.

Mind-Body Interventions: Use a variety of techniques designed to enhance the Mind’s capacity
to affect bodily functions and symptoms;

 Art Therapy: Use of art to reconcile emotional conflicts, foster self awareness and
express clients unspoken and frequently unconscious concerns about their disease.
 Biofeedback: A process providing a person with visual or auditory information about
autonomic physiological functions of the body such as muscle tension skin temperature
and brain wave activity through the use of instruments.
 Dance therapy: Intimate and powerful medium for therapy because it is a direct
expression of the mind and body therapy treats person with social emotional cognitive or
physical problems.
 Breath work: Using any of a variety of breathing patterns to relax invigorate or open
emotional channels.
 Guided imagery: Therapeutic technique for treating pathological conditions by
concentrating on an image or series of images.
 Meditation: Self directed practice for relaxing the body and calming the mind using
focused rhythmic breathing.
 Music therapy: Uses music to address physical psychological cognitive and social needs
of individuals with disabilities and illnesses. Therapy improves physical movement or
communication develops emotional expression evokes memories and distracts people
who are in pain.
 Healing intention (prayer): Variety of techniques used in multiple cultures that
incorporate caring compassion love or empathy with the target of prayer.
 Psychotherapy: Treatment of emotional and mental disorders by psychological
techniques.
 Yoga: Discipline that focuses on the body’s musculature posture breathing mechanism
and consciousness. Goal of yoga is attainment of physical and mental well being through
mastery of body achieved through exercise holding of postures proper breathing and
meditation.

Energy therapies –involve the use of energy fields:

Energy therapies are of two types. Biofield therapies are intended to affect energy fields that
purposely surround and penetrate the human body. Bioelectromagnetic –based therapies
involves the unconventional use of electromagnetic fields such as pulsed fields, magnetic fields
or direct current fields.

 Relki therapy: Therapy derived from ancient Buddhist practices in which practitioner
places hands on or above a body area and transfers “universal life energy” to the client.
This energy provides strength harmony and balance to treat health disturbances.
 Therapeutic touch: Treatment involving direction of a practitioners balanced energies in
an intentional manner toward those of a client. Involves laying of practitioners hands on
or close to a clients body.

ALTERNATIVE MEDICAL SYSTEMS:

CHINESE MEDICINE:
Chinese medicine is based on the belief that the body is pervaded with energy or Qi
which is produced from the air and food and travels throughout the body providing nourishment
and engendering movement for healthy and normal functioning. Both Qi and blood travel along
the meridians, extensive pathways or channels that connect the surface of the body and the
internal organs. The balance of Yin and Yang influences Qi. When Yin and Yang are balanced
they work with the natural flow of Qi to help the body to achieve and maintain health. TCM
includes a variety of therapies such as acupuncture, accupressure, auricular therapy, moxibustion
and qi ging.

ACUPUNCTURE:

Acupuncture was developed in China. Acupuncture involves stimulating specific

anatomic points in the body for therapeutic purposes such as pain reduction, healing or
physiologic changes. The body has more than 2000 acupuncture points which connect 12 main
and 8 secondary meridians. Practitioners usually stimulate these points using a thin hair sized
needle but they may also use heat, pressure, friction, suction, laser light or impulses of
electromagnetic energy. Most states require a license, registration, or certification to practice
acupuncture.

Adherents believe that acupuncture balances the Qi that flows through the body’s 12
major meridians. Each meridian and anatomic point are linked to internal organs and specific
problems so pathologic condition can be accurately targeted. Scientific research suggests that
acupuncture relives pain through neurologic pathways. High threshold sensory nerves at the
acupuncture points are stimulated and send messages to the spinal cord, midbrain and pituitary to
release endorphins and block pain. Cortisol levels are also elevated which may explain the
prolonged pain relief achieved by patients with arthritis.

The acupuncture diagnoses illnesses by assessing the quantity and quality of Qi flowing
through the channels and determining the individuals balance. After the assessment the
practitioner selects points to stimulate based on the theory that when Qi is blocked it causes pain
and dysfunction and that restoration of flow is critical to the health of the body and mind.

Acupuncture is safe and has a much lower incidence of complication than invasive
surgical procedures. Possible adverse effects including infection and organ puncture are possible.

CONTRAINDICATIONS:

o Phobias to needles
o Clotting disorders such as hemophilia
o Pregnancy
o Age less than 7 years
o The influence of alcohol or narcotic medications
o Dementia

INDICATIONS:

Research studies found that acupuncture to be effective in treating the nausea caused by
surgical anesthesia and cancer chemotherapy as well as pain after dental surgery. It is also useful
to treat addiction, headaches, Menstrual cramps, tennis elbow, fibromyalgia, myofascial pain,
osteoarthritis, lower back pain, carpel tunnel syndrome, and asthma. It is also used to assist in
stroke rehabilitation.

ACUPRESSURE:

Acupressure is a combination of acupuncture and massage in which the thumbs and

finger tips apply pressure to stimulate pressure points along the acupuncture meridians.
Acupressure may be incorporated into a massage therapy session.

AURICULAR THERAPY:

Auricular therapy is the diagnosis and treatment of pain and disease using the auricle
or pinna of the ear. Points on the ear which represent different parts of the body and its structure
are stimulated with needles, magnets, lasers, massage or electricity. The technique has been
found to be useful in smoking cessation and addiction control therapy.

MOXIBUSTION:

Moxibustion uses the powdered leaves of moxa herb or mugwort. The herb is burned
above the skin or on an already inserted needle at the acupuncture points to apply heat and
alleviate a variety of symptoms.

QI GONG, CHI KUNG, AND T’ AI CHI:

 Qi gong, chi kung, and t’ai chi all have their roots in Chinese martial arts. T’ ai means
“meditation in motion”. Practice may involve vigorous exercise or slow movements and postures
that focus on Qi performed in a continuous chain of movement. The technique demands
mindfulness of movement and breathing and can increase circulation.

HOMEOPATHY:

The American Institute of Homeopathy founded in the United States in 1845, was the
first national medical society. Homeopathy is based on the law of similar- like cures like. The
similar principle suggests that any state of disturbance that is not corrected spontaneously ( and
leads to a state of disease) can be corrected by minute doses of a compound which at a higher
dose can produce effects closely resembling the symptoms of the disease being treated or by
minute amounts of the compound actually causing the disease. This theory was the basis for
early vaccine development.

The homeopathic practitioner gives small doses of a compound derived from plant,
animal or mineral sources which in large doses may produce symptoms of a disease in a healthy
persons. Frequently homeopathic remedies are prepared with tinctures of plants in ethyl alcohol
or water. The mixture is shaken and strained over a 2 to 4 week period. Potentiation is the
combination of diluting and shaking of a substance. The higher potencies are more powerful than
lower potencies. Homeopathic medicines may be so dilute that no molecules of the original
substance may remain. Preparations are given in tablet, granule, ointment, liquid or suppository
form and more than one remedy can be used to treat the same problem.

Homeopathy is one of the difficult forms of CAT for most people to accept. Homeopathy
has few documented adverse effects.

AYURVEDA:

Ayurveda is derived from Sanskrit consisting of words ayur meaning life and Veda
meaning related to knowledge or science. It is a system of medicine native to the Indian
subcontinent and practiced in other parts of the world as an alternative system of medicine. The
earliest mention of Ayurveda appeared during the Vedic period in India, in the texts of the
Sushrutha Samhitha and Charka Samhitha. Ayurvedic practitioners identified a number of
medical preparations and surgical procedures for curing various ailments and diseases. Ayurveda
is based on the theory of the three regulatory principles- doshas (humors), namely vata (wind),
pitta (bile), and kapha (phlegm). These remain in balance to maintain a healthy body and when
imbalanced the body has diseases. Ayurveda believes in building a healthy metabolism, a good
digestion and proper excretion to maintain vitality. It also focuses on massage, exercise,
meditation and yoga for well being. Treatment is based on natural herbs, minerals, yoga and
panchakarma. Surgery and surgical instruments are also used. Panchakarma is Ayurvedas
detoxication treatment based on five therapeutic principles. The principles are vamana
(vomiting), virechana (purgation), vasti (enema), nasya (nasal application of herbs), and rakta
moksha (therapeutic release of toxic blood). Ayurveda in India has eight branches- internal
medicine, pediatrics and gynecology, surgery, ENT (ear, nose, and throat), toxicology,
rejuvenation, psychiatry, and study of sexual function and reproduction.

MIND BODY AND SPIRITUAL THERAPIES:

Mind body medicine involves psychologic (behavioral), social, and spiritual
approaches. Options include art therapy, bio feedback, color therapy, hypnosis, imagery, prayer
and spiritual healing, relaxation techniques and sound therapy including binaural beat
technology.

HYPNOSIS:

Hypnosis is a state of attentive, focused concentration with suspension of some

peripheral awareness. A hypnotic state has four components:

∞ Absorption or deep contemplation of a theme or focus,

∞ Controlled alteration of attention,
∞ Dissociation or compartmentalization of ones experience and suggestibility or
∞ Capacity for heightened responsiveness to instruction.

Hypnosis has been used to treat pain, duodenal ulcers, irritable bowel syndrome, and
nausea as well as for smoking cessations.

IMAGERY:

Imagery or visualization techniques use the conscious mind to create mental images to
stimulate physical changes in the body, improve perceived well being and or enhance self
awareness. Frequently imagery combined with some form of relaxation training facilitates the
effect of the relaxation technique. Imagery is self directed, in which individuals create their own
mental images or it is guided during which a practitioner leads an individual through a particular
scenario. For example direct the client to slow abdominal breathing. Then direct the client to
visualize ocean waves coming to to shore with each inspiration then receding with expiration.
Next instruct the client to notice the smells, sounds and temperatures that he or she is
experiencing. As the imagery session progresses instruct the client to visualize warmth entering
the body during inspiration and tension leaving the body during expiration. Individuals imagery
scenarios for each client.

Imagery often evokes powerful psycho physiological responses such as alterations in

immune function. Many imagery techniques involves visual imagery, but they also include the
auditory, proprioceptive, gustatory and olfactory senses. An example of this involves
visualizing a lemon being sliced in half and squeezing the lemon juice on the tongue. This
visualization produces increased salivation as effectively as the actual event. People respond to
their environment according to the way they perceive it, as well as by their own visualizations
and expectancies.

Creative visualization is one of the form of self directed imagery that is based on the
principle of mind-body connectivity ie, every mental image leads to physical or emotional
changes.

CLINICAL APPLICATIONS OF IMAGERY:

Imagery has been used to visualize cancer cells being destroyed by the cells of the
immune system.To control or relive pain, and to achieve calmness and serenity. Imagery also
aids in the treatment of chronic conditions such as asthma, hypertension, functional urinary
disorders, menstrual and pre menstrual syndromes, gastro intestinal disorders such as irritable
bowel syndrome and ulcerative colitis and rheumatoid arthritis.

LIMITATIONS OF IMAGERY:

Imagery is a behavioral intervention that has few side effects. However it is probably one
of the least clearly defined interventions and ranges from highly structured to consisting of
spontaneous daydreams by the individual.

SPIRITUALITY:

Spirituality is ones inward sense of something greater than the individual self,
a personal awareness of dimensions of existence that extend beyond the physical domain.
Spirituality encompasses a variety of perspectives, and personal biases and terminology can be
confusing. Spirituality frequently involves but is different from religion. Religion is the outward,
concrete experience of believing in something greater than the individual self. Religious care
involves helping people maintain their belief systems and worship practices. Spiritual care on the
other hand involves helping people to maintain their personal relationship to a higher authority as
defined by that persons and to identify meaning and purpose in life. Both spirituality and religion
have therapeutic potential.

All cultures incorporate spirituality. Spiritual understanding depends on a basic faith, and
it has no tangible or physical benefit or value. The healing component of spirituality involves the
intentional influence of one or more persons on a living system with out using known physical
means of interaction. Quieting the mind is usually a prelude to spiritual healing, which is
predominantly an activity of the mind as it impinges on matter. The planned use of spirituality
includes the laying on of hands, intent, prayer, psychic healing, spiritual healing, faith healing,
mental healing, and transpersonal healing. It can also involve the energy f heat, tingling,
vibration, and color although it remains unclear whether an unidentified exchange of energy or
energy fields actually occurs through the healing interaction.

Spiritual healing has two main types:

  In the first the healer enters a prayerful altered state of consciousness and views the
patient and self as a single entity.
 In the second the healer touches the patient and energy flows through the healers hand to
the patients area of disease. Many cultures accept the laying on of hands as a powerful
means of healing.

Nurses need to explore spiritual and religious issues with patients as consistently as they do
physical ones. The belief that life threatening diseases such as cancer can disappear suddenly and
completely and that radical healing is somehow connected with ones state of mind is more
common than is generally acknowledged. The belief that “miracles do happen” may help restore
hope and flighting spirit, which are important to recovery from illness.

PRAYER:

Prayer is a universal spiritual practice, a conscious relationship with the force of the
universe or God. It may take the form of intercessory prayer, confession, gratitude, or silent
communion. Prayer involves no direct physical contact and no attempt to do anything or give
anything. The only God is to become one with the person and his or her god. Seeking medical
care and using prayer are not mutually exclusive activities.

MEDITATION:

Meditation creates a state of deep, quiet contemplation that filters out distractions and
seeks to refine consciousness so that thought and being are in tune with the universal plan. Quiet
centering or meditation for just 20 minutes each day can redirect energies for healing and
decrease stress. Meditation decreases oxygen consumption and cardiac and respiratory rates and
is a component of some types of yoga. Meditation is contraindicated for persons who fear loss of
control such as those with a history of schizophrenia or psychosis.

YOGA:

Yoga is a philosophy that integrates the spiritual, mental, emotional, and physical
aspects of life. The word yoga means the union of different aspects of the individual. Yoga has
several different forms but they all involve self improvement through focused breathing,
stretching, and meditation. Yoga emphasizes breath as the link connecting mind, body, spirit, and
emotions. Paraná, or life force energy is taken in through the nose with breathing. Principles of
Alexander technique are derived from yoga. Yoga techniques are used to improve a wide variety
of problems such as hypertension, depression, osteoporosis, and the discomfort associated with
menopause.

GROUP THERAPY:

Group therapy provides mutual support, encouragement, and socialization. It can be

used for psychologic therapy to work through grief and loss, to lose weight, or too work on self
improvement. Group therapy usually centers around a common theme for example a breast
cancer survivors support group.

ART AND COLOR THERAPY:

Art, color, light and environment affect mood and attitude. Art and color allow a
person to express inner needs and desires and record dreams and meditations. Art and color
therapy may be used along with other mind body therapies.

MUSIC THERAPY:

Different parts of the body resonate to different sounds and pitches. The controlled
use of music can influence a person during illness or injury treatment. Some music is specifically
recorded at 60 beats per minute, the rates of the resting heart beat, to promote relaxation and
decrease heart rate. This music has been used effectively in coronary care units, neonatal
nurseries, and cancer units. Music therapy can decrease stress and anxiety. Binaural beat tapes
use a combination of rhythm and beat, delivering it asynchronously and separately to each ear
through head phones.

RELAXATION THERAPY:

People face stressful situation that evoke the stress response. The mind modulates the
biochemical functions of the major organ system. Thoughts and feelings influence the production
of chemicals (ie, neurotransmitters, neurohormones and peptides) that circulate throughout the
body and convey messages via calls to various system within the body. The stress response is a
good example of the way in which systems cooperate to protect an individual from harm.

Physiologically the cascade of changes associated with the stress response appears as
increased heart and respiratory rates, tightened muscles, increased metabolic rate, and a general
sense of foreboding, fear, nervousness, irritability and negative mood. Other physiological
responses include elevated blood pressure, dilated pupils, stronger cardiac contractions, and
increased levels of blood glucose, serum cholesterol, circulating free fatty acids, and
triglycerides. Although these responses prepare a person for short term stress but the effects of
long term stress on body causes structural damage and chronic illnesses such as angina,
headaches, arrhythmias, pain, ulcers and atrophy of the immune system organs.

The relaxation response is the state of generalized decreased cognitive, physiological, and
or behavioral arousal. Relaxation also involves arousal reduction. The process of relaxation
elongates the muscle fibers, reduces the neural impulses sent to the brain as well as other body
systems. Decreased heart and respiratory rates, blood pressure, and oxygen consumption and
increased alpha brain activity and peripheral skin temperature characterize the relaxation
response. The relaxation response occurs through a variety of techniques that incorporates a
repetitive mental focus and the adoption of a calm peaceful attitude lists client teaching strategies
for relaxation.

Relaxation helps individuals develop cognitive skills for reducing the negative ways in
which they respond to situations within their environment. Cognitive skills include:

∞ Focusing (the ability to identify, differentiate, maintain attention on and return attention
to simple stimuli for an extended period)
∞ Passivity (the ability to stop unnecessary goal directed and analytic activity)
∞ Receptivity (the ability to tolerate and accept experiences that are uncertain, unfamiliar,
or paradoxical)

The long term goal of relaxation therapy is for persons to continually monitor themselves for
indicators of tension and to continuously let go and release the tension contained in various body
parts.

PROGRESSIVE RELAXATION:

Progressive relaxation training teaches the individual how to effectively rest and
reduce tension in the body. The persons learns to detect localized sensation of muscle tension in
one muscle group. In addition the individuals learns to differentiate between high intensity
tension and subtle tension. The individuals then practice this activity using different muscle
groups. One active progressive relaxation technique involves the use of slow, deep abdominal
breathing while tightening and relaxing an ordered succession of muscle groups. When guiding a
client, you may decide to begin with the muscles in the face, followed by those in the arms,
hands, abdomen, legs and feet.

PASSIVE RELAXATION:

Passive relaxation involves teaching the individual to relax individual muscle groups
passively (ie, without actively contracting the muscles), one passive relaxation technique
incorporates slow, abdominal breathing exercises in addition to the person imagining warmth
and relaxation flowing through specific muscle groups while letting go of muscle tension during
expiration. Passive relaxation is useful for persons whom the effort and energy expenditure of
active muscle contracting leads to discomfort or exhaustion.

CLINICAL APPLICATIONS OF RELAXATION THERAPY:

Relaxation technique effectively lower heart rate and blood pressure, decrease muscle
tension, improve well being and reduce symptom distress in persons experiencing a variety of
situation(eg: complications from medical treatment or disease or grieving the loss of a significant
other) it is important to match the type of relaxation intervention to the individuals functional
status, the energy expenditure of the relaxation technique and the motivation of the individual for
frequent practice.
 Research shows that relaxation, alone or in combination with deep breathing, imagery,
yoga and music reduces pain, reduces tension headaches and helps reduce human
immunodeficiency virus anxiety. It also facilitates burn care , helps clients deal with post
traumatic stress and even improves cognition in healthy aging adults.

Relaxation is a valuable technique because it enables individuals to exert some control

over their lives. Some experience a decreased feeling of helplessness and a more positive
psychological state which helps them to have a less negative view of their situation.

LIMITATIONS OF RELAXATION THERAPY:

Individuals undergoing relaxation training have reported fearing loss of control,

feeling like they are floating and experiencing relaxation induced anxiety related to those
feelings. During the relaxation training, individuals learn to differentiate between low and high
levels of muscle tension. During the first months of training session when the person is learning
how to focus on body sensations and tensions, there are reports of increased sensitivity in
detecting muscle tension. Usually these feeling are minor and resolve as person continues with
the relaxation training,

An important consideration when choosing the type of relaxation technique is the

physiological and psychological status of the individual. Clients with advanced diseases such as
cancer or AIDS often seek relaxation training to reduce their stress response. Relaxation training
requires a moderate expenditure of energy which can increase persons existing fatigue and limit
the persons ability to complete relaxation sessions and practice. Therefore active progressive
relaxation is not appropriate for clients with advanced disease or those who have decreased
energy reserves. Passive relaxation or guided imagery is more appropriate for these individuals.

BIOFEEDBACK:

Biofeedback techniques used in addition to relaxation interventions assist individuals

in learning how to control specific autonomic nervous system responses. Biofeedback is a group
of therapeutic procedures that use electronic or electromechanical instruments to measure,
process, and provide information to persons about their neuromuscular and autonomic nervous
system activity. the information or feedback is given in physical, physiological, auditory and
visual feedback signals. For eg: clients connected to a biofeedback device hear a sound if their
pulse rate or blood pressure increase out of their therapeutic zone.

Biofeedback is an effective addition to more traditional relaxation programe because it

immediately demonstrates to clients their ability to control some physiological responses. It also
helps individuals to focus on and monitor specific body parts. By providing immediate feedback
in terms of what stress relaxation behaviors work most effectively, it helps the clent to control
physiological functions that are most difficult to control. Eventually the client will be able to
notice positive physiological changes without the need for instrument feedback. Finally,
biofeedback demonstrates to the client the thoughts, feelings and physiological responses.

CLINICAL APPLICATIONS OF BIOFEEDBACK:

Biofeedback in a variety of forms has applications in numerous situations. Biofeedback

can be successful in treating migraine headaches, other pain, stroke and a variety of gastro
intestinal and urinary tract disorders. One of the most critical component of any behavioral
programe is adherence to the treatment regimen. Clients who are compliant with appointments,
practice times, and goal setting and basically takes responsibility for their treatment tend to be
the most successful.

LIMITATIONS OF BIOFEEEDBACK:

Although biofeedback has demonstrated effectiveness in a number of client populations,

there are several precautions. During relaxation therapy and feedback sessions repressed
emotions or feelings are sometimes uncovered that clients cannot cope with by themselves. For
those reason practitioner who offer biofeedback should either be trained in more traditional
psychological methods or have qualified professionals available for referral.

PSYCHONEUROIMMUNOLOGY:

Psychoneuroimmunology is the study of mechanisms that turn through thoughts and

feelings in to chemical and neurologic sequale. It explores the interaction between behavior,
neural and endocrine activity and the immune process. Psychologic distress can suppress the
immune system and increase the risk of illness. At the same time a person can work with mind
and emotions to increase resistance to disease or to influence recovery. It has been used
effectively to treat headaches, moderate blood pressure, heart rate and rhythm, heal ulcers and
irritable bowel syndrome, manage pain, anger, anxiety, and panic and reduce muscle spasms.

BIOLOGICALLY BASED THERAPIES;

Biologically based therapies include the use of natural products, both botanical and
herbal, and nutritional supplements. Natural products represent one of the fastest growing
consumer markets .

HERBAL MEDICINE:

Phyto medicine, the use of plant material for medicinal purposes has been used by every
known culture. In the United States the Frontier Nursing Service nurses made tea from ginseng
leaves to treat colic and menstrual pain, made arrow wood bark in to cough syrup, and used
cloves to treat tooth aches.
 Herbal elements and content vary depending on the part of the plant harvested, time of
year harvested and soil content. Herbal products often are not as potent as commercially
prepared medicines and may take several weeks to build up blood levels of the active ingredient
and produce their effects.

People often assume that herbal products are safe because they are natural but natural
does not always guarantee safety and they are not inherently a better option. A new drug goes
through a lengthy clinical trials process to attempt to ensure its safety and efficacy.
Pharmaceuticals that are derived from plants (eg: aspirin, digoxin, atropine and morphine) are
the chemically isolated constituents of plants. Prescription drugs are purified, standardized and
thoroughly researched and their pharmaco kinetics and pharmacodynamics are well known. In
contrast , herbal or natural products are regulated as foods rather than drugs and are not subject
to the clinical trials process.

COMMONLY USED HERBAL PRODUCTS:

BLACK COHOSH (CIMICIFURA RACEMOSA):

Black cohosh root is a Native American therapy. It is used primarily for treatment of
menopausal symptoms and menstrual irregularities and to stimulate uterine contraction. The
mechanism of action is unknown. It does exert some estrogenic activity.

BUTTERBUR (PETASITES HYBRIDUS):

Butterbur extract is made from the rhizomes, roots, and leaves of this perennial shrub. It
is frequently used in the treatment of migraines, chronic cough, asthma and bladder spasms and
in the prevention of gastric ulcers. There may be cross reactivity in patients allergic to daisies
and rag wood.

ECHINACEA (AMERICAN CONEFLOWER, PURPLE CONE FLOWER):

Echinacea is widely used as an immune system enhancer. It is believed to have antiseptic,

antiviral, and peripheral vasodilatory properties and can be used as supportive therapy for colds
and flu. Many persons use it for prevention. It is most effective when used at the onset of cold
symptoms to reduce the duration and severity of upper respiratory tract infections, both viral and
bacterial.

ELDERBERRY (SAMBUCUS NIGRA):

Elderberry is a small tree that grows to heights of 12 feet. The berries contains vitamins
A, B and C, flavonoids, carotenoids, and amino acids. It is also used as topically for infections
and to decrease inflammation and swelling. Elderberry tea can help speed recovery from cold
and flu symptoms.

FEVERFEW (TANACETUM PARTHENUM):

It is a member of sunflower family. It has antipyretic properties and acts like nonsteriodal
anti inflammatory medications. It is used to treat arthritis and to reduce fever and inflammation.
It also inhibits platelets and should be used with caution by persons concurrently taking anti
coagulants. It should be stopped two weeks before surgical procedures. It is also used to prevent
migraine.

GARLIC (ALLIUM SATIVUM):

It lowers cholesterol, regulates blood sugar, decreases blood pressure, and platelet
adhesiveness, prevents age related vascular changes and has anti bacterial properties. It is helpful
in avoiding heart disease. It is not used with anti coagulants because it can prolong bleeding.

GINGER (ZINGIBER OFFICINALE):

Sailors historically chewed ginger root to alleviate seasickness. It is used to prevent

nausea and vomiting associated with motion sickness as a digestive aid and as a peripheral
circulatory stimulant. It is used cautiously with anti coagulants since it can potentiate bleeding.

GINGKO (KEW TREE, MAIDENHAIR TREE):

It increases general circulation, improves micro circulation, inhibits platelet aggregation,

and inactivates oxygen free radicals. It is used in intermittent claudication and dementia. It may
slow the progress of Alzheimer’s disease. It inhibits platelet aggregation, it should be used with
caution after trauma or surgery.

GINSENG (PANAX GINSENG):

It increases resistance to stress and excessive activity and has an effect in times of fatigue
or disability. It can interact with anti coagulants and potentiate bleeding.

HORSE CHESTNUT (BASCULES HIPPOCASTANUM):

It decreases capillary permeability. It has been used to treat symptoms of venous

insufficiency and to prevent varicose veins. It seems to equivalent to the stockings.

KAVA KAVA (PIPER METHYSTICUM):

 It act as a sedative. It has been used for anxiety, stress and restlessness.

SAW PALMETTO (SABAL SERRULATA):

It has both anti inflammatory and anti edema effects. It is used to treat the urination
problems associated with BPH.

TEA TREE OIL (MELALEUCA ALTERNIFOLIA):

It is used as topical antiseptic. It is used for multitude of skin conditions.

VALERIAN ROOT (VALERIANA OFFICINALIS):

It is used for restlessness, sleeping disorders due to nervous conditions and insomnia.

NUTRITION:

It is the science that studies the use of food to promote health and avoid disease. Patients
recovering from trauma or major illness benefit from nutritional support, but nutrition also plays
a major role in the prevention and treatment of chronic disease.

Eg: instead of using hormone replacements to control menopausal symptoms, a patient can use
soy products because of their phytoestrogen content and can supplement the diet with whole
grain cereals, vitamin E,C, beta carotene, fish oil, calcium and vitamin B6.

AROMATHERAPY:

It involves the use of essential oils and hydrosols to promote personal health and balance
heal the mind, body and spirit. Dr. Rene Maurice Gattefosse coined the term aromatherapy and
published a book that earned him the title “father of modern aromatherapy”.

Essential oils are applied or inhaled to achieve physical, emotional, and spiritual balance
and harmony. Odors are transmitted to the brain via olfactory nerve and stimulate the limbic
system of the brain which controls primitive needs such as hunger, thirst and emotion. Odors
also act on hypothalamus which controls the secretion of hormones in the endocrine system. A
persons reaction to an odor occurs on an emotional and largely subconscious level.

It can be used with or without touch therapies. They can be used in massage lotions,
baths, compresses, steam inhalation, and hair and skin care products. Small quantities are
therapeutic but larger could be toxic.

BACH FLOWER REMEDIES:

They are the combination of flower essence. The combination are obtained from 38
common non toxic flowers. Hydro therapy baths, douches and packs can also be made with
Bach flower remedies.
 MANIPULATIVE AND BODY BASED THERAPIES:
Manipulative and body based therapies integrate the structural and functional integrity of
the body using manual methods. They may involve reeducation about movement and structured
exercise. “Body work” and manipulative therapies with a structural focus include chiropractic,
craniosacral, Trager and Alexander technique. Neuro muscular therapies include reflexology and
Trager. Structural and postrual reintegration therapies include Rolfing and Alexander technique.

MASSAGE:

Massage therapy perhaps the best known of the manipulative therapies involves the
manipulation of tissues to enhance healing and health. Massage manipulates the soft tissues
(skin, muscles, tendons, ligaments, fascia) and structures wit in the soft tissue to normalize these
tissues. Massage therapist may use their hands, forearms, or elbows to apply pressure and move
the body tissues. Techniques includes touch, stroking (effleurage), friction, vibration, percussion
(tapotement), kneading (petrissage), stretching, compression and passive and active joint
movements. Massage modalities includes European massage, Swedish massage, deep tissue
therapy, sports massage, manual lymph draining, N D Esalen massage.

Massage integrates mechanical, physiologic, reflexive, mind body and energetic

mechanism. Massage affects the musculoskeletal, circulatory, lymphatic nervous, and other body
systems. It can reduce muscle tensions, improve circulation, decrease blood pressure, reduce
acute and chronic pain, and increase joint mobility and range of motion. It increases oxygen
delivery to the tissues and improves the removal of lactic acids and other waste products from
the cells. The levels of beta endorphins increase moderately after connective tissue massage
which decreases pain perception.

Massage also creates a state of relaxation that relives anxiety and enhances the
individuals sense of well being. Mental centering can also occur. Deep massage can create a
meditative state that recharges energy and activates the Para sympathetic nervous system for
restoration and rejuvenation.

Touch is the fundamental medium of massage therapy. Massage establishes a mind body
connection between the therapist and patient in a safe non sexual environment.

Historically nursing programs taught back massage as a part of night time care ant to help
patients relax.

CHIROPRACTIC:

Chiropractic means “hand work” and refers to manual therapy that focuses on the spine
and its effect on the nervous system. The practitioner analyses structural relationship and
manipulates them to restore proper alignment and function. Chiropractors use the patient
history, physical examination, neuromuscular examination, radiographic examination, and
laboratory or special studies to determine the appropriateness of chiropractic care for the
individual patient.

It is used to treat shoulder pain, lower back pin, and temporomandibular joint disorders.
Chiropractors use mobilization and manipulation as a treatment modality for spine disorders,
pain, altered musculoskeletal function, altered flexibility, and disturbed physical performance. It
is also used in the treatment of headaches and neck pains.

Chiropractic treatment does carry a risk of adverse outcomes such as brainstem or

cerebellar infarction, spinal cord injury, vertebral fracture, tracheal rupture, diaphragm paralysis
and even death.

CRANISACRAL THERAPY:

It focuses on normalization of the cranio sacral system. John Upledger, an osteopathic

physician developed cranisacral therapy in 1970. The therapy is based on the theory that a cranio
sacral rhythm or pulse motion reflects the rise and fall of the CSF with in the Dura matter
compartment occurs 6 to 12 times per minute in a healthy person. He believed that the skull
sutures are not entirely fused , but can be used to access the flow of CSF through the Dural
membranes. The therapist works with the patient to identify where this pulsing rhythm is
obstructed. The therapist monitors the rhythm using light, gentle touch, no heavier than 5 g. after
identifying the obstruction, the practitioner assists the natural flow of fluid to help the body self
current. Work in this area can increase energy flow and break up restrictions. It is used to
manage chronic fatigue syndrome, chronic headaches, joint problems, and head injury and as
part of stroke rehabilitation.

TRAGER:

Trager uses gentle rhythmic movements or rocking to give the mind sensory information
about where body parts are and how they feel and move. This was developed by Milton Trager.
Trager connects a person to his or her body stimulates deep relaxation and focuses on a model of
optimal functioning. This approach provides a back ground for the physical therapy,
occupational therapy, massage therapy, chiropractic care, physical rehabilitation and psycho
therapy.

ALEXANDER TECHNIQUES:

Alexander technique is a system of posture and movement that capitalizes on the body’s
natural grace and poise. The technique focuses on postrual reflexes or anti gravity reflexes, “the
use of our selves”. This technique has been used for two main purposes :

 Performing arts and

  Physical therapy.

It involves kinesthetic reeducation. Children have the excellent use of their body from birth.
A young child with an erect spine, free joints, and a large head that is balanced easily on the
neck. Over time through environmental socialization the person loses this poise this technique
reteaches it. Through one on one lessons with a teacher a person learns to move the body with
minimal strain and maximum balance for optimal functional mobility and decreased pain. Over
time a person acquires a sense of postrual awareness which enables him or her to automatically
modify muscular response to stress.

This technique is useful for the persons with chronic pain conditions, traumatic injuries,
back, hip, and neck dysfunction, repetitive stress injuries, neurologic dysfunctions, respiratory
dysfunction and posture or balance disorders.

REFLEXOLOGY:

It involves applying pressure with the thumb and fingers to stimulate the reflex areas in
the feet and hands that correspond to all the glands, organs, and parts of the body. It can improve
the function of the whole body or a specific targeted area that may be distant from the area being
stimulated. It encourages energy flow and removes impurities to promote healing.

Reflexologists work each reflex triggering release of stress and tension in the
corresponding area or body zone and promoting an overall relaxation response. Patients express
relief from tension and pain, greater well being and increased energy.

EXERCISE:

Exercise is movement that promotes health and fitness, including cardiovascular

endurance, muscle strength, and body flexibility. Appropriate physical activity and exercise
condition the heart and other muscles and provide a sense of well being. Stretching relaxes and
loosens muscles, releases toxins, and increases blood flow. Lymph movement in the body
depends on stretching and breathing. Exercise decreases stress hormones, improves relaxation
and helps the body deal with stress more effectively. Exercise can improve cardio vascular and
pulmonary function, hypertension, diabetes, osteoporosis and depression.

ENERGY THERAPIES:
All living systems are based on energy and vibration and all forms of body work interact
with this energy in some way. Energy therapies include therapeutic touch, relki, physioacoustics,
and bioelecromagnetics.

THERAPEUTIC TOUCH:
 Therapeutic touch is a training specific therapy that was developed by nurse. Therapeutic
touch is a training specific therapy. Therapeutic touch is a natural human potential that consists
of placing the practitioners hands either on or close to the body of a person. The process of
therapeutic touch involves the practitioner scanning of the body of the client and diagnosing
areas of accumulated tensions.

Therapeutic touch consists of 5 phases.

 Centering
 Assessing
 Unruffling
 Treating and
 Evaluating

Centering is the process where by the practitioner becomes aware and fully present during the
entire treatment.

The next phase involves assessing the client in which the practitioner moves his or her
hands in a rhythmic and symmetrical movement from the head to the toes. During this phase the
practitioner notices the quality of energy flow and detects accumulation of energy. Clients
perceive physiological indicators of energy imbalance as feelings of congestion, pressure,
warmth, coolness, blockage, pulling or drawing, or static or tingling.

During the third phase, unruffling, the practitioner facilitates the symmetrical and
rhythmical flow of energy through the body. The practitioner performs this technique using long
downward strokes over the energy field located over the entire body either by touching the body
or maintaining the hands in a position a few inches away from the body.

During the actual treatment the practitioner directs and balances the energy attempting to
rebalance the energy flow.

The final phase consists of evaluating the client and reassessing the energy field. If a
rebalance has occurred the practitioner detects a more symmetrical freely flowing energy field
and greater well being.

CLINICAL APPLICATIONS OF THERAPEUTC TOUCH:

Therapeutic touch reduces anxiety levels in hospitalized clients with cardiovascular

disease reduces headache pain and improves mood in bereaved adults. It is also used in treating
trauma recovery and dementia.

LIMITATIONS OF THERAPEUTIC TOUCH:

Therapeutic touch is contraindicated in certain client populations. For eg; persons who
are sensitive to human interaction and touch (eg; those who have been physically abused or have
psychiatric disorders) may misinterpret the intent of the treatment and feel threatened and
anxious by the treatment. Other clients who are sensitive to the energy repatterning may also
need to avoid therapeutic touch. These include premature infants, newborns, children, pregnant
women, older or debilitated people, or those in critical or unstable conditions.

RELKI:

Relki involves the use of intentional touch with a receptive patient to promote healing.
The term relki means, “universal life force energy”. Relki practitioners draw energy in to their
bodies through the crown of their heads. This energy then passes through the body and out of
their hands to the patient. Healing can occur as energy passes to the patient.

VIBRATIONAL MEDICINE:

Vibrational medicine uses the fluctuating energy fields from electronic devices , the
human voice, or musical instruments to promote health. The use of resonant vibration through
music and sound can produce changes in heart rate, blood pressure, brain waves and muscle
contraction and restore this balance in the body.

PHYSIOACOUSTICS:

Physioacoustics specifically applies low frequency stimulation to the human body to

obtain desired effects. It uses sine waves in the range of 20 to 120 Hz. The subject may sit in a
special chair or lie on a special mattress. Preselected frequencies or sounds are played through
simple speakers and are more felt than heard. A contraindication for vibrational therapy is an
acutely herniated disk. Potential uses include stress, anxiety and pain reduction.

BIOELECTROMAGNETICS:

Bioelectromagnetics explores the interaction of electromagnetic fields and radiation with

living tissues. Researchers are currently studying the use of magnets for a variety of purposes
including wound healing and the treatment of bone, muscle and joint pain. Women with bladder
incontinence and men who have had prostatectomies are using chairs with pulsed magnetic fields
to improve continence.
 NURSES ROLE
The role of the nurse with respect to complementary and alternative therapies is evolving.
Roles of the nurse, may includes :

 Assessing patients use of complementary and alternative therapies and their risk for
complications or adverse reactions with conventional therapies.
 Serving as a resource about complementary or alternative therapies, including teaching
patients about complementary and alternative options , providing information about
evidence concerning effectiveness and making referrals to qualified practitioners.
 Serving as a provider of therapies for which the nurse obtains training and certification
such as therapeutic touch or acupuncture, and
 Conducting research about complementary and alternative approaches.

SERVING AS A RESOURCES:

To serve as a resource for patients, nurses must first develop their own knowledge base.
Even if specific information about complementary and alternative therapies is not provided to
seek ongoing education regarding complementary and alternative therapies and to continue to
read and critique research conducted on such therapies. Resources for complementary and
alternative approaches have dramatically increased with the development of the internet. Nurses
should also be prepared to assist patients in differentiating between internet sites that approaches
and those that include systematically reviewed information. Knowledge of internet sites or other
listings that include information about local practitioners of various therapies who are certified,
registered, or licensed is also useful.

SERVING AS A PROVIDER:

Nursing has a long history of providing therapies that have been considered
complementary and alternative within the context of contemporary biomedical approaches to
health. These include massage, relaxation therapy, music therapy, and therapeutic touch, as well
as other strategies are generally included within the scope of nursing practice, though they are
not specifically addressed in most U.S. state nursing practice acts. Similarly, practice act in the
united Kingdom and Australia address nurses accountability for their own actions and their
responsibility to know their limitations and function within those limits. The requirements for
use of a specific complementary or alternative therapy are not different than for use of other
nursing interventions. The nurse should have specific training in the use of the therapy and
should be aware of the evidence base that address the condition for which the therapy is
indicated the effectiveness of the therapy, and the potential for adverse outcome or synergistic
effect.
INVOLVEMENT IN RESEARCH:

Nurses are responsible for critiquing and applying relevant research findings to their
practice, as well as participating in the identification of researchable problems. Participating on
team whose focus is to develop evidence based protocols that address appropriate use of
complementary and alternative is another effective approach. Practicing with a questioning mind
can facilitate identification of research question that can be investigated with research-trained
health care professionals. Types of research questions that can be posed include describing the
extent of patients use of specific therapies, exploring patients experiences of using various
complementary or alternative therapies, and documenting the effectiveness of therapies in
commonly used by nurses.

CONCLUSION:
Patient interest and participation in complementary or alternative therapies is increasing.
Therefore it is important for nurses to be knowledgeable of the multiple therapies available and
to develop effective strategies to document the use of these therapies. It is also impotent for
nurses to keep abreast of the current research being done this area to provide accurate
information to both patients and health care professionals.
BIBLIOGRAPHY:
 Monahan, Sands, Marek; Phipps Medical- Surgical Nursing; 8th Edition; Elsevier
Publication; Page No:50-70.
 William. S. Linda, Hopper. D. Paula; Understanding Medical Surgical Nursing; 4 th
Edition; F.A Davis Company; Page No: 59-65.
 Smeltzer. C. Suzanne, Bare Brenda; Brunner And Suddarth’s Text Book Of Medical
Surgical Nursing; 10th Edition; Lippincott Publications; Page No: 119-120.
 Ignativicus, Workman; Medical Surgical Nursing; 5th Edition; Elsevier Publications;
Page No: 32-39.
 Lewis, Heitkemper; Lewis Medical Surgical Nursing; 6th Edition; Elsevier Publications;
Page No: 78-91.
 Perry And Potter; Fundamentals Of Nursing; 7th Edition; Elsevier Publication; Page No:
78-91.

JOURNAL REFERENCE:
 Health Action; AYUSH; Prof. Sofia Christopher, Mrs. Neseeba. U; October 2012; Page
No: 35-38.

NET REFERENCE:
 www. libertpup.com
 www.wikipedia.org
 www.cinhal.com
COMMUNITY HEALTH NURSING

SEMINAR
ON
ALTERNATIVE SYSTEMS OF
MEDICINE

SUBMITTED TO: SUBMITTED BY:

MRS.NIDHI ALEX, MS.SELJA ELSA SAJI,

ASSO.PROFESSOR, 2ND YEAR MSC (N),

TMM CON. TMM CON.