MARK A. GOLDSTEIN, MD, is chief of adolescent and young adult medicine at Massachusetts General Hospital in Boston. He lives in Lincoln, Massachusetts.

MYRNA CHANDLER GOLDSTEIN, MA, is a former newspaper correspondent whose work has been recognized by the Massachusetts Press Association and the New England Press Association. She lives in Lincoln, Massachusetts.

LARRY P. CREDIT, OMD, maintains a practice at Sancta Maria Hospital in Cambridge, Massachusetts, and is on the faculty of Fitchberg State College in Fitchberg, Massachusetts. He resides in Belmont, Massachusetts.

Excerpt. © Reprinted by permission. All rights reserved.

Integrative Medicine: The Best of All Worlds

In this book, you're going to find treatments from both conventional medicine and complementary disciplines. Combining the two in a treatment plan has come to be known as an integrative approach to care.

For many years, conventional and complementary medicine operated in separate universes, with little common ground except their mutual objective of helping patients to heal from illness or--in the case of chronic conditions--to minimize symptoms. Why are they coming together now? Mostly because health care consumers like you have demanded it. They recognized that conventional and complementary therapies alike have benefits as well as risks--and that combining the two can optimize healing while, in many cases, reducing costs.

In this chapter, we'll provide brief overviews of conventional and complementary medicine in turn. This information will provide a foundation for the condition-specific "prescriptions" in Part 2.

What Is Conventional Medicine?

Until relatively recently, the words "complementary medicine" seldom were spoken in a medical setting. For the most part, the care and treatment provided by doctors fell within the conventional realm.

Conventional medicine--sometimes called allopathic medicine or mainstream medicine--has been practiced by generations of traditionally trained physicians. Those who wish to pursue a career in medicine must complete 4 years of study (beyond a bachelor's degree), followed by an internship, a residency, and possibly a fellowship. Generally, students who attend one of the nation's 125 medical schools are taught to use medications, surgery, and other conventional modalities to treat medical conditions. They may not learn about complementary disciplines, unless they choose to do so. (Many schools are offering training on the relationship between body and mind, so doctors-tobe can recognize when treatment may need to involve a mental health practitioner.)

Among the key differences between conventional and complementary medicine is that conventional modalities must undergo a certain level of scientific scrutiny before they become available to the general public. Every day, medical researchers in laboratories throughout the United States are conducting thousands of studies in a continual effort to develop new diagnostic procedures, medications, and surgical techniques. To a certain extent, these endeavors are overseen and regulated by the federal government.

In recent years, many medical doctors have embraced evidence-based medicine- -that is, the use of the best evidence from research studies to guide their clinical decisions. Thanks to the Internet, they now have quick and easy access to these findings, which allows them to provide their patients with the most up-to-date medical care possible.

Conventional medicine also places an emphasis on prevention. From a very young age, children are given vaccines to help protect against a host of different illnesses. Likewise, adults are encouraged to get certain shots-- such as the one that prevents influenza--and to undergo regular screenings designed to detect various illnesses in their earliest and most treatable forms.

But conventional medicine isn't without challenges, particularly with regard to cost and access to care. There's a serious shortage of medical doctors--especially those who specialize in certain areas of medicine--in rural communities. Further, more than 46 million Americans have no health insurance, while another 40 million have inadequate coverage. These people all too often neglect preventive care, and they may put off treatment for their health problems until they require emergency intervention.

Perhaps not surprisingly, those with greater financial resources tend to receive better medical care in the conventional medical system. The recent emergence of "boutique practices" promises to widen the gap even more, with some doctors limiting their practices to a preset number of patients. Patients, in turn, pay thousands of dollars above their normal health insurance premiums for improved access to their doctors.

Despite the problems within a conventional medical system, it is a good idea to have a traditionally trained physician as your primary care provider. To some degree, whom you choose may be determined by your health plan, as some plans require their members to utilize certain physicians or practices. Beyond that, you want a doctor who's board-certified, meaning that he or she has met the training requirements and passed the certification exam of a medical organization such as the American Board of Internal Medicine. These exams are designed to assess competency in various medical specialties.

Also be sure to ask whether a doctor has hospital admitting privileges. This means that if you ever require hospitalization, your doctor can admit you to the appropriate facility.

These days, it's relatively easy to check out a doctor's training and credentials online through the Web sites of organizations such as the American Medical Association (www. ama-assn.org). Still, many people find their primary care providers by word of mouth--through family members, friends, and colleagues who are happy with the quality of care that a particular doctor provides. At the end of the day, perhaps what matters most is finding someone with whom you feel comfortable and in whom you have the confidence to entrust your care.

What Is Complementary Medicine?

Complementary medicine--also known as alternative or holistic medicine--is an umbrella term for a number of healing disciplines, some of which date back thousands of years. A typical complementary treatment plan takes into account all of the elements that influence a person's health--including the physical, mental, emotional, spiritual, and social, and sometimes the environmental. Complementary therapies also tend to be quite sensitive to the mind-body connection--that is, how a person's mental and emotional state can influence physical health and vice versa. A complementary practitioner will actively involve a patient in his or her own care by teaching the person to use remedies and techniques that not only support healing but also prevent future illness.

Where conventional medicine tends to focus on alleviating the symptoms of a disease, complementary therapies attempt to identify and treat the root cause. These perspectives may seem at odds, but as practitioners and patients are coming to realize, combining conventional and complementary modalities--that is, an integrative approach to care--often can be more effective than using either alone.

One of the enduring criticisms of complementary medicine is that very few of the treatments have been subject to the same rigorous scientific scrutiny as conventional medicine. Indeed, though certain complementary disciplines have thousands of years of anecdotal evidence to support their therapeutic powers, the scientific literature remains rather scant. Gradually that is changing, due in large part to the creation of the National Center for Complementary and Alternative Medicine in 1999. This government-funded institution--under the auspices of the National Institutes of Health--is training researchers, financing clinical trials, and disseminating authoritative information about various complementary therapies to physicians and laypeople alike.

Within complementary medicine, the philosophies and practices of the disciplines can vary greatly. If you're thinking about adding one of these therapies to your health care regimen, it's important for you to consider your personal preferences and comfort level when weighing your options. For example, acupuncture, massage, and therapeutic touch are all effective treatments for headaches, but they're very different in what they entail. Choosing the one that's best for you requires some research, and perhaps a bit of trial and error.

More and more insurance companies are expanding their coverage to include complementary therapies, so before you make a decision, you may want to check the provisions of your own health plan. Other factors that you should take into account: how far you'll be traveling to a qualified practitioner, how often you'll require in-office visits and treatments, and whether you can use the treatments at home, on your own.

Depending on the discipline, finding a qualified practitioner can take some legwork. To simplify the process, we've provided a listing of professional organizations beginning on page 563. Often the Web sites for these organizations have tools that allow you to search for practitioners by location. We've included a guide to practitioners' credentials (see page 567), which may help you assess whether someone has the appropriate training and certifications to practice a particular therapy.

What follows are brief descriptions of the complementary disciplines that you're most likely to encounter in this book. You'll find more detailed remedies in the condition entries of Part 2.

Acupressure

Based on the principles of acupuncture and traditional Chinese medicine, acupressure is the application of pressure to specific points on the body via deep circular movements of the thumbs, fingers, elbows, or palms. This pressure is said to release chi, or healing energy, which circulates throughout the body along specific pathways called meridians. By clearing blockages in the energy flow, acupressure improves the body's ability to heal itself.

Acupuncture

The main difference between acupuncture and acupressure is that the former uses hair-thin, sterile, disposable needles rather than firm pressure to release chi. Studies have shown that acupuncture treatment is able to stimulate various physical reactions, including changes in brain activity, blood pressure, blood chemistry, heart rate, endocrine function, and immune system response.

Alexander Technique

Developed by the Australian actor Frederick Matthias Alexander, who suffered from chronic hoarseness when performing, the Alexander Technique (AT) identifies poor postural habits and replaces them with improved body mechanics. An AT instructor teaches basic exercises that improve balance, posture, and coordination and help relieve posture-related problems such as back pain.

Aquatic Therapy

Also known as water therapy, aquatic therapy involves performing gentle, rhythmic movements and exercises in a warm (92° to 99°F), shallow pool. Participants may be seated or standing during their therapy sessions, and they may walk or float in the water. Since many aquatic therapy facilities have an additional pool that's set to a cooler temperature, a therapy session may include time in both pools.

Aromatherapy

Aromatherapy is the use of aromatic essential oils from herbs and flowers for therapeutic purposes. Aromatherapists believe that the perfume from the essential oils stimulates the release of neurotransmitters in the brain. These neurotransmitters, in turn, stimulate or calm the body and relieve pain. Moreover, certain essential oils may have antibacterial, anti- inflammatory, or astringent properties when applied directly to the skin. Each essential oil has unique therapeutic benefits.

Ayurveda

Developed in India more than 5,000 years ago, Ayurveda is a holistic (whole- body) discipline that tailors treatment to a person's body type (prakriti) and energy type (dosha). Each of the three energy types--vata, pitta, and kapha--corresponds to particular body types. Although everyone has a combination of the three doshas, one (sometimes two) tends to be most prevalent.

Once an Ayurvedic practitioner has determined your dominant dosha, he will make recommendations that collectively will bring the three energy types into balance. A typical Ayurvedic treatment plan will combine a number of approaches, including nutritional therapy, herbal remedies, physical exercise, massage, and meditation.

Biofeedback

In biofeedback, an electric monitoring device is placed on the surface of the skin to record data on vital functions such as heart rate, blood pressure, muscle tension, brain wave activity, and skin temperature. These data are transmitted to a biofeedback machine, which "translates" them into sounds (beeps), visual images (flashes), or dial readings. By paying attention to these signals, you become more aware of stress-related physical changes and better able to control them--usually through relaxation techniques such as deep breathing, meditation, and/or visualization. The goal of biofeedback training is to learn how to achieve and maintain a relaxed state even when you are not using a biofeedback machine.

Bodywork

Bodywork is a general term for a number of therapeutic approaches that use hands-on techniques to manipulate and balance the musculoskeletal system. These approaches relieve pain, facilitate healing, increase energy, and promote relaxation and wellbeing. Examples of bodywork techniques include acupressure, craniosacral therapy, reflexology, Rolfing, shiatsu, therapeutic touch, and trigger point therapy.

Chiropractic

Based on the premise that good health requires a strong, agile, and aligned spine, chiropractic medicine involves spinal manipulation and adjustment. This moves the backbone into its proper position, thereby facilitating the correct functioning of the nervous system and the well-being of the entire body. A chiropractic session also may include nutritional counseling.

Craniosacral Therapy

Craniosacral therapy is the gentle manipulation of the craniosacral system, which includes the brain, spinal cord, cerebrospinal fluid, dural membrane, cranial bones, and sacrum. The pressure applied to these parts is no more than the weight of a nickel. By reducing stress and correcting systemic imbalances, craniosacral therapy may stimulate the body's innate healing powers.

Diet

Proper nutrition is vital to the healing process, and to optimal health. In general, we advocate a well-balanced diet that's high in fiber and low in unhealthy fats, with an abundance of whole grains, fresh fruits and vegetables, and lean proteins. Try to avoid hydrogenated fats, fried foods, and processed foods containing artificial colors and other chemicals. For certain medical conditions in Part 2, we recommend eating some foods that help heal the body while avoiding other foods that can contribute to or aggravate the problem.

Feldenkrais Method

Similar to the Alexander Technique, the Feldenkrais Method teaches you to become more aware of your movement patterns and to correct unhealthy habits by relearning proper body mechanics. Sessions may be one-on-one or group instruction. In a private session, the instructor manually guides you through the various movements, a technique called Functional Integration. Group sessions involve a technique called Awareness Through Movement, in which the instructor provides verbal cues to the movement sequences. The goal of the Feldenkrais Method is to reduce pain, increase mobility, and enhance well-being.

Flower Essences

First developed by the English physician Dr. Edward Bach in the 1930s, flower essences are liquid extracts of various flowers and plants that help to stabilize emotions, which in turn cultivates physical healing. Unlike the essential oils of aromatherapy, flower essences are highly diluted, and the fragrance does not contribute to their therapeutic properties. The essences may be mixed into a beverage; placed under the tongue; or applied directly to the temples, wrists, elbows, or knees or behind the ears. Because each essence has unique soothing or healing properties, practitioners tailor their recommendations to a person's personality and emotional state.

Herbal Medicine

Herbal remedies are among the most popular and accessible of the complementary therapies. Each herb has its own set of therapeutic properties, and often it's necessary to use a particular part of the plant-- perhaps the roots, stems, leaves, or flowers--to obtain an optimal dose of the medicinal constituent(s). Herbal remedies are available as pills, teas, tinctures, creams, and ointments. Herbalists may recommend multiple herbs to treat a particular condition.

Although herbs are available over-the-counter, they are potent substances that can interact with medications and cause side effects. For this reason, we strongly advise talking with your doctor or a qualified herbalist before adding any herbal remedy to your self-care regimen.

Homeopathy

Homeopathy is a healing system based on the principle that substances capable of producing symptoms of sickness in healthy people can have a healing effect when given in very minute quantities to sick people who exhibit the same symptoms. Homeopathic remedies--which are derived from plants, animals, and minerals--work in part by encouraging symptoms to run an accelerated course through the body, thereby speeding the healing process.

Although high-dose homeopathic remedies are available from homeopaths and other trained practitioners, you can find lower-dose products in health food stores, some drugstores, and online. Most remedies are tiny pills that dissolve when placed under the tongue.

Hydrotherapy