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Fundamentals of
COMPLEMENTARY
ALTERNATIVE
AND
MEDICINE
Fifth Edition
MARC S. MICOZZI, MD, PhD
Adjunct Professor
Department of Physiology & Biophysics
and Department of Pharmacology
Georgetown University School of Medicine
Washington, DC;
Former Director
Center for Integrative Medicine
Thomas Jefferson University Hospital
Philadelphia, Pennsylvania
With forewords by
C. EVERETT KOOP, MD, ScD AVIAD HARAMATI, PhD GEORGE D. LUNDBERG, MD
(1916–2013) Professor, Department of Biochemistry, Former Editor-in-Chief, Journal of the
Former Surgeon General of Cellular and Molecular Biology and American Medical Association, 1982–1999;
the United States Department of Medicine and The Medscape, Journal of Medicine and
Georgetown University School of Medicine eMedicine from WebMD, 1999–2009;
Washington, DC; Consulting Professor, Stanford University
President and Chair, The Lundberg
Institute
3251 Riverport Lane
St. Louis, Missouri 63043
FUNDAMENTALS OF COMPLEMENTARY AND ALTERNATIVE MEDICINE ISBN: 978-1-4557-7407-4
Copyright © 2015, 2011, 2006, 2001, 1996 by Saunders, an imprint of Elsevier Inc.
Chapter 30: Tibetan medicine: Kevin Ergil retains copyright for the chapter.
No part of this publication may be reproduced or transmitted in any form or by any means, electronic or
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This book and the individual contributions contained in it are protected under copyright by the Publisher
(other than as may be noted herein).
Notices
Knowledge and best practice in this field are constantly changing. As new research and experience
broaden our understanding, changes in research methods, professional practices, or medical treatment
may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in
evaluating and using any information, methods, compounds, or experiments described herein. In
using such information or methods they should be mindful of their own safety and the safety of
others, including parties for whom they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check the
most current information provided (i) on procedures featured or (ii) by the manufacturer of each
product to be administered, to verify the recommended dose or formula, the method and duration of
administration, and contraindications. It is the responsibility of practitioners, relying on their own
experience and knowledge of their patients, to make diagnoses, to determine dosages and the best
treatment for each individual patient, and to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors,
assume any liability for any injury and/or damage to persons or property as a matter of products
liability, negligence or otherwise, or from any use or operation of any methods, products, instructions,
or ideas contained in the material herein.
Library of Congress Cataloging-in-Publication Data
Fundamentals of complementary and alternative medicine / [edited by] Marc S. Micozzi ; with forewords
by C. Everett Koop, Aviad Haramati, and George D. Lundberg. – Fifth edition.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-4557-7407-4 (hardcover : alk. paper)
I. Micozzi, Marc S., 1953- , editor.
[DNLM: 1. Complementary Therapies. WB 890]
R733
615.5–dc23
2014039588
Content Strategist: Kellie White
Publishing Services Manager: Jeff Patterson
Senior Project Manager: Anne Konopka
Design Direction: Christian Bilbow
Printed in China
Last digit is the print number: 9 8 7 6 5 4 3 2 1
Dedicated to
Baruch S. Blumberg, MD, PhD (1925–2011)
C. Everett Koop, MD, ScD (1916–2013)
Acknowledgment to Jennifer Gehl for editorial assistance
An Anatomy of the World
And new philosophy calls all in doubt
The element of fire is quite put out
The sun is lost, and the earth, and no man’s wit
Can well direct him where to look for it
And freely men confess that this world’s spent
When in the Planets, and the Firmament
They seek so many new; they see that this
Is crumbled out againe to his Atomies
’Tis all in pieces, all cohaerence gone;
All just supply, and all relation
John Donne (1572–1631),
Physician and Metaphysician
Contributors
Mones S. Abu-Asab, PhD Claire M. Cassidy, PhD, Dipl Jennifer Gehl, BA, MHS(c)
Senior Scientist Ac, LAc Certified Acutonics® Practitioner
Laboratory of Immunopathology Licensed Acupuncturist CEU Instructor
National Eye Institute Medical and Nutritional Anthropologist Altoona, Pennsylvania
National Institutes of Health Executive Editor, Journal of Alternative and
Bethesda, Maryland Complementary Medicine
Sherry W. Goodill, PhD,
Bethesda, Maryland
BC-DMT, NCC, LPC
Hunter “Patch” Adams, MD Clinical Professor and Chairperson
Executive Director of Gesundheit Patrick Coughlin, PhD Department of Creative Arts Therapies
Institute Retired Professor, Department of Drexel University
Urbana, Illinois Anatomy Philadelphia, Pennsylvania
Philadelphia College of Osteopathic Past President
Medicine American Dance Therapy Association
Hakima Amri, PhD
Philadelphia, Pennsylvania Columbia, Maryland
Associate Professor
Co-Director, Physiology and CAM
Graduate Program Judith DeLany, LMT, CNMT Howard Hall, PhD, PsyD, BCB
Department of Biochemistry, Cellular, Director, Curriculum Developer Professor of Pediatrics, Psychiatry, and
and Molecular Biology Neuromuscular Therapy Center Psychological Sciences
Division of Integrative Physiology St. Petersburg, Florida University Hospitals, Case Medical Center
Georgetown University School of Rainbow Babies & Children’s Hospital
Medicine Cleveland, Ohio
Washington, DC Kevin V. Ergil, MA, MS, LAc
Professor
Finger Lakes School of Acupuncture and Mariana G. Hewson, PhD
Donald A. Bisson, Q.Reflex, Oriental Medicine Author
OCR-CR, Q.Med, RRPr New York Chiropractic College Madison, Wisconsin
Dean and Professor of Reflexology Seneca Falls, New York
Ontario College of Reflexology
New Liskeard, Ontario, Canada John A. Ives, PhD
Marnae C. Ergil, MA, MS, LAc Senior Director, Brain, Mind, and Healing
Professor Samueli Institute
Gerard C. Bodeker, EdD Finger Lakes School of Acupuncture and Alexandria, Virginia
Department of Primary Care Health Oriental Medicine
Sciences New York Chiropractic College
Division of Medical Sciences Seneca Falls, New York Michael A. Jawer, CAE
University of Oxford Director of Government and Public
Oxford, UK Affairs
Department of Epidemiology Laurel S. Gabler, PhD, MSc American Association of Naturopathic
Mailman School of Public Health Harvard Medical School Physicians
Columbia University Boston, Massachusetts Washington, DC
New York, New York
iv
contributors v
Wayne B. Jonas, MD Daniel E. Moerman, PhD Kevin Spelman, PhD, MCPP
President and CEO William E. Stirton Professor Emeritus of Research Scientist and Natural Products
Samueli Institute Anthropology Industry Consultant
Alexandria, Virginia University of Michigan-Dearborn Health, Education and Research in
Dearborn, Michigan Botanical Medicine (HERB Med)
Ashland, Oregon
John M. Jones, DO, MEd
Professor of Clinical Medicine Paul Nolan, MCAT, MT-BC, LPC
Chair, Department of Osteopathic Director of Music Therapy Programs Julie K. Staples, PhD
Principles and Practice Hahnemann Creative Arts in Therapy Adjunct Assistant Professor
William Carey University College of Program Department of Biochemistry and
Osteopathic Medicine Drexel University Molecular & Cellular Biology
Hattiesburg, Mississippi Philadelphia, Pennsylvania Georgetown University School of
Medicine
Washington, DC
David Larson Carole A. O’Leary, PhD Principal
Senior Adviser Awareness Technologies, Inc.
Michael Moran & Associates (MMA) Placitas, New Mexico
Rhiannon Lewis, FIFPA Chevy Chase, Maryland
Editor-in-Chief, International Journal of Denver, Colorado
Clinical Aromatherapy Robert T. Trotter II, PhD
Director of Essential Oil Resource Regent’s Professor and Chair
Consultants Joseph E. Pizzorno, Jr., ND Department of Anthropology
Provence, France Editor-in-Chief, Integrative Medicine, A Northern Arizona University
Clinician’s Journal Flagstaff, Arizona
Seattle, Washington
David Mayor, MA, Bac, MBAcC, President Emeritus
Hon member AACP Bastyr University Richard W. Voss, DPC, MSW,
Acupuncture Practitioner Kenmore, Washington MTS
Welwyn Garden City Professor of Social Work
Visiting Research Associate Undergraduate Social Work Department
(formerly Hon Research Fellow) Salome Raheim, PhD, ACSW West Chester University
Department of Physiotherapy Dean and Professor West Chester, Pennsylvania
School of Health and Social Work The University of Connecticut Visiting Professor and Researcher
University of Hertfordshire School of Social Work Friedensau Adventist University
Hertfordshire, UK West Hartford, Connecticut School of Social Work & Social Sciences
Möckern, Germany
Donald McCown, PhD, Daniel Redwood, DC
Associate Professor
MAMS, MSS, LSW Michael I. Weintraub, MD,
Cleveland Chiropractic College
Assistant Professor, Health
FACP, FAAN, FAHA
Overland Park, Kansas
Co-Director, Center for Contemplative Clinical Professor of Neurology and
Studies Internal Medicine
Program Director, Minor in Pamela Snider, ND New York Medical College
Contemplative Studies Executive and Senior Editor Valhalla, New York
West Chester University Foundations of Naturopathic Medicine Adjunct Clinical Professor of Neurology
West Chester, Pennsylvania Project Mt. Sinai School of Medicine
Associate Professor New York, New York
National College of Natural Medicine
Lisa Meserole, MS, ND
Portland, Oregon
Sage Healing
Seattle, Washington
Coupeville, Washington
Alicia M. Micozzi, BA, WEMT
Survey Researcher
University of Maryland Medical Center
Baltimore, Maryland
Foreword from the
Third Edition
In Memory of C. Everett Koop, MD, ScD
New England Journal of Medicine focused on attitudes toward com-
For more than 50 years I have tried to identify the mix of personal plementary and alternative medicine in the United States. They
attributes and technical skills that make one an outstanding indicate that one-third of adult Americans regularly use some
doctor. I am sure that most physicians in the United States have kind of complementary or alternative treatment even though it
pondered the same question. Now, through the work of the C. was not covered by insurance and they had to pay for it them-
Everett Koop Institute at Dartmouth I have an opportunity to selves. This is an opportune time for us to take a second look at
influence the way medical students are trained. The Institute, such alternative treatment approaches as acupuncture, botanical
working in partnership with the Dartmouth Medical School and medicine, homeopathy, and others—not to offer these treatment
the Dartmouth-Hitchcock Medical Center, is actively engaged in modalities blindly but to expose them to the scientific method.
training physicians for the new century. Physicians have to depend on facts—on empirical data—when
Because doctors must remain abreast of a growing volume of they determine treatment strategy for a particular patient. Today
new information, our medical schools help both their graduates we do not have enough data on the potential of alternative
and society by producing physicians who are computer literate approaches to help or harm human health. It is time to discover
and comfortable with telemedicine. As a scientific pursuit, medi- the value of these treatment regimens. We can conduct the neces-
cine should take advantage of the technologic innovations that sary studies and assemble the data that doctors and health policy
allow us to better serve the lifetime learning needs of physicians makers need, a type of biomedical research that would be a
as well as the health education needs of patients. Nonetheless, prudent long-term investment.
because medicine is also an art, doctors still need to listen to their In my lifetime we have achieved great successes in the fight
patients. This aspect of medical practice has not changed. against infectious diseases. We have more work to do in our effort
As I travel across the country, many of the people I meet are to improve quality of life and make people more comfortable as
eager to share their ideas for improving the nation’s health care they endure chronic health problems such as cancer, heart disease,
system. The most common complaint I hear focuses on poor and arthritis. Drugs and surgery can be useful tools in the effort
communication in the doctor–patient relationship. Too many to treat these diseases, but when possible I would like to see us
patients feel that their physician does not really listen to them. increase the range of approaches that can be used. My experience
When the patient attempts to explain his or her problem, the as a doctor has taught me that often a mix of different approaches
doctor interrupts. Subsequently, when the doctor tries to explain is necessary to achieve success. We need to be flexible and adapt-
what conditions the patient has and attempts to outline a treat- able because the diseases that challenge us certainly are not static.
ment regimen, the patient is confused because the physician does A recent trend that concerns me is the growth of drug-
not communicate to the level of the patient’s understanding. resistant bacteria. Today it is easy to forget that prior to the devel-
From my perspective, medical students need to master the art opment of antibiotics in the 1940s, a child’s ear infection could
of listening to and communicating with their patients just as be a frightening and fatal experience. I well remember patients
much as they need to learn the fundamentals of human biology. with serious complications and death caused by the lack of anti-
We have found at the Koop Institute that a student’s communica- biotics. If drugs we have depended on for decades are compro-
tion skills are greatly improved by having to explain the first mised, we may return to a time when even routine infections
principles of health promotion and disease prevention to second could be dangerous. As both a grandfather and a physician, I
graders. Medical students who choose to participate in programs would hate to see that happen.
sponsored by the Koop Institute work in and with local commu- There is an element of good news in this picture. If some of
nities from their very first year. Some choose to advise junior high the synthetic drugs we have developed are no longer as depend-
and high school students on the risks associated with alcohol, able as they once were, studies have shown that the botanical
tobacco, and sexually transmitted diseases; others help rural phy- substances these drugs are based on are still effective in treating
sicians take better advantage of the computer revolution. disease. I have never claimed to be an expert on botany or ecology,
Just as a physician should be sensitive to the feelings of a but current trends suggest that we need to do more. We need to
patient and the needs of the community, he or she must be con- conserve the plants that may contain the medicines of the future
versant with major trends and developments in society. I would and, more importantly, we need to learn what local experts seem
like to tell you about one current trend that is of interest to me. to understand about the pharmacological properties and uses of
Studies conducted at Harvard Medical School and reported in the these medicines.
vi
foreword from the third edition vii
Reduced health care costs are an important by-product of the to foreign policy: “Trust but verify!” So it is with complementary
work we are doing at the Koop Institute. Our students know that and alternative medicine. So many people have relied on these
the physician of the future must be a health educator first and approaches for so long that they may have something of value to
foremost. Today, the challenge is to treat the patient once he or offer. Let us begin the necessary research so that we could have
she has gone to the hospital. Tomorrow, the challenge will be to substantive answers in the near future.
keep the patient out of the hospital in the beginning. One reason such research is worth doing is that 80% of the
Preventive medicine means education, empowerment, and world’s people depend on these alternative approaches as their
personal responsibility. Many patients want alternatives to inva- primary medical care. For years, we have attempted to export
sive medical procedures and long stays in the hospital. Physicians Western medicine to the developing world. The sad truth is that
can conserve time and resources by teaching patients how to the people we are attempting to help simply cannot afford it. I
reduce their risk of cancer, heart disease, and other life-threaten- have doubts about how much longer we can afford some of it
ing diseases. As our students know, the most inexpensive treat- ourselves. It is possible that in this new millennium, we may be
ment is to keep the patient from becoming sick in the first place. more ready to ask the peoples of the developing world to share
Demand reduction in the health care system is the most immedi- their wisdom with us.
ate cost-saving effort. During the nineteenth century, American medicine was an
I think that alternative/complementary therapies may poten- eclectic pursuit, where a number of competing ideas and
tially be an important part of this overall educational process. approaches thrived. Doctors were able to draw on elements from
One must have an open mind about complementary therapies different traditions in attempting to make people well. Perhaps
and understand belief systems that emphasize the mind–body there is more to this older model of American medicine than we
connection. At a time when many Americans complain of stress, in the twentieth century had been willing to examine. My experi-
make poor nutritional choices, and are increasingly concerned ence with physicians has convinced me that they are healers first.
about environmentally induced illnesses, these messages could As such, they are willing to use any ethical approach or treatment
not be more timely. that has been proven to work. However, in the opinion of many
Many people are confused about alternative medicine, and I doctors, there is not yet a definitive answer on the value of com-
do not blame them. For many Americans alternative therapies plementary and alternative medicine. I would like us to undertake
represent a new discovery, but in truth, many of these traditions the study and research that will provide definitive answers to
are hundreds or thousands of years old and have been used by prudent questions about the usefulness of complementary and
millions of people worldwide. To ease the uncomfortableness of alternative medicine for society at large.
the word alternative, one must realize that while treatments may
look like alternatives to us, they have long been part of the C. Everett Koop, MD, ScD (1916–2013)
medical mainstream in their cultures of origin. Surgeon General of the United States (1982–1989)
When I worked in Washington as Surgeon General for eight
years, President Reagan had an important credo in his approach
Foreword from the
Fourth Edition
As I write these words in early February 2010, I am returning from in offering the public lecture series on CAM was to provide the
my first trip to India. The purpose of my visit was to lead a delega- best evidence available for what was harmful, what was safe and
tion of six prominent leaders in complementary and integrative beneficial, and what aspects of CAM were simply unknown or
medicine from prestigious academic medical centers in the untested.
United States, at the invitation of the Ministry of Health in India, This initial foray into a rather controversial field bore fruit. In
Department of AYUSH (Ayurveda, Yoga, Unani, Siddha, and December 1999, in an effort that demonstrated considerable
homeopathy). The expressed goal of the Indian government was courage, the leadership at the National Center for Complemen-
to inform our delegation about the evidence base for Ayurvedic tary and Alternative Medicine at the National Institutes of Health
medicine and to give us first-hand exposure to the use of tradi- issued a call for grant proposals from allopathic schools (conven-
tional Indian medicine in clinical practice and in education and tional medicine and nursing) to develop curricular modules that
to explore potential research projects in this area. My own specific would integrate CAM into the conventional training of physi-
objective was to determine whether anything we saw or heard cians and other health professionals. The initiative led to impor-
about traditional Indian medicine should eventually be included tant interactions between like-minded academic leaders of
in the curriculum for physicians and other health professionals in integrative medicine who were interested in determining, in an
the United States. objective fashion, what aspects of CAM ought to be part of a
What struck me during this intense, seven-day visit was the medical curriculum. Those initial efforts led to a landmark series
chasm, even in India, between those trained in traditional medical of articles that were published in the October 2007 issue of Aca-
practices and those trained in Western allopathic medicine. Many demic Medicine, which addressed such topics as rationale for CAM
of the traditionalists feel that centuries of continued practice education in health professions training programs, what should
provides sufficient rationale for the use of various medical students learn about CAM, and instructional strategies for inte-
approaches (what in Europe constitutes “historic use” in terms of grating CAM into the medical curriculum.
regulatory approval), irrespective of whether these therapies have At Georgetown University School of Medicine, in addition to
been “proven” by modern scientific means, whereas most of those introducing CAM-relevant material into the medical and nursing
who are conventionally trained express a healthy skepticism and curricula, our faculty in the Department of Physiology and Bio-
demand clear and unambiguous data to support the use of any physics created an innovative graduate degree program of study
therapy or medicinal plant. in CAM. The mission of the program is to provide advanced study
This tension is very familiar to me. A decade ago, I helped in the science and philosophy of predominant CAM therapies
launch a public lecture series on complementary and alternative and disciplines and to train students to objectively assess the
medicine (CAM) at Georgetown University School of Medicine. safety and efficacy of various CAM modalities. The program seeks
At that time, a fellow colleague and I established a “mini-medical to understand the mechanistic basis for CAM therapies such as
school” series at Georgetown University aimed at informing the acupuncture, massage, herbs and supplements, and mind–body
public about the advances in medical science and health. For interactions. By embedding CAM principles and paradigms firmly
several years, over 200 men, women, and young adults, ranging in into a conventional, basic clinical sciences context, our intent is
age from 16 to 83, would come to the medical center on eight to prepare a new generation of health care providers, educators,
Tuesday nights in the fall and spring semesters to hear some of and researchers for the challenging task of delivering the health
our finest faculty teachers lecture on a myriad of medical issues. care of the future—namely, a multidisciplinary approach to
In response to our surveys inviting suggestions for future topics, improved wellness, emphasizing health maintenance and disease
many participants kept requesting lectures on CAM. Initially, we prevention.
did not know what to make of these requests, but eventually we However, literacy in CAM, for students and faculty in our
invited our fellow faculty member, Dr. Hakima Amri, to develop program, as well as for others around the nation, depends on an
an eight-lecture series on CAM. authoritative, comprehensive textbook that can provide the basic
Thus began my education into this field, and I quickly real- information regarding the philosophy and science for many of
ized that the public was eager to learn more about these treat- the CAM therapies. Fortunately, Dr. Marc Micozzi has done the
ment approaches and ancient medical systems. In contrast, the field a great service by producing an outstanding text, entitled
academic medical community was, in general, wary of venturing Fundamentals of Complementary and Alternative Medicine. Joined by a
into areas many deemed unproven and unscientific. Our purpose list of distinguished experts in the field, Dr. Micozzi introduces
viii
