Essentials of Complementary and Alternative Medicine (June 1999)

Part I, “The Social and Scientific Foundations of Complementary and Alternative Medicine,” includes five chapters outlining the history and utilization patterns of CAM, 
issues related to professional ethics and evaluation of efficacy claims, and how to practice in an evidence-based context. Part II, “The Safety of Complementary and 
Alternative Products and Practices,” includes five chapters reviewing the safety of herbal and animal products, dietary and nutrient products, and homeopathy, as well 
as the adverse effects of acupuncture and manipulative therapies. Part III, “Overviews of Complementary and Alternative Medicine Systems,” provides thorough 
summary overviews of key issues such as history, principal concepts, patient assessment and diagnostic procedures, therapeutic options and treatment evaluation, 
indications and contraindications, training, quality assurance, and future prospects for 20 major systems of CAM. These include osteopathy, naturopathy, 
homeopathy, chiropractic medicine, traditional Chinese medicine, biofeedback, behavioral medicine, medical acupuncture, and a dozen other systems of therapy.
It is our hope that Essentials of Complementary and Alternative Medicine will provide a useful resource for clinicians and clinicians-in-training. We also hope that this 
book will serve to further the integration of safe, efficacious complementary and alternative therapies into the mainstream of primary care practice.
Wayne B. Jonas, M.D.
Jeffrey S. Levin, Ph.D., M.P.H.

CHAPTER 1. T
HE
 H
ISTORY OF
 C
OMPLEMENTARY AND
 A
LTERNATIVE
 M
EDICINE
Essentials of Complementary and Alternative Medicine
CHAPTER 1. T
HE
 H
ISTORY OF
 C
OMPLEMENTARY AND
 A
LTERNATIVE
 M
EDICINE
James C. Whorton
General Considerations
Origins of Alternative Medicine
 
Thomsonianism, Homeopathy, Hydropathy, and Mesmerism
The Second Generation of Alternative Medical Systems
Alternative Medicine's Critique of Allopathic Medicine
 
Alternative Medicine's Emphasis on Empiricism
Holistic Medicine in the Nineteenth Century
Allopathic Medicine's Criticism of Alternative Medicine
Medical Licensing
The Issue of Consultation
Elevation of Alternative Medicine's Standards
The Revival of Alternative Medicine
Chapter References
GENERAL CONSIDERATIONS
The notion of complementary medicine—the possibility that treatments not commonly employed or recognized by the allopathic medical profession might be combined 
with the conventional therapeutic armamentarium to balance and complete it—has appeared only recently. Before the 1990s, unconventional therapies were largely 
dismissed by the American medical profession as opposed to and incompatible with scientific medical practice. Even the term  alternative, which has been used since 
the 1970s, would not have been acceptable to the allopathic practitioners of previous generations; it would have conferred too much respectability, implying that 
non-allopathic remedies might be an equal, if separate, option. Historically, the phrases preferred by mainstream physicians have been  irregular medicine, fringe 
medicine, sectarian medicine, medical cultism, and quackery—all pejorative terms. To avoid such dismissive language as well as to maintain consistency, the term 
alternative medicine is used throughout this chapter.
However, if our present willingness to think of alternative medicine as complementary signifies the opening of a new era, we can hardly expect to make a clean break 
with the past. The story of complementary medicine's years as despised alternative medicine is one of unceasing conflict with the medical establishment, during which 
an untold amount of bad feeling accumulated on both sides. If alternative medicine is to be enfranchised scientifically and professionally, if it is to become 
complementary in fact and not just in aspiration, this historical legacy of mutual ill will must be addressed and overcome.
An awareness of the historical development of complementary medicine is essential for understanding the philosophical orientation that binds together many 
alternative systems of practice. Whether an alternative system proclaims itself to be natural healing (the favored description in nineteenth-century parlance), drugless 
healing (the term popular during the early twentieth century), or holistic healing (the label since the 1970s), alternative medicine has consistently, from its beginnings 
in the late 1700s, seen itself as offering a distinctive approach to therapy and to physician–patient interactions. That distinctive outlook is drawn, ironically, from the 
work of the very same physician whom orthodox practitioners revere as the “father” of their medicine—Hippocrates. Complementary medical philosophy might thus be 
thought of as the Hippocratic heresy.
ORIGINS OF ALTERNATIVE MEDICINE
I am stating only what everybody knows to be true, when I say that the general confidence which has heretofore existed in the science and art of medicine 
... has within the last few years been violently shaken and disturbed, and is now greatly lessened and impaired. The hold which medicine has so long had 
upon the popular mind is loosened; there is a widespread skepticism as to its power of curing diseases, and men are everywhere to be found who deny its 
pretensions as a science, and reject the benefits and blessings which it proffers them as an art (
1
).
This complaint sounds modern enough, something that might have appeared in last week's  JAMA. In fact, it was issued in 1848. At that time (as with today), the 
clearest sign of erosion of public confidence in allopathic medicine was the rapid growth over the preceding two decades of rival healing systems that claimed to be 
safer and more effective than conventional medicine. Those systems began to appear at the turn of the century, largely as protests against the bleeding, purging, and 
other heroic measures practiced by physicians of the day; however, there were more reasons for revolt than dissatisfaction with standard therapies. There had been 
alternatives to conventional methods of cure before the 1800s: both folk medicine and quackery had been options for centuries. But the different versions of 
alternative medicine, as they were derisively labelled even through the early decades of the twentieth century, were a distinct departure. They were actual  systems of 
care, the practitioners of each being bound together not just by their opposition to the medical establishment, but also by shared theoretical precepts and therapeutic 
regimens: by membership in local, state, even national societies and by publication of their own journals and operation of their own schools. Essentially, they were 
professionalized. And by the end of the 1840s, this medical counterculture had cornered roughly 10% of the health care market (
2
, 
3
, 
4
, 
5
 and 
6
).
Thomsonianism, Homeopathy, Hydropathy, and Mesmerism
Thomsonianism was the first alternative system to be developed in America. It involved a program of botanical healing formulated in the 1790s by Samuel Thomson, a 
New Hampshire farmer. His combinations of plant drugs that either evacuated or heated the body (e.g., the emetic lobelia, cayenne pepper enemas) were warmly 
received by the public of the 1820s and 1830s. However, the system quickly foundered after Thomson's death in 1843 (
7
). Homeopathy, the system formulated by the 
German physician Samuel Hahnemann in the 1790s, established a foothold in the United States in the 1830s. Derived from Greek roots meaning “like the disease,” 
homeopathy treated constellations of symptoms with drugs that had been found to produce the very same symptoms in healthy people—i.e., like cured like. 
Homeopathic remedies were claimed to work most effectively after being carried through a series of dilutions that essentially removed all the matter of the original 
drug before the preparation was given to the patient; molecularly speaking, homeopathic remedies were “infinitesimals.” Hahnemann also coined the term 
allopathy—“other than the disease”—to signify the orthodox philosophy of neutralizing complaints with therapies opposite to the symptoms. By the mid-1800s, all 
alternative medical groups had embraced  allopathic as the standard term for orthodox medicine; only in recent years has the word shed its negative connotations. 
Homeopathy was easily the most popular alternative system by midcentury, and would remain so into the early 1900s (
8
, 
9
).
The next most popular medical alternative at midcentury was hydropathy, an Austrian creation of the 1820s imported into the United States in the early 1840s. The 
water-cure, as Americans liked to call it, stimulated the body to rid itself of disease through a variety of baths (usually cold), supplemented with careful regulation of 
lifestyle (e.g., diet, exercise, sleep, dress). Hydropathy maintained a sizeable following into the 1860s, but steadily faded after the Civil War (
10
, 
11
 and 
12
). During 
this time in America, the rise and fall of Mesmerism, or magnetic healing, occurred. The invention of eighteenth-century Austrian physician Franz Mesmer, magnetic 
therapy relied on hypnotism and the power of suggestion to relieve patients; Mary Baker Eddy, the founder of Christian Science in the 1870s, was highly influenced by 
this therapy (
13
). Finally, eclecticism, as its name implies, was an assortment of therapies selected from all schools of practice, allopathic and alternative, on the basis 
of clinical experience. Originated by New York practitioner Wooster Beach in the late 1820s, eclectic medicine lasted into the 1930s (
14
).
THE SECOND GENERATION OF ALTERNATIVE MEDICAL SYSTEMS
Less successful challengers of allopathic medicine—Baunscheidtism, chronothermalism, physiomedicalism, and other medical  isms—might also be mentioned to 
complete the antebellum generation of alternative systems. A second wave appeared in the later nineteenth century, beginning with osteopathy, a technique of 
musculoskeletal manipulation originated by Andrew Taylor Still in the 1870s. However, the first osteopathic school would not begin operation until 1892 (
15
). The first 
school of chiropractic opened its doors in 1895, the same year that the manipulation method was discovered by Daniel David Palmer in Davenport, Iowa (
16
). During 
the last few years of the century, German emigre Benedict Lust blended the new manipulation procedures with hydropathic philosophy and treatments, herbal 
tradition, and other natural remedies to create naturopathy (
17
). By then, nearly 20% of all practitioners of medicine were alternative physicians, up from the estimated 
10% of the 1850s; in 1900 in America, there were approximately 110,000 allopaths, 10,000 homeopaths, 5000 eclectics, and another 5000 practitioners of other 
alternative systems (
18
, 
19
). Acupuncture has more recently been rediscovered; there was some experimentation with acupuncture in Europe and America in the 

nineteenth century. Reports of its efficacy by travelers to China in 1970 triggered an explosion of interest not only in acupuncture, but also in all aspects of traditional 
Chinese medicine and in Ayurveda, the ancient healing system of India (
20
).
ALTERNATIVE MEDICINE'S CRITIQUE OF ALLOPATHIC MEDICINE
Despite the differences between Hahnemann's and Thomson's drug, or between Palmer's and Still's theories, the philosophy of healing and its implicit critique of 
allopathy was (and remains) the same for all alternative systems. That philosophy was presented in a cartoon published in 1834, in the first issue of  The Thomsonian 
Botanic Watchman, at the very beginning of the clash between orthodoxy and the new medical heretics (
Fig. 1.1
). This Thomsonian cartoonist shows a man mired in 
the slough of disease, despite—actually, because of—the ministrations of an allopathic doctor. The physician is attempting to bludgeon the disease into submission 
with a club labelled  calomel. Calomel (mercurous chloride) was the most popular purgative in nineteenth century medical practice; in fact, with the possible exception 
of opium, it was the most frequently prescribed drug. As a mercurial, it could (and often did) produce severe side effects: ulceration of the mouth, loss of teeth, 
necrosis of the jawbone, and, most typically, a profuse, thick, fetid salivation. In the cartoon, the MD is assuring his patient that, “You must be reduced, Sir!,” intending 
that the disease will be reduced by calomel's cleansing of the intestinal tract. The patient, however, fears that he is being reduced to the grave: “The Doctor knows 
best,” he moans facetiously, “but send for the Parson.” In the middle of the picture, an objective observer attempts to get the doctor's attention, to show him there is a 
better way, the way of the Thomsonian healer to the right, who rescues the patient by pulling him up the steps of common sense (
21
).
F
IGURE
 1.1. The Contrast; or an illustration of the difference between the regular and Thomsonian systems of practice in restoring the sick to health.
By depicting the allopathic physician as seemingly “holding his patient down,” depicting calomel as a club, and having the patient call for the parson, the Thomsonian 
cartoonist is suggesting that allopathy attacks disease so brashly as to indiscriminately overwhelm the patient, too; its therapies are, in the language of a later day, 
invasive. However, Thomsonian remedies are indicated to be gentle and natural, and to support and enhance the body's own innate recuperative powers: “I will help 
you out,” the Thomsonian doctor tells the patient, “with the blessing of God.” He might as well say, “with the blessing of nature” because, in nineteenth century 
thought, God and nature were implicitly one. Thomsonians often stated the matter explicitly though, Thomson himself declaring that nature “ought to be aided in its 
cause, and treated as a friend; and not as an enemy, as is the practice of the physicians.” His approach had “always been ... to learn the course pointed out by 
nature,” then to administer “those things best calculated to aid her in restoring health” (
22
). He hardly stood alone. Most alternative practitioners, in his day and the 
present, professed to consult and cooperate with the  vis medicatrix naturae, the healing power of nature first described and praised by Hippocrates:
“All healing power is inherent in the living system.” (Russell Trall, hydropath, 1864) (
23
)
“Naturopathy, with all its various methods of treatments, has always one end in view and one only: to increase the vital force.” (Benedict Lust, naturopath, 1903) 
(
24
)
Osteopathic manipulation removes obstacles to “the free flow of the blood ... and with the lifting of this embargo nature itself does the necessary work to restore 
the body to its normal state and even beyond it.... Osteopathy fights on the side of nature.” (M. A. Lane, osteopath, 1925) (
25
)
In 
Figure 1.1
, the diploma hanging from the physician's coat pocket is as prominent as his calomel club. Emblazoned with the MD, the diploma is emblematic to 
Thomsonians of the abstruse theoretical training the allopath has received and that dictates his practice. As the person in the middle of the figure observes, the 
allopathic physician is “scientific with a vengeance,” hellbent on doing what theory tells him ought to work, oblivious to the common sense that would show him he is 
poisoning his patient. But the error of his allopathic way is not just that he makes the sick even sicker with misguided therapies; his devotion to theory, the cartoonist 
suggests, prevents him from even attempting a fair evaluation of alternate remedies, remedies that cannot be rationalized by, or that seem to conflict with, his science.
Hence, from the onset, homeopathic drugs were laughed at by allopaths because of what seemed the theoretical simple-mindedness of the “like cures like” principle 
and the impossibility of infinitesimals exerting any material action. Still's musculoskeletal manipulations were dismissed because of the perceived naivete of his “rule 
of the artery” theory; Palmer's chiropractic adjustments were dismissed because of the apparent silliness of the vertebral subluxation model; and acupuncture in the 
early 1970s was dismissed because of the alien concepts of  qi and energy meridians. The recent response of a university medical scientist to reports of clinical trials 
showing that patients who are prayed for recover better than those who do not receive prayers is a wonderfully direct summary of this historical attitude: “That's the 
kind of crap I wouldn't believe,” this scientist is reported to have said, “even if it were true.” (L. Dossey, unpublished). Complementary physicians contend that the 
scientific medical establishment has always had a negative attitude about complementary methods—most allopaths refuse to believe them even if they are true 
because they make no sense in terms of conventional science. Like the doctor in the cartoon, MDs as a group are seen by alternative practitioners to be scientific with 
a vengeance.
Alternative Medicine's Emphasis on Empiricism
Alternative practitioners have never relied on purely theoretical determinants of practice, maintaining their methods have been derived largely from empirical bases. 
With the exception of Mesmerism, alternative medical systems originated from the founder's therapeutic experiences, initially untainted by the influence of speculative 
hypothesis. Hahnemann claimed for his materia medica that it was “free from all conjecture, fiction, or gratuitous assertion—it shall contain nothing but the pure 
language of nature, the results of a careful and faithful research” (
26
). Likewise, Thomson “had nothing to guide him but his own experience .... His mind was 
unshackled by the visionary theories ... of others; his whole studies have been in the great book of nature” (
27
). The power of musculoskeletal manipulation was 
discovered by Still through practical trials on his neighbors and by Palmer during an experiment on his janitor. Alternative systems have consistently started through 
what today would be described as observational, or outcome, studies.
Once a therapeutic method was determined to have positive outcomes, however, the temptation to explain it was almost never resisted, and theoretical 
rationalizations were soon forthcoming. Eclecticism alone was able to stand firm with an “it works, who cares how” attitude; all other systems quickly surrendered to 
the lure of conjecture and visionary theories. Hahnemann conjectured his infinitesimals operated through dynamic—i.e., spiritual—action. Thomson theorized his 
empirically demonstrated herbs worked by promoting the distribution of life-sustaining heat through the system. Still hypothesized a “rule of the artery” that restored 
the body to health as soon as skeletal pressures on blood vessels were relieved by manipulation. Palmer imagined that vertebral subluxations constricted nerves and 
impeded the flow of Innate Intelligence, a divine life force, through the body. Alternative practitioners, in other words, generally reversed the process attributed to 
allopathic physicians. Instead of formulating a theory, then deducing therapy from it—the allopathic model—they discovered a therapy, then deduced a theory. And 
invariably, the theoretical principle that followed was that the therapy in question worked by eliminating some obstacle to the free functioning of the body's innate 
healing power. Ultimately, it was nature that did the curing, not the manipulation or the infinitesimal similar or the cayenne in the enema. Those original theoretical 
formulations would eventually be recognized by adherents as unfounded and confining, and during the twentieth century they have been steadily abandoned for more 
sophisticated and demonstrable arguments (although nature remains the fundamental healing power). But the initial dedication of many alternative systems to a 
simple, all-inclusive theory gave alternative medicine the appearance of sectarian fanaticism in allopaths' eyes.
HOLISTIC MEDICINE IN THE NINETEENTH CENTURY
The Thomsonian in 
Figure 1.1
 is extending a fraternal helping hand to the weak and harried patient, whereas the MD appears to be restraining him, even pushing the 
struggling man deeper into the slough of sickness and death. The Thomsonian practitioner's show of caring for his patient as a person is an expression of a holistic 

orientation—treat the whole patient and treat him as a unique human being. This cartoon shows holistic orientation nearly a century and a half before the word  holistic 
came into vogue. Homeopathy went even farther, giving consideration to a patient's every little complaint, mental as well as physical, in the search for just the right 
drug to duplicate the sick person's full array of symptoms. Holism was exhibited in the teachings of other alternative schools of practice as well. From the beginning, 
practitioners of complementary medicine have claimed superior relations with patients, sometimes offending conventional physicians with an air of “holisticer than 
thou” condescension.
The holism of nineteenth-century alternative medicine, however, went well beyond the basic principle of paying heed to the emotional and spiritual side of patients. 
Today's definition of  holistic has been expanded from “treatment of the whole patient” to include an emphasis on motivating patients to assume some responsibility for 
and participation in their care and recovery. Likewise, from its inception, alternative medicine aimed to give patients the power to help themselves. Thomsonianism 
took self-help most seriously, actually selling Family Right Certificates that gave purchasers the legal right to prescribe for and treat themselves botanically: “Every 
man his own physician” was the Thomsonian motto. But homeopaths encouraged people to be their own physicians, too, selling domestic kits of the most useful 
remedies, complete with instructions on how to use them for self-care; hydropaths published manuals of health advice and home water treatments; and in the early 
twentieth century, naturopaths also produced an extensive body of popular literature promoting a wide array of natural remedies for home use (
28
).
Our contemporary interpretation of holism has also embraced lifestyle regulation and the promotion of wellness as a major element of complementary care. This 
orientation, it can be argued, stems from American hydropathy in the 1850s, which drew on an earlier popular health reform movement to graft behaviors, such as 
abstinence from alcohol and tobacco, vegetarianism, regular exercise, fresh air, and sexual restraint, onto the original system of various cold water baths (
29
). The 
resulting hybrid was known as hygeio-therapy, a method that “restores the sick to health by the means which preserve health in well persons” (
30
). The 
hygeio-therapeutic tradition was preserved and carried on to the present by naturopathic medicine.
Other features of nineteenth-century alternative medicine have persisted to the present, such as objection to the medicalization of pregnancy and labor. Enough has 
been said, however, to make it clear that nineteenth-century alternative practitioners looked upon the allopaths as the true irregulars in medicine (
31
, 
32
).