Session 3 Clinical Skills 1 3 Clinical Skills 1 ... planes which biology encompasses and ......

HMCL211

www.endeavour.edu.au

Session 3

Clinical Skills 1

Naturopathic/Nutritional Medicine

Departments

© Endeavour College of Natural Health www.endeavour.edu.au 2

Introduction

o Holistic Clinical Theory & the Therapeutic

Order

• Re-establish the basis for health

• Stimulate the Vis Medicatrix Naturae (VMN)

• Tonify or nourish weakened systems

• Correct structural integrity

• Address pathology

• Co-management & referral

o Application of the Therapeutic Order to

individual cases


Holistic Clinical Theory

o Holistic physicians view symptoms as

expressions of an underlying dysfunction of

the psychophysical organism, and therefore, it

is the dysfunction rather then the symptom

that must be ultimately resolved.

o The holistic physician strives to identify and

resolve disturbances to health by supporting

the body's inherent capacity to maintain

optimal function. (Litchy A, 2011)



o Holistic physicians address the complexity of

individual clients, including physical, mental,

emotional, genetic, environmental, social, and

spiritual factors.

o Treatment initially may palliate a particular

symptom, but must ultimately address the

underlying imbalance or imbalances, which

may have originated in physical, behavioural,

or emotional processes. (Litchy A, 2011)



o Resolution of illness is often achieved through

a wide variety of treatment modalities, not

limited to pharmaceuticals or nutraceuticals

and in conjunction with lifestyle

recommendations such as therapeutic diet

and exercise.(Litchy A, 2011)



"Medicine must move away from the application

of Occam’s razor and strict Cartesian

reductionism and take into account the different

planes which biology encompasses and

particularly the interactions between the different

“omics” in order to allow a deeper and more

holistic understanding of cause-effect, what is

today understood as “systems biology”, or

according to some when applied to medicine,

“systems medicine”. Dr. Earnest Schiffrin


Holistic Therapeutic Order

• The therapeutic order is a natural hierarchy

of therapeutic intervention, based on or

dictated by observations of the nature of the

healing process, from ancient times through

to the present.

(Zeff JL, 2006)



o It is not so much WHAT we do, as WHY and HOW we

do it….

o In facilitating the process of healing, it is important to

use those therapies which are most effective and

which have the least potential to cause harm.

o The concept of “harm” is hard to define; it may include

suppression or exhaustion of natural healing

processes, including inflammation and fever.

o These precepts, coupled with an understanding of the

process of healing, result in a therapeutic hierarchy:

The Therapeutic Order.



Group Discussion:

oConsidering the concept of ‘harm’ discuss

the ways in which a therapist may

unwittingly contribute to or cause harm to a

client.

oWith each example consider ways to

ameliorate such risk.



• The therapeutic order recognises a

sense of order in the healing process,

and proceeds from least to most

therapeutic force.

• Modern holistic medicine has adapted

to incorporate client individuality within

the hierarchy of self-healing.

(Zeff JL, 2006)



The therapeutic order MUST be considered and

should underpin the construction of EVERY

treatment plan:

• Re-establish the basis for health

• Stimulate the Vis Medicatrix Naturae (VMN)

• Tonify or nourish weakened systems

• Correct structural integrity

• Address pathology

• Co-management & referral


1. Re-establish the basis for health

o Re-establish the basis for health by identifying

and removing causes of disease and

obstacles to healing:

• identify and modify or eliminate adaptive demands

(biochemical, biomechanical, psychosocial).

• initiate enhancement of adaptive capacity of

tissues, systems, and the individual.

• establish a healthy regime.

(Zeff JL, 2006)


2. Stimulate the VMN

o Stimulating the Vis Medicatrix Naturae (or

vitality) of the client, is with the aim of

increasing the effectiveness of the client's

innate healing ability.

o We can stimulate the VMN generally or

specifically

– General: hydrotherapy, gentle exercise, exposure to

natural elements

– Specific constitutional homeopathy, acupuncture,

energy medicine, constitutional herbal medicine

(Zeff JL, 2006)


Stimulate the VMN

Activity:

Come up with restorative practices you can

encourage your clients to do/partake in to

stimulate the VMN.


3. Tonify Weakened Systems

o If the strategies employed at the first two

levels of the therapeutic order are insufficient

to move the client towards healing, then the

third level is to Tonify Weakened Systems.

o This is often used where vitality is more

severely lowered or with long-standing chronic

illnesses.

o Therapeutic doses of nutrients and herbs are

employed rather than nutrition from food.


Tonify Weakened Systems

o Examples of objectives are to:

• strengthen the immune system

• decrease toxicity

• normalize inflammatory processes

• optimize metabolic function

• balance regulatory systems

• enhance regeneration

• harmonize with the life force.

(Zeff JL, et al, 2006)


Tonify Weakened Systems

Activity: Discussion Points

By employing the use of nutrients and herbs that

specifically target systems, are we employing a

form of ‘reductionist’ medicine?


4. Correct Structural Integrity

Image: Wikimedia Commons


5. Address Pathology

o Address Pathology:

• Natural Substances

• Pharmacologic or Synthetic Substances

o If a naturopath or nutritionist chooses to

practice almost solely at this level of the

therapeutic order, are they just practicing

“green allopathy”?


Acute vs Chronic Illness

o The therapeutic order is followed whether the

client is experiencing an acute illness or a

chronic one.

o Where the practitioner begins treating within

the therapeutic order depends upon the

client's current condition and also their

preference for treatment.


Therapeutic Order

o Activity: Discussion Topic

What do you feel might be a practitioner’s

greatest challenge in following the therapeutic

order in practice?


Activity: Where in the Therapeutic Order

do the following treatment options fall?

o Adding turmeric and

ginger to food

o Taking “Active Curcumin’

1200mg supplement

o Meditation classes

o Spending time in nature

o A weekly massage

o Adopting a gluten-free

diet

o Taking a magnesium salt

bath

o Taking flower essences

for a specific issue

o Daily PPMP celloids

o Drinking Chamomile Tea

o Taking an anti-anxiety

herbal mix

o Having monthly

osteopathy treatments


Current Challenges

Activity:

o Read HMCL211_SN03_Reading_1:

“Current challenges and future directions for

holistic medicine in Australia: a qualitative

examination of perceptions and experiences

from grassroots practice”.

o As a group discuss the concepts within this

paper specifically focusing on page 3:

“Misconception and erosion of holistic

philosophy”


Case Study

Read HMCL211_SN03_Case_Study and

answer the following questions:

1. Is the client's skin condition an acute or

chronic illness? Her fatigue? What factors

identify the nature of the illness?

2. What are some of the disturbing

factors/obstacles to cure that may relate to

her fatigue? Her skin condition?


Case study3. Identify and RANK which levels of the therapeutic order

you would employ in treatment of this client:

# Therapeutic order

Re-establish the basis for health

Remove obstacles to cure

Stimulate the vis medicatrix naturae

Tonify or nourish weakened structures or systems

Correct structural integrity

Use lowest-force interventions that will safely and effectively promote healing

Co-management and/or referral


References

o Litchy, A, P 2011. holistic Physicians: Holistic Primary Care and

Integrative Medicine Specialists, Informa Healthcare, December 2011,

Vol. 8, No. 4 , Pages 369-377

o Pizzorno, J, E 2013. Textbook of natural medicine [electronic

resource], Elsevier/Saunders

o Ernesto L. Schiffrin, "Systems biology and medicine", Department of

Medicine, McGill University:

http://www.medicine.mcgill.ca/deptmedicine/newsletter/Systemsbiology

andmedicine_longversion_ES.pdf

o Zeff, J, Snider, P & Myers, SP 2006, 'A hierarchy of healing: the

therapeutic order', in J Pizzorno & MT Murray, Textbook of natural

medicine: volume 1, 3rd edn, Churchill Livingstone Elsevier, St Louis,

Missouri, USA, pp. 27-39.

http://www.medicine.mcgill.ca/deptmedicine/newsletter/Systemsbiologyandmedicine_longversion_ES.pdf


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