First, do no harm (primum non nocere)

‘First, do no harm’ has been a principle of medicine since the time of Hippocrates and it refers not only to the patient but to the patient’s vital force. It refers to choosing treatments that support the innate healing ability of the body and that honor the laws of nature. To ‘do no harm’, a practitioner chooses the therapy, and fashions the most gentle and non-invasive strategy to achieve the desired outcome for each individual patient. By respecting the integrity and vitality of the patient the healing process is supported versus overridden or suppressed. ‘Do no harm’ involves practitioners teaching their patients how to have more insight and awareness of how their lifestyle choices affect their health. It involves educating patients that more is not necessarily better.

When lifestyle factors are the root cause of disease or a contributing factor, it is important to address these factors in the initial part of treatment. Often when these factors are appropriately addressed, minimal or no other treatment is required; for example, a patient who has low energy due to poor dietary and sleep habits, or a patient who has stiffness due to being very sedentary and dehydrated. Ignoring the lifestyle factors negatively impacts the innate healing process of the body, and the patient’s overall health. When supportive treatments are required they are chosen based on which treatments are the most gentle to achieve the desired outcome. In some situations, especially when the progression of disease is advanced or the current state of disease is critical, it is necessary to choose more aggressive treatments that have the potential for adverse effects. From a naturopathic perspective, there are no side-effects, there are only effects and these range from beneficial to adverse. Some adverse effects of drugs and other treatments occur when treatments are prescribed prior to, or in place of, addressing lifestyle factors, when a treatment is prescribed for longer than needed, or when an inappropriate treatment is prescribed for a patient. The aim of any treatment strategy is to minimize adverse effects.

‘First, do no harm’ is about choosing the most subtle and gentle treatment that establishes health or increases the patient’s state of well being. It is not, as sometimes written, about only using gentle treatments. In some situations, for example, internal bleeding, fractures, or cancer, a radical approach is what is needed, but that does not mean it has to be invasive. It is possible to employ a potent approach, at the same time as supporting the healing power of the body. For example, a radical treatment strategy might mean a complete transformation of a person’s lifestyle – such as, dietary changes, removing or addressing many external obstacles to healing at the same time, such as alcohol, smoking, recreational drugs, heavy metals, etc., increasing the amount of rest to allow for healing, spending time on a daily basis to actively address the psychological aspects of the illness, and taking time off work, changing one’s daily lifestyle regimen and making substantial life changes. It might also involve naturopathic treatments, such as herbal medicines, supplements, homeopathy, acupuncture, physical alignment techniques or even treatments such as intravenous therapy to address and support the specific symptoms; or a radical treatment might involve the necessity for surgery or conventional medical intervention. The more any treatment is due to what the patient does (i.e. changes that they make) the more likely the healing.

Identifying and respecting the healing intention and capacity of the patient is an essential part of all therapeutic encounters. There is a difference between what is possible with supplements, drugs, and medication, and what is right to do. For example, in cases of palliative care, the patient might desire treatments aimed at improving quality of life, not necessarily at prolonging their life. There are a range of treatment intentions ranging from curative to balancing to supportive to managing to palliative to suppressive. At times, the patient’s intention is limited due to their belief system or due to what they have read not due to the pathophysiology of their condition. For example, a patient who is diagnosed with fibromyalgia might read that there is no cure, and the only option that they have is to manage their pain. In situations like this, the practitioners might first re-educate the patient and provide the knowledge that when the disrupting factors which involve lifestyle, both environmental and psychological, are addressed there is the potential of a greater state of health than they currently anticipate.

The healing power of Nature (vis medicatrix naturae)

The healing power of Nature is an important principle of naturopathic medicine.

The definition of the healing power of Nature, according to the American Association of Naturopathic Physicians (1999), is ‘the inherent self-organizing and healing process of living systems, which establishes, maintains and restores health.’ This healing process is organized, ordered, and intelligent (Lipton 2005). It is the naturopathic doctor’s role to support, facilitate and augment this process by identifying and removing obstacles to health and recovery, and by supporting the creation of a healthy internal and external environment. A naturopathic doctor Dr. Papadogianis wrote ‘Within you lies a healing force more powerful than any treatment and more effective than any health-care practitioner’ (Papadogianis 1998).

Throughout time, there have been many beliefs about disease and theories about healing. Hippocrates believed that everything in nature had a rational basis that followed the laws of nature. The followers of Hippocrates used the term vis medicatrix naturae, the healing power of Nature, to denote the body’s ability to heal itself (Murray & Pizzorno 1991). Georg Ernst Stahl (1660–1734) believed that the ‘soul’ was responsible for overseeing bodily functions and that the ‘soul’ held the power to heal.

Medical therapy can take two general forms: practitioners can attempt to strengthen the body so that it can heal, organize and defend itself, or they can attack the agents and mechanisms of disease directly. A naturopathic doctor addresses foreign agents of disease, but the focus is on strengthening the body thus decreasing its susceptibility to infection. When we cut our finger the body automatically knows what to do to stimulate the healing process and to close the wound. When we have the flu, the body initiates a fever and other efforts to kill the invading pathogens. When we eat spoiled food, the body responds by inducing vomiting or diarrhea. There is no mistaking that there is an innate healing ability to the body. The role of the doctor is to work with patients in order to identify the root cause(s) of disease and to remove the obstacles to cure. Naturopathic doctors support the creation of a healthy internal and external environment, they recommend that patients conserve vital energy and support the healing ability of the body, they work with patients to remove toxins, they assist in restoring structural integrity, and they encourage patients to adopt a healthy lifestyle.

Symptoms often are the manifestation of the organism’s attempt to defend and heal itself.

For example, a patient complains of hip pain and numbness down his leg. If the patient has poor posture and continually sits on a thick wallet, the treatment involves correcting the misalignment, educating the patient on proper posture, and informing him not to sit on his wallet. When the flow of energy (or Qi), nutrients, blood, and nerve stimuli is returned to the area, the remaining symptoms often resolve on their own. Simply recommending an anti-inflammatory (whether drug, botanical, or homeopathic) does not address the root cause and even if the symptoms diminish temporarily, until the root cause is addressed, they likely will not completely resolve. The healing power of Nature is an innate process, but it is impacted by the choices that we make and the lifestyle and external factors that are imposed on the body.

Health is the natural state of the body. Maintaining health is the driving force of the innate healing response. When the optimal state of health is affected, the body aims to achieve the state of greatest health possible. The body compensates and diverts resources to ensure that life is sustained. According to Hering’s Law of Cure, the body heals from the head down, from the inside out, and in the reverse order of the appearance of symptoms (Vithoulkas 1980). The body ‘unwinds’ as it heals, protecting the internal organs, thus providing the organs that are responsible for sustaining life with the resources they require. The more that the inherent healing ability and healing process of the body is supported versus overridden, the greater the depth of health achieved.

The healing power of Nature refers to both the body’s innate ability to heal and the healing ability of Nature itself. The use of natural remedies has the power to stimulate healing. In fact, being in Nature itself can contribute to healing. This is discussed later in this chapter.

Identify and treat the root cause of disease (tolle causam)

We experience the body’s ability to maintain homeodynamic functionality as health. When the homeodynamic functioning is overwhelmed, the body attempts to compensate. This compensation manifests as symptoms and as a disruption to health. The aim of the practitioner is to determine the specific trigger, signal, or patterns that initiated the disruption and that needs to be addressed.

Health and disease are complex and logical; the outcome of one versus the other occurs for specific reasons. The manifestation of disease is never the root cause of the problem. To understand the root cause a practitioner must start at when and why the disruption of health was initiated. To elicit a cure, the signal that initiated the imbalance – the root cause – needs to be addressed, especially if it is still signaling the body that there is a problem. For example, if a patient is angry because of the way they are being treated at work and they hold in their anger, this suppression of emotion might result in digestive discomfort, headaches, and red rash. If the treatment involves taking something to mask the digestive discomfort, medication for the headache, and a cream to minimize the redness of the rash, but does not address the anger, the suppressed anger continues to signal the body resulting in the same or deeper, more severe, symptoms.

Recognizing a relationship between lifestyle and health is a concept that has been around for centuries. In the 1600s, Thomas Sydenham, who is recognized as the founder of European clinical medicine, believed it was the task of the doctor to assist the body’s natural processes while searching for the causes of disease (Magner 1992). Over the years, most people have moved further away from a lifestyle that is supportive of health. Fast food, stimulants, sedentary jobs, fast-paced lifestyles, and less time resting and sleeping are all contributing factors. The invention of pesticides, plastics, paints, cell phones, video games and more, have all had a negative impact on health. Human beings are complex, living, multi-dimensional energetic systems that have a limited capacity to handle the onslaught of a toxic lifestyle and environment. Identifying the root cause of disease and the aggravating factors is an essential aspect of health care. Nowadays there are just more factors. A practitioner needs to be more thorough with their history-taking and needs to recognize that there are contextual influences, external and environmental factors, and lifestyle factors that disrupt health and initiate signs of disease. As part of the therapeutic encounter, a naturopathic doctor needs to explore a much greater number of factors as health is improved by reducing the number of factors that strain the body and interfere with its normal functioning and ability to heal. Naturopathic treatment involves teaching patients that a return to a more simple and health promoting lifestyle often is the best medicine for them.

The body is complex and yet logical. It displays symptoms that correspond – provide a road map – to the root cause. For example, when a patient falls, their injuries correspond to how they fell and how they compensated. There are times when the physical manifestation of the symptoms and their corresponding root cause indicate a direct correlation and other times when the correlation is not as clear. Often when a patient is recalling their history they will use somatic metaphors to describe their symptoms or they intuitively link symptoms with events. For example, a patient recalls that their palms get sweaty and their heart races every time they have to speak to a certain person or speak in public. The primary issue that needs to be addressed is the anxiety associated with the event, not just the sweaty palms and the racing heart.

Identifying and treating the root cause of disease does not imply a linear causality between events in a person’s life and disease. Human beings are a complex, dynamic and integrated system and it is the accumulation of multiple factors that contributes to health and disease. A specific event might be the primary trigger that initiated or amplified a series of symptoms, but their overall state of health, their adherence to lifestyle factors that are suited to their constitution, the impact of environmental factors, the support of family and community etc, all play a role in their ability to handle disrupting factors. The impact of any single event, at any point in time, depends on a number of other factors. The complex workings of the body follow the concept of mutual causality and recognize that the impact of any specific event is contextual and individual.

Treat the whole person (tolle totum)

Each patient’s personal essence and the psychological, functional and structural aspects are an inseparable whole, that is, interconnected and interdependent with family, community and environment. The concept of a multi-dimensional individual differs significantly from the conventional model that generally focuses on the physical symptoms usually in isolation. ‘Treat the whole person’ is a holistic concept that recognizes that the whole is greater than the sum of the parts. There is also the recognition that each individual is unique with their own specific susceptibilities and way of manifesting disharmony and disease. The management of health and the progression of disease are complex processes that are influenced by many different factors. Naturopathic medicine recognizes that it is the harmonious functioning of all aspects of the individual, within the self and with their environment, that is essential to health.

Naturopathic medicine recognizes that each person has their own unique susceptibilities and ways of manifesting symptoms. This concept is shared in other medical systems. For example, according to Ayurvedic medicine, a person who has a vata constitution will be aggravated in the winter, with consumption of excess dry, cold food, by too much worrying, excessive movement, and if there isn’t sufficient routine in their life. This is because vata relates to the qualities of cold and dry as well as to the mind and movement. For a person with this constitution when the season, their food and their lifestyle mirror these qualities versus balance them, they are more likely to be aggravated and hence symptoms relating to the aggravation appear (Lad 1998). Homeopathy is based on the understanding that the unique expression of an individual’s symptoms is the most important criterion in the assessment process (Hahnemann 1996). For most traditional medical systems, and for naturopathic medicine, the concept of everyone having a unique makeup or constitution influences the assessment, diagnosis, and treatment of each patient. There is an understanding that you cannot separate the individual from their symptoms and the focus of treatment is to treat the patient, not the illness.

The principle ‘treat the whole person’ recognizes that human beings are complex and evolving systems. Understanding the complexity of individuals requires a practitioner to be able to look at a problem in all its dimensions. It requires the ability to synthesize (bring together), as well as the ability to analyze (to break things apart), and the recognition that living systems are dynamic, and non-linear.

It also involves teaching patients to recognize the integration of all aspects of themselves and their surroundings. It is about encouraging patients to explore their life purpose, to be mindful of their habits and thought processes, to pay attention to their internal functions and posture, and to recognize the correlation between their life, their choices, and their health.

Disease prevention and optimal wellness

The Huang Di Nei Jing, a Chinese medical classic written in the second century bce, states:

Preventive medicine involves assessing resources and risks and acknowledging how lifestyle and personal choices affect our health. Health and disease is, to a large part, a reflection of how an individual chooses to live.

Prevention of disease is a continual process that starts at conception and continues throughout all of life. It involves every aspect of a person’s life, from their lifestyle, to their emotional health, the choices that they make, their family and community, and the environment that they live in. It is very difficult for individuals to be healthy, in an unhealthy environment. Individuals do have the ability to influence their lifestyle choices to a significant degree, for example, what they eat, their posture, their exercise and movement, and their daily regimen including sleep and relaxation. Symptoms indicate that something needs to change. The role of the practitioner is to facilitate increased awareness and to educate patients on the changes that are required, not only address these current concerns, but to ensure their prevention. Maintaining health and preventing disease is an ongoing process, not a short-term project.

Prevention of disease is a mind-set. It is about living a life of awareness, it is about self-responsibility and making choices conscious of their impact. It is about following the laws of nature, and implementing the principles of naturopathic medicine into daily life. Prevention of disease is a proactive approach to life and involves recognizing the interrelationship between individuals, their environment, their family and their community is an important aspect of this.

Health promotion and the degree to which a person feels well depends on their perception of wellness and often changes with different stages of one’s life. According to Dr. William (Bill) Mitchell, a naturopathic doctor, ‘body vitality + mental vitality + spiritual vitality = wellness’ (Mitchell 2007). Body vitality includes the functioning of internal organs and systems, and a person’s flexibility, strength, and endurance and how strong and healthy a person physically feels. Mental vitality is a sense of well-being, feeling happy, experiencing and sharing love and thoughtfulness. Spiritual vitality is a sense of the greatness of the evolved universe, an appreciation of the efforts of people to understand the larger meaning of life and death, a humble and praisefull adoration of an omniscient guide (Mitchell 2007).

Wellness is a concept that many have attempted to define and measure. Some measurement scales include the spiritual, social, mental, emotional and physical. Others include concepts such as creative, coping, social, essential, and physical (Bell 2007). Some scales consist of solely one dimension, such as the physical, others emphasize the emotional. Wellness is an individual perception; it changes with time and with the different experiences that one encounters. It is the role of the naturopathic doctor to determine what wellness means to each patient and then to guide them in finding ways to achieve this.

Part of guiding a patient to wellness involves assessing risk factors and hereditary and lifestyle susceptibilities. It involves recommending appropriate interventions to prevent illness and taking steps to remove the obstacles to healthy function in order to stimulate the healing ability of the body. Other important factors affecting wellness include: intention, meaning, or purpose in life, one’s perception of life and sense of hope. Having the intention to achieve wellness and believing that there is a purpose to life is necessary and valuable. Intentions refer not only to the patient but to the doctor as well. Intention relates to the internal mind chatter, and the conscious and unconscious thoughts that a person has. If the thoughts are dysfunctional or doubtful of the ability to heal, they will adversely affect the healing process. It a person does not see the purpose to healing, if they have given up on life or feel that they would rather die, that too disrupts the healing process and the willingness that a patient has to comply with any treatment regimen or recommendation for lifestyle changes. Intention and purpose, on the part of both the practitioner and the patient, provide a focus, a direction and a guide in the therapeutic encounter and in the patient’s healing journey. If a doctor recognizes that there is a concern at this level it is best addressed early in the treatment plan.

Doctor as teacher (docere)

Docere is the Latin word for ‘teacher.’ Teaching takes time and the therapeutic encounter needs to allow sufficient time for the doctor to educate and teach the patient how to make and maintain the lifestyle choices and changes needed to assist them in achieving wellness. Many patients desire an understanding of why they are sick, what they can do to improve the situation, and what they have to change for the future. It is this awareness and understanding by the patient that determines long-term wellness, not the knowledge level of the doctor. Thomas Edison wrote ‘The doctor of the future will give no medicine, but will interest his patient in the care of the human frame, in diet and in the cause and prevention of disease.’ ‘The successful doctor of the future will have to fall in line with the procession and do more teaching than prescribing’ (Lindlahr 1975).

With permission from the Canadian Association of Naturopathic Doctors.

The doctor is a facilitator and serves as a guide in the patient’s healing process. It is the patient that does the healing; the doctor assists in the process. What the doctor brings to the relationship is the knowledge and the experience to appropriately guide the patient. The aim of the doctor is to establish a collaborative doctor–patient relationship, which in itself has inherent therapeutic value. By understanding the goals, healing intention, resources and limitations of the patient, the doctor can provide each patient with an individualized and evolving road map for their journey, and along the way they can educate patients and encourage self-responsibility for health. The greatest healing counsel a doctor can give to a patient is the knowledge and tools needed to establish and maintain their own health simply through living a healthy lifestyle that is in tune with their constitution and with nature.