Table of Contents

I. The nature of health, homeostasis, adaptation, biological plasticity, repair.

This introductory chapter frames the overall issues of health, disease – both health restoring therapy and disease focused therapy are necessary.

•                     The concept of health

•                     Scientific ways of describing a state of balance

•                     Healing as observed in the human body

•                     The reasons why our self-repair mechanisms fail

•                     The two pillars of medicine in the Western tradition – The Rational and Empirical Schools

•                     Naturopathic medicine and the Hippocratic tradition – making the flame burn more brightly

•                     Indigenous medicine and traditions that precede contemporary naturopathic medicine

 

II. Disease (Theory of)

While disease is an observable phenomenon at the cellular and biochemical level, the reasons that the human system lapses into disease and dysfunctions are more complex that the end stage pathological finding. This chapter looks at how these dysfunctions occur over time, as this is the ground of chronic ill health of the kind that patients seek help for.

•                     Deviation from normal control systems

•                     Oscillations

•                     Degeneration

•                     Neoplasm

•                     Sub-optimal function

•                     Drastic compensations – chain reactions

•                     The extracellular matrix – the interior milieu of human cells, and it’s degeneration

•                     Immune and human - microbiome symbiosis

 

 

III. Where does a naturopathic approach apply?

The need for and success of conventional medicine is indisputable. So where does a naturopathic approach become needed? Between pure prevention, and the suppression of pathology, what is the need for a naturopathic approach. Allopathic approaches at sub-toxic levels can work to restore balance, and in more advanced disease, naturopathic approaches can still optimize remaining function and improve quality of life.

•                     Why are allopathic therapies sometimes not enough?

•                     Why are natural approaches sometimes not enough?

•                     What is the threshold – what happens to make repair impossible?

•                     What is the value of supporting the body even in incurable conditions?

•                     The role of the naturopathic physician in setting the stage for healing

 

 

IV. Causes of ill health

The states of dysfunction discussed in Chapter II, that lead to disease development don’t always happen by random chance. What are the causes of those states, and to what degree does stressors, disturbances to determinants of health, and intrinsic/genomic factors produce the states of dysfunction.

•                     Disturbances

•                     Chronic dysfunction

•                     Toxins

•                     Mind and body

•                     Microbiome

•                     Genomic susceptibility

•                     Developmental influences

•                     Suppressive treatments

•                     Nutritional elements in disease

•                     Social determinants

 

 

V. Assessment of the patient

Diagnosis is necessary in health care – even if disease states have more complex causes, the situations that are described by diagnostic categories (such as “peritonitis”) require action. The assessment must start here, but go well beyond this, to overall function, identification of factors that are holding back healing, and insight into the disturbed determinants of health and stressors that are undermining the patient’s total health.

•                     Diagnosis

•                     Overall Health Assessment including organ function

•                     Levels of function and dysfunction – limitations

•                     Social – emotional context

•                     Inventory of Determinants of Health

•                     Nutritional status

 

 

VI. Therapeutics

A look at naturopathic therapeutics as purposeful and how they align with a whole person approach.

•                     Historical roots

•                     Indebtedness to key traditions

•                     Current and future scientific research

•                     Purposes of each type of therapy (clinical nutrition, botanical medicine, physical medicine etc.)

•                     How they relate to reversing modes of disease

•                     How they relate to eliminating causes of disease

•                     How they relate to enhancing the healing or repair – regeneration process

 

 

VI. States of ill health – assessment and overall mitigation

These are biological states are both clinical presentations, and blanket conditions that give rise to multiple issues and usually multiple secondary diagnoses.

•                     Chronic pain

•                     Pre-cancer

•                     Liver damage

•                     Mucosal immune dysfunction and Allergy

•                     Auto-immune conditions

•                     Poor immune competence

•                     Mood disorder

•                     Insulin dysfunction

•                     Mitochondrial dysfunction

•                     Post-viral syndromes

•                     PTSD and trans generational trauma

•                     Obesity

 

VII. Systems Approach to Therapy

Building on the framework of fundamental causes of ill-health, chronic dysfunction, and states of permanent organ dysfunction, this chapter takes an organ system review of therapy for these systems. The reason it is grouped by system versus by condition is that the purpose of this chapter is to look at the mechanistic issues that underlie function for each system. There is discuss of specific treatments and doses. The preceding analytical approach to disease is the real basis for this chapter. Students will find it information rich, but the ability to analyze problems in these organ systems and to create actionable conclusions is the true goal of this chapter.

•                     Cardiovascular

•                     Pulmonary

•                     Renal

•                     Hepatobiliary

•                     Gastrointestinal

•                     Neurologic

•                     Hematopoeitic

•                     Muscuo-skeletal

•                     Dermatologic

•                     Endocrine systems

•                     Sensory organs

 

 

VIII. Life-span considerations

This chapter focuses mainly on the challenges and opportunities for addressing the determinants of health in each of these life stages. Some of the more prominent challenges are discussed. For instance, the chronic oxidative stress, LDL intoxication, and inflammation that leads to atherosclerosis tends to assert itself in later adulthood.  There are some tables and highlights such as nutritional requirements at different stages, but this chapter will not present a complete pediatric or gerontology resource.

•                     First 2 years

•                     Childhood early

•                     Ages 8 to 12

•                     Adolescence

•                     Adulthood early

•                     Later adulthood

•                     Maturity – senescence

•                     Life extension

•                     The oldest old

 

 

IX. Naturopathic medicine in context

This chapter examines the roles that naturopathic physicians can perform in healthcare. This is not merely descriptive we’ll look at how having a distinct and complementary model of care and skill set can make this approach welcome across a variety of settings. The degree to which a naturopathic physician can and should (in the absence of a 3 to 5 year residency learning allopathic approaches) use the upper range of the scope of practice which does include prescription medications. Is referral or co-management with other providers a better alternative than doing it all?

•                     Primary care roles

•                     Adjuvant Roles

•                     As part of health systems and integrated practices

 

X. The role of research and scientific inquiry in naturopathic medicine

There are different kinds of evidence, and different questions to ask in clinical practice research. Although the double blinded, randomized control trial is powerful, it is best suited to single therapy approaches, particularly with singular substances (drugs) or a combination of these drugs in some instances. Not only outcomes, but insight into how patient resilience is increased ought to be a strong focus in naturopathic medicine.

•                     The use of aggregated clinical trials as a guide to therapy selection

•                     Mechanisms of injury, disease, repair, and homeostasis – how does this knowledge guide practices

•                     What kinds of scientific investigations are more relevant to naturopathic medicine

•                     How practitioners can contribute to knowledge creation – and need to

 

 

XI. The role of informatics and artificial intelligence in naturopathic medicine

The aggregation and searching of data is becoming more powerful all the time. Assisted decision making is here now, and will only become more relevant. Its fallacious to presume that a simple query of the vast amount of scientific publications can always tell a doctor what to do, but it can strongly inform decisions. The “Garbage In – Garbage Out” principle of computing is still at work today.

·         Organized citations

·         Hierarchies of researches

·         Statistical interpretations – power and limitations

·         Individualized medicine in the 21st century

·         Assisted decision making

 

 

XII. Societal, global, environmental impact that naturopathic physicians can have.

All human beings are a part of, and influenced by their cultural, socioeconomic, environmental and ecology milieu. Naturopathic physicians need to understand these powerful drivers of health, and to what degree physicians should be actively seeking to improve these factors as part of their actual professional responsibility.

•                     Cultural impacts on health

•                     Socio-economic drivers

•                     Environmental toxins

•                     Ecological factors – deforestation, green space, drinkable water, food availability.

 

 

Appendix A: Recommended resources for clinical/scientific information.

 

Appendix B: Professional associations and public interest groups related to whole health, complementary and integrative medicine, naturopathic medicine, etc.