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CHAPTER 3
A Hierarchy of Healing: The Therapeutic Order
The Unifying Theory of Naturopathic Medicine
Jared Zeff, ND, Lac
Pamela Snider, ND
Stephen P. Myers, ND, BMed, PhD
CHAPTER CONTENTS
A Brief History of Naturopathic Medicine 27
Original Philosophy and Theory 28
Modern Naturopathic Clinical Theory:
The Process of Development 29
A Theory of Naturopathic Medicine 31
Illness as Process 32
The Determinants of Health 34
Therapeutic Order 34
1. Establish the Conditions for Health 34
2. Stimulate the Self-Healing Mechanisms 36
3. Support Weakened or Damaged Systems
or Organs 36
4. Address Structural Integrity 37
5. Address Pathology: Use Specific Natural
Substances, Modalities, or Interventions 37
6. Address Pathology: Use Specific
Pharmacologic or Synthetic Substances 38
7. Suppress Pathology 38
Theory in Naturopathic Medicine 38
A BRIEF HISTORY OF NATUROPATHIC
MEDICINE
Benedict Lust “invented” naturopathy in 1902. Naturo-
pathic medicine has deep roots, some of its therapies
emerging from the mists of prehistory, but the modern
naturopathic profession originated with Lust, and it
grew under his tireless efforts. He crisscrossed the
United States lecturing and lobbying for legislation to
license naturopathy, testifying for naturopaths indicted
for practicing medicine without a license and traveling
to many events and conferences to help build the profes-
sion. He also wrote extensively to foster and popularize
the profession, and through his efforts the naturopathic
profession grew rapidly.1-3 By the 1940s naturopathic
medicine had developed a number of 4-year medical
schools and had achieved licensure in about one third
of the United States, the District of Columbia, four
Canadian provinces, and a number of other countries.2,4
By 1957, however, there was only one naturopathic college
left. By 1965 only eight states still licensed naturopathic
physicians, and by 1979 there were only six. A survey
conducted in 1980 demonstrated only about 175 naturo-
pathic practitioners still licensed and practicing in the
United States and Canada.5In 1951 the number was
approximately 3000.6
The decline of naturopathic medicine after a rapid rise
was due to several factors. By the 1930s a significant
tension was developing within the profession regarding
naturopathic practice; the development of unified stan-
dards; and the role of experimental, reductionist science
as an element of professional development.7,8 This
tension split the profession of naturopathic physicians
from within after the death of Lust in the late 1940s, at a
time when the profession was subject to both significant
external forces and internal leadership challenges. Many
naturopathic doctors questioned the capacity for the
reductionist scientific paradigm to research naturopathic
medicine objectively in its full scope. This perception
created mistrust of science and of research. Science was
also frequently used as a bludgeon against naturopathic
medicine, and the biases inherent in what had become
the dominant paradigm of scientific reductionism made a
culture of scientific progress in the profession challenging.
The discovery of effective antibiotics elevated the stan-
dard medical profession to dominant and unquestioned
stature by a culture that had turned to mechanistic
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science as an ultimate authority. The dawning of the
atomic age reinforced a fundamental place for science in
a society increasingly dominated by scientific discovery.
In this culture, standard medicine, with its growing
political and economic strength, was able to force the
near elimination of naturopathic medicine through the
repeal or sunsetting of licensure acts.1,2,9
In 1956, as the last doctor of naturopathy (ND) program
ended (at the Western States College of Chiropractic),
several doctors in the Northwest created the National
College of Naturopathic Medicine in Portland, OR, to
keep the profession alive. But that school was nearly
invisible, the last vestige of a dying profession, and
attracted rarely as many as 10 new students a year. The
profession was considered dead by its historic adversaries.
The culture of America, dominated by standard med-
icine since the 1940s, began to change by the late 1960s.
The promise of science and antibiotics was beginning to
seem less perfect. Chronic disease was increasing in
prevalence as acute infection was less predominant, and
standard medicine had no “penicillin” for chronic
diseases. In the late 1970s, family medicine proposing a
biopsychosocial model of care emerged within conven-
tional medicine in response to the perception then of a
growing crisis in standard medicine. The publication of
Engel’s “The Need for a New Medical Model”10 in April
1977 signaled this trend. Elements of the culture were
rebelling against plastics and cheap synthetics, seeking
more natural solutions. The publication of Rachael
Carson’s Silent Spring, an indictment of chemical pesti-
cides and environmental damage, marked a turning
point in cultural thinking. In Silent Spring (1962) Carson
challenged the practices of agricultural scientists and
the government and called for a change in the way
humankind viewed the natural world.11 New evidence
of the dangers of radiation, synthetic pesticides, and
herbicides, as well as environmental degradation from
industrial pollution, were creating a new ethic. Organic
farming, natural fibers, and other similar possibilities
were starting to capture attention. A few began seeking
natural alternatives in medicine. By the late 1960s
and early 1970s, enrollments at National College of
Naturopathic Medicine began to reach into the 20s. In
1975 National College enrolled a class of 63 students.
The 1974 class had numbered 23.12 The profession was
experiencing a resurgence.
In 1978, with increasing enrollment interest at
National College, Joseph E. Pizzorno, ND, LM, and his
colleagues (Les Griffith, ND, LM; Bill Mitchell, ND;
and Sheila Quinn) created the John Bastyr College of
Naturopathic Medicine in Seattle, WA. With the creation of
Bastyr, named after the eminent naturopathic physician
Dr. John Bartholomew Bastyr (1912-1995), the profession
entered a new phase. Not only did this new college
double the profession’s capacity to produce new doctors,
it also firmly placed the profession upon the ground of
scientific research and validation. “Science-based natural
medicine” was a major driving force behind the creation
and mission of Bastyr. Both Drs. Bastyr and Pizzorno
had significant influence and leadership in achieving
this focus.
One of Bastyr’s important legacies was to establish a
foundation and a model for reconciling the perceived
conflict between science and the deeply established
healing practices of naturopathic medicine. Kirchfeld
and Boyle described his landmark contribution as
follows:
Although naturopathic colleges in the early 1900s did
include basic sciences training, it was not until Dr. John Bastyr
(1912-1995) and his firm, efficient and professional leadership
that science and research-based training in natural medicine
was inspired to reach its fullest potential. Dr. Bastyr, whose
vision was one of “naturopathy’s empirical successes docu-
mented and proven by scientific methods,” was himself “the
prototype of the modern naturopathic doctor, who culls the
latest findings from the scientific literature, applies them in
ways consistent with naturopathic principles and verifies the
results with appropriate studies.” Bastyr also saw a tremendous
expansion in both allopathic and naturopathic medical knowl-
edge, and he played a major role in making sure the best of both
were integrated into naturopathic medical education.3,13
Bastyr met Lust on two occasions and was closely tied
to the nature cure tradition of Kneipp through his mother
and Dr. Elizabeth Peters. He effortlessly reconciled the
empirical tradition of naturopathy with the latest scien-
tific studies, and helped create a new and truly original
form of clinical care naturopathic medicine. He spent the
twentieth century preparing the nature cure of the nine-
teenth century for entry into the twenty-first century.1,13
“Today’s debates concerning the philosophical range in
the profession are no longer about science. They tend to
center on challenges to “green allopathy” vs the impor-
tance of implementing the full range of healing practices
derived from nature cure, along with natural substances.
Professional consensus appears strong that the full range
of naturopathic healing practices must be retained,
strengthened and engaged in the process of education
and scientific research and discovery in the twenty-first
century.14-16
ORIGINAL PHILOSOPHY AND THEORY
Through the initial 50-year period of professional
growth and development (1896-1945), naturopathic
medicine had no clear and concise statement of identity.
The profession was whatever Lust said it was.
He defined “naturopathy” or “nature cure” as both a
way of life and a concept of healing that used various
Philosophy of Natural Medicine
28
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natural means of treating human infirmities and disease
states. The “natural means” were integrated into naturo-
pathic medicine by Lust and others based on the emerg-
ing naturopathic theory of healing and disease etiology.
The earliest therapies associated with the term involved
a combination of American hygienics and Austro-
Germanic nature cure and hydrotherapy. Leaders in this
field included Lindlahr, Trall, Kellogg, Holbrook, Tilden,
Graham, Kuhne, McFadden, Rikli, and others who wrote
foundational naturopathic medicine treatises or developed
naturopathic clinical theory, philosophy, and texts,
enhancing, agreeing with, and diverging from Lust’s
original work.17-25
Naturopathic medicine was defined most formally
by the various licensure statutes, but these definitions
were legal and scope-of-practice definitions, often in
conflict with each other, reflecting different standards
of practice in different jurisdictions. In 1965 the U.S.
Department of Labor’s Dictionary of Occupational Titles26
presented the most formal and widespread definition,
perhaps, but it reflected one of the internally compet-
ing views of the profession, primarily the nature cure
perspective:
Diagnoses, treats and cares for patients using a system of
practice that bases treatment of physiological function and
abnormal conditions on natural laws governing the human
body. Utilizes physiological, psychological and mechanical
methods such as air, water, light, heat, earth, phytotherapy,
food and herbs therapy, psychotherapy, electrotherapy, physio-
therapy, minor and orificial therapy, mechanotherapy, naturo-
pathic corrections and manipulations, and natural methods or
modalities together with natural medicines, natural processed
food and herbs and natural remedies. Excludes major surgery,
therapeutic use of x-ray and radium, and the use of drugs,
except those assimilable substances containing elements or
compounds which are components of body tissues and physi-
ologically compatible to body processes for the maintenance
of life.26
This definition did not list drugs or surgery within
the scope of modalities available to the profession.
It defined the profession by therapeutic modality and
was more limited than most of the statutes under
which naturopathic physicians practiced, even in 1975
when there were only eight licensing authorities still
active.27
The bulk of professional theory was found in Lust’s
magazines: Herald of Health and The Naturopath. These
publications displayed the prodigious writings of Lust
but did not contain a comprehensive and definitive
statement of either philosophy or clinical theory. Lust
often stated that all natural therapies fell under the
purview of naturopathy. Several other texts were also
used as somewhat definitive by various aspects of the
profession at different times. These texts included Henry
Lindlahr, MD’s seven-volume Natural Therapeutics, pub-
lished in the early 1900s. Lindlahr’s Nature Cure (1913) is
considered a seminal work in naturopathic theory, laying
the groundwork for a systematic approach to naturopathic
treatment and diagnosis. Lindlahr ultimately presented
the most coherent naturopathic theory extant, summa-
rized in his Catechism of Naturopathy, which presented a
five-part therapeutic progression:
1. “Return to Nature,” which meant attend to the basics
of diet, dress, exercise, rest, etc.
2. Elementary remedies—water, air, light, electricity
3. Chemical remedies—botanicals, homeopathy, etc.
4. Mechanical remedies—manipulations, massage, etc.
5. Mental/spiritual remedies—prayer, positive thinking,
doing good works, etc.28
In the 1950s Spitler wrote Basic Naturopathy, a
Textbook,29 and Wendel, Standardized Naturopathy.30 These
texts presented the somewhat opposing perspectives of
the more science-based, or “green allopathic,” and the
nature cure camps. Kuts-Cheraux’s Naturopathic Materia
Medica, written in the 1950s, was produced to satisfy a
statutory demand by the Arizona legislature but persisted
as one of the few extant guides. Practitioners have relied
on a number of earlier texts, many of which arose from
the German hydrotherapy practitioners31-36 or the Eclectic
school of medicine (a refinement and expansion of the
earlier “Thomsonian” system of medicine)37-41 and pre-
dated the formal American naturopathic profession
(1896). But by the late 1950s, publications diminished.
The profession was generally considered on its last gasp,
an anachronism of the preantibiotic era.
MODERN NATUROPATHIC CLINICAL
THEORY: THE PROCESS
OF DEVELOPMENT
“Medical philosophy comprises the underlying premises on
which a health care system is based. Once a system is acknowl-
edged, it is subject to debate. In Naturopathic medicine, the
philosophical debates are a valuable, ongoing process which
helps the understanding of health and disease evolve in an
orderly and truth revealing fashion.”
—Randall Bradley, ND.42
After the profession’s decline in the 1950s and 1960s,
a rebirth was experienced, more grounded in medical
sciences and fueled by a young generation with few
teachers. The profession’s roots were neglected out of
ignorance, for the most part, along with a youthful arro-
gance. By the early-1980s it was apparent that attempts
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to regenerate the progress made by Lust would require
the creation of a unified professional organization and
all which that entailed: accreditation for schools,
national standards in education and licensure, clinical
research, and the articulation of a coherent definition of
the profession for legislative purposes, as well as for its
own internal development. These accomplishments
would be necessary to be able to demonstrate the
uniqueness and validity of the profession, guide its edu-
cational process, and justify its status as a separate and
distinct medical profession.
In 1987 the newly formed (1985) American Association
of Naturopathic Physicians (AANP) began this task
under the leadership of James Sensenig, ND, (president)
and Cathy Rogers, ND, (vice president) appointing a
committee to head the creation of a new definition of
naturopathic medicine. The “Select Committee on the
Definition of Naturopathic Medicine” succeeded in a
3-year project that culminated in the unanimous adoption
by AANP’s House of Delegates of a comprehensive,
consensus definition of naturopathic medicine in 1989 at
the annual convention held at Rippling River, OR.43-45 The
unique aspect of this definition was its basis in definitive
principles, rather than therapeutic modalities, as the defin-
ing characteristics of the profession. In passing this resolu-
tion, the House of Delegates (HOD) also asserted that the
principles would continue to evolve with the progress of
knowledge and should be formally reexamined by the
profession as needed, perhaps every 5 years.43-48
In September 1996 the AANP HOD passed a resolu-
tion to review three proposed principles of practice that
had been recommended as additions to the AANP defi-
nition of naturopathic medicine originally passed by the
HOD in 1989. These three new proposed principles were
rejected, and the AANP HOD reconfirmed the 1989
AANP definition unanimously in 1999. The results of a
profession-wide survey conducted from 1996-1998 on
these three new proposed principles demonstrated that
while there was lively input, the profession agreed
strongly that the original definition was accurate and
should remain intact. The HOD recommended that the
discussion be moved to the academic community
involved in clinical theory, research, and practice for
pursuit through scholarly dialogue.49-53 This formed the
basis for further efforts to articulate a clinical theory.
AANP members had stated in 1987-1989 during the
definition process: “These principles are the skeleton, the
core of naturopathic theory. There will be more growth
from this foundation.”45 By 1997 this growth in modern
clinical theory was evident.
The first statement of such a theory was published
in the AANP’s Journal of Naturopathic Medicine in 1997
in an article titled “The Process of Healing, a Unifying
Theory of Naturopathic Medicine.” This article contained
three fundamental concepts that were presented as an
organizing theory for the many therapeutic systems and
modalities used within the profession and was based on
the principles articulated in the consensus AANP defini-
tion of naturopathic medicine. The first of these is the
characterization of disease as a process rather than a
pathologic entity. The second is the focus on the determi-
nants of health rather than on pathology. The third is the
concept of a therapeutic hierarchy.54
The article, “The Process of Healing: AUnifying Theory
of Naturopathic Medicine” signaled the emergence of a
growing dialogue amongst physicians, faculty, leaders
and scholars of naturopathic philosophy concerning
theory in naturopathic medicine. The hope and dialogue
sparked by this article was the natural next step of a
profession redefining itself both in the light of today’s
advances in health care, and with respect to the founda-
tions of philosophy at the traditional heart of naturo-
pathic medicine. This dialogue naturally followed the
discussions of the definition process and created a vehicle
for emerging models and concepts to be built on the
bones of the principles. The genome of traditional
naturopathic philosophy had been carried in the hearts
and minds of a new generation of naturopathic physi-
cians into the twenty-first century—these modern natur-
opathic physicians began to gather to redefine and reunify
the soul of the medicine and articulate the code of the
naturopathic genome.
This new dialogue was formally launched in 1996,
when the AANP Convention opened with the plenary
session: “Towards a Unifying Theory of Naturopathic
Medicine” with four naturopathic physicians presenting
facets of emerging modern naturopathic theory. The ses-
sion closed with an open microphone. The impassioned
and powerful comments of the naturopathic profession
throughout the United States and Canada engaged in
the vital process of deepening and clarifying its unifying
theory. Dr. Zeff presented “The Process of Healing: The
Hierarchy of Therapeutics”; Dr. Mitchell presented “The
Physics of Adjacency, Intention Naturopathic Medicine
and Gaia”; Dr. Sensenig presented “Back to the Future:
Reintroducing Vitalism as a New Paradigm”; and Dr.
Snider announced the Integration Project, inviting the
profession to engage in it by “sharing a beautiful and
inspiring anguish—the labor pains of naturopathic
theory in the twenty-first century. We know what we
have done, and we know there is much more. . . . The
foundation is laid. We are ready now [for integration].”55
Days later, in September 1996, the Consortium of
Naturopathic Medical Colleges (now American
Association of Naturopathic Medical Colleges [AANMC])
formally adopted and launched the Integration Project:
an initiative to integrate naturopathic theory and philos-
ophy throughout all divisions of all naturopathic college
curricula, from basic sciences to clinical training. A key
element of the project engaged the further development
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and refinement of naturopathic theory. The project has
been cochaired by Drs. Snider and Zeff since 1996.
Steering members from all colleges have participated
and contributed.45 Methods include professional and
scholarly research, expert teams, symposiums, and train-
ing. The proposed result is the fostering of systematic
inquiry among academicians, clinicians, and researchers
concerning the underlying theory of naturopathic medi-
cine and to bring the fruits of this work and inquiry into
the classroom and into scientific research.56
The Integration Project has sustained both formal and
informal dialogue since its inception in 1996, which con-
tinues today. The work has engaged faculty and scholars
of naturopathic philosophy in the United States, Canada,
and Australia. It also engaged institutional leaders and
practicing doctors and faculty in all areas of the profes-
sion. Why? Naturopathic philosophy is deeply felt as the
“commons” of naturopathic medicine: a place where the
profession meets; one that is owned by all naturopathic
physicians; and reflects, holds, and deepens the heart of
naturopathic medicine. Naturopathic philosophy is the
foundation and heart of naturopathic medicine. It remains
valid by evolving with the progress of knowledge, the
progress of science, and the progress of the human spirit.
Because naturopathic philosophy engages the felt mission
of nature doctors, it is vital that the profession periodi-
cally gathers to renew and revitalize progress regarding
its unifying foundations.
The Integration Project sparked a wide range of activ-
ities in all six ND colleges, resulting in all-college retreats
to share tools, retreats for training of non-ND faculty in
naturopathic philosophy, integration of basic sciences
curriculum, expert teams revision of core competencies
across departments ranging from nutrition to case man-
agement and counseling, development of clinical tools
and seminars for clinic faculty, creation of new courses,
and the integration of important research questions
derived from naturopathic philosophy into research stud-
ies and initiatives.57 North American core competencies
for naturopathic philosophy and clinical theory were
developed by faculty representing all accredited ND
colleges in a landmark AANMC retreat in 2000. The
AANMC’s Dean’s Council formally adopted these
competencies in 2000 and recommended that they be
integrated throughout curricula in all ND colleges.
These national core competencies included the hierarchy
of therapeutics, or the therapeutic order.58,59
Finally, many meetings with scholars and teachers of
naturopathic theory and other faculty and leaders—
formal and informal—have resulted in the further devel-
opment and refinement of the hierarchy of therapeutics
developed by Dr. Zeff in 1997. Drs. Snider and Zeff and
naturopathic theory faculty have worked closely with
other naturopathic faculty from AANMC colleges in a
series of revisions. Drs. Snider and Zeff collaborated in
1999 to develop the hierarchy of therapeutics into the
therapeutic order. The therapeutic order has been subse-
quently explored and refined also through a series of
faculty retreats and meetings, as well as experience with
students. A key finding of the clinic faculty at Bastyr
University was the emphasis on the principle “holism:
treat the whole person” and respect for the patient’s own
unique healing order and his or her values as a context
for applying the therapeutic order to clinical decision
making.60
The therapeutic order, or hierarchy of healing, is now
incorporated into ND college curricula throughout the
United States, Canada, Australia, and New Zealand. For
example, an important international outgrowth of the
profession’s development of theory is the adoption of
the unified “Working Definition of Naturopathic Nutrition”
in June 2003 by the Australian naturopathic profession
(Box 3-1). The 3-year project under the coordination of
Professor Stephen Myers, ND, BMed, PhD, brought
together nutrition faculty from naturopathic medicine
colleges throughout Australia. The project was cohosted
by the Naturopathy and Nutrition panel, an indepen-
dent group of naturopaths and nutrition educators whose
mission is to foster and support the development of the
science, teaching, and practice of naturopathic nutrition,
and the School of Natural and Complementary Medicine
at Southern Cross University. The definition evolved
over two retreats attended by more than 40 faculty mem-
bers involved in teaching nutrition as part of naturo-
pathic medicine education. It commenced as a general
agreement within the group that there was a real and
distinct difference between conventional nutrition and
naturopathic nutrition. General agreement was that the
distinction between the two had to date been poorly
defined and had been the source of dissonance between
the naturopathic and science faculty within the colleges.
The obvious next step was to define that difference to
ensure that nutrition curriculum within naturopathic
medicine colleges reflected the core elements of naturo-
pathic nutrition. At the second retreat held in June 2003,
the working definition was adopted with a recommen-
dation that it be widely circulated within the naturo-
pathic medicine profession to commence a dialog aimed
at both appropriate revision and broad adoption. This
process created a much-needed consensus definition on
naturopathic nutrition. This definition is based on the
AANP defining principles and incorporates the thera-
peutic order theory.
A THEORY OF NATUROPATHIC
MEDICINE
Standard medicine, or biomedicine, has a simple and ele-
gant paradigm. Simply stated, it would be “the diagnosis
and treatment of disease.” In practice, this statement
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contains several assumptions. One assumption is that
illness can be understood in terms of discrete diseases
(i.e., human suffering can be divided into identifiable
entities, such as measles or cancer [in its specific types],
or all the other catalog of illnesses to which we are
subject). Next is that “cure” is the elimination of the dis-
ease entity. Third, this is accomplished by the evidence-
based application of pharmaceuticals, surgeries, or similar
treatments to eliminate, palliate, or suppress the entity
and its symptomatic expressions. These are so obvious
that they are not commonly considered. They form the
background thinking in medical decision making:
identify and treat the disease.
The elegance of this model, and the science behind it,
has taken medicine to its highest point in history as a
reliable vehicle to ease human suffering, and its applica-
tion has saved countless lives. The understanding of the
physician, at least about the nature of pathology, has never
been as complete. But illness has a near infinite capacity
to baffle the physician. New diseases arise, such as human
immunodeficiency virus/acquired immune deficiency
syndrome, and shifts occur in disease focus, such as the
shift between 1900 and 2000 from acute infection to
chronic illness as the predominant cause of death.
Beyond these obvious changes, even with the current
depth of understanding, standard medicine physicians
continue to experience a depth of ignorance. So, even
representing an apex of human achievement as it does,
modern medicine is not without its weaknesses. Its
greatest weakness is probably its inability to cure chronic
illness as easily as it once dealt with thingslike infectious
pneumonia with penicillin, or even tuberculosis with
streptomycin. To compound that problem is the growing
prevalence of antibiotic-resistant infections. Part of the
reason for the failures within modern medical science is
the mechanistic basis of it, with its fundamental igno-
rance of and disrespect for the wholeness of the individ-
ual, the natural laws of physiology governing health and
healing, and especially for all things spiritual. Inherent
in the dictum—diagnose and treat the disease—is the gen-
eral neglect of the larger understanding that disease is a
process conducted by and within an intelligent organism
“whose genome(s) is (are) developed and expressed in
the natural world.”1
The uniqueness of naturopathic medicine is not in its
therapeutic modalities, “natural” alternatives to the drugs
and surgeries of standard medicine. It is in the clinical
theory that governs the selection and application of these
modalities, captured in the unifying definition adopted
in 1989 and expressed more specifically in the continuing
articulation of clinical theory. That is, it is the way the
naturopath thinks about illness and healing.
The first element of this theory is based upon the first
defining principle: vis medicatrix naturae. It is based on
the understanding that disease can be seen as a process,
as well as an entity. One can analyze the process of illness
and derive some understanding. But to do this, one needs
to examine the assumptions underlying this concept.
The governing assumptions of standard medicine are
principally that diseases are entities and that drugs and
surgery can eliminate these entities from the suffering
person. These are not the governing assumptions of
naturopathic medicine.
ILLNESS AS PROCESS
Naturopathic medicine can be characterized by a dif-
ferent model than “identify and treat the disease.”
Philosophy of Natural Medicine
32
Working Definition of Naturopathic Nutrition
Box 3-1
Preamble
Naturopathic medicine is a distinct system of primary health care—an
art, science, philosophy and practice of diagnosis, and treatment and
prevention of illness. Naturopathic medicine is distinguished by the prin-
ciples that underlie and determine its practice. These principles include
the healing power of nature
(vis medicatrix naturae),
identification and
treatment of the causes
(tolle causam),
the promise to first do no harm
(primum non nocere),
doctor as teacher
(docere),
treatment of the
whole person, and emphasis on prevention.These principles give rise
to a practice that emphasizes the individual and empowers him or her
to greater responsibility in personal health care and maintenance.
Definition
Naturopathic nutrition
is the practice of nutrition in the context of
naturopathic medicine.
Naturopathic nutrition
integrates both scientific nutrition and the
principles of naturopathic medicine into a distinct approach to
nutritional practice.
Core components of
naturopathic nutrition
are:
• A respect for the traditional and empirical naturopathic approach to
nutritional knowledge
• The value of food as medicine
• An understanding that whole foods are greater than the sum of their
parts and recognition that they have vitality (properties beyond
physiochemical constituents)
• Individuals have unique interactions with their nutritional environments
Practice
In the context of the definition, and with respect to the therapeutic
order, the practice of
naturopathic nutrition
may include the
appropriate use of the following:
• Behavioral and lifestyle counseling
• Diet therapy (including health maintenance, therapeutic diets, and
dietary modification)
• Food selection, preparation, and medicinal cooking
• Therapeutic application of foods with specific functions
• Traditional approaches to detoxification
• Therapeutic fasting strategies
• Nutritional supplementation
Data from Snider P, Payne S. Making naturopathic curriculum more naturopathic:
agendas, minutes, 1999-2001. Clinic faculty task force on integration. Faculty
development retreat, Bastyr University, 1999.
F7300-003 6/18/05 6:48 PM Page 32
“The restoration of health” would be a better characteri-
zation. In fact, naturopathic physicians adopted the fol-
lowing ultrashort definition of naturopathic medicine in
1989 in an AANP position paper: “Naturopathic physi-
cians treat disease by restoring health.” Immediately one
can see a difference: Standard medicine is disease based;
naturopathic medicine is health based. Although naturo-
pathic medical students study pathology with the same
intensity and depth as standard medical students, as
well as its concomitant (diagnosis), the naturopathic
physician applies that information in a different context.
In standard medicine, pathology and diagnosis are the
basis for the discernment of the disease “entity” that
afflicts the patient, the first of the two steps of identifying
and destroying the entity of affliction. In naturopathic
medicine, however, disease is seen much more as a
process than as an entity.
Rather than viewing the ill patient as suffering from
a “disease,” the naturopath views the ill person as
functioning within a process of disturbance and recov-
ery, in the context of nature and natural systems. Various
factors disturb normal health. If the physician can iden-
tify these disturbances and moderate them (or at least
some of them), the illness and its effects abate, at least to
some extent, if not totally. As disturbances are removed,
the body can improve in function, and in doing so the
health naturally improves. The natural tendency of the
body is to maintain itself in as normal a state of health as
is possible. The role of the physician is to facilitate this
self-healing process.
The obvious first task of the naturopathic physician,
therefore, is to determine what is disturbing the health
so that these causative elements may be ameliorated.
Disease is the process whereby the intelligent body
reacts to disturbing elements. It employs such processes
as inflammation and fever to help restore its health. In
general, one can graph this process simply:
healthy state +disturbing factors disturbance
of function reaction discharge of the products
of reaction resolution
One can see this most easily in the common cold.
Within standard medical understanding, the common
cold is caused by a virus, from among a family of patho-
logic viruses, which infects the person. The immune
system responds, developing appropriate antibodies,
which eventually neutralize the virus. There is no “cure”
yet discovered, except time. Medications are used to
ameliorate the symptomatic experience: aspirin or aceta-
minophen for fever, antihistamines to dry the mucus dis-
charge, etc. These measures are not cures: They reduce
the symptomatic expression of the “cold” but often
lengthen the process. In naturopathic medicine, the cold
is seen not as a disease entity but as a fundamental
process whereby the body restores itself.
If colds were caused solely by a virus, then everyone
who came in contact with the virus would get the cold.
Obviously, this does not happen. Susceptibility factors
include immune competence, fatigue, vitality, and
other resistance factors. The virus enters a milieu in
which all these factors affect the process. Once the virus
enters the system, if it overcomes some resistance fac-
tors, one begins to see disturbance of function. One
does not feel quite right. One may begin to get a sore
throat, the first inflammatory reaction, occurring at the
point of entry of the virus into the body. The immune
factors may overcome the virus at this point or may be
insufficient or suppressed. All of this is mutable to
some extent and is affected by nutrition, fatigue, an
increase in immune tonics, vitamin C, etc. But the
“cold” may proceed into a general state of fatigue and
inflammation, possibly fever, etc., followed by mucus
discharge, cough, and so forth, as the body processes
the virus and its effects, eventually overcoming it and
eliminating the results.
This model is not understood so much to be a sepa-
rate disease entity but a general and fundamental process
of disturbance and recovery within the living body. It is
a method whereby the body restores itself after a sufficient
amount of disturbance accumulates within the system.
This is why the cold has no “cure.” It is the cure for what
is ailing the body.
Chronic illness arises, in general, when any or all of
three factors occur: (1) The disturbing factors persist,
such as a chronically improper diet, which continues
to burden the body cumulatively, as the digestive
processes slowly weaken under the stress of that
improper diet; (2) The reactive potential is blocked or
suppressed, usually by drugs, which interferes with the
capacity of the body to process and remove its distur-
bances; or (3) The vitality of the system is insufficient to
mount a significant and sufficient reaction. As these
three factors prevent a sufficient reactive purge of distur-
bances, the body slides into a chronic, weaker reactive
state or episodes of intermittent reaction, perceived as
persistent and chronic illness.
Ultimately, as function is sufficiently disturbed, struc-
tures or functions are damaged and chronic inflammation
becomes ulceration or scar tissue formation. Atrophy,
paralysis, or even tumor formation may occur. All of this
is the body manifestly doing the best it can for itself in
the presence of persistent disturbing factors and with
respect to the limitations and range of vitality influenced
by the constitution, psycho-emotional/spiritual state,
and genotype of the person and his or her surrounding
environment.
The reversal of this condition is rarely accomplished
by “drugging” the pathologic state, which usually
results in the control of symptoms and persistence of the
illness, hopefully controlled in its more dangerous
A Hierarchy of Healing: The Therapeutic Order 33
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aspects by the presence of the drug or performance of the
surgery. Reversal is more likely accomplished by identi-
fying and ameliorating the disturbance, and as necessary,
strengthening or supporting the reactive potential. The
first step in this process is to identify and reduce disturb-
ing factors.
THE DETERMINANTS OF HEALTH
In order to reduce the disturbance, one must identify the
disturbance. In standard medicine, the first step is to
identify the pathology, which is then treated. In naturo-
pathic medicine, one must come to understand what is
disturbing the health. To do this, the physician needs to
understand what determines health in the first place.
The physician can then evaluate the patient in these
terms and come to understand what is disturbing the
natural state of health. Such a list could be created by
any doctor, certainly any naturopathic physician. The
authors propose the list in Box 3-2.
The naturopathic physician evaluates the patient with
these areas in mind, looking for aspects of disturbance,
first in the spirit, and most generally in diet, digestion,
and stress in its various aspects. In this evaluation the
naturopathic physician brings to bear a body of knowl-
edge somewhat unique to naturopathic medicine, to
evaluate not solely in terms of pathologic entity but in
terms of normal function and prepathologic functional
disturbance. Locating areas of abnormal function or
disturbance, the physician acts or recommends ways to
ameliorate the disturbance.
As disturbing factors are reduced in the system, the
natural tendency of the system to improve and optimize
its function directs the system back toward normalcy.
This is the removal of the obstacles to cure, which allows
the action of the vis medicatrix naturae, the vital force, the
healing power of nature. This is the first step in the
hierarchy of healing and what naturopathic physicians
may call the overarching clinical theory of naturopathic
medicine: the therapeutic order.
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 the present.61 It is a natural ordering of the
modalities of naturopathic medicine and their application.
The concept is somewhat plastic in that one must evaluate
the unique needs, and even the unique healing require-
ments, of the specific patient or situation,62 but in general
the nature of healing dictates a general approach to
treatment. In general, this order is listed in Box 3-3.
1. Establish the Conditions for Health
Identify and Remove Disturbing Factors
If one understands health to be the natural state and
“disturbance” the original culprit, then identifying and
Philosophy of Natural Medicine
34
Determinants of Health
Box 3-2
In order to understand what disturbs health, one must understand
what determines health. Therefore doctors of naturopathy study the
determinants of health. A determinant of health becomes a
disturbance when it is absent or present but distorted.
1. Inborn
• Genetic makeup (genotype)
• Intrauterine/congenital
• Maternal exposures
• Drugs
• Toxins
• Viruses
• Psychoemotional
• Maternal nutrition
• Maternal lifestyle
• Constitution: determines susceptibility
2. Hygienic Factors/Lifestyle Factors: How We Live
Environment, Lifestyle, Psychoemotional, and Spiritual Health
• Spiritual life
• Self-assessment
• Relationship to larger universe
Exposure to Nature
• Fresh air
• Clean water
• Light
Diet, Nutrition, and Digestion
• Unadulterated food
• Toxemia
Rest and Exercise
• Rest
• Exercise
Socio-economic Factors
• Culture
• Loving and being loved
• Meaningful work
• Community
Stress (Physical, Emotional)
• Trauma (physical/emotional)
• Illnesses: pathobiography
• Medical interventions (or lack of)
• Surgeries
• Suppressions
• Physical and emotional exposures, stresses, and trauma
• Toxic and harmful substances
• Addictions
From Zeff J, Snyder P. Course syllabus: NM51 71, Naturopathic clinical theory. Seattle: Bastyr University, 1997-2005.
F7300-003 6/18/05 6:48 PM Page 34
reducing disturbance is the obvious first step, unless
there is immediate danger to life or limb, in which case
acting to preserve life or limb is paramount. In most
chronic disease, neither life nor limb is immediately
threatened. This understanding dictates the first thing the
physician must attend to: the identification and ameliora-
tion of those factors disturbing health, especially factors
that most disturb health (inappropriate diet, excessive
stress, and spiritual disharmony). To understand what
disturbs health, one must understand what determines
health. The naturopathic physician evaluates a patient
with reference to the determinants of health to discover
wherein the patient’s health is disturbed. In this step, the
physician is essentially “removing the obstacles to cure,
and allowing the vis medicatrix naturae to do its work.”
Among these many possibilities, in general, the most
significant are diet, digestion, stress, and what might be
called “spiritual integrity.” Humans are spiritual beings.
They are spirits that reside within bodies. Though the
general purview of the physician is the body, that
instrument cannot be separated from the spirit, which
animates it. If the spirit is disturbed, the body cannot be
fundamentally healthy. Hahnemann, the brilliant founder
of homeopathy, instructs physicians thus. Disturbance in
the spirit permeates the body and eventuates in physical
manifestation. Physicians are responsible for perceiving
such disturbances and addressing them. At colleges of
naturopathic medicine in Australia and North America,
faculty work with naturopathic medicine students to
develop their ability to perceive the spiritual nature of an
individual as those factors that give rise to an individual’s
“will to live,” their “joie de vivre,” and their core beliefs
and values. This is a foundational skill in addressing
spirituality and health. Using this definition, both athe-
ists and agnostics can be seen to have a spiritual aspect.
This definition also removes spirituality from religiosity
in a way that does not denigrate any individual religious
belief a patient may hold, allowing the naturopathic cli-
nician to explore this aspect of the individual. Perceived
in this way, it is also easier to understand that many
individuals within society are experiencing a “spiritual
crisis.”
One of the oldest concepts in naturopathic medicine is
the concept of toxemia. Toxemia is the generation and
accumulation of metabolic wastes and exogenous toxins
within the body. These toxins may be the results of
maldigestive processes, non–end product metabolites,
environmental xenobiotics, colon bacteria metabolites,
etc. These toxins become irritants within the body, result-
ing in inflammation of tissues and interference with
biochemical processes. The maldigestive and dysbiotic
origin of these toxins is the product of inappropriate
diet, broad spectrum antibiotics, and the effects of exces-
sive stress on digestion. Eating a diet that cannot be
easily digested or is out of appropriate nutrient balance
for the individual results in the creation of metabolic
toxins in the intestines. Stress, resulting in the excessive
secretion of cortisol and adrenalin, results in the decrease
of blood flow to the digestive process, which decreases
the efficient functioning of digestion and increases the
tendency toward maldigestion, dysbiosis, and toxemia.
Physicians can now easily measure the degree of toxemia
in various ways (e.g., urinary indican or phenol).
Spiritual disharmony, inappropriate diet, digestive
disturbance, stress, and toxemia are primary causes of
chronic illness and must be addressed if healing is to
occur. Beyond these, other disturbing factors must be
discerned and addressed, whichever pertain to the
individual patient.
Institute a Healthier Regimen
As a corollary of the first, once physicians have deter-
mined major contributing factors to illness, they construct
a healthier regimen for the patient. Some disturbing
factors can be eliminated, like inappropriate dietary
elements. Others are a matter of different choices or
living differently. The basics to consider are: appropriate
diet, appropriate rest and exercise, stress moderation, a
healthy environment, and a good spiritual connection.
If this model is correct, these measures alone should
result in enhanced health. The problem arises in know-
ing how to do these things. What is an appropriate diet?
This is an area of considerable controversy. Physicians
think about diet in many different ways. The goal of
dietary improvement is to reduce the symptomatic
consequences of the patient’s diet and provide optimal
nutrition to the patient. The point here, regardless of
A Hierarchy of Healing: The Therapeutic Order 35
The Therapeutic Order
Box 3-3
1. Establish the conditions for health
• Identify and remove disturbing factors
• Institute a more healthful regimen
2. Stimulate the healing power of nature
(vis medicatrix naturae):
the
self-healing processes
3. Address weakened or damaged systems or organs
• Strengthen the immune system
• Decrease toxicity
• Normalize inflammatory function
• Optimize metabolic function
• Balance regulatory systems
• Enhance regeneration
• Harmonize with your life force65
4. Correct structural integrity
5. Address pathology: Use specific natural substances, modalities, or
interventions
6. Address pathology: Use specific pharmacologic or synthetic
substances
7. Suppress or surgically remove pathology
From Zeff J, Snyder P. Course syllabus: NM51 71, Naturopathic clinical theory.
Seattle: Bastyr University, 1997-2005.
The actual therapeutic order may change, depending on the individual patient’s
needs for safe and effective care. The needs of the patient are primary in deter-
mining the appropriate approach to therapy.
F7300-003 6/18/05 6:48 PM Page 35
how this is done, is that it is central and essential for fun-
damental health improvement. If the diet is not correct,
if digestion is not appropriate, if nutrition is not adequate,
the patient cannot maximally improve. If the diet and
digestion are appropriate, the basis for improvement in
other areas is enhanced.
The same is true with these other fundamental
elements, to which Lindlahr referred in the first element
of his catechism, “return to nature”: exercise, rest, dress,
etc.28 These have been expanded in the “determinants of
health.” They create the basis for improvement. What
this really means is to change the “terrain,” the conditions
in which the disease has formed—not only to change but
to improve the conditions so that there is less basis for
the disease. Hahnemann addresses this on the first page
of his Organon of Medicine. He identified four tasks for
the physician: to understand the true nature of illness,
“what is to be cured”; to understand the healing poten-
tial of medicines; to understand obstacles to recovery
and how to remove them; and to understand the
elements that derange health and how to correct them
so that recovery may be permanent.63 Changing and
improving the terrain in which the disease developed is
the obvious first step in bringing about improvement.
This sets up the basis for the following elements to have
the most beneficial effects.
2. Stimulate the Self-Healing Mechanisms
A certain percentage of patients improve sufficiently
simply by removing disturbing factors and establishing
a healthier regimen. Most require more work. Once the
patient is prepared, once the terrain is beginning to clear
of disturbing factors, then one begins to apply stimula-
tion to the self-healing mechanisms. The basis of this
approach is the underlying recognition of the vis medica-
trix naturae, the tendency of the body to be self-healing,
the wisdom and intelligence within the system that
constantly tends toward the healthiest expression of
function, and the healing “forces” in the natural environ-
ment (air, water, light, etc.). The body heals itself. The
physician can help create the circumstances to promote
this. Then, as necessary, the physician stimulates the
system.
One of the best ways to do this is through constitu-
tional hydrotherapy, as developed by Otis G. Carroll,
ND, early in the past century. This procedure is simple,
involving the placement of hot and then cold towels on
the trunk and back, in specific sequence (depending on
the patient), usually accompanied by a sine wave stimu-
lation of the digestive tract. This is a dynamic treatment,
simple, inexpensive, and universally applicable. It helps
recover digestive function, stimulates toxin elimination,
“cleans the blood,” enhances immune function, and has
several other effects. It moves the system along toward a
healthier state.64 Exercise often achieves similar results.
Many naturopathic modalities can be used to stimulate
the overall vital force.
More specific approaches to stimulation, though
general in effect, are applied differently to each patient
and have a less general effect than those previously
mentioned. Homeopathy and acupuncture are primary
methods of such stimulation. They add little to the system:
They are not gross chemical treatments. They work with
what is there, stimulating a reaction, stimulating function,
correcting disturbed patterns.
Each method helps move the system out of its
disturbed state and, with the reduction of encumbrance,
helps move it toward health.
Finally, exposure to the patterns, rhythms, and forces
of nature is a traditional part of naturopathic medicine
and the tradition of nature doctors throughout the world.
As Pizzorno and Snider wrote: “We are natural organisms,
our genomes developed and expressed in the natural
world. The patterns and processes inherent in nature are
inherent in us. We exist as part of complex patterns of
matter, energy, and spirit.”1The natural processes of
these patterns and the drive toward health inherent in
them is a natural ally for the physician. Exposure to
appropriate rhythms, patterns, and forces of nature
strengthens vitality and stimulates the healing power of
nature.
3. Support Weakened or Damaged
Systems or Organs
Some systems or functions require more than stimula-
tion to improve. Some organs are weakened or damaged
(e.g., adrenal fatigue after prolonged stress), and some
systems are blocked or congested (e.g., the hepatic
detoxification pathways) and require extra help. This is
where naturopathic physicians use their vast natural
medicinary. Botanical medicines can affect any system or
organ, enhancing its function, improving its circulation,
providing specific nutrition, stimulating repair. Glandular
substances can be applied to a similar purpose. And
then there are the growing number of evidence-based
“nutraceuticals,” biological compounds that enhance
metabolic pathways and provide substance for metabolic
function.
Naturopathic physicians can also apply specific
homeopathic medications, usually in the lower potencies,
which act nutritively and can stimulate specific organs
or functions. This method can be used to stimulate
detoxification of specific substances from the body in gen-
eral or of specific organ systems or tissues. Dr. Pizzorno’s
work in Total Wellness and the work of “functional med-
icine” leader Jeffrey Bland, PhD, exemplify the clinical
strategies applied at this level of the therapeutic order.
These strategies are used to restore optimal function to
an entire physiologic system (immune, cardiovascular,
detoxification, life force, endocrine, etc.).65
Philosophy of Natural Medicine
36
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One can use specific exercises to stimulate or enhance
organ health. Some systems of Yoga and Qi Gong are
organ specific. And specific applications of hydrotherapy
and other physiotherapy systems can be applied to
enhance the function of organs or tissues.
These methods, combined with an appropriate diet
and a healthier regimen, along with constitutional
hydrotherapy, appropriate homeopathy, and acupuncture,
usually bring most health problems back to normal,
without negative consequence, rapidly, efficiently, and
permanently.
4. Address Structural Integrity
Many structural problems result from stress of some
kind on internal systems. For example, midback mis-
alignment or discomfort is often found associated with a
history of underlying stress on the digestive organs, the
ennervation of which originates at those spinal seg-
ments. One can manipulate that vertebra back into proper
alignment or massage contracted musculature, but until
one corrects the underlying functional disturbance, there
will be a tendency to repeated structural misalignment.
In some circumstances the singular problem may be
simply structural disintegrity. One may have fallen or
been hit in some fashion and simply need the neck
manipulated back into proper alignment and the sur-
rounding soft tissue relaxed. There may be no diet error
or other disturbance aside from the original injury, and
correction requires only simple manipulation or thera-
peutic massage. This is an example of the flexibility of
the “therapeutic order” concept. In this case, first-order
therapeutics is to manipulate the cervical spine or to
relax chronically contracted muscles. Usually, how-
ever, the problem of structure is part of the larger
problem, and such intervention becomes a fourth-order
therapeutic.
Reintegrating structure can occur in many ways, one
of which is the method of “bone cracking” known to the
ancient Greeks and Chinese and probably all other
ancient healing cultures. But there are nonforce manipula-
tive systems that include many modalities of therapeutic
massage. Some systems of exercise are designed to rein-
tegrate and maintain normal structural relationships.
Any of these might be appropriate to a specific patient.
By approaching the problem in the context of the thera-
peutic order, one can expect structural corrections to be
required only occasionally and for the results to be more
or less permanent.
5. Address Pathology: Use Specific
Natural Substances, Modalities, or
Interventions
Having gone through the first four steps of this therapeu-
tic hierarchy, most patients improve. The improvement is
based on the sound footing of the underlying correction
or removal of fundamental causative elements. It is also
based on the intrinsic nature of the body to heal itself by
using the least possible force. Most pathology improves or
disappears under these circumstances. Sometimes it is
necessary to address pathology. This may be the case
because the particular pathology may be threatening to
life or limb. Acting on this threat is imperative. It can be
done often with naturopathic means, directed specifi-
cally against the pathology. Biochemical or genetic indi-
viduality also can demand an emphasis at this level of
intervention.
One of the major conflicts in naturopathic medicine is
that some practitioners find it expedient to diagnose and
treat pathology (the standard medical model) rather than
pursue a naturopathic model of practice. This approach
tends to be less satisfying and less productive of the most
elegant outcomes and the long-term continued health of
the patient. It also reduces the capacity of the physician
to treat, such as in cases where there is no evidence-
based treatment for the pathology in question, or where
there is no clear diagnosis (i.e., no distinct pathology to
treat). This approach is increasingly referred to as “green
allopathy.” But the vast body of knowledge that naturo-
pathic education presents in this arena makes such an
approach seductive, especially in a culture that more or
less expects, supports, reinforces, and pays for an “allo-
pathic” approach to diagnosis and treatment.
It is easy to do this. The culture is accustomed to this
model and often expects to encounter this in the naturo-
pathic physician’s office. In some states, such as Oregon,
where the naturopathic formulary includes most antibi-
otics and many pharmaceutic drugs, one can practice
almost without distinction from a medical doctor. The
typical naturopathic formulary is often sufficient to
prescribe on a strictly pathologic basis.
The problem with this is that it is generally not as
effective, especially in the treatment of chronic disease.
The value of naturopathic medicine in our culture is not
that naturopathic physicians can function almost like
medical doctors, with a “natural” formulary instead of
drugs. It is that they offer a fundamentally different
approach, one based on the restoration of health rather
than the treatment of pathology.
Given all of this, it still may be useful to directly
address the pathologic entity or its etiology. When treat-
ing an antibiotic-resistant infection, for example, it may
be useful to apply botanical medicines with specific
antibiotic properties along with immune tonics, and the
more fundamental steps of this therapeutic hierarchy. In
difficult cases, such as many cancers, using agents that
have specific, pathology-based therapeutics may be
an essential element of comprehensive treatment. The
naturopathic formulary provides a vast and increasing
number of such options. One advantage of such treatment
is that, in general, when applied by a knowledgeable
A Hierarchy of Healing: The Therapeutic Order 37
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practitioner, it rarely adds more burden or toxicity to the
system. Naturopathic pathology-based treatments still
follow the dictum “do no harm.”
6. Address Pathology: Use Specific
Pharmacologic or Synthetic Substances
About 800,000 medical doctors and osteopathic physi-
cians in the United States are well trained in the science
of pathologic-based treatment, using pharmaceuticals,
surgery, etc. There are times when such an approach is
necessary to preserve life, limb, or function. Although
some naturopathic physicians, by training and by
statute, may prescribe pharmaceutics or even perform
surgeries, naturopathic physicians may also refer
patients in need of such services to appropriate medical
doctors or osteopaths, depending on licensed formulary.
In a growing number of states, NDs can legally provide
an expanding range of prescription drugs. Although
this is an important tool for the naturopathic primary
care giver, this privilege requires enhanced responsibil-
ity for the ND to prescribe those substances only as
needed—and to thoroughly rely on applying the least
force appropriate to effect recovery and protect patient
safety.
Naturopathic physicians are well trained in this
regard and respect the necessity and utility of standard
medical practice in appropriate situations. Some disagree-
ment exists regarding which situations may be appropri-
ate. The AANP has developed position papers to resolve
some of these questions.
In general, while recognizing the necessity of such
treatment, most naturopathic physicians also recognize
that such treatment often carries consequences that must
also be addressed.
7. Suppress Pathology
Sometimes it is necessary, for the preservation of life or
limb, to suppress pathology. Medical doctors are espe-
cially trained in this art and have powerful and effective
tools with which to do this. Unfortunately, suppression,
because it does not fundamentally remove or address
essential causative factors (such as dietary error) often
results in the development of other, often-deeper dis-
turbance or pathology. Since much pathologic expres-
sion is the result of the actual self-healing mechanisms,
such as inflammation, suppressive measures are, in
general, anti–vis medicatrix naturae. The result of sup-
pression is that the fundamental disturbing factors are
still at play within the person, still disrupting function
to some extent, while the suppression reduces the
symptomatic expression and resolution of disturbance.
One simple example of this is the use of steroidal anti-
inflammatory and antihistaminic drugs in the treatment
of acute asthma. This usually effectively opens the
airways. But prolonged use weakens the patient. If the
treatment persists, the patient becomes immune com-
promised and osteoporotic and can develop psychologic
disorders. These symptoms are part of the long-term
effects of prednisone. It may necessarily maintain
breathing, but the long-term cost to the organism is
expensive.
Suppression, although it may be life saving, often has
serious consequences. With standard medical methods
of care, cure of chronic illness is often elusive. This is the
benefit of the naturopathic approach: by taking a nonsup-
pressive course of action, based on sound physiologic
principles, one can often restore health without recourse
to the potential damage of suppression. Naturopathic
physicians, while recognizing the occasional necessity of
suppressive approaches, in general avoid suppression,
which is a primary way in which physicians can inflict
harm, even with the best of intentions.
THEORY IN NATUROPATHIC MEDICINE
This therapeutic hierarchy is based on the observation of
the nature of healing and the inherent order of the
healing process. It is part of a unifying theory of naturo-
pathic medicine, an outgrowth of the principles which
underlie naturopathic thinking. It provides the physician
with instructions that order the many therapeutic
modalities used by the practice.
The consensus definition of naturopathic medicine,
adopted by the AANP in 1989, is a statement of identity,
distinguishing naturopathic medicine from other systems
of medical thought. Contained within it is a set of
instructions regarding the practice of the medicine. The
three concepts discussed here—“disease as process,”
“the determinants of health,” and “the therapeutic
order”—are an articulation of these instructions. They
are presented as a clinical theory of naturopathic medi-
cine. They are abstracted, as is the definition, from the
observation by nature doctors throughout time and across
many traditions of the nature of health and of disease
and of the nature of healing. They provide the physician
with instructions. These instructions include a proce-
dure for thinking about human illness in such a way that
one can approach its cure in an ordered and elegant
fashion by understanding its process as an expression of
the vis medicatrix naturae. It provides the framework for
truly evaluating the patient as a whole being: spiritual,
mental/emotional, and physical, rather than as a cate-
gory of pathology. And it provides the physician a sys-
tem for organizing and efficiently integrating the vast
therapeutic array provided in naturopathic medicine.
Ultimately, it satisfies Hahnemann’s observation of the
ideal role of medicine, that “the highest ideal of cure is
rapid, gentle and permanent restoration of the health . . .
in the shortest, most reliable and most harmless way,
upon easily understood principles.”63 As in any system
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of medicine, it is understood that medicine evolves with
understanding. The roots of the observations that form
this theory are traceable through the mid- and early-
twentieth century, to the traditional theory of nine-
teenth-century European nature cure, and to the
roots and theories of traditional world medicines.
Hippocrates’ writings on the vis medicatrix naturae form
a foundation that historically underpin the development
of this theory.66,67
Finally, it is observable across many traditional world
medicines that various healing orders are described.
Such structures hold implications for public and com-
munity health priorities and suggest the reprioritization
of health care priorities and financing. Implications for
public policy and the growing national disease debt
invite exploration.
Although this presentation is not comprehensive, the
attempt has been made to demonstrate these roots, at
least in some of their major articulations. The work
presented here is a continuation of this historical
process, which ultimately is driven by the true mission
of the physician: to ease suffering and to preserve life.
A Hierarchy of Healing: The Therapeutic Order 39
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... Selected therapies targeted the following tiers of the naturopathic therapeutic order: addressing pathology and providing natural symptom relief while establishing the foundations for optimum health, stimulating self-healing, and supporting and restoring weakened systems ( Fig. 1). 94 For concurrent oral dietary supplementation, if patients were already taking the product or a combination product containing the constituent (e.g., vitamin D3), they were instructed to continue and adjust dosing as needed to follow the dosing listed in Table 3. One patient did not take the probiotic supplement as she had poor tolerance (i.e., probiotic supplementation historically led to side effects of abdominal cramping and bloating in this patient). ...
... The therapeutic order of naturopathic medicine and treatment strategies for COVID-19.94 ...
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... This is in line with the third therapeutic order, supporting weakened or damaged organs, and the fifth order, addressing pathology using specific natural substances. 15 Ulmus rubra exerts demulcent and nutritive actions, with large amounts of mucilage soothing irritation of mucous membranes within the gastrointestinal tract. 14 This was followed 4 hours later with 2 heaped teaspoons of Plantago ovata (psyllium, dried husks) taken in a similar fashion but with less water in order to check the diarrhoea via its absorptive properties. ...
... With colour and energy returning to the patient, a gentle, meandering hike in the local nature reserve was taken to stimulate the vital force and encourage ambulation, and thus fulfilling the second therapeutic order of stimulating the self-healing mechanisms (vis medicatrix naturae). 15 The hike was roughly 6km in length and 3 hours in duration, and the patient reported feeling tired but revitalized afterwards. He developed some loose stools later in the day and was treated again with Ulmus rubra bark. ...
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... A new therapeutic order is being proposed by a physician 85 and a group of naturopaths. 86 While differing in the details, both propose inverting the current triage of healthcare for chronic illness in which holistic modalities are resorted to only after conventional drugs and surgery have failed. Instead, these authors propose a "first do no harm" order of treatment interventions: lifestyle modifications including changes in diet, exercise, and stress reduction, followed by energy-based modalities such as acupuncture and homeopathy. ...
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