Allen M. Schoen, MS, DVM, PhD (hon.)
Various terms have been used to describe the numerous approaches to the prevention and treatment of disease outside of conventional medicine and surgery, including alternative medicine, complementary medicine, naturopathic medicine and integrative medicine. Naturopathic medicine is considered a form of alternative medicine. Naturopathic medicine prefers a holistic approach and seeks to find the least invasive measures necessary for treatment and resolution of conditions. Naturopathic philosophy believes in the body's innate wisdom to heal and attempts to assist in the natural healing process.
Human naturopathic practitioners are split into two groups, traditional naturopaths and naturopathic physicians. Naturopathic physicians employ principles of naturopathy within the context of conventional medical practices. Naturopathy comprises many different treatment modalities with varying degrees of acceptance by the conventional medical community.
In the veterinary medical community, naturopathy is normally included under the terms complementary and alternative veterinary medicine. More recently, the terminology has evolved into integrative veterinary medicine.
Integrative veterinary medicine is defined as the integration of conventional and complementary and alternative diagnostic and therapeutic approaches into a comprehensive preventive and therapeutic approach to disease. Integrative veterinary medicine also considers the mind, body and other relationships in its approach to the prevention, diagnosis and treatment of disease and maintenance of good health. It integrates preventive medicine and health programs, conventional medical and surgical approaches with acupuncture, botanical medicine (herbs, phytotherapy), chiropractic, homeopathy, physical therapy including cold lasers, magnetic therapy and others, nutritional supplements and nutraceuticals, behavior management, environmental medicine and other miscellaneous therapies. The combination of the complementary and alternative approaches is commonly called complementary and alternative veterinary medicine (CAVM).1 Based on the patients' history and a comprehensive physical examination, all diagnostic and therapeutic options are discussed with the client and then a program is developed that is appropriate for the particular patient and client. The program may include one or a combination of various therapies based upon the patient's needs. Examples are presented for geriatric medicine, musculoskeletal, neurologic, gastrointestinal, cardiovascular and other conditions.
Integrative Approach to Geriatric Medicine
An integrative approach to geriatric medicine often addresses numerous geriatric conditions including musculoskeletal, neurologic, cardiovascular, metabolic, gastrointestinal and other issues. An integrative approach to geriatric medicine includes a comprehensive conventional diagnostic workup incorporating the physical examination, blood chemistry, urinalysis and diagnostic imaging techniques where appropriate. Based on the diagnosis, a comprehensive therapeutic approach is offered to the client. In addition to conventional approaches, other CAVM therapies are offered. Acupuncture may be added to address specific disease conditions associated with geriatric medicine, including the treatment of renal disease, hepatic disease, degenerative joint disease as well as others. Based on traditional Chinese medical theory (TCM), acupuncture may address underlying TCM diagnoses such as Kidney Yin deficiency. Oriental herbal formulas may be prescribed based on the specific western medical condition or the TCM diagnosis. Physical therapy for musculoskeletal conditions including massage, stretching, swimming, low level laser therapy, magnetic therapy and others may be integrated as well. Western botanical medical formulas,2 nutraceuticals, nutritional supplements may also be prescribed. Vitamin and mineral supplements, digestive enzymes, amino acid supplements, essential fatty acid supplements such as fish oil, flaxseed oil, and others, antioxidants such as vitamin E, selenium, alpha-lipoic acid as well as others should be considered. Adaptogen herbs such as ginseng, ashwagandha and astragalus may be appropriate. They help support hypothalamic-pituitary-adrenal axis function. Herb/drug interactions must be considered when prescribing these in addition to conventional medications. Medicinal mushrooms have been found to benefit the immune system in geriatric patients. Once an integrative program is developed, one should reevaluate the patient in four to eight weeks to consider any changes or additions to the program. Ideally, a geriatric patient should be reevaluated every one to three months or more frequently based on the condition to evaluate progress and improvement.
Integrative Approach to Degenerative Joint Disease
An integrative approach to degenerative joint disease can be quite rewarding for the patient and the veterinarian. This goes beyond prescribing analgesic and antiinflammatory medications to the incorporation of proactive chondroprotective supplements such as injectable and oral glycosaminoglycans. The development of a proactive approach including an appropriate exercise program is essential to proper maintenance of the musculature without overdue stress on the joints. Physical therapy including underwater treadmills and magnetic and low-level laser therapy have been found to be extremely beneficial as well.
Western botanicals such as Devil's Claw has been found to be beneficial for degenerative joint disease. An ayurvedic herb, Boswellia, has been found to have antiinflammatory effects in joints. Curcumin has also been found to be very beneficial as an antiinflammatory as well. Chinese herbal formulas address degenerative joint disease from a TCM perspective based on treating the underlying causes and Chinese disease patterns. Essential fatty acid supplements are beneficial for joints as well.
Acupuncture and physical manipulative therapies can be very beneficial for degenerative joint disease.3 Acupuncture can be used to relieve inflammation, improve analgesia, increase circulation and decrease muscle spasms around particular joints. It may also be used to treat underlying TCM conditions that predispose to arthritis. Manipulative therapies may be added to treat secondary compensatory problems. Massage and acupressure may be taught to the client in order that they can support the program at home.
Integrative Approach to Gastrointestinal Conditions
Numerous gastrointestinal conditions may be responsive to an integrative approach, including inflammatory bowel disease, megaesophagus, feline obstipation syndrome, and others.4 The key to an integrative approach to gastrointestinal conditions, as with most conditions, is proper diet. Proper dietary management with the incorporation of natural foods, a Paleolithic diet, and removal of allergenic foods is the foundation to an integrative approach to GI conditions. Appropriate supplementation with probiotics, digestive enzymes, and amino acids is also critical. L-glutamine is the fuel for enterocytes and is essential in the treatment of inflammatory bowel disease and allergic gastroenteritis. Western herbs such as slippery elm bark, ginger, and others are beneficial for specific conditions as well. Ginger is an excellent remedy for motion sickness in dogs.1
Acupuncture has been found to be beneficial in the treatment of vomiting and diarrhea. Acupuncture helps regulate gastrointestinal motility. It has been used in the treatment of megaesophagus; feline obstipation; allergic, bacterial, and viral gastroenteritis; and pancreatitis. Chinese herbal formulas may be prescribed to address underlying TCM conditions.
Integrative approaches to pancreatitis, hepatic disease, cardiovascular and other conditions are also beneficial.
Integrative Approach to Neurologic Conditions
With the improved ability of diagnostic imaging equipment, including CT scans and magnetic resonance imaging, veterinary neurologic diagnostics have greatly progressed, and we are able to have much more specific neurologic diagnoses. With this ability, we are now able to be much more specific in the treatment of neurologic disease with integrative approaches. In addition to conventional medical and surgical approaches, acupuncture, Chinese herbal medicine, physical therapy and nutraceuticals have been found to be clinically beneficial in the treatment and management of neurologic conditions including various causes of paralysis, paresis, seizures, coma, etc.5-7
No one form of medicine has all the solutions to all diseases. The future of veterinary medicine should include the most successful approaches to specific conditions, including conventional western medicine and surgery along with CAVM. An individualized, specific integrative approach to a patient will allow the animal to live a longer, quality life with the human caretaker.
1. Schoen AM, Wynn S. Complementary and Alternative Veterinary Medicine, Principles and Practice. St. Louis, MO: Mosby; 1998.
2. De Guzman E. Western herbal medicine: clinical applications. In: Schoen AM, Wynn S. Complementary and Alternative Veterinary Medicine, Principles and Practice. St. Louis, MO: Mosby; 1998:337–378.
3. Schoen AM. Acupuncture for musculoskeletal disorders. In: Schoen AM. Veterinary Acupuncture, Ancient Art to Modern Medicine. St. Louis, MO: Mosby; 2001:161–170.
4. Dill S, Bierman N. Acupuncture for gastrointestinal disorders. In: Schoen AM. Veterinary Acupuncture, Ancient Art to Modern Medicine. St. Louis, MO: Mosby; 2001:239–244.
5. Kline K, et al. Acupuncture for neurologic conditions. In: Schoen AM. Veterinary Acupuncture, Ancient Art to Modern Medicine. St. Louis, MO: Mosby; 2001:179–192.
6. Acupuncture for thoracolumbar and cervical disk disease. In: Schoen AM. Veterinary Acupuncture, Ancient Art to Modern Medicine. St. Louis, MO: Mosby; 2001:193–198.
7. Xie H, et al. Traditional Chinese veterinary medicine for neurological diseases. In: Proceedings of the 13th Annual International TCVM Conference, Jing Tang Publ. Reddick, FL; 2011.