Fraser Smith, MATD, ND

Naturopathic medicine traces its origins to European Nature Cure, as practiced by Father Sebastian Kniepp. This approach was based on a natural setting, with simple diet, exercise, and hydrotherapy. Herbs to stimulate digestion and elimination were incorporated. This practice evolved as it was transplanted to the United States. Benedict Lust created the fusion of Kniepp cure with some of the natural approaches that were growing as the ferment of imaginative medical practices was taking off in the US in the late 19th century. Of course, hydrotherapy had a longer history, and water cure already existed in the United States. The first designated hydrotherapy center was opened by David Ruggles, an African-American businessman, abolitionist, and healer. The Eclectic school of medicine was composed of MDs who used herbal medicines in very precise ways, with an increasing knowledge of their chemistry and bio-activity. This was not only based on a long European herbal tradition but borrowed heavily from the Materia Medica of indigenous peoples.

Lust described naturopathy as a return to nature, with the elimination of “evil” habits, and the adoption of corrective habits–avoiding things that break us down, and adopting practices that build up. Chemical (herbal, nutrients) and mechanical (massage, manipulation, physiological therapeutics) were an important but secondary feature. Henry Linlahr developed many of these concepts, in practice and in written form, into what he termed “Nature Cure.” This approach both heralded the evolution of naturopathy into a distinct medical art that include specific diagnosis and harkened back to the core principles of Hippocrates. For example, Lindlahr stated that acute diseases were an effort to expel toxins. The Hippocratic notion of “coction” or cooking out the disease is reflected here.

Lindlahr traced the origin of diseases from the violation of nature’s laws, to an eventual decline in health that included lowered vitality, disordered blood and lymph, and the accumulation of morbid matter. In more modern language, Lindlahr was saying that circulation and blood-borne agents (cytokines, blood cells, hormones) became deranged, and that disease-causing compounds (poisons, toxins, oxidants, pro-inflammatory molecules) rose to chronic and dangerous levels. The net result was a lowered vitality—that is, less resilience and overall energy.

In the rebirth era of naturopathic medicine, new therapies and a more integrative stance mark a departure from the early 20th century. This journey from naturopathy to “naturopathic medicine” is excellently described by George Cody.¹  During this phase, homeopathy and in-office surgical procedures are added to the practice. During the 1980s and onward, intravenous therapies were increasingly used, and the range of supplements and plant extracts became broader and more nuanced. For example, curcuminoids in a nano encapsulation are a more recent creation.

As the range of therapeutic tools increased, including access to pharmaceutical preparations, the challenge became to define the practice of naturopathic medicine. Although one could examine how various naturopathic doctors practiced and form a general impression, the field lacked codification. This lack of a defined model was ameliorated somewhat by the adoption of the six naturopathic principles in the late 1980s. They were developed by a committee of the American Association of Naturopathic Physicians, which was led by Dr. Pamela Snider and Dr. Jared Zeff. The definition of naturopathic medicine including the six principles was formally adopted by the AANP House of Delegates at the Rippling River convention in 1989.² The principles are:

• The Healing Power of Nature (Vis Medicatrix Naturae)
• Identify and Treat the Causes (Tolle Causam)
• First Do No Harm (Primum Non Nocere)
• Doctor As Teacher (Docere)
• Treat the Whole Person (Tolle Totum)
• Prevention (Preventare)

A next important step was the publication, in the 1997 Journal of Naturopathic Medicine, an article by Dr. Jared Zeff entitled A Hierarchy of Healing.³ This landmark article outlined an order of therapeutics that work with the natural healing processes. It was not a strictly linear process, rather, guided the practitioner to do a sequence of fundamental treatments that could maximize the healing potential of the patient. These steps were:

• Re-establishing the basis for health;
• Stimulation of the Vis Medicatrix Naturae;
• Tonification and nourishment of weakened systems;
• Correction of structural integrity.

This was further refined into a 7 level Therapeutic Order by Dr. Zeff, Dr. Pamela Snider, and others.⁴ These levels are:

• Establish the Conditions for Health
• Stimulate the Vis Medicatrix Naturae and Self-Healing Processes
• Support and Balance Physiologic and Bioenergetic Systems
• Address or Correct Structural Integrity
• Address Pathology Using Specific Natural Substances or Interventions
• Address Pathology Using Pharmaceutical or Synthetic Substances
• Suppress or Surgically Remove Pathology

In the next article in this series, we’ll discuss the relationship of naturopathic therapies to the adaptive responses of the human organism, as well as the maladaptive responses using the cardiovascular system as an example.

As a bridge to that discussion, let’s examine the factors that cause injury in the first place, and the result of chronic states that are, in fact, the ground of the emergence of states of being that we would identify as diseases. One broad category with regards to things that injure health is, per Zeff and Snider, disturbances to the requisite factors of health. This can be as foundational as prenatal nutrition, to necessary but easily overlooked factors such as hydration, sleep, proper breathing, social and emotional support, movement and exercise, etc. When these are lacking, there is some defect or compensatory response in the body. As naturopathic physician and teacher Dr. Louise Edwards⁵ reminds her students, symptoms are usually symptomatic of a physiological compensation to disturbances in one or more determinants of health.

Toxin exposure from many sources—food, air, water, everyday objects, including plastics, and clothing—make demands on the body’s detoxification systems. Toxins can damage DNA, mitochondria, and the extracellular matrix upon which all cells depend for the delivery of nourishment. Some very virulent microbes can harm the body, or leave long term disturbances even after the infection has been cleared; Lyme disease, post COVID syndrome, and Epstein Barr virus are just a few examples. Electromagnetic energy can disrupt the transmissions of our nervous system. Moreover, the wear and tear—accidents and injuries of life—can leave their mark.

Although some of these injurious factors can lead to acute disease, even when they don’t, they can set a person up for chronic disease. That pathway is discussed in my recent textbook.⁶ The pernicious factors can lead a person to certain states that are ripe for the development of pathology. These states are the ground from which many possible diseases can spring. Individual susceptibility, bounded by nutritional status, genomics, environment, and health history, will determine what kind of diseases develop. Examples of these dangerous states of being include:

• Loss of coordination and synchronization of the body’s regulatory systems. An example of this would be deep disruption to circadian cycles.
• Disturbed microbiota. This is seen very commonly with a narrowing of the variety of microbial phyla, or the expansion of a pathogenic species of bacteria in the gut or other areas.
• Cellular debris.The failure of autophagy within cells leads to accumulation of broken proteins that can impair cellular function (reminiscent of Lidhalahr’s “accumulation of morbid matter”).
• Self perpetuating inflammatory responses. These events lead to immune activated damage, and a harmful cycle of cell fragments that activate immune attack, and subsequent increased cellular damage, sets in.

What Is the Real Purpose of Treatments?

It can be seen from the nature of disease development, and the ways in which the body responds to this process and its events, that therapeutics can be used to either increase healing resources, or to lessen the intensity of dysfunction. The fundamental measures to address any deficiency in the factors that determine health are, of course, always necessary, as without those requirements being met, there will be ongoing disruptions to function and structure. But when people have developed true dysfunction, when they have entered in the states of cellular and tissue degeneration that are the ground of clinical pathology, creating the conditions for health will not always automatically result in a recovery.

In any situation of prolonged dysfunction, the body will mount various adaptive responses. This can include the initiation of cellular defenses such as sirtuins, heat-shock proteins, and sestrins, or the recruitment of undifferentiated cells to replace damaged tissue. More elaborate adaptations such as changes to hormonal secretion, and alternations to immune function are other examples. Sub-systems such as the endocannabinoid system and possibly what we call the bitter taste receptor system also can be adaptive during extreme stress.

There are also maladaptive responses, which emerge for various causes. Sometimes the virulence or force of a disturbance to the human organism simply elicits a pathological and maladaptive response. Adaptive responses that continue for too long can become maladaptive. The secretion of renin in the early stages of chronic heart failure is at first adaptive; this hormone keeps the kidneys from failing due to lack of perfusion. But over time the sodium retention and the adrenergic activation will lead to massive problems with lungs, blood vessels, and the heart itself.

Therapies that support adaptive responses tend to do so in one of three ways. One very common type of therapy is to provide biochemical support. This enhances the normal function of an organelle or provides the substrates and enzymatic support for certain biochemical pathways. A simple example is supplementing patients with congestive heart failure with Coenzyme Q10, in order to help out their faltering mitochondria in the cardiac tissue. Certainly, addressing nutrient deficiency or even providing nutrients above the range for preventing deficiency signs and symptoms can be a form of biochemical support. In some cases, the dose that provides this support is lower than a dose of a nutrient, or plant extract, that begins to exert a more obvious pharmacological effect at higher doses. Plant extracts are not only sources of pro-drugs—they have many localized nutritive and supportive effects. A common example would be the benefits of Crataegus oxycantha (Hawthorne) on the heart, as it improves circulation to heart muscle cells and increases cardiac output in those who have heart failure.

Another support for adaptive responses is to provide small amounts of nutrients or plant extracts that exert a hormetic effect. Hormesis is a phenomenon where doses of a substance, usually at midpoint between a dose of zero and the dose at which observable adverse effects are possible, exerts an effect that is opposite of what that substance is typically thought to do. This produces a U or J shaped dose response curve. This is a complex topic, and the work of many researchers, particularly Professor Edward Calabrese of University of Massachusetts,⁷ have expanded our understanding of hormesis. It appears that very small doses of some substances can elicit adaptive responses via gene transcription in cells. These substances, often plant derived, are not providing a substitute or even a strong supplement to normal activity. They are providing a very light challenge or pre-conditioning stimulus to which human cells react in an adaptive manner. An example would be phytochemicals that cause the pro-survival proteins such as sirtuins to be more expressed in heart tissue.

Finally, there is the concept of whole person therapies that increase adaptation. A nourishing diet in itself can be thought of this way, in that the positive effect of a diet replete with nutrients consisting of real foods, has a global beneficial impact on a person. But there is much more to do on the whole person aspect of treatment. Hydrotherapy, physical medicine, homeopathy, mind-body medicine, and many other modalities cause an overall strengthening of a person. In a way, this is very similar to what Dr. Zeff referred to as specific and non-specific stimulation of the Vis Medicatrix Naturae.³

Therapies that reduce maladaptive responses have much in common with the conventional approach to medicine. If they are natural medicine treatments, they tend to be less intense and more tolerable. An example would be an herbal preparation that simply reduces pain and inflammation but does not have any long-term effect on the body. Likewise, in a patient who has an acute inflammation of a joint, such as the glenohumeral, an injection of cortisol can lead to a reduction in overly exuberant inflammation that could damage the joint capsule. It’s not surprising that, in many instances, reducing maladaptive responses leads to rapid improvement.

A positive outcome resulting from the dampening of maladaptive responses is common enough, but possible only if the person is in fairly good health and if their level of damage to the body or dysfunction is not too deep. If they are not, then superficial therapy will result in temporary improvement, with recurring and sometimes more serious symptoms re-emerging in time. Sometimes this is a reasonable goal, especially in patients with very advanced pathologies—no one questions the benefit of dialysis for patients with renal failure. In other occasions, the rapid medical treatment to quell maladaptive responses is the thing that saves someone’s life—such as in the case of septic shock.

A comprehensive model of this approach can be visualize as such in the image below.

Although naturopathic medicine has some excellent tools for reducing the intensity of maladaptive responses to stressors, the truly strong aspect of its methodology are the therapies that support adaptive responses. This might result in a permanent state of restoration to normal, but if it doesn’t, it can mean real improvement and better quality of life. When treatment is seen in this light, as a serious attempt to disinhibit, strengthen, and possibly guide the adaptive responses of the body, it puts the application of scientific knowledge to the practice of naturopathic medicine in a new light. In this model, medicine is not solely the business of reducing maladaptive responses (perhaps supplemented by highly generalized primary prevention education). It is the application of scientific and traditional healing knowledge to make the flames of our life system burn brighter. This is the very kind of help that so many patients earnestly seek today.

References

1. Cody GW. Naturopathic Medicine. Integr Med (Encinitas). 2019 Aug;18(4):34-35. PMID: 32549830; PMCID: PMC7219462.
2. Zeff, J. LSnider P, Zeff J. Unifying Principles of Naturopathic Medicine Origins and Definitions. Integr Med (Encinitas). 2019 Aug;18(4):36-39. PMID: 32549831; PMCID: PMC7219457. 
3.  Zeff J. (1997). The process of healing: a unifying theory of naturopathic medicine. Journal of Naturopathic Medicine, 7, 122-125.
4. Finnell JS, Snider P, Myers SP, Zeff J. A Hierarchy of Healing: Origins of the Therapeutic Order and Implications for Research. Integr Med (Encinitas). 2019;18(3):54-59.
5. Personal conversations with Louise Edwards, 2006 to 2021.
6. Smith, F. Naturopathic Medicine. Naturopathic Medicine, A Comprehensive Guide. Springer Nature. Chaim, Switzerland, 2022.
7. Calabrese, E.J., Mattson, M.P. How does hormesis impact biology, toxicology, and medicine?. npj Aging Mech Dis 3, 13 (2017). https://doi.org/10.1038/s41514-017-0013-z

Published August 12, 2023

About the Author

Fraser Smith, MATD, ND, is Assistant Dean of Naturopathic Medicine and an associate professor at National University of Health Sciences (NUHS; Lombard, Illinois).

Dr. Smith was the founding academic leader of the ND program at NUHS, which joined NUHS’ family of programs in 2006. He is the author of several books on wellness and nutrition for the public and author of the textbook Introduction to the Principles and Practice of Naturopathic Medicine. In addition to being an educator and licensed naturopathic physician, Dr. Smith is a licensed dietician nutritionist and cardiovascular health researcher.