Complementary and alternative medicine

See also: Alternative medicine (theories)

Alternative medicine is a set of therapies that are considered whole systems of healthcare that typically operate outside the realm of mainstream healthcare in the Western world. Complementary medicine is comprised of those systems, or parts of systems, that have shown some efficacy experimentally and are frequently used in conjunction with the mainstream. Since some techniques may be found both in whole and complementary systems, it is convenient to speak of complementary and alternative medicine (CAM) as one broad field. Many of these systems predate modern scientific methods and some, particularly the eastern therapies, stem from well before the time of Hippocrates. Some of these practices include acupuncture, homeopathy, herbal medicine, faith healing, chiropractic, and prayer.

Conventional, biologically-based medicine is not inherently critical of CAM, as some alternatives show as much efficacy as conventional methods, certainly for specific indications. Physicians do express concerns over whole systems whose patients have not first been evaluated by medically trained physicians for fear that this might delay proper treatment for conditions that are not sufficiently assessed. They also suggest that therapists may either not identify dangerous conditions that are treatable by conventional medicine, such that the patient does not have the information to decide to give informed consent to alternative treatment alone. Another aspect of that concern is that some conditions can respond to mainstream medical treatment early in the process, but delay of diagnosis could put the patient in a situation where the conventional treatment would no longer be effective.

Integrative medicine is a term coming into increased use, which looks at wider and wider partnerships. While many patients today see both conventional and alternative practitioners, there may be no communication among them; the patient keeps them in different compartments. In integrative medicine, there is active consultation among the various practitioners and the patient. Integrative medicine also includes [nursing|nurses]], whose training emphasizes managing chronic diseases (e.g., compliance with monitoring and medicine), encouraging healthy lifestyles, and providing continuity.

Integrative medicine reduces some of the concerns that physicians have with patients who self-refer to practitioners of what are indeed complementary techniques, but which might interact with other treatments if all the prescribers are not aware of everything being done. Indeed, one of the challenges of many primary care physicians is simply to find out all the drugs their patients are taking, prescribed by different physician specialists who do not share information.

While some conventional physicians will reject any complementary method for which they do not know the exact mode of action, there are many productive, collaborative treatments by teams of mainstream and complementary (but not whole system) practitioners. For example, it is quite common for pain medicine specialists to use complementary methods.

Complementary techniques may complement one another. For example, one preliminary clinical trial found that aromatherapy alone, while pleasant, did not speed healing, while using the essential oils of aromatherapy as the lubricants in massage therapy caused more of an effect than massage alone.

Classification of CAM

To begin a discussion, it is necessary to define the scope of the problem. The table below is derived from one created by the U.S. National Center for Complementary and Alternative Medicine.

Major field and Description	Subfield	Subfield
Whole Medical Systems comprise complete systems of theory and practice. Often, these systems have evolved apart from and earlier than the conventional medical approach used in the United States. These are usually alternative rather than complementary.	Western systems include homeopathy and naturopathy	Non-western systems include classical traditional Chinese medicine and ayurveda
Mind-Body Medicine uses a variety of techniques designed to enhance the mind's capacity to affect bodily function and symptoms. Some of the "still considered CAM" techniques are more and more accepted.	Accepted as mainstream (not strictly CAM) include patient support groups and cognitive-behavioral therapy	Still considered CAM include meditation, visualization, and relaxation (physiology) techniques; eye motion desensitization reprocessing; healing prayer, mental healing, and creative outlets such as art therapy, music therapy and dance
Biologically based practices in CAM use substances found in nature, such as medicinal herbs, diet therapy, pharmacologic doses of vitamins, essential oils, and dietary supplements. An example of an unproven method is using shark cartilage to treat cancer.
Manipulative and Body-Based Practices involve the controlled use of force against parts of the body, or maneuvers that move body parts out of their usual range of motion. These may be used as whole systems or as complementary methods. They include osteopathic manipulation, massage therapy, chiropractic, and methods involving movement or posture instruction.
Energy Medicine breaks into therapies that use forces that are, and are not, detectable with conventional scientific instrumentation.	Bioelectromagnetic-based therapies involve the unconventional use of electromagnetic fields, such as pulsed fields, magnetic fields, or alternating-current or direct-current fields.	Biofield therapies are intended to affect energy fields that purportedly surround and penetrate the human body. These include qi gong (part of traditional Chinese medicine), reiki, and therapeutic touch