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Unit 1 - General Texts. Non-allopathic healthpracticesThere has been a growing debate over whether or not alternative medicine is effective. While it has not been

scientifically proven to heal illnesses, it has been known to work for many people. And because of this, thevarious treatments continue to grow in popularity. Here are 5 types of alternative medicine you may find yourself5needing in the future.

1. Acupuncture: It can be done for a number of different conditions. The treatment consists of placing fineneedles into the body at various points along the bodys energy channels. It has been found to be a promisingtreatment for dental pain and nausea for chemo. Additionally, it is used to treat arthritis and back pain, but hasnot been proven to help either of these conditions.10

2. Biofeedback: This is one of the more controversial alternative medicine treatments because of the effects ithas on the mind. It is a procedure in which electronic monitors help train a patient to use the mind to relax andcontrol pain. Throughout the procedure, the heart rate, blood pressure, and muscle tensions are measured. Ithas been found to help patients with back pains, headaches, fibromyalgia, and muscle pains.

3. Chiropractic: Chiropractic has become perhaps the most practiced non-allopathic approach. There are15thousands of chiropractic offices where a patient can go in and get adjusted and be on their way. Chiropractic isa system of spinal adjustments or manipulations that help correct misalignment of the vertebrae. It can be helpfulfor back pains, neck pains, headaches, sports injuries and anything else related to the spinal cord.

4. Hypnosis: This is a practice that induces an intense state of focused attention with the hope that thesubconscious mind becomes more powerful. There is some solid evidence that this alternative medicine20treatment can reduce pain and anxiety. It can also assist in relieving chronic pain, severe burns, and disordersthat are worsened by stress.

5. Magnet therapy: Magnet therapy is done by placing magnets on the body to stimulate circulation and increasethe release of the bodys own-relieving chemicals. There is little evidence that can prove that this method really

does work. However, there are a number of athletes that are adamant that this treatment works.25

For now, many alternative medicine treatments do not have concrete evidence that they do work effectively.Despite this, many of the methods continue to grow in popularity and more and more people every year areturning to alternative medicine to treat their illnesses. (415)

Healing Power of Colours

Chromotherapy is a method of treatment of diseases by colour. It is best used as a supportive therapy along with30other natural methods of preserving health such as correct diet, adequate rest and relaxation, exercise, yogicasanas and so on.

According to practitioners of chromotherapy, the cause of any disease can be traced to the lack of a particularcolour in the human system. Colour therapy is a technique of restoring imbalance by means of applying colouredlight to the body. It was a popular method of cure even in ancient times. Some 2,500 years ago, Pythagoras35applied colour light therapeutically and colour halls were used for healing in ancient Egypt, China and India.

The pioneer of modern colour therapy was Niels Finsen of Denmark. Following the discovery, in 1877, of thebactericidal action of solar ultra-violet energy, Finsen studied the possibility of assisting the healing of woundswith visible light. He subsequently used red light to inhibit the formation of smallpox scars and, in 1896, foundeda Light Institute (now the Finsen Institute of Copenhagen) for the photo-treatment of tuberculosis. In 1932,40Gerrard and Hessay, two Californian psychologists, scientifically established that blue light had a calming effectand red a stimulating power on human beings.

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Blue and red colours are considered at the two extremes with yellow representing the midpoint. These are alsothe three principal colours in a rainbow. A patient is first subjected to an examination to ascertain which colourhe lacks. The deficiency is determined by observing the colour of the eyeballs, nails, urine and excrement. In45cases of the lack of red the eyes and nails will be bluish, and the urine and excrement white or bluish. If there isa deficiency of the blue colour, the eyes and nails will be reddish and urine and excrement yellowish or red.

Every substance on earth contains colour. Even the rays cast on earth by celestial bodies contain colour in theform of white light. The rays of the sun contain seven different colours - violet, indigo, blue, green, yellow, orange

and red. These are natural colours which are highly beneficial to the maintenance of health and for healing50diseases.

According to Dr. Babbit, a well-known authority on chromotherapy, "sunlight is the principal curative agent innatures laboratory and where light cannot enter, disease does. Chlorosis, anaemia, leukaemia, emaciation,muscular debility, degeneration of heart and liver, dropsical effusion, softening of bones, nervous excitability,physical deformity, and stunted growth -just to mention a few complaints- are the result of excluding oneself from55the beneficial effects of sunlight. "Sunlight plays an important role in the recovery from chronic diseases.Judicious use of sunlight can be part of the curing process in almost every affliction. The rays of the sun improvedigestion and nutrition, quicken blood and lymph circulation and increase the elimination of impurities throughthe skin.

Action and effect of various colours on the body and their healing qualities60

Red:Symbolic of heat, fire and anger. It is a stimulating and energising colour. It stimulates arterial blood andbrings warmth to cool extremities. Used as a general tonic, it is very valuable in the treatment of diseases likelow blood pressure, rheumatism, paralysis, anaemia and advanced cases of tuberculosis.

Orange:Symbolic of prosperity and pride, orange is useful for stimulating blood supply and energising thenerves. It is beneficial in the treatment of kidney and gall stones, hernia and appendicitis. It is also used to65stimulate the milk producing action of breasts after childbirth.

Violet:Violet is beneficial in the treatment of nervous and emotional disturbances, arthritis, acute cases ofconsumption and insomnia.

Yel low:Associated with joy and happiness, yellow is laxative and diuretic. It is a stimulant to the brain, the liver

and the spleen. It is also effective in the treatment of diabetes, indigestion, kidney and liver disorders,70constipation, eye and throat infections, syphillis and impotence.

Purple:Purple or indigo combines the blood-warming red and the cooling antiseptic blue. It is an excellentstimulant without being an irritant. It is beneficial in the treatment of advanced stages of constipation, hydrocele,leucorrhoea, many disorders of the stomach and womb, cataract, migraine and skin disorders. It exerts asoothing effect on the eyes, ears and the nervous system.75

Green:Made up of the blue and yellow, green is regarded as a colour of harmony. It is a mild sedative. It isuseful in the treatment of nervous conditions, hay fever, ulcers, influenza, malaria , colds, sexual disorders andcancer. It preserves and strengthens eyesight. Being highly medicinal and depressive, it is of great help in thetreatment of inflammatory conditions.

Blue:Cool, soothing and sedative, blue alleviates pain, reducing bleeding and heals burns. It is beneficial in the80treatment of dysentery, colic, asthma, respiratory disorders, high blood pressure and skin aberrations. In a studyat the New England State Hospital in the United States, 25 members of staff with normal blood pressure werebathed in blue light for half an hour. It resulted in universal fall in blood pressure. The blood pressure rose whenred light was applied.

Methods of Treatment There are two methods of treating diseases by colour: ( i) by the application of light85through different coloured glasses; and (ii) by external or internal use of colour-charged water.

In the first approach, sheets of glass, 30 cms. X 36 cms. of the required colours are needed. These are placed atthe window frames or any other convenient place in such a way that the suns rays can pass through them and

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fall directly on the patients body. The usual duration of the colour treatment is 30 minutes. In case of localapplication, a pane of glass can be placed in front of the diseased part so that the light passing through the glass90falls on the afflicted area. At night lanterns can be used for the purpose. A single lantern can have glass panes offour different colours and the required colour can be focussed on the patient or the affected parts.

In the second one, coloured bottles are needed. These bottles should be cleaned and filled up to three-fourthslevel with fresh well water, distilled water or rain water. The bottles should be corked and then placed in brightsunlight for three to four hours. After this exposure, the water is said to acquire medicinal properties and this95

colour-charged water can be used both internally and for external applications. Wounds and ulcers can bewashed with this water and it can also be used to massage the affected parts or applied as compress on them.For internal use, an adult can take 30 ml. of colour-charged water as a single dose. The dose can be repeatedas required.

Diet A correct and balanced diet is essential during the treatment through chromotherapy. The patients should100take food items with analogous colouring.

Red:Beets, radish, red cabbage, tomatoes, watercress, most red-skinned fruits, red berries and water melon.

Orange:Orange-skinned vegetables and fruits such as carrot, orange, apricot, mango, peach and pappaya.

Violet:Egg plant, berries, black carrot and purple grapes.

Yel low:Lime and lemon, sweet lime, grapes, pumpkin, melon, banana, mango, yellow apple and guava.105

Green:Most of the green vegetables and fruits such as gourds, spinach, plantain, lettuce, pea, green mango,gooseberry, pears, beans , etc.

Blue:Blue plum, blue beans, blue grapes, etc.

Contraindications There are some important contraindications to colour treatment which should be borne inmind while adopting this mode of cure. For instance, the red colour would be injurious in a naturally inflammatory110condition of the system, and in case of persons with feverish and excitable temperament. If the red light isemployed for too long and frequently, it may produce dangerous fevers. The danger can be obviated by usingthe red light for a few minutes at a time or by placing a wet bandage over the head.

Similarly, yellow should not be used when the nerves are very active or irritable. Yellow or orange reddish tonesmay prove injurious in fevers, acute inflammations, delirium, diarrhoea, neuralgia, palpitation of the heart and115any condition of over- excitement.

In cases of paralysis, chronic rheumatism, gout, consumption and in all cold, pale and dormant conditions of thesystem, blue, indigo and violet may prove too cooling and constricting and should be avoided. (1393)

COLOURS

Everybody has a favourite colour with which they identify but what about the healing and soothing effects of120colours? How do they affect you? When white light is passed through a crystal or glass prism a rainbow effect is

produced. The colours of violet, indigo, blue, green, orange, yellow and red are revealed to us.

Red, Yellow and Blue are called the primary colours whereas any mixture thereof is called secondary colours.They are Orange, Green and Violet. A third series called Tertiary colours is formed when primary and secondarycolours are mixed. There are dozens of combinations and each has its own mood which is able to affect your125mind and your life.

Violet. Violet is associated with physical healing and has a marked influence on the skeletal system. It clears,purifies and tunes you into the spiritual realms and your Higher Self. It is a balancer between the physical andastral worlds.

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If you suffer from any aches in the bones such as arthritic pain, it is said that violet can assist in that area. If you130are a meditator, violet can assist in deepening meditation and evoking the higher human sentiments such ashumility and truth. It is a majestic colour that is said to reveal past lives to you.

Indigo. This colour and some of the bluer shades have an influence on the third eye. This means that if youare trying to develop your psychic and spiritual powers, then, just like violet, it can have a marked influence onyour evolutionary growth. It is said to detoxify and cleanse the lymphatic system and strengthen your immunity to135

disease. It purifies the blood and eliminates waste from the glandular system and body generally. You shoulduse indigo to lighten the spirit, but an excess of use may in fact give the opposite effects.

Blue. Blue is a cleanser and relaxing to the entire body. It has a marked effect on the lungs and is consideredantiseptic in its action. Asthma, any infant diseases and skin disorders are said to be assisted using the colourblue. It produces a very conservative feel, and thus any activities requiring a traditional mood are benefited by140the use of blue. If you are depressed or sad, you should avoid the sedating effect of blue. If you like blue, trymixing other colours to lighten the effects.

Green. Plants predominantly exhibit this colour as does the deep ocean. It is therefore regarded as one of themost natural and uplifting of colours. It is very sedating in its effect and unruly children are pacified by its use. Ifyour nerves are on edge or you are overworked, try using green light or colours on you to calm and soften your145

mind. Green brings luck in social and financial circles too where it has the power to attract commercial luck. Itrelates to the heart and is tonifying to the cardio vascular region. As the heart chakra relates to love- it is said toraise your awareness to a Universal level as well.

Yellow. The Solar Plexus is linked to this colour. The chakra or energy centre there is activated by its use. Ifyou are tired or listless, lacking in initiative or drive for life, try using yellow or sleeping under yellow lights. It will150reactivate your mind and heart and renew your interest in life. Any digestive or eating disorders are helpedthrough the use of yellow. The stomach and even the urinary tract respond well to its influence.

Orange. Orange, like yellow, signifies the Sun and has a warming effect on the system. It is also a colour ofsocial interaction too. It can help you in drawing favourable people to you in friendship and romance as it has anendearing quality to it. Emotional conditions respond most favourably to the use of orange light or orange colours155

in the environment or in fashion and also have a benefic effect on the pancreas, spleen and other internalorgans. The nervous system is purified and toned through the use of orange and is a great pep up when feelingphysically run down.

Red. Red is a most powerful colour and is sometimes regarded with caution due to its association with blood,death, hospitals and emergencies, etc. It is therefore a colour which calls all senses into action and can revive a160sagging mental attitude or withered spirit. It is a physical colour which warms the system. If the blood is weak,anaemic or the circulation is sluggish then red will activate its action. Red is a passionate and sexual colour andtherefore should be used sparingly unless sensual and sexual enhancement is called for, in which case it excels.It regulates the base chakra.

Gold. Gold is a colour of royalty and healing. It protects and nourishes the body and assists in the165

improvement of immunity against diseases.

Silver. As the Moon rules silver whites and greys, the power of imagination is increased through its use. Itassists in highlighting other colours.

Brown. To induce an earthier approach to life, the colour brown is useful. It is healing and traditional in itseffects.170

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Black. Conservative and settling colour but may create a depressive mood in those who are apathetic, lazy oremotionally imbalanced.

Turquoise. It is useful in skin conditions especially due to overheating.

Lemon. Awakens the nervous system and tunes the brain to higher energies of the cosmos. It is refreshing

and deodorising.175

Pink. Compassionate colour which also exhibits a passionate tone. Good for meditation and strenghtening tothe immune system

White. Purifies the whole system and contains all other colours. It is a spiritual symbol of purity. (950)

Therapeutic Value of MassageMassage is an excellent form of passive exercise. The word is derived from the Greek word massier which180means to knead. It involves the scientific manipulation of the soft tissues of the body. If correctly done on a bare

body, it can be highly stimulating and invigorating.

As far back as 400 B.C., the great Hippocrates, the father of medicine, employed massage and manipulation inhealing his patients. Since then it has been used as a mode of treatment for many ailments and it has restoredmany a sufferer to health and vigour.185

Benefi tsThe general massage, dealing with all parts of the body, is highly beneficial in many ways. It tones upthe nervous system, influences respiration and quickens the elimination of poisons and waste material from thebody through the various eliminative organs such as the lungs, skin, kidneys and bowels. It also boosts bloodcirculation and metabolic processes. A massage removes facial wrinkles, helps to fill out hollow cheeks and neckand eases stiffness, sore muscles and numbness.190

Variousmovements There are five fundamental modes of manipulation in massage and these are: effleurage

(stroking), friction (rubbing), petrissage (kneading), tapotment (percussion) and vibration (shaking or trembling).

1. Effleurage: This involves sliding with the hands, using long even strokes over the surface of the body.Effleurage is performed in five ways, namely stroking with (I) palms of two hands; (ii) the palm of one hand; (iii)the knuckles; (iv) the ball of the thumb and (v) the finger tips. Effleurage increases blood circulation and soothes195the nervous system. It also warms and relaxes. It is very helpful in atrophied condition of the skin.

2. Friction: The movements, which are circular in nature, are performed with the help of the thumb and tips offingers or the palm of the hand towards the joints or around the joints. Friction limbers up joints, tendons, andmuscles and facilitates the removal of deposits by breaking them. It also helps in reducing swelling after nerveinflammation.200

3. Petrissage: This is the process of kneading, pressing and rolling of the tissues and is performed with one or

both hands, with two thumbs or with thumbs and fingers. One should apply heavy pressure for deep kneadingand light pressure for superficial kneading. Petrissage is a treatment of the muscles. It increases nutrition,strengthens muscles, relieves intestinal congestion and helps elimination of the poisons. It boosts long activityand cellular respiration, eliminates fatigue poisons and tones up nerve endings.205

4. Tapotement: This involves hacking, tapping, clapping and beating and is achieved by striking the body rapidly.Short and quick blows are generally given from the wrist. Tapotement helps in atrophied condition of themuscles. It increases blood supply, soothes nerves and strengthens muscles.

5. Vibrations: This is achieved by rapidly shaking the pressing movements by use of the hand or fingers on thebody. Vibrating hand should move constantly. This is beneficial in neuritis and neuralgia after the inflammatory210

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stage is over. It stimulates circulation, glandular activity and nervous plexuses. It also helps in bowel movement.

Another form of massage helpful in most elements is the vibratory massage. This can be done by trainedpersons only. The vibratory to muscles is more efficiently administered by a special, electrically operatedmachine.

Material for Massage Cotton seed oil is most commonly used for massaging, but butter is used for filling out215cheeks and the neck. If the patient is averse to oil, talcum powder may be used. Oil should not be used by

persons with excessive body hair. General body massage may be done for 40 to 45 minutes and local bodymassage for 10 to 15 minutes. The oil should be washed off completely after massage.

Therapeutic Uses Massage can be used with advantage as a method of treatment for many common ailments.The various forms of massage and their usefulness in various diseases are described briefly hereinbelow.220

Massage of the Joints: Stiff and swollen joints can be cured by massage combined with mechanicalmovements. Massage is, however, not recommended in serious inflammatory cases of the joints and intubercular joints. It should also be avoided in infectious diseases like diphtheria and gonorrhoea which causeformation of pus as massage may spread the pus to the entire system. Sprains and bruises can be cured bymassage. In these cases, affected parts should first be bathed with hot water for 15 to 30 minutes. Next the225massage should be done for a few minutes. Gentle stroking and kneading is recommended on and around theinjured tissues. Fractures can also be treated through massage.

This form of massage is of great help in atrophy of the muscles which usually follows if the muscles are not usedfor any length of time. This condition may also be brought about by injuries, diseases of the joints, inflammationof the muscles and nerves, and by too long use of bandages and splints.230

A human being carries one -half of the weight of his body in the form of muscular tissues. One-fourth of theblood supply circulates in the muscles. When one gets a good massage treatment, the muscles get regeneratedand are then capable of holding half of the blood supply. Massage thus provides additional nourishment to feedthe muscular tissues, helping them to grow strong. Tapping, striking, and vibrating help the muscle to develop itscontractile power. Muscle massage is brought by first effleurage, kneading, followed by tapotement. Later, active235and passive movements are given.

Massage is employed for eliminatng muscle contraction and for breaking of adhesions. A little moderate

kneading, and percussion cause muscles to contract and become stronger. Deep circular kneading and vibrationloosens the muscles. Kneading under and round the muscles breaks up adhesions.

Massaging the nerves: Massage benefits many nerve problems. In case of acute inflammation of the nerves,240massage should be done carefully. Light and gentle stroking are recommended. Deep pressure should not beused on swollen nerves for it will increase the inflammation. All that is needed is just a gentle tapotement orbeating of the nerve.

Nerve compression is recommended for soothing nerves. Grasp the limb with both hands, and create firmpressure around and down the arm. Start with the shoulder and proceed down to the wrist. As you leave the grip,245bring the hands down a little and make another pressure. As a result, blood circulation will increase. Spinal nervecompression is extremely beneficial. It is done by the palm of the hand. Vibration of the fingers stimulate it.Sleeplessness can be cured by long slow and gentle stroking down the spine and entire back.

Abdominal Massage: This form of massage is beneficial in constipation. It stimulates the peristalsis of the smallintestines, tones up the muscles of the abdomen walls and mechanically eliminates the contents of both large250and small intestines. Abdominal massage should not be done in general, femoral, inguinal and umbilical hernia;inflammation of the uterus, bladder, gall bladder, ovaries and fallopian tubes; kidney stones; ulcers of thestomach and intestines; and pregnancy.

Abdominal massage should not be done after a heavy meal, but after two hours or so. The bladder should beemptied before the massage. The patient is made to lie on his back with his knees drawn up, position which255enable the abdomen wall to relax. The masseur should stand at the right side of the patient and use his fingertips for friction round the umbilical region from right to left. He should likewise alternatively knead the walls and

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roll with both hands, making deep and firm pressure. He should knead with the hand and finger tips and keepclear of any wound or tender places. He should later take up massaging of the larger intestines.

The manipulation of the large intestine should begin on the right side. Keep it going upwards and across the260transverse colon and move right down on the left side to the signoid flexure and rectum. Circular kneadingshould be done with the help of the three middle fingers. At the same time, press into the contents of theabdomen, following the course of the larger colon with a crawling motion. Keep kneading by means of a fewcircular movements in one spot with the help of finger tips. Knead repeatedly. Use knuckles of the hand to make

deep pressure along the colon, moving the hands along after each pressure.265

Once the kneading of the abdomen is over, follow up by tapotement with both hands cupped or use the knucklesof the hand. Vibration may also be employed. The patient could also be asked to do some gymnastic exercisesfor strengthening the walls of the abdomen. Since blood pressure increases during abdominal manipulation,patients with hypertension should avoid abdominal massage. Massage should also be avoided in cases wherethere has been recent bleeding in the lungs, the stomach or the brain.270

Chest Massage: Chest massage is helpful in many ways. It strengthens the chest muscles, increasescirculation and tones up the nervous system of chest, heart and lungs. It is especially recommended inweakness of the lungs, palpitation and heart disorders. Bust and mammary glands can be developed by propermassage.

The patient is made to lie on the back with the arms at the sides. The masseur starts manipulating the chest by275means of strokes with both hands on each side of the breast bone., making a circular motion formed by up anddown movements. Next the muscle kneading is done by picking up the skin and muscles with both hands.Treatment is given to both sides of the chest likewise. Circular kneading is next done by placing one hand oneach side of the breast bone and making the circular motion outward towards the side. Tapotement follows byhacking and slapping.280

Massage of Back: The purpose of the massage of the back is to stimulate the nerves and circulation for treatingbackache, rheumatic afflictions of the back muscles, and for soothing the nervous system.

The patient is made to lie down with the arms at the sides. The masseur effleurages the back from the shouldersdownwards using both hands on each side of the spine. Stroking is done from the sacrum upward. Frictionfollows with each hand at the sides of the spine going down slowly. Next, kneading by muscle picking is done285

with squeezing. Alternate rapid pushing and pulling movement of the hands sliding down the spine. Circularkneading should also be done.

The treatment should end by slapping, hacking and cupping on each side of the spine. Gentle stroking and lightkneading of the back is relieving and soothing. Percussion and vibration result into stimulating experience.Vibration of the end of spine benefits the sacral nerves and pelvic organs. It is recommended in constipation,290hemorrhoids, weakness and congestion of the bladder and sexual organs.

Massage of the Throat: This helps to overcome headache, sore throat and catarrh of the throat. The patient ismade to throw his head back. The masseur places palms of both hands on sides of neck with thumbs under thechin, and fingers under the ears. A downward stroke is next made towards the chest over the jugular veins. Donot exert heavily on the jugular veins. Repeat several times. (1882)295

Swedish massage uses a system of long gliding strokes, kneading, and friction techniques on the moresuperficial layers of muscles, generally in the direction of blood flow toward the heart, and sometimes combinedwith active and passive movements of the joints. It is used to promote general relaxation, improve circulation andrange of motion, and relieve muscle tension. Swedish massage is the most commonly used form of massage.

Deep tissue massage is used to release chronic patterns of muscular tension using slow strokes, direct300pressure, or friction directed across the grain of the muscles. It is applied with greater pressure and to deeperlayers of muscle than Swedish, which is why it is called deep tissue and is effective for chronic muscular tension.

Sports massage uses techniques that are similar to Swedish and deep tissue, but are specially adapted to dealwith the effects of athletic performance on the body and the needs of athletes regarding training, performing, and

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recovery from injury.305

Neuromuscular massage is a form of deep massage that is applied to individual muscles. It is used primarily torelease trigger points (intense knots of muscle tension that refer pain to other parts of the body), and also toincrease blood flow. It is often used to reduce pain. Trigger point massage and myotherapyare similar forms.

Acupressure applies finger or thumb pressure to specific points located on the acupuncture meridianschannels of energy flow identified in Asian concepts of anatomyin order to release blocked energy along these310

meridians that causes physical discomforts, and re-balance the energy flow. Shiatsu is a Japanese form ofacupressure.

Regardless of the technique applied, most sessions last one hour. Frequency of massage sessions can varywidely. If a person is receiving massage for a specific problem, frequency can vary widely based on thecondition, though it usually will be once a week. Some people incorporate massage into their regular personal315health and fitness program. They will go for massage on a regular basis, varying from once a week to once amonth.

The first appointment generally begins with information gathering, such as the reason for getting massagetherapy, physical condition and medical history, among other areas. The client is asked to remove clothing toones level of comfort. Undressing takes place in private, and a sheet or towel is provided for draping. The320massage therapist will undrape only the part of the body being massaged. The clients modesty is respected at

all times. The massage therapist may use an oil or cream, which will be absorbed into the skin in a short time.

To receive the most benefit from a massage, generally the person being massaged should give the therapistaccurate health information, report discomfort of any kindwhether its from the massage itself or due to theroom temperature or any other distractionsand be as receptive and open to the process as possible.325

Insurance coverage for massage therapy varies widely. There tends to be greater coverage in countries thatlicense massage therapy but a physicians prescription for massage therapy is needed. Once massage therapyis prescribed, authorization from the insurer may be needed if coverage is not clearly spelled out in ones policyor plan.

Preparations. Going for a massage requires little in the way of preparation. Generally, one should be clean330and should not eat just before a massage. One should not be under the influence of alcohol or non-medicinal

drugs. Massage therapists generally work by appointment and usually will provide information about how toprepare for an appointment at the time of making the appointment.

PrecautionsMassage is comparatively safe; however it is generally contraindicated, i.e., it should not beused, if a person has one of the following conditions: advanced heart diseases, hypertension (high blood335pressure), phlebitis, thrombosis, embolism, kidney failure, cancer if massage would accelerate metastasis (i.e.,spread a tumor) or damage tissue that is fragile due to chemotherapy or other treatment, infectious diseases,contagious skin conditions, acute inflammation, infected injuries, unhealed fractures, dislocations, frostbite, largehernias, torn ligaments, conditions prone to hemorrhage, and psychosis.

Massage should not be used locally on affected areas (i.e., avoid using massage on the specific areas of the340body that are affected by the condition) for the following conditions: rheumatoid arthritis flare up, eczema, goiter,and open skin lesions. Massage may be used on the areas of the body that are not affected by these conditions.

In some cases, precautions should be taken before using massage for the following conditions: pregnancy, highfevers, osteoporosis, diabetes, recent postoperative cases in which pain and muscular splinting (i.e., tighteningas a protective reaction) would be increased, apprehension, and mental conditions that may impair345communication or perception. In such cases, massage may or may not be appropriate. The decision on whetherto use massage must be based on whether it may cause harm.

For example, if someone has osteoporosis, the concern is whether bones are strong enough to withstand thepressure applied. If one has a health condition and has any hesitation about whether massage therapy would beappropriate, a physician should be consulted.350

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Side effects Massage therapy does not have side effects. Sometimes people are concerned that massagemay leave them too relaxed or too mentally unfocused. To the contrary, massage tends to leave people feelingmore relaxed and alert.

Research & general acceptance Before 1939, more than 600 research studies on massageappeared in the main journals of medicine in English. However, the pace of research was sl owed by medicines355disinterest in massage therapy.

Massage therapy research picked up again in the 1980s, as the growing popularity of massage paralleled thegrowing interest in complementary medicine. Well designed studies have documented the benefits of massagetherapy for the treatment of acute and chronic pain, acute and chronic inflammation, chronic lymphedema,nausea, muscle spasm, various soft tissue dysfunctions, anxiety, depression, insomnia, and psycho-emotional360stress, which may aggravate mental illness.

Premature infants treated with daily massage therapy gain more weight and have shorter hospital stays thaninfants who are not massaged. A study of 40 low-birthweight babies found that the 20 massaged babies had a47% greater weight gain per day and stayed in the hospital an average of six days less than 20 infants who didnot receive massage, resulting a cost savings of approximately $3,000 per infant. Cocaine-exposed, preterm365infants given massage three times daily for a 10 day period showed significant improvement. Results indicatedthat massaged infants had fewer postnatal complications and exhibited fewer stress behaviours during the 10

day period, had a 28% greater daily weight gain, and demonstrated more mature motor behaviours.

Another study showed massage therapy produced relaxation in 18 elderly subjects, demonstrated in measuressuch as decreased blood pressure and heart rate and increased skin temperature.370

A combination of massage techniques for 52 subjects with traumatically induced spinal pain led to significantimprovements in acute and chronic pain and increased muscle flexibility and tone. This study also foundmassage therapy to be extremely cost effective, with cost savings ranging from 15-50%. Massage has also beenshown to stimulate the bodys ability to naturally control pain by stimulating the brain to produce endorphins.Fibromyalgiais an example of a condition that may be favorably affected by this effect.375

A pilot study of five subjects with symptoms of tension and anxiety found a significant response to massagetherapy in one or more psycho-physiological parameters of heart rate, frontalis and forearm extensor

electromyograms (EMGs) and skin resistance, which demonstrate relaxation of muscle tension and reducedanxiety.

Lymph drainage massage has been shown to be more effective than mechanized methods or diuretic drugs to380control lymphedema secondary to radical mastectomy, consequently using massage to control lymphedemawould significantly lower treatment costs. A study found that massage therapy can have a powerful effect uponpsycho-emotional distress in persons suffering from chronic inflammatory bowel disease. Massage therapy waseffective in reducing the frequency of episodes of pain and disability in these patients.

Massage may enhance the immune system. A study suggests an increase in cytotoxic capacity associated with385massage. A study of chronic fatigue syndrome subjects found that a group receiving massage therapy hadlower depression, emotional distress, and somatic symptom scores, more hours of sleep, and lower epinephrineand cortisol levels than a control group.

Training & certificationThe generally accepted standard for training is a minimum of 500 classroomhours. Training should include anatomy, physiology, pathology, massage theory and technique, and supervised390practice. Most massage therapists also take additional courses and workshops during their careers. (3308)

Sleep Restorative of Tired Body and MindSleep is one of greatest habits and blessings of life. It is a periodic rest of the body which is absolutely essentialfor its efficient functioning. It has been called "most cheering restorative of tired bodies." Sleep is the

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indispensable condition to the recuperation of energy. We go to bed fatigued and get up refreshed. Sleep repairs395the wear and tear of the body and mind incurred during waking hours. Nothing is so restorative to the nerves assound and uninterrupted sleep. Sleep is thus a vital element in a total way of life. It is a basic need in man smental as well as physical life.

During sleep most of the functions of the body are carried on at the lowest level possible in health. Heatproduction is from 10 to 15 per cent below the basal level. The mechanism regulating the body temperature are400less sensitive than in the waking state. The rate of the heart is reduced by 10 to 30 beats per minute and a

decline in blood pressure of about 20 mm occurs in quiet restful sleep. The urine volume is considerablyreduced, but its concentration in solids is increased. The tone of all the skeletal muscles is lessened. The eyesare usually rolled upward and the pupils constricted.

Loss of sleep exerts seriously detrimental effects upon the nervous system. Long periods of wakefulness may405cause profound psychological changes such as loss of memory, irritability, hallucination and even schizophrenicmanifestations. During World War II, prisoners in Nazi concentration camps who kept awake for days by stronglights and blaring sounds, collapsed.

Sleep versus rest For correct living, it is essential to differentiate between sleep and rest. At rest the body isdisturbed by all exterior stimuli (for example noises); but in sleep it is screened from them by partial loss of410consciousness and also by what is called "dream protection." One useful purpose of the dream is to convertoutside stimuli that might awake the sleeping person, into fantasies that do not disturb him.

During rest the limbs are normal, but in sleep they swell. Blood flows from the brain, distends the arteries, andmakes the limbs bigger. In sleep more muscles are relaxed than in rest, though the sleeping person changes hisposition about 35 times in one night, without knowing it. Many organs which work during rest suspend their415activities in sleep. Thus the recouping value of sleep is much more than that of rest or simple lying down.

Theories of sleep Many theories of sleep have been advanced to explain the temporary loss of consciousnesswhich we know as sleep. The oldest theory is that sleep is induced by a reduction in the blood supply to the brainor at least to conscious centres. This is known as ischemic theory. Even the ancient Greek physicians wereaware that the carotid artery was in a way concerned with the onset of sleep. The name itself expresses this420belief. The Greek word Karotides for carotid arteries is derived from karoo which means put to sleep. Inmodern times, the drowsiness after a meal, presumably due to the diversion of blood from the brain to thedigestive organs, is cited in support of the ischemic theory.

Another important theory about sleep is the chemical theory. As a result of experiments in the metabolism ofsleeping subjects, it is considered that the fatigue inducing sleep may be a mild form of blood poisoning or425toxaemia. This "poisoning" is believed to be brought on by the expenditure of energy during the waking hours.

According to this theory, every contraction of a muscle and every impulse passing through the brain or thenerves breaks down a certain amount of tissue. The debris from broken down tissue is then thrown into thebloodstream. In the waking state, much of the waste from broken down tissue is got rid of through the naturaleliminating processes of lungs, kidneys, bowels and skin. But there comes a saturation point when there is such430an accumulation of waste that it cannot be disposed of by these processes and it then invades the grey matter ofthe brain. In such an eventuality, mental and physical alertness are impaired. It is natures warning that thewaste product must be reduced to replenish the lost energy. So we get tired and the urge to get sleep becomesirresistible.

During sleep, the cells and tissues that break down to produce toxic waste become less active and the435production of toxic waste is dramatically reduced. Simultaneously, constructive activities take place within thebody during sleep, which rebuild the broken down tissue.

Another theory places a sleeping centre in the hypothalamus. Many of the bodily changes in sleep such asconstriction of pupils, reduced frequency of heart beat, increased gastric tone and secretion are manifestationsof the activity of hypothalamus nuclei, especially parasympathetic centres. Perhaps some of the sleeping pills440affect this centre in the brain.

Although the various theories have certain amount of experimental evidence to support them, none has really

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solved what is the most mysterious process in our lives. All we know is that sleep substitutes constructivemeasures for the destructive processes of our waking hours. We cannot live without sleep.

Duration Another mystery about sleep is that no two persons need the same amount of sleep. Dr. Nathaniel445Kleitman, Associate Professor of Physiology at the University of Chicago, who conducted years of extensiveexperiments at the Universitys "Sleeping Laboratory" says that there is no more a normal duration of sleep thanthere is normal height and weight. A study of 25 subjects spread over thousands of nights showed that theaverage amount of sleep needed to feel well rested is seven-and-a-half hours, though individuals varied from six

to nine hours.450

According to Dr. Demmis Williams, a noted authority on sleep, the amount of sleep needed for an individualswell-being, is determined by what he feels he needs, not by what other people, including the doctor, think isreasonable.

On the whole, women sleep from 45 minutes to one hour more than men. The amount of sleep required varies atdifferent ages as follows: New Born: 18 to 20 hours Growing children: 10 to 12 hours Adults: 6 to 9 hours Aged455persons: 5 to 7 hours. The depth of ordinary restful sleep fluctuates throughout the sleep. In most adults, sleepdeepens through the first hour, after which it lightens rather sharply and then more gradually until morning oruntil the usual time of wakening. In growing children, however, sleep deepens a second time for a little while.According to Dr. Lindlahr, a famous naturopath, two hours before and two hours after midnight are the mostvaluable for sleep of all the twenty-four hours of the day. In these four hours, mental and physical vigour are at460

their lowest ebb and sleep is soundest and most natural.

It is believed that three-quarters of our sleep consists of what is called slow wave sleep. The restorativeprocesses occur during this time. The remaining quarter is taken by what is called rapid eye movement (REM)sleep. It is also called paradoxical or dreaming sleep and it comes in episodes of about 20 minutes durationabout five times in a night. It involves dreaming, irregular heart rates, and raised blood pressure. Both forms of465sleep are considered equally important, being normal sleeping rhythms.

Sleeping positions There are many theories about good and bad sleeping positions. Practically everyonechanges positions several times during sleep. Hence how one starts out is of no consequence. It is a good thingwe do turn about in our beds. If we did not, we would awake in the morning stiff, having maintained the sameposition all night. For proper sleep, however, one should not sleep on ones back but on the side with one or both470legs brought well up and the head and the shoulder slightly forward.

Sleeping pills are no remedy for sleeplessness. They are habit-forming and become less effective when takencontinuously. They lower the I.Q. dull the brain and can prove fatal if taken in excess or before/after alcohol. Theside-effect of sleeping pills include indigestion, skin rashes, lowered resistance to infection, circulatory andrespiratory problems, poor appetite, high blood pressure, kidney and liver problems and mental confusion.475

Sleeping well is an art. It needs a perfect blend of healthy habits and control of mind. A clean body and mind,relaxed mood, physical exercises, and perfect dietary control are some of the basic sleep-inducing methods.

Unpleasant situations at bed time such as arguments, quarrels, watching a horror movie, listening to loud musicwhich would create anxiety, fear, excitement and worries should be avoided. Such situations stimulate thecerebral cortex and tend to keep one awake.480

The sleeping place should be well ventilated, with balanced temperature and free from noises. The bed shouldbe neither too hard nor too soft, but comfortable. The pillow should not be too hard or too high. The bed clothesshould be loose-fitting and light coloured. Another important rule is not to have heavy food shortly before bedtime. (1530)

Secrets of Food Combining485

The observance of rules of food combining is neither faddish nor eccentric. It is a simple, scientifically-basedsystem of selecting foods, from among different types, which are compatible. This facilitates easy and efficientdigestion and ensures after-meal comfort.

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Digestion is not merely a chemical or physical process, but also a physiological one. When food enters the body,it undergoes several changes before it is broken down into its constituent parts and assimilated. But no food can490be assimilated by the system and used by various organs unless it has first been digested and then absorbed inthe digestive system (known as alimentary canal), while the residue, unfit for absorption, is eliminated from thesystem.

The chemical part of digestion is accomplished by a series of juices and their enzymes. The juices alternatebetween alkalies and acids, and their character is determined by the requirement of the enzymes they contain.495

These enzymes remain active in suitable media of well defined acid-alkaline ranges and are destroyed inunsuitable media.

For instance, the salivary amylase (ptyalin) or starch-splitting enzyme of the mouth is active only in an alkalinemedia and is destroyed by a mild acid. The gastric enzyme, pepsin, which initiates protein digestion, is activeonly in the acid medium and is destroyed by alkalies.500

A noteworthy feature of the digestive secretions is that the body suits its fluid and enzymes to the character ofthe food eaten. There are, however, severe limitations in this process. It is possible to suit the juices to aparticular food, but not to a wide variety of foods taken together. It is the combining of many varieties andincompatible foods at a meal that causes 90 per cent of digestive disorders.

There is a marked tendency to gastro-intestinal fermentation with certain combinations of foods. There is no505

fermentation and digestion will be much more satisfactory when the foods comprising a meal are of the sametype. This generally means eating similar foods at one time in order to accomplish the most complete digestion.

The most important rule for combining foods is to avoid mixing protein- and carbohydrate-concentrated foods.Although every food contains some protein, those regarded as protein-concentrated foods demand the longestdigestive time. They are held in the stomach for some hours until the gastric juices have performed their task.510This may vary from two-and-a-half to six hours, depending upon the complexity of the protein in the food. If aprotein food is mixed with starch- or sugar-concentrated foods, it will usually result in fermentation. This maylead to indigestion and gas in the stomach.

Animal-food proteins, such as meats, fish and cheese, require very high concentration of hydrochloric acid. Theirgastric digestion will be greatly inhibited by carbohydrate fermentation in the stomach. This will produce more515gas and increased discomfort. Eating meat, potatoes, bread and sweets should, therefore, be especially

avoided.

Protein foods are best digested when eaten with fresh vegetable salad. Primary protein foods such as nuts,seeds and soy-beans also combine very well with acid fruits like oranges, pineapples, grapefruit and lemons,and fairly well with sub-acid fruits, like grapes, pears, apples, berries, apricots and peaches. These vegetables520and fruits are rich natural sources of vitamin C which aids protein digestion.

The second important rule for food combining is to avoid mixing proteins and fats at the same meal. Fat in foodsinhibits the secretion of gastric juice through the small wall. Thus when fat-concentrated foods are taken withprotein foods, gastric catabolism will decrease by the degree of liquid concentration in the stomach. Fat willremain undigested in the stomach until gastric juices complete their work on the complex protein molecule.525

Although all primary protein foods contain high concentration of fat, such lipids will be held in suspension,

awaiting catabolism in the intestine, without impeding gastric action. Free fats like oil, butter, and milk tend tocoat the gastric mucosa, thereby inhibiting its effort to secrete gastric juice. Fat surrounding fried foods is alsoregarded as free fat and it interferes with gastric catabolism.

Another important rule for food combining is to avoid mixing carbohydrates and acid fruits in the same meal. The530starch-splitting enzyme ptyalin in the saliva plays an important role as the food is chewed. It converts thecomplex starch molecules into simpler sugars. Ptyalin requires a neutral or slightly alkaline medium for properfunctioning and this is the normal condition of the saliva in the mouth. However, when acid foods are taken, theaction of ptyalin is halted. It is, therefore, necessary to avoid acid fruits in the same meal as sweet fruits orstarches. Thus tomatoes should not be eaten with starches especially potatoes or bread.535

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Refined sugar products are also acidic, both in the mouth and in the bloodstream. The acidifying of the saliva bysucrose is one of the main causes of tooth decay. It can also cause severe damage to the digestion.

Food combining is designed to facilitate easier digestion. The chart in Table I, represents diagramatically foodcombining rules in an easy-to-follow method. Accompanying this chart are the lists of food in their correctclassification.540

In a nutshell, starches, fats, green vegetables and sugars may be eaten together as they require either an

alkaline or neutral medium for their digestion. Similarly, proteins, green vegetables and acid fruits may be eatentogether as they require an acid or neutral medium for their digestion. But starches and proteins, fats andproteins and starches and acid fruits should not be eaten together as a general rule.

This in brief is the whole basis for successful food combination.545

An important point to remember about meals is that the smaller the number of courses they consist of, the betterit will be. They should approximate to a one-course meal as much as possible. Simple meals in every way aremore conducive to health, than more elaborate ones, no matter how well they may be combined.

A meal consisting of proteins,carbohydrates and fats may remain in the stomach for six to seven hours beforethe stomach is emptied. If carbohydrates are eaten without proteins, they remain in the stomach for a relatively550short period. A fruit meal remains in the stomach for even shorter time. It is advisable to eat these different foods

at different meals - a fruit meal, a starch meal and a protein meal. The ideal practice is a fruit meal for breakfast,a starch meal with salad and non- starchy vegetables for lunch, and a protein meal with a salad and non-starchyvegetables for dinner.

Table I Food Combining Chart555

Food Groups Proteins Fats Starches Vegetables Sweet Fruits Sub-acid Fruits Acid Fruits

Proteins

Fats

Starches

Vegetables

Sweet fruits

Sub-acid Fruits

Acid fruits

Good

Poor

Poor

Good

Poor

Fair

Good

Poor

Fair

Good

Poor

Fair

Good

Good

Fair

Fair

Good

Good

Good

Good

Good

Poor

Poor

Poor

Poor

Fair

Fair

Poor

Good

Good

Poor

Fair

Fair

Fair

Poor

Good

Good

Good

Good

Fair

Poor

Poor

Poor

Good

Good

Proteins:Nuts, seeds, soybeans, cheese, eggs, poultry* meat*, fish*, yogurt.

Fats:Oils, olive, butter, margarine.

Starches:Whole cereals, peas, beans, lentils.

Vegetables:Leafy green vegetables, sprouted seeds, cabbage cauliflower, brocoli, green peas, celery,tomatoes, onions.560

Sweet Frui ts:Bananas, fits, custard apples, all-dried fruits, dates.

Sub-acid-frui ts:Grapes, pears, apples, peaches, apricots, plums, fruits guavas, raspberries.

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Acid fru i ts :Grapefruit, lemons, oranges, limes, pineapple, strawberries.

* Not recommended for good nutrition (1236)

Meditation565

Definition Meditation is a practice of concentrated focus upon a sound, object, visualization, the breath,movement, or attention itself in order to increase awareness of the present moment, reduce stress, promoterelaxation, and enhance personal and spiritual growth.

OriginsMeditation techniques have been practiced for millennia. Originally, they were intended to developspiritual understanding, awareness, and direct experience of ultimate reality. The many different religious570traditions in the world have given rise to a rich variety of meditative practices. These include the contemplativepractices of Christian religious orders, the Buddhist practice of sitting meditation, and the whirling movements ofthe Sufi dervishes. Although meditation is an important spiritual practice in many religious and spiritual traditions,it can be practiced by anyone regardless of their religious or cultural background to relieve stress and pain andas Western medical practitioners begin to understand the minds role in health and disease, there has been575more interest in the use of meditation in medicine.

Meditative practices are increasingly offered in medical settings and hospitals as a tool for improving health andquality of life. Meditation has been used as the primary therapy for treating certain diseases; as an additionaltherapy in a comprehensive treatment plan; and as a means of improving the quality of life of people withdebilitating, chronic, or terminal illnesses.580

Benefits Meditation benefits people with or without acute medical illness or stress. People who meditateregularly have been shown to feel less anxiety and depression.

They also report that they experience more enjoyment and appreciation of life and that their relationships withothers are improved. Meditation produces a state of deep relaxation and a sense of balance or equanimity.According to Michael J. Baime, Meditation cultivates an emotional stability that allows the meditator to585experience intense emotions fully while simultaneously maintaining perspective on them. Out of this experienceof emotional stability, one may gain greater insight and understanding about ones thoughts, feelings, and

actions. This insight in turn offers the possibility to feel more confident and in control of life. Meditation facilitatesa greater sense of calmness, empathy, and acceptance of self and others.

Meditation can be used with other forms of medical treatment and is an important complementary therapy for590both the treatment and prevention of many stress-related conditions. Regular meditation can reduce the numberof symptoms experienced by patients with a wide range of illnesses and disorders.

Based upon clinical evidence as well as theoretical understanding, meditation is considered to be one of thebetter therapies for panic disorder, generalized anxiety disorder, substance dependence and abuse, ulcers,colitis, chronic pain, psoriasis, and dysthymic disorder. It is considered to be a valuable adjunctive therapy for595moderate hypertension (high blood pressure), prevention of cardiac arrest (heart attack), prevention ofatherosclerosis (hardening of arteries), arthritis (including fibromyalgia), cancer, insomnia, migraine, andprevention of stroke. Meditation may also be a valuable complementary therapy for allergies and asthma

because of the role stress plays in these conditions.

Meditative practices have been reported to improve function or reduce symptoms in patients with some600neurological disorders as well. These include people with Parkinsons disease, people who experience fatiguewith multiple sclerosis, and people with epilepsy who are resistant to standard treatment.

Overall, a 1995 report to the National Institutes of Health on complementary medicine concluded that, Morethan 30 years of research, as well as the experience of a large and growing number of individuals and healthcare providers, suggests that meditation and similar forms of relaxation can lead to better health, higher quality605of life, and lowered health care costs. A study of health care professionals published in 2002 indicates that themajority of physicians, nurses, and occupational therapists in the United States accept meditation as a beneficial

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adjunct to conventional medical or surgical treatments.

DescriptionSitting meditation is generally done in an upright seated position, either in a chair or cross-legged on a cushion on the floor. The spine is straight yet relaxed. Sometimes the eyes are closed. Other times610the eyes are open and gazing softly into the distance or at an object.

Depending on the type of meditation, the meditator may be concentrating on the sensation of the movement of

the breath, counting the breath, silently repeating a sound, chanting, visualizing an image, focusing awarenesson the center of the body, opening to all sensory experiences including thoughts, or performing stylized ritualmovements with the hands.615

Movement meditation can be spontaneous and freeform or involve highly structured, choreographed, repetitivepatterns. Movement meditation is particularly helpful for those people who find it difficult to remain still.

Generally speaking, there are two main types of meditation. These types are concentration meditation andmindfulness meditation.

Concentration meditation practices involve focusing attention on a single object. Objects of meditation can620include the breath, an inner or external image, a movement pattern (as in tai chi or yoga), or a sound, word, orphrase that is repeated silently (mantra). The purpose of concentrative practices is to learn to focus onesattention or develop concentration. When thoughts or emotions arise, the meditator gently directs the mind backto the original object of concentration.

Mindfulness meditation practices involve becoming aware of the entire field of attention. The meditator is625instructed to be aware of all thoughts, feelings, perceptions, or sensations as they arise in each moment.Mindfulness meditation practices are enhanced by the meditators ability to focus and quiet the mind. Manymeditation practices are a blend of these two forms.

The study and application of meditation to health care has focused on three specific approaches: (i)transcendental meditation, a.k.a. TM; (ii) The relaxation response, a general approach to meditation developed630by Dr. Herbert Benson; and (iii) mindfulness meditation, specifically the program of mindfulness-based stressreduction (MBSR) developed by Jon Kabat-Zinn.

Transcendental meditation TM has its origins in the Vedic tradition of India and was introduced to the West by

Maharishi Mahesh Yogi. TM has been taught to somewhere between two and four million people. It is one of themost widely practiced forms of meditation in the West. TM has been studied many times; these studies have635produced much of the information about the physiology of meditation.

In TM, the meditator sits with closed eyes and concentrates on a single syllable/word (mantra) for 20 minutes ata time, twice a day. When thoughts or feelings arise, the attention is brought back to the mantra. According to animportant TM researcher, During TM, ordinary waking mental activity is said to settle down, until even thesubtlest thought is transcended and a completely unified wholeness of awareness is experienced. In this silent,640self-referential state ofpure wakefulness, consciousness is fully awake to itself alone ....

The relaxation response The relaxation response involves a similar form of mental focusing. Dr. Herbert Benson,one of the first Western doctors to conduct research on the effects of meditation, developed this approach afterobserving the profound health benefits of a state of bodily calm he calls the relaxation response. In order to

elicit this response in the body, he teaches patients to focus upon the repetition of a word, sound, prayer,645phrase, or movement activity (including swimming, jogging, yoga, and even knitting) for 1020 minutes at a time,twice a day. Patients are also taught not to pay attention to distracting thoughts and to return their focus to theoriginal repetition. The choice of the focused repetition is up to the individual. Instead of Sanskrit terms, themeditator can choose what is personally meaningful, such as a phrase from a prayer.

Mindfulness meditation Mindfulness meditation comes out of traditional Buddhist meditation practices.650Psychologist Jon Kabat-Zinn has been instrumental in bringing this form of meditation into medical settings. Informal mindfulness practice, the meditator sits with eyes closed, focusing the attention on the sensations andmovement of the breath for approximately 4560 minutes at a time, at least once a day. Informal mindfulnesspractice involves bringing awareness to every activity in daily life. Wandering thoughts or distracting feelings are

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simply noticed without resisting or reacting to them. The essence of mindfulness meditation is not what one655focuses on but rather the quality of awareness the meditator brings to each moment. According to Kabat- Zinn, Itis this investigative, discerning observation of whatever comes up in the present moment that is the hallmark ofmindfulness and differentiates it most from other forms of meditation.

The goal of mindfulness is for you to be more aware, more in touch with life and whatever is happening in yourown body and mind at the time it is happeningthat is, the present moment. The MBSR program consists of a660series of classes involving meditation, movement, and group process. There are over 240 MBSR programs

offered in health care settings around the world.

Meditation is not considered a medical procedure or intervention by most insurers. Many patients pay formeditation training themselves. Frequently, religious groups or meditation centers offer meditation instructionfree of charge or for a nominal donation.665

PrecautionsMeditation appears to be safe for most people. There are, however, case reports and studiesnoting some adverse effects. Thirty-three to 50% of the people participating in long silent meditation retreats (twoweeks to three months) reported increased tension, anxiety, confusion, and depression. On the other hand, mostof these same people also reported very positive effects from their meditation practice. Kabat-Zinn notes thatthese studies fail to differentiate between serious psychiatric disturbances and normal emotional mood swings.670These studies do suggest, however, that meditation may not be recommended for people with psychoticdisorders, severe depression, and other severe personality disorders unless they are also receivingpsychological or medical treatment.

Side effects There are no reported side effects from meditation except for positive benefits.

Research & general acceptance The scientific study of the physiological effects of meditation675began in the early 1960s. These studies prove that meditation affects metabolism, the endocrine system, thecentral nervous system, and the autonomic nervous system. In one study, three advanced practitioners ofTibetan Buddhist meditation practices demonstrated the ability to increase inner heat as much as 61%. Duringa different meditative practice they were able to dramatically slow down the rate at which their bodies consumedoxygen.680

Preliminary research shows that mindfulness meditation is associated with increased levels of melatonin. These

findings suggest a potential role for meditation in the treatment and prevention of breast and prostrate cancer.

Despite the inherent difficulties in designing research studies, there is a large amount of evidence of the medicalbenefits of meditation. Meditation is particularly effective as a treatment for chronic pain. Studies have shownmeditation reduces symptoms of pain and pain-related drug use. In a four-year follow-up study, the majority of685patients in a MBSR program reported moderate to great improvement in pain as a result of participation in theprogram.

Meditation has long been recommended as a treatment for high blood pressure; however, there is a debate overthe amount of benefit that meditation offers. Although most studies show a reduction in blood pressure withmeditation, medication is still more effective at lowering high blood pressure.690

Meditation may also be an effective treatment for coronary artery disease. A study of 21 patients practicing TM

for eight months showed increases in their amount of exercisetolerance, amount of workload, and a delay in theonset of ST-segment depression. Meditation is also an important part of Dean Ornish s program, which has beenproven to reverse coronary artery disease.

Research also suggests that meditation is effective in the treatment of chemical dependency. Gelderloos and695others reviewed 24 studies and reported that all of them showed that TM is helpful in programs to stop smoking and also in programs for drug and alcohol abuse.

Studies also imply that meditation is helpful in reducing symptoms of anxiety and in treating anxiety-relateddisorders. Furthermore, a study in 1998 of 37 psoriasis patients showed that those practicing mindfulnessmeditation had more rapid clearing of their skin condition, with standard UV light treatment, than the control700

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subjects. Another study found that meditation decreased the symptoms of fibromyalgia; over half of the patientsreported significant improvement. Research by a group of ophthalmologists indicates that nearly 60% of a groupof patients being treated for glaucoma found meditation helpful in coping with their eye disorder. In addition,meditation was one of several stress management techniques used in a small study of HIV-positive men. Thestudy showed improvements in the T-cell counts of the men, as well as in several psychological measures of705well-being.

Training & certificationThere is no program of certification or licensure for instructors who wish to teach

meditation as a medical therapy. Meditation teachers within a particular religious tradition usually have extensiveexperience and expertise with faith questions and religious practices but may not have been trained to work withmedical patients. Different programs have varied requirements for someone to teach meditation. In order to be710recognized as an instructor of TM, one must receive extensive training. The Center for Mindfulness in Medicine,Health Care and Society at the University of Massachusetts Medical Center offers training and workshops forhealth professionals and others interested in teaching mindfulness-based stress reduction. The Center does not,however, certify that someone is qualified to teach meditation. The University of Pennsylvania program forStress Management suggests that a person have at least 10 years of personal experience with the practice of715mindfulness meditation before receiving additional instruction to teach meditation. Teachers are also expected tospend at least two weeks each year in intensive meditation retreats. (2262)

Relaxation

DefinitionRelaxation therapy is a broad term used to describe a number of techniques that promote stress reduction, the elimination of tension throughout the body, and a calm and peaceful state of mind.720

OriginsRelaxation therapy has been around for thousands of years in the forms of transcendental meditation(TM), yoga, tai chi, qigong, and vipassana (a Buddhist form of meditation meaning insight and also known asmindfulness meditation).

Progressive relaxation, a treatment that rids the body of anxiety and related tension through progressiverelaxation of the muscle groups, was first described by Dr. Edmund Jacobson in his book Progressive725Relaxation, published in 1929. And in 1975, Dr. Herbert Benson published his groundbreaking work TheRelaxation Response, which described in detail the stress-reduction mechanism in the body that short-circuits

the fight-or-flight response and lowers blood pressure, relieves muscle tension, and controls heart rate. Thiswork gave further credence and legitimacy to the link between mind and body medicine. A number of todayscommonly used relaxation techniques, such as cue-controlled relaxation, are a direct result of Bensons work in730this area.

Benefits Stress and tension have been linked to numerous ailments, including heart disease, high bloodpressure, atherosclerosis, irritable bowel syndrome, ulcers, anxiety disorders, insomnia, and substance abuse.Stress can also trigger a number of distinct physical symptoms, including nausea, headache, hair loss, fatigue,and muscle pain. Relaxation therapies have been shown to reduce the incidence and severity of stress-related735diseases and disorders in many patients.

Description There are a number of different relaxation methods available. Some of the most widely taught

and practiced by healthcare providers include progressive relaxation, cue-controlled relaxation, breathingexercises, guided imagery, and biofeedback.

Progressive relaxation Progressive relaxation is performed by first tensing, and then relaxing, the muscles of the740body, one group at a time. Muscle groups can be divided into a number of different ways, but a common methodis to use the following groupings: 1) Hands and arms; 2) head, neck, and shoulders; 3) torso, including chest,stomach and back; and 4) thighs, buttocks, legs, and feet. The patient lays or sits in a comfortable position, andthen starts with the first muscle group, focusing on the feeling of the muscles and the absence or presence oftension. The patient then tenses the first muscle in the group, holds the tension for approximately five seconds,745and releases and relaxes for up to 30 seconds. The contrast allows the individual to notice difference betweenfeelings of tension and feelings of relaxation. The procedure is repeated with the next muscle in the group, and

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so on, until the first group is completed. The patient then starts on the next muscle group.

Progressive relaxation can be guided with verbal cues and scripts, either memorized by the patient or providedon instructional audiotapes. The procedure remains the same, but the individual is prompted on which muscles750to flex and relax and given other cues about noticing the difference between the tense and relaxed state. Someindividuals may prefer progressive relaxation that is prompted with a tape, because it allows them to completelyclear their minds and to just follow the given instructions.

Deep breathing exercises Individuals under stress often experience fast, shallow breathing. This type ofbreathing, known as chest breathing, can lead to shortness of breath, increased muscle tension, and inadequate755oxygenation of blood.

Breathing exercises can both improve respiratory function and relieve stress and tension. Before starting to learnbreathing exercises, individuals should first become aware of their breathing patterns, i.e. chest or abdominalbreathing. This can be accomplished by placing one hand on the chest and one hand on the abdomen, andobserving which hand moves farther during breathing. If it is the hand placed on the chest, then chest breathing760is occurring and breathing exercises may be beneficial.

Deep breathing exercises are best performed while laying flat on the back, usually on the floor with a mat. Theknees are bent, and the body (particularly the mouth, nose, and face) is relaxed. Again, one hand should beplaced on the chest and one on the abdomen to monitor breathing technique. The individual takes a series of

long, deep breaths through the nose, attempting to raise the abdomen instead of the chest. Air is exhaled765through the relaxed mouth. Deep breathing can be continued for up to 20 minutes. After the exercise iscomplete, the individual checks again for body tension and relaxation.

Once deep breathing techniques have been mastered, an individual can use deep breathing at any time or placeas a quick method of relieving tension.

Release-only relaxationLike progressive relaxation, release-only relaxation focuses on relieving feelings of770tension in the muscles.

However, it eliminates the initial use of muscle tensing as practiced in progressive relaxation, focusing insteadsolely on muscle relaxation. Release-only relaxation is usually recommended as the next step in relaxationtherapy after progressive relaxation has been mastered.

In release-only relaxation, breathing is used as a relaxation tool. The individual sits in a comfortable chair and775begins to focus on his breathing, envisioning tension leaving the body with each exhale. Once even, deep,abdominal breathing is established, the individual begins to focus on releasing tension in each muscle group,until the entire body is completely relaxed.

Cue-controlled relaxationCue-controlled relaxation is an abbreviated tension-relief technique that combineselements of release-only relaxation and deep breathing exercises. It uses a cue, such as a word or mental780image, to trigger immediate feelings of muscle relaxation. The cue must first be associated with relaxation in theindividuals mind. This is accomplished by choosing the cue, and then using it in breathing and release-onlyrelaxation exercises repeatedly until the cue starts to automatically trigger feelings of relaxation outside of thetreatment sessions. Cues can be as simple as the word relax, and are frequently used on relaxationaudiotapes. They can also be a visual cue, such as a mental image of a white sand Caribbean beach, a flower-785

filled meadow, or other relaxing images. Guided imagery also uses such visualization exercises to producefeelings of relaxation.

Guided imageryis a two-part process. The first component involves reaching a state of deep relaxation throughbreathing and muscle relaxation techniques. During the relaxation phase, the person closes his eyes andfocuses on the slow, in and out of his breathing. Or, he/she might focus on releasing the feelings of tension from790his muscles, starting with the toes and working up to the top of the head. Relaxation tapes often feature softmusic or tranquil, natural sounds such as rolling waves and chirping birds in order to promote feelings ofrelaxation.

Once complete relaxation is achieved, the second component of the exercise is the imagery, or visualization,

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itself. Relaxation imagery involves conjuring up pleasant, relaxing images that rest the mind and body. These795may be experiences that have already happened, or new and even imaginary situations.

The individual may also use mental rehearsal. Mental rehearsal involves imagining a situation or scenario and itsideal outcome. It can be used to reduce anxiety about an upcoming situation, such as childbirth, surgery, or evena critical event such as an important competition or a job interview. Individuals imagine themselves goingthrough each step of the anxiety-producing event and then successfully completing it.800

Biofeedbackor applied psychophysiological feedback, is a patient-guided treatment that teaches an individual tomanipulate muscle tension through relaxation, visualization, and other cognitive techniques. The namebiofeedback refers to the biological signals that are fed back, or returned, to the patient in order for the patient todevelop techniques of controlling them.

During biofeedback, one or more special sensors are placed on the body. These sensors measure muscle805tension, brain waves, heart rate, body temperature, and translate the information into a visual and/or audiblereadout, such as a paper tracing, a light display, or a series of beeps. While the patient views the instantaneousfeedback from the biofeedback monitors, he begins to recognize what thoughts, fears, and mental imagesinfluence his physical reactions. By monitoring this relationship between mind and body, he can then usethoughts and mental images deliberately to manipulate heart beat, brain wave patterns, body temperature, and810other bodily functions, and to reduce feelings of stress. This is achieved through relaxation exercises, mentalimagery, and other cognitive therapy techniques.

As the biofeedback response takes place, the patient can actually see or hear the results of his efforts instantlythrough the sensor readout on the biofeedback equipment.

Once these techniques are learned and the patient is able to recognize the state of relaxation or visualization815necessary to alleviate symptoms, the biofeedback equipment itself is no longer needed. The patient then has apowerful, portable, and self-administered treatment tool to deal with problem symptoms.

There are dozens of other effective therapies that promote relaxation, including hypnosis, meditation, yoga,aromatherapy, hydrotherapy, tai chi, massage, art therapy, and others. Individuals should choose a type ofrelaxation therapy based on their own unique interests and lifestyle requirements.820

Preparations If an individual is considering relaxation therapy to alleviate physical symptoms such asnausea, headache, high blood pressure, fatigue, or gastrointestinal problems, he or she should consult a doctorfirst to make sure there isnt an underlying disorder or disease causing the symptoms. A complete physicalexamination and comprehensive medical history will be performed, and even if an organic cause for thesymptoms is found, relaxation exercises may still be recommended as an adjunct, or complementary, treatment825to relieve discomfort.

Relaxation therapy should always take place in a quiet, relaxing atmosphere where there is a comfortable placeto sit or recline. Some people find that quiet background music improves their relaxation sessions. If aninstructional audiotape or videotape is to be used, the appropriate equipment should be available.

The relaxation session, which can last anywhere from a few minutes to an hour, should be uninterrupted. Taking830the phone off the hook and asking family members for solitude can ensure a more successful and relaxingsession.

PrecautionsMost commonly practiced relaxation techniques are completely safe and free of side effects.Relaxation techniques that involve special exercises or body manipulation such as massage, tai chi, and yogashould be taught or performed by a qualified professional or instructor. These treatments may not be suitable for835individuals with certain health conditions such as arthritis or fibromyalgia. These individuals should consult withtheir healthcare professionals before engaging in these therapies.

Biofeedback may be contraindicated (not recommended) in some individuals who use a pacemaker or otherimplantable electrical devices. These individuals should inform their biofeedback therapist before startingtreatments, as certain types of biofeedback sensors have the potential to interfere with their use.840

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Some relaxation therapies may also be inappropriate for cognitively impaired individuals (e.g., patients withorganic brain disease or a traumatic brain injury) depending on their level of functioning. Given the wide range ofrelaxation therapies available, if one type of relaxation treatment is deemed inappropriate for these patients, asuitable alternative can usually be recommended by a qualified healthcare professional.

Side effects Relaxation therapy can induce sleepiness, and some individuals may fall asleep during a845session. Relaxation therapy should not be performed while operating a motor vehicle or in other situations where

full and alert attention is necessary. Other than this, there are no known adverse side effects to relaxationtherapy.

Research & general acceptance Relaxation therapies have been successfully used in relievingstress and anxiety for many years, and are generally well-accepted by the medical community for this purpose.850

Recently published research has also indicated that relaxation therapy may be useful in reducing the incidenceof preterm labor in women at risk for delivering prematurely. The study also found that women who discontinuedrelaxation exercises for whatever reasons delivered earlier and had lower birth-weight babies than those whocontinued the treatment.

Training & certification Relaxation therapy techniques are used by many licensed therapists,855counselors, psychologists, psychiatrists, and other healthcare professionals. There are many self-help books,

audiotapes, and videos available that offer instruction in relaxation techniques. (2002)

Botanical medicine

Botanical medicine is a vital component of the healing arts that draws on the accumulated and developingknowledge of the medicinal properties of plants in the prevention and treatment of disease. Botanical medicine860includes medical herbalism, a healing art that relies on the synergistic and curative properties of plants to treatsymptoms and disease and maintain health, and pharmocognosy, the study of natural products. Botanicalmedicine is an important component of numerous traditional medical systems and therapies, including traditionalChinese medicine (TCM), Ayurvedic medicine, naturopathy, indigenous and shamanic medicine, homeopathy,flower essence therapy, and aromatherapy.865

Botanical medicine has survived for many thousands of years in some form and in all cultures throughout theworld. The study of the plant lore of these various cultures is known as ethnobotany.

Plants have been used since prehistoric times as medicinal remedies applied in various ways to provide relieffrom irritations as minor as a mosquito bite to situations as catastrophic as the plague. In modern medicine,some drugs are derived from plants, and many of these medicines are used in ways that are similar to their870traditional uses. Many more drugs in modern medicine, however, are synthetic, and part of the reason for thistrend is economic: plants can rarely be patented, so a pharmaceutical company will not gain the exclusive rightto sell a plant-derived medication even after expensive research and marketing.

Also, the processing of plants into a medicine cannot be as easily standardized and controlled as themanufacturing of a synthetic. As a result, the efficacy and safety of only a relative few of the traditionally used875botanical remedies have been verified by clinical research. Approximately only 5,000 of the estimated 500,000

known species (including subspecies) of plants have been identified and studied for their medicinal properties.

The knowledge of the healing properties of herbs has been preserved from the time of the clay tablets of theancient Sumerians over 5,000 years ago, to the sacred texts and pharmacopoeias of the Hindu and Chinesecultures, to the works of Greek and Roman physicians preserved by Byzantine scholars, to the European folk880herbalists and physicians such as Nicholas Culpeper and, more recently, to the Native American herbalists. Oneof the earliest records of botanical medicine is the Pen Ts ao Kang Mu, a work compiled by Li Shih-chen duringChinas Yellow Emperor reign around 2500 B.C. Another is the Ebers papyrus, an Egyptian medical text datingfrom 1,550 B.C. The Rig-veda, an ancient Hindu scripture, lists more than 1,000 medicinal plants used in theancient Ayurveda system of medicine, already well developed by 1000 B.C.885

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Theophrastus, who lived from 327285 B.C. is considered the first scientific botanist; he recorded the use ofmore than 500 medicinal plants. The Greek physician Dioscorides produced what has been called the first trueherbal text, or herbal, the De materia medica in the first century A.D. By the Middle Ages, the monks in medievalEuropean monasteries were working to preserve this ancient knowledge by copying texts and cultivatingextensive gardens of medicinal plants. European folk medicine was passed from generation to generation890through oral tradition, and later, with the introduction of the printing press, the information became more widelyavailable in popular written texts. Colonists brought their herbal knowledge and plant specimens to settlementsin North America and learned from the indigenous Americans how to make use of numerous additional plants

native to the New World. The first record of Native American herb use is the manuscript of the Native Mexicanphysician Juan Badianus in 1552.895

The use of herbs for medicinal purposes has been developed over the centuries by personal experimentation,local custom, anecdote, and folk tradition. According to the World Health Organization, an estimated 80% of theglobal population continues to rely on medicinal plant preparations to meet primary health care needs. Forexample, a 2003 study found t