The Rational Basis of "Nature Cure"
Naturopathic Gathering, SCNM—November 15, 2008
by André Saine, N.D.
William Durant, the great American philosopher and historian, said, "Philosophy is the pursuit of understanding through perspective." There are no subjects more vital to humanity than the ones related to health, disease, healing, and the quality and prolongation of life. Unfortunately, much confusion continues to reign over this domain despite great strides made in biomedical and other sciences in recent centuries. The increasing rate of iatrogenic and chronic diseases in the Western world clearly depicts this state of confusion. It has been postulated that the main reason for this state of confusion is that conventional medicine has no coherent philosophy, if it has one at all. Arthur L. Caplan, professor of medical ethics at the University of Pennsylvania, wrote, "It is unfortunate that the philosophy of medicine does not exist because it can and should be contributing to the analysis of the goals that ought be driving endeavors and make vital contributions" (Caplan, 1992).
Sixty-five years earlier, Crookshank had written, "In default of a Philosophy of Medicine there can indeed be no true Science of Medicine … He is the best physician in the classical and fullest sense of the word who unites a mastery of his Art to an intimate acquaintance with the great historical doctrines and the philosophies on which they are based" (Crookshank, 1927).
Clarity of mind leads to clarity of action. The objective of this essay is to develop a clear understanding of the most fundamental principles of medicine for the purposes, first, of guiding physicians to practice in the most effective and wisest way possible, and second, to provide guidelines to educators to develop a more effective system of medical training.
Let's begin our "pursuit of understanding" with the meaning of the title of this essay. "Rational" refers to an exposition of principles that is based on sound reasoning and accurate observation.
The expression "Nature Cure" is in quotation marks in the tile of this essay because of its questionable meaning.
It is an expression that was most used towards the end of the nineteenth century and throughout a large part of the twentieth century, and now seems to be more rarely used, except perhaps in circumstances when naturopathic students and physicians are searching for or are being reminiscent of their roots.
In this context, the word "cure" means care, treatment or a method of treatment, and not the recovery of health. Therefore, "Nature Cure" essentially means a system of natural treatment.
As a method of treatment, the expression "Nature Cure" first appeared in the English literature in the 1890's (Conger, 1893), which corresponded with Arnold Rikli's influential publication of Die Grundlehren der Naturheilkunde (The Basic Teachings of Naturheilkunde) (Rikli, 1890). Therefore, the expression "Nature Cure" seems to be the arbitrarily adopted translation of "Naturheilkunde," (Dodds, 1897 and Aidall, 1897). The expression "Naturheilkunde" precedes Rikli, and can be found in the German literature throughout the nineteenth century and as early as 1802 (Erdmann, 1802). Incidentally, the German word "Wasserheilkunde" had been translated and commonly used in English as "water cure" since the 1830's. The 1849 biography of J. H. Rausse was entitled, Der Reformator der Wasserheilkunde oder Naturheilkunde (The Reformator of Water Cure or Nature Cure [sic: Worlcat]) (Kapp, 1849).
"Naturheilkunde" comes from three German words, namely, Natur, according to Nature or natural; heilen, to restore wholeness or healing; Kunde, all encompassing knowledge. Therefore, the more accurate translation of "Naturheilkunde" would be the Principles and Practice of Natural Healing.
However, as natural healing is inseparable from natural living, it should be the Principles and Practice of Natural Living and Healing.
Today, when German physicians who specialize in Naturheilkunde are asked to translate in English "Naturheilkunde," they spontaneously say, "naturopathy." "Naturheilkunde" is also translated as "naturopathy" in the German-English Technical Dictionary (Leidecker, 1951). We can thus conclude that Nature Cure, Naturheilkunde, naturopathy, and naturopathic medicine, all mean the Principles and Practice of Natural Living and Healing.
Even though, the "nature cure" movement of the nineteenth century was very rich in experience and much is to be learned from it, I would argue that, as naturopathic physicians, we should not be confined to a movement or an era in search of our roots. Instead, we should consider all the principles and practice of natural living and healing expounded by various traditions throughout the eras. A common goal should be the continual pursuit of a coherent understanding of all the principles and practice of natural living and healing for the welfare of humanity.
The Roots of Naturopathic Medicine
Before further developing perspective on the roots of naturopathic medicine, let's look at the etymology of five words which are key to naturopathic medicine, namely, the words, "natural," "naturopathic," "medicine," "physician," and "healing."
The word "natural" or "nature" comes from the Latin "natus," which means to be born, or innate, and gave us the word "nativity." It also gave the Latin words "natura," which means Nature, and "naturalis," which means natural or that which is innate, or in conformity with the laws of nature.
The word "natural" was commonly used in reference to new health care and healing approaches throughout the nineteenth century simply because conventional medicine of that time was based on the belief that disease was caused by bad humors which needed to be purged out of the body, commonly with the use of bleeding, vomiting, cathartics and heroic polypharmacy, often with very toxic drugs, all with complete disregard for the nature of man and the innate process of healing. Therefore, the expression "natural" was a very strong message of a health care movement respectful of the nature of man.
The word "naturopathic" comes from the Latin "natura," and the Greek "pathos," meaning affection, feelings or symptoms. In the nineteenth century, it was common to name new healing art approaches finishing with pathy, such as hydropathy, osteopathy, naturopathy, naprapathy, etc. Originally, at the beginning of the nineteenth century, Samuel Hahnemann had called his therapeutic approach based on similarity, homoeopathy, from the Greek "homoios" (similar). He had also called the medicinal system not based on similarity, allopathy, from the Greek "alloios" (dissimilar), and antipathy, the one based on contrary. It seems that the ending "pathy," first used by Hahnemann was commonly but wrongly interpreted by others as a method of treatment (by similarity in the case of homeopathy). Hydropathy and water cure were therefore synonymous. As for the exact origin of the word "naturopathic," Benedict Lust wrote, "Perhaps a word of appreciation is due to Mr. John H. Scheel, who first used the term "Naturopathic" in connection with his Sanitarium 'Badekur' " (Lust, 1902). Incidentally, a physician by the name of Jacob W. Crosby practiced "Naturepathy" in Boston from at least 1866 and until 1880.
The word "medicine" comes from the Proto-Indo-European (PIE) root "med," meaning to measure, consider, ponder upon or advise, which gave rise to "meditation" and "mediation," but also to three pertinent Latin words, namely, "medicus" which means the one who knows the best course, "mederi," which means to treat, and "medecina," which means the art of healing.
The word "physician" comes from the Greek "phusis," which means Nature. It gave rise to "phusikos" in Greek, "physicus" in Latin and "physician" in English, whose original meaning is a student of nature, a natural philosopher or natural scientist, or even better, the one who studies nature's laws and principles, and their applications.
As for the word "healing," it comes from the PIE root "kailo," which means whole or uninjured, and gave rise to "holy" and three Old English words, namely, "hælp," which means wholeness, of being whole, sound or well, "hal," which means hale, robust or in good health, and "hælan," which means to heal, to restore wholeness.
As for the immediate roots of the nature cure movement at the time of the foundation of the naturopathic profession at the end of the nineteenth century in America, they are a mix of mostly German and American approaches of natural living and healing, which include hygiene, inspired by Hufeland, Graham, Jennings, Trall and Jackson; hydrotherapy, emerging from the teachings of Priessnitz, Rausse, Shew, Jackson, Kneipp and Kellogg; homeopathy, developed by Hahnemann and pursued by a large and influential American following; physical medicine, from the teachings of Kellogg, Palmer and Still; botanical medicine, from the Native American traditions, Thomson, Beach (eclectism), and the European herbal traditions.
I would like to make the simple argument that the roots of natural living and healing are as old as humanity and medicine. As the essence of medical endeavors at all times throughout humanity has been the enhancement of health, the prevention and cure of diseases, and the prolongation of life, it would be difficult to find a civilization or a system of traditional medicine throughout the different eras which doesn't mention some elements of natural living and healing.
To name a few examples, the concepts of innate healing, wholism, or health, as a state of balance and harmony, are found in the Nei Ching (2,700 BC) and in Ayurveda (science of life) (1,500 BC). The concepts of iatrogenic diseases and that disease is a multifactorial phenomenon with a fundamental cause and auxiliary causes are also found in Ayurvedic medicine. The concept of psychic causes of somatic diseases is almost universal in ancient medicine. Hygiene is omnipresent in all traditional systems. Galen (2nd century AD) wrote a text on the Art of Preserving Health (De Sanitate Tuenda), which reflects the medical lore of several centuries. Hydrotherapy is found in the Egyptian, Greek, Roman and Arabic medical traditions. Heliotherapy was used by the Egyptians more than 5,000 years ago. Therapeutic fasting can be found in the writing of the Pythagorean (6th century BC) and Hippocratic (5th century BC) schools. Pythagoras had learned about fasting and doing a 40-day initiation fast from the Egyptians in Memphis where he studied for 20 years. The principle of similitude is found throughout the history of medicine, notably in the writings of Hippocrates and Paracelsus. Celsus (1st century AD) left the famous maxim, Cito, tuto et jucunde (quickly, safely and pleasantly), which has ever since profoundly impacted medical thinking.
We also have to mention that in most of these old medical traditions you will find elements that are contrary to human nature, or to put it more mildly, less favorable to health and healing. For instance, blood-letting was used since the most ancient times, and was popular in the Egyptian and Greek medical traditions. Mercury in crude doses was used in Chinese, Tibetan, Indian, Egyptian, Greek and Roman medical traditions.
If we try to integrate what can be learned since ancient times, we find seven fundamental principles solidly embedded throughout the history of medicine.
Incidentally, the word "principles" comes from the Latin "principium," which means beginning or fundamental truth.
I would argue that the principles elaborated below are indisputable, universal, and impeccably sound, and are in fact the fundamental principles of classical medicine.
"Classical" is referring here of the highest standards and traditionally authoritative.
The Seven Fundamental Principles of Classical Medicine
The first principle applies to the physician, the actor, while the six others apply to the actual practice of medicine, the acting.
1. Aude sapere: Physician, dare to know, and become a true philosopher and scientist but above all, a true artist. Constant inquiry is the way to knowledge.
2. Praeventum: Prevention is better than a cure. Therefore, the highest mission of the physician is to guide people to choose ways of living and adopt environments that are conducive to good health.
3. Primum non nocere: First, physician, do no harm. In spite of the best prevention, people will be affected by numerous influences and will fall sick. Any prophylactic, diagnostic or therapeutic intervention by the physician should not further harm the patient.
4. Tolle causam, cessat effectus: Remove the cause and the effect will cease. There are causes of sickness and above all, physician: address them.
5. Vis medicatrix naturae: The healing power of nature. It is neither the physician nor the treatment that heals but only the living organism. Therefore, the physician must seek to encourage this innate process by first making sure that the conditions of life are met and, if necessary, by using the help of the various outer influences and forces of nature to enhance the recovery of health.
6. Nunquam pars pro toto: Never the part but always the whole. The physician considers the patient as a unique indivisible whole and, therefore, takes into consideration all the conditions of life and pertinent aspects of each individual, including the physical, emotional, mental, spiritual, energetic, genetic, sociological and environmental aspects.
7. Cito, lenis, jucunde, toto, durabile, certo, simplex et tuto curare: The highest ideal of therapy is the rapid, gentle, pleasant, complete and permanent restoration of health in the surest, simplest and least harmful way.
Incidentally this set of principles can be applied to any aspect of life, especially related to solving problems, whether they are personal or societal, physical or psychological, or in economics, politics, mechanics, etc.
Each of the above principles has a subset of numerous implications and sub-principles.
Perhaps you have noticed that I didn't call this set of principles, "The Seven Fundamental Principles of Naturopathic Medicine," as it has been my experience that, at this time, too few naturopathic physicians truly practice according to these principles. I understand that the profession has adopted some of these principles but, at this time, it seems to be more an ideal than a reality. Would it be right to say we abide by the totality of these principles when in actual practice we very rarely do?
Naturopathic medical colleges, associations and institutions should strive to insure that naturopathic medical education becomes and remains fully concordant with the above set of principles.
From these seven principles, many dozens sub-principles and multiple implications can be deducted which further guide physicians in their mission and educators in developing effective training programs for physicians. As an instance, a sub-principle of Tolle causam, cessat effectus is Bona diagnosis, bona curatio (good diagnosis, easy cure). This implies that physicians must be well trained in diagnosis with a thorough knowledge in the examination of patients in order to find the precise causes of disease and their effects. This further implies that physicians must have a thorough knowledge of physiology and pathology, and have the basis to make accurate prognoses. The study of pathology can't be reduced to lesional changes, as it is commonly found in modern textbooks of pathology, but must also include all changes from the normal state of health, including functional, emotional or mental changes, abnormal sensitivities or particular sensations.
Essentially, the practice of naturopathic medicine when dealing with sick people can be summarized in three basic steps: first, a thorough examination of the patient with the objective of obtaining a precise diagnosis of the causes of disease and their effects, therefore the identification of the forces and influences at play; second, the removal of the most ultimate and primary causes of disease; and third, to support the organism to heal with the adoption of conditions, forces and influences conducive to good health, healing and recovery.
In conclusion, naturopathic medicine is wise, rational, resourceful, scientific and effective.
It is wise, because it is safe and wholistic; it affects the fundamental causes of disease, and uses the different forces and influences of nature to heal in a gentle manner.
It is rational, as it is based on impeccably sound reasoning and accurate observation by large groups of people over long periods of time.
It is resourceful, as it draws its body of knowledge from many traditions and eras in all the disciplines of natural living and healing. Our armamentarium is as rich and powerful as are the healing forces in nature.
It is scientific, as from observation of nature we draw principles, apply these principles and report our results and verifications. Peer-reviewed journals already contain a huge wealth of this information.
It is effective, as above all, we guide sick people to recover their health and when our principles are appropriately applied and our armamentarium is fully employed, few are the ones who can't be significantly helped in their recovery of health from acute or chronic ailments. Moreover, the cost effectiveness of naturopathic medicine is so superior to conventional medicine that they are not in the same league.
Magna est veritas et prævalebit.(1)
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(1) Great is the truth and it will prevail
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