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According the National Center for Complementary and Integrative Health, integrative medicine brings together complementary therapies (eg, supplements, natural products, and mind-body therapies) into mainstream health care. It is evidence-based and patient-centered in that it considers the clinician's relationship with the patient as the central therapeutic element. It is comprehensive in its approach, assessing the patient's mind, body, and spirit, as well as the social, community, and environmental dimensions of health. It strongly emphasizes foundational health practices such as nutrition, exercise, sleep, and stress management. In addition, it recognizes that the human being has a powerful, innate capacity for healing. Finally, it incorporates complementary modalities when clinically indicated, in a way that is safe and synergistic with conventional therapies.

Complementary and integrative therapies (CIT) can be divided into five categories:

  1. Biologically based therapies (eg, use of natural products such as fish oil, probiotics, botanical medicines)

  2. Mind-body medicine (eg, biofeedback, meditation, hypnosis, guided imagery)

  3. Manual medicine (eg, osteopathy, chiropractic, massage therapy)

  4. Energy medicine (eg, reiki, therapeutic touch)

  5. Whole systems (eg, traditional Chinese medicine, Ayurveda, homeopathy)

Some of these therapies, especially some of the whole systems, are several thousand years old, and as complete systems, they include elements from all other categories. For example, traditional Chinese medicine uses acupuncture (which might be energy medicine or manual medicine), botanical medicines (biologically based therapies), tui na (manual medicine), and qigong (mind-body medicine).

The use of CIT is common in the United States and around the world. To maintain effective patient-provider communication and ensure responsible clinical practice, it is important that clinicians learn some theory, practice, and scientific evidence associated with these therapies. This chapter provides an overview of three CIT modalities: herbal and dietary supplements (HDS), acupuncture, and mind-body medicine, as they represent the commonly used therapies studied in research and used in clinical practice.

GENERAL CONSIDERATIONS

The National Health Interview Survey (NHIS) conducted by the Centers for Disease Control and Prevention (CDC) in 2017 included questions on the use of CIT. Results showed that approximately one-third of Americans reported using some form of CIT in the previous 12 months. This proportion has stayed very consistent over 15 years. In addition, National Health and Nutrition Examination Survey (NHANES)—another CDC-administered survey—has looked at the prevalence of use of individual supplements or multivitamins/multiminerals in civilian, non-institutionalized persons living in the United States. The overall use of dietary supplements has remained stable (52% of the US population reporting any use in the previous 12 months), with the largest increases in vitamin D (5.1% to 19%) and fish oil (1.3% to 12 %). Among children, overall dietary supplement use has remained stable at ~30%, with largest increases observed in the use of omega-3 polyunsaturated fatty acids. Compared to the 2012 NHIS survey, the 2017 NHIS survey noted that there were increases in the use of yoga (from 9.5% to 14.3%), meditation (4.1% to 14.2%), and chiropractic ...

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