used as part of a multidisciplinary approach to cardiac rehabilitation and in many settings that specialize in treating chronic pain.

Hypnosis and hypnotic suggestion have been a part of healing from ancient times. The induction of trance states and the use of therapeutic suggestion were a central feature of the early Greek healing temples and variations of these techniques were practiced throughout the ancient world.

Modern hypnosis began in the 18th century with Franz Anton Mesmer, who used what he called "magnetic healing" to treat a variety of psychological and psychophysiological disorders, such as hysterical blindness, paralysis, headaches, and joint pains. Since then, the fortunes of hypnosis have ebbed and flowed. Freud, at first, found it extremely effective in treating hysteria and then, troubled by the sudden emergence of powerful emotions in his patients and his own difficulty with its use, abandoned it.

In the past 50 years, however, hypnosis has experienced a resurgence, first with physicians and dentists and more recently with psychologists and other mental health professionals. Today, it is widely used for addictions, such as smoking and drug use, for pain controls, and for phobias, such as the fear of flying.

One of the most dramatic uses of hypnosis is the treatment of congenital ichthyosis (fish skin disease), a genetic skin disorder that covers the surface of the skin with grotesque hard, wartlike, layered crust. Hypnosis is, however, most frequently used in more common ailments, either independently or in concert with other treatment, including the management of pain in a variety of settings, reduction of bleeding in hemophiliacs, stabilization of blood sugar in diabetics, reduction in severity of attacks of hay fever and asthma, increased breast size, the cure of warts, the production of skin blisters and bruises, and control of reaction to allergies such as poison ivy and certain foods.

Biofeedback is a treatment method that uses monitoring instruments to feed back to patients physiological information of which they are normally unaware. By watching the monitoring device, patients can learn by trial and error to adjust their thinking and other mental processes in order to control bodily processes heretofore thought to be involuntary-such as blood pres

sure, temperature, gastrointestinal functioning, and brain wave activity.

Biofeedback can be used to treat a very wide variety of conditions and diseases, ranging from stress, alcohol and other addictions, sleep disorders, epilepsy, respiratory problems, and fecal and urinary incontinence to muscle spasms, partial paralysis, or muscle dysfunction caused by injury, migraine headaches, hypertension, and a variety of vascular disorders. More applications are being developed yearly.

pre

Yoga is a way of life that includes ethical cepts, dietary prescriptions, and physical exercise. Its practitioners have long known that their discipline has the capacity to alter mental and bodily responses normally thought to be far beyond a person's ability to modulate them. During the past 80 years, health professionals in India and the West have begun to investigate the therapeutic potential of yoga. To date, thousands of research studies have been undertaken and have shown that with the practice of yoga a person can, indeed, learn to control such physiologic parameters as blood pressure, heart rate, respiratory function, metabolic rate, skin resistance, brain waves, body temperature, and many other bodily functions.

Regular yogic meditation also has been shown to reduce anxiety levels; cause the heart to work more efficiently and decrease respiratory rate; lower blood pressure and alter brain waves; increase communication between the right and left brain; reduce cholesterol levels (when used with diet and exercise); help people stop smoking; and successfully treat arthritis.

Dance therapy began formally in the United States in 1942, and in 1956 dance therapists from across the country founded the American Dance Therapy Association, which has now grown to over 1,100 members. It publishes a journal, the American Journal of Dance Therapy, fosters research, monitors standards for professional practice, and develops guidelines for graduate education.

Dance/movement therapy has been demonstrated to be clinically effective in the following: developing body image, improving self-concept and increasing self-esteem; facilitating attention; ameliorating depression, decreasing fears and anxieties, and expressing anger; decreasing isolation, increasing communication skills, and

fostering solidarity; decreasing bodily tension, reducing chronic pain, and enhancing circulatory and respiratory functions; reducing suicidal ideas, increasing feelings of well-being, and promoting healing; and increasing verbalization.

Music therapy is used in psychiatric hospitals, rehabilitation facilities, general hospitals, outpatient clinics, day-care treatment centers, residences for people with developmental disabilities, community mental health centers, drug and alcohol programs, senior centers, nursing homes, hospice programs, correctional facilities, halfway houses, schools, and private practice.

Studies have found music therapy effective as an analgesic, as a relaxant and anxiety reducer for infants and children, and as an adjunctive treatment with burn patients, cancer patients, cerebral palsy patients, and stroke, brain injury, or Parkinson's disease patients.

Art therapy is a means for the patient to reconcile emotional conflicts, foster self-awareness, and express unspoken and frequently unconscious concerns about his/her disease. In addition to its use in treatment, it can be used to assess individuals, couples, families, and groups. It is particularly valuable with children who often cannot talk about their real concerns.

Research on art therapy has been conducted in clinical, educational, physiological, forensic, and sociological arenas. Studies on art therapy have been conducted in many areas including with burn recovery in adolescent and young patients, with eating disorders; with emotional impairment in young children, with reading performance, with chemical addiction, and with sexual abuse in adolescents.

Prayer and mental healing techniques fall into two main types. In Type I healing, the healer enters a prayerful, altered state of consciousness in which he views himself and the patient as a single entity. There need be no physical contact and there is no attempt to "do anything" or "give something" to the person in need, only the desire to unite and "become one" with him or her and with the Universe, God, or Cosmos. Type II healers, on the other hand, do touch the healee and describe some "flow of energy" through their hands to the patient's area of pathology. Feelings of heat are common in both healer and healee. These healing techniques are offered only as generalities. Some healers use both methodologies,

even in the same healing session, and other healing methods could be described.

There exist many published reports of experiments in which persons were able to influence a variety of cellular and other biological systems through mental means. The target systems for these investigations have included bacteria, yeast, fungi, mobile algae, plants, protozoa, larvae, insects, chicks, mice, rats, gerbils, cats, and dogs, as well as cellular preparations (blood cells, neurons, cancer cells) and enzyme activities. In human "target persons," eye movements, muscular movements, electrodermal activity, plethysmographic activity, respiration, and brain rhythms have been affected through direct mental influence.

These studies in general assess the ability of humans to affect physiological functions of a variety of living systems at a distance, including studies where the "receiver" or "target" is unaware that such an effort is being made. The fact that these studies commonly involve nonhuman targets is important; lower organisms are presumably not subject to suggestion and placebo effects, a frequent criticism when human subjects are involved.

Many of these studies do not describe the psychological strategy of the influencer as actual "prayer," in which one directs entreaties to a Supreme Being, a Universal Power, or God. But almost all of them involve a state of prayerfulness-a feeling of genuine caring, compassion, love, or empathy with the target system, or a feeling that the influencer is "one" with the target.

In addition to preventing or curing illnesses, these therapies by and large provide people the chance to be involved in their own care, to make vital decisions about their own health, to be touched emotionally, and to be changed psychologically in the process. Many patients today believe their doctor or medical system is impersonal, remote, and uncaring. The mindbody approach is potentially a corrective to this tendency, a reminder of the importance of human connection that opens up the power of patients acting on their own behalf.

More work needs to be done, but there is already a growing amount of evidence that many of the mind-body therapies discussed in this report, if appropriately selected and wisely applied, can

be clinically as well as economically cost-effective, that they work, and that they are safe.

Bioelectromagnetics Applications in Medicine

Bioelectromagnetics (BEM) is an emerging science that studies how living organisms interact with electromagnetic (EM) fields. Electrical phenomena are found in all living organisms, and electrical currents in the body can produce magnetic fields that extend outside the body. Those that extend outside the body can be influenced by external magnetic and EM fields. Changes in the body's natural fields may produce physical and behavioral changes.

Endogenous (internal) fields are distinguished from exogenous (external) fields. The latter can be natural, such as the earth's geomagnetic field, or artificial, such as power lines, transformers, appliances, radio transmitters, or medical devices. Oscillating nonionizing EM fields in the extremely low frequency (ELF) range can have vigorous biological effects that may be beneficial. Changes in the field configuration and exposure pattern of low-level EM fields can produce specific biological responses, and certain frequencies have specific effects on body tissues.

The mechanism by which EM fields produce biological effects is under increasing study. At the cutting edge of BEM research is the question of how endogenous EM fields change with consciousness. Nonionizing BEM medical applications are classified according to whether they are thermal or nonthermal in biological tissue. Thermal applications of nonionizing radiation include radio frequency (RF) hyperthermia, laser and RF surgery, and RF diathermy.

The most important BEM modalities in alternative medicine are nonthermal applications of nonionizing radiation. Major new applications of nonthermal, nonionizing EM fields are bone repair, nerve stimulation, wound healing, treatment of osteoarthritis, electroacupuncture, tissue regeneration, and immune system stimulation.

In the study of other alternative medical treatments, BEM offers a unified conceptual framework that may help explain how diagnostic and therapeutic techniques such as acupuncture and homeopathy may produce results that are hard to understand from a more conventional viewpoint.

Alternative Systems of Medical Practice Worldwide, only an estimated 10 percent to 30 percent of human health care is delivered by conventional, biomedically oriented practitioners. The remaining 70 percent to 90 percent ranges from self-care according to folk principles to care given in an organized health care system based on an alternative tradition or practice.

Popular health care is the kind most people practice and receive at home, such as giving herbal tea to someone who has a cold. Community-based health care, which reflects the health needs, beliefs, and natural environments of those who use it, refers to the nonprofessionalized but specialized health care practices of many rural and urban people. Professionalized health care is more formalized; practitioners undergo more standardized training and work in established locations.

Professionalized health care systems. The professionalized health care practitioners often have conducted scientific studies about the causes of illness and explanations and results of treatment. Each of the major professionalized systems has certain characteristics: a theory of health and disease; an educational scheme to teach its concepts; a delivery system involving practitioners; a material support system to produce medicines and therapeutic devices; a legal and economic mandate to regulate its practice; cultural expectations about the medical system's role; and a means to confer professional status on approved providers. These professionalized medical systems include traditional oriental medicine, acupuncture, Ayurvedic medicine, homeopathy, anthroposophy, naturopathy, and environ

mental medicine.

Traditional oriental medicine is a sophisticated set of many systematic techniques and methods, including acupuncture, herbal medicine, acupressure, qigong, and oriental massage. The most striking characteristic of oriental medicine is its emphasis on diagnosing disturbances of qi, or vital energy, in health and disease. Diagnosis in oriental medicine involves the classical procedures of observation, listening, questioning, and palpation, including feeling pulse quality and sensitivity of body parts.

The professionalization of oriental medicine has taken diverse paths in both East Asia and the

United States. Currently, the model in the People's Republic of China, which was established after the 1949 revolution, involves the organized training of practitioners in schools of traditional Chinese medicine. The curriculum of these schools includes acupuncture, oriental massage, herbal medicine, and pharmacology, though the clinical style of making a diagnosis and then designing a treatment plan is the one traditionally associated with herbal medicine. The graduates of these colleges are generally certified in one of the four specialty areas at a training level roughly equivalent to that of a Western country's bachelor's degree.

In the United States, the professional practitioner base for oriental medicine is organized around acupuncture and oriental massage. There are about 6,500 acupuncturist practitioners in the United States. The American Oriental Body Work Therapy Association has approximately 1,600 members representing practitioners of tuina, shiatsu, and related techniques. Many American schools of acupuncture are evolving into "colleges of oriental medicine" by adding courses in oriental massage, herbal medicine, and dietary interventions. They also are offering diplomas, master's degrees, and doctor's degrees in oriental medicine. The legal sanctioning of oriental medical practice is most extensive in New Mexico, where the acupuncture community has established an exclusive profession of oriental medicine. Their legal scope of practice is currently similar to that of primary care M.D.s and D.O.s (doctors of osteopathy), and their State statute restricts other licensed New Mexico health professionals' ability to advertise or bill for oriental medicine or acupuncture services.

Extensive research has been done in China through the institutions of traditional Chinese medicine, but only in the past quarter century have biomedical scientists in China characterized and identified active agents in much of traditional medical formulary. The use of traditional oriental herbal medicines and formulas in China and Japan has been studied for therapeutic value in the following areas: chronic hepatitis; rheumatoid arthritis; hypertension; atopic eczema; various immunologic disorders, including acquired immunodeficiency syndrome (AIDS); and certain cancers. It would be useful to repeat these studies in the United States, assessing U.S. clini

cal populations according to high-quality research criteria.

Acupuncture involves stimulating specific anatomic points in the body for therapeutic purposes. Puncturing the skin with a needle is the usual method, but practitioners also use heat, pressure, friction, suction, or impulses of electromagnetic energy to stimulate the points. In the past 40 years acupuncture has become a wellknown, reasonably available treatment in developed and developing countries. Acupuncture is used to regulate or correct the flow of qi to restore health.

Modern theories of acupuncture are based on laboratory research conducted in the past 40 years. Acupuncture points have certain electrical properties, and stimulating these points alters chemical neurotransmitters in the body. The physiological effects of acupuncture stimulation in experimental animals have been well documented, and in the past 20 years acupuncture has become an increasingly established health care practice. An estimated 3,000 conventionally trained U.S. physicians have taken courses to incorporate acupuncture in their medical practices.

Acupuncture is one of the most thoroughly researched and documented of the so-called alternative medical practices. A series of controlled studies has shown compelling evidence for the efficacy of acupuncture in the treatment of a variety of conditions, including osteoarthritis, chemotherapy-induced nausea, asthma, back pain, painful menstrual cycles, bladder instability, and migraine headaches. Studies on acupuncture also have shown positive results in the areas of chronic pain management and in the management of drug addiction, two areas where conventional Western medicine has had only a modicum of success.

Ayurveda is India's traditional, natural system of medicine that has been practiced for more than 5,000 years. Ayurveda provides an integrated approach to preventing and treating illness through lifestyle interventions and natural therapies. Ayurvedic theory states that all disease begins with an imbalance or stress in the individual's consciousness. Lifestyle interventions are a major Ayurvedic preventive and therapeutic approach. There are 10 Ayurveda clinics in North America, including one hospital-based clinic that has served 25,000 patients since 1985.

In India, Ayurvedic practitioners receive staterecognized, institutionalized training in parallel to their physician counterparts in India's statesupported systems for conventional Western biomedicine and homeopathic medicine. The research base is growing concerning the physiological effects of meditative techniques and yoga postures in Indian medical literature and Western psychological literature. Published studies have documented reductions in cardiovascular disease risk factors, including blood pressure, cholesterol, and reaction to stress, in individuals who practice Ayurvedic methods.

Laboratory and clinical studies on Ayurvedic herbal preparations and other therapies have shown them to have a range of potentially beneficial effects for preventing and treating certain cancers, treating infectious disease, promoting health, and treating aging. Mechanisms underlying these effects may include free-radical scavenging effects, immune system modulation, brain neurotransmitter modulation, and hormonal effects.

Homeopathic medicine is practiced worldwide, especially in Europe, Latin America, and Asia. However, even in the United States the homeopathic drug market is a multimillion-dollar industry. Homeopathic remedies, which are made from naturally occurring plant, animal, or mineral substances, are recognized and regulated by the Food and Drug Administration (FDA) and are manufactured by established pharmaceutical companies under strict guidelines. Homeopathy is used to treat acute and chronic health problems as well as for disease prevention and health promotion. Recent clinical trials suggest that homeopathic medicines have a positive effect on allergic rhinitis, fibrositis, and influenza.

Basic research in homeopathy has involved investigations into the chemical and biological activity of highly diluted substances. Some homeopathic medicines are diluted to concentrations as low as 10-30 to 10-20,000 This particular aspect of homeopathic theory and practice has caused many modern scientists to reject homeopathic medicine. Critics of homeopathy contend that such extreme dilutions of the medicines are beyond the point at which any active molecules of the medicine can theoretically still be found in the solution. On the other hand, scientists who accept the potential benefits of homeopathic theory suggest several theories to explain how

highly diluted homeopathic medicines may act. Using recent developments in quantum physics, they have proposed that electromagnetic energy in the medicines may interact with the body on some level. Researchers in physical chemistry have proposed the "memory of water" theory, whereby the structure of the water-alcohol solution is altered by the medicine during the process of dilution and retains this structure even after none of the actual substance remains.

Anthroposophically extended medicine is an extension of Western biomedicine and also incorporates approaches and therapeutics from two alternative medicine movements: naturopathy and homeopathy. There are an estimated 30 to 100 M.D.s in the United States who practice anthroposophical medicine. Hundreds of uniquely formulated medications are used in anthroposophical practice, each seeking to match the key dynamic forces in plants, animals, and minerals with disease processes in humans to stimulate healing. Much research in anthroposophically extended medicine has been connected with attempts to understand the nature of disease, assess treatments qualitatively, and understand how the essential properties of the objects under investigation could be applied in therapy.

Naturopathic medicine, as a distinct American health care profession, is almost 100 years old. It was founded as a formal health care system at the turn of the century by medical practitioners from various natural therapeutic disciplines. By the early 1900s, more than 20 naturopathic medical schools existed, and naturopathic physicians were licensed in most States. Today there are more than 1,000 licensed naturopathic doctors in the United States.

As practiced today, naturopathic medicine integrates traditional natural therapeutics-including botanical medicine, clinical nutrition, homeopathy, acupuncture, traditional oriental medicine, hydrotherapy, and naturopathic manipulative therapy-with modern scientific medical diagnostic science and standards of care. The medical research base of naturopathic practice consists of empirical documentation of treatments using case history observations, medical records, and summaries of practitioners' clinical experiences.

At present, the two accredited naturopathic medical schools in the United States have active