The Stars of Medicine

Introduction to Naturopathic Medicine

Naturopathic medicine is a practice of medicine that focuses on holistic care, proactive prevention, comprehensive diagnosis, and non-invasive treatment. By using interventions that are all-natural or low-risk, naturopathic doctors help restore the body’s innate ability to heal itself.

Naturopathic doctors (also known as NDs) are hybrid doctors; we are trained not just in natural medicine, but also in conventional care. Naturopathic physicians combine the wisdom of nature with the rigors of modern science. Steeped in traditional healing methods, principles and practices, naturopathic medicine focuses on holistic, proactive prevention and comprehensive diagnosis and treatment. Naturopathic physicians help facilitate the body’s inherent ability to restore and maintain optimal health. It is the naturopathic physician’s role to identify and remove barriers to good health by helping to create a healing internal and external environment.

The curriculum of medical school for naturopathic doctors is strikingly similar to medical doctor counterparts. Naturopathic doctors at accredited institutions are trained as primary care physicians. As a result, NDs have a strong understanding of western medicine and pharmaceutical drugs. Just like MD school, the program is 4 years long after a Bachelor’s Degree. 

Where the training differs is that naturopathic doctors focus more time on prevention and natural treatments of disease versus solely drugs and surgery. Naturopathic doctors believe there is more to health than popping pills and managing symptoms. NDs look to identify the root cause of disease and then use the least invasive means possible to address it, using things like nutrition, lifestyle change, herbal medicines, homeopathy, and other natural medicines. One of the incredible things about naturopathic medicine is that the toolkit never runs dry. 

Tenets of Naturopathic Medicine

All naturopaths follow six primary tenets. They include primum non nocere (first do no harm), vis medicatrix naturae (the healing power of nature), docere (doctor as teacher), praevenire (prevention), tolle causum (treat the whole cause), and tolle totum (treat the whole person). These guiding principles allow naturopaths to see people as people, not as diseases.  

Emunctorology

In Naturopathic Medicine, there is a concept of emunctories which follows closely to the French system of drainage. Emunctories are the innate elimination channels of the body – they are the ways in which the body remove toxins and stress from the organism. Emunctories are divided into primary emunctories (the principal eliminators) and secondary emunctories (the back-up eliminators).

Primary Emunctories include:

  • Lungs
  • Kidney
  • Digestive Tract/Liver
  • Skin
  • Emotions

Secondary Emunctories include:

  • Skin
  • Musculoskeletal
  • Mucous membranes
  • Emotions  

In health, the toxins and stressors that enter the body are eliminated by the emunctories in a more or less net-neutral fashion. If a body has become overburdened by physical, mental, or emotional toxins and the emunctories cannot keep up with eliminating that which enters the system, disease results. It is our goal, therefore, to support the emunctories to perform optimally once more so that the body can clear these toxins and stressors. By supporting the emunctories, we support the body to heal itself.  

Palliation vs. Cure

Palliation is often referred to as a ‘band-aid’ approach. It allows for the short-term improvement of symptoms without looking at the overarching problem, or its root cause. For instance, the use of corticosteroids for eczema or a non-steroidal anti-inflammatory drug (NSAID) for headaches. In neither case is the root cause of the problem recognized nor addressed. Using either of these medications often allows for improvements in symptoms. However, once the respective medication is discontinued, the eczema or headache may recur. 

Cure is a different approach altogether. While working to support healing of the organism, we are working toward long-term resolution without the continual need for conventional or natural medicines for managing symptoms. When we are addressing the root cause of disease, we are working in the direction of cure. 

Natural medicines can be used in a palliative or a curative fashion. The philosophy and approach distinguishes the difference. When working with patients, I find it helpful to determine my treatment strategy: am I focusing on palliation or am I focusing on addressing the root cause? Palliation often provides immediate or short-term relief; addressing the root cause often takes time to see improvement. I often ask my patients the direction they would like to start. Of course, we can complement palliative measures while utilizing a deep-acting approach. Setting clear expectations and goals is immensely important.

Case #1 – Acute Bronchitis

A long-term patient returns to clinic for an acute office visit. She is a nurse and works in a medical office. Many of her co-workers are getting sick and have been diagnosed with acute bronchitis. Her colleagues were prescribed z-packs (Azithromycin) and she wants to do something to help her condition without having to use pharmaceuticals. She has had bronchitis previously and reports this feels just as it did before. She reports a painful, productive cough with yellow sputum. In addition to respiratory symptoms, she experiences fatigue and headaches. At the time of visit, she denies hemoptysis (coughing up blood).

Aromatic Treatment:

Treatment Objectives: 1) kill the infection 2) support and soothe the bronchioles and lungs
Dose Form: Rectal Suppository
Dose: 175 mg of essential oils per 3 g suppository 
Instructions: insert one suppository rectally twice daily for 10 days

Amount Essential Oil Essential Oil Composition
35% Eucalyptus globulus – Eucalyptus 64.00% – 1,8-Cineole
35% Picea mariana – Black Spruce 64.99% – Monoterpenes

24.54% – Bornyl acetate

15% Thymus vulgaris ct thymol – Thyme thymol 46.93% – Thymol

17.17% – p-Cymene

2.81% – Carvacrol

1.62% – beta-Caryophyllene

15% Rosmarinus officinalis ct verbenone – Rosemary verbenone   14.11% – Camphor

9.82% – Bornyl acetate

9.42% – 1,8-Cineole

8.65% – Verbenone

 

Treatment Objective Primary Constituents Satisfying Objective
Anti-microbial Thymol, p-Cymene, Carvacrol
Anti-inflammatory beta-Caryophyllene, bornyl acetate 
Terrain Support Monoterpenes (alpha-pinene, beta-pinene, camphene, d-3-carene, amongst others).
Anti-spasmodic Bornyl acetate, 1,8-cineole
Mucolytic 1,8-cineole, carvacrol

 

Patient’s Log of Symptoms: 

Day 1:
Symptoms: painful productive cough, yellow sputum, fatigue, headache

Day 2:
Symptoms: painful productive cough, yellow sputum, fatigue, headache (not much of an improvement)

Day 3:
Symptoms: productive cough still present, fatigue has lifted, headache has improved slightly

Day 4:
Symptoms: chest pain, productive cough, blood in yellow sputum, headache, fatigue returned

Day 5:
Symptoms: chest pain, productive cough, yellow sputum no blood, headache, fatigue continues

Day 6:
Symptoms: chest pain, productive cough, yellow sputum, headache, stomachache, fatigue but starting to regain energy

Day 7:
Symptoms: feeling good. No more coughing or chest pain/tightness during the day, in the evening productive cough returns

Day 8:
Symptoms: cough more infrequent today, has not slept well since Sunday (keeps waking up)

Day 9:
Symptoms: sleeping better, cough is now dry and not productive

Day 10:
Symptoms: cough gone, normal energy level, sleeping well.  “I feel normal again! It’s over and I avoided a z-pack!”

Case #2 – Cold Sore

“I was in the midst of an early breakout one day in May when I was sitting with Dr. Tim trying to ignore the pain stabbing at me from my lower lip. I excused myself to reach into my bag and pull out my Abreva. It’s good stuff. It shortens the length of the breakout and helps to heal the sore within 8-10 days instead of 12-14 days with no treatment. But it still goes through its whole process…swelling, erupting, oozing, and hurting. I thought it was good stuff.

Dr. Tim suggested we try some essential oils instead. I was happy to try anything, as this one was on the cusp of breaking open. He gave me a drop on the tip of my finger, which I touched on the aching spot. First one essential oil (Spike Lavender – Lavandula latifolia), then a second one (Palmarosa – Cymbopogon martinii). They didn’t taste very good, but I was willing to give it a try. After 30 minutes of the first application the pain was completely gone and the sore felt less swollen.

I told Dr. Tim, “I think you cured my cold sore.” I loved his answer: “It wasn’t me, it was the essential oils.” Dr. Tim gave me four or five more sets of repeat applications throughout the day. I wasn’t able to continue with them past that day, but with just those treatments, the next day the cold sore was entirely gone. Come to think of it: it’s now the middle of July and I haven’t had one since.

Never in my life did I think a cold sore could be resolved so fast.”

Chemistry of Spike Lavender – Lavandula latifolia

40.57% Linalool
30% 1,8-Cineole
11.28% Camphor

Rationale of Use: pain-relieving; anti-inflammatory

Chemistry of Palmarosa – Cymbopogon martini

89.76% Geraniol
1.56% Beta-Caryophyllene

Rationale of Use: anti-viral; anti-inflammatory

Geraniol

Primary Alcohol

Shoji Y, Ishige H, Tamura N, Iwatani W, Norimatsu M, Shimada J, Mizushima Y (1998). Enhancement of anti-herpetic activity of antisense phosphorothioate oligonucleotides 5′ end modified with geraniol. J Drug Target, 5(4):261-73.

Case #3 – Itchy Skin Rash

1st Visit – 4/18/2016

History:

30 year old female with chief complaint of widespread, itchy, raised, red rash with areas of depigmentation. The itching is constant and intense. She has had this rash for 10-12 years and the onset was gradual. She first noticed the rash when she moved to North Carolina for college. While there, after visiting a dermatologist, they diagnosed the rash as tinea versicolor. Tinea versicolor happened to be a common occurrence for folks living in the area.  However, while it was seasonal for others, she had the rash all-year round. 

For the first two years, the rash was primarily on her upper abdomen (epigastric area) and shoulders. Thereafter, it spread and was located nearly everywhere on her body (sparing her face, head, front of legs, and palm side of her forearm). She reports she got a tattoo on her shoulder to help cover up the spots she was constantly seeing. 

When she was a child she was always sick. Everything from really bad nose bleeds, allergies, strep throat, and scarlet fever. She has a history of frequent antibiotic use as a child but she has not taken any antibiotics since college. 

Occupation: college campus chef and community gardener

Review of Systems:

Digestion: gas and bloating daily; she has a tendency toward diarrhea and has 3 loose bowel movements daily; she denies blood in her stool and denies undigested food in her stool; she has significant bloating every morning even before she eats anything; she has regular abdominal pain

Energy: she has a lot of energy, but she loses energy if she sits at her desk or is idle

Sleep: sleeps like a rock

Stress: she reports she has always been high-strung and that there is always something for her to do; she works very hard on her projects and she holds a very high level of expectation for herself.

Cravings: patient reports intense sugar cravings all of the time, especially for cookies

Treatment Plan:

  • Nutrition: Gluten-free and corn-free diet
    • Rationale: I typically start people on an Anti-Inflammatory Food Plan (gluten-free, corn-free, dairy-free, alcohol-free, nightshade-free, etc.). For some people, this can feel particularly restrictive. She’s young and busy, and I wanted to remove what I felt were the most likely things to be aggravating her intestinal symptoms. That way, rather than having to remove a dozen major food groups, she would only need to eliminate two. I wanted to make it manageable for her and set her up for success.
  • Water: Drink 64+ oz of water daily
    • Rationale: Most of us don’t drink enough water each day; water is highly important. 
  • Apple Cider Vinegar: 1 tsp in ½ cup water 15 mins before each main meal
    • Rationale: In Naturopathic Medicine, there is the pun “The Road to Health is Paved with Good Intestines.” It was obvious that her digestion was lousy and I needed to improve it. Apple cider vinegar has a multitude of benefits – the primary one for prescribing it is that it supports digestive secretions and the digestive process. 
  • Candaclear 4: 1 strip (4 capsules) daily
    • Rationale: In Naturopathic Medicine, we believe that if yeast/fungi are living on the skin, almost definitively there is dysbiosis taking place (or yeast/fungi living) in the gastrointestinal tract. This is further supported by intense sugar cravings which are also a sign of a candida infection in the GI tracts. Candaclear 4 is a proprietary product that combines garlic, cinnamon bark, probiotics, and intestinal nutrients to kill the nasty organisms and bring in the good bacteria. This helps to re-establish balance and health in digestion. 
    • For more info: http://www.seroyal.com/candaclear-four.html 
  • Bitters Extra: 1 cap with each meal
    • Rationale: As stated above, I knew her digestion was terrible and she needed support. Bitters Extra is a proprietary product that contains bitter herbs like gentian and dandelion root to stimulate digestion. 
    • For more info: http://vitanica.com/all-vitanica-supplements/bitters-extra-digestion-support/ 
  • Adrenal Assist: 3 caps daily in the morning
    • Rationale: She was a tremendously busy person – she was constantly on the go and she was stressed out. Her poor adrenal glands were overworked and fatigued. Adrenal Assist is a proprietary product that contains adaptogens like Eleutherococcus, Panax ginseng, Rhodiola, and Ashwagandha (Withania somnifera), as well as vitamin and mineral co-factors for adrenal health. Another key to identifying that I needed to support the adrenals is that she said she ‘has a lot of energy, but she loses energy if she sits at her desk or is idle.’ People who appear to be very active and energetic can actually have a massive underlying level of exhaustion – which they don’t experience because they are constantly forcing themselves to keep busy and keep moving. 
    • For more info: http://vitanica.com/all-vitanica-supplements/adrenal-assist-adrenal-support/ 
  • Aromatic Spritzer Spray: spray liberally on body twice daily; more, as needed
    • Rationale: Since I had a working diagnosis of tinea versicolor (a fungal infection), I wanted something not just internally, but something topically to kill the infection. I also knew that itching was terrible for her, so I wanted something that would soothe her skin and decrease itching. 
  • Meditation: 4 Square Breathing
    • Rationale: She was in a sympathetically-dominant state (“fight or flight” response / stress response). I wanted to support her into entering a parasympathetic state (“rest and digest” response); this is where deep healing can happen.
  • Read: You Can Heal Your Life by Louise Hay
    • Rationale: Healing is not just a physical journey; indeed, it is also a mental and emotional one. She had created patterns of stress and self-pressure. If she was willing, she could change and create new ways of being. 
  • Return in 4 weeks for follow-up. 

Aromatic Treatment:

Dose Form: Water-Based Spray

Concentration: 8% Essential Oils

Treatment Objectives: Antifungal and Anti-pruritic

Amount Ingredient Rationale
200 mL Distilled Water Carrier
8 mL Pelargonium x asperum – Rose Geranium Anti-fungal
3 mL Mentha piperita – Peppermint  Anti-pruritic; cooling effect
3 mL Citrus limon – Lemon  Anti-pruritic; cooling effect
2 mL Cymbopogon citratus – Lemongrass Anti-fungal
2 mL Vitamin E Solution 

(10% TPGS* : 90% Distilled Water) 

*TPGS stands for d-alpha tocopheryl polyethylene glycol 1000 succinate; it is a derivative of Vitamin E that increases the solubility of lipophilic substances in water. It is non-toxic and easy-to-use. For more information: http://www.tpgs.com/ 

Solubilizing Agent

 

Case Management / Follow-Up Results:

2nd Visit – 5/18/2016 

Her rash is still present but is much improved. She notices a strong correlation with her rash and gluten. After being consistent with following a corn-free and gluten-free food plan, there was a contamination exposure. She was at a restaurant where she ordered a gluten-free food that was fried in a deep-fryer with gluten-containing foods. From this exposure, her rash came back instantaneously and lasted for 12 hours. She reports that anytime she has had incidental or intentional gluten exposure, itching and redness will recur. 

Within the last week, she reports that the itching has basically stopped completely. She will still have occasional twinges. She’s mentioned she’s forgotten all about the Aromatic Spritzer Spray without even realizing it, because she hasn’t needed it. For the first few weeks, patient reports the Aromatic Spritzer Spray was helpful to calm and ease her itching.

Digestion: good; she is now having regular bowel movements that are well-formed; she reports her digestion took about 2 weeks to regulate itself and now it is much improved. She noticed a major change in bloating after about 2 weeks and she reports her clothes are feeling looser. She reports weight loss of 5 lbs since last visit. 

3rd Visit – 6/22/16

Patient is looking great. Her skin is clearer and she reports weight loss of 20 lbs since our first visit on 4/18/2016. 

She reports her skin is better still. The pigment is returning to her skin, which she thought would never happen again. She reports that every year at this time in the warm-weather season, her rash exacerbates. Her skin is doing great in the warm weather and she is even able to garden wearing a tank-top, whereas before she would wear long sleeve shirts to cover her skin from being seen. She reports her back is still a little itchy and flaky. 

Patient reports she had a Bloody Mary (tomato juice and vodka cocktail) at brunch with her family and she broke out into an itchy rash immediately after starting to drink it. She identified that the vodka was sourced from grains (likely wheat). She is now almost 100% gluten-free. She works to avoid corn as well, though it doesn’t seem to be a major trigger for her. 

Digestion: good. Upon thinking about it, she remembers now that she had a constant, low-grade abdominal pain for at least the past 10 years. Now, she rarely has abdominal pain. 

Cravings: she no longer has sweet cravings

An Important Lesson from this Case:

Essential oils may not always be curative and may, in some cases, be strictly palliative. In this last case, the root cause of disease was digestive distress and a food sensitivity to gluten. The way in which I used essential oils in this case was strictly palliative. While the Aromatic Spritzer Spray improved the itching (and almost instantaneously upon application), it was only managing her symptoms. As long as she continued to eat gluten, she would need the Aromatic Spritzer Spray forever. In order to have long-lasting improvement, the focus must be on intestinal repair and food trigger removal.  

When we are working with patients, we must set clear expectations and goals for our interventions. Is the intervention palliative? Is the intervention curative? Or perhaps a combination of both?

Your Toolkit: Bringing it All Together

We each have our own interests and our own very unique combination of healing modalities. Natural medicine is about integration. Not simply integration with conventional medicine, but also integration with different flavors of natural medicine itself. Different modalities will call to you and different modalities will, for one reason or another, work better for you. Find them and use them. Our essential oils are the stars of medicine, but they don’t need to bask in the limelight all by their lonesome. Combine all of the tips and tricks that you have up your sleeve for the best results possible. 

 This article was originally published at Botanica 2016, an international conference celebrating herbs and clinical aromatherapy.

Timothy Miller ND, LAc, RA

Timothy Miller ND, LAc, RA is a naturopathic physician, licensed acupuncturist, and registered aromatherapist. He is a graduate of the National College of Natural Medicine (NCNM) in Portland, OR.

Dr. Miller is a chemistry nerd. He is fascinated by the chemistry found in the natural world. Fueled by the abundant, potent, and unique components within aromatherapy, Dr. Miller has sought to understand how essential oils act on the body and identify which clinical applications are best incorporated into practice.

Dr. Miller first began his aromatherapy studies in 2005. He has since traveled the world to advance his understanding of essential oils and their clinical implications. Dr. Miller has studied with Rhiannon Lewis, Mark Webb, Gabriel Mojay, Kurt Schnaubelt, and Jeffrey Yuen. He has successfully completed a National Association of Holistic Aromatherapy (NAHA) approved course and has completed the requirements to become a registered aromatherapist. He is a member of the Aromatherapy Registration Council (ARC).

Beyond his love of aromatherapy, Dr. Miller is an avid traveler and student of foreign languages. He enjoys spending time with his family, watching movies, and being in nature. Dr. Miller loves to learn new things and is driven by self-improvement and emotional intelligence.

Dr. Miller believes deeply in Docere and loves to teach. He is an international speaker, workshop leader and contributing author. He believes learning should be fun and makes every attempt to engage his students in a profound and meaningful way.