Spagyric Tinctures

Spagyric medicine is a ancient form of botanical medicine and is similar to that of homeopathic medicine, in the sense that through the process of creating a spagyric tincture the herbal remedy becomes more potent and reaches a highly energized state.1,3,4  Spagyric medicine, theory, and philosophy have much more depth than I just stated and if the reader is keen to learn more I would point them to the references listed at the end of the article.

Spagyric tinctures differ from regular botanical tinctures in that the process of creating the tincture a remedy is created that not only is in a highly energized state but also incorporates the minerals found in the herb back in to the tincture.1,2,3,4  This is a significant difference because once a regular botanical tincture is made the remaining plant material is generally discarded, including any of the constituents not extracted.

A spagyric tincture involves at least three steps, that of separation, purification, and cohobation (recombination).1,3  Separation involves an extraction with alcohol to separate various constituents, for approximately 40 days.  Purification involves a process of grinding and burning the remaining dried plant material until it becomes a white ash.  Cohobation involves recombining the white ash with the liquid extract, again for approximately 40 days.  These steps may involve heat and agitation.


Contact Dr. Peters for a free “meet the doctor” visit to see if naturopathic medicine is right for you.



  1. Junius, M. M. (2007). Spagyrics: The alchemical preparation of medicinal essences, tinctures and elixirs. Rochester, VT: Healing Arts Press.
  2. Liquid Herbal Extracts. (n.d.). Retrieved April 3, 2016, from
  3. Sinclair, J. (2013). The alchemy of herbal medicine: Spagyric tinctures, elixirs and the vegetable stone. Australian Journal of Herbal Medicine, 25(4), 188-194.
  4. What is Spagyric Medicine. (2013, April 09). Retrieved April 03, 2016, from

Herbal Bitters

Herbal Bitters

Bitters are a group of plant constituents, which are not like other plant constituents but are rather distinguishable by their taste when consumed (bitter principle).  Many believe that for bitters to induce their physiological effects they must be tasted.  This is important when considering how to use bitters, for example as a tincture or a capsule. 

Bitters have been traditionally used as a digestive stimulant, enjoyed most often as a cocktail before a meal.  Using bitters before a meal helps to stimulate digestion generally, including the flow of digestive secretions, stimulating gallbladder bile flow (cholagogue), acting as a hepatic to aid liver function, and stimulating the vagus nerve to promote intestinal peristalsis. 

Spring is a perfect time to introduce bitters to help aide in sluggish winter digestion, where most of us have been indoors and sedentary far more.  Spring is also a great season to help the liver detoxify.

Taraxacum officinale, or Dandelion leaf and root, is a great example of bitter plant that can be used fresh in salads or in soups, is abundant in spring, and promotes both digestion and liver function.  Of course it can be used as a dried leaf/root or tincture. 

Another commonly recognized bitter used as food (or beverage in this case), is Humulus lupulus, or Hops, which is found in beer.

Many plants have the bitter principle and also have secondary actions apart from the actions that I listed above, so it is important to exercise caution when using any new herb. 

Bitters are great for spring and for putting a little spring in your digestion.  See the references listed for more information.


Contact Dr. Peters for a free “meet the doctor” visit to see if naturopathic medicine is right for you.



Hoffmann, D. (2003). Medical herbalism: The science and practice of herbal medicine. Rochester, VT: Healing Arts Press.

Marciano, M., Dr. (2013, November 05). The Bitter Principle. Retrieved April 23, 2016, from

Energy for Peak Performance

Many of us feel an extra boost of energy in the summer. We spend more time outside, soaking up the sun and getting fresh air. Many folks play more sports, go camping or boating, and BBQ in the backyard.  We often have more leisure time to explore the things we love doing.

All of this sun, fresh air, and activity can improve our physical and mental energy.

As we head back to work and kids head back to school, how can we maintain this energy?  With increased demands on our time, how can we optimize our physical and mental performance?

Utilizing preventative strategies, we can support a few main systems in the body that help to keep our energy stable and consistent throughout the day and days.

Breakfast is the place to begin.  As is true for many of us in Canada, breakfast contains primarily carbohydrates.  Breads, bagels, cereals and the like are all high in carbs which can wreak havoc on our energy.  This is because carbs are easily absorbed causing both a spike in our blood sugar and our energy but a resulting crash afterwards.  This leads to grabbing a mid-morning snack or extra coffee to keep our energy up.  The key is to balance breakfast carbohydrates with healthy protein and fats.  This helps to delay the absorption of sugar in to our blood resulting in a steady energy increase over time.

Throughout the day, managing stress is the key to consistent energy and a sharp mind.  Many of the folks I see have increased levels of stress on a day-to-day basis.  Over time, the consistent and prolonged elevation in our cortisol levels (our stress hormone) can lead to difficulty concentrating, irritability, energy crashes, and impaired sleep.  Elevated cortisol further imbalances our blood sugar causing us to reach for that afternoon doughnut and coffee.  And the cycle continues.

As a naturopathic doctor, managing stress is key to optimizing physical and mental performance.  The secret to success is offering a treatment that is individualized to each person.  That may include promoting stress-reduction techniques like meditation and a walk in the park or using specific herbal medicines and supplements.  The key is that each person is different and requires an individualized approach.

Testing cortisol levels and ordering other lab tests can help me determine if stress is impacting one’s sleep.  Promoting a restful sleep, improving insomnia, and reducing elevated nighttime cortisol levels can all improve energy the next day and keep you performing at your best.

As a naturopathic doctor, many of the folks I see have concerns of fatigue, disturbed sleep, and increased stress.  These three factors are often linked together and can lead to a reduction in physical and mental performance.  Improvement in all of these areas together is key to success.

Contact Dr. Peters for a free “meet the doctor” visit to see if naturopathic medicine is right for you.

How to be an EMPOWERED Patient

Medical science now shows that when patients are empowered to play an active role in their health care, they are more invested in the process, which results in greater health. Medical education is redefining the doctor-patient relationship as one that respects the patient as an intelligent participant in health care decisions. The old doctor-patient relationship put the doctor in an authoritative role, as in “doctor knows best” and patients were in a passive role, as in “follow the doctor’s orders.” Now physicians are taught the principles of “shared informed decision making”; doctors and patients share information and collaborate in treatment decision. Patients are empowered with information and take ownership in creating their health. Here are four tips for becoming a more engaged and empowered patient.

Firstly, knowledge is power. You need to understand your body and any issues that you have. Ask your doctor to write down any words that are new to you, such as the name of a diagnosis, a test or treatment. Ask them to explain anything that you don’t fully understand, or work with a naturopathic physician to deepen your understanding of your health conditions. The internet can be a wonderful source of information, but, without the context a physician can provide, it can be overwhelming.

Secondly, keep a health journal. A health journal is a place where you can keep a record of your health issues, tests, procedures and medication. Keeping track of your health history helps you to be an informed, knowledgeable patient. Knowledge allows you to take more control of your healthcare. The best health journals have separate tabs for pharmaceutical and natural medicine history, hospitalizations, surgeries, blood work, imaging and other tests, specialist reports, allergies, and family medical history. I encourage my patients to get copies of all their lab work. Sixteen percent of abnormal lab results are not reported to the patient in Canada. In my 22 years of practice, I have found many missed diagnoses by going over lab work that the patient hadn’t seen. You can get copies of blood work easily by having your blood taken at Life Labs and setting up an online account to view your labs, or if you have blood taken at your doctor’s office or one of the hospital’s outpatient labs you can call 1 866 370-8355 and ask them to mail you your lab work. Your doctor can also print a copy of your lab work. I encourage my patients to ask their family doctor for copies of their specialist reports as well as imaging reports (x-rays, CT scans and MRIs).

Thirdly, an empowered patient needs to ask why. Any good problem solver needs to investigate the cause of the problem in order to create a lasting solution. Yet, in health care, we are often satisfied with treatments that mask symptoms but don’t address the underlying causative factors. You can take medications to lower blood pressure, but pills are not able to address the reasons why your blood pressure went up in the first place. When I prescribe pharmaceuticals, it is often because we need to control symptoms quickly, and buy the patient some time while we implement a plan to address the underlying causes and seek a long term solution that will optimize their health.

Fourthly, you can create a health care team to support your health goals. It may serve you to consult more than one health professional to create the optimal plan for your health. Your family doctor is an essential player in helping you access the conventional medical system when you need it. Family doctors are incredibly knowledgeable and hardworking, but they don’t have the time or training to provide for all the complex needs of their patients. Naturopathic physicians are medically trained physicians who focus on optimizing health with lifestyle, natural medicines, and pharmaceuticals when needed. Counsellors, physiotherapists, and other practitioners can all add their expertise to your health care team. An empowered patient lets their family doctor know who is on their team and encourages communication between practitioners.

How Carbs Can Trigger Food Cravings

Are all calories created equal? A new study suggests that in at least one important way, they may not be.  The New York Times reported on research showing that sugary foods and drinks, bread, and other processed carbohydrates that are known to cause abrupt spikes and falls in blood sugar appear to stimulate parts of the brain involved in hunger, cravings and reward. The findings, published in the American Journal of Clinical Nutrition, shed new light on why eating a diet high in refined carbohydrates like sweet, bread, pasta, crackers etc. are associated with weight gain.  The more you eat, the more you want.

A much more satisfying nutrition plan is to eat healthy, lean protein at every meal, vegetables at almost every meal, and enjoy some fruit and whole grains like brown rice and quinoa.  You’ll stay full on fewer calories, making it easier to shrink your waist line.

Autoimmune Disease and Naturopathic Medicine

Autoimmune Disease is a major health problem in our society. One in twelve people in general, and one in nine women, will be diagnosed with an autoimmune disease. There are over one hundred different autoimmune disorders, including multiple sclerosis, Lupus, Rheumatoid arthritis, Inflammatory Bowel diseases and Celiac disease. Together these conditions affect more people than cancer or heart disease and can rob patients of their quality of life, mobility and even take their lives.

Scientists worldwide are puzzled over the alarming rise in the rates of autoimmune disease, particularly in the Western world. The rates have more than doubled in the last three decades. Genetics can no longer be blamed as the only cause of autoimmune disease since our genetics can’t change that quickly.

As a naturopathic physician, I have treated many patients with a variety of autoimmune diseases in my years of practice. The familiar story is one of misdiagnosis, dismissal and frustration with limited treatment options. In half of all cases, women with autoimmune disease are told there is nothing wrong with them for an average of five years before receiving diagnosis and treatment. Once a diagnosis is made, treatment is focused on reducing symptoms but not treating the underlying factors that may have caused the disease. Commonly used immunosuppressant treatments can be lifesaving, but can also lead to significant long-term side effects.
The path to a long lasting recovery from autoimmune conditions focuses on correcting the underlying stress factors that may have caused the immune dysregulation that drives the disease.

Exciting research was recently presented at a gastroenterology convention I attended in Victoria. The immune system has well developed mechanisms to attack foreign invaders. In autoimmune disease, the immune system loses its ability to differentiate our own normal tissues from foreign invaders. That ability to temper the immune system’s inflammatory reactions to invaders is something our bodies must learn. And strangely enough, in fact, the teacher lives in our guts. The bacterial lining of the intestines (the intestinal microbiome) is responsible for educating our immune systems, letting them know when to attack and when to cease fire.

The delicate intestinal bacterial lining is made up of over 1000 species of bacteria and weighs about three pounds in an adult. We are created in a sterile womb, devoid of bacteria and acquire our first dose of beneficial bacteria in the birth canal. In the western world, there is an ever increasing trend towards delivering babies by C-section. Without that first dose of beneficial bacteria from the birth canal, the baby’s microbiome is different than a baby born via vaginal birth. Abundant research has shown that there are increased rates of asthma and autoimmune disease in those delivered by C-section. Researchers concluded that a C-section (or Caesarean section) raises the risk of type 1 diabetes by 20%. They also crunched the data from 23 studies and showed the same increased risk for asthma—20%—in children delivered by C-section.

Antibiotics are the other western phenomenon that disturbs the intestinal microbiome. We know not what we do when we take an antibiotic for an infection without consideration of the trillions of beneficial bacteria that form an integral part of our digestive and immune systems. Mice given antibiotics were more likely to develop inflammatory bowel diseases like Crohn’s and Ulcerative Colitis.
Naturopathic physicians have long emphasized the importance of correcting deficiencies in the intestinal microbiome. Programs to repair the intestinal mucosal lining, replenish probiotics and kill off harmful elements of the microbiome have long been a mainstay of the treatment of autoimmune disease.

Vitamin D deficiency in northern countries have also been linked with increased rates of autoimmune disease. As we spend more time indoors and lessen our exposure to sunlight, thus using sunscreen more often (as those with paler skin tend to do) when we are outdoors, we play an active role in depleting our Vitamin D stores. Vitamin D has also been shown to play a role in the regulation of inflammatory fires of the immune system. Vitamin D helps tell the immune system to tolerate our own cells. Some studies show that Vitamin C inhibits induction of disease in autoimmune encephalomyelitis, thyroiditis, type-1 diabetes, inflammatory bowel disease (IBD), lupus, rheumatoid and Lyme arthritis.

For my patients with joint pain associated with autoimmune disease, laser therapy is an excellent way to manage pain, reduce joint destruction and improve joint function. A recent Canadian expert panel determined that this painless laser therapy is an effective treatment for rheumatoid arthritis. I have been using a high tech laser light treatment for my patients for years. It is very effective for most patients with osteoarthritis and is part of an overall treatment for inflammatory arthritis too.

Natural anti-inflammatory medicines may reduce the dependence on harsh prescription drugs. A turmeric extract called Meriva has been shown to be a safe and defective pain reliever in arthritis. Fish oil is considered an essential part of auto-immune treatment in that it helps alleviate the inflammation that drives most symptoms. Most auto-immune disease involves high levels of oxidative stress, so sufferers who incorporate anti-oxidant foods and supplements into their daily regime are making a wise choice. Kale and blueberries are my favorite high anti-oxidant foods; grape seed extract and resveratrol are my favorite supplements.

Fatigue is often a crippling element of auto-immune disease. I also work with patients to support their adrenal gland through teaching them meditation and relaxation techniques using herbs like rhodiola.

Science is beginning to shed light on the complexities of the immune system and ways that we can influence the health of it. Take care of your immune system, and if you have an autoimmune disease, learn ways to tame your inflammation – naturally.

Cancer and Naturopathic Medicine

The Holistic Picture on Cancer Treatment

Dr. Deidre Macdonald, ND

A diagnosis of cancer can strike fear deep within our souls. It is a very vulnerable time, when we are suddenly thrust into the confusing world of medical terms, statistics, and treatment choices. Conventional medicine will often offer some combination of surgery, chemotherapy and radiation. In addition, cancer patients often seek information about natural medicines and dietary approaches to assist in their healing. Well meaning friends often bombard the newly diagnosed cancer patient with stories of miracles cures from a myriad of sources. All this information can be overwhelming to sort through. The internet can also be a frightening and confusing source of information. But there are ways of using natural medicine to significantly enhance the cancer treatment process

The primary goal of naturopathic cancer care is to enhance the body’s ability to fight cancer by selecting natural medicines that have demonstrated to be toxic to tumor cells, or that bolster the cancer patient’s immune response to cancer. Many such substances exist. For instance, a mushroom extract used extensively in Japan called Coriolus versicolor has been shown in scientific studies to stimulate the immune system’s natural killer cells and lymphocytes by two fold. Clinical trials of this mushroom extract have shown significantly increased survival times in patients undergoing chemotherapy for cancer. There are many other herbs and antioxidant nutrients that can play an important role in helping the body to overcome cancer and prevent metastasis (spread).

Another important role for naturopathic care is to aid in the recover from surgery and to eliminate or reduce the common side effects of chemotherapy and radiation. It is critical to select only those natural medicines that are compatible with specific chemotherapy agents or with radiation. Chemotherapy knocks down the white blood counts, sometimes dangerously impairing the person’s resistant to infection. Natural medicines can be used to enhance white blood cell production so that chemo can be continued. Mouth sores from chemo or radiation can be treated with licorice extracts, L-glutamine or Vitamin E. I had a young patient whose chemotherapy for breast cancer was causing nerve pain in her hands and feet. High doses of a natural amino acid called alpha lipoic acid solved the problem and she was able to continue her treatments. In fact she rode her bike to her appointment a few days after her next chemo session!

Once cancer has been treated, I encourage patients to engage in a program to lower the risk for recurrent tumors thereby significantly increasing the chances for sustained remission. Detoxification programs are often indicated after conventional treatments. Antioxidant nutrients and immune boosting foods and herbs can help the immune system stay vigilant against cancer. If possible, we need to search for ways to change the internal environment of the body that created cancer in the first place.

There are many possibilities in the treatment of cancer, both conventional and natural. The goal is to tailor a plan that feels right for you and will give you the best chance to overcome cancer.

Dr. Deidre Macdonald is a naturopathic physician who has had a natural medical practice in downtown Courtenay for 15 years. Her office can be contacted at (250) 897-0235 or via this website.

Depression and Naturopathic Medicine

A 62 year old woman named Carol came to my clinic this winter concerned that she was depressed.  She had tried anti-depressants in the past and didn’t find them satisfactory.  She asked for my help in creating a program to help her regain her joie de vivre.  I let her know that we would do a proper depression assessment, and if I felt she was mildly to moderately depressed, then a naturopathic medical approach would be an appropriate and often very successful strategy for treating her depression.  My experience is that often depression is caused by a combination of physical, emotional and spiritual factors. And yes, there are a number of alternatives to anti-depressant drugs that have far fewer side effects and withdrawal effects. (That said, if someone has severe depression, or has the urge to hurt themselves or someone else, they must get psychiatric help immediately.)

One of the tenets of Naturopathic medicine is “treat the cause”. Therefore, in treating a patient with depression, I first do a thorough evaluation of their physical and mental health. Sometimes, to get to the bottom of depression we have to treat an illness, manage pain, reverse anemia, balance hormones such a thyroid, overcome addictive behavior, support the adrenal glands, correct digestive disorders, find nutritional deficiencies, assist in sleep and more. The brain is profoundly affected by the rest of the body, and for it to function properly, the rest of the body needs to be balanced and healthy. That said, there are some specific ways to support good brain health and create a better mood.  Getting coaching on how to implement these principles into your life can be very helpful.  When working with my patients, we start with small goals, monitor progress, problem-solve obstacles, and celebrate successes as we move towards a healthier mind and body.

Eat to fuel your brain by eating high quality proteins, fats, whole grains, and lots of vegetables and some fruits. Avoid refined sugar and flour products but enjoy some whole grains like brown rice and quinoa. Include fish or fish oil supplements as their omega 3 fats are important for the brain. Avoid stimulants, alcohol and drugs. Work with a naturopathic physician to identify and eliminate any food allergies or intolerances that may be dragging you down. Optimize your intestinal gut bugs (microbiome) with probiotics and fermented foods. Make sure you don’t have undiagnosed or untreated Celiac disease (autoimmune gluten reaction) as this one factor can have a serious impact on mood and brain function.

 Get out and exercise: The evidence is very clear. Exercise is a very potent anti-depressant. Head to head, it works as well as anti-depressant medication for many people.  Getting outdoors provides needed light for our brains to balance its chemistry. Working out with others has the added benefit of providing social contact, a key element of good mental health. Getting outside in nature has added benefits to the nervous system, hormones and mood.

Vitamins: Even if you are eating a healthy diet, extra magnesium and a B complex supplement can give the brain the building blocks it needs to make neurotransmitters, the brain chemicals that ward off depression.  Supplement with Vitamin D, as deficiency is rampant in the Canada, and has been linked to depression.

Balance brain chemistry naturally: St. John’s Wort has been extensively studied and has been shown to be as effective as several of the common prescription antidepressants for most types of depression. Another effective natural anti-depressant is 5-HTP. (5-hydroxy-tryptophan). It gives the brain the raw materials for making serotonin, which helps depression, carbohydrate cravings and sleep. I have used both of these natural medicines with success in my practice over the past twenty years. I recommend being supervised by your naturopathic doctor before taking them, especially if you are on other medication.

Counselling:  Research shows that counselling, especially Cognitive Behavioral Therapy, can help people learn the skills to overcome depression.  I regularly teach my patients proven, practical skills like relaxation training and mindfulness techniques.  Research shows that Self Compassion practices offer a gentle way of coming to terms with emotions. Counsellors offer insight, trauma work, addiction recovery and more that can help people become more adjusted and alive. Good counselling, combined with natural medical approaches is often a successful combination for the treatment of depression.

For more information on naturopathic medicine and Dr. Macdonald, check out or call the office at 897-0235.

Pharmaceutical Prescribing

Naturopathic physician licensed to prescribe pharmaceutical medicines:

Courtenay naturopathic physician, Dr. Deidre Macdonald, is one of the first group of naturopathic physicians in Canada to be granted the authority to prescribe pharmaceutical medicines. After a rigorous pharmaceutical upgrading course, and the successful completion of oral and written examinations, she is looking forward to serving her patients with another tool in her medicine bag.

On April 9th, 2009 the BC government granted a new and expanded scope of practice for Naturopathic Physicians in British Columbia. The new scope of practice includes pharmaceutical prescribing authority and access to publicly funded laboratories. The prescription medicines available to naturopathic physicians include most prescription medications that general practitioner medical doctors have access to. Among the medicines not included are pain medications, steroids and chemotherapy drugs.

The primary purpose of this change is to ensure that naturopathic physicians can continue to utilize the increasing number of natural medicines that are becoming “scheduled”, meaning available only by prescription. In addition, with access to most pharmaceutical medicines, naturopathic physicians will be better able to serve the needs of their patients. Whether it is to prescribe an antibiotic for a serious infection, to provide an antidepressant to a patient in need, or use pharmaceuticals to decrease blood pressure, pharmaceutical medicines are deemed to have a place in any primary care medical setting, including the naturopathic physician’s office.

Dr. Deidre Macdonald says, “I have always believed that most health issues are best addressed by the tenet of lifestyle first, natural medicines second and pharmaceutical medicines third. I still aim to find the underlying cause of health problems and take the time to work with patients to make the real changes necessary to find lasting solutions to their health problems. I discuss with my patients the full range of options for treating their conditions, including dietary change, exercise, stress management, herbal medicine, physical therapy, homeopathy and pharmaceutical options. Pharmaceutical medications are one tool in the quest for health. We discuss the pros and cons of each approach and the patient decides what they feel most comfortable with. The training I have received in pharmacology helps me to educate patients about those medicines that have real benefits that outweigh the risks, and those that do not. My aim is for my patients to have the best plan for their individual health goals and at times that will include pharmaceutical medicines.”

Naturopathic medical services are covered by most extended health insurance plans. ND’s offer lengthy and thorough consultations, physical examinations, lab work, pap smears and breast exams. Their medical training includes a university undergraduate degree with pre med sciences, graduation from an accredited 4-year naturopathic medical school, and mandatory continuing education.

For more information about this new legislation contact or Dr. Macdonald’s office at (250) 897-0235 or via this website.

Naturopathic Medicine – What Patients Can Expect

Naturopathic medicine: What can patients expect?

Naturopathic care—covered by many major carriers—can complement customary clinical practice

Nancy Dunne, ND President, American Association Naturopathic Physicians, Washington, DC

William Benda, MD Institute for Children, Youth, and Families, University of Arizona

Linda Kim, ND Medical Director, Southwest College Research Institute, Southwest College of Naturopathic Medicine, Tempe, Arizona

Paul Mittman, ND President, Southwest College of Naturopathic Medicine

Richard Barrett, ND National College of Naturopathic Medicine, Portland, OR

Pamela Snider, ND Managing Editor, Foundations of Naturopathic Medicine; Adjunct Faculty; Bastyr University; Executive Director, Academic Consortium for Complementary and Alternative Health Care

Joseph Pizzorno, ND President emeritus, Bastyr University

Practice recommendations

  • Patients who inquire about naturopathy will want to know that clinical tools typically include nutrition evaluation and dietary revision, counseling for lifestyle modification, botanical medicine, homeopathy, physical medicine, and mind-body therapies.

  • Advise patients who wish to seek naturopathic care to contact the state licensing authority to learn the scope of naturopathic practice allowed in their local area.

What can patients expect when they seek a naturopathic approach to disease management? A case presented in this article illustrates the applications of naturopathy in practice (see Naturopathic approach to one patient’s case: A summary).

Naturopathic physicians (NDs) diagnose and treat conditions typically seen in a “first contact” setting. They are not trained in the advanced use of highly technical conventional therapies for life-threatening diseases. Rather, they focus primarily on health issues encountered in out-patient ambulatory care settings (see Naturopathic training).

Though some tools of naturopathic practice differ from those of conventional practice, the goals of naturopathic medicine parallel those of family medicine in providing for and maintaining the well-being of both the patient and the healthcare system as a whole.

Collaboration is growing between conventional and naturopathic communities to examine the safety and efficacy of naturopathic medicine in preventing and managing a broad range of common conditions, and to determine whether availability of naturopathic services will improve patient health in a cost-effective manner.

Naturopathic approach to one patient’s case: A summary

Patient encounter

Martha S., a 39-year-old Asian-American

Presenting complaint: Has not felt well since onset of light-headedness, fatigue, muscle pain, and lassitude 4 years earlier/muscle tightness or tension and achiness come and go, often relieved by chiropractic treatment/some fuzzy cognition/dry gritty feeling in back of eyes/decreased libido/intermittent heart palpitations/sadness, easy weeping in conjunction with menses, lessens somewhat with St John’s Wort/disturbed, unrefreshing sleep 4 out of 7 days/body pain worse on waking


Three normal births and 3 spontaneous abortions with anticardiolipin antibodies that resolved after pregnancy/2 D&Cs, no other surgery/incidental finding of partially empty sella tursica on MS MRI investigation

Extensive specialty workups since 2001 have ruled out disease/internist who coordinated specialty consultations favors diagnosis of generalized anxiety disorder/some improvement with low doses Celexa, but unacceptable side effects (same with Effexor)/has tried amitriptyline/husband travels and she is uncomfortable with a “drugged sleep” when alone with the children

Fell off horse as teenager/no other physical injury or significant viral or bacterial illness/job exposes her to adversarial atmosphere and also requires occasional extensive hours at keyboard/infertility issues; experience of foreign adoption was a prolonged stressor


Maternal aunt and grandmother had breast cancer age 50+; both survivors/paternal grandmother had stroke/father had postoperative DVT


1–2 glasses wine/week; recreational drug use over 10 years in past/no regular exercise/attorney for city/married 11 years; husband 48, Euro/American, smokes, on anti-HTN medication/adopted sibs from Korea 1 year ago, 5-yr-old girl, 2-year-old boy, some malnutrition, parasites, now recovered


Patient is pleasant, articulate/no active disease/5’8”, 128#, BP 128/62, P 82/findings normal for HEENT, neck, chest, heart, abdomen, extremities, neurology, and skin/tender trigger points at bilateral trapezoids, paraspinal to subscapular, upper third gluteal and at hips


extensive records provided, essentially normal, none since 11/2003


None now


Sensitive to drug side effects, but no known drug allergies

Management plan discussed with patient

In absence of other underlying disease, would like to treat you for fibromyalgia syndrome from long-term professional and personal stress/will work to recover your system from the physiologic effects of tension, worry, and hard work over past decade/if progress unsatisfactory after 3 months, we will revisit the diagnosis

Plan is to restore-rejuvenate your body, which knows how to right itself/think 6 months to a year for full recovery, after which you will have new knowledge of yourself and tools to maintain
your well-being/details of the plan will shift as you recover and learn to use developing self knowledge to protect yourself during new challenges/flexibility and resilience are key and develop continually from self awareness/note what works for you and what doesn’t

Diet Goal

Hypoallergenic, whole-foods; small, frequent meals/adjust eicosanoid balance to increase systemic circulation, musculoskeletal flexibility, and cellular repair (patient given background article)/decrease production of pain-signaling chemistry, swelling that presses on nerves and creates the sensations of pain and stiffness; avoid sweets and refined carbohydrates, in order to maintain steady blood sugar levels

Use serotype diet (diet printed for patient) for the next 6 weeks/stick with best foods; dip into OK foods as little as possible/whet appetite for best food by “selfishly” focusing on your recovery/invite family to share meals, but primary purpose is your recovery; this can be hard for a mom to pull off; please invite your husband to call me if I can help him understand how he can enable you accomplish goal

Possible further steps

(see online version for details of action steps):

  1. Support/restore digestive tract: May not be making optimal gastric acid and other digestive factors as a result of long term stress stealing circulation away from those tissues that produce it.

  2. Eliminate simple sugars and refined flour products: Will help reduce pain/simple sugar creates hypoglycemic episode that can be experienced as nameless anxiety, weakness, fatigue, and dizziness/stable blood sugar essential for sense of well-being/eat pears, berries, or nuts if you need dessert.

  3. Exercise: Aerobic exercise 45 to 60 minutes, 3 or more times/week

  4. Sleep: Melatonin 250 μg to 500 mcg 30 or so minutes before bedtime/Deeper, assisted sleep will help, and you can adjust dosages to keep head clear in morning.

  5. Fundamental supplementation: For general well being, including fish oils, vitamins, and minerals.

  6. Adrenal recovery formula: We can presume your endocrine system has been affected by perceptions of threat (anxiety as related to the mystery of your physical pains) as well as long-term pain/recommend adrenal function test, to more closely determine optimal timing and doses of raw material that supports adrenal function

  7. Massage/body work

  8. Generalized anxiety disorder: your internist is convinced of this diagnosis; let’s discuss.


Over 2 months: Sleep improved; trigger point pain diminished in upper body (by 30%), in gluteal and hips (80%)/able to manage diet “70% to 80% of the time”/exercise 3 to 5 times weekly, less when husband travels

Vacation interlude: Treatment plan jettisoned for vacation/return of rheumatic symptoms; dizziness and lassitude, however, continued to improve

Next 2 months: Continued improvement, with trigger point pain flaring only on long drives

Naturopathic training

Naturopathic physicians graduate from 1 of 6 naturopathic medical schools accredited by the Council on Naturopathic Medical Education (CNME) (TABLE 1). The CNME is a member of the Association of Specialized and Professional Accreditors recognized by the US Department of Education. Each school in the United States is also accredited by, or has candidacy status through, the specific regional agencies responsible for overseeing postsecondary institutions of higher learning.

Requirements for admission. The goal of naturopathic medical education is to prepare clinicians for the challenges of general practice, with a foundation in current medical science as well as traditional naturopathic theory. Candidates for admission to naturopathic medical school must earn a baccalaureate degree (or equivalent) prior to matriculation, including standard premedical undergraduate courses.

Naturopathic curricula. Subjects include inorganic and organic chemistry, physics, general biology and psychology. Other coursework is comparable to that of allopathic and osteopathic medical schools (TABLE 2). While the first 2 years of education combine courses in naturopathic principles with basic and diagnostic sciences, third and fourth year students focus on clinical practice, receiving training at naturopathic primary care outpatient clinics as well as conventional medical facilities (TABLE 3). Academic faculty at such institutions include NDs, PhDs, MDs, DOs, and other allied health professionals.

For information on postgraduate residencies, research, and collaborative opportunities for NDs, please see APPENDIX I. For additional information on naturopathic licensure, please see APPENDIX II.

Practice principles of Naturopathic Medicine – What Patients Can Expect

Naturopathic medical practice is based upon the premise that it is intrinsic to the nature of living organisms to heal. The naturopathic physician understands illness to be a disruption of normal orderly function. Healing therefore is the process by which living systems return to a resilient equilibrium, either unassisted or with the therapeutic support of the practitioner.


Standard review of systems is supplemented with patient reports of dietary habits, physical activities, etc

Western medicine rarely takes into consideration the inherent organizing forces underlying known physiologic processes such as metabolism or tissue repair. Naturopathic medicine calls this primary principle the vis medicatrix naturae, or the healing power of nature.
Another principle fundamental to the can complement customary clinical practice restoration of health is the understanding that any intervention employed should not further disrupt a system attempting to regain homeostasis. This is expressed as primum non nocere, the imperative to first choose interventions which do the least harm.



  • dietary revision

  • lifestyle changes

  • botanical medicine

  • homeopathy

  • physical medicine

  • mind-body therapies

When confronted with an ill patient, the naturopathic physician seeks to understand the totality of fundamental causes disrupting the patient’s optimal equilibrium. In order to remove the cause of the illness (tolle causum), one must treat the whole person.

In pursuit of removing or moderating the insults and stressors that result in harm to the patient, the doctor becomes teacher (docere) and engages the patient in the essential responsibilities of self-care. Participation in the restoration of personal wellbeing prepares the patient to behave proactively in the future, when mutual efforts at prevention predominate in the physician-patient relationship.1
Although these practice principles form the foundation of the naturopathic approach to health and healthcare, the philosophic and conceptual approaches of conventional medical theory apply as well, including complexity science, quantum physics, medical ecology, public health, energy medicine, and the biological basis of healing. The above principles do not replace the foundation of biological pathology, but offer the practitioner an expanded perspective when treating each individual patient. Naturopathic medicine ascribes to a therapeutic hierarchy that integrates the full spectrum of modern biomedicine in a continuum that includes mental, emotional and spiritual therapies, as appropriate to each patient’s needs.2 Applied in this context, biomedical interventions are highly valued as both diagnostic and therapeutic approaches.


NDs often work with physicians to co-manage patients and help decide when to refer for evaluation by other practitioners

Clinical approach to patients

The ultimate goal of each clinical assessment is to obtain an in-depth understanding of the patient’s underlying condition (including his or her experience) and to effectively communicate relevant information to other healthcare providers participating in the patient’s care.
Essential to a comprehensive evaluation is the extended interview, which ranges from 60 to 90 minutes for new patients. Follow up visits range between 30 and 60 minutes. A standard review of systems is supplemented with patient-generated reports of daily activities, such as dietary habits, physical activity, and psychological issues (see Naturopathic approach to one patient’s case). NDs perform physical examinations appropriate to the patient’s presenting complaint and health history, and employ conventional laboratory and diagnostic imaging services as needed. Clinical evaluation is patient-centered and addresses a full range of factors that influence health as well as illness, generating a problem-oriented patient record based on International Classification of Diseases (ICD-9) criteria.
Modalities most often used in naturopathic practice include clinical nutrition and dietary revision, counseling for lifestyle modification, botanical medicine, homeopathy, physical medicine, and mind-body therapies.

Scope of practice. Depending on local licensure statutes, naturopathic physicians may be fully recognized as primary healthcare providers.3 Prescriptive authority varies, as do provisions for other procedures commonly associated with general medical practice.4
Details of the scope of naturopathic practice in each licensed jurisdiction can be accessed by contacting local licensing authorities, usually via a state or provincial agency website. In the majority of jurisdictions, licensed NDs are responsible for all public health regulations including reportable diseases and immunizations. Most ND practice acts require annual continuing education credits to maintain practice privileges.

Interdisciplinary collaboration. NDs are trained to recognize serious and life-threatening situations and to identify conditions outside of the scope of their professional or legal limitations. Appropriate referral mechanisms are indoctrinated during educational and clinical training. NDs often work with conventionally trained family practice physicians, internists, and specialists in co-managing patients, participating in decisions regarding referral for evaluation and treatment by other allopathic and complementary/alternative medicine practitioners.

Safety and effectiveness of naturopathic medicine

Naturopathic practice is distinguished by treatments individualized to a patient’s physical condition and environmental circumstances, requiring combination therapies adjusted over time as guided by patient response. Documenting the safety and efficacy of naturopathic interventions presents significant challenges—eg, the limitations of the reductionistic approach of allopathic research models when applied to complex interventions and inadequacy of available funding sources. Research on the clinical and quality of life outcomes, particularly evaluation of the actual, complex whole practice as opposed to single agent or specific modalities, is relatively scant.5

Responding to this challenge, in 2002 the NIH funded more than 1200 scientists and physicians from both conventional and naturopathic academic and professional communities in a 2-year effort to design the Naturopathic Medical Research Agenda (NMRA). Guided by the NMRA process, the research departments of naturopathic academic centers are systematically developing the collaborative infrastructure required to examine the theory and practice of naturopathic medicine.6 The recently inaugurated International Journal of Naturopathic Medicine (available at provides access to naturopathic-specific, peer-reviewed research.

Documentation of safety is as relevant as documentation of efficacy. As the potential for harm does exist within the naturopathic scope of practice,7 licensure in the US requires that adverse medical events be reported to the federally mandated
National Practitioner Databank.8 The disciplinary records of naturopathic licensing boards provide scrutiny of practices regulated in those jurisdictions as well as documentation of specific offenses: over a 10-year period (1992–2002), 173 complaints were filed with state licensing boards from a total of 1805 licensees. During this period, 31 disciplinary actions were initiated, ranging from probation to fines or censure.9


Increasingly, NDs are covered as specialists and primary care providers under corporate reimbursement plans

Safety and efficacy are also of concern to third-party payers. More than 70 companies, trade unions, and state organizations offer health plans that cover naturopathic medical services,1011 requiring utilization reviews incorporating documented patient outcomes. As NDs are increasingly covered as specialists and primary care providers under reimbursement plans of corporations such as Microsoft and Boeing, the credentialing processes required by their insurers (such as Blue Cross and Blue Shield, Kaiser Permanente, Connecticare, Oxford, and Healthnet) result in formal analyses of safety and efficacy of practice. Malpractice insurance industry data also verify incidents of harm that may occur related to naturopathic practice.

More about naturopathy

To access more in-depth information, including how to identify licensed NDs in a particular geographic area, contact the American Association of Naturopathic Physicians at

For information on naturopathic medical education, particularly the advanced standing programs available to degreed professionals, contact the American Association of Naturopathic Medical Colleges at

An additional resource for degreed medical professionals interested in naturopathic professional practice is the website for the North American Board of Naturopathic Examiners at

The advent of integrated care has resulted in staff privileges granted to NDs at approximately 20 conventional hospitals and numerous integrated clinics. As a result, efficacy of peer review is strengthened as payers elect naturopathic medical directors to peer advisory committees charged with formulating reimbursement and case management policies.12


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    Zeff J.
    Report of the Select Committee on the Definition of Naturopathic Medicine. Washington, DC: AANP; 1988.
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    Fundamentals of Complementary and Alternative Medicine. 2nd ed. Philadelphia, Pa: Churchill-Livingstone; 2001;181–183.
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    The other side of the coin: Safety of complementary and alternative medicine. Med J Aust. 2004;181:222–225.
  8. Healthcare Integrity and Protection Databank National Practitioner Databank. Available at: Accessed on February 1, 2004.
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CORRESPONDING AUTHOR: Nancy Dunne, ND, Bitterroot Natural Medicine, 200 East Pine St., Missoula, MT 59802. E-mail: