Review Article

Alternative Medicine: New Ways to Treat Diseases and

Therapies
T. R. MAMIDI*, MATCHA YAMINI, V. S. P. CHERUKURI AND S. R. YARRAGUNTLA
Department of Pharmaceutics, Vignan Institute of Pharmaceutical Technology, Duvvada, Visakhapatnam

Rao et al.: New Ways to Treat Diseases and Therapies

Alternative medicine is the most widely used remedy systems, in the treatment of various diseases.
Alternative medicine is used widely because there are a large health care alternatives to be more congruent
within the own values and beliefs towards health. Alternative medicine is more compatible with patients,
offers more personal autonomy and control over the health care decisions. It is accepted worldwide because
of its compatibility and acceptability in increasing the beliefs regarding the nature and meaning of health
and illness. This review deals with various alternative therapies used such as Ayurveda, homeopathy,
acupuncture, naturopathy, yoga, herbal medicine, massage therapy; effectiveness of the alternative
medicine; assessment of the effectiveness of alternative medicine; sources of information about the
alternative medicine; alternative medicine therapies in treatment of various diseases; perceived benefits of
alternative medicine and thereby concluding with the increased level of acceptance of alternative medicine,
its widespread use in various diseases and their treatment with various alternative therapies.
Key words: Alternative medicine, Ayurveda, homeopathy, acupuncture, naturopathy, yoga, herbal
medicine, massage therapy, diseases, treatment

Alternative medicine is a type of any health care traditional medicine in some countries. The public is
remedy or a system which is not accepted generally in becoming aware of the alternative medical therapies
the modern biomedicine or therapies that are usually through all forms of the media and large proportions
offered in place of or as a substitute for the conventional of the public self-prescribe alternative medicines
therapies[1]. The main stream of medical practice and also by visiting the alternative practitioners in
usually includes the Allopathic medicine. The Various Europe, the United States and Australia[3,4]. Many
alternative therapies used are: homeopathy, acupuncture, patients consult their doctor or the alternative health
naturopathy, herbal medicine, diet fads, folk medicine, care providers such as the naturopaths, herbalists,
faith healing, Ayurveda medicines, chiropractic, yoga, chiropractors, homeopaths and the practitioners of
massage therapy and music therapy. Courses in the Chinese or the Ayurveda medicine for the alternative
alternative medicine are also known as complementary medicine therapy. Pediatricians are becoming usually
medicine; private medical insurance agencies more open to alternative medicine. Forty two percent
increasingly include the alternative medicine options of Canadians use Alternative medicine therapies[5].
among their coverage. In many countries alternative Alternative medicine is used not so much because of
medicines and the therapies are usually regulated with their dissatisfaction with the conventional medicine
almost no requirements to prove the efficacy or long but largely because that they find these health care
term safety. Alternative medicine industry is booming[2] alternatives to be more congruent with their own values
and many companies selling alterative medicines and beliefs towards health and life. The therapies have
appear to have escalating share prices on the world experienced the highest increase in use including the
stock markets. The term complementary medicine
This is an open access article distributed under the terms of the Creative
and the alternative medicine refer to a set of health Commons Attribution-NonCommercial-ShareAlike 3.0 License, which
care practices that are not a part of the country’s own allows others to remix, tweak, and build upon the work non-commercially,
as long as the author is credited and the new creations are licensed under
traditional or the conventional medicine and are not the identical terms
fully integrated into the dominant health care system.
Accepted 22 February 2021
In some countries they are used interchangeably with
Revised 30 December 2020
Received 10 September 2020
*Address for correspondence
Indian J Pharm Sci 2021;83(1):1-12
E-mail: [email protected]
January-February 2021 Indian Journal of Pharmaceutical Sciences 1
 www.ijpsonline.com
homeopathy, energy healing, massage, mega vitamins, practices the treatment is not typically single drug or
self-help groups, folk remedies and herbal medicine. intervention, but is a complex therapeutic modality that
also may involve physical and emotional interaction
ALTERNATIVE MEDICINE AND ITS with the therapist.
EFFECTIVENESS
ASSESSING THE EFFECTIVENESS
Alternative medicine has a widespread use by over 40
percent of the total U.S population which has been a Assessment depends on the clinician’s healing paradigm,
considerable challenge to the conventional health care such as the biomedical, homeopathic, or naturopathic.
practitioner which has shown a necessity to appreciate The effect of philosophy of healing such as self-healing,
the different healing approaches of conventional systems approach, balance and holism; the effect of
medicines and many complementary and alternative clinician-patient relationship; the set of therapeutic
therapies and the understanding of how these differences methods used to enhance the healing process all the
affect the treatment approaches and the measurement three effects play an important role in the assessment
outcomes. In addition one must understand how of alternative medicines and complementary medicines
the conventional research methodologies and the treatments’ effectiveness. The healing philosophy on
evidence reporting limit or conflict with the ability the evaluation of the outcomes is usually offered by
to accurately assess the effectiveness of alternative the homeopathy. In some cases the clinicians strongly
therapies and where to find reliable information about reject the scientific conclusions of the effectiveness of
such therapies. Effectiveness of care usually implies homeopathy therapy because the non-material nature
the positive outcome of the treatment which is the of homeopathic remedies is outside the conventional
result of combination of the factors like efficacy of scientific paradigm and is dismissed as placebo.
an intervention, the approach to the patient, response
of the patient and setting in which care is given. EFFECTIVENESS WITH THE POWER OF
Effectiveness also reflects the aspects of placebo or the BELIEFS
expectancy effect. Due to the costs, safety issues and Patient’s beliefs regarding the treatments and medicines
the dominance of the pharmaceutical interventions, the usually play an important role in any healing setting.
demonstrating efficacy relied heavily on a single tool The patients centered approach fits the model described
for the measurement of a biological therapeutic effect– by Benson 1997, for obtaining the nonspecific placebo
Randomizes controlled clinical trial (RCT). The RCT effect. This effect is usually produce by the health
approach to determining of all the clinical merits of the professional’s style and clinical setting rather than
alternative invention are usually important, given the a placebo or chemical effect of the intervention such
highly individualized and the multifaceted treatment as the manual therapy or the acupuncture needling.
protocols typically employed. The RCT research The success of the alternative therapy practitioners
technique usually tests a well specified and standardized is achieved by maximizing the non-specific placebo
treatment, delivered uniformly in a standard setting to response for many of the complementary and the
specified subjects, designed for those who ideally have alternative medicines practitioners, it is a goal of the
only the target condition being treated and also includes therapy to engage the patient including emotional and
agreements with subjects to comply and adhere to the physical expectations in the healing process which may
protocol usually for a reward. Due to this design the be more difficult to control for the placebo effect in the
efficacy studies specifically exclude the multiple, real study design. Other beliefs also influence the success of
world clinical factors which include the approach to a treatment or therapy.
the patient, treatment setting, life style issues and the
EXAMPLES FOR THE ASSESMENT OF
adherence to medication protocol. The model of the
EFFCTIVENESS OF ALTERNATIVE
single intervention clinical trials are more useful for
THERAPIES
the pharmaceutical treatments than for assessing the
outcomes of the most alternative medicine therapies An example of an analysis of the weight of evidence
where treatment protocols are tailored to individuals in the alternative and the complementary medicines
rather than a standard group of subjects. Assessment from the article Rheumatology, ‘Herbal Medicines for
of the alternative therapy effectiveness may require a the treatment of Osteoarthritis: A systematic review’
different approach for the gathering and interpreting published in the journal. This article also includes
evidence. In the clinical world of the alternative the treatment of osteoarthritis with Nonsteroidal anti-
2 Indian Journal of Pharmaceutical Sciences January-February 2021
 www.ijpsonline.com
inflammatory drugs (NSAID’s) by the authors of (from builds the trust and hence promotes integration;
Exeter University, UK and the University of Maryland Promote the body’s self-healing abilities (important
School of Medicine, US) causes about 2000 deaths a principle); Emphasize the self-care and empowerment
year. The search for the literature of RCT’s of herbal of the patient in the healing process; Recognize the
remedies for the osteoarthritis was done and found those mind, body and spirit as interactive and inseparable;
12 trials and 2 systemic reviews of which some of these Address underlying causes of illness-including the
were unreplicated studies. A set of Eleven remedies environmental emotional and spiritual factors rather
were studied: Articulin-F (an ayurvedic herbal mineral- than just the clinical manifestations; Prevent ill
formulation); avocado/soybean unsaponifiables (ASU); health by remaining in balance and harmony with
capsaicin (derived from hot chili peppers, applied the psychosocial and physical environment; Enhance
topically); devil’s claw (African plant, active agent: wellness with the optimal diet, exercise and reduced
iridoid glycoside); eazmov (Ayurvedic herbal mixture); stress life style; Individualize the treatment to particular
ginger; gitadyl (combination of feverfew, aspen patient, rather than focusing on the disease condition;
and milfoil); phytodolor (three herb combination); Emphasize the use of natural non-pharmaceutical
reumalex (white willow bark, guaiacum, black cohosh, substances or non-surgical techniques in the care of
sarsaparilla and poplar bark); stinging nettle and willow patient; Appreciate the electromagnetic and energetic
bark. After reviewing the weight of evidence the nature of the human organism and the importance of
following recommendations were made: moderately vitality in healing; Acknowledge the healing journey
strong (3+favorable trials) evidence for the phytodolor, and that the return to wholeness can be a gentle and
capsaicin. Weak evidence (1 trial with favorable gradual developmental process.
outcome) for reumalex willow bark, stinging nettle,
articulin-F. No evidence (no positive trials for eazomov, SOURCES OF INFORMATION ABOUT
gitadyl, ginger extract). Finally, stated that there are ALTERNATIVE MEDICINE ON INTERNET
some of the promising alternative and complementary The internet resources usually provide the information
options for the clinical care. and satisfy the needs of both health care workers
There is evidence supporting the efficacy and and physicians. The following list is useful starting
effectiveness of a number of alternative therapies point and accessing these websites leads to different
and complementary therapies for different health alternative medicines websites.
conditions. The following table summarizes the
Metadirectories:
efficacy and the effectiveness of the selected therapies
for common clinical problems for which some evidence The metadirectories that offer hyperlinked listings of
has accumulated (a positive direction of evidence the alternative medicine websites are-The Alternative
indicates that the treatment provides benefit, a negative medicine Home Page www.pitt.edu/~cbw/altm.
direction indicates no benefit for the clinical problem). html provides the information about the alternative
Summary of the alternative and the complementary medicines with access to the databases, internet
medicine effectiveness for selected medical conditions resources, mailing lists and government resources.
(Table 1). The site Alternative Medicine Health Care Information
Resources–McMaster University <www-hsl.mcmaster.
PRINCIPLES OF HEALING OF VARIOUS
ca/tomflem/altmed.html> offers access to the general
ALTERNATIVE THERAPIES
resources on alternative medicines on the World Wide
The complementary and the alternative medicines Web. Links to the pages are inclusive or encyclopedic
therapeutic systems emphasize some or all of the in nature. Each link usually offers access to multiple
following principle to a greater degree than the alternative medicines topics. The links to inclusive
conventional medicines. Effective integration of these resources are followed by a list of very specific
therapies and also the conventional care must rest on the resources on single topics. This is an excellent site
acknowledgment, appreciation and application of these to access and also has many appropriate hyperlinks.
principles in patient-centered context. They provide a The site National Center for Complementary and
framework for understanding the complementary and Alternative Medicine (NCCAM) National Institutes of
alternative therapy approaches to healing that contrast Health (NIH) is sponsored by the office of Alternative
with the biomedical model of care: Emphasize effective Medicine established in 1992 as a part of the National
communication between the patient and healer, which Institutes of Health (Table 1). NCCAM was established
January-February 2021 Indian Journal of Pharmaceutical Sciences 3
 www.ijpsonline.com
TABLE 1: SUMMARY OF ALTERNATIVE AND COMPLEMENTARY MECIDINES EFFECTIVENESS FOR
SELECTED MEDICAL CONDITIONS
Problem Therapies Evidence strength Evidence direction
Alzheimer’s disease Ginkgo Low to moderate Uncertain
Anxiety Kava, relaxation, aromatherapy Moderate Positive
Asthma Hypnosis, homeopathy, yoga Low to moderate Positive
Eczema Prime rose oil, Chinese herbs Moderate Uncertain
Back pain Acupuncture, massage, manual therapy Moderate Positive
Chronic Fatigue Exercise, herbals, homeopathy Low to moderate Positive
Constipation Biofeedback, massage, herbals Low to high Positive
Depression St. john’s worth, relaxation, music Low to high Positive
Fibromyalgia Exercise, homeopathy, biofeedback Low to moderate Positive
Hypercholesterolemia Diet, garlic, gaur gum, red yeast rice High Positive
Insomnia Kava, valerian, relaxation, melatonin Moderate Positive
Migraine Acupuncture, bio feedback, feverfew Moderate Positive
Osteoarthritis Acupuncture, devil’s dow, glucosamine Moderate Positive
Palliative care Acupuncture, healing touch Low Positive
Prostatic Hyperplasia Palmetto, African plum moderate Positive

to ‘facilitate the evaluation of alternative medical Supplement (IBIDS) <odp.od.nih.gov/ods/databases/

treatment modalitie’s[6] to determine the effectiveness. ibids.html> is the database of published, International,
NCCAM conducts the applied research and training and scientific literature on dietary supplements, including
it disseminates information on the alternative medicine the vitamins, minerals and botanicals. This database
and the complementary medicine practitioners and the contains 300 000 scientific citations and abstracts. It
public and also brings the researchers together to prepare provides a journal list of more than 1500 publications
grant applications. With the united states food and drug with links to websites where the users may order the
administration the NCCAM holds regular meetings full journal articles. Southwest school of Botanical
to enlist its cooperation in re-evaluating current rules Medicine-Plant Abstracts includes the European and
and regulations governing research about devices and Asian plants and provides an alphabetical listing of
their use, acupuncture needles, herbs and homeopathic plants that have received some investigations. The
remedies and corresponds with many alternative medical abstracts from the foreign medical and pharmacological
organizations and provide information about research journals include both human and animal research.
support and development. The site Alternative Health
News Online www.altmedicine.com/ corresponds to the VARIOUS ALTERNATIVE THERAPIES
statement ‘be aware that alternative health and healing AND THEIR TREATMENT ON VARIOUS
covers everything from pure hogwash to promising and DISEASES
proven therapies. This helps the consumer evaluate the
Ayurveda:
alternative medical approaches.
Ayurveda (ayush=life, vid=wisdom-Sanskrit) is the
Databases:
ancient medical systems within ancient Vedic tradition
Databases allow the users to search for articles on specific offering the wealth of knowledge for meaning full life
topics regarding alternative medicines. Alt-Health and health[7]. Ayurveda, part of atharvaveda, the last
Watch www.softlineweb.com/althealth includes the full one of the four Vedas is timeless and unbounded it has
text database of peer-reviewed journals, periodicals, relevance even to the present day. The philosophy of
academic and professional publications, magazines, Ayurveda believes that everything in this universe is
consumer newsletters and newspapers, research reports composed of five elements, the panchabhootas. They, in
and the association newsletters focused on alternative, turn constitute the three doshas or bio-energetic forces
complementary and integrated approaches to health that govern our health and determine our constitution.
care. Alt-Health Watch provides the information Mental and the spiritual health are determined by the
regarding the professional and consumer levels across trigunas or psychic forces. The modern risk factor
the full spectrum of 200 therapies, modalities and the hypothesis pales into insignificance in the view of most
various perspectives addressed by integrated medicine. elaborate knowledge in Ayurveda.
The International Bibliographic Information on Dietary The recent additions to the modern medical list like
4 Indian Journal of Pharmaceutical Sciences January-February 2021
 www.ijpsonline.com
hostility from the basis of Ayurveda risk factors. Viz. various details of ancient Indian vaccination methods
Krodha, sokha, bhaya, aayasa, virudhaannabhojana, to the London Royal College of Physicians on 1747[10].
Thaponnalaan, lavanakshara…rekta pitta prakopayeth.” Various detailed texts existed for the physiology,
(Anger, depression and sorrow, extreme fear, exhaustion, symptomatology, surgery, drug therapy and diet. The
wrong foods, sedentary living, too much salt and spices descriptions of the angina pain and its origin were
lead to most of the major killer diseases). explained[11].
The solution for this is Nithyahitha, mithaaaharasevi, “Athaathohradrogaprathishedamvyakyawamyah
sameekshkaari, dhatasamahasathyapara Kshamavaana
YathovaachaBaghavanDhanvantharim:
apthopaseviaarogyam.”(Have food in moderation and
also that which pleases the mind. Do not cheat tell lies. “AyaammyatheMaaruthajeHradayamThudyathe,
Work very hard, forgive others even if they hurt you.
NirmaathyatheDheeryathe Cha Spotyathe,
Treat all as your own kith and kin. Health would be
yours always)[8]. PaatichaThrinoshadaahachoshaamsyuhuPaithikecha,
Vedic wisdom is the right approach for holistic Dhoomaayam Cha Moorchaa Cha Swedhahako.”
assessment of health and disease. The Vedic wisdom In the above chapter the symptoms of heart diseases
aims not only to heal the sick, but also to preserve life and impending death by heart attacks is described by
by preventing illness-the most complete system of Bhaghvan Dhanvanthari (God of Healing). There are
health care known. It follows non–linear mathematics. eight branches of Ayurveda integrated at all levels:
Ayurvedic treatment depends on restoring the Surgery, medicine, gynecology, pediatrics, toxicology,
distributed balance of the three dosha–vata, pitta and otorhinolaryngology, rejuvenation and the virilification
kapha. Ti considers the whole human being not only the therapy.
phenotype. It includes the genotype as also the mind in
The oath of Indian physician is much more elaborate
classifying patients. Based on the constitutional types
compared to that of the Hippocratic Oath. In a classic,
treatment differs from individual to individual even for the Greek historian described how Aryans (cultured
the same disease. Ayurveda astrology usually plays an men-Sanskrit) migrated from India to Greece via
important role in disease and its cure but the science of Sumeia and many other countries[7]. History shows the
astrology is good but not the astrologers’ predictions, much data how the ancient Indian texts and pundits
most predictions including those in the scientific were taken to Greece by the army of Alexander the
predictions are just “predicting the unpredictable”[9] Great. Charaka Samhitha and the Susrutha Samhitha,
The long term prospective studies from the basis of were the most famous of all the texts, many others
therapy in Ayurveda, includes the treatment tailored like MadhavaNidhaana are also said to be significant.
to individual needs and is broadly grouped into the Several thousands of medicinal plants mentioned in
following: the ancient texts hold the key to future inexpensive
pharmacology. Charaka, the great Ayurveda sage wrote.
Detoxification-panchakarmas, diet, yoga, herbal
“That is designated as Ayurveda or the science of life
medications, meditation and prayer (no particular god
wherein are laid down the good and bad of life, the happy
or book prescribed), Ayurveda surgery.
and unhappy life and what is wholesome and what is
Sushruta described the various advances in Ayurveda unwholesome of life, as also the measure of life”[12]. In
surgery which could be gauged from the intricate order to complement modern medicine whitins all of
rhinoplasty, thousands of years ago. Stone removal and its disadvantages, Ayurveda fits the bill perfectly with
trephining from various sites, hysterectomy, abdominal less expensive and equally effective methods good for
child birth, episiotomy, fracture setting, tumor surgery, long term care and is highly effective. Ayurveda is not
minor surgical procedures has been described. They just an alternative medicine but the key basis of India’s
had 127 instrument and suture materials. Anesthesia, health.
sanmohini, was the much more advanced and aseptic
Homeopathy:
methods were the most modern. The lancet used for
small pox vaccinations resembles the one used in the Homeopathy is defined as the therapeutic method
modern medicine. Jenner’s vaccination has gained the using preparation of substances whose effect when
authentication from the ancient ayurvedic vaccination’s administered to healthy subjects correspond to the
proven track record. Dr. T. Z. Holwell, presented the manifestations of the disorder (symptoms, clinical
January-February 2021 Indian Journal of Pharmaceutical Sciences 5
 www.ijpsonline.com
signs and pathological states) in the individual patient. atopic dermatitis. Homeopathy could significantly
Homeopathy as an alternative and complementary decrease the pulmonary discharge in patients with
medicine and a holistic medicine can solve some Chronic obstructive pulmonary diseases (COPD)
of the modern medical problems. This method was who admitted in the Intensive care unit (ICU) and
developed by-Samuel Hahnemann (1755-1843) a mechanically ventilated and the patients were separated
German physician in 1810 and treatment for diseases and discharged from the ventilator device faster than
with about 3000 homeopathic remedies was addressed the control arm[19]. The effect of Homeopathic remedies
based on the golden principles and now it is practiced efficacy on animals and herbals has been proven and
throughout the world[13]. Homeopathy is based on two these evidences discourage induction in homeopathy
main principals[14,15]. The first principle-‘like cures like (the use of Blatta orientalis in Indian guinea pig
principle’ (similiasimilibuscurentur), states that patients and rat has been led to reduction of acetyl choline,
with particular signs and symptoms can be helped by histamine, eosinophil, immunoglobulin E (IgE) and
a homeopathic remedy that produces there signs and mast cell in hypersensitive lungs accompanied with
symptoms in healthy individuals. The second principle bronchospasm[20]. Gamma interferon production rate
states that homeopathic remedies retain the biological by T cells has been increased up to 24 % after the
activity after repeated dilution and succession even homeopathic remedies use. This also discourages the
when diluted beyond Avagadro’s number. The origin induction in homeopathy[21].
of homeopathic medicines includes the following
percentages of Herbal >80 %, Salts 10 %-15 % and Acupuncture:
Animal about 5 %. The Food and Drug administration Acupuncture means “to puncture with a needle”.
of the United States of America in 1938 recognized The term acupuncture implies two different words
all the Homeopathic remedies as “medicine”, not a from Latin: acus means needle and puncture means
supplement or vitamin. Homeopathic remedies were insertion[22]. It is the best known of alternative and
proven to be effective, safe and cost-effective. After complementary therapies. Acupuncture is a treatment
this study Switzerland joined the countries of Germany, method that originated more than 3000 y ago in
England, France, Denmark and Luxembourg and China and also practiced in most of the world[23].
provided the homeopathic remedies under insurance[16]. Traditional Chinese medicine defines acupuncture as:
Now a day’s homeopathy is recognized as the second the stimulation of certain points on or near the surface
important medicine of world in terms of the extent of the of the human body through any technique of point of
patients covered. 40 % of the French people use these stimulation with or without the insertion of needles,
homeopathic medicines for common cold and allergies. these include the use of electrical, magnetic, light and
In Germany, the most commonly used treatment for sound energy, cupping and moxibustion (the burning
Hay Fever (a seasonal sensitivity) is homeopathy[17]. on or over the skin of selected herbs), to normalize
In the 200 y history critics have pointed out that its very the physiologic functions or to treat various conditions
principles fly in the face of science, while proponents of the human body[24]. The practice of acupuncture
have maintained that it is narrow minded to reject an consists of inserting fine, solid needles (usually 32 to
overtly helpful approach to healing only because cannot 36 gauges) into selected body locations (acupuncture
points). It describes there are 365 points located in
explain how it might work[14]. Various conclusions have
systematic fashion on meridians or “channels of energy
been given for the homeopathic medicines describing
flow” that are mapped onto the surface of the body.
them that they are more than mere placebo and superior
The key principles in traditional Chinese medicine
to placebo by Linde in 1997[15]. Despite this and other
(TCM) are that both wellness and illness sult from an
caveats homeopaths worldwide have celebrated this
imbalance of yin and yang. Yin refers to the feminine
publication the ultimate proof of their treatment. Since
aspect of life: nourishing, lower, cool, deficient, inside,
then, a flurry of interest in homeopathy has emerged.
receptive, protective, soft and yielding. Yang is the
Since 1997 with a view to defining the clinical
male counterpoint: hard, dominant, energetic, upper,
effectiveness of homeopathic medicines has emerged.
hot, excessive, outside and creative. The movement
A scientist named Cohort revealed that homeopathy between these opposite forces, named Qi, is considered
could effectively reduce patients’ disease severity to be the essential element in the healing system of
and improve their quality of life[18] from his study TCM. Within the wide usage of acupuncture, patients
on 3981 patients with allergic rhinitis, headache and self-refer to acupuncturist for a variety of indications.

6 Indian Journal of Pharmaceutical Sciences January-February 2021

 www.ijpsonline.com

The National Institutes of Health (NIH) convened a post extraction pain, gingivitis, acute and chronic
consensus panel to review the available literature about Pharyngitis.
acupuncture[25], clinical efficacy and effectiveness,
Overall in the United States, acute and chronic
biological effects implications on health care system and
musculoskeletal indications for acupuncture treatments
the need for further research. Further the acupuncture
have found greatest acceptance. Acupuncture may
research trials have been funded by the NIH/NCCAM
be useful in difficult conditions such as asthenic
and other agencies. Various national institutes of health
states (“tired all the time”, “low energy”), autonomic
consensus panel on acupuncture[26]. Skeptics maintains
dysregulation disorders (Anxiety, sleep disturbance,
that acupuncture has basically a placebo effect since, bowel dysfunction) and immune dysregulation
acupuncture meridians and their “energy” or “chi (Qi)” disorders (recurrent infections and inflammations)
as described in the TCM cannot be directly observed, [31]
. In many acupuncture practices, the most common
dissected or measured with standard anatomic indications are mainly for chronic pain unresponsive to
approaches or physiologic instrumentation. The standard therapy. The ancient method of acupuncture
acupoints are located at sites that have a high density has gained significant popularity in our era, most of the
of neurovascular structures, between or at the edges patients select acupuncture as part of their therapeutic
of muscle groups[27] and these are of less painful than plan because if it’s long history of use, safety and
random needle sticks into the muscle group. A study reports of efficacy. Physicians may also wish to expand
demonstrated that needling a point on the lower leg the scope of their practice by taking additional training
traditionally associated with eye activated the occipital to administer acupuncture, even if one doesn’t add this
cortex of the brain as detected by functional magnetic training, knowing how to refer the credible, well trained
resonance imaging[28]. The explanation of TCM system acupuncturists and for what indications is increasingly
of medicine, including the effects of acupuncture, is rich important in evolving model of integrative, combining
with metaphor and allegory[29]. These explanations refer the best of both scientific medicine and traditional
to different kinds of Qi, the influence and interaction of systems of care.
the five elements (fire, earth, metal, water and wood) Naturopathy:
yin and yang and other terminology that requires
contemplation and long study of a culturally distinct Naturopathic medicine is a distinct method of primary
system. Other organizations have also addressed the health care-an art, science, philosophy and practice of
potential benefits of acupuncture. The World Health diagnosis, treatment and prevention of illness[32]. It is
Organization has identified more than 40 medical a distinct type of primary health care medicine that
conditions treated effectively with acupuncture. The usually blends age-old healing traditions with scientific
various indications for acupuncture by world health advances and current research. It is guided by unique
set of principles that recognize the body’s innate
organization[30]: Respiratory tract acute sinusitis, acute
healing capacity, emphasize the disease prevention
rhinitis, common cold, acute tonsillitis; Gastrointestinal
and encourage individual responsibility to obtain
disorders spasm of the esophagus and cardia, hiccup,
optimal health. Principles of naturopathic medicine:
gastroptosis and chronic gastritis, gastric hyperacidity,
The healing power of nature–naturopathic recognizes
chronic duodenal ulcer (pain relief), acute and chronic
the body’s natural healing ability and trusts that the
colitis, constipation, diarrhea, acute bacillary dysentery,
body has the innate wisdom and intelligence to heal
paralytic ileus; Bronchopulomonary disorders-acute itself given the proper guidance and tools; Identify
bronchitis, bronchial asthma; Neurological disorders- and treat causes–ND’s attempt to identify and treat
headache, migraine, trigeminal neuralgia, facial palsy, the underlying causes of illness, rather than focusing
paresis After stroke, peripheral neuropathiesis, Meniere on individual presenting symptoms; First do no harm–
disease, Sequelae of poliomyelitis (early stage), ND’s begin with minimal interventions and proceed to
Meniere disease, Neurogenic bladder dysfunction, higher level interventions only as determined necessary;
nocturnal enuresis, Intercostal neuralgia; Disorders of Doctor as teacher–ND’s educate patients, involve them
the eye-acute conjunctivitis, central retinitis, myopia in the healing process and emphasize the importance
(in children) Cataract (without complications); of doctor-patient relationship; Treat the whole person–
Musculoskeletal disorders-cervicobrachial syndrome, naturopathic medicine takes into account all aspects
frozen shoulder, tennis elbow, Sciatica, low back of an individual’s health including physical, mental,
pain, osteoarthritis; Disorder of mouth-toothache, emotional, genetic, environmental, social and spiritual
January-February 2021 Indian Journal of Pharmaceutical Sciences 7
 www.ijpsonline.com

factors; Prevention–naturopathic medicine emphasizes Yoga:

optimal wellness and the prevention of disease.
Yoga is specified as a mind and body therapy comprising
Treatment addresses the patient’s underlying condition of various breathing and relaxation techniques. This
rather than the individual presenting symptoms. The includes the meditation, postures and phrase recitation
naturopathic physician (ND) strives to thoroughly to improve the mental illness and physical illness[39].
understand each patient’s condition and view symptoms Yoga nidra is a type of relaxation technique, a form of
as the body’s means of communicating and underlying sleep to attain a form of blissful awareness which is
imbalance. The main modalities the ND’s utilize are not attained with other forms of yoga[40]. Iyengar yoga
diet, clinical nutrition, behavioral change, hydrotherapy, usually helps in postural alignment and movement; this
homeopathy, botanical medicine, physical medicine, usually promotes the use of blocks, mats, blankets and
pharmaceuticals and minor surgery[33,34]. Naturopathy belts[41]. Hatha yoga incorporates yoga postures (asanas),
can also be traced back to the European “nature cure,” breathing exercises (pranayama’s), meditation (dyana),
practiced in 19th century, which was a system for balancing of opposite properties (heat/activation
treating disease with natural modalities such as water, with cool/calming) for mental health development[42],
fresh air, diet and herbs. In 20th-century developed kripalu[43] and mindfulness based stress reduction[44]
in the U.S and Canada, combining nature cure, also include in the Yoga. Sudarshankriya yoga helps
homeopathy, spinal manipulation and other therapies[35]. in rhythmic breathing techniques performed within
Naturopathy is most accurately viewed as a “whole sitting posture eyes and mouth kept closed[45]. Yoga is
system” medical practice[36,37], a paradigm guiding the used to treat various diseases and disorders like anxiety,
selection and prescription of complex, indivualized, depression, menustral irregularity, fibromyalgia,
multimodality treatments regimens. Naturopathy has hypertension and stress also used in the treatment of
cancer.
defined reduction to single modality. Naturopaths will
take care of reviewing dietary and lifestyle patterns Yoga in treatment of anxiety:
and may offer prescriptions in these areas at a level
of detail that exceeds what is commonly provided Anxiety is most common psychiatric disorders with
by allopathic primary care physicians. Naturopathic various comorbidities like depression, restless leg
physicians having a good training and expertise in syndrome, cancer and hypertension. The higher costs
herbal medicine, which allopathic physicians generally of pharmacological therapies, gave rise to the use of
lack. According to Ayurveda, the indigenous system alternative methods of treatment[46]. Yoga is used as a
therapy to lower the heart rate and blood pressure in
of Indian medicine, which predates naturopathy by
case of people suffering with anxiety[47]. Symptoms
thousands of years, dairy products properly prepared,
associated with anxiety include short and choppy breaths
are a “stavic” food, of the highest order of nutritional
yoga is able to treat the warning signs of anxiety[47].
value. Treatment modalities those utilized by the
Yoga works because of the activation parasympathetic
ND’s include the diet and clinical nutrition, behavioral
nervous system and increases the neurotransmitter
change, hydrotherapy, homeopathy, botanical medicine
Gamma aminobutyric acid (GABA) in the brain and
and physical medicine, also perform minor office
thereby relieving anxiety. Yoga also decreases anxiety
procedures and surgery, administer vaccinations and in patients with psychiatric disorders (anxiety, stress or
prescribe many prescriptive drugs[38]. Proper nutrition depression). Yoga also helps to reduce the physiological
is the foundation of a naturopathic practice; here the and psychological responses to stress.
food is utilized for both health promotion and disease
prevention. The ND’s recommended diets to each Yoga in cancer therapy:
patient a set of balanced whole-foods diet rich in fruits,
The use of yoga as Complementary and alternative
vegetable, whole grains, legumes, wild caught fish,
medicine (CAM) is proven to be beneficial. Most of the
lean animal proteins, whole dairy products. Although
studies reported that yoga improved the physical and
acupuncture and chiropractic care have achieved a set physiological symptoms, quality of life and markers
of measure of acceptance within mainstream medicine, of immunity of the patients providing a strong support
the integrative role of naturopathy has yet to be well for yoga’s integration into conventional cancer care.
specified. Cancer affects the quality of life from its starting stage of

8 Indian Journal of Pharmaceutical Sciences January-February 2021

 www.ijpsonline.com
diagnosis, progression, adverse effects of its treatment antioxidants. Diabetes mellitus usually affects a set
and diagnostic procedures by affecting the physical, of 150 million people worldwide. Herbal medicines
physiological and emotional problems of patients[48-56]. and their preparations are useful for the treatment
Yoga interventions are beneficial in improving the of diabetes mellitus, 200 traditional plants and their
adverse symptoms in cancer patients caused either by bioactive constituents possess anti-diabetic property.
the disease or its treatment. Phytochemicals of various plants are said to be much
effective as alternative medicines. Extracts of various
The greatest challenges of cancer care providers are:
medicinal plants act at different levels by inhibiting
How to prevent the onset of cancer (transformation of
the glucose absorption from intestine, increasing the
a cell into a cancer cell); How to arrest its progression;
insulin secretion from pancreas, increasing the uptake
How to cure cancer; How to maintain the survivors
of glucose by adipose and muscle cells, inhibiting the
Quality of life (QOL).
glucose production from hepatocytes[57]. Anti-diabetic
The studies proved the evidence of the beneficial effect of oral borapetol B compound isolates from
effects of yoga on the physical and the emotional the plant Tinospora crispa, helps by stimulating the
health and QOL of cancer patients. Yoga prevents the insulin release. Stevioside obtained for the plant Stevia
tumorigenesis and progression and ultimately cures rebaudiana Bertoni increases the insulin sensitivity in
cancer. Cancer caregivers are trained and certified 3T3-L1 adipocytes, also exerts the anti-hyperglycemic
as the ‘Yoga therapists’ who have knowledge of the effect. Hence, herbal medicine as an alternative
particular disease and understand the needs of the medicine helps in treating diabetes mellitus by various
patients. Greater efforts must be made to integrate yoga mechanisms of action.
as a main stream therapeutic program.
Massage therapy:
Herbal medicine:
Massage therapy is mainly used to manage a health
Herbal medicines are the use of medicinal plants for condition or top increase the wellness, by manipulating
the prevention and treatment of various diseases. the soft tissues of the body. Massage therapy is
Herbal medicine is mainly based on the remedies those defined as the soft tissue manipulation mainly for the
containing active principles at very low concentrations, therapeutic purposes done by the trained therapists[58].
or relying on magical-energetic principles. Traditional This therapy is mainly used to relieve pain. Massage
medicines are sum total of practices based on theories, therapy has been followed using the mechanical
belief and experience of different cultures and times devices in addition to the therapists, applied to single
used in the maintenance of health mainly in the or multiple body parts. Swedish/classical massage is
prevention, diagnosis, improvement and treatment the main type of massage therapy in several countries,
of illness. The mind body medicine is considered as clinical massage and sports massage is mainly used
alternative or the complementary mode of traditional for muscle spasms. Other various massage therapies
western medicine and various modes used are a part of are Shiastu, Rolfing, reflexology and craniosacral
therapy. Massage therapies are mainly used to treat
the mind body connection. A successful treatment using
several types of pain such as low back pain, shoulder
this herbal medicines and the assessment of efficacy is
pain, neck pain and pain from osteoarthritis of the knee
not different from that of conventional medicine. Herbal
and headache. Massage therapy is also known to be
medicinal plants are used in the treatment of various
the adjunctive therapy to help prepare the patient for
types of diseases such as Garlic (Allium sativum L.)
exercise or any other interventions. Massage therapy is
used for the treatment of Influenza and Diarrhea etc.
rarely administered as main treatment.
Herbal medicines in treatment of Diabetes Mellitus:
Massage therapy in cancer:
Diabetes mellitus emerges due to various factors–
Massage therapy has been used to relieve pain and other
inhibition of glucose absorption, up regulation of
symptoms in cancer patients but the quality of evidence
glucose transporters, increase in glucose uptake,
was very low. This therapy was used for the care of
glycogen metabolism, decreased insulin production,
breast cancer patients by helping in the reduction of
activation of the nuclear receptors peroxisome stress, anxiety, fatigue, depression and QOL. In patients
proliferator-activated receptors (PPARs), Also because suffering with lung cancer massage therapy is used as
of effects of some opioids on glucose homeostasis and a care for those patients whose anxiety, pain is not
January-February 2021 Indian Journal of Pharmaceutical Sciences 9
 www.ijpsonline.com
controlled by usual care. Massage therapies should muscular atrophy are treated using acupuncture, herbal
be of less pressure while being used in case of cancer medicine and chuna treatment. Various CAM therapies
patients. for muscular atrophy have also been reported. The
CAM therapy promoted protein synthesis and inhibited
Massage therapy in baby growth: the degradation by enhancing the phosphoinositide
Massage therapy effects baby growth by weight gain in 3-kinase (PI3K)/protein kinase B (Akt)/mammalian
infants, 34 studies of massage therapy for the premature target of rapamycin (mTOR) signaling pathway.
infants in the y 2017 has evaluated the effect of massage CAM alleviated skeletal muscle metabolism through
therapy on infants with improvement. modulating mitochondrial biogenesis factors, thereby
prevention of muscle loss, it also restored the expression
Massage therapy in HIV/AIDS: of proteins involved in the cell apoptotic pathway and
autophagy pathway in the various models of muscular
Massage therapy shown a better response for quality
atrophy.
of life, anxiety and depression in case of patients
suffering with human immunodeficiency virus (HIV)/ Alternative medicine in management of
Acquired immunodeficiency syndrome (AIDS). In the osteoarthritis:
y 2010 the review of 4 studies has proven that quality
of life for people has been increased in case of HIV/ Osteoarthritis is a degenerative and progressive
AIDS patients, in the y 2013 massage therapy has been disease mainly affecting the joint cartilage and the
proven for its use in reducing anxiety and depression in subchondrial bone which increases with age[62]. A large
patients suffering with HIV/AIDS. number of different therapies have been described in
the medical literature in relation to the treatment of
Massage therapy in treatment of pain: osteoarthritis. The non-pharmacological modalities
include education about the objectives of treatment
Massage therapy was considered superior to relaxation,
and changes in life style, such as exercise and weight
acupuncture and this therapy was considered to be equal
reduction[63]. There was proven evidence that capsaicin
to exercises and corsets. The acupressure/pressure
gel and S-adenosyl methionine were effective in the
point massage techniques provided more pain relief. management of osteoarthritis[64], Indian Frankincense,
Massage therapy is mainly used in case of chronic pain methyl sulphonyl methane and rose hip may also be
(a continuous recurrent pain that persists for longer than effective. Homeopathic remedies in the treatment
the normal time of healing)[59]. There was an evidence of osteoarthritis were tested. Local application of
for the craniosacral massage in managing tension type a homeopathic remedy (Spiroflor), which contains
Headache pain, sub-acute and chronic nonspecific low Symphytum officinale R., Toxicondendron and Ledum
back pain management, a preliminary support for pain palutres or piroxicam gel (0.5 %). Only a set of minor
relief in carpal tunnel syndrome and equivocal support adverse symptoms were reported among persons taking
for the analgesic effects in fibromyalgia was reported the homeopathic remedies. Alternative medicines are
with massage therapy. also useful in the treatment of Rheumatoid arthritis,
osteoarthritis and fibromyalgia.
Alternative medicine therapies on Muscular
Atrophy: BENEFITS OF ALTERNATIVE MEDICINE
Muscle atrophy is defined as the reduction in the The most frequently endorsed benefits are get relief for
muscle mass that includes the partial or complete my symptoms, the pain or discomfort is less or goes
wasting away from the muscle. The functional and away, feel better and the treatment works better for my
morphological changes those caused by the muscular particular health problem than standard medicines. The
atrophy usually result in decreased protein content, treatment promotes health rather than just focusing on
muscle fiber cross sectional area, muscle strength and illness. Narendra Modi prescribes Ayush traditional
increased insulin resistance[60]. The muscle atrophy ways and endorsed traditional ways to boost immune
also occurs in cachexia, a comorbidity of abnormal system, also suggested people to follow the protocol
conditions such as cancer, AIDS, congestive heart of ministry of Ayurveda, Yoga and Naturopathy,
failure and chronic obstructive pulmonary disease, also Unani, Siddha and Homeopathy to fight with various
occurs in sarcopenia, a decreases in muscle mass and diseases. Narendra Modi said that Ayurveda is not
strength associated with aging[61]. The symptoms of just an alternative today but is one of the key bases
10 Indian Journal of Pharmaceutical Sciences January-February 2021
 www.ijpsonline.com
of the Country’s health policy. Bhadra Ayurveda and serves as the important therapies in treatment of several
panchakarma are the permanent cure for joint pains diseases and increases the level of acceptance in
and determined to be expert treatment for Arthritis, patients which is reported to be a problem with some
Spondylitis and all types of joint pains. Oscar Fernandes conventional therapies and serves to a greater degree
a Congress leader shares story of cow urine curing within some or all of its principles.
cancer, known as the virtues of “gaumutra”. The virtues
of Indian systems of medicine were also praised and Conflict of interests:
said that knee joint pain has been cured completely with The authors declared no conflicts of interest.
the help of “vajrasana” in yoga stating that Yoga is our
wealth. Our Indian systems of medicine will provide a REFERENCES
lot of reliefs even before going to a doctor. Cow cuddling 1. Berkenwald A. In the name of medicine. Ann Intern Med
is believed to promote positivity and reduce stress by 1995;128:246-50.
2. Eisenberg DM, Kessler RC, Foster C, Horlock FE, Calkins
boosting oxytocin in humans, the calming effects of DR, Delbanco TL. Unconventional medicine in the United
curling with a pet or emotional support animal, it seems, States. prevalence, costs and patterns of use. N Engl J Med
are accentuated when cuddling with larger mammals. 1993;328(4):246-52.
3. Goldbeck-Wood S, Dorozynski A, Lie Lg,. Complementary
Embracing Cows, or “KoeKnuffelen” in Dutch, is more medicine is booming worldwide. BMJ 1996;313(7050):131-3.
than a cute wellness trend. With immense mental health 4. MacLennan AH, Wilson DH, Taylor AW. Prevalence and cost of
benefits, the practice has growing global appeal. Tai alternative medicine in Australia. Lancet 1996;347(9001):569-
73.
chi, acupuncture and osteopathic manipulation therapy 5. CTV/Angus Reid Group poll. Use of alternative medicines and
are all the viable options for improving mobility and practicies. Angus Reid Group, Inc 1997.
reducing the pain symptomatology. CAM has a large 6. Saul G. Alternative Medicine and internet. Paediatr Child
Health 1999;4(8):539-41.
and growing in this country and all over the world.
7. Laxminkantham V. Origin of Human Past. Bharathiya Vidya
The increasing use of CAM represents significant Bhavan, Bombay 1999.
shift in the health care received by the populations of 8. Kutumbaih P. Ancient Indian Medicine. Orient Longman’s
Bombay 1962.
industrialized countries.
9. Firth WJ. Chaos-predicting the unpredictable. BMJ
1991;303(6817):1565-68.
CONCLUSION 10. Dharmapal. Indian Science and Technology in the 18th century,
1983, Academy of Gandhian Studies, Hyderabad.
Alternative medicine has become popular and many 11. Hegde BM: Angina an Indian Disease. J Assoc Physicians
of the professionals working in occupational and India 1999;47:440-2.
environmental medicine feel the need to learn about 12. Frawley David. Ayurveda and the Mind. 2000. Motial
Banarsidas. Ayurveda the mother of all wisdoms.
it and implement it. Many adults and children, several 13. Swayne J. International Dictionary of Homeopathy
patients, ambulatory patients use alternative medicine 2002;54:577-82.
in addition to the traditional therapies. A wide spread 14. Ernst E. Homeopathy, past present future. Br J Clin Pharmacol
1997;44(5):435-7.
of increase in the use of alternative medicines and 15. Linde K, Clausius N, Ramirez G, Melchart D, Eitel F, Hedges
practicing has been noted in the recent years. There is LV, et al. Are the clinical effects of homoeopathy placebo
effects? A meta-analysis of placebo-controlled trials. Lancet
a need for the alternative medicine industry and also its 1997;350:834-43.
health professionals to improve its self regulation and 16. Bornhoft JM, Strabala KW, Wortman TD, Lehman AC,
standards. The public has gained accurate information Oleynikov D, Farritor SM. Stereoscopic visualization and
haptic technology used to create a virtual environment for
about the alternative medicines within the internet remote surgery-biomed 2011. Biomed Sci Instrum 2011;47:76-
and alternative medicine websites where the safety 81.
and efficacy information is clearly presented. Several 17. Reilly DT, Taylor MA, McSharry C, Aitchison T. Is
homoeopathy a placebo response? Controlled trial of
challenges have been set for the researchers to find homoeopathic potency, with pollen in hayfever as model.
more appropriate ways of studying the effectiveness Lancet 1986;2(8512):881-6.
18. Witt CM, Ludtke R, Baur R, Willich SN. Homeopathic
of complementary and alternative therapies .Various medical practice: long-term results of a cohort study with 3981
alternative therapies are assigned to treat various patients. BMC Public Health 2005;5(1):1-8.
diseases, most of the alternative therapies are used to 19. Frass M, Dielacher C, Linkesch M, Endler C, Muchitsch I,
Schuster E, et al. Influence of potassium dichromate on tracheal
treat various diseases which could be mentioned as secretions in critically ill patients. Chest 2005;127(3):936-41.
problem with the conventional medicine therapy. CAM 20. Nimgulkar CC, Patil SD, Kumar BD. Anti-asthmatic and anti-
is and increasingly important system which implies anaphylactic activities of Blatta orientalis mother tincture.
Homeopathy 2011;100(3):138-43.
good patient compliance. Hence alternative medicine 21. Enbergs H. Effects of the homeopathic preparation Engystol

January-February 2021 Indian Journal of Pharmaceutical Sciences 11

 www.ijpsonline.com
on interferon-gamma production by human T-lymphocytes. based stressreduction: results from a 3-armed randomized
Immunol Invest 2006;35(1):19-27. controlled trial. Pain. 2011;152(2):361-369.
22. Rosted P. Introduction to acupuncture in dentistry. Br Dent J 45. Telles S, Singh N, Joshi M, Balkrishna A. Post-traumatic stress
2000;189(3):136-40. symptoms and heart rate variability in Bihar flood survivors
23. Ernst E, Pittler MH, Stevinson C, White A. The desktop guide following yoga: a randomized controlled study. BMC
to complementary and alternative medicine: an evidence-based Psychiatry 2010;10(1):1-0.
approach. Mosby International Ltd 2001;98(3):330-7. 46. Katzman MA, Vermani M, Gerbarg PL, Brown RP, Iorio
24. Stux G, Pomeranz G. Scientific Basis of Acupuncture: C, Davis M, et al. A multicomponent yoga-based, breath
Acupuncture Textbook and Atlas. Heidelberg: Springer intervention program as an adjunctive treatment in patients
Verlag;1987medical acupuncture 2014;26(6). suffering from generalized anxiety disorder with or without
25. Sierpina VS, Frenkel MA. Acupuncture: a clinical review. comorbidities. Int J Yoga 2012;5(1):57-65.
South Med J 2005;98(3):330-7. 47. Thygeson MV, Hooke MC, Clapsaddle J, Robbins A, Moquist
26. NIH Consensus Statement: Acupuncture. South Med J K. Peaceful play yoga: serenity and balance for children with
2005;98(3):330-7. cancer and their parents. J Pediatr Oncol Nurs 2010;27(5):276-
27. Helms J. Acupuncture Energetics. Berkeley, CA, Medical 84.
Acupuncture Publishers, Acupuncture: A Clinical Review 48. Allard P, Maunsell E, Labbé J, Dorval M. Educational
1996;(98);3300-7. interventions to improve cancer pain control: A systematic
28. Cho ZH, Chung SC, Jones JP, Park JB, Park HJ, Lee HJ, et review. J Palliat Med 2001;4:191-203. 
al. New findings of the correlation between acupoints and 49. Brændengen M, Tveit KM, Bruheim K, Cvancarova M,
corresponding brain cortices using functional MRI. Proc Natl Berglund A, Glimelius B. Late patient-reported toxicity
Acad Sci 1998;95(5):2670-3. after preoperative radiotherapy or chemoradiotherapy in
29. Traditional Chinese Medicine/Acupuncture. Southern Medical nonresectable rectal cancer: Results from a Randomized phase
Association 2005;98(3). III study. Int J Radiat Oncol Biol Phys 2011;81(4):1017-24. 
30. World Health Organization list of common conditions treatable 50. Bruheim K, Guren MG, Skovlund E, Hjermstad MJ, Dahl
by Chinese Medicine and Acupuncture. Available at: http:// O, Frykholm G, et al. Late side effects and quality of life
tcm.health-info.org/WHO-treatment-list.htm; 2003. after radiotherapy for rectal cancer. Int J Radiat Oncol Biol
31. Helms J. An overview of medical acupuncture. Altern Ther Phys 2010;76(4):1005-11. 
Health Med 1998;4:35-45.
51. McGuire DB. Occurrence of cancer pain. J Natl Cancer Inst
32. House of Delegates position paper: definition of naturopathic
medicine [monograph on the Internet]. Washington, DC: Monogr 2004;2004(32):51-6. 
American Association of Naturopathic Physicians; amended 52. Ram P Agarwal, Adi Marko-Afek. NIH NCI. Side Effects; 2015.
2011. 53. Oh D, Huh SJ, Nam H, Park W, Han Y, Lim DH, et al. Pelvic
33. Sara A. Fleming, Nancy C. Gutknecht, Bastyr University insufficiency fracture after pelvic radiotherapy for cervical
2010;37(1):119-36. cancer: Analysis of risk factors. Int J Radiat Oncol Biol
34. The American Association of Naturopathic Physicians. PMC Phys 2008;70(4):1183-8. 
2010:1-16. 54. Quasthoff S, Hartung HP. Chemotherapy-induced peripheral
35. Kirchfeld F, Boyle W. Nature Doctors: Pioneers in Naturopathic neuropathy. J Neurol 2002;249(1):9-17. 
Medicine. Med Biol 1994;37(1):119-36. 55. Gorin SS, Krebs P, Badr H, Janke EA, Jim HS, Spring B, et al.
36. Ritenbaugh C, Verhoef M, Fleishman S, Boon H, Leis A. Whole Meta-analysis of psychosocial interventions to reduce pain in
systems research: a discipline for studying complementary and patients with cancer. J Clin Oncol 2012;30(5):539-47.
alternative medicine. Altern Ther Health Med 2003;9:32-6. 56. Van den Beuken-van Everdingen MH, De Rijke JM, Kessels
37. Elder C, Aickin M, Bell IR, Fønnebø V, Lewith GT, Ritenbaugh AG, Schouten HC, Van Kleef M, Patijn J. Prevalence of pain in
C, et al. Methodological challenges in whole systems research. patients with cancer: a systematic review of the past 40 years.
J Altern Complement Med 2006;12(9):843-50. Ann Oncol 2007;18(9):1437-49.
38. Fleming and Gutknecht.Washington Association of 57. El-Abhar HS, Schaalan MF. Phytotherapy in diabetes: Review
Naturopathic Physicians;2009. Available at: http://www.wanp. on potential mechanistic perspectives. World journal of
org/mc/page.do?sitePageId=58070&orgId=wanp. diabetes 2014;5(2):176.
39. Rocha KK, Ribeiro AM, Rocha KC, Sousa MB, Albuquerque 58. Field TM. Massage therapy effects. Am Psychol
FS, Ribeiro S, et al. Improvement in physiological and 1998;53(12):1270-81.
psychological parameters after 6 months of yoga practice. 59. Merskey HE. Classification of chronic pain: Descriptions of
Conscious Cogn 2012;21(2):843-50. chronic pain syndromes and definitions of pain terms. Pain
40. Rani K, Tiwari S, Singh U, Agrawal G, Ghildiyal A, Srivastava 1986.
N. Impact of yoga nidra on psychological general wellbeing 60. Frontera WR, Ochala J. Skeletal muscle: a brief review of
inpatients with menstrual irregularities: a randomized structure and function. Calcif Tissue Int 2015;96(3):183-95.
controlled trial. Int J Yoga 2011;4:20-25.
61. Cohen S, Nathan JA, Goldberg AL. Muscle wasting in disease:
41. Harner H, Hanlon AL, Garfinkel M. Effect of Iyengar yoga on molecular mechanisms and promising therapies. Nat Rev Drug
mental health of incarcerated women: a feasibility study. Nurs
Discov 2015;14(1):58-74.
Res 2010;59(6):389-99.
42. Gururaja D, Harano K, Toyotake I, Kobayashi H. Effect of 62. March LM, Bagga H. Epidemiology of osteoarthritis in
yoga on mental health: Comparative study between young and Australia. Med J Aust 2004;180(5):S6.
senior subjects in Japan. Int J Yoga 2011;4(1):7. 63. Woolf AD, Pfleger B. Burden of major musculoskeletal
43. Carson JW, Carson KM, Jones KD, Bennett RM, Wright CL, conditions. Bull World Health Organ 2003;81:646-56.
Mist SD. A pilot randomized controlled trial of the Yoga of 64. Zhang W, Moskowitz RW, Nuki G, Abramson S, Altman RD,
Awareness program in the management of fibromyalgia. Pain Arden N, et al. OARSI recommendations for the management
2010;151(2):530-9. of hip and knee osteoarthritis, Part II: OARSI evidence-
44. Schmidt S, Grossman P, Schwarzer B, Jena S, based, expert consensus guidelines. Osteoarthritis Cartilage
NaumannJ,Walach H. Treating fibromyalgia with mindfulness- 2008;16(2):137-62.

12 Indian Journal of Pharmaceutical Sciences January-February 2021