The Therapeutic Order

This week is all about important concepts of Naturopathic medicine. Therapeutic order is a set of guidelines to help Naturopathic Doctors make decisions regarding treatment that are in alignment with the medicine's philosophy of health (check out my post about The Naturopathic Principles). Today, I will break down what "The Therapeutic Order" actually is!

Naturopathic Medicine is a system of medicine that focuses on health promotion, disease prevention, and ecological sustainability. As the medicine began to adapt itself into the evidence based medicine world, there were more opportunities for funding. As a result of this funding, more research was able to be conducted. It was suggested that the profession codify its knowledge, operationalize its core concerns and principles, and develop rigorous standards for research.

In the mid-nineties Jared Zeff, ND, LAc published "The process of Healing: Unifying Theory of Naturopathic Medicine." In his theory, he identified a system of applied clinical theory that included three levels of hierarchy. He drew his inspiration from the knowledge of Naturopathic thought leaders from the past (Spitler and Lindlahr). As time went on, with contributions from others in the profession, the theory was codified as the seven level Therapeutic Order

The seven levels were defined so to play a role in promotion of health, the delivery of safe and effective care, the prevention of suffering and further degeneration of the condition, and the preservation of life.

The seven levels:

Establish the foundations of health

Stimulate the Healing Power of nature and self healing processes

Support and balance physiologic and bioenergetic systems

Address or correct structural integrity

Address pathology using specific natural substances or modalities

Address pathology using pharmaceutical or synthetic medicines

Suppress or surgically remove pathology

Often you might see something similar to the picture below in a ND's office. This is most easily depicted as a pyramid, making it easiest for these concepts to be visualized and understood by the public. The therapeutic order works from least to most invasive interventions, from the bottom to the top, ND's apply these steps to patient care when needing to restore health. This is not a rigid concept though, the starting point for each patient may look different depending on what symptoms and pathology the patient is dealing with.

Some of these terms may not be familiar to you, so I am going to give a little bit more in-depth information into each level. This is so you can have a better understanding of what it all means and how it applies to naturopathic practice.

Establishing the foundations of health

The initial step towards health is identifying the "root cause" of disease and removing anything that is impeding the healing process. ND's will often say, "we need to remove the obstacles to cure." Therefore, practitioners will take a very in depth intake interview exploring many different aspects of health. ND's will often explore topics that are called, "The Determinates of Health". The DOH include topics such as diet, hydration, exercise, sleep, stress, bowel health, and toxin exposures amongst others. ND's will work collaboratively with the patient to identify any areas of their lifestyle that are contributing to illness.

For example, if a patient is coming into the office stating that they are having trouble sleeping and we identify that they are drinking three cups of coffee throughout the day, then the first course of action is to work with the patient to remove the caffeine from their diet. Once the obstacle to cure (coffee) is removed, then the person's vitality will increase. The self healing process will be engaged and any other interventions that the patient decides to utilize will have the most beneficial effects possible.

Stimulate the self healing processes

I have talked about the "Vis" or healing power of nature in my Principles post. In simple terms it has been identified by this medicine as the innate wisdom and intelligence of a human to self heal. This process of healing engages with our life force to promote the healthiest expression of function. ND's can help to create the circumstances that promote stimulation of the healing process. This idea leads to a different philosophy about health, health care, and the role of the health provider. The intent of naturopathic medicine is to assist the patient in healing themselves.

This concept of Vitalism is one that is quite controversial amongst medical professionals and is seen as a philosophy that is anti-scientific and superstitious. In order to give you a better understanding of the topic I will need to delve more deeply into the concept of Vitalism in another post, so be on the lookout for that in the near future.

Support and restore weakened systems:

We might find that the body, mind and spirit's systems or functions may need more support than just stimulation of the "Vis". If the systems have changed in activity, are in need of repair, or extra support then a ND will take the necessary therapeutic steps in order to help that system heal. The practitioner will use the necessary therapeutic modalities such as botanical medicine, nutraceuticals, homeopathy, and others to enhance the function of the system in need.

Correct structural integrity:

Physical therapies such as spinal manipulation, massage, electrotherapy, cranio-sacral therapy, visceral manipulation therapy and others can be utilized to support and maintain muscle, fascial, and bone integrity. NDs can make various recommendations in order to help promote the patient's return to optimal structural condition. In some states, the physical therapies used are very similar to that of chiropractors and osteopathic doctors.

Use natural therapies to address pathology and symptoms

When there is a specific symptom picture or pathological condition that needs to be addressed and managed NDs will utilize natural substances to help relieve the symptoms which are causing the patient to suffer.

Use of pharmaceuticals or synthetic substances to stop progressive pathology

Synthetic or pharmaceutical substances can be necessary in some cases to restrain or strongly manage symptoms or pathological conditions. This treatment is considered when the condition is significantly impacting the patient's quality of life and/or safety.

Use high force, invasive therapies to suppress pathology

This is the idea again, that suppression, with more invasive measures will definitely be able to control symptoms and may even halt the the pathological process. Yet the underlying causes of how the systems came to be disrupted are not being addressed. This treatment is considered in cases where the patient's quality of life and/or safety are impacted by their condition.

This month I will continue to post more about the world of Naturopathic medicine. Continue to follow for more concepts of Naturopathic Medicine next week!

You can also follow my instagram account @the_naturopathic_counselor

References:

Coulter I, Snider P, Neil A. Vitalism-A Worldview Revisited: A Critique Of Vitalism And Its Implications For Integrative Medicine. Integr Med (Encinitas). 2019;18(3):60-73.

Finnell JS, Snider P, Myers SP, Zeff J. A Hierarchy of Healing: Origins of the Therapeutic Order and Implications for Research. Integr Med (Encinitas). 2019;18(3):54-59.

Myers, SP, Hunter, A, Snider, P & Zeff, J 2003, ‘Naturopathic medicine’, in T Robson (ed.), An introduction to complementary medicine, Allen and Unwin, Crows Nest, NSW, pp. 48-66.

Pizzorno JE, Snider P, J. K.Naturopathic Medicine. In: Micozzi MS, ed. Fundamentals of complementary and alternative medicine. 2nd, 3rd, 4th ed. New York: Churchill Livingstone; 2001, 2006, 2011:xxv, 464 p.

Pizzorno JE, Snider P, Micozzi MS. Contemporary Naturopathic Medicine. In: Micozzi MS, ed. Fundamentals of Complementary and Alternative Medicine. Philadelphia: Churchill Livingston; 2015.

Pizzorno JE, Snider P. Nature Cure, Naturopathy, and Natural Medicines. In: Micozzi MS, ed. Fundamentals of Complementary and Alternative Medicine. Philadelphia: Churchill Livingston; 2015.

Snider P, Zeff J. NM 5131 – NMTP 5141-5143. Naturopathic Clinical Theory. Course Syllabus and Materials 1998.

Zeff J. The Process of Healing: A Unifying Theory of Naturopathic Medicine. Journal of Naturopathic Medicine 1997;7:122-5.

Zeff JL, Snider P, Myers S. A Hierarchy of Healing: The Therapeutic Order. The Unifying Theory of Naturopathic Medicine. In: Pizzorno JE, Murray M, eds. Textbook of Natural Medicine. Missouri: Churchill Livingston; 2006.

Zeff JL, Snider P, Myers S, DeGrandpre Z. A Hierarchy of Healing: The Therapeutic Order. A Unifying Theory of Naturopathic Medicine. In: Pizzorno JE, Murray M, eds. Textbook of Natural Medicine. Missouri: Churchill Livingston; 2013.

Zeff J, Snider P, Myers SP, DeGrandpre Z. The Therapeutic Order, the Determinants of Health, and the Process of Healing in Naturopathic Medicine and Education. In: Wisneski L, ed. The Scientific Basis of Integrative Health. 3rd ed. New York: Routledge; 2017.