Table Of Content

Edited by Joseph E. Pizzorno, ND Editor in Chief Integrative Medicine: A Clinician’s Journal Eagan, Minnesota; President Emeritus Bastyr University Kenmore, Washington; Chair Science Board Bioclinical Naturals Burnaby, British Columbia Michael T. Murray, ND Director of Product Development and Education Natural Factors Nutritional Products, Inc. Everett, Washington; President Dr. Murray Natural Living, Inc. Paradise Valley, Arizona TEXTBOOK OF NATURAL MEDICINE, FOURTH EDITION ISBN: 978-1-4377-2333-5 Copyright © 2013 by Churchill Livingstone, an imprint of Elsevier Inc. Copyright © 2006, 1999, 1993 by Elsevier Ltd. 3251 Riverport Lane St. Louis, Missouri 63043 No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). Notice Knowledge and best practice in this field are constantly changing. As new research and experience broaden our under- standing, changes in research methods, professional practices, or medical treatment may become necessary. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility. With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. Library of Congress Cataloging-in-Publication Data or Control Number (in STL) Textbook of natural medicine / edited by Joseph E. Pizzorno, Michael T. Murray.–4th ed. p. ; cm. Includes bibliographical references and index. ISBN 978-1-4377-2333-5 (hardcover : alk. paper) I. Pizzorno, Joseph E. II. Murray, Michael T. [DNLM: 1. Naturopathy. WB 935] 615.5’35–dc23 2012019245 Content Strategist: Claire Wilson Content Development Specialist: Joe Gramlich Publishing Services Manager: Catherine Jackson Senior Project Manager: Mary Pohlman Designer: Jessica Williams Printed in United States of America Last digit is the print number: 9 8 7 6 5 4 3 2 1 To Dr. John Bastyr and all the natural healers of the past and future who bring the “healing power of nature” to all the people of the world. Dr. Bastyr, the namesake for Bastyr University, exemplified the ideal physician/healer/teacher we endeavor to become in our professional lives. We pass on a few of his words of wisdom to all who strive to provide the best of health care and healing: “Always touch your patients—let them know you care,” and “Always read at least one research article or learn a new remedy before you retire at night.” �� vii Kathy Abascal, BS, JD, RH(AHG) Vashon, Washington Yaser Abdelhamid, ND, LAc, MS, BS, BA President Integrative Natural Health Strategies, LLC Westlake, Ohio Zemphira Alavidze, PhD The Eliava Institute Tbilisi, Republic of Georgia Tbilisi State Medical University Central Clinic Tbilisi, Republic of Georgia Jason Allen, ND, MPH Clinical Research Assistant Professor Bastyr University Kenmore, Washington; Staff Physician, Seattle Integrative Medicine PhD Student (Toxicology), University of Washington Seattle, Washington Lise Alschuler, ND, FABNO Vice President of Quality and Education Emerson Ecologics Bedford, New Hampshire; Independent Practitioner Naturopathic Specialists Scottsdale, Arizona Steve Austin, ND Columnist Emerson Ecologics Update Emerson Ecologics Bedford, New Hampshire Jeff Baker, ND, DHANP, CCH Homeopathic Family Practice Makawao, Hawaii Peter W. Bennett, ND, RAc Naturopathic Physician Meditrine Naturopathic Medical Clinic Langley, British Columbia, Canada; Adjunct Faculty Boucher Institute of Naturopathic Medicine New Westminster, British Columbia, Canada Bob G. Blasdel, BS Graduate Teaching Associate Department of Microbiology The Ohio State University Columbus, Ohio; Graduate Research Associate Laboratory of Phage Biology The Evergreen State College Olympia, Washington Peter B. Bongiorno, ND, LAc Co-Director InnerSourceHealth New York, New York Dennis N. Bourdette, MD, FAAN Chairman and Roy and Eulalia Swank Family Research Professor Department of Neurology Oregon Health & Science University Portland, Oregon Rachelle S. Bradley, ND Naturopathic Physician Heartland Naturopathic Clinic Omaha, Nebraska J. Alexander Bralley, PhD CEO Metametrix, Inc. Clinical Laboratory Division Duluth, Georgia Kate Broderick, JD, ND, LAc Owner Evolution Natural Medicine Seattle, Washington Carlo Calabrese, ND, MPH Executive Director Naturopathic Physicians Research Institute Portland, Oregon Alan Christianson, ND Private Practice Integrative Health Scottsdale, Arizona Anthony J. Cichoke, Jr., MA, DC, DACBN, PhD Author, Researcher, and Lecturer Fellow of the International Association for the Study of Pain Medizinische-Enzym-Forschungsgesellschaft (Medical Enzyme Research Society) Portland, Oregon Contributors viii Contributors George W. Cody, JD, MA Consultant Capital Projects and Land Use Natural Medicine HPI Kenmore, Washington Kevin L. Conroy, ND Owner Port Angeles Natural Health PLLC Port Angeles, Washington Walter J. Crinnion, BS, ND Professor and Chair Environmental Medicine Southwest College of Naturopathic Medicine Tempe, Arizona T. Michael Culp, MA, NMD Director and Chief Medical Officer The Natural Health & Wellness Centre, Ltd. London, England Peter J. D’Adamo, ND, MIFHI Distinguished Professor, Clinical Sciences Center of Excellence in Generative Medicine University of Bridgeport Bridgeport, Connecticut Zora DeGrandpre, MS, ND Hazel Dell Natural Health Clinic Vancouver, Washington Rhonda Dorren, BScPharm Calgary, Alberta, Canada Mark Dreher, PhD President and Chief Scientific Officer Nutrition Science Solutions, LLC Wimberley, Texas John R. Endres, ND Chief Scientific Officer AIBMR Life Sciences, Inc. Puyallup, Washington Geovanni Espinosa, ND, LAc Director Integrative Urology Center New York Langone Medical Center New York, New York Cathryn M. Flanagan, ND Naturopathic Physician Natural Family Health Care Old Saybrook, Connecticut Alan R. Gaby, MD Author and Lecturer Concord, New Hampshire Leo Galland, MD, FACP, FACN Director Foundation for Integrated Medicine New York, New York Susan A. Gaylord, PhD Associate Professor, Department of Physical Medicine and Rehabilitation Director, Program on Integrative Medicine University of North Carolina School of Medicine Chapel Hill, North Carolina Andrea Girman, MD, MPH Director of Medical Education Genova Diagnostics Asheville, North Carolina Alan Goldhamer, DC Director TrueNorth Health Center Santa Rosa, California Mark D. Groven, ND Director Physical Rehabilitation Physical Medicine Graham Rehabilitation and Wellness Center Seattle, Washington Patrick Hanaway, MD Chief Medical Officer Genova Diagnostics; Co-founder and Owner Family to Family Asheville, North Carolina Heidi Hascall, MA Program Administrator and Senior Research Associate Health Policy Research Northwest Eugene, Oregon Jason Hawrelak, ND, BNat(Hons), PhD Goulds Naturopathica Hobart, Tasmania, Australia Leah Hechtman, M Sci Med (RHHG), BHSc (Naturopathy), ND Director, The Natural Health and Fertility Centre; President, National Herbalists Association of Australia (NHAA); PhD Candidate: Department of Obstetrics, Gynecology and Neonatology Faculty of Medicine University of Sydney Sydney, New South Wales, Australia Stephen Helms, NMD Salt Lake City and Park City, Utah Wendy Hodsdon, ND Portland Alternative Medicine, LLC Adjunct Faculty National College of Natural Medicine Portland, Oregon ix Contributors Tori Hudson, ND Clinical Professor National College of Natural Medicine Portland, Oregon; Clinical Professor Bastyr University Seattle, Washington; Medical Director A Woman’s Time; Program Director Institute of Women’s Health and Integrative Medicine Portland, Oregon Corene Humphreys, BHSc, ND, DipMedHerb, Dip Hom Director and Owner Medical Research and Development Nutritional Medicine Ltd.; Faculty Wellpark College of Natural Therapies; Member Naturopaths of New Zealand Inc. Auckland, New Zealand; Member Institute of Functional Medicine Gig Harbor, Washington; Member Natural Health Council (NZ) Inc. Auckland, New Zealand Aimee Huyck, ND, PT Private Practice Mountlake Terrace, Washington; Adjunct Faculty Bastyr University Kenmore, Washington Tim Irving, DC, MS, LMT Faculty Physical Medicine Department; Curriculum Coordinator Nutrition Department National College of Natural Medicine; Owner Optimum Function Portland, Oregon Mary James, ND Senior Health Educator Medical Education Genova Diagnostics Asheville, North Carolina; Research Fellow Optimal Health & Prevention Research Foundation San Diego, California; Senior Editor Alternative Medicine Review Dover, Idaho Kelly Jennings, ND, MSOM, LAc Private Practice Urban Wellness Group, LLC Portland, Oregon Herb Joiner-Bey, ND Nutrition Instructor Seattle School of Homepathy Edmonds, Washington; Medical Science Consultant Barlean’s Organic Oils Ferndale, Washington David S. Jones, MD, FABFP President and Director of Medical Education Institute for Functional Medicine Gig Harbor, Oregon Tina Kaczor, ND, FABNO Senior Medical Editor Natural Medicine Journal; Owner/Clinician Clinic of Natural Medicine Eugene, Oregon Parris M. Kidd, BSc, PhD Biomedical Consultant PMK Biomedical El Cerrito, California Richard Kitaeff, MA, ND, DiplAc, LAc Director New Health Medical Center Edmonds, Washington; Acupuncture Pain Specialist Northwest Hospital Seattle, Washington; Clinical Affiliate Faculty Bastyr University Kenmore, Washington Thomas A. Kruzel, BA, MT, ND Medical Director Rockwood Natural Medicine Clinic Scottsdale, Arizona Sarah J. Kuhl, MD Physician–Scientist VA Northern California and Contra Costa Regional Medical Center Martinez, California Elizabeth Kutter, PhD Professor Emeritas Lab of Phage Biology The Evergreen State College Olympia, Washington Andrew Lange, ND Naturopathic Medicine Boulder, Colorado x Contributors Rick Liva, RPh, ND Managing Physician The Connecticut Center for Health Middletown, Connecticut; Director of Quality and Chief Medical Officer Vital Nutrients Middletown, Connecticut Pina LoGiudice, ND, LAc Co-Director InnerSource Health Huntington, New York Richard S. Lord, BS, PhD Chief Science Officer Clinical Laboratory Division Metametrix, Inc. Duluth, Georgia; Professor, Clinical Biochemistry Nutrition Institute University of Bridgeport Bridgeport, Connecticut John C. Lowe, MA, DC Director of Research Fibromyalgia Research Foundation Juno Beach, Florida Michael Lyon, BSc, MD Adjunct Professor Food, Nutrition and Health Program University of British Columbia Vancouver, British Columbia, Canada Douglas “Duffy” Mackay, ND Vice President Scientific and Regulatory Affairs Council for Responsible Nutrition Washington, DC Robert M. Martinez, DC, ND Private Practice Kirkland, Washington L. Charles Masur, MD Scientific Support Physician Scientific Support Department Doctor’s Data Inc. St. Charles, Illinois Steven C. Milkis, ND Clinical Faculty School of Naturopathic Medicine Bastyr University Seattle, Washington Laurie K. Mischley, ND Clinical Research Assistant Professor Bastyr University Research Institute Kenmore, Washington; Physician, Naturopathic Neurology Seattle Integrative Medicine Seattle, Washington Gaetano Morello, BSc, ND Private Practice Naturopathic Medicine Complement Health Care West Vancouver, British Columbia, Canada; Scientific Advisory Board Scientific and Educational Affairs Schwabe North America Green Bay, Wisconsin Gerard Mullin, MD Associate Professor of Medicine Johns Hopkins University School of Medicine Baltimore, Maryland Stephen P. Myers, ND, BMed, PhD Professor NatMed-Research Health and Wellbeing Research Cluster School of Health and Human Sciences Southern Cross University Lismore, New South Wales, Australia Paul J. Nicolai, ND Portland, Oregon Mark H. Nolting, ND, LAc, DiplAc, DNBAO Senior Medical Director CAM Healthways Sterling, Virginia Melissa Palmer, MD Clinical Professor of Medicine Hepatology New York University New York, New York; Director of Hepatology New York University Hepatology Associates New York University Plainview, New York Cristiana Paul, MS Nutrition Independent Consultant: nutrition researcher, formulator, writer, clinician Los Angeles, California Lara Pizzorno, MDiv, MA, LMT Senior Medical Writer, Editor, and Researcher Integrative Medicine Consultants, LLC Seattle, Washington; Editor Longevity Medicine Review Petaluma, California; Senior Medical Editor Salugenecists, Inc. Seattle, Washington Dirk Powell, BS, ND Adjunct Professor Naturopathic Medicine Bastyr University Bothell, Washington xi Contributors David Quig, PhD Vice President Scientific Support Doctor’s Data, Inc. St. Charles, Illinois Sheila Quinn Freelance Medical Writing and Editing Services Gig Harbor, Washington Irfan Qureshi, ND Chief Regulatory Officer Vitamin Research Products Carson City, Nevada; Vice President VMN Research Enumclaw, Washington Ronald G. Reichert, BA, ND Director of Scientific Affairs Canadian Centre for Functional Medicine Coquitlam, British Columbia, Canada Paul Reilly, ND, LAc, FABNO National Director of Naturopathic Medicine Cancer Treatment Centers of America Renton, Washington Corey Resnick, ND President Integrative Health & Nutrition, Inc. Lake Oswego, Oregon; Medical Advisory Board Integrative Therapeutics, Inc. Green Bay, Wisconsin Sally J. Rockwell, CCN, PhD Owner Diet Design Shoreline, Washington Robert A. Ronzio, PhD Emeritus Certified Nutrition Specialist Executive Director, Insight Learning Institute Austin, Texas Sam Russo, ND, LAc Private Practice Vermont Naturopathic Clinic South Burlington, Vermont Angela Sadlon, ND Tahoma Clinic Renton, Washington Trevor K. Salloum, BA, ND Kelowna, British Columbia, Canada Alexander G. Schauss, PhD, FACN Senior Director of Research Natural and Medicinal Products Research AIBMR Life Sciences, Inc. Puyallup, Washington Lynne Shinto, ND, MPH Associate Professor Neurology Oregon Health & Science University Portland, Oregon Barbara Siminovich-Blok, ND, LAc Health Services Manager Physician and Acupuncturist North American Pharmacal Wilton, Connecticut Pamela Snider, ND Executive and Senior Editor Foundations of Naturopathic Medicine Project North Bend, Washington; Associate Professor National College of Natural Medicine Portland, Oregon; Adjunct Professor Bastyr University Seattle, Washington Virender Sodhi, MD, ND Private Practice Ayurvedic and Naturopathic Medical Clinic Bellevue, Washington; Faculty School of Naturopathic Medicine Bastyr University Kenmore, Washington Nick Soloway, LMT, DC, LAc Helena, Montana Nancy Sudak, MD American Board of Integrative Holistic Medicine Duluth, Minnesota Jade Teta, ND, CSCS Owner and Founder Metabolic Effect Inc. Winston-Salem, North Carolina Keoni Teta, ND, LAc, CSCS Co-Owner and Founder The Naturopathic Health Clinic of North Carolina; Co-Owner and Founder Metabolic Effect Winston-Salem, North Carolina Sherry Torkos, BScPharm Pharmacist and Author Fort Erie, Ontario, Canada Jessica Tran, ND Private Practice Wellness Integrative Irvine, California xii Contributors Michael Traub, ND, DHANP, FABNO Medical Director Lokahi Healing Center Kailua Kona, Hawaii; Consulting Staff Department of Medicine North Hawaii Community Hospital Kamuela, Hawaii; Adjunct Faculty Center for Spirituality and Healing University of Minnesota Minneapolis, Minnesota; Adjunct Faculty Postgraduate Medical Education National College of Natural Medicine Portland, Oregon Terry Willard, ClH, PhD Director Herbal Wild Rose College of Natural Healing Calgary, Alberta, Canada Michelle M. Wong, MD Manakai O Malama Integrative Healthcare and Rehabilitation Center Honolulu, Hawaii Vijayshree Yadav, MD, MCR Assistant Professor Neurology Oregon Health & Science University Portland, Oregon Eric L. Yarnell, ND, RH(AHG) Associate Professor Botanical Medicine Bastyr University; Chief Medical Officer Northwest Naturopathic Urology Seattle, Washington; President Heron Botanicals Poulsbo, Washington; Chief Financial Officer Healing Mountain Publishing Wenatchee, Washington Gregory T. Yasuda, ND, LMP Adjunct Faculty Naturopathic Medicine Bastyr University Kenmore, Washington Jared L. Zeff, ND, LAc Medical Director Private Practice Salmon Creek Clinic Vancouver, Washington; Professor and Adjunct Faculty Bastyr University Kenmore, Washington; Senior Editor Foundations of Naturopathic Medicine Textbook Project Seattle, Washington; Chairman International Educational Project Foundations of Naturopathic Medicine Seattle, Washington Ira D. Zunin, MD, MPH, MBA Assistant Clinical Professor Department of Integrative Medicine John A. Burns School of Medicine University of Hawaii at Manoa Honolulu, Hawaii; Medical Director Manakai O Malama Integrative Healthcare Group and Rehabilitation Center Honolulu, Hawaii Heather Zwickey, PhD Dean of Research and Professor of Immunology Director of Helfgott Research Institute National College of Natural Medicine; Adjunct Associate Professor Department of Neurology Oregon Health & Science University Portland, Oregon xiii In addition to updating all the content and research, the fourth edition of the Textbook of Natural Medicine (which has now been in publication since 1985) brings several new features: new chapters, a new utilization guide, comprised into one volume. The new chapters include topics such as female infertility, medicinal mush- rooms, natural products and quality control, pregnancy health, Unani medicine, and vitamin K. In addition to new chapters, some chapters have been renamed for better consistency and some have been moved to Sections which we felt were more appropriate. To facilitate utilization, we have provided alphabetical tabs to help searching for specific diseases. Closely related diseases have been placed in a single chapter―for example depression, dysthymia, manic phase, and seasonal affective disorder are all located in the Affective Disorders chapter―so becoming familiar with these groupings is essential for finding specific diseases. There are twelve appendices that provide additional resources for the clinician. Finally, for the first time in over two decades the Textbook of Natural Medicine is back to a single volume. We worked with authors to make their writing more succinct and eliminate unnec- essary content. We also reduced the length of Section VI by removing duplication of content from Section V in the therapeutics portion of the chapters. We hope you will be as pleased with the latest edition as we are. Joseph E. Pizzorno Michael T. Murray Preface �� xv The scientific support for the philosophical and therapeutic foundation of natural medicine has evolved remarkably over the past 35 years. Concepts that were once considered “quaint” at best are now recognized as fundamental to good health and the prevention and treatment of disease. This textbook, with its roughly 10,000 cita- tions to peer-reviewed research literature, provides well- documented standards of practice for natural medicine. Based on a sound com- bination of philosophy and clinical studies, this work provides the astute practitioner with a reliable informational resource to provide health care that identifies and controls the underlying causes of disease, is supportive of the body’s own healing processes, and is con- siderate of each patient’s unique biochemistry. This textbook is composed of six sections, each focused on a fundamental aspect of the practice of natural medicine. “Philoso- phy of Natural Medicine” covers the history and conceptual basis of natural medicine. “Supplementary Diagnostic Procedures” provides a primer on diagnostic procedures not commonly taught in conventional medical schools. Diet analysis, food allergy testing, immune function assessment, fatty acid profiling, and hair min- eral analysis are examples of these analytical procedures. The next section, “Therapeutic Modalities,” provides a descriptive, practi- cal, scientific, and historical review of the common modalities of natural medicine, including botanical medicine, nutritional therapy, therapeutic fasting, exercise therapy, hydrotherapy, counsel- ing, acupuncture, homeopathy, and soft tissue manipulation. “Syndromes and Special Topics” considers underlying issues rele- vant to many diseases. “Pharmacology of Natural Medicines” covers the pharmacognosy, pharmacology, and clinical indications for the most commonly prescribed botanical medicines, special nutrients, and other natural agents. “Specific Health Problems” provides an in-depth natural medicine approach to more than 70 specific diseases and conditions. The comprehensive therapeutic rationales are well documented and based on the pathophysiology and causes of each condition. Preface to the Third Edition ��