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Touch and manipulation with the hands have been in use in health and medical practice since the beginning of medical care. The hands once were the physician's greatest and most important diagnostic and therapeutic tool. All the manual healing methods addressed in this chapter rely on the practitioner's hands as a primary modality both to access information from (that is, to diagnose) and to treat the patient. All the biomechanical therapies-grouped here as "physical healing methods"-are based on the understanding that dysfunction of any discrete body part often affects secondarily the function of other discrete, not necessarily directly connected, body parts, both in close proximity and at a distance. One of the earliest systems of health care in the United States to use manual healing methods was osteopathic medicine. The body has the ability to heal itself, and the role of the osteopathic physician is to enhance the healing process as much as possible. Diseases, impairments, and disabilities arise from disruptions of the normal interactions of anatomy, physiology, and behavior.
Appropriate treatment is based on the ability to understand, diagnose, and treat-by whatever methods are available-including manually applied procedures.
Development and use of osteopathically oriented manipulative skills began around the time of Still's search (Carlson, 1975; Gevitz, 1980), but how he developed his system that combined "lightning bone setting" with the magnetic healing concepts of Mesmer is not clear (Hood, 1871). It seems likely that his knowledge (of manipulation) was derived from simply observing the work of another practitioner in the field. Whatever the circumstances, Still began his new health profession in 1874, before beginning his use of manipulation, which he was reported to use somewhat later in that decade (Gevitz,1980). Osteopathy spread to England in the 1920s when John Littlejohn emigrated from Chicago to London, establishing the British School of Osteopathy, the first of several such schools.
Historically, many currently popular manual medical techniques-with the exceptions of "energy" techniques, massage, and high-velocity maneuvers (Hood, 1871)-originated within American osteopathy and spread elsewhere.
In many instances, contemporary practices of these methods throughout the world are extensions and refinements of original osteopathic concepts. Many osteopathic physicians from a variety of disciplines regularly incorporate structural diagnosis of abnormalities of musculoskeletal function and manual medical treatments in their day-to-day activities.1 Ironically, because of current attitudes among third-party payers toward physician use of manual medicine, many are not paid for these services.
Basic palpation and structural diagnosis and treatment skills are emphasized in preclinical American osteopathic education, and eight major manual medical methods are taught in osteopathic colleges. Isometric and isotonic techniques (often referred to as muscle energy or postisometric relaxation) that focus primarily on restoring physiological movements to altered joint mechanics.
Articulatory techniques (also called joint play and manipulation without impulse) that emphasize restoration of intrinsic joint mobility. High-velocity, low-amplitude techniques (also called manipulation with impulse), designed to restore the symmetry of the movements associated with the vertebral joints. Myofascial release techniques (also called fascial release techniques) that use combinations of so-called direct and indirect methods (see the glossary) to modify problems of individual and interactively related muscle groups and surrounding or covering (myofascial) tissues. Functional techniques that emphasize treatment of restrictive patterns in joint, myofascial, and neural systems, using "ease," "bind," "sensing," and "motor" hands (see the glossary) as proprioceptive (see the glossary) diagnostic concepts.
Strain and counter strain techniques, designed to locate sore places at specific sites on the body, tender points that relate to specific patterns of abnormal joint movement. Cranial techniques (also called craniofacial techniques) that highlight the manual ability to assess and release tensions associated with subtle, reciprocating cranial (head) and sacral (tailbone) oscillations. A number of continuously evolving diagnostic and treatment systems that are osteopathically oriented and manually based incorporate various of these eight manual techniques. Postdoctoral training, certification, and fellowship status in manual medicine are available to American osteopathic graduates, approximately 35 postdoctoral positions are available each year. An extensive body of work supports a physiological basis for using osteopathic techniques in both musculoskeletal and nonmusculoskeletal problems.
Early work performed by Louisa Burns demonstrated that spinal strain has adverse effects on both functional and motor neuron levels (Burns, 1917). By considering function along with structure, osteopathic theory has included conjecture on the role of the body's communication systems nervous, circulatory, and endocrine-in initiating somatic dysfunction and causing additional responses in the body. Figure 1 demonstrates potential effects of repeated facilitation; that is, inducing a hyperactive response, leading to somatic dysfunction.
Other current clinical research projects that examine the effects of manual treatments have researched their effects on postoperative pulmonary flow rates (Sleszinski and Kelso, 1993), pain management (Zhu et al., 1993), and electromyography changes associated with manual treatments. One example of the diagnostic potential of osteopathic palpation is the studies of Johnston and colleagues (Johnston et al., 1980, 1982b), comparing subjects with normal and high blood pressure. Another issue that osteopathic researchers have addressed is the accuracy of their examinations of patients before and after manipulative treatment, including whether such observations are consistent among a group of osteopathic physicians. Virtually all osteopathically oriented research has been funded from the private sector, mainly through the bureau of research of the American Osteopathic Association. Selecting appropriate patient populations in which to study the effects of manual manipulation. Arranging for knowledgeable peer review and research guidance, including (1) ensuring that persons with osteopathic experience serve on peer review panels (see also the "Peer Review" chapter) and (2) determining appropriate procedures for measuring success of osteopathic treatments. Establishing whether previous inter-rater agreement studies support the use of the interpreter agreement method in osteopathic and other kinds of research. Making previous osteopathic research more accessible (for example, the recent inclusion of the Journal of the American Osteopathic Association in Index Medicus), which could educate other investigators about osteopathic issues and possibly lead to collaborative research.
Ensuring that osteopathic clinician-researchers are part of any research team so that persons inexperienced with osteopathic diagnosis and treatment do not conduct the work improperly.
Setting up a review process to integrate available information from outside the osteopathic profession with osteopathically based research on the structure-function relationship. Documenting anecdotal observations of patients and osteopathic clinicians who treat the somatic component of medical and health-related problems to tabulate patient benefits that include relief from stress and improvement in function and well-being.
Designing and conducting research to support or refute the use of palpatory examination and manipulative treatment for the somatic component of dysfunction and illness. Developing alternative research designs for safety and efficacy studies that do not require blind controls for manual procedures. Developing and integrating cost-benefit research that compares the use of palpatory examination and manipulative treatment with mainstream health care and disease management procedures. Chiropractic science is concerned with investigating the relationship between structure (primarily of the spine) and function (primarily of the nervous system) of the human body in order to restore and preserve health. The human body has an innate self-healing ability and seeks to maintain homeostasis (see the glossary), or balance. The nervous system is highly developed in humans and influences all other systems in the body, thereby playing a significant role in health and disease. The presence of joint dysfunction and subluxation (see the glossary) may interfere with the ability of the neuromusculoskeletal system to act efficiently and may lead to or be a concomitant of disease.
Treatment is based on the chiropractic physician's ability to diagnose and treat existing pathologies and dysfunctions by appropriate manual and physiological procedures. The chiropractic physician relies heavily on hands-on procedures using touch (palpation) to determine both structural and functional joint "dysrelationships." These hands-on procedures are carried out alongside more traditional forms of diagnostic assessment.
Within 2 years of this initial discovery, Palmer had founded his Chiropractic School and Cure, while at the same time developing the concept of subluxation, a type of partial joint dislocation, as a causal factor in disease. What these innovators did-in addition to all their educational and scientific advancements was to place disease in a different context involving the concept of subluxation (Bergmann et al., 1993).
Chiropractors are responsible for the development and refinement of manual therapies, particularly those known as high velocity, short amplitude. Today's common chiropractic procedures are refinements of systems developed during the past half-century, both in diagnosis (the motion palpation of Fay and Gillet, for example [Gillet and Liekens, 1984; Schaefer and Fay, 1989]) and in therapy. Today chiropractic procedures are being examined by researchers from most of the chiropractic colleges, who also are receiving input from field-based chiropractors.
In reaching their decisions concerning practice parameters and standards of care, the various groups of chiropractors have been participating in consensus-development procedures (Hansen et al., 1992). Most chiropractic physicians incorporate structural diagnosis into their practice and use manual adjusting therapies as their main treatment mode. Manual therapies include any procedure during which the hands are used to palpate, diagnose, mobilize, adjust, or manipulate the somatic or visceral structures of the body.
Today CCE accredits chiropractic colleges on the professional level, while regional accreditation also occurs. Current chiropractic research interests include back and other pain, somatovisceral disorders, and reliability studies. Besides these trials, research has examined patient perceptual issues in the use of chiropractic care. Studies examining manipulation for pain other than low back pain include work of Barker (1983) on thoracic pain; Molea et al.
Studies that have examined manipulation in treating hypertension include work of Fichera and Celander (1969), Morgan et al. Motion palpation (examination for presence or absence of joint play) was first advanced by Gillet and Fay as a diagnostic procedure; it has since become a well-studied, common diagnostic procedure. Lack of access to Federal funds has negatively affected the chiropractic research enterprise. Lack of access to previous chiropractic research through indexing and databases also hampers research. Journal of Manipulative and Physiological Therapeutics is indexed in the former Soviet Union as well as in the Western publications previously cited.) Because other chiropractic research journals are unlikely to gain the status of indexing in a conventional database, it is necessary to consider including chiropractic research in an alternative medicine database. Philosophical differences (the straight-vs.-mixer controversy) continue to split the profession without any obvious solution.
Inclusion of chiropractic in any of the proposed reforms of the health care system, such as those proposed by the Clinton administration, is not assured.
Canon of Medicine, which was considered the authoritative medical text in Europe for several centuries. Modern, scientific massage therapy was introduced in the United States in the 1850s by two New York physicians, brothers George and Charles Taylor, who had studied in Sweden. As the health care system in the United States became more influenced by biomedicine and technology in the early 1900s, physicians began assigning massage duties (which were also labor intensive, requiring more time to be spent with patients) to assistants, nurses, and physical therapists. The National Certification Exam, a professional certification program accredited by the National Commission for Certifying Agencies in December 1993 and currently administered by the Psychological Corporation, was inaugurated in June 1992. The primary sponsor of the national certification and accreditation programs is the American Massage Therapy Association (AMTA), the largest and oldest national professional membership association for massage professionals. Each of a number of other national nonprofit membership associations for massage professionals has between 200 and 1,500 members. The number of massage therapists in the United States can only be estimated, because no formal census has been taken. The period of the 1940s to the mid-1970s was relatively dormant for the massage therapy profession. Another source of new techniques was the various forms of massage native to most cultures around the world but not previously described outside each culture.
The forms of massage therapy described in this section are either among the most widely used or representative of a group of similar practices.
Swedish massage uses a system of long gliding strokes, kneading, and friction techniques on the more superficial layers of muscles, generally in the direction of blood flow toward the heart, sometimes combined with active and passive movements of the joints. Deep-tissue massage is used to release chronic patterns of muscular tension using slow strokes, direct pressure, or friction directed across the grain of the muscles with the fingers, thumbs, or elbows. Sports massage uses techniques that are similar to Swedish and deep-tissue massage but are specially adapted to deal with the needs of athletes and the effects of athletic performance on the body. Neuromuscular massage is a form of deep massage that is applied specifically to individual muscles. The reflexology, zone therapy, tuina, acupressure, rolfing (structural integration), Trager, Feldenkrais, and Alexander methods are addressed in the following sections.
Traditional European methods based on traditional Western concepts of anatomy and physiology, using five basic categories of softtissue manipulation: effleurage (gliding strokes), petrissage (kneading), friction (rubbing), tapotement (percussion), and vibration. Contemporary Western methods based on modern Western concepts of human functioning, using a wide variety of manipulative techniques.
In addition, there are structural, functional, and movement integration methods that organize and integrate the body in relationship to gravity through manipulating the soft tissues or through correcting inappropriate patterns of movement; methods that bring about a more balanced use of the nervous system through creating new, integrated possibilities of movement.
Journal of the American Medical Association, Archives of Surgery, and the British Medical Journal. Premature infants treated with daily massage therapy gain more weight and have shorter hospital stays than infants who are not massaged. A study comparing 52 hospitalized depressed and adjustment-disorder children and adolescents with a control group that viewed relaxation videotapes found that the massage therapy subjects were less depressed and anxious and had lower saliva cortisol levels (an indicator of less depression) (Field et al., 1992). A combination of Swedish massage, shiatsu, and trigger point suppression in 52 subjects with traumatically induced spinal pain led to significant alleviations of acute and chronic pain and increased muscle flexibility and tone.
Another study found that massage therapy can have a powerful effect on psycho emotional distress in persons suffering from chronic inflammatory bowel disease. Lymph drainage massage has been shown to be more effective than mechanized methods or diuretic drugs to control lymphedema (a form of swelling) secondary to radical mastectomy (removal of breast tissues).
Infant studies-infants exposed to human immunodeficiency virus (HIV), depressed infants, infant colic, sleep disorders, and pediatric oncology. Child studies-asthma, autism, posttraumatic stress disorder following natural disasters, neglected and abused children in shelters, preschool behavior, pediatric skin disorders, diabetes, and juvenile rheumatoid arthritis.
Adolescent studies-depressed adolescent mothers, adolescent mothers after childbirth, and eating disorders. Adult studies-job performance and stress, eating disorders, pregnancy and neonatal outcome, hypertension, HIV-positive adults, spinal cord injuries, fibromyalgia syndrome, rape and spouse abuse victims, and couples therapy.
Since massage therapy is especially effective with soft-tissue problems, studies involving muscle strains, sprains, tendinitis, problems related to acute and chronic muscle tension, and other such conditions would be useful, as would studies of the effect of massage on the tissue healing process.
Because research offers mounting evidence that a significant percentage of health problems can be attributed to stress and that stress reduction can be a powerful means of preventing or treating such problems, studies of the stress-reduction effects of massage therapy would be valuable. Another question that needs to be addressed is whether massage can cause cancerous tumors to metastasize. The various subject areas under investigation at the Touch Research Institute are also examples of areas that merit further study. If regulatory, insurance payment, and research barriers are not removed, they will inhibit progress regarding massage therapy, along with other forms of alternative health care. Pressure point therapies use finger pressure on specific points-usually related to the oriental meridian points (see the glossary), but also other neurological release points-to reduce pain and treat various disease states. Shiatsu and tsubo rely largely on sequenced applications of pressure applied from one end of each meridian to the other. Jin shin jyutsu and jin shin do have developed sequences of meridian point pressure applications that are specific to the ailment being addressed. Three prominent therapies in the United States use as their approach the reeducation of the body through movement and physical touch. Alexander practitioners report success with neck and back pain, postural disorders, whiplash injury, breathing problems, myalgia, rheumatica, repetitive strain injury, hypertension, anxiety, stress, and other chronic conditions. Practitioners report success with a variety of postural and functional disorders in such diverse applications as sports performance, equine training, physiotherapeutic, zoo animal rehabilitation, the performing arts, neurological and orthopedic physical therapy practice, pain management, and habilitation of developmentally impaired children. In one research study, Jackson-Wyatt and colleagues (1992) used video analysis to measure the kinetics of the change in motor ability in a vertical jump test in a subject who completed eight 5-day weeks of 6-hour training days in a Feldenkrais practitioner training program. Narula (1993) similarly examined the sit-to-stand movement, walking speed, and grip strength of four subjects with class 2 rheumatoid arthritis.
Ruth and Kegerries (1992) used a 25-minute, four-step process to test the flexion range of neck motion in college students before and after half the group received a 15-minute sequence from the awareness through movement methods.
Since Feldenkrais's functional integration method involves a highly individual interaction between practitioner and client, outcomes research should be long-term, using both subjective and objective measures.
This method of movement reeducation is distinguished by compressions, elongations, and light bounces as well as rocking motions. The goal of Trager work is general functional improvement, partly by creating a feeling of pleasure in being able to move body parts more freely. The Trager method also includes Trager "mentastics," a system of mentally directed physical movements developed to maintain and enhance a sense of lightness, freedom, and flexibility. Unlike most systems of body manipulation, which are concerned with the muscular system or the skeletal systems or both, structural integration focuses on the fascias, which are sheets of connective tissue.
Later theorists have used renowned architect and designer Buckminster Fuller's "tensegrity mast" as an explanatory model for the relationship of the bones and fascias.
When the body attempts to distribute the stress of an injury, the result is likely to be shortened and thickened fascias, which may in turn lead to symptoms somewhere other than the site of the original trauma. Rolf postulated that the plasticity of the fascias in the body could offset the aging process (Rolf, 1973). The Rolf Institute, the first school to teach the principles of structural integration, offers a post bachelor’s degree training program requiring 28 weeks of classroom work.
Aston patterning, developed by Judith Aston, and Hellerwork, developed by Joseph Heller, are major offshoots of structural integration.
Several therapeutic systems using manual healing are designed to release bodily held emotions through various combinations of activity on the part of the client and applied pressure or holding on the part of the practitioner.
Bioenergetics, core energetics, Lowenwork, neo-Reichian therapy, radix, and some other methods derive from Reich's basic approach.
Although some psychotherapists incorporate various forms of this work into their practices, there are constraints in some States because of ethical questions about touching the client. Biofield (see the glossary) therapeutics, often called energy healing or laying on of hands, is one of the oldest forms of healing known to humankind.
The earliest Eastern references are in the Huang Ti Nei Ching Su Wen (The Yellow Emperor's Classic of Internal Medicine), variously dated between 2,500 and 5,000 years ago (Veith, 1949). Historically, beliefs about causation in this type of healing have clustered around two views that remain active today.
Therapeutic application of the biofield is a process during which the practitioner places his or her hands either directly on or very near the physical body of the person being treated. Alternative Therapy Courses was started with the aim to promote and educate in the art of Alternative Therapy. The Open International University for Complementary Medicines was founded in 1962 as per the World Health Organization Alma Ata Declaration and accorded international recognition to make alternative medicines popular. It was hoped that this goal be well underway by the year 2000, as this year marks the way for people to begin a new holistic approach to life. It was decided that by establishing international teaching facilities, the student would be exposed to many different theories, ideologies and schools of thought on alternative medicines, from all over the world, resulting in a wide-range approach to health.
The Open International College for Complementary Medicines Affiliated with Medicina Alternativa Inc. Throughout his life the late Prof Sir Anton Jayasuriya believed that education was one of the best ways to improve mankind. Whilst this platform teaches the a€?Theorya€™ of all types of complementary medicine, a€?Practicala€™ courses can be arranged through AMC and OIUCM.
Whether in comforting a child by stroking or rubbing a body stiffened by the cold, touch was the first and foremost of all diagnostic and therapeutic devices.
Today the medical and health practitioner retreats further and further from physical contact with the patient, ever more distanced by banks of diagnostic equipment, legal constraints, and time factors. Nevertheless, many manual healing methods are highly individualized; there is much art in this field, much individualization.
The various manual medicines have developed theories and processes that treat these secondary dysfunctions through a variety of methods that manipulate the soft tissues or realign the body parts.
To its practitioners and to much of the public, the manual healing methods of osteopathic medicine are mainstream processes, but some people consider them alternative. Furthermore, behavior is an intermingled complex in which psychosocial influences can affect both anatomy (structure) and physiology (function). When hands-on procedures are used to identify somatic dysfunction (see the glossary), the practitioner then determines whether the pattern of somatic dysfunction that is observed can be related to any visceral (that is, related to the internal body organs), neuromusculoskeletal, or-occasionally-behavioral dysfunction. However he learned these methods, Still soon afterwards made an important discovery, namely, that the sudden flexion and extension procedures peculiar to the spinal area were not limited to orthopedic problems; furthermore, they constituted a more reliable means of healing than simply rubbing the spine (Gevitz, 1980).
After advertising and working as both a magnetic healer and a lightning bone setter, he began writing about his ideas (Still, 1899). The expansion continued as continental European practitioners studied at the British schools in the 1930s and 1940s. Among those techniques are manual methods applied in other medically oriented systems and also activities of alternative health care providers. Other systems, such as chiropractic, Swedish massage, Cyriax (Great Britain), Mennell (Great Britain), Lewit (Czech Republic), Dvorak (Switzerland), and several German systems also have influenced current practices, both in the United States and elsewhere. Much of the reluctance to pay is based on a lack of adequately funded research, particularly relating to outcome measures. These skills have been used by osteopathic physicians for more than 100 years in a context of total patient care.
The points are "turned off" by moving the body or limb to a treatment position that quiets painful feedback. These movements are thought to arise from a complex combination of dual (covering) and ligament us (fibrous connecting tissue) relationships in the spinal network. Osteopathic physicians are involved in all aspects of total patient care (Northup, 1966), including structural diagnosis and manipulative treatment. Since its inception, the osteopathic profession has maintained and pursued active research in many areas. Present activities designing research tend to be directed toward evaluating (1) long-term effects of somatic dysfunctions and facilitated segments in disease states and (2) the outcome resulting from the use of manipulative treatment.
Later work by Dens low and Korr demonstrated long-lasting, highly individual patterns of spinal hyper excitability associated with neuromuscular and various visceral dysfunctions.
Some early research (Northup, 1970) supports this supposition with regard to reflexes having a role in mediating both the origin of somatic dysfunctions and the effects of manipulative treatment.
The term facilitation is usually used to describe enhancement or reinforcement of otherwise sub threshold neuronal activities that stimulate effectors units to inappropriately carry out whatever action they are programmed to do. Thermograph was selected as a promising method to study segmental facilitation of sympathetic nerves without invading the body (as would be required if needle electrodes were used). If vibration is applied to muscles near the spine or these par spinal muscles contract voluntarily weakened electrical potentials are observed in the cerebrum, the main part of the human brain. A significant number of the hypertensive patients were shown to have a stable pattern of musculoskeletal findings in the cardiothoracic spinal region. Results suggest that when there is prior training or agreement on which tests to use and what is clinically significant with respect to findings, inter-rater agreement can be achieved consistently. The largest grant to date, $400,000, is for evaluating outcomes associated with the use of manipulation for back pain in a Chicago health maintenance organization population.
Historically, Federal research initiatives relevant to osteopathic medicine (for example, from the National Institute of Neurological Disorders and Stroke at the National Institutes of Health (NIH) or from the Centers for Disease Control and Prevention) have been controlled by traditionally defined disciplines and their expert panels. Additional training in planning, conducting, evaluating, and reporting clinical research should be made available to the osteopathic clinicians. Common examples include headaches of all kinds, back pain, allergy, asthma, many orthopedic problems, postoperative and posttraumatic effects of all kinds, and various rheumatologic diseases. Chiropractic medicine addresses how to apply this knowledge to diagnose and treat structural dysfunctions that affect the nervous system.
By training and by law, chiropractic physicians use manual procedures and interventions, not surgical or chemotherapeutic ones. While manipulative medicine has been practiced for millennia, the chiropractic profession is only now preparing for its centennial. Palmer in a "straight" form of chiropractic, while others followed the lead of Howard in developing "mixer" programs. Within the purview of these therapies, many systems have been developed concerning how to apply the various procedures. Standards of care are being determined by coalitions of chiropractors, including practitioners, academics, researchers, and administrators. In 1993 more than 45,000 licensed chiropractors were practicing in the United States alone.
Today's chiropractic educational program is a 5-year curriculum that emphasizes chiropractic philosophy, basic and clinical science, and clinical care in outpatient settings. There are two broad groups joint manipulation procedures and soft-tissue manipulation procedures. However, other journals such as Spine, which is indexed in the major medical data bases, do public chiropractic-related research. Recent emphasis in research trials has been on manipulation and back pain, manipulation and various organic disturbances, and reliability and validity. In other situations, the literature was found to present too many conflicts to determine effectiveness of manipulation. Notable here is the research of Cherkin and MacCornack (1989), who reported that patients seeing chiropractors for low back pain were happier with the treatment they received than were similar patients seeing medical doctors for similar problems. One area that is gaining in research interest is the type 0 disorder (0 for organic, as opposed to M for musculoskeletal). Clinical trials are simply not possible unless their assessment procedures have themselves been tested and found reliable.
Lawrence (1985) published a critique of reliability studies for measuring leg length, and Frymoyer et al.
The largest funding agency in the chiropractic profession is the Foundation for Chiropractic Education and Research, which generally has an annual research budget well below $1 million. Ways must be found to make funds available for chiropractic research through the various agencies. As mentioned earlier, only a single solely chiropractic research publication is internationally indexed.
Meanwhile, the inclusion of CHIROLARS (Chiropractic Literature and Retrieval System) in BRS Colleague as a sub-database may help to make chiropractic literature more accessible. It may be that the decision whether to include chiropractic in a national health care plan will be driven by congressional action. In turn, in the 1930s and 1940s, nurses and physical therapists lost interest in massage therapy, virtually abandoning it. Massage therapy is the scientific manipulation of the soft tissues of the body to normalize those tissues.
While massage methods can be described in terms of a series of techniques to be performed, it is important to understand that touch is not used solely in a mechanistic way in massage therapy; there is also an artistic component. The advancement of higher standards and the development of a system of professional credentials have paralleled the dynamic growth of the massage therapy profession.
The association recently founded the public, charitable AMTA Foundation to fund projects for research, education, and outreach; the foundation awarded its first grants in June 1993. Furthermore, a census or estimate would be affected by the criteria for inclusion, which would involve such variables as extent of training, number of hours worked, and whether methods used by an individual are considered forms of massage.

Some 80 different methods may be classified as massage therapy, and approximately 60 of them are less than 20 years old. For example, many of the forms of massage that come from Asia are based on concepts of anatomy, physiology, and diagnosis that differ from Western concepts. It is expected-as has happened in the development of other professions-that as the development of standards and credentials continues, there will be some consolidation and integration of methods.
Several forms that include additional techniques besides massage are listed briefly here and discussed in more detail in the following sections. This system is used to promote general relaxation, improve circulation and range of motion, and relieve muscle tension. It is used to increase blood flow, release trigger points (intense knots of muscle tension that refer pain to other parts of the body), and release pressure on nerves caused by soft tissues. It is primarily used for conditions related to poor lymph flow, such as edema, inflammation, and neuropathies.
During the past 50 years, reports on nearly 100 clinical trials have been published in the medical and allied health literature. The following studies reflect the versatility of massage therapy and its broad and diverse range of applications. This study demonstrated physiological signs of relaxation in measures such as decreased blood pressure and heart rate and increased skin temperature (Fakouri and Jones, 1987). This study also found massage therapy to be extremely cost effective in comparison with other therapies, with savings ranging from 15 percent to 50 percent (Weintraub, 1992a, 1992b).
Stress can worsen the symptoms of ulcerative colitis and Crohn's disease (ileitis), which can cause great pain and bleeding and even lead to hospitalization or death. It is expected that using massage to control lymph edema will significantly lower treatment costs (Zanolla et al., 1984). The pace of research in the United States involving massage therapy appears to be increasing, and the activities of OAM may play a supportive role. The preceding section indicates the diversity and breadth of applications of massage therapy and suggests the range of possibilities for future research. Outcome studies are recommended that would allow massage therapists to work in a manner and setting that approximate actual working conditions as much as is possible. A key issue related to research is the need for researchers to collaborate with massage therapists during the design stage of a study. Since few individuals are both doctorate-level researchers and massage therapists, it is recommended that NIH facilitate collaboration between researchers and massage therapists. Another key issue is the existence of barriers to practice that hinder massage therapists; these must be removed. Fitzgerald's work with hand reflex points was developed and promoted by Ingram in the United States and Marquardt in Europe. Traditional Chinese remedial massage methods were described in the texts of the Han period (202 B.C. Currently, four systems in which the fingers manipulate the oriental meridian system are in widespread use in the United States. The patient reclines, usually lying on the back and then the front for approximately equal periods as the practitioner uses thumb pressure to stimulate the point through a combination of direct pressure and transference of qi (see the glossary) to the point from the practitioner's thumb.
These systems are used more often than shiatsu and tsubo as alternative treatment approaches. In all three systems-Alexander, Feldenkrais, and Trager-to improve coordination and balance, and to relieve structural and functional stress. The Alexander method is a system of body dynamics, especially in respect to the head, neck, and shoulders.
The Feldenkrais method was developed by Moshe Feldenkrais, a Russianborn Israeli physicist, who turned his attention to the study of human functioning. This verbally directed form of the Feldenkrais method consists of gentle exploratory movement sequences organized around a specific human function (such as reaching, bending, or walking) with the intention of increasing awareness of multiple possibilities of action.
This method involves the practitioner's use of words and gentle, noninvasive touch to guide an individual student to an awareness of existing and alternative movement patterns. As of January 1994, 31 training programs lasting 3 to 4 years were available around the world for Feldenkrais practitioners.
Only limited clinical research studies have been conducted to document the Feldenkrais method. After attending a twice-weekly 75-minute class for 6 weeks, all subjects showed decreased pain, improved walking performance, and improved kinetics of the sit-to-stand movement, but no improvement in grip strength. Compared with the control group, students experiencing this sequence showed measurably improved neck flexion motion and a decrease in the perceived effort to accomplish this motion. Such studies could establish whether various applications of the Feldenkrais method are useful both for medical care and in educational systems.
The Trager method uses light, rhythmic rocking and shaking movements that loosen joints, ease movement, and release chronic patterns of tension.
These actions cause patients or clients to begin to experience freedom of movement of their body parts. The process incorporates a meditative state called "hookup," which is intended to enhance sensory, kinesthetic, and other pleasurable experiences for the client.
Other reports suggest success in treating chronic pain of various sorts, headaches, muscular dystrophy, muscle spasms, temporomandibular joint pain, recovery from stroke, spinal cord injuries, and polio. Ida Rolf, whose work was the foundation of the various systems of structural integration, noted that while bones support the body and muscles connect the bones. In this structure, none of the solid elements are connected directly together but are held by tensioned wires. Structural integration is a system to "unwind" and stretch the distorted fascias back to their normal condition, thereby allowing the bones and muscles to come back to normal alignment and the body to return to normal functioning. Today there are also three other schools based on Rolf's work and 1,500 practitioners who treat an estimated 150,000 individuals per year.
Both incorporate movement reeducation training to bring the body into fuller activity and expression. These systems derive from Wilhelm Reich's original observations about bodily held emotions and his work with patients and clients to release emotion (Reich, 1973). Discussions with various psychotherapists indicate that some would like to include these therapies but fear to do so at this time, when the legal and ethical considerations have not been resolved. Discovery, partial characterization, and use of the biofield have risen independently among peoples and cultures in every sector of the world (see table 1). The earliest Western references are in hieroglyphics and in depictions of biofield healings dating from Egypt's Third Dynasty.3 Hippocrates, a major figure in Western medicine, referred to the biofield as "the force which flows from many people's hands" (Schiegl, 1983).
The first is that the "healing force" comes from a source other than the practitioner, such as God, the cosmos, or another supernatural entity. In so doing, the practitioner engages the perceived biofield from his or her hands with the recipient's perceived biofield either to promote general health or to treat a specific dysfunction. In fact, this trend started before the onset of the new millennium as people were expressing increasing dissatisfaction with the western medical system and turning towards alternative medicines. Through the Institutions relationships, with long-standing internationally accredited educational facilities, which have been collectively responsible for educating more than 165,000 students, we are offering our students the opportunity to become well-rounded practitioners in a variety of alternative medicines, while adopting a humanitarian approach to peoplea€™s ailments. Apart from giving the students a chance to extend their a€?workinga€™ knowledge, these Practical courses have a humanitarian benefit by encouraging students to visit these facilities and donate their time and knowledge of alternative health care to those in need. Hippocrates discussed the benefits of therapeutic massage and instructed his students in its use and in spinal manipulation.
Psychotherapists are admonished not to touch their clients, and the price of medical doctors' time is now so high that they cannot even massage the stiffness from a patient's back; instead, the doctor or psychotherapist must write a prescription for a massage therapist, a person with therapeutic skills no longer taught in medical schools. The second discusses those that are described as using a biofield, or "energy." Therapies that appear to rely on both physical and biofield elements are described in the third section.
Overcoming these misalignments and manipulating soft tissues bring the individual parts back to optimal function and return the body to health. Ultimately, he founded his first school, the American School of Osteopathy, in 1892 at Kirksville, MO, to improve on existing surgical and obstetrical practices.
Examples include muscle energy and post isometric relaxation concepts, which were originally developed and codified by Fred Mitchell, Sr.
Two current osteopathically based examples are advances in myofascial release and fascial unwinding maneuvers and in "energy"-based practices arising from basic cranial concepts, codified by both Sutherland and Harold Magoun, Sr.
From an osteopathic perspective, what is considered "alternative" by most of the medical and research establishment is mainstream for the average D.O.
Manipulative treatment is commonly used, especially by osteopathic family physicians, as adjunctive care for systemic illness and for various neuromusculoskeletal problems, such as low back, head, and neck pain. Osteopathic medicine needs continuing basic research on the role of the nervous system in establishing and maintaining somatic dysfunctions and effecting interactions with the rest of the body.
Examples of effectors sites are muscle bundles, muscle groups, viscera, and other neural units and networks.
Initial studies have been complicated, however, by the number of variables affecting skin-level circulation, including circulatory patterns, local influences, and local shunting.
This finding suggests that muscle spindle receptors are responsible for providing signals that cause the early components of magnetically evoked brain potentials. Moreover, in some preliminary observations with cadavers, Reynolds and Ward (Ward, 1994) found that palpatory diagnoses tended to correlate with radiographic and autopsy data. This finding suggests that osteopathic diagnoses could contribute to identifying internal difficulties. This ability to reach agreement becomes particularly important as the basis for establishing a method of setting up controlled clinical trials to determine the success of manipulative treatments. This is a 3-year prospective study conducted by two osteopathic physicians specializing in musculoskeletal medicine. Manual-methods research panels are not among them, and the result is a lack of genuine peer review capability. One alternative is to use naive patients who lack any expectation that the treatment will be beneficial.
The development of the profession could not have occurred without the missionary zeal of B.J. Both recognize the existence of bacteria and other "germs" and their role in creating disease; both mandate that a susceptible host be present along with the germ. One group has already produced a set of guidelines called the Mercy Conference guidelines (Haldeman et al., 1992). Standard forms of medical diagnosis are heavily detailed, with additional workloads in structural and functional diagnosis and chiropractic technique. In addition, the profession offers postdoctoral training in a wide range of disciplines, with orthopedics and radiology the most popular.
However, at least in one sense, the research within the profession is still very much in its infancy, because the profession "lost" much of its early work for lack of an appropriate forum in which to publish it. In 1984, Brunarski identified 50 trials of spinal manipulation (Brunarski, 1985); the number has increased since then. Much of the early impetus for studies of type 0 disorders came from osteopathic research examining somatic dysfunction. All of these studies demonstrated changes in blood pressure following spinal manipulation, but the changes were relatively transient. A procedure is said to be reliable if it gives similar results when applied more than once to the same object it is measuring or when it gives similar results when applied to a series of objects with similar qualities.
Chiropractors have made an impressive addition to scientific knowledge despite the lack of encouragement and support by government agencies and medical personnel outside the chiropractic profession. To date, no chiropractic research has been funded by NIH, although several approved studies later failed to meet funding cutoff guidelines. Major efforts are already under way to make contact with politicians regarding this issue, and chiropractic input was provided to the President's Health Care Task Force. However, a small number of massage therapists carried on until the 1970s, when a new surge of interest in massage therapy revitalized the field, albeit in the realm of alternative health care.
Because massage usually involves applying touch with some degree of pressure, the massage therapist must use touch with sensitivity to determine the optimal amount of pressure appropriate for each person.
Massage therapists are currently licensed by 19 States and a number of localities; additional States are expected to adopt licensing acts in the near future.
Six States have already adopted the exam as their licensing exam, and more States are expected to follow suit. Curriculums must consist of 500 or more hours and include specified hours of anatomy, physiology, massage theory and practice, and ethics. To alleviate the competition and infighting that are sometimes found among various professional groups, an innovative coalition known as the Federation of Therapeutic Massage and Bodywork Organizations was formed in 1991 by the AMTA, the American Oriental Bodywork Therapy Association, the American Polarity Therapy Association, the Rolf Institute, and the Trager Institute. It is estimated that there are approximately 50,000 qualified massage therapists in the United States, providing some 45 million 1-hour massage sessions per year. Then in the 1970s, stimulated by changes in society such as greater interest in fitness, healthier lifestyles, personal improvement, and alternative methods of health care to complement conventional medicine, interest in massage therapy increased.
In actual practice, many massage therapists use more than one method in their work and sometimes combine several. These methods go beyond the original framework of Swedish massage and include neuromuscular, sports, and deep-tissue massage; and myofascial release, myotherapy, Bindegewebsmassage, Esalen, and manual Lymph Drainage.
Cocaine-exposed preterm infants given massages three times daily for a 10-day period showed significant improvement. Massage has also been shown to stimulate the body's ability to control pain naturally; in one study, massage stimulated the brain to produce endorphins, the petrochemicals that control pain (Kaarda and Tosteinbo, 1989). Massage therapy was effective in reducing the frequency of episodes of pain and disability in these patients (Joachim, 1983). Some studies have been carried out in which individuals who were untrained or under trained applied massage; it then became impossible to discern whether any negative results meant that massage was ineffective or that it was not applied properly.
Researchers would benefit by knowing more about interesting and promising possibilities for research, resources available from the massage therapy profession, and massage therapy itself. In some States, regulatory boards use powers granted through licensing laws to limit the practice of legitimate massage therapy by qualified massage therapists. Adamus and A'tatis described a pressure system in 1582, and the sculptor Cellini (1500-71) wrote of using pressure points to relieve pain. Because in this system specific "zones" on the feet are related to specific organs, the system is often called zone therapy. In all these systems, pressure is applied to meridian points (acupuncture points on the meridians; also called acupoints) to stimulate or sedate them. Jin shin jyutsu, the "art of circulation awakening," was developed in Japan by Jiro Murai in the early 1900s and brought to the United States in the 1960s by Mary Eno Burmeister. A major principle underlying the three methods is that awareness has to be experienced rather than taught verbally. His work integrated an understanding of the physics of the body's movement patterns with an awareness of the way people learn to move, behave, and interact (Feldenkrais, 1949, 1972, 1981, 1985).
The teacher communicates to the student-who may be lying, sitting, standing, kneeling, or in motion-how she or he organizes herself or himself and suggests additional choices for functional movement patterns. The results suggest that lessons in awareness through movement could be used by individuals to improve their functions despite long-term disabling medical conditions. This method was developed by a Hawaiian physician, Milton Trager, on the basis of his experience as a trainer for the sport of boxing.
Since practitioners believe they are affecting the inhibiting patterns at their source, it is expected that clients can experience long-lasting gains. The structure becomes a model for the body if the solid segments are called the bones and the flexible wires are called the fascias (Robie, 1977). Structural integration, or "Rolfing," involves stretching the fascia sheaths by applying sliding pressure to the affected area with fingers, thumbs, and occasionally elbows. Changes in psychological and physiological function have also been measured (Silverman et al., 1973). In this work, the client assumes and holds one of several different postures, either seated or reclining. Those who do the work operate in a dual capacity-as psychotherapist and bioenergetics body worker. Franz von Mesmer, an Austrian physician who investigated and popularized this process in the late 18th century, referred to the biofield as "animal magnetism" to differentiate it from "metal magnetism," which he understood to be a similar but different medium (Mesmer, 1980).
The second is that a human biofield, directed, modified, or amplified in some fashion by the practitioner, is the operative mechanism.
People are looking for practitioners who care about the health of the entire person and not only interested in prescribing medications that will treat their symptoms. Our goal is to offer professional educational programs to educate, not only the practitioner, but also society as a whole, about the potential and power of alternative medicines. It is recognized by the Sri Lankan government as being the educational arm of Medicina Alternativa and was given approval to conduct graduate and undergraduate teachings and subsequently, award degrees. The Chinese also included massage in its ancient healing practices and touch in its diagnostic methods (see "Alternative Systems of Medicine" chapter); the practitioner's taking of the pulse with the fingertips was considered to be the most important diagnostic tool of the ancient Chinese physician (Veith,1949). It is skills of this type-ancient traditional healing skills that are now called "alternative"-that this chapter addresses.
Consequently, there are many more systems than can be discussed here; no slight is intended by the omissions. The fourth section illustrates how manual healing methods are becoming included in mainstream health care.
It is said that he attended a medical school in Kansas City, MO, for one semester but found it boring and irrelevant (Gevitz, 1980). Standalone 2-year programs leading to manual medicine certification are available in several colleges.
In this context, a wide variety of hands-on and-in some situations-"energy" applications are used in a range of disciplines, including family practice, pediatrics, geriatrics, physical medicine, surgery of all kinds, physical medicine and rehabilitation, neurology, rheumatology, pulmonology, and sometimes behavioral medicine and psychiatry. Osteopathic treatment is designed to raise these stimulus thresholds so that the stimulatory event is less likely to occur.
If methods can be developed to identify the effects of these variables, then thermograph may prove useful for detecting changes in the sympathetic nervous system that affect skin level circulation.
The brain's evoked potentials return to normal amplitude (1) when the muscle spasm subsides after a period of time and (2) after spinal manipulative therapy is applied (Zhu et al., 1993).
Patients having acute back pain with and without sciatica (pain radiating downward into the leg) are randomized into the project so that some receive manipulative care while others receive "standard" medical care.
This sociological fact of life has inhibited development and understanding of the manual medicine field, even though public acceptance has been and continues to be high throughout the world. While Palmer was not the first to practice manual thrusting, he was the first to use the bony projections, or processes, of the vertebrae (specifically, the spinous and transverse processes) as levers for the manual contact.
Chiropractors provide various aspects of health care but cannot use surgery or drugs; they have several specialty areas, such as radiology, orthopedics, neurology, and sports medicine.
The most common forms of adjustment taught in chiropractic colleges are the diversified, Gonstead, activator, and sacrooccipital techniques. In this country, some hospital training has recently become available to chiropractic students and residents; such training has been available in Canada since 1975. While it is likely to take many years to overcome the AMA's history of opposition to chiropractic, continuing quality research and patient care will negate this opposition. These techniques affect the musculoskeletal, circulatory-lymphatic, nervous, and other systems of the body.
Touch used with sensitivity also allows the massage therapist to receive useful information about the body, such as locating areas of muscle tension and other soft-tissue problems. Most States require 500 or more hours of education from a recognized school program and a licensing examination. The number of massage therapists appears to be increasing rapidly along with a corresponding increase in use by the American public.
An influx of new practitioners brought with them a wave of new ideas and creativity regarding ways to use hands-on techniques. A larger number of studies also have been carried out in Europe, particularly in the former Soviet Union and East Germany.
Results indicated that massaged infants had fewer postnatal complications and exhibited fewer stress behaviors during the 10-day period, had 28-percent greater daily weight gain, and demonstrated more mature motor behaviors at the end of the 10-day course of massage therapy (Field, 1993). Fibromyalgia, a painful type of inflammation, is an example of a condition that may be favorably affected by this mechanism. Several of the studies cited in this report have indicated that massage therapy provides substantial cost savings; this is a critical issue related to health care reform. For example, the duration of massage is an important factor; a common error is use of massage sessions that are too brief to be effective. Massage therapists would benefit by being able to locate researchers with whom to collaborate (1) to pursue study ideas and (2) to have a better understanding of the needs of researchers and the research process itself. These barriers also restrict the ability to conduct research on massage therapy in traditional settings, such as clinics and hospitals, thereby hampering research efforts. In 1770 the Jesuit Amiat contributed to European understanding with an article on Chinese pressure point "massage." This article influenced the Swedish therapeutic massage pioneer Ling.
Amounts of pressure and length of application vary according to the system, the ailment, and the intent.
Sessions typically treat the meridians of the entire body in an attempt to bring relaxation, harmony, and balance to the patient. It is the antecedent of jin shin do, which was developed in the United States by Iona Teeguarden in the 1980s. Alexander, who created the method after concluding that bad posture was responsible for his chronic periods of voice loss (Maisel, 1989).
The use of touch is for communication, not correction, and there are no special techniques of pressing or stroking. The Trager practitioner uses his or her hands with the aim of influencing deep-seated psychophysiological patterns in the client's mind and interrupting the projection of those patterns into body tissues. Rolf's second precept was that the fascias would maintain not only the normal relationship of bone and muscle but also whatever postural misalignment the body might adopt.
In its early days, the process was known to be quite painful, but later refinements in technique have made Rolfing considerably more comfortable. Simultaneously, the practitioner applies pressure to areas of abnormal stress that are revealed by the posture. However, they do not apply touch during straight psychotherapy sessions, and the straightforward touch used during the body work is clinically applied pressure and not sensually evocative. In the United States, use increased after Mesmer's "magnetic healing" became popular in the 1830s. Some of the terms presented in table 1 are devoid of religious or spiritual overtones, while others carry religious aspects common to the culture in which they were or are used.
This institution, and its affiliates are known to be international organizations that are private, autonomous universities whose degrees are accepted by many countries including the United States. Cat?s Claw is most noted for its immune enhancing properties but constituents of the plant have also demonstrated anti-inflammatory and anti-oxidant properties. Entire healing systems of touch based on the meridian system (see the glossary) were developed centuries ago and remain in use today in the United States as well as in Asia. As a result of many adverse experiences with then contemporary medical practices, including the death of several family members from untreatable meningitis and pneumonia, Still began a personal search for improved methods to treat diseases and restore health (Gevitz, 1980; Schiotz, 1958). He incorporated assumptions that manual restoration of normal anatomic relationships leads to physiological improvements.
While graduates make up about 5 percent of the country's physician population, the profession is responsible for approximately 10 percent of total health care delivery in the United States. Interdisciplinary 3- and 4-year programs that combine some of the many specialties and subspecialties are also available. The concept of the facilitated segment is that repeated stimulation produces hyperactive responses, resulting in improper functioning of some body part.
But others helped to advance the profession as well, including Carl Cleveland, Earl Homewood, Fred Illi, Joseph Janse, Herbert Lee, and Claude Watkins.
But only in the chiropractic model is the presence of sublimation stressed as an important factor; the contention of chiropractic is that since the sublimation can serve as a noxious irritant to the body, its removal becomes critical for restoring optimal health. Seventeen American chiropractic colleges graduate more than 2,000 chiropractors annually; colleges also exist in Canada, Australia, England, France, and Japan.
One approach to alleviating this situation is through the workshops the Office of Alternative Medicine (OAM) is conducting on grant writing and research design. The current processes by which chiropractors are reviewing standards of care and chiropractic procedures should help solidify the public standing of this field. Because touch is also a form of communication, sensitive touch can convey a sense of caring which is an essential element in the therapeutic relationship-to the person receiving massage.
While some States require continuing education, most massage therapists voluntarily take additional courses and workshops on a regular basis during their careers. Since there was little standardization, these techniques sometimes developed into freestanding methods rather than being incorporated into an existing system of classification.
Unfortunately, the published reports on most of these have not been translated into English. To verify the savings, some of the more recent studies should be replicated as part of this approach. In turn, Swedish therapeutic massage influenced traditional Japanese folk massage in the early 20th century, and this cross-fertilization became known as shiatsu. Both "tonification" (energizing) and "sedation" techniques are used to treat and relieve many medical conditions. All of these systems-shiatsu, tsubo, jin shin jyutsu, and jin shin do-rely on traditional oriental medical theory (see the "Alternative Systems of Medical Practice" chapter), although their treatment methods vary considerably.
Shiatsu, which is traditional in Japan, has been used in the United States quite extensively for about 20 years. The technique includes simple movements that improve balance, posture, and coordination and relieve pain. In addition, these institutions have been recognized by the United Nations Charter of the University of Peace by the U.N. Echinacea: Both Native Americans as well as early conventional practitioners have used this herb in the 19th century for disorders ranging from venomous bites and syphilis to the common cold.
This reasoning included by definition a spectrum not only of health issues but of specific recommendations for disease and obstetrical interventions. More than 60 percent of osteopathic physicians are involved in primary care areas-family medicine, pediatrics, internal medicine, and obstetrics-gynecology (Annual Directory, 1993). The most popular are combinations of manual medicine with either family practice or physical medicine and rehabilitation. Johnston developed a way to detect "mirror image asymmetries," a presumed indicator of the presence of somatic dysfunction (the osteopathic spinal lesion).

Using the wrong kind of touch-sometimes thought of as "toxic touch"-is counterproductive, tending to render a technique ineffective and to cause the body to defend or guard itself, which in turn introduces greater tension. Indeed, in the study by Eisenberg and colleagues (1993)-which found that 34 percent of the American public used alternative health care-relaxation techniques, chiropractic, and massage were the most frequently used forms of alternative health care. The approach is similar to that of acupuncture, as the meridian connections to the organs are understood and applied, but from somewhat different application perspectives.
During a session the client typically goes through a series of standing and seated exercises while the practitioner applies light pressure to points of contraction in the body. The combination of external, inwardly directed pressure and outwardly directed breath exaggerates holding patterns that have become so deeply imbedded that the client is no longer aware of them.
He laid out placatory procedures to look for these asymmetries and later refined his concepts in a series of three papers (Johnston, 1988a, 1988b, 1988c) discussing placatory diagnosis. Procedures include specific treatments for a variety of functional disorders as well as postural, stress-related, and emotional problems.
Pressure is applied to the meridian points, which are then held in specific patterns, to tonify or detonify (energize or enervate) the meridian qi.
These pressures are intended to awaken kinesthetic response (sensitivity to motion by the muscles) and retrain the kinesthetic organs in the joints to their proper spatial relationship. Release of the emotion can be quite pronounced, resulting in spontaneously revealed insight, increased freedom of movement, and new social postures. Today, Echinacea enjoys wide use as an immune stimulant maximizing the power of the individuals own immune system by enhancing the production and activity of the body?s own white blood cells (disease fighting cells). THESE VERY SAME ENFORCEMENT AGENCIES, WHO HAVE SWORN TO PROTECT AND SERVE, OUR COUNTRY, AND CITIZENS ,ARE BUT SOME, OF THE CORRUPT,GREEDY TRAITORS .ENGAGED IN THE TYRANNY AND TORTURE. The use of pressure points has evolved under several systems, some of which are discussed below. Conditions that have been improved include headache, asthma, bronchitis, diarrhea, depression, and circulatory problems (Namikoshi, 1969). As these institutions are international organizations, they claim no affiliation with any government. Essential Fatty Acids: Essential fatty acids are designated as essential based upon the fact that our bodies do not have the ability to manufacture these critical components of life.
The argument for including chiropractic in British National Health Service coverage was based on recent work by Meade et al. The techniques help clients learn how to use their bodies with less tension and more awareness and efficiency.
Thus, it is "essential" that individuals obtain these nutrients from their foods or through supplementation. Significant research has shown the benefits of appropriate amounts of essential fatty acids in reducing the risk of heart disease and stroke. It is of critical importance to obtain both adequate levels and appropriate ratios of the different types of essential fatty acids. Further, the RAND report (cited in Haldeman et al., 1992), a recent and large undertaking examining all published literature on the use of manipulation for low back pain, made definitive comments regarding its use in specific situations. Ginkgo Biloba has demonstrated positive benefits in enhancement of general brain function with improvements in cognition and memory loss associated with aging, enhancement of circulatory blood flow to the brain and periphery, as well as demonstrating anti-oxidant properties also. Golden Seal Root: Native Americans traditionally used goldenseal for digestive, respiratory and urinary disorders. Garlic: Garlic not only has been utilized as a medicinal herb within a number of cultures throughout history but also enjoys wide use today based upon good scientific research.
Garlic has demonstrated anti-bacterial, anti-fungal, anti-viral and anti-parasitic properties. This herb provides excellent cardiovascular support through its beneficial effects on cholesterol, triglycerides and lowering blood "stickiness" (platelet aggregation).
It has been used for centuries for its ability to provide a sedative and relaxant effect in individuals.
There exists today amongst various disciplines of medicine, a lot of controversy surrounding the use of herbs medicinally. It has been my experience that some of this controversy could be seen in plainer light if all the herbs in question had their full potency potential. It is very important when choosing herbs for purchase, that very careful attention be given to finding the most reliable source of quality herbal products. Cat's Claw Supportive Information Oxyindole alkaloids appear to provide the immune system stimulation properties of this herb.
Glycosides may be responsible for the anti-inflammatory and antioxidant actions of the plant.
There do exist, though, a number of animal and test tube studies that confirm the immune stimulating benefits of this herb. Large anecdotal experiences in South America also attest to its immune stimulating properties. Also, lab research has demonstrated anti-inflammatory powers as well as vasodilating and platelet aggregation inhibition all of which may exert potential benefit for cardiovascular disease.
Cat?s Claw is popular in South American folk medicine for intestinal complaints, gastric ulcers, arthritis and to promote wound healing.
Cat?s Claw has gained increasing popularity in North America for its immune stimulating properties and its potential benefit in supporting the cardiovascular system.
Echinacea Supportive Information Echinacea?s effectiveness is due to several constituents including polysaccharides, alkylamides and caffeic acid derivatives. These phytochemicals act to increase the production and activity of lymphocytes and macrophages and natural killer cells (the white blood cells).
A recent review study has assessed the effects of Echinacea in the treatment of the common cold.
This review study performed by Bruce Barrett MD, PhD at the University of Wisconsin reevaluated 13 clinical trials held between 1980 and 1999 comprising a total of 2368 subjects.
The school district has moved to a biometric identification program, saying students will no longer have to use an ID card to buy lunch.A  BIOMETRICS TO TRACK YOUR KIDS!!!!!i»?i»?A TARGETED INDIVIDUALS, THE GREEDY CRIMINALS ARE NOW CONDONING THEIR TECH!
These were all double blind placebo controlled studies (consistent with drug study protocols in the US).
When compared to patients on a placebo (sugar pill), those taking Echinacea developed fewer major colds, reported milder symptoms or had colds that ended earlier than the average untreated cold. Based on the evidence, it was Barrett?s opinion that Echinacea may be helpful in treating the severity and duration of a cold when taken early in the course of the infection. According to the author, these studies showed that Echinacea is more effective for acute treatment of colds than for long term prevention. In fact, while additional research has confirmed Echinacea?s benefit for acute cold and flu symptoms (once the infection has begun), other studies have called into question the effectiveness of long term Echinacea use for prevention of cold and flu. Individuals with a history of allergy to the daisy flower family should check with their health care provider prior to use. Some authorities suggest that Echinacea should not be used in individuals with autoimmune illness.
Gingko Biloba Supportive Information The two known active components of the Ginkgo Biloba Extract are ginkgo flavone glycosides and the terpene lactones. These compounds have demonstrated anti-oxidant activity, enhanced circulatory activity and ability to decrease platelet "stickiness". These properties allow for improved blood flow to the brain (and other body organs and peripheral tissues) while enhancing central nervous tissue (brain) protection from free radical damage that may occur with aging.
These findings make Ginkgo Biloba an important herb for brain and blood vessel protection and health. Research Findings: Numerous studies have addressed supplementation with Ginkgo biloba and the area of brain function. All of these studies revealed positive benefits of enhanced memory and cognitive function in both Alzheimer?s dementia and senile dementia (loss of memory in the elderly) in those individuals utilizing Ginkgo biloba extract.
This is based on Ginkgo?s ability to reduce free radical damage to brain cells and its ability to enhance blood flow to the brain. One study has suggested that elderly individuals with depression may respond to Ginkgo biloba with improvement in depression.
Again, this was felt to be due to improvement in brain blood flow and "awakening" of the brain in these elderly individuals. Also, there has been research demonstrating that males with impotence related to poor blood flow to the penis received benefit from the use of this herb following six months of daily use.
Fifty percent of the individuals with previous impotence were able to generate an erection following long-term use of this herb. Side Effects: This herb is well tolerated by most individuals although headache and gastrointestinal upset has been reported in a small percentage of users. Due to its ability to inhibit platelet function, individuals on blood thinning medication or other medication which affects platelet function should consult with their doctor prior to use.
Golden Seal Supportive Information The two primary phytochemicals in goldenseal are hydrastine and berberine. Side Effects: There are no significant side effects if used in recommended amounts, although a mild laxative as well as hypertensive effect are possible. If used over an extended period of time, it may cause digestive disorders, excitatory states, hallucinations and occasionally delirium. Kava Kalm Supportive Information Kava-Kava - This herb, grown in the Pacific islands, is believed to directly affect the limbic system of the brain, the part of the brain associated with emotions. There are a number of excellent studies, which document the effectiveness of kava for people suffering from anxiety.
Additionally, women undergoing uneasiness associated with menopause have also been shown to benefit from kava.
Passion Flower - Physicians in Europe recommend passion flower for anti-anxiety treatment, particularly in situations of mental overwork, stress and nervousness.
Passion flower has not been demonstrated to have any negative reactions when combined with other sedating agents.
Schizandra - This Chinese herb enjoys wide use in the Far East for numerous medical issues. One of its roles has been to assist in enhancing individuals? response to stress not unlike ginseng.
Its inclusion is based on the ability of promoting a "relaxed stomach" during periods of stress.
Hops flower - Hops has also demonstrated mild sedative properties as well as enhancing digestive wellness.
Its inclusion is primarily for promoting gastrointestinal relaxation during times of uneasiness or agitation. Any such reaction should be reported to your health care professional and the herbs should be discontinued until advised by your health care professional. Exceedingly strong doses of Kava Kava could result in the inability of the striated muscles, (your voluntary muscles needed for standing and walking etc.), to maintain posture.
I witnessed one student of herbal medicine take an entire one ounce bottle of Kava Kava tincture as it was passed around the room for students to look at during an herbal seminar on Kava Kava. He was completely consciousness, and all vital functions to maintain health remained intact. Kava Kava should NOT be taken together with other substances that also act on the central nervous system, such as alcohol, barbiturates, anti-anxiety sleep medications, antidepressants, and anti-psychotic drugs.
Garlic Supportive Information The active constituent of garlic is the sulfur compound allicin. The compound alliin is converted to allicin by the enzyme alliinase, which is activated when garlic is crushed. Pasteur noted garlic?s antibiotic activity in 1858 and Albert Schwietzer in Africa used garlic for the treatment of dysentery.
More recent research has shown garlic to have broad-spectrum antimicrobial activity against many types of bacteria, viruses, worms, and fungi.
In addition to its antibiotic activity, garlic also has been shown to enhance various aspects of immune function. These effects support the historical use of garlic for a wide array of infectious conditions. Clinical studies have shown garlic to positively impact many key factors involved in heart and blood vessel disease. Garlic has been shown to lower blood pressure; lower LDL-cholesterol (bad cholesterol) in some studies, lower triglycerides (fats) and decrease blood stickiness (platelet aggregation). Side Effects: Garlic is generally safe and well tolerated although occasional individuals experience gastric upset or allergic dermatitis. As garlic may inhibit platelet function, individuals undergoing surgery should discontinue garlic at the advice of their health care professional prior to surgery. Double blind studies have shown that valerian is more effective than placebo for people with sleep difficulties. Valerian appears to allow sleep onset to occur more quickly, provides more restful sleep but does not increase total sleep time.
Aloe Vera: Quality Comparisons All Aloe Vera products available on the health food shelves are not equal in quality. To obtain the highest quality products, be sure the aloe your purchase has Certification and Seals from the INTERNATIONAL ALOE SCIENCE COUNCIL (IASC), AND CERTIFIED PLUS? AND ACTIVE ALOE? SEALS of Certifications.
TeraForma Health is the First Company to offer a full range of CERTIFIED PLUS and ACTIVE ALOE, Aloe Vera products. These products are the next generation of technology, with Certification and Seals of CERTIFIED PLUS and ACTIVE ALOE using International Aloe Science Council (ISAC) approved Aloe.
These certifications mean the TeraForma Health's Aloe Vera products can guarantee a retention of medium to high weight polysaccharides (50,000 - 100,000 mw), ensuring a pure Aloe Vera product. Jeannie and I personally visited the home office in Houston Texas and interviewed the presidency of TeraForma Health. Paul Weindling, history of medicine professor at Oxford Brookes University, describes his search for the lost victims of Nazi experiments.
One of our discussions was how the harvesting of their Aloe Vera differs from conventional harvesting of other Aloe Vera products sold all over the world. If you can obtain a small Aloe Vera plant for your home and look carefully with me, you will get a better understanding. The chairman of the board at ESL a€” then proprietor of the desert wasteland in Nevada known as a€?Area 51a€? a€” was William Perry, who would be appointed secretary of defense several years later. EUCACH.ORG PanelIn a 2-hour wide-ranging Panel with Alfred Lambremont Webre on the Transhumanist Agenda, Magnus Olsson, Dr.
Directly under each of these nodules are the most potent parts of the Aloe Vera "meat or gel." TeraForma Health uses only those parts of the gel that are the most potent.
Henning Witte, and Melanie Vritschan, three experts from the European Coalition Against Covert Harassment, revealed recent technological advances in human robotization and nano implant technologies, and an acceleration of what Melanie Vritschan characterized as a a€?global enslavement programa€?.Shift from electromagnetic to scalar wavesThese technologies have now shifted from electromagnetic wave to scalar waves and use super quantum computers in the quantum cloud to control a€?pipesa€? a reference to the brains of humans that have been taken over via DNA, via implants that can be breathed can breach the blood-brain barrier and then controlled via scalar waved on a super-grid.
These specific parts of the gel are about thirty (30) times more potent than the surrounding, or majority of the remaining gel. Eventually, such 'subvocal speech' systems could be used in spacesuits, in noisy places like airport towers to capture air-traffic controller commands, or even in traditional voice-recognition programs to increase accuracy, according to NASA scientists."What is analyzed is silent, or sub auditory, speech, such as when a person silently reads or talks to himself," said Chuck Jorgensen, a scientist whose team is developing silent, subvocal speech recognition at NASA Ames Research Center in California's Silicon Valley. This assures them that they will know which parts of the leaf they are using for their specific marketing uses. We numbered the columns and rows, and we could identify each letter with a pair of single-digit numbers," Jorgensen said. Hundreds of Scientific Research Papers describe the activities of Aloe Vera taken internally or applied externally to the skin or hair. These Research Papers include, but are not limited to the following nutritional uses: A natural cleaner, powerful in penetrating tissue, relieving pain associated with the joints and muscles, bactericidal, acts as a strong antibiotic, virucidale when in direct contact for long periods, fungicidal, anti-inflammatory, instrumental in increasing circulation to area, breaks down and digests dead tissue, and moisturizes tissues. Aloe has been used topically for cuts, burns, insect stings, bruises, acne and blemishes, poison ivy, welts, skin lesions, eczema, and sunburns. Aloe also has a history of traditional use by Native Americans for stomach disorders and intestinal disorders including constipation, hemorrhoids, colitis and colon problems. Additionally, numerous constituents within aloe vera have demonstrated enhancement of immune system functioning within the body. People in noisy conditions could use the system when privacy is needed, such as during telephone conversations on buses or trains, according to scientists."An expanded muscle-control system could help injured astronauts control machines. This plant has been traditionally used through the centuries; for both internal ingestion as well as for topical purposes. If an astronaut is suffering from muscle weakness due to a long stint in microgravity, the astronaut could send signals to software that would assist with landings on Mars or the Earth, for example," Jorgensen explained. Historically, the aloe plant has enjoyed wide use for its enhancement of normal gastrointestinal functioning. It has been used by many for constipation, intestinal colic, and inflammatory conditions of the small and large intestine and for digestive disturbances. Topically, aloe has demonstrated benefits in assisting in the healing of minor cuts, wounds and burns. These are processed to remove noise, and then we process them to see useful parts of the signals to show one word from another," Jorgensen said.After the signals are amplified, computer software 'reads' the signals to recognize each word and sound.
More recent research and clinical use has shown even wider applications for this amazing plant including enhancing immunity, balancing blood sugar and providing pain relief. With the impressive elements found in Aloe that work in synergy with one another, it's no wonder that Aloe Vera is so effective in the nutritional assistance and supplementation of the human metabolism. Enzymes - At least five different enzymes have been identified and likely more are contained within.
Polysaccharides - Including B1-3 and B1-4 Glucomannans known for their immune stimulating effects Based on its constituent make up, aloe has a wide array of applications.
Wound healing - Numerous studies have shown improved wound healing in both diabetics as well as non diabetic individuals using Aloe Vera. Aloe stimulates epidermal growth factor (responsible for enhancing skin growth), and enhances fibroblast function (cells responsible for collagen formation). This results in the "healing and sealing" of wounds and makes topical Aloe an important product for assistance in the healing of minor burns, cuts, scrapes and even skin ulcers. Immune modulation - Research has indicated that Aloe has the ability to stimulate macrophages.
Macrophages help the immune system to "see" dangerous microorganisms and tumor cells and assist in their destruction.
The long chain polysaccharides (B1-3 and B1-4 Glucomannans) have direct immune enhancing and modulating properties. These properties include increasing immune cell production and stimulating and improving white blood cell activity. Our Research and Development Division has been in contact with the Federal Bureau of Prisons, the California Department of Corrections, the Texas Department of Public Safety, and the Massachusetts Department of Correction to run limited trials of the 2020 neural chip implant.
We have established representatives of our interests in both management and institutional level positions within these departments. Federal regulations do not yet permit testing of implants on prisoners, but we have entered nto contractual agreements with privatized health care professionals and specified correctional personnel to do limited testing of our products.
He found improved bowel regularity, increased protein absorption, decreased unfriendly bacteria and yeast and increased water content of the stool. In this study the use of aloe also resulted in an overall improvement in an individual's energy and sense of well- being in addition to enhanced bowel functioning. We need, however, to expand our testing to research how effective the 2020 neural chip implant performs in those identified as the most aggressive in our society.
Anti-inflammatory - Aloe has shown biologic anti-inflammatory properties over a wide range of animal experiments.
In California, several prisoners were identified as members of the security threat group, EME, or Mexican Mafia. The sterols in Aloe have strong abilities to inhibit acute inflammation, similarly to cortisone, without any of the side effects.
They were brought to the health services unit at Pelican Bay and tranquilized with advanced sedatives developed by our Cambridge,Massachussetts laboratories. It is believed that aloe works in a manner similar to aspirin in blocking prostaglandin effects but this remains to be proven. Analgesia (Pain Relief) - A number of the smaller chain polysaccharides found within aloe have anti-inflammatory activity, as do the plant sterols. The results of implants on 8 prisoners yielded the following results: a€?Implants served as surveillance monitoring device for threat group activity. Blood Sugar Balancing - Lowering of the blood sugar has been observed in individuals ingesting Aloe on a regular basis.
One single-blind study in Thailand reported that combining 1-tablespoon of Aloe Juice twice daily with glyburide (a medication to lower blood sugar in diabetics), significantly improved blood sugar and lipid levels in people with diabetes, compared with placebo.
Previously, glyburide by itself had not effectively controlled the diabetes in the people in this study. However, during that period substantial data was gathered by our research and development team which suggests that the implants exceed expected results.
One of the major concerns of Security and the R & D team was that the test subject would discover the chemial imbalance during the initial adjustment period and the test would have to be scurbbed. Herbal Medicine is the collective name for 2 fairly different therapies:- Traditional Chinese Medicine (TCM)- Western Herbal Medicine (mainly Europe and the Americas)Other regions, such as India of course also use herbs and spices, but I'm not sure how that should be classified. However, due to advanced technological developments in the sedatives administered, the 48 hour adjustment period can be attributed t prescription medication given to the test subjects after the implant procedure.
My knowledge about TCM is also very limited, so I'll happily leave that to my friend Peter Lach and others to educate you on that subject.My knowledge about Western Herbal Medicine goes a bit further but I'll restrict myself to the small area that I have worked in. One of the concerns raised by R & D was the cause of the bleeding and how to eliminate that problem. For more information, a link to Michael Moore's website can be found on the Links page.I have experimented with herbal tinctures and with infused (macerated) oils. Unexplained bleeding might cause the subject to inquire further about his "routine" visit to the infirmary or health care facility.
The tinctures are made with an alcoholic beverage and for the oils I use extra virgin olive oil as a base. The oils are used either as base oils for Aromatherapy or as a base for creams and other products.
Security officials now know several strategies employed by the EME that facilitate the transmission of illegal drugs and weapons into their correctional facilities. One intelligence officier remarked that while they cannot use the informaiton that have in a court of law that they now know who to watch and what outside "connections" they have.
The prison at Soledad is now considering transferring three subjects to Vacaville wher we have ongoing implant reserach. It is usually digested as a thick fluid (gel), but can also be used in creams and other products and thus applied externally. Our technicians have promised that they can do three 2020 neural chip implants in less than an hour. Soledad officials hope to collect information from the trio to bring a 14 month investigation into drug trafficking by correctional officers to a close. Essentially, the implants make the unsuspecting prisoner a walking-talking recorder of every event he comes into contact with. There are only five intelligence officers and the Commisoner of Corrections who actually know the full scope of the implant testing. In Massachusetts, the Department of Corrections has already entered into high level discussion about releasing certain offenders to the community with the 2020 neural chip implants. An ingredient that plays a major role for migraines and headaches, but also good for flu, joint and digestive problems.
Our people are not altogether against the idea, however, attorneys for Intelli-Connection have advised against implant technology outside strick control settings. While we have a strong lobby in the Congress and various state legislatures favoring our product, we must proceed with the utmost caution on uncontrolled use of the 2020 neural chip.
If the chip were discovered in use not authorized by law and the procedure traced to us we could not endure for long the resulting publicity and liability payments.
Massachusetts officials have developed an intelligence branch from their Fugitive Task Force Squad that would do limited test runs under tight controls with the pre-release subjects. Its list of properties is almost endless; I mostly use it for skin problems or joint and muscular problems. Correctons officials have dubbed these poetnetial test subjects "the insurance group." (the name derives from the concept that the 2020 implant insures compliance with the law and allows officials to detect misconduct or violations without question) A retired police detective from Charlestown, Massachusetts, now with the intelligence unit has asked us to consider using the 2020 neural chip on hard core felons suspected of bank and armored car robbery. Producing the oil is simple but laborous as it is made with millions of small delicate flowers that need careful picking from plants, often growing in hardly penetrable wastelands. He stated, "Charlestown would never be the same, we'd finally know what was happening before they knew what was happening." We will continue to explore community uses of the 2020 chip, but our company rep will be attached to all law enforcement operations with an extraction crrew that can be on-site in 2 hours from anywhere at anytime. We have an Intelli-Connection discussion group who is meeting with the Director of Security at Florence, Colorado's federal super maximum security unit. The initial discussions with the Director have been promising and we hope to have an R & D unit at this important facilitly within the next six months.
Although it has other uses, I prefer to use it (in synergy with Hypericum) for skin problems or viral infections.
Its nickname 'knitbone' clearly indicates its healing properties, not just in healing bones and joints, but also in healing wounds or skin problems! This oil is very expensive and for that reason it is well worth producing it yourself.Plants' listPlants' list in order alphabeticalDISCLAIMER This information is provided for Educational Purposes Only and has NOT been designed to diagnose, treat or cure any health conditions.
Please consult a qualified Health Care Professional with Nutritional Training to diagnose your health conditions and avoid self-diagnosis. Food and Drug Administration have not evaluated statements about these health topics or any suggested product compositions. Napolitano insisted that the department was not planning on engaging in any form of ideological profiling. I will tell him face-to-face that we honor veterans at DHS and employ thousands across the department, up to and including the Deputy Secretary," Ms. Steve Buyer of Indiana, the ranking Republican on the House Committee on Veterans' Affairs, called it "inconceivable" that the Obama administration would categorize veterans as a potential threat.

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    Within the first trimester (first 12 weeks), the.
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    Violet gentle so keep out of hot although blood exams keep coming again began seeing.