Naturopathic Model of Healing—The Process of Healing Revisited

Introduction

In 1997 the Journal of Naturopathic Medicine published a landmark article—The Process of Healing-A Unifying Theory of Naturopathic Medicine in which Jared Zeff, ND, proposed a three-part system for applying naturopathic principles and concepts to clinical decision making. One part of this system was a naturopathic model of healing. This model introduced illness and healing as processes of reaction, elimination and restoration in response to disturbing and health promoting factors. In its essence, this model represented “the foundation of nature cure, which is based on the observation that it is the nature of things to heal themselves.”¹ This intrinsic process is dependent on vitality and the vital force, and aims to restore health when the basis for health is established: the presence of factors conducive to healing and health. This model depicts the general healing reaction (response, crisis), its elements and phases. It also illustrates that when disturbances are too great, too many and/or too persistent for the healing response to successfully engage, physiological, spiritual or psycho-emotional suppression can develop, leading to degeneration and severe illness.^1-10

Dr. Zeff developed this model following years observing Harold Dick, ND, (D. 1994) in his Spokane, WA practice, Dr. Dick was a protégé of Otis G. Carroll ND. Observing Dr. Dick guide his patients back to health despite challenging and even ‘impossible’ illnesses inspired Dr. Zeff to document his observations as The Process of Healing Theory, a naturopathic model of healing depicted the healing reaction, or healing response. Subsequent discussion has been published particularly by Drs. Zeff, Snider and Myers; Pizzorno and Snider.^1-5,7,8,9, This concept is found in various forms and names as part of the core curriculum in clinical theory in naturopathic colleges throughout the world.¹⁰

The Naturopathic Model of Healing—The Process of Healing

Models of Medical Thought

Mainstream medicine is based upon a simple and elegant, implicit model: the diagnosis and treatment of disease. In brief, the doctor is expected to determine the specific nature and name of the disease process (diagnosis), and then apply the various tools which conventional medical science and experience have provided to eliminate the disease (treatment). This is taken as self-evident and unquestioned. Upon analysis this model contains at least three assumptions:

1. that there are distinct disease entities which exist as though independent or separate from the patient;

2. that these disease entities can be identified;

3. that these disease entities can be treated and eliminated.

In this conventional, mainstream system, the doctor identifies the disease and then “does battle” with it, almost as if the patient were a neutral field upon which this battle takes place. The principal tools in this battle are pharmaceutical or prescriptive drugs and surgery.^1,2,7

The Naturopathic Model in Chronic Illness

The naturopathic model of healing is a general model describing the fundamental process of disturbance and recovery within the living body. It is understood as a process rather than a separate disease entity. It is a method that proposes that the body restores itself after a sufficient amount of disturbance accumulates within the system. This is why the common cold has no “cure” It is the ‘cure’ for what is disturbing the body.

Chronic illness arises, in general, when any or all of three factors occur:

1. The disturbing factors persist, such as a chronically improper diet, which continues to systematically burden the body cumulatively, as the digestive processes slowly weaken under the stress of the improper or inadequate diet and toxins thereby generated accumulate. This can be seen in an altered microbiome and dysbiosis.

2. The reactive potential of the body to respond is blocked or suppressed, or fatigued, often by drugs, which interfere with the capacity of the body to process and remove its disturbances.

3. The vitality of the system is insufficient, or has become too overwhelmed, to mount a significant and sufficient reaction.^1,2,7

Illness and Healing as Process

Naturopathic medicine can be characterized by a different model than ‘identify and treat the disease.’ “The restoration of health” would be a better characterization. In fact, naturopathic physicians adopted the following short definition of Naturopathic medicine in 1989: “Naturopathic physicians treat disease by restoring health.”¹¹ One can see a difference in orientation between mainstream conventional medicine (or standard medicine), which is disease-based; and naturopathic medicine, which is health-based. Naturopathic medical students study pathology with the same intensity and depth as standard medical students, and its concomitant: diagnosis. The naturopathic physician applies that information in a different context. In standard medicine, pathology and diagnosis are the basis for the discernment of the disease “entity” which afflicts the patient, the first of the two steps of identifying and destroying the entity of affliction. In naturopathic medicine, however, disease is seen much more as a process than as an entity.”^1,2,7

It is the naturopathic physician’s role to support, facilitate and augment this process by identifying and removing obstacles to health and recovery, and by supporting the creation of a healthy internal and external environment.¹¹ Rather than see the ill patient as suffering from a “disease,” the naturopath views the ill person as functioning within a process of disturbance and recovery, in the context of nature and natural systems. Normal health is disturbed by a variety of factors; these affect the organism, which responds in predictable ways (fever, inflammation, etc.) to restore normal function. If the physician can identify these disturbances, moderate them (or some of them), and insure that factors which promote or impair health (for example - diet, exercise, community, exposure to nature, social determinants of health, environmental toxicity, etc) are optimized; and stimulate or assist the self-healing tendency of the body the illness and its effects will abate, at least to some extent if not totally. It is the natural tendency of the body to correct itself. It is the natural tendency of the body to maintain itself in as normal a state of health as is possible. As disturbances are removed, and health promoting factors and activities are instituted, the body, mind and spirit are able to improve in function, and in doing so the health naturally improves.^1,2,7

This model serves as one visual depiction of the vis medicatrix naturae at work. It expresses that by decreasing disturbing inputs (“removing obstacles to health and recovery”¹¹) and adding positive inputs (“a healthy …environment”¹¹) vitality rises and healing begins: the process and force of the Vis Medicatrix Naturae at work.

The Disease Crisis

One model for understanding the effect of chronic disease has been described as illness leading to a “disease crisis” (or disease reaction). The concept states that some people experience illness of such long standing or suffer the effects of repeated improper treatment of their illness, that their body loses the ability to mount a true healing reaction. In this state they often become less and less able to have any potential for a return to normal health (and with that a potential for the normal response to illness). The result is a system which progresses further and further from health, and one which when stimulated by methods normally able to cause a healing crisis actually enters a state of greater disorder. This state of disorder is a disease crisis rather than a healing crisis. The patient in this situation has no opportunity for the crisis to heal, but rather experiences simply more illness during the crisis. In this state if the physician does not recognize the disease crisis, they may drive the patient deeper into their illness or even facilitate their progression to worsening illness or death.

In such a chronically ill state the physician must make small steps to return the patient slowly to a state of enough health that they can achieve a true acute reaction and healing crisis. In many chronically ill patients this can be a multiple year process. One view of this processes is that the physician’s role is to support and gently heal the patient’s fragile system while moving them back to more stable and robust health. Once the patient reaches the ability to have a true healing crisis (rather than a disease crisis) the focus can change from support and chronic healing to stimulating the system to a healing crisis/reaction.

An example of this is the difference between treatment in an otherwise healthy patient with an acute viral illness (such as a common ‘cold’) and one with a 25-year history of colitis treated with steroids on multiple occasions. If the physician uses the same approach, they will drive the patient with the ‘cold’ into a reaction leading to healing but will drive the patient with colitis into a disease crisis leading to an unstable and more dangerous state. The patient in this case with colitis must have their vitality rebuilt carefully before stimulating a global healing response or reaction.^1,2,7

History

It is noteworthy that at the time The Process of Healing was published, Dr. Zeff had only minimal exposure to the conceptually analogous early writings of Hippocrates (coction), Kuhne (curative crisis), Lindlahr (healing crisis), Tilden (degeneration and healing model), Spitler and others; ancient and recent nature doctors who historically described the healing response in similar ways. His article was empirical, encapsulating successful clinical decisionmaking principles, the essential clinical patterns which were observed.

Hippocratic Coction – Early Model of Healing:

Hippocrates proposed the doctrine of coction (πέΨις) or “cooking, digestion” (inflammation) which was based on a combination of humoral theory and Hippocrates understanding of the healing process: (1) health exists when humors are well mixed and balanced (eucrasia); (2) imbalance in elements disturbs the organism (dyscraisia); and (3) disease results from improper mixture(dyscrasia). When the organism is disturbed, the process of disease/ healing has 3 stages: (1) disturbance, (2) ‘coction’, (3) discharge/resolution. Early Hippocratic humoral medicine and theory is the basis for numerous systems of medicine connected with nature and constitutional medicines; Unani, Ayurveda, Tibetan.

The doctrine of “coction” is in essence the inflammation resulting from poor digestion and diet. It is really the process which leads to κρᾶσις (crisis), it is the action which so combines the opposing humors that there results a perfect fusion [balance] of them all. The author of Ancient Medicine takes three types of illnesses—the common cold, ophthalmia and pneumonia--and shows that as they grow better the discharges become less acrid and thicker as the result of πέΨις (cooking, digestion). The most complete account of coction as the ancient physician conceived of it can be found in Chapters XVIII and XIX of Ancient Medicine.¹²

Louis Kuhne’s Curative Crisis—The Unity of Cause and Cure

In 1899 Louis Kuhne, a key progenitor of Naturopathy and its theory of illness causation and healing, saw “disease as the presence of foreign matter in the body” described the healing reaction as the “curative crisis,” proposing that all disease had a toxemic cause, and by stimulating the body to rid itself of morbid matter, the natural process of self-healing would result in the “curative crisis” (the aggravation of symptoms, followed by a discharge, and elimination of symptoms).¹³

Lindlahr’s Healing Crisis—Unity of Disease and Cure through Nature Cure

In 1914 Henry Lindlahr, MD, the ‘grand theorist’ of naturopathy proposed that loss of vitality, accumulation of morbid matter and inadequate composition of blood and lymph were the primary causes of disease. He observed that these primary causes result from not following nature’s laws concerning health and healing; from not living in accordance with nature’s laws governing health. According to Lindlahr these causative factors could be remedied through nature cure: engaging the healing reaction/response, by removing disturbing factors, adopting nature cure practices and therapies which stimulated healing, and engaging in a “return to nature” – living in accordance with nature’s laws. Lindlahr put it this way in Nature Cure, Chapters 2 and 4: “Disease is caused by one or more of the following as a result of violating Nature’s Laws of healthy living:

Lowered vitality;

Abnormal composition of blood and lymph;

Accumulation of morbid matter and poisons.”¹⁴

Tilden’s Degeneration—Healing Model: Toxemia Explained

It was John Tilden however, who in 1926 published a structure nearly identical to Dr. Zeff’s model in “Toxemia Explained.” John H. Tilden, MD (d. 1940) was a graduate of Eclectic Medical Institute, Cincinnati, OH who practiced in Illinois; he published numerous periodicals, pamphlets, and books, including The Philosophy of Health, renamed Health Review and Critique, 1926. Tilden advanced the understanding of toxemia and the healing response through an extensive discussion on his degeneration and healing model (enervation, toxemia, irritation, catarrh, inflammation, ulceration, induration, fungation/cancer). In Tilden’s words: “to find the cause of cancer, start with colds and catarrh, and watch the pathology as it travels from irritation, catarrh, inflammation, induration, ulceration to cancer.”¹⁵

Degeneration—Healing Model

• Enervation

• Toxemia

• Irritation

• Inflammation

• Ulceration

• Induration Fungation/cancer

• Tilden ¹⁵

An NM Model of Healing

• Disturbance

• Reaction

• Irritation

• Inflammation

• Ulceration

• Induration

• Fungation/cancer

Reverse process

• Disturbance

• Reaction

• Resolution of inflammation Discharge

• Normal Health

• Optimal Health

• Zeff ^{1, 2,7}

Tilden’s and Zeff’s models correspond with the Hippocratic concept of ‘coction,’ Kuhne’s curative crisis and with Lindlahr’s healing crisis/reaction model (1914). As far as the authors can tell, Tilden’s model was not depicted graphically as Dr. Zeff presented it.^1,2,7,15

William A. Mitchell’s—The Equation of The Vis Model

In 2006, the concept of vis medicatrix naturae as an equation was proposed by William A. Mitchell, ND, Bastyr University co-founder, in his treatise The Vis as an Equation.¹⁶

Dr. Mitchell proposed that “the concept of the Vis as an equation is metaphorical, but it is meant to be an operative metaphor. The Vis is also probably best translated to our conscious understanding if thought of as an equation. While the many inputs into an equation, perhaps thought of aspects of vitality, can change the value of, say, X, Y, or Z, the equation itself exists as a structure in which these values interact with each other. Values in the equation can be changed, thus affecting how strong an individual is, or how long they live, or how much blood can be produced, etc. but the law of nature simply exists. The level or vitality of any part of the equation can change, however the Vis is the equation itself.”¹⁶ The depiction of the vis as an equation expands our modelling of how vitality is built by inputting positive and removing disturbing health determinants.

The Vis Medicatrix Naturae and Vitality. Differences and Interconnectedness

Confusion arises when one equates vitality with the vis medicatrix naturae. The Vis is the framework in which vitality has significance. Vitality has no inherent value unless it can be integrated into the equations of the Vis. An example of this is a perfectly vibrant and healthy kidney that exists in a man who has just died of a heart attack. The kidney has no value to the man, and in spite of its own inherent vitality, very rapidly loses significance. By the same token, a dysfunctional kidney can affect the vitality of the man with an otherwise extremely vital heart. If both kidneys fail, the vitality of the system fails. The Vis is an equation that says that the relationship of the heart to the kidneys to the overall vitality of the man exists internally. The strength of the heart, kidneys, or general vitality is infinitely variable within the context of the Vis, which is the law that is eternally operative in the system.

The Vis defines the effects of the variables with respect to each other. The variables themselves affect the “health” of the system. The Vis is the law defining the rules and interactions of the aspects of all systems, including the body, the mind and what we may call the spirit.”¹⁶

Scientific Considerations—A Mechanism

Myriad examples in the scientific literature demonstrate that indeed disturbing factors such as cellular toxin burden^17,18,19,20 or childhood trauma²¹ trigger the inflammatory response and that the inflammatory reaction is reversible under the right conditions: conditions for health which move the inflammatory process towards resolution (healing) rather than through suppression which arrests the inflammatory process.

Inflammation and Adverse Childhood Experiences (ACE’s)

In children with ACES, childhood trauma causes dysregulation among three systems with lifetime negative effects; the endocrine system (HPA axis), neurological system, and the immune system. “Chronic or repeated exposure to psychosocial stressors has been linked to prolonged activation of the allostatic systems, with detrimental physiological consequences, leading to allostatic load, and its more severe form, “allostatic overload”²¹ “Because of the activation of the sympathetic nervous system, psychosocial stress also triggers inflammation.”²¹ “In the immune system, chronic exposure to psychosocial stressors leads to enduring elevation in inflammation levels.”²¹ In the model of healing, psychosocial trauma is seen as a disturbance which triggers a reaction-activating the inflammatory response. Evidence shows that healing occurs when ongoing trauma (disturbance) is removed and a health promoting environment is established.

Inflammation and Cellular Toxin Overload

Environmental toxins are well known disturbances to health ^22. Adverse immunological effects of environmental pollutant burden at the cellular level include either depressed immune function, hypersensitivity reactions or reactive inflammation. “Environmental chemicals have a wide range of effects on immune system function, ranging from decreased cell-mediated immunity (with a decrease in ability to fight infections and tumors) to increased sensitivity (allergy) and autoimmunity.”^17,18,19,20 Both possibilities-suppression and reaction/inflammatory mechanisms, map to the healing models described in this article.

Conclusion

In 2005, the Naturopathic Medical Research Agenda proposed Hypothesis Three: “The scientific exploration of naturopathic medical practices and principles will yield important, even perhaps revolutionary, insights into the nature of health and healing.”²³ The representation of the Vis as an equation enhances the model of healing concept and its empirical antecedents. Both models” operationalize” our clinical understanding of how the vis medicatrix naturae, works in living organisms within natural systems. The discovery that Tilden’s model was nearly identical to Dr. Zeff’s, whose models in turn are similar to our historical predecessors which also correlate with the late Dr. Mitchell’s proposed equation points to the value of further scientific investigation, using these consistent, empirically reported observations as the basis for important scientific research, and critical guidance in understanding the process of healing in solving intractable illnesses, and preventing chronic disease

Figure 1.

Naturopathic Model of Healing^2,7