Notes from the Field: September, 2020
JARED L. ZEFF, ND, VNMI, LAC
The following is not an article prepared for a medical journal. Not every statement of fact is cited or referenced. This is a commentary on the medicine, a running set of observations about practice in the field. It’s not meant to be a peer-reviewed presentation; rather, these are notes and thoughts from a practicing naturopathic physician, a primary care doc in general practice.
Prescribing Strategies – Part 2
In my last submission, I discussed the origin of the Therapeutic Order concept – how I observed my primary mentor, Harold Dick, ND, healing the incurable cases. I learned that hydrotherapy works much better once the diet has been corrected. I learned, more importantly, that some things have to occur before other things will work well. I learned that there is an order to effective therapeutic intervention. I initially called this a Hierarchy of Therapeutics, in a paper published in the Journal of Naturopathic Medicine in 1997. At that time, I was teaching naturopathic philosophy and clinical theory at NCNM and Bastyr. Pamela Snider, then the dean at Bastyr, led an effort to further develop this concept, and we renamed it the “Therapeutic Order.” This concept was developed primarily to teach naturopathic students how to think about the medicine and how to organize the many therapeutic options we have. It is a beginning point, and also a place to go to when you are having trouble with a case.
I recently “attended” the OANP annual pharmacy conference. It was online, due to the current fears over SARS-CoV-2. One of the talks was on the use of IV ozone. The presenter mentioned that if you give ozone to a patient who is really toxic, you will not see the results you are expecting. You first need to detox the patient so there is less toxic material to react with the ozone. In other words, to benefit from the ozone, you must clear the terrain somewhat. This is a treatment strategy to improve success and to reduce ill effects or aggravations. Start with nutrients, get the antioxidant buffers up, and start with a lower dose, or you will “wreck” the patient. This is a strategy for success. It reflects the Therapeutic Order concept: Some things must be done before other things to get the best response.
The Therapeutic Order is a basic prescribing strategy for a naturopathic physician. It tells us that there is an intrinsic order in which to introduce therapies for the best effect. I would like to break this down a bit more. Simply stated, it instructs us to reduce the causes of disturbance, then to improve nutritional status, then to stimulate the vital force, then to support the organs or systems that are burdened or stressed or damaged, and then to correct structure.
(Lindlahr instructed us to do 3 things primarily. As Jim Sensenig used to say, “Take out the garbage…)
A Case of Multiple Sclerosis
A young woman came to see me in May of 2020. The summer before, she developed numbness and tingling in her right leg. She went to the ER. She was given an MRI of the brain and spine, and a lumbar puncture, and MS was diagnosed. She was put on steroids and hospitalized for 3 days. Then she became blind in her right eye, and she was put on steroids for a week. Her sight returned, and she was referred to a neurologist, who prescribed teriflunomide. She was on it for 6 months, and another MRI was performed, which showed more lesions and active inflammation. She was put on steroids again for 3 more days. She developed some arrhythmia and acid reflux from the steroids, and became quite fatigued. At that point, she came to see us.
Upon examination, her blood pressure was rather low, at 104/54 mm Hg. Her stomach was disturbed. I gave her dietary recommendations (based upon old Dr Carroll’s method), a bitter tonic, a set of initial drainage remedies, Natrum muriaticum 200c (based upon her presentation and a positive response in the office), 3000 mg of fish oil daily, and 300 mg of adrenal cortex each morning; I also recommended a short course of constitutional hydrotherapy. Finally, I urged her to discontinue the teriflunomide, which did not seem to be helping. I wrote to her neurologist about my findings and recommendations, but did not receive a response.
I saw her 1 month later. She reported an increase in energy, improved moods, no further acid reflux, and improved menses. I continued her on the protocol, and added Kali phos 6x, the cell salt, which I have often found to improve brain function. She remained on this protocol through the summer.
When I saw her again in September, she was asymptomatic and feeling well. She reported having good energy, more happy days, more smiling, and normal menses. She had an MRI scheduled for November 20th. I had her maintain the same protocol, though I changed the remedies. I asked to see her again after the MRI.
She returned last week (late November), with a copy of the MRI. Let me quote from it: “Impression: Demyelinating disease in the supratentorial brain, without active disease. A large lesion in the left frontal operculum noted previously has diminished in size significantly compared to 5/9/2020.”
I have seen this before, but I do not always see it: a reduction or resolution of MS and other demyelinating disease. I do not have a specific strategy for treating MS; I have no specific strategy for treating most diseases. Rather, I approach my patients based upon fundamental vitalistic naturopathic theory, as laid out by Henry Lindlahr, and as I saw practiced by my mentor, Dr Harold Dick. Lindlahr laid out a simple strategy, on which he elaborated in his books. In Chapter 4 of Nature Cure,1 Lindlahr described 3 primary causes of disease:
- Lowered vitality
- Accumulation of morbid matter and poisons
- Abnormal composition of blood and lymph
Understanding these causes creates for us a strategy for reversing disease:
- Increase the vitality, and decrease the habits or causes of lowered vitality
- Improve the nutrition and digestion to normalize the composition of blood and lymph
- Reduce the toxins and promote their elimination from the body
As we do these things, we can expect the Vis Medicatrix Naturae to direct the processes and functions back toward normal. In Chapter 2 of Nature Cure, Lindlahr gave us a strategy for reversing disease:
- Establish normal surroundings and natural habits of life in accord with Nature’s Laws
- Economize vital force
- Build up the blood on a natural basis, that is, supply the blood with its natural constituents in right proportions
- Promote the elimination of waste matter and poisons without in any way injuring the human body
- Arouse the individual in the highest possible degree to the consciousness of personal accountability and the necessity of intelligent personal effort and self-help
Although much of the first 4 chapters of Nature Cure elaborates upon these causes and instructions, we can summarize these instructions more simply.
First, one must strive for as much normal and natural function as possible. Realizing that there may be different cultural norms, I think that the following measures are more or less universal:
To accomplish the first 2 of these instructions, one should eat regularly and eat foods that are as naturally and organically sourced as possible. Sleep regularly and sufficiently and, presumably, at night. Live in peace, as much as is possible, with those around one. Drink clean water in sufficient quantity. Work as much as possible in ways that satisfy one and provide for one and one’s family. These kinds of measures come under the heading of “hygienics” – doing the usual things that promote healthy function. They satisfy the first 2 of these 5 instructions.
The third is similarly based upon good hygienics and upon diet, but also upon digestion, which may need repair. Digestion is repaired most efficiently through correct diet, specific tonics or supplements that may be required, usually temporarily, and occasionally through external forces, such as constitutional hydrotherapy, which improves circulation and motility in the digestive system. There are other methods which can aid in this, such as therapeutic needling and specific massage or manipulation.
The fourth of these – to promote the elimination of waste matter and poisons – is also aided by constitutional hydrotherapy and, at times, other forms of hydrotherapy, such as enema or colonics. This is a specific area where drainage systems are very useful: the application of low-dose homeopathic medicines in order to stimulate the detoxification and proper function of the organs involved, especially the emunctory system.
The fifth of these – the arousal of personal responsibility – is accomplished in part through the interaction of the physician and the patient, but also through the patient’s own spiritual efforts and development.
All this, then, is a strategy that Lindlahr laid out, 100 years ago, to prevent and reverse disease. The language of his books is language of the early 20th century. Some have complained that some of Lindlahr’s ideas may not be appropriate to a 21st-century consciousness, but the intelligent physician can certainly overlook such cultural differences and take from Lindlahr the simple and elegant methods he presents to the vitalist physician.
Applying the Vis Medicatrix Naturae
When I began my struggle to learn how to heal the sick, shortly after I graduated from NCNM and began my practice (which I have written about elsewhere in these “Notes”), I found a mentor. He was not the kind of teacher that lays out his ideas and observations in a clear and linear or logical fashion. He was the kind of teacher who made me learn by observing him, over and over, time after time, healing people, and slowly come to an understanding, through observation, of what he was doing. The result of that was my own articulation, expressed first in that article in the Journal, in which I laid out a simple strategy, before I had really heard of Lindlahr, but which was simply a restatement of Lindlahr. This was because I was reporting upon my observations of Dr Dick, who was a student of Dr Carroll, who was a student of Lindlahr.
My initial strategy, as expressed in my Journal article, contained 4 elements:
- Reestablishment of the basis for health
- Stimulation of the Vis Medicatrix Naturae
- Tonification and nourishment of weakened systems
- Correction of structural integrity
One establishes the basis for health, I wrote then, through dietary assessment and modification, and modification of stress. One stimulates the Vis generally, the same way for everyone, through the application of constitutional hydrotherapy. This method stimulates the circulation to the digestive and eliminative organs, stimulates the nervous system, stimulates the function of the digestive organs, and stimulates the “vital force.” Specific stimulation of the Vis is accomplished by the individual application of homeopathic medicines or acupuncture. These methods do not add substance to the patient, but rather stimulate the intrinsic energetics of the patient.
Tonification and nourishment of weakened systems, I wrote, is accomplished through glandular and protomorphogen supplementation, botanical medicines, therapeutic exercise, the application of specific electromagnetic or mechanical force, specific nutrition with vitamin, mineral, or other nutrient supplementation, and, potentially, pharmaceutical application, though pharmaceuticals carry the greatest toxic and suppressive potential.
One would correct structural integrity through specific manipulations, specific exercises, or, if necessary, the most invasive of interventions: surgery.
Herein is a strategy that encompasses all of the modalities commonly in use by naturopathic physicians, ordered into an application array that proceeds from least to most invasive, and from least to most potential for harm. It was a simple articulation of the principle, which was further developed through the work of Pamela Snider, ND, and upon which we have published a number of articles.
If we consider the above-mentioned case of multiple sclerosis, we can see this strategy in operation. The key is to depend upon the Vis Medicatrix Naturae to organize and direct the healing processes within the body. All I must do, as the physician, is to apply this strategy in its simple form and to let the body govern and guide the healing. Regarding this patient, first, I got the diet right and improved the digestion so that we reduced the source of inflammatory toxicity in the body and enhanced the nutritional supply for the healing processes to proceed. Hydrotherapy excited the healing, improved digestion, and stimulated emunction. The homeopathic medicine stimulated the vital force. Botanical medicine (bitters) stimulated digestive function. The drainage remedies supported emunction and reduced inflammation thereby. The fish oil and adrenal cortex supported the brain and the adrenals in their recovery. I did not specifically treat MS, her menses, her moods, or anything else. I treated her, in the manner I had learned, to improve her health, following a simple set of ordered instructions. The result of the application of the strategy is that the patient’s MS is apparently reversing and she is feeling better than she has in a long time.
A Strategy & an Order
This is why I am excited about this medicine. As naturopathic physicians, we have a huge number of therapeutic substances, systems, and modalities at our disposal. There is a strategy for their use and a way to order their application that will generally produce the result we seek: the restoration of health to the sick. The application of these simple principles, the ordered use of these simple and generally harmless methods, can result in profound healing.
Jared L. Zeff, ND, VNMI, LAc
- Lindlahr H. Nature Cure. Scotts Valley, CA: CreateSpace Independent Publishing Platform; 2010.
Jared L. Zeff, ND, VNMI, LAc is a licensed doctor of naturopathic medicine and a licensed acupuncturist. In addition to functioning as Medical Director at the Salmon Creek Naturopathic Clinic in Vancouver, WA, Dr Zeff taught on the faculty at National University of Natural Medicine in Portland, OR, where he was also Dean from 1988 to 1993, and holds a professorship in Naturopathic Medicine. Dr Zeff is a graduate of the University of California, NCNM, and the Emperor’s College of Traditional Oriental Medicine. He, along with Pamela Snider, is the author of the AANP’s Definition of Naturopathic Medicine, and the Therapeutic Order concept.