Therapeutic Order

“The Therapeutic Order is a concept unique to the naturopathic medicine and it is essentially the order in which Naturopathic Therapies should be applied in order to provide the greatest benefit for the patients with the least potential for damage . They should follow this progression:

  1. Remove Obstacles to Health – Health, the “natural state” of one’s body, is disturbed by obstacles that lead to disease. The first step in returning to health is to remove those entities that disturb health, most commonly: poor diet, digestive disturbances, inappropriate stress levels and spiritual disharmony. Naturopathic Doctors construct a healthy regimen based on each individual’s “obstacles to health” in an attempt to change and improve the terrain in which the disease developed. This allows additional therapeutics to have the most beneficial effects possible.
  2. Stimulate the Vis – The Vis is one’s vital force, the body’s innate self-healing ability. NDs use therapies, such as botanicals, constitutional hydrotherapy, homeopathy, acupuncture, to facilitate the stimulation and strengthening of this powerful, curative force.
  3. Strengthen Weakened Systems – Those systems that need repair, and not simply stimulation, are addressed at this level of healing. Naturopathic Doctors have an arsenal of therapeutics available to enhance specific tissues, organs or systems, including: botanical medicine, orthomolecular therapy (use of substances that occur naturally in the body – vitamins, amino acids, minerals etc), homeopathy, acupuncture.
  4. Correct Structural Integrity – Physical modalities such as spinal manipulation, massage therapy, craniosacral therapy etc. are utilized to improve and maintain skeletal and musculature integrity.
  5. Use Natural Substances to Restore and Regenerate – Naturopathic Medicine’s primary objective is to restore health, not to treat pathology. However, when a specific pathology must be addressed NDs employ safe, effective, natural substances that do not add toxicity, nor burden, to the already distressed body.
  6. Use Pharmacologic Substances to Halt Progressive Pathology – When necessary pharmaceutical drugs are used to suppress symptoms. This, however, does not allow for the removal of the fundamental disturbing factors, nor the improvement of the underlying terrain. Some NDs prescribe these drugs and some refer, this typically depends on the license status of the state in which they practice.
  7. Use High Force, Invasive Modalities: Surgery, Radiation, Chemotherapy – When life, limb or function must be preserved, NDs refer to Medical Doctors who are expertly trained in these arenas. However, there are complementary, or supportive, therapies that Naturopathy can provide to decrease side effects and often increase the effectiveness of these invasive procedures.

This is order was first identified and articulated by Jared Zeff, ND and Pamela Snider, ND in the text “A Hierarchy of Healing: The Therapeutic Order.” Though this order may shift according to individual patient need, circumstance and safety, it serves as a guideline by which to encourage a patient’s own healing nature to prevail. And of course, there are cases where clearly a patient needs to go straight to the last steps, but even in those cases, the first steps then become a crucial aspects of adjunctive care. This methodological approach to the individual patient is why the Naturopathic physician’s role in healthcare becomes so unique to what already exists.

For natural and integrative medicine to be successful, patients usually need to play an active role though. Sometimes that is more than a patient cares to take on even if it may be to their benefit in the long run. But disease processes often begin far before symptoms manifest. The preventative aspect of Naturopathic medicine involves action prior to the point where the process manifests symptoms, or early on, to help prevent progression and any potential damage from disease taking course.”

Written by Val Cremanaru, ND

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