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Alternative Medicine: A Recent Overview

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Chapter

Alternative Medicine: A Recent

Overview
Salima Akter, Mohammad Nazmul Hasan, Begum Rokeya,
Hajara Akhter, Mohammad Shamim Gazi, Farah Sabrin
and Sung Soo Kim

Abstract

Alternative medicine has renewed its growing public interest in recent times due
to inequality of patients and healthcare professionals’ ratios with increased work-
load for the latter, various side effects of modern medicine, lack of complete remis-
sion from chronic diseases, high cost of new drugs, and emerging new diseases.
Hence, people have become more dependent on treatment systems replying on
alternative medicine or herbal medicine from traditional medicinal practitioners.
Alternative medicine has grown substantially over time and encompasses several
millennia of therapeutic systems. The significant areas of alternative medicine
include mind–body therapies, body manipulation, and the therapies based on
biological systems. Natural products based biological treatment is the most popular
of them as nature has endowed us with abundance of effective pharmacologically
active phytochemicals. These phytochemicals possess numerous specific clinical
health benefits including antioxidant, antidiabetic, anti-inflammatory, anticancer,
anti-infectious and analgesic effects. In addition, alternative medicine is easily
accessible, affordable, most often noninvasive, and provides favorable benefits
during terminal periods of some diseases. However, due to the lack of well-designed
clinical trials, the safety and effectiveness of many alternative medicines/therapies
remains elusive. This chapter will critically discuss major areas, uses, safety and
regulation, current challenges & future perspectives of alternative medicine.

Keywords: alternative medicine, health benefit, safety & regulation,

challenges & future perspective of AM

1. Introduction

Alternative medicine (AM) is a holistic approach recognized as a heterogeneous

set of medicinal products and practices with potent healing effects. The practices
remain as the most ancient yet traditions for treating different ailments continues
[1, 2]. It is estimated that two-thirds of the world’s population seek health care sup-
port and services from alternative sources over modern medicine. Recent statistics
show that half of the global population are dependent on AM, including the USA
42%, Australia 48%, Canada 70%, and France 49% (Figure 1) [3, 4]. Despite
current progress in modern medicine, the use of AM has been found to be radically
focused on treatment of deadly pandemic diseases e.g., novel coronavirus disease
2019 (COVID 19) when there is no approved systematic targeted therapy yet [5].

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Figure 1.
Utilization of alternative medicine up to 2019.

The renewed public interest has revitalized due to the lack of curative treatment for
several emerging and chronic diseases, high cost of modern drugs, time constrain
from both patients and healthcare providers, microbial resistance and side effects of
modern medicine [5, 6]. The most common treatments of AM are self-medication,
traditional healing practices, indigenous systems of medicine particularly ayurveda,
herbal preparations, yunani, homeopathy, acupuncture, naturopathy, chiropractic
manipulation, etc. which have made AM more popular [1, 7]. In comparison,
modern medicine focuses on symptom- related care, often utilizing pharmacologi-
cal or invasive elimination procedures [8]. Although AM is not guaranteed to be
safe, effective and biologically plausible [9], there is still a debate about which
method can be proven as useful and secure. Old records encourage alternative
modes whereas comprehensive clinical trials support conventional modes based on
modern approaches [10]. However, today, many physicians accept the benefits of all
forms of medicine, incorporating effective complementary and modern approaches
in terms of patients, symptoms, and circumstances [11].
This scenario has necessitated development of knowledge bridge among physi-
cians, traditional practitioners, pharmacist, and patients about AM treatments,
safety use, and toxicity or contraindications. In addition, advancement of research
efforts, minimizing publication bias, protecting intellectual property rights, and
policymaker’s contribution are required to make decisions about the future of alter-
native medical practice to provide cost-effective treatments. This would strengthen
the position of AM industry and increase public acceptance in future [12, 13]. This
chapter primarily discusses the different areas of AM, its uses, safety and regula-
tion, current challenges and future perspectives.

2. Areas of AM

The National Center for Complementary and Alternative Medicine (NCCAM)

has characterized the complementary and alternative medicine (CAM) as a com-
munity of various medical practices, methods and products currently excluded
from modern medicine [14]. NCCAM has also categorized AM branches into five
main groups: (1) traditional medical techniques, such as whole medical systems;
(2) mind–body therapy; (3) biological substance-based treatment; (4) manipula-
tive and body-based treatment; and (5) energy medicine [15].

2.1 Whole medical systems

A whole medical system is a complete system of theory and practice works inde-
pendently or along with modern medicine. The methods contain various groups of

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therapies or treatments that are practiced in diverse communities across the globe.
Indian ayurveda and traditional Chinese medicine (TCM) are mainly practiced
in the Eastern part of the world while homeopathy and naturopathy are predomi-
nantly used in the western region [16].

2.1.1 Ayurvedic medicine

Ayurveda is an extensive medical system that contemplates the body, mind, and
soul essential to maintain the individual’s wellbeing. Its fundamental purpose is to
maintain good health instead of struggling against the illness. Various ayurvedic
herbs or medicinal plants like turmeric, ashwagandha, amla, black cumin, rhubarb
root, triphala, and kumanjam have medicinal properties for treatment of various
diseases or health complications like cardiovascular conditions, cancer, neurological
disorders, and diabetes [17–18]. To determine the efficacy of the ayurvedic thera-
pies, appropriate research with rigorous investigation is required [19].

2.1.2 Traditional Chinese medicine

Traditional Chinese medicine (TCM) originated thousands of years ago from

ancient China and has flourished over time. Japan, Korea, and Vietnam have also
developed similar systems for treatment of ailments [20]. TCM consists of several
different techniques such as acupuncture, moxibustion, Chinese herbal medicines,
nutrition, t’ai chi, qi gong and massage. However, the most frequent therapies are
Chinese herbal medicine, t’ai chi and acupuncture [21].

2.1.2.1 Chinese herbal medicine

Chinese herbal medicine restores the balance of the whole body and equilibrates
the forces of qi, yin and yang, which are basic elements of human body. Qi describes
as a vital force energy which is carried throughout the body via meridians. Yin
shows slow, cold and passive strength, where yang shows excited, hot, and active
strength [22]. Chinese herbal formulas are known to have an advantage with regard
to body regulation [23]. Several herbs tonify qi to treat patients with qi deficiency
syndrome; some herbs promote yin to treat patients with yin deficiency syndrome
and some reduce phlegm to treat patients with Phlegm syndrome. The medications
related to Chinese herbal medicine are given in different ways like powders, tablets,
and teas. Botanical extracts or plants are typically familiar to treat different diseases
such as Chinese herbal medicine is often used as defensive care and improves health
by stimulating an immune response before diseases arise [24].

2.1.2.2 Acupuncture

Acupuncture is a form of AM originated in China more than 2000 years ago. It

is commonly used to alleviate pain or stress by inserting hair-thin needles through
the skin at specific points on the body. Traditional Chinese medicine explains
acupuncture as a technique for balancing the flow of energy or life force followed
the principle of Yin and Yang. Acupuncture practitioners believe the human body
has more than 2,000 acupuncture points connected by 12 pathways or meridians
that interact with various organs such as heart, liver and kidneys [25]. Along these
meridians, the energy flow rebalances by inserting the needles into specific points.
In our contemporary lifestyle, numerous physical challenges arise due to the lack
of proper physical activity, unbalanced food habits and lifestyle. Acupuncture
has numerous positive effects against metabolic diseases, inflammation, digestive

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Alternative Medicine

issues, respiratory and nervous system problems [26]. In addition, releasing neu-
rotransmitters and hormones also regulates neurochemistry, thus influencing the
sensing and cognitive functions.

2.1.2.3 T’ai Chi

T’ai Chi is another type of AM of traditional Chinese medicine initiated dur-

ing the 13th century in China. It is a movement technique that facilitates recovery
through breathing and gradual movements of the body. The advantages of t’ai chi
are improved mobility and balance, and reduced tension and anxieties [27]. It has
been found to improve the quality of life, particularly those who are suffering from
chronic diseases [28]. Many controlled and uncontrolled trials showed the effects
of t’ai chi on various health conditions and diseases such as cardiovascular disorders
[29], diabetes, osteoarthritis [30], anxiety, insomnia, functional mobility and fall
prevention [31, 32]. The benefits of t’ai chi are generally most significant before
developing a chronic illness or functional limitations. Tai chi is very safe, and no
costly equipment is needed for the practice.

2.1.3 Naturopathy

Naturopathy is an integrating division of AM by combining traditional practices

and health care approaches, and became popular in Europe during the 19th century.
This medication system provides a unique way of treating patients, which maintains
the homeostatic principle of the body, identifies the source as well as treats the
diseases. Although many other allopathic or holistic therapy fields offer specific
therapies to specific conditions, naturopathic practitioners tend to employ the self-
healing process by maintaining healthier lifestyles, diet and nutrition [33]. Popular
naturopathic therapies include physical treatments (light therapy, ultrasound and
electric currents), dietary supplements, homeopathy, medical counseling, hormone
therapy and personalized treatment modalities to relieve mental and emotional
stress [34–35].

2.1.4 Homeopathy

Homeopathy is another type of AM system discovered in the 19th century.

Homeopathy comes from the Greek word in which homoios means ‘similar’ and
pathos indicates ‘suffering’. Homeopathic drugs treat diseases by triggering the
body’s natural defenses instead of fighting against them. The underlying principle
of homeopathy is “like cures like”. In other words, when a substance is capable of
inducing a series of symptoms in a healthy living system, low doses of the same
substance can cure these symptoms under certain circumstances (‘similia similibus
curentur’) [36]. Hahnemann stated that treatments for a specific disorder could
cause undesirable effects identical for the disease itself to stimulate a homeostatic
or complementary reaction to correct these disorders [37]. This medicine industry
solely depends on a “minimum dose law,” in which dosage concentrations are
inversely related to the active potency. Many homeopathic medicines contain active
substances overly diluted and minimal amounts of active substances throughout the
resulting dosages.

2.2 Mind–body therapy

Mind can control physical and biological processes, and the mind–body
modality regulates the connections between mind, body, spirit, and attitude.

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Many of the treatments involved in the mind and body’s stimulation aim to main-
tain sound health and heal diseases. Mind–body therapies include relaxation,
meditation, yoga, breathing hypnotherapy, cognitive behavioral therapy, and
visualization. Music, movement, and dance therapy have shown to have benefi-
cial roles for patients with anxiety [38–39], while hypnosis, acupuncture, and
music therapy serve as a successful therapy for depression and anxiety in cancer
patients [40].

2.3 Biology-based therapy

Natural and biological-based practices refer to the substances made from

nature or living things, such as herbs, special dietary and orthomolecular sub-
stances to improve, control, and regulate human health. Among these, herbal
preparations, are the most common variety of CAM in the United States [9]. The
mechanism of this therapy is to stimulate the immune system of the body and
help to fight against cancer, infection, and other diseases. Common supplements
used for biology-based therapy are botanicals, nutritional supplements, such as
vitamins and minerals, probiotics, prebiotics, fatty acids, proteins, amino acids,
and functional foods [41].

2.4 Manipulative and body-based therapy

Manipulative and body-based practices rely on structures and systems of the

body, such as bones and joints, the soft tissues and the circulatory as well as lym-
phatic systems. It is one of integral tools of alternative medicine in which body can
regulate and heal itself [35]. Various manipulative and body-based techniques are
currently used – such as massage (normalizes the soft tissues), reflexology, cranio-
sacral therapy, chiropractic (affiliated between spinal structure and role), rolfing,
and osteopathic manipulation [42]. These therapies are thought to stimulate the
body’s energy and enables toxins to leave the body.

2.5 Energy therapy

Energy therapies are based on the belief that vital life energy flows through
the body. The goal of energy therapy is to restore energy balance in the body
by unblocking flow of energy. The ancient Chinese healing traditions, energy
therapies were well-established as a technique for easing pain, reducing anxiety,
and mitigating side effects of cancer treatment. Energy therapies focus either on
energy field originating into the body (biofields) or from other sources (elec-
tromagnetic fields). There are different energy medicine techniques, including
hands up and down and remote therapies [43]. Biofield therapy aims to trigger
the energy that covers and penetrates the body and has not been experimentally
proven to exist. Certain types of energy treatment control biofields by putting
pressure or controlling the body by bringing the hands in or through therapies
touch [44]. Different ancient Chinese arts like qigong, which put together subtle
physical action, deeper breath, and mental intensity, regulate the human body.
The approach integrates body and soul efficiently and productively [45]. Another
type of energy therapy denoted as bioelectromagnetic therapy is based on an
electromagnetic field used to treat or prevent diseases, and promote health and
longevity. It may be given singly or in combination with many other methods.
This therapy involves different magnetic fields, pulsed fields, direct or altered
electric sources to treat many kinds of ailments like asthma, cancer and migraine
pain [46].

5
Alternative Medicine

3. Uses of AM in different ailments

Alternative medicine became much popular over the past several decades. The
use of this medicine has always been commonly seen among Chinese and other
Asian patients in the countries such as Korea, Taiwan, Singapore, India and Hong
Kong. A number of AM has been often used to manage some chronic diseases
namely diabetes, cancer, cardiovascular diseases (CVD), asthma, menopause,
rehabilitation, autism spectrum disorder etc. [47–53]. Patient characteristics, socio-
demographic status, and gender are the predominant determinants of AM use. The
following describes the multiple uses of AM in different fields.

3.1 Control of blood glucose

Diabetes mellitus (DM) is the most prevalent and chronic metabolic disorder.
The worldwide prevalence of diabetes has risen approximately from 4.7% to 8.5%
over the last 34 years [54]. To control blood glucose levels, numerous modern
antidiabetic drugs have been discovered and introduced in the market. However,
most of the drugs may have some drawbacks when it is used for long time, such as
drug resistance, drug addiction, adverse side effects and so on [55]. In addition,
the therapeutic expenditures and dissatisfaction with mainstream have prompted
the search for alternatives [47]. Intriguingly, the treatment strategies of diabetes is
in favor of alternative practices. Along with conventional drugs, diabetes patients
are treated by diet and exercise [56]. Therefore, it has drawn much attention as the
effects of AM particularly herbal medicine has been found effective in diabetes
prevention, management and/or delay its complications.
The alternative treatment of diabetes is mainly accomplished by non-pharmaco-
logical ways including diet therapy, relaxation, kinesitherapy, acupuncture therapy,
psychotherapy, hydrotherapy, yoga etc. [57]. Natural Health Products (NHP) based
therapy including vitamins and minerals, herbal remedies, homeopathic medicines,
traditional medicines, such as traditional Chinese medicines, probiotics, and other
products like amino acids and essential fatty acids are also commonly used for the
effective management of diabetes [47, 58]. All are used in both type 1 and type 2
diabetes and found to improve diabetic condition significantly, or even, it can revert
from prediabetes to normal stage [59, 62]. For example, the traditional Chinese
medicine Shenzhu Tiaopi granule (SZTP) decreased the conversion rate of 8.52%
from impaired glucose tolerance (IGT) to type 2 diabetes and 15.28% from with
placebo, and normalized blood glucose from patients with IGT [59]. NHP have also
been shown to improve diabetes complications by reducing 0.5% glycated hemo-
globin within 3 months [47]. The following products are used in the treatment, and
prevention of diabetes and its complications:

• Ayurveda polyherbal formulation, Citrullus colocynthis, Coccinia cordifolia,

Eicosapentaenoic acid, Ganoderma lucidum, Ginger (Zingiber officinale),
Gynostemma pentaphyllum, Hintonia latiflora, lichen genus Cladonia BAFS
“Yagel-Detox”, marine collagen peptides, soybean extract etc. are used for
T2DM management [60]

• Traditional Chinese medicine herbs are also used for DM treatment like,
fructus mume, gegenqinlian decoction (GQD), jianyutangkang (JYTK)
with metformin, jinlida with metformin, sancaijiangtang, shen-qi-
formula (SQF) with insulin, tang-min-ling-wan (TM81), xiaoke (contains
glyburide), zishentongluo (ZSTL) and Trigonella foenum-graecum (fenu-
greek) [61]

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Alternative Medicine: A Recent Overview
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• A few products, such as vitamin D, vitamin E, L-carnitine, cinnamon,

gymnema, green tea, fibre, bitter melon, momordica, chromium, and vana-
dium have been the subjects of special interest in diabetes [62].

• Panex ginseng and P. quiquefolius (ginseng) play significant role in controlling

diabetes by altering hepatic glucose metabolism, however, evidence of its
clinical use in patients with diabetes is scarce [63]

For decreasing stress-related hyperglycemia, mind–body medicine, such as

yoga, reflexology, chiropractic or osteopathic manipulation, homeopathy, shiatsu,
registered massage therapy or craniosacral therapy have been shown short term
significant benefits in clinical use, however, specific mind–body interventions
and long-term improvements in glycemic control have not been found in larger
randomized controlled trials (RCTs) [64].

3.2 Management of inflammation

The body naturally responses to various stresses including infection, irradiation,

chemical, or physical injury [65]. Short term inflammation protects the body, while
long term inflammatory response in the body damages healthy cells, tissues, and
organs leading to the development of some diseases, such as arthritis, alzheimer’s
disease, and even cancer [65–66]. The common treatment option for inflammatory
diseases have been limited to nonsteroidal anti-inflammatory (NSAIDs) medica-
tions such as COX-2 inhibitors or steroid hormones (e.g., corticosteroids). Although
most of the NSAIDs are considered to be safe however, it may aggravate other
diseases such as stomach ulcer, hemorrhage, liver or kidney impairments for long
term use [67]. The National Kidney Foundation reported that in each year, approxi-
mately 10% of kidney failures are directly associated with the substantial overuse
of NSAIDs [68]. AM has been used for hundreds and even thousands of years in the
management of chronic inflammation through antioxidative alternative medicine-
based therapies, mainly diet- and natural products based therapies [69]. Strong
scientific evidence supports the use of some products such as omega-3 essential
fatty acids (EFAs) (ω-3) as an alternative and/or complementary agent to NSAIDs
[70]. Capsaicin, oil of camphor, is commonly being used for muscle soreness and
it has also local application for painful traumatic injuries [68]. Epidemiological
studies and associated meta-analyses strongly suggest that long term consumption
of diets rich in plant polyphenols (red and blueberries, green and black tea) protects
the body from cancers, cardiovascular diseases, diabetes, osteoporosis and neuro-
degenerative diseases [71, 72].
Other alternative practices namely exercise, mind–body treatments like t’ai chi,
qigong, yoga, meditations, massage, acupuncture, and moxibustion may decrease
pain intensity by reducing circulatory concentrations of proinflammatory cytokines
like IL-6, IL-18, C-reactive protein and other circulatory inflammatory cytokines
like IL-1α, and TNF-α, through controlling the expression of these proinflammatory
and inflammatory marker genes [73, 74].
Music therapy plays an important role in alleviating pain of various etiology. A
systematic review of 42 RCTs documented the effect of music therapy on relieving
preoperative anxiety and stress as well as postoperative pain in cardiac surgery [75].
A Cochrane database of systemic review of 51 studies concluded that listening to
music reduced pain intensity and opioids requirements [76]. Thus, the above find-
ings strongly support the importance of different alternative approaches to pain and
inflammation management, and better understanding on the mechanism and func-
tion associated with AM may provide new insights to treat inflammatory diseases.

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Alternative Medicine

3.3 Asthma treatment

Asthma is a common, multifactorial respiratory disease with chronic inflamma-

tion of the respiratory system affecting more than 300 million people world-wide
and 25 million people in the United States, including 1 in 10 US children (10%)
[77]. Common symptoms of asthma include: wheeze, cough, shortness of breath,
and chest tightness. Despite advancement of modern medicine and its treatment
modalities, many people are turning to alternative medicine as an another option
for treating respiratory diseases.
Several types of alternative medicine are used in asthma treatment such as herbs
and supplements, yoga, relaxation therapy, and biofeedback [50, 78]. Herbal prod-
ucts and dietary supplements have been used for thousands of years to treat lung
problems. Ethnobotanical Survey in Nigeria found 87 local medicinal plant species
from 39 families and these plant species are being used for treating cough associated
respiratory diseases [79]. Whole plants, leaf, roots, fruit etc. are preferentially used
to combat the diseases [9]. Korean ginseng root extract has potential role for treat-
ing lung inflammatory disorders. Some Chinese herbs, like ding-chan tang, may
decrease inflammation and relieve bronchospasm [80]. The fruits of Momordica
charantia L. are commonly used for cold, cough, tuberculosis, and asthma [81].
Again, caffeine is a natural and mild bronchodilator, which can improve airway
function in people with asthma. Further, supplements like magnesium and fish oil
(omega-3 fatty acids), vitamin C, D, and E may reduce inflammation and alleviate
asthma symptoms. Moreover, both breathing exercises in yoga and massage therapy
can control breathing and relieve stress [50, 82]. Although much of the research is
currently under investigation or found to elicit significant improvements of the dis-
eased conditions yet some findings indicate that many natural and over-the-counter
products have potential side effects.

3.4 Management of cancer

The most common modern treatment modalities for cancer are surgery with
radiation and/or chemotherapy, and immunotherapy. However, these therapies
possess severe side effects including fatigue, skin problems, hair loss and low blood
count [83]. Thus, many cancer patients and health care practitioners prefer AM as a
potential therapeutic management [84]. AM may provide numerous health benefits
by managing disease symptoms, preventing illness, or improving immune function
[85]. The widely accepted and safe alternative practices are acupuncture, aroma-
therapy, massage therapy, exercise, hypnosis, meditation, music therapy, relaxation
techniques, tai chi and yoga [86].
The uses of AM vary among different cancers. The highest uses of AM are found
in breast cancer patients (93%), followed by colorectal cancer (83%), prostate cancer
(77%), and lung cancer (77%). Each of the 4 cancer types, dietary supplements were
the prominent alternative modality (52% to 82%), followed by energy medicine (39%
to 55%), mind–body medicine (16% to 52%), and body-based therapy (14% to 42%)
[87–88]. Although AM is not powerful enough to replace modern medicine, it may be
used parallelly with modern medicine for better management in cancer patients. The
following alternative practices are commonly used in different symptoms related care

• Hypnosis, massage, meditation, prayer, relaxation techniques are predomi-

nantly used to relief patients from anxiety [89]

• Exercise, message, relaxation techniques and yoga reduce fatigue and improve
quality of life in cancer patients [90]

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Alternative Medicine: A Recent Overview
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• Acupuncture, aromatherapy, hypnosis and music therapy prevent nausea as

well as vomiting

• Acupuncture, aromatherapy, hypnosis, massage and music therapy are helpful

in relieving pain [84, 86]

• Exercise, prayer, relaxation techniques and yoga may help cancer patients to
sleep better [86, 91].

There are also some alternative modalities used in cancer patient’s treatment,
which are outlined as

• Dietary treatments including gerson, ketogenic, peskin, budwig, alkaline,

paleo, vitamins and minerals, and herbalism [92].

• Biologic products-based therapy including different kinds of tea (e.g.,

green, medicinal, chaga mushroom, Essiac), natural health products such as
ginger, curcumin, flaxseed oil; and miscellaneous products like pancreatic
enzyme therapy, medicinal cannabis, laetrile B17, and probiotic foods and
supplements [48].

• Energy therapies based on therapeutic touch and reiki, which use surrounding
subtle known energy field and penetrate the human body [93]

• Alternative medical systems that are mainly traditional Chinese medicine,

Indian medicine, homeopathy, chiropractic etc. used in different
cancers [23, 48].

• Improvements in physical and psychosocial well-being and increasing hope to

the cancer patients e.g., osteopathy, and Aboriginal medicine.

• Certain natural products (taxol, vinca alkaloids) are also much famous [94].

3.5 Management of blood pressure and CVD

CVDs are the leading cause of deaths all over the world. The recent advances in
modern western medicine have been made available for treating CVDs, however,
the complications and disease recurrence still occur, which compromise quality of
life. Noticeably, AM has drawn great attention to treat such chronic CVDs for long
term benefits by relieving symptoms, rehabilitation, and even in preventing these
diseases.
Many of the natural products can act more directly on cardiovascular homeo-
stasis by improving lipid profiles and vascular reactivity, and reducing the unde-
sirable immune response [95, 96]. Diet should be regarded as a cornerstone of
preventive medicine and, at least in part, as a viable treatment for blood pressure
(BP), CVD and other chronic diseases [49]. Certain dietary supplements like fish
oil, multivitamins, and coenzyme Q10 are considered the best preventive medica-
tions [97].
Beyond dietary strategies, certain additional non-pharmacological treatments
have been shown to lower BP. These alternative approaches can be broadly clas-
sified into three categories: behavioral therapies, including meditation, yoga,
biofeedback, and relaxation or stress-reduction programs; noninvasive procedures
or devices, including device-guided breathing modulation and acupuncture; and

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Alternative Medicine

exercise-based regimens, including aerobic, resistance, and isometric exercise

methods [98].
Traditional medicine methods, including acupuncture, electroacupuncture, and
transcutaneous electrical acupoint stimulation, have been increasingly adopted by
health-care professionals despite the lack of evidence on its effects on CVDs [99].
Medicinal herbs namely Allium sativum, Ginseng, Aesculus hippocastanum,
Ginkgo biloba, Salvia miltiorrhiza have been used in patients with atherosclerosis,
hyperlipidemia, systolic hypertension, cerebral and venous insufficiency, angina
pectoris, and congestive heart failure [100–102]. In fact, numerous bioactive
compounds present in the herbs can prevent vascular smooth muscle cell pheno-
typic switching, endothelial dysfunction, platelet activation, lipid peroxidation,
ROS production, and macrophage atherogenicity, and thus, it may have the ability
to modulate the CVD incidence [49, 103]. However, the role of these herbs in
CVDs still needs more clinical evidence and elucidation of definite mechanism of
actions.
A Cochrane database of systematic review of 23 RCT’s concluded that listening
to music has beneficial effects on BP, heart rate and respiratory rate, and also on
anxiety and pain in persons with coronary heart disease [104].
Therefore, alternative medicine use in patients with CVDs seems to be com-
mon, however, a more patient-physician communication about the use of AMs and
evidence-based research are required.

3.6 Alternative medicine for management of anxiety or sleep disorders

Anxiety disorders are the most common psychiatric disorder, with an esti-
mated lifetime prevalence is 29% in the general population [105]. The high preva-
lence and complex comorbidity of anxiety or sleeping problems such as insomnia
makes a concern particularly in elder people because it affects physical and mental
health, and worse the quality of life by relating with significant clinical implica-
tions in obesity, diabetes, hypertension, cardiovascular and neurological diseases
[106]. It is well documented that treatment of anxiety or insomnia may provide
positive effects, not only by alleviating comorbidity but also by preventing new
incidents.
Insomnia patients can be treated by alternative therapies namely herbs, supple-
ments, relaxation and meditation, acupuncture, and exercise. Among these
therapies, biologically-based products such as herbal or nutritional medicine, and
mind–body therapies, are the most commonly used interventions. For instance,
herbal supplements particularly Valerian root and Chamomile may help to fall
asleep faster and boost the quality of sleep however, more research is needed for
the safety and efficacy [107]. Melatonin is the key natural hormone in the sleep–
wake cycle produced by the pineal gland, regulates numerous biological functions
including circadian rhythm, sleep, stress response, aging, and immunity [108].
Aromatherapy with lavender (Lavandula angustifolia) increases serum melato-
nin levels as evident from nonrandomized clinical trials on older adults [109].
Furthermore, acupuncture, relaxation and meditation, and regular exercise may
improve sleep quality, sleep onset latency, total sleep time, and insomnia severity
[110–112]. Lately, high levels of anxiety, fear, depression, panic, emotional outburst
and sleep disturbances has been observed in COVID-19 positive patient, particu-
larly from isolation and quarantine events [113]. Some sedatives and antianxiety
drugs are used to manage these symptoms however, it may inhibit the respiratory
system and worsen the condition [114]. Evidence suggests that progressive muscle
relaxation technique can reduce anxiety and improve sleep quality in patients with
COVID-19 beyond the side effects [115].

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Alternative Medicine: A Recent Overview
DOI: http://dx.doi.org/10.5772/intechopen.97039

Music has a powerful effect on our emotions, therapy such as mind–body

medicine has a direct influence in antianxiety effect. Listening to music may have
an immediate positive impact on stress-related physiological, cognitive, and emo-
tional processes [116]. It enhances parasympathetic activity, increase physiological
coherence, reduce the cortisol ratio, and boost immunity. A systematic review of
23 studies on physiological parameters, the anxiolytic effect of music therapy is
proved in all the studies [117]. Moreover, it has been shown that music can increase
comfort, decrease anxiety thereby can improve sleep disorder [118]. Hence, healthy
and safe alternative practices may at least in part, replace the strong anti-anxiety
medications thereby improving the quality of life in these patients.

3.7 Treatment of menopause

Hormone therapy is one of the most effective treatment for managing symptoms
of menopause. However, many women need to avoid hormone therapy due to
health risks from stroke, heart attack and cancer. In these cases, AM is preferred for
symptom management [51].
There are various alternative interventions for the treatment of menopause. They
fall into two main categories: a) mind–body practices that combines mental focus,
controlled breathing, and body movements resulting in relaxation of body and mind.
It has significant health benefits by reducing pain, stress, anxiety, and mood. Some
common mind–body practices are meditation, hypnosis, cognitive behavioral therapy,
biofeedback, yoga, and tai chi, and b) natural products-based intervention by using
herbs, vitamins, minerals, and dietary supplements [51, 119]. Apart from these catego-
ries, some interventions based on system-wide AM have been commonly used such as
traditional Chinese medicine, reflexology, acupuncture, and homeopathy [120]. Several
studies indicate that mind–body practices such as hypnotherapy, meditation, relaxation
etc. are beneficial in reducing problematic menopausal symptoms [119, 121]. Therefore,
AM may improve the quality of life particularly, the women who are transitioning to
menopause. Finally, though natural products, such as herbs, vitamins, minerals etc. are
commonly used for remedy of symptoms related menopause, consistent evidence to
support their safety and efficacy still remains elusive [122].

3.8 Management of rehabilitation

Patients in rehabilitation of musculoskeletal conditions often use alternative

medicine treatments. Commonly used treatments including massage therapy,
acupuncture, manipulation medicine, yoga and pilates, mind–body medicine,
effleurage, petrissage, friction, tapotement, and vibration [52, 123, 124].
Massage therapy is one of the most commonly used therapies for athletes to
enhance recovery and performance, particularly postexercise [123]. The benefits
from therapeutic massage are enormous such as relieve of muscle tension and
stiffness, healing of strains and sprains; reduce muscle pain, swelling and spasm;
improve flexibility and motion, enhance blood flow and so on [125–126].

3.9 Treatment of autism spectrum disorder

Autism spectrum disorder (ASD) is a heterogeneous group of neurodevelop-

mental conditions, which is characterized by impaired social interactions and
communications, restricted, repetitive, and stereotyped patterns of behavior and
interests [127]. It is assumed that both genetic and environmental factors play a
key role in ASD etiology, but no clear pathogenesis has been identified yet [128].
Although autism is a lifelong disorder and there is no causal treatment currently

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known, AM may stand as an therapeutic option for alleviating symptoms of

patients with autism spectrum disorder.
Biologically based therapy including dietary supplement (vitamins and minerals),
and herbal medication (meadowsweet, calendula, chamomile, marshmallow root
and lemon balm etc.) can be used for treating ASD. In addition, mind–body medicine
(i.e., prayer, yoga, music, dance, and art in general), manipulative and body-based
practices (i.e., massage, chiropractic care, and acupuncture), and energy medicine
(i.e., reiki or homeopathy) are useful for treating ASD [129]. Music therapy may have
strong impact in autistic children. Cochrane meta-analysis showed that listening
music significantly improved the cooperation and communication ability in autistic
children [130]. Another study remarked that music therapy might provide a basic and
supportive therapy for children with delayed speech development [131].
Though some trials demonstrated the importance of chosen alternative therapies
(e.g., equine therapy) and have gained attention by the scientific community, there
is insufficient evidence to assess the safety and efficacy of AM [9, 132]. Therefore,
combination of standard medical therapies along with safe alternative approaches
like diet, exercise and lifestyle modification might benefit patients from functional
disorder like autism.

3.10 Prevention or treatment of COVID-19

COVID-19 is considered as a life-threatening disease, which is caused by severe

acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [133]. To date, it has been
accounted as a global public health emergency and declared as a pandemic by World
Health Organization (WHO) as there is no specific antiviral treatment available in
the modern medicine system [5, 19]. Although several attempts have been initiated
after the disease onset, truly effective vaccine is still unavailable [134, 135]. A few
vaccines exist in the market but the safety and efficacy need further scrutiny using
multi-site clinical data [134]. Under this circumstance, a more rational phytothera-
peutic choice to the disease may be a cheaper option for prophylaxis or treatment
against this virus [136]. Strikingly, the phytocompounds of Momordica charantia
L. and Azadirachta indica have been recently shown adequate inhibitory potential
aganist SARS-CoV-2 when compared with FDA reference drugs such as ribavirin,
remdesivir and hydroxychloroquine [137]. In China itself, the total number of con-
firmed cases treated by TCM has reached 60,107 [138]. Indian government ministry
of Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy (AYUSH)
recommended homeopathy and ayurveda for prophylaxis and unani medicines for
symptomatic management of COVID-19 [139, 140]. In Bangladesh, herbal and fruit
extracts have been used to get relief from COVID-19. Infected people are advised to
drink masala tea, ginger tea, and lemon with hot water for recovery [141].
It has been shown that Chinese, Indian and Iranian herbal medicine with
1000 years’ experience in the prevention of pandemic and endemic infectious dis-
eases are worth learning, and provide alternative candidates for controlling patients
with COVID-19 infection [19, 142]. As there are no effective treatments for COVID-
19, it provides one of the biggest opportunities to test different plants and discover
new targeted bioactive compounds for therapeutic management of this disease.

4. Safety and regulatory issue of AM

Though approximately 80% ailing people in developing countries rely on AM

as a source of primary healthcare or traditional medical practice [143], there is
limited scientific evidence regarding the potential toxicity of a variety of AM [9].

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In fact, most of the AM are untested and the safety and efficacy are either poorly
or not even monitored at all [144]. Moreover, doctors and nurses are not trained
enough to describe the potential side effects and contraindications to their
patients [145]. Again, not all health professionals favor the concept of integrative
health approaches, neither do they have the confidence in dealing with CAM
due to lack of knowledge on standardization of practices and overall benefits of
holistic approaches. In contrast, most of the patients who use CAM are hesitant
to inform their primary health care provider about the methods for fear of
disapproval [145]. Further more, biological substances are not tested rigorously
to ensure their safety and efficacy in the context of pharmaceutical products
because FDA approval is not mandatory in case of a new therapeutic component
[146]. Manufacturer only need to attest as a dietary supplement’s safety, purity,
and contents by expressing on the label before marketing. However, some medici-
nal plants might be inherently toxic. Herbal products may also cause adverse side
effects including hypersensitivity reactions, cardiovascular events, neurologic
dysfunction, hepatic and renal failures, and the development of malignant
disease due to the presence of mercury, lead, arsenic, corticosteroids and poison-
ous organic substances [147, 148]. Adverse events may also arise from the lack
of knowledge by selecting wrong species of medicinal plants, incorrect dosing,
interactions with other drugs and error in the use of herbal medicines [144]. For
example, the herb arnica, black seed and feverfew stimulate uterine contractions
and possible miscarriage in pregnant women [149, 150]. In addition, ginkgo
Ginkgo biloba and chamomile (Matricaria chamomilla) may increase the risk of
bleeding in patients taking nonsteroidal anti-inflammatory drugs like aspirin,
and anticoagulant-warfarin. Even many forms of AM are rejected by orthodox
medicine as the safety and efficacy of the drugs have not been confirmed in clini-
cal trials [144].
The regulation on AM varies widely from country to country because each
country has their own regulations policy. In most countries, the AM market
is poorly regulated, and the medical products are often neither registered nor
controlled [151]. However, relatively few countries have developed policies
and regulations on TM/AM. Among the 194 Member States of WHO, only 98
countries have a national policy on TM/AM, and 109 countries regulate herbal
products. The WHO African and South-East Asian countries (>80%) have the
highest percentage of national or state level laws and regulations for traditional
and AM whereas, European (40%) and American (43%) region have the lowest
percentage [152]. In the United States, TM/AM legislation is the responsibility of
state, provinces or territorial jurisdictions, and regulation varies from jurisdiction
to jurisdiction.
In the United Kingdom (UK), there is no regulation that restricts the practice
of AM except of chiropractic and osteopathy. However, now the UK Government
has gradually acknowledged the need for extensive regulation of AM. Chiropractic
and osteopathy have adopted statutory self-regulation, though this has proved
expensive for individual members of these professions. A recent House of Lords
has recommended that the herbal medicine and acupuncture professions should
also develop a system of statutory regulation. Some occupations, such as aroma-
therapists, are in the process of forming a common professional body as a first step
towards self-regulation [153].
Hence, it would be helpful to increase training opportunities for health care
professionals and share information to their patients about potential interactions
of AM with modern treatments. Finally, the knowledge of the usage, safety and
efficacy of AM as well as the evolution of awareness may increase the ability of
health care providers to follow the legislation.

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Alternative Medicine

5. The current marketplace of AM

The global demand for AMs was reported at USD 69.2 billion in 2019 and is rising
every day. Different energy healing therapy comprises reflexology, reiki, and havening
techniques are increasingly used in anxiety and mental disorder patients in different
countries. Nowadays, many magnetic therapies such as bioflex magnets, mattresses,
and magnabloc for pain reduction are used. Other alternative therapies like yoga,
meditation, and spa have been well attributed globally due to their popularity, which led
to development in the number of yoga studios, meditation centers, spas, and comple-
mentary healing facilities institutes in the particular communities [154–156]. Moreover,
some alternative medicine services are now offered as benefits in state Medicaid
programs, Medicare, and private health insurance plans [157, 158]. Study shows that
at least 50% American medical schools are currently offering courses in alternative
medicine to their medical students. Among which 25.0% of the courses referenced
personal growth or self-care through alternative practices, while only 11.0% referenced
inter-professional education activities involve interaction with alternative medicine pro-
viders [159]. In the promotion of CAM, a governmental initiative can play a crucial role.
In India “Ministry of Ayush” has been set up by national authorities to govern research,
development, increased funding opportunities, education, and other facilities pertain-
ing to ayurveda, yoga, naturopathy, and homeopathy [154]. Therefore, the expensive
existence of mainstream treatment and governmental facilities devoted to alternative
therapies may encourage companies to invest in alternative medicine markets.

6. Major challenges for AM

Alternative treatment has improved our awareness and centered our view of medi-
cal treatment, but it still faces tremendous challenges. After two eras of robust efforts
by the NCCAM at the National Institute of Health (NIH) on behalf of AM research,
it remains an extreme challenge for scientists to analyze thousands of years’ worth
of clinical research issues to demonstrate the safety as well as efficacy of AM [160].
The complex and complicated, multivariate and multifaceted factors of AM systems
require continual innovations for comprehensive and well-designed studies. The con-
trol trends of existing biomedicine restrict alternative treatment research, which must
be expanded and extended [161]. The exploration and eventual discovery of plausible
scientific mechanisms, theoretical and historical investigations are essential to further
and fully understand the holistic role of alternative medicine and claim it within the
realm of modern medicine [162]. In many cases, alternative therapies are commonly
documented as false cases due to proper public awareness [124, 146]. Many modern
medical practitioners and physicians are reluctant to discuss the importance of new
effective AM with patients. A study showed 89% of patients were self-referred to an
alternative practitioner and 72% did not inform to their physicians about their AM
use [163]. In addition, alternative treatments defy the scientific procedures in terms
of objectivity, measurement, codification, and classification because it comprises
physical and spiritual realms, that cannot be subjected to scientific analysis [154]. So,
it is essential to generate important insights into comparative clinical efficacy trials to
improve patients’ treatments, especially for long-term results.

7. Conclusion

AM has been practiced in numerous countries before the advent of modern

medical science but its usage is not supported by the medical community due to lack

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DOI: http://dx.doi.org/10.5772/intechopen.97039

of evidence-based safety and effectiveness evaluation. Despite the promising results

reported with various natural and biologic products, the clinical efficacy of such
alternative therapies is yet to be determined. More than half of the world’s popula-
tion does not have access to modern medicine where most funding for healthcare
in the developing world goes to 20% of the population and it can certainly be
presumed that healthcare costs will be expected to double over the next decade.
Low-cost intervention, such as lifestyle modifications, diet, supplement therapy
and behavioral medication, can be used as a replacement for prescribed high-cost
medications and technological innovation. More research of AM treatments in
humans are needed to elucidate whether alternative treatments can have beneficial
effects when they are used alone or have additional benefit while used with mod-
ern treatment methods. As a result, its usage requires exploration and eventual
discovery of plausible scientific mechanisms, theoretical and historical investiga-
tions, continual innovations, comprehensive and well-designed studies in order
to validate, advance and fully understand the holistic roles of AM and position it
appropriately within the context of modern medicine. It is imperative that medical
practitioners and physicians need to be aware about potential alternative therapies
and discuss benefits and potential adverse effects or limitations with patients. With
concerted efforts involving different relevant stakeholders including medical and
research councils in different countries, systematic approaches could be developed
and incorporation of standardized procedures, awareness of validated, authenti-
cated and easily accessible scientific resources can substantially improve the current
scenario of AM and meet the increasing healthcare needs of global population.

Acknowledgments

We are gratefully acknowledged to Professor Morsaline Billah, Biotechnology

and Genetic Engineering Discipline, Khulna University, Khulna 9208, Bangladesh,
for critical reviewing, editing and improving the chapter. This study was sup-
ported by the National Research Foundation of Korea (NRF) (Grant No: (NRF-
2020H1D3A1A04080389 t), the Ministry of Education, Bangladesh, (Grant No:
LS17617) and Asian Network of Research on Antidiabetic Plants (ANRAP) for
funding the project, and Bangladesh University of Health Sciences (BUHS) for
providing logistic facilities to conduct this work.

Conflict of interests

The authors declare that they have no conflict of interests.

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Alternative Medicine

Author details

Salima Akter1,2*, Mohammad Nazmul Hasan3, Begum Rokeya4, Hajara Akhter2,

Mohammad Shamim Gazi5, Farah Sabrin6 and Sung Soo Kim1

1 Department of Biochemistry and Molecular Biology, School of Medicine,

Kyung Hee University, Seoul, Republic of Korea

2 Department of Medical Biotechnology, Bangladesh University of Health Sciences

(BUHS), Dhaka, Bangladesh

3 Pristine Pharmaceuticals, Patuakhali, Bangladesh

4 Department of Pharmacology, Bangladesh University of Health Sciences, Dhaka,

Bangladesh

5 Biotechnology and Genetic Engineering Discipline, Khulna University, Khulna,

Bangladesh

6 Department of Biotechnology and Genetic Engineering, Mawlana Bhashani

Science and Technology University, Tangail, Bangladesh

*Address all correspondence to: [email protected]

© 2021 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms
of the Creative Commons Attribution License (http://creativecommons.org/licenses/
by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,
provided the original work is properly cited.

16
Alternative Medicine: A Recent Overview
DOI: http://dx.doi.org/10.5772/intechopen.97039

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