Current Approaches of Research in Naturopathy: How Far is its Evidence Base?

Naturopathy is a system of health care comprises a traditional system of healing based on philosophical principles vogue to ancient India. It has its own concepts of health and disease and also principles of treatment. Ancient scriptures like Vedas give a comprehensive detail about these practices. This system laid more importance on the preventive health rather than curative one. This is one of the reasons that Naturopathy system is gaining popularity day by day. Naturopathy is a science of health and healthy living. It teaches us how to live healthy? What to eat? And how our daily routine should be? And help a person in attaining freedom from disease and with the help of their regular use, positive and vigorous health can be acquired. The main objectives of Naturopathy are to change the unhealthy living habits of people and to teach them the healthy and positive lifestyle in accordance to the laws of Nature with the effective help of different Naturopathy modalities. Naturopathy system is found very effective in the management of various disorders where there is no cure. However, in depth clinical studies are required to be conducted to establish its efficacy in prevention and management of diseases especially in Naturopathy. Some efforts have been made but not adequate. The present paper states the current approaches of research in Naturopathy highlighting its basic principles. It also throws light on the reasons behind and explores new areas of research indicating the need of evidence base. *Corresponding author: Rajiv Rastogi, Central Council for Research in Yoga & Naturopathy (CCRYN) 61-65, Institutional Area, Janakpuri, New Delhi-110058, India, Tel: 011-28520430/31/32; Fax: 011-28520435; E-mail: rrastogi2009@gmail.com Received December 05, 2011; Accepted February 12, 2012; Published February 15, 2012 Citation: Rastogi R (2012) Current Approaches of Research in Naturopathy: How Far is its Evidence Base? J Homeop Ayurv Med 1:107. doi:10.4172/21671206.1000107 Copyright: © 2012 Rastogi R. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Introduction
Naturopathy comprises a traditional system of healing based on philosophical principles vogue to ancient India. Many techniques of Naturopathy system like ushapanam and upvas (fasting) were part of routine living practices peculiar to early days. Ancient scriptures like Vedas give us a comprehensive detail about these practices [1]. Naturopathy is a system of health care. It is called as science of healthy living. It is a drugless system of healing based on well founded philosophy. Naturopathy has its own concepts of health and disease and also principles of treatment. It lays more importance on the preventive aspect of health care rather than curative one. This is one of the reasons that Naturopathy system is gaining popularity day by day. Naturopathy is a system of man building in harmony with constructive principles of nature on physical, mental, moral and spiritual planes of living. It has great health promotive, diseases preventive and curative as well as restorative potential [2] (Figure 1). Naturopathy is also defined as a system of medicine for cure of diseases by encouraging natural curative reactions inherent in every diseased cell through methods and treatments based upon the fundamental laws which govern health.
Naturopathy is basically a preventive system of treatment. It believes that man is a complete health unit and treat the body physically, mentally, socially (morally) and spiritually for all round health [3]. If one follows the laws of nature he may prevent himself from various diseases ( Figure 2).
According to Naturopathy as defined by Lindlahr [4], "The primary cause of disease, barring accidental or surgical injury to the human organism and surroundings hostile to human life, is violation of Nature's laws. The effects of violation of Nature's laws on the physical human organism are: • Lowered Vitality • Abnormal composition of blood and lymph • Accumulation of waste matter, morbid materials and poisons" To prevent the diseases one has to obey the universal laws of nature in life by adopting the natural methods of living and of treatment. These methods which are applicable in the prevention and management of most of the disorders have been described by Lindlahr [4], as under: • Return to Nature by the regulation of eating, drinking breathing, bathing, dressing, working, resting, thinking, the moral life, sexual and social activities, etc. establishing them on a normal and natural basis.
• Chemical remedies, such as scientific food selection and combination, homeopathic medicines, simple herb extracts and the vito chemical remedies. • Mechanical remedies, such as corrective gymnastics, massage, magnetic treatment, structural adjustment and in cases of accident, surgery.
• Natural and spiritual remedies, such as scientific relaxation, normal suggestion, constructive thought, the prayer of faith etc.
The difference between Naturopathy and other systems of medicine is that in Naturopathy the methods and treatments used to encourage the inherent curative reaction within each cell are based upon the five fundamental laws which govern health. The cure is obtained, not by reactions to the medicines introduced but because the very vitality and the health of diseased cells improve with the help of the methods and treatments used. According to Naturopathy for sound health tranquility of mind, balanced food, regular exercise and proper rest are essential [3] (Figure 3). 9. According to Gandhiji "Ramanama is the best natural treatment", means doing prayer according to one's spiritual faith is an important part of treatment.
Naturopathy is a science of health and healthy living. It teaches us how to live healthy? What to eat? And how our daily routine should be? The methods of Naturopathy helps a person in attaining freedom from disease and with the help of their regular use, positive and vigorous health can be acquired. Hence, Naturopathy is also called as Natural life. Its main objective is to change the unhealthy living habits of people and to teach them the healthy lifestyle in accordance with the laws of Nature. Different modalities of Naturopathy are very effective in the fulfillment of this pursuit.
It believes that the human body has remarkable recuperative power. It is composed of five great elements i.e. Panchamahabhootas, imbalance of these creates disease. Treatment of the diseases by these elements i.e. Air, Water, Earth, Fire and Ether is known as Naturopathy ( Figure 4).

Modalities of Naturopathy
The main modalities of Naturopathy are comprised of:

Diet therapy
It is the main modality under Naturopathy which stresses that the food must be taken in natural or maximum natural form only. Fresh seasonal fruits, fresh green leafy vegetables and sprouts are excellent form of natural foods. These diets are further broadly classified into following three types:  These diets are alkaline in nature and purify the body, improve health and render it immune to disease. Naturopathy believes that for preserving health the diet should consist of at least 20% acidic (cooked) and 80% alkaline (uncooked) food. Considering the importance of food in Naturopathy it is regarded as Basic Medicine [5].
Stange R [6] stated that when applied to functional disorders, dietary treatment-the most important measure in natural medicinehas its greatest effect when these disorders affect the gastrointestinal tract, in particular epigastric dyspepsia and irritable bowel syndrome. On the basis of a comprehensive dietary anamnesis, it is often possible to identify foodstuffs and eating behavior capable of aggravating the patient's symptoms. The underlying basic principle of treatment is that the gastrointestinal tract first undergoes a temporary period of rest before being gradually re-accustomed to a biologically high-quality diet. A central approach includes various forms of fasting therapy, in particular in the case of severe conditions, which can usefully be supported by additional relaxation techniques, psychotherapy, hydrotherapy, massage and special manual techniques.
In a study responses to cooked and uncooked food in 32 outpatients with essential hypertension was examined; 28 were also overweight. By varying cooked and uncooked food percentages and salt intake, patients acted as their own control subjects in this unblinded study. After a mean duration of 6.7 months, average intake of uncooked food comprised 62% of calories ingested. Mean weight loss was 3.8 kg and mean diastolic pressure reduction 17.8 mm Hg, both statistically significant (P less than 0.00001). Eighty percent of those who smoked or drank alcohol abstained spontaneously [7].

Fasting therapy
It is an important modality comes under Naturopathy. Mental preparedness is essential to yield effective results in fasting. According to Naturopathy there is only one cause of disease i.e. accumulation of morbid matter and only one cure i.e. elimination of morbid (toxic) matter from the body. Fasting is an effective treatment for removing the disorders of mind and body and is a process of providing rest to digestive system. The vital energy which digests the food is wholly engaged in the process of elimination during fasting.
To determine the effects of short-term fasting on carbohydrate tolerance, 10 obese women with noninsulin-dependent diabetes mellitus (NIDDM) were studied with meal tolerance tests before and after 3 days of fasting. The study revealed that Carbohydrate tolerance improves in obese diabetic (NIDDM) women after 3 days of fasting, in contrast to the impairment of glucose tolerance seen in lean or obese nondiabetic subjects after fasting [8].

Mud therapy
It is one of the important modality, which is very simple but highly effective. The mud used for therapeutic purpose is neat and clean and free from contamination of stone pieces or chemicals, manure etc., and is taken from 5 to 6 ft. depth from the surface of the ground.
Mud therapy gives coolness to the body. It dilutes and absorbs the toxic substances of body and ultimately eliminates them from body. Mud packs and Mud baths are the main forms of treatment. Mud is used effectively in constipation, headache due to tension, high blood pressure and skin diseases etc. Mud pack is applied on forehead also in headache and high blood pressure. Gandhiji also used to take mud packs for getting rid of his constipation.
A study was conducted to evaluate the short-term effects of mudpack therapy on pain relief and functional improvement in knee osteoarthritis in comparison with intra-articular hyaluronic acid injections.
The study included 23 patients who were diagnosed as having knee osteoarthritis according to the ACR (American College of Rheumatology) criteria, and had complaints lasting for more than three months. All the patients had stage 2 or 3 osteoarthritis radiographically according to the Kellgren-Lawrence criteria. Twelve patients (3 males, 9 females; mean age 54±6 years; range 46 to 67 years) received mud therapy bilaterally. Mud packs were heated to 45ºC and applied on both knees for 30 minutes daily for a total of 12 weekdays. Eleven patients (2 males, 9 females; mean age 53±9 years; range 40 to 66 years) received a total of three bilateral intra-articular hyaluronic acid injections, each interspersed by weekly intervals. The study revealed that Mud-pack therapy is a noninvasive, complication-free, and costeffective alternative modality for the conservative treatment of knee osteoarthritis [9].

Hydrotherapy
Water is a main component of Naturopathy. It is an ancient method of treatment used mainly for preserving health, relieving the inner congestion [10] and curing different types of diseases. Taking bath in clean and fresh water is very effective as it opens up the pores of skin, imparts lightness and alertness to the body, all systems and muscles of body are activated and the blood circulation improves. It is believed that the old tradition of taking bath in rivers, ponds or water falls on specific occasions in India is virtually a form of Hydrotherapy only. Hip bath, Enema, Hot and Cold fomentation, Hot foot bath, Spinal bath, Steam bath, Immersion bath, Hot and Cold packs on Abdomen, Chest and other parts of the body are the recent developments in Hydrotherapy.
In naturopathy, application of a cold chest pack for 30 min daily over a period of time is believed to improve lung functions in bronchial asthmatics. For scientific evaluation of this treatment, a study was carried out on 15 medication-free bronchial asthma patients (2 males) with ages from 19 to 42 years. The peak expiratory flow rate (PEFR, in l/min) was recorded before, during and after a 30 min application of a cold chest pack. This treatment was carried on for 21 days, during which the patients received other naturopathy treatments such as fasting, diet changes, hydro therapy, massage, magneto therapy, color therapy and application of mud packs, along with yoga therapy. The results suggest that (I) an application of a cold chest pack increase the PEFR as an immediate effect and (ii) this effect is augmented following 21 days of other naturopathy treatments along with yoga [11].

Massage therapy
It plays an important role in Naturopathy treatment procedure. It is a scientific and systemic manipulation of the tissues and organs of the body, aims at improving the blood circulation and also at strengthening muscles and bodily organs. Taking Sun bath after massaging the whole body is a well known health practice in India during winters. It bestows combined benefits of massage and Sun rays therapy. To overcome A randomized controlled trial including 60 participants was conducted in Sweden between 2005 and 2007 to evaluate change in health-related quality of life for people with constipation receiving abdominal massage. The control group continued using laxatives as before and the intervention group received additional abdominal massage. Health-related quality of life was assessed using the EQ-5D and analyzed with linear regression. The study revealed that abdominal massage may be cost-effective in the long-term and it is relevant to consider it when managing constipation [12].

Chromo therapy
The seven colours of spectrum i.e. Violet, Indigo, Blue, Green, Yellow, Orange and Red are used in Naturopathy as therapy which have different therapeutic properties and effects. Chromo therapy is applied by coloured bottles filled with water or oil and exposed to Sun rays for specified hours. This colour charged water is used as an external application for skin disorders and is also ingested as a tonic for digestive disorders. Specific colours are applied on specific parts with the help of lamps with the specific coloured glasses. These devices of Chromo therapy are used effectively in prevention and treatment of different diseases. These colours are also applied in daily life in various ways like coloured light in the room, coloured clothing, colours in dining form, foods charged by specific colours, wall paints, colour of furniture etc.

Air therapy
Fresh air, an important part of Naturopathy is most essential for good health. The advantage of air therapy is achieved by taking air bath daily for at least 20 minutes. Walking in fresh air is a best form of air bath. It is more advantageous when combined with morning cold rub and exercises. Air bath has soothing and tonic effect upon the millions of nerve endings all over the surface of the body and enhances the elimination process. It has shown good results in nervousness, neurasthenia, rheumatism, skin, mental and various other chronic disorders.
As Lindlahr [4] says, 'Walking is a splendid form of exercise, provided it is made vigorous enough to set in motion all the muscles of the body and to produce perspiration. There is no better form of elimination than natural perspiration' [13].
Naturopathy provides a systemic schedule to all its patients consisting of a diet prescription followed by certain Naturopathy treatments and do's and don'ts with a view to change their life style in a positive manner as under. 5.00 a.m. 5.30 a.

m.
Get up from bed. Drink about half a liter of water (Ushapanam). Attend natural calls and prayer. Brisk walk/Suryanamaskara/ Yogasanas/Games/Gardening/Swimming and Pranayama or Breathing exercises followed by Shavasana or Yoga Nidra.

a.m.
One glass of lemon water (Half/ one lemon + one/two table spoonful of honey or jaggery + 300 ml. of water Or tender coconut water / triphala water / amla water / Bittergourd juice / Methi water / Diabetic Herbal Juice / Herbal Tea etc.)

a.m.
Treatments if necessary.
• Enema if constipated during fasting.
• Cold Hip Bath -10 mts or Cold towel pack on the abdomen for 20 to 30 minutes / Mud packs for 20 minutes. Weekly thrice / daily.
• Cold / Neutral wet spinal pack for 20 to 30 minutes. Weekly thrice / daily.
• Affusion with hot and cold water alternatively 3 minutes / 1 minute daily.
• Cold neutral wet knee pack / chest pack for 30 to 45 minutes daily.
• Bath with cold / neutral water and do prayer or meditation.
If necessary drink one glass of seasonal fruit juice / tender coconut water / one glass of buttermilk / barley water or drink only water.
• Avoid indulgence in all unnatural physical / psychological habits.
• Water immediately before and after food.

Follow
• Regular eating of natural diet preferably two times in a day.
• Chew well and eat with a peaceful mind.
• Drink at least three liters of water in a day, (300 ml. at 2 hours gap) • Practice exercise in any form.
• Fasting one day in a week with only liquids -seasonal fruits and vegetable juices 4 to 6 glasses in a day or with water only.
• Prayer / Yoganidra / meditation or relaxation twice in a day.
• Expose body to sunlight / fresh air as far as possible [14].
Yoga & Naturopathy systems, recently, are found to have a global spurt evidenced by a constant growth of their followers across the world [15].Their low cost structures; simplicity, inclination towards natural modalities and a consideration of psyche besides other causes of an ailment are possibly the best reasons explaining this spurt. For past many years, these non-pharmacological techniques have also shown their potential to prevent and intervene in a variety of systemic and life style disorders [16][17][18][19][20].
Close interconnection between Body-Mind-Soul has become a widely accepted phenomenon now. Subsequently, psyche and soma thus are taken up as two expressions of one integrated body in an undulating manner representing the dominant ones at one time.

Research in Naturopathy
In view of increasing role of Naturopathy to intervene in various psychosomatic and lifestyle disorders, the scope of research to establish the efficacy of Naturopathy is also increasing. Currently, an exploration of potential of this system is approached at various premier Indian research institutions of modern medicine and also by some Naturopathy Hospitals.
Research is a determined and disciplined activity aiming at answering a particular question [21]. It is a challenging work requiring a great sum of efforts and dedication. The priority of research in naturopathy system is required to be decided as per the needs in reference to its limitations and expectations [14]. Bhole has categorized a few potential areas where research in the field of yoga can be undertaken. These areas are -Philosophical-literary research, Educational research, Experimental research, Clinical and applied research and experiential research [21]. A further exploration to these areas may be done as under-1. Standardization

Research on nutritional aspects
Rastogi and Murthy [14] have shown an inclination of patients towards non-pharmacological and non-invasive therapies of Yoga & Naturopathy for various acute and chronic disorders of common existence [14]. Some conditions which require a mention in this category include stress related ailments, irritable bowel syndrome, bronchial asthma, diabetes, rheumatoid arthritis, coronary artery disease, computer related health problems, insomnia, epilepsy, skin disorders, ulcerative colitis, osteoarthritis, gout and cancer. Stress related ailments like anxiety neurosis, depression and hypertension are having a high prevalence these days. Studies revealed that these can be effectively managed by the techniques of Yoga & Naturopathy i.e. relaxation, pranayama, yoga nidra and water therapy.

Conclusion
The scientific development of a system primarily depends upon the findings of scientific studies conducted through a good protocol and methodology. Selection of various parameters and intervention programme therefore required to be designed carefully in consultation of experienced investigator and subject experts. The mechanism of working of intervention programme may be demonstrated clearly by the researchers. A research oriented scientific approach to establish the system of naturopathy is therefore, required urgently. Though various trials to study the efficacy of naturopathy have been made, a lot of work is still required to explore the potentials of this system for bringing an ultimate and dependable cure from their ambit. Rigorous clinical trials are required to affirm the possible role of naturopathy in management of various disorders.