Aggravations, Risks and Benefits:

Aggravations can be divided into two broad categories: on the one hand, those involving straightforward damage or injury to the patients, and secondly the so-called "healing crisis" where there is a temporary aggravation of symptoms while the patient is healing.

Risks in Orthodox Medicine: Western medicine causes countless illnesses. An important example is Adverse Drug Reactions (ADR), more commonly called "side effects" (which might better be called "collateral damage"). ADRs from correctly prescribed pharmaceuticals are the fifth leading cause of death in America. Incorrectly prescribed medicine accounts for half as many deaths again. When we include deaths from surgery, we have a 6% chance of being killed by our doctor! (And that is a conservative estimate). "Complications" caused by doctors are called "iatrogenic" illness. If you take a pharmaceutical drug you have (roughly) a 15% chance of experiencing a noteworthy iatrogenic complication, an ADR. Those are the risks. What are the benefits? Well, there is very little polio around and that's nice. And there is no smallpox. But don't get cancer, and if you want to avoid the first leading cause of death, cardiovascular disease, don't look to your doctor. Change your diet!

Risks in Alternative Medicine:

Chiropractic: Now, I'm a chiropractor, and I see amazing benefits in chiropractic, but it is also where many of the (few) risks we see in fringe medicine occur. Adjustments of the neck can, rarely, cause stroke-like catastrophes. This is very much in the news, now, as I write, despite the fact that they are very rare (while the carnage from orthodox medicine is so astounding). An article in the Canadian Medical Association Journal, 2001, estimates the risk of stroke-like episodes associated with neck adjustments as 0.2 per million adjustments (and therefore perhaps 1 or 2 per million patients). Immediately we have to make two observations on the context of this phenomenon (that is, morbidity from cervical chiropractic adjustments):

First, "spinal adjustments are significantly safer than other common therapies for back and neck pain and headaches. Long-term use of non-steroidal anti-inflammatory drugs for pain cause 1,000 serious complications per million cases and 100 - 200 deaths per million. Surgeries for neck and back pain cause 15,600 cases of paralysis or stroke per million cases, and 6,900 deaths per million."

Second: Wherever we have any data on the type of chiropractic adjustments which have caused major problems, we find that rotation (and extension) are involved. Rotation may tug on the vertebral artery. If your chiropractor is rotating and extending your neck, ask him/her why. The answer may be because they haven't learned the Gonstead Technique of Chiropractic. Clarence Gonstead hypothesized that when a vertebra slipped out of place it fell backwards, posterior, off its disc. It did this, he said, because this is what the anatomy allows, because that is what Gonstead saw on X-ray, and because when he corrected for posteriority he got the best results. Indeed, when scientists finally looked at subluxations, they loaded cadaveric spine till failure and… that's what happened. "Failure" was a shift posterior. The vertebra falls backward.

In my opinion, the Gonstead technique is the most effective chiropractic therapy. But also, because it minimizes rotation, it is the safest. Remember, it seems to be rotation that puts the body, and more specifically, the vertebral artery, at risk. The Gonstead Technique minimizes that risk. And, as it seems to correct the underlying problem, it does not need as much repetition as other techniques. So Gonstead's motto was, "Find the subluxation, correct it, and leave it alone."

Now, as well as the very remote risk of major stoke-like events, there is also, in chiropractic, a small risk of minor injuries, primarily little muscle sprains/strains. I think that perhaps I hurt, in a minor way, as many as 1 or 2 patients in 100 and while this is upsetting for them, and me, 1 or 2 percent of "chiatrogenic" adverse effects are statistics medical doctors would die for. (Remember, you have a 6% chance that they will kill you.) And the benefits. Well, I see "miracles" with chiropractic. Long-standing pain leaving, with the Gonstead Technique, in two or three sessions. (Not that I can promise that in each case. But I see it often.)

Other risks in Alternative Medicine:

Acupuncture: In acupuncture make sure that the acupuncturist doesn't puncture your lungs. That's a disaster. Otherwise, acupuncture is pretty risk free, but it certainly isn't always painless. It can be quite painful, though usually this is only momentarily. More often than not acupuncture is painless, or if painful, it is just a pinprick.

Herbs: Some herbs can be toxic, though most herbs commonly used are risk free. In herbology the "side effect" that I see most often is an improvement in untargeted systems. You take Motherwort for your sleeplessness and your indigestion and your period pains clear up. Of the commonly used herbs perhaps only Goldenseal needs a caution. It has a low-grade liver toxicity (comparable, say, to that of aspirin) and should only be taken for a couple of weeks at a time.

I think most of the other complementary techniques are pretty much free of risk. Or we might rather say that the only substantial risk is a missed diagnosis. Say you've got some dread disease. You go to the massage therapist. You feel much better. You delay going to the orthodoc. But would the orthodoc have diagnosed it correctly anyway? (The science, the statistics, on medical diagnosis are not encouraging.)

So, that's a brief look at risks. Now let's look at "healing crisis" and "homeopathic aggravations".

"Aggravations", as opposed to damage, are of several types. The archetype is the "homeopathic aggravation", or "healing crisis".

I think of homeopathic aggravations as a surfacing of the disease, as it leaves. As condition leaves the body, it passes through the surface (breaks surface, as it were) and manifests. First note that the homeopathic remedy is a vibration, and there is very little physical energy involved. To understand homeopathy we might look at a disease as a disharmony (in the body, or of the personality, or of the mind). For example, when we are subject to physical trauma the body (and mind) go into a certain type of vibration (think, for instance, of tense shivering seen in shock). The remedy Arnica is the "similar" of that vibration. We give trauma victims Arnica and it helps relieve the vibration of traumatic shock. Presenting the body with the remedy "similar" to its disharmony appears to allow, to encourage, the body to release that vibration.

Now imagine that your present symptoms, be they a headache or skin rash, are the tip of the iceberg. When we give the "similar", the iceberg comes to the surface, through the surface (in my image of the thing), and it is this surfacing that we see as an aggravation or healing crisis. Likewise, the leftover disharmony of old diseases often seems to be buried in the body (as a "subclinical" entity). The homeopathic remedy may bring these old disharmonies through the surface as they are released. When the homeopath gives you a remedy and you come out in a rash (or show any type of "discharge"), the homeopath says, "Good!" for that is the ailment leaving the body. The remedy Lycopodium has a reputation for causing (some) patients to recapitulate all their former symptoms, serially, sequentially from the most recent back to the earliest. The problem, then, with "aggravations" is when the release is too fast. (Compare "die-off", below.) Careful handling of dose (repetition and potency) can minimize the distress of aggravations.

That's the classical homeopathic aggravation or healing crisis, and we see something similar with some other therapies. In CranioSacral Therapy we can unwind the body's tensions, distortions, compensations, and this can take us back to an earlier state which might be more symptomatic, but is also closer to health.

There is another sort of "aggravation" that we see in Cranio, another mechanism of healing crisis. When we "repress" thoughts, or feelings, what we most often do is "anchor" them... (associate them with… tie them to…) anchor them somewhere in the body, often as a "contraction" in the tissues of the abdomen or thorax, and then we ignore them. Eventually, as they accrue, these contractions can become symptomatic. Now, when we unwind and release the contractions, the psychic (psychological and emotional) content anchored with them is released, becomes free-floating. Hopefully, now that we are away from the original trauma, we can cope with the problem: we can "digest it".

Withdrawals: What about "withdrawals"? They, too, are "healing aggravations", but they represent quite a different mechanism. Withdrawal can be looked at as a readjusting to changed circumstances. With opiate addiction, when we supply opiates from outside there is a feedback down regulation of the body's own endorphin production (because the opiate is doing the job). With withdrawal of the exogenous opiate, the body is left with an endorphin deficit until it up-regulates and produces enough of its own. With coffee withdrawal, again, there is an imbalance of some modulations and we are distressed until the body rebalances.

Detoxification: Detoxification is another example of a resurfacing, in a sense, of (the agents of) disease. Often, if we load the body with toxins it stores them, sequesters them. When we stop loading the body and start to unload, the toxins resurface, in the blood stream, and as symptoms, headaches, rashes, etc.

Related to this is the phenomenon of change in sensitivity to toxins that we see as our health returns. Here there is a heightening of both "vital energy" (scientists might choose to see this as an increase in vigor of the homeostatic mechanisms) and an increase in the sensitivity in the clean body (in contrast to the deadening of sensitivity and vital energy in the toxic body). Consider a child smoking its first cigarette. His eyes water, his skin perspires, his stomach gags and retches, he coughs and turns green/pale: the body does everything it can to get rid of the toxin. Now, if he persisted in smoking and yet went on reacting this strongly, he would soon die of exhaustion. So the body, assaulted, just accepts the toxins. We no longer react. But if we start to detox, if we stop taking in the toxins, the body again starts to reject them. So, after we clean up our acts we may react very strongly to toxins, but we also rebound to a health more and more quickly.

"Die-off": Quite similar to the surfacing of symptoms during detoxification is the phenomenon called "die off" (or the Herxheimer reaction) which is seen, for example, when treating candidiasis with phasmaceuticals. When you kill off the yeast quickly, their dead bodies become a highly irritating toxic refuse and you get symptoms. You may get fevers, headaches, you feel wretched. There is a proper pace, even to healing.

Symptoms: I think that while discussing aggravations we need to say a word about symptoms themselves. My herb teacher, Michael Vertolli, says that the symptoms are the body's best attempt to deal with a problem. For instance, fevers weaken microbes and so help the immune system get rid of them. If we suppress the symptom, the body will come up with its next best attempt. Suppress that and the body will try its next best option. Eventually, the story goes, you might, say, produce a tumor to try and wall off the toxins. So it is better to pay attention to our symptoms, to heal, better to deal with the underlying problem than to suppress the headache, the heartache, or whatever. We should not necessarily look at symptoms, or aggravations, as sinister. We need to learn to understand, and respect, our symptoms. They are our body talking to us. We need to listen and to use our intuition and intelligence. So with pain, there is a pain that signals injury (or further injury) and a pain that may accompany return of function. We must learn to discriminate. In the end, we live and die by our intelligence and our intuition, so we had better sharpen them. It's a complex world. A world full of aggravations, risks and benefits. A complex world.