There is nothing new about manipulation. Hippocrates in the fifth century BC and Galen (AD 131-202) both practised and wrote about it. The practice of spinal manipulation is very ancient. Chinese writings dating back to 2700 BC refer to manipulation as a healing art. There is also evidence that similar procedures were used in ancient Egypt, Babylon, Syria, Tibet and by the Aztecs and Incas of Central and South America.
Manipulation Buddhist temple Thailand 2000 years ago
Manipulation during Traction Medieval Turkey
Greek manuscript 900AD Hippocratic treatise on dislocation
The first attempts to influence the bony alignment of joints systematically by manipulation were probably developed in ancient Greece. Hippocrates, the father of modern medicine, stated; “it is most necessary to know the nature of the spine, what its natural purposes are, for such a knowledge will be requisite for many diseases” and “In all disease first look to the spine”.
Five hundred years after Hippocrates, Galen, the celebrated physician to the Emperer of Rome, whose writing in the field of healing was the most extensive and accurate at the time, recognised the importance of spinal manipulation in treating many physical conditions. About the year 1000, Avicenna in Bagdad used and taught Hippocrates’s methods. Charaf Ed Din (1465) in Turkey and Vidio (1500-69) advised and illustrated manipulation during traction. Pare (1510-90) in France described how acute backache could be brought on by heavy work with the spine flexed and descibed and illustrated manipulative techniques which are very up to date. In Spain similar illustrations are found in Mercado’s book (1599) on “Bonesetting”. In 1656 Friar Moulton published “The Complete Bonesetter”. Many bonesetters were medical doctors and due to the rapid expansion westward in the settling of America the demand for their skill progressed to the establishment of the first teaching institution specifically for manipulation in 1893 in Kirkville, Missouri (see the history of osteopathy below).
What is the Origin of Osteopathy?
It is well to remember that the first drug to be manufactured was aspirin in 1899 by Bayer. Prior to that medical doctors had a more diverse role than today, dispensing herbal remedies and other plant drugs such as foxglove (1785) and morphine (1803), mineral drugs including large doses of heavy metals, as well as tending, cuts and abrasions, stitching wounds, setting broken bones and performing manipulations until then referred to as ‘bonesetting’. In the Hollywood Westerns, doctors are often referred to as “sore bones”.
Osteopathy as we know it today started a century and a half ago in America. At the time the west was being settled and the rough and tumble injuries the early settlers encounted required hands on remedies. Paget (1866) in his lecture “Cases that Bone Setters Cure”, describes the inconsistancy amongst bonesetters. Uniformity was needed, the first attempt to describe bonesetters’ manipulation systematically was by Hood, a medical doctor who published “On Bonesetting” (1871), describing the bonesetting methods of Hutton. It is not surprising that in settling America lots of injuries occurred and new medical schools flourished. Specific manipulative therapy as opposed to the medicine of the day is attributed to an American physician Andrew Taylor Still. In 1874 he established a system of manipulative treatment, which he called Osteopathy. In 1893 he founded the first Osteopathic College in Kirkville, Missouri. Unhappy with the way other doctors prescribed the medicines of the day to excess, Still sought more holistic approaches. He rejected the idea that germs alone cause disease but that diseases where more common when bones moved out of place and disrupted the flow of blood or the flow of nervous impulses making the body more susceptible to disease. He therefore concluded that one could cure diseases by manipulating to restore the interrupted flow. Observing that the human body had much in common with the machines he worked on in earlier life, Still approached the study of the human body as one would approach the study of a machine. Over time and with his study of medicine he developed a series of specialised physical treatments for which he coined the name ‘Osteopathy’.
In September 1895 Daniel David Palmer, a magnetic and spiritual healer said that he manipulated the forth or fifth dorsal vertebra in the upper back of a Negro janitor Harvey Lillard and claimed to restore his hearing fully after 17 years of deafness. D. D. Palmer is attributed to be the founder of modern chiropractic establishing the first chiropractic colleges in Davenport, Iowa in 1897. One of his first patients was a Greek scholar, Reverend Samuel Weed. Palmer asked him was there a Greek word meaning ‘done by hand’. Reverend Weed offered a combination of two Greek words PRACTKOS (to practise) and CHEIRO (by hand), hence the name Chiropractic was coined.
Daniel David Palmer
In Australia Chiropractors like Osteopaths undergo a five year masters degree to be eligible to be registered allied health care practitioners. Likewise Chiropractors are registered with every state registration board. Two broad groups of Chiropractors exist commonly known as ‘straights’ and ‘mixers’. Straight Chiropractors only manipulate the spinal joints without any soft tissue work, whereas Mixers, mix in peripheral joint and muscle work and many practise similarly to Osteopaths. Therefore mainstream Chiropractic is more a system of joint release only while Mixers and Osteopathy addresses the supportive joint ligaments, muscles and tendons.
The Birthplace 40,000 years ago in India
It was long believed that the birthplace of medicine was China but the dicovery in 1991 of Otzi the ‘Iceman’ mummified for 5,300 years in the Schnalstal glacier, a late Neolithic glacier in the Otzal or Italian Alps near the Austrian border changed the origins to India. Medical knowledge and techniques followed the spice routes from India to Tibet, then China and Japan, and later also to Eygpt, Greece, then Rome. Otzi had several tattoos on both sides of his lumbar spine, both ankles and one behind his right knee, all corresponding to x-ray evidence of strain induced degeneration in all of these area. These are thought to be acupressure or acupuncture points pre-dating the known such use in China (c 1000 BC) by 2,000 years. Similarly humans were not thought to have discovered copper (used in his axe) for another 1000 years forcing archaeologists to re-date the copper age as well as the birthplace of medical knowledge.
The oldest system of naturopathy is now considered to be from the Indian subcontinent known as Ayurveda. AYUR means life, and VEDA means science. The four aspects of life are the soul (atma), the mind (manas), the 5 senses (indriya) and the body (sharira). Ayurveda has an oral tradition dating back more than 40,000 years and a written tradition dating 5,000 years. The Ayuverdic model links the microcosm of the individual with the cosmos. At the heart of the system are three primal forces: prana, the breath of life; agni, the spirit of light or fire; and soma, a manifestation of harmony, cohesiveness and love.
The science is based on five elements comprising all matter: Ether (a nebulous nothingness that fills space), Air, Fire, Water, and Earth. An interplay of these five elements give rise to to three humours(wind, fire or bile, and phlegm) referred to as doshas and are the functional intellegences within the body derived from physiological actions: vata,(a combination of space and air), concerned with movement, transport, communication, and emotions: pitta (from air, fire and water), associated with digestion, conversion, hormone and enzyme activity and intellect; and kapha (from water and earth), aligned with structure, cohesion, liquidity and anabolism.
Three phases of activity (the gunas) are considered to govern existence: sattwa is inspiration, rajas is implementation and tamas is completion. Imbalances in the gunas can lead to ill health, likewise ill health can lead to imbalance in the gunas.The five universal elements are converted by agni, the digestive fire into the three humours, which influence individual health and temperament and are considered the wastes of digestion and metabolism. If digestion were perfect there would be no humoral imbalance, but because it is not, imbalance and ill health can follow. Air and Ether yield vata (wind), fire produces the humour pitta (fire or bile), while earth and water combine to give kapha (phlegm). Boby types (prakruti) are based on the doshic characteristics and can be single monodoshic, any combination of two bidoshic or all three being tridoshic.
The dominant humour is seen as controlling the character of the individual: Galen’s melancholic personality roughly conforms to a vata-type, his choleric personality matches the pitta -type and his phlegmatic personality is reminiscent of kapha-type. Food, drink, sensual gratification, light, fresh air, exercise and spiritual activities are used to fuel the digestive fire and produce the correct mix of humours, as well in Ayurveda 80% of disease is considered to arise from the mind as a “mistake of the intellect” (pragya aparadha). Ayurvedic medicine emphasizes a holistic approach, correcting the whole person with appropriate remedies for the mind, body and spirit. This can include meditation, exercise, or herbs that are focused at some particular imbalance. Problems of the heart, for example, are considered as much a spiritual issue as pathology since the heart is the seat of the atman or divine self. Suitable heart tonic herbs such as arjuna would be combined with remedies sandalwood oil that would calm and uplift the spirits and encourage joy. Ayurveda describes interconnected energy centres of the body (the chakras) like the Chinese acupuncture meridians. Ayurveda like Traditional Chinese Medicine stresses the need to strengthen these energy centres. They can be stimulated by applying particular herbs to the energy points or by taking other herbs orally. Modern medicine now link the chakras to various organs and glands in like manner that acupuncture has been scientifically validated.
Ayurvedic Pulse Diagnosis
Ayurvedic Medicinal Herbs
The essential energy of the body(ojas, like the Chinese qi ) can be strengthened with tonic herbs such as ashwagandha, shatavari or guduchi. Like the Chinese wei qi, ojas is associated with the immune system and herbs to strengthen it tend to be immunostimulants. Ayurveda describes weak digestion as a major cause of illness in that semi-digested material is actually toxic (ama) which causes imbalance leading to disease. Lifestyle factors that modern natural therapists are now fully appreciating are described by Ayurveda and include: constant physical, emotional or mental stress, life/work imbalance, frequent travelling, excess alcohol, drinking iced drinks often especially before or during meals,skipping meals, eating on the run, eating irregularly, overeating, eating before the previous meal is completely digested, imbalanced diet (eating too regularly light dry vatagenic foods, spicy,pungent, hot, sour pittagenic foods or sweat, heavy, oily kaphagenic foods). The prolonged effect of leads to a breakdown in our bodily systems(allergies, inflammation, fatigue, neurological dysfunction and cancer), and the six stages of disease described by Ayurveda: accumulation, aggravation, migration, localisation, manifestation and finally disruption. It is in these last two stages that western medicine tries to intervene but treatment is much harder and less effective by this stage. Ayurveda is very much a lifestyle, balancing and preventative healing system true to its name: life science.
Ayurvedic Theories Migrate to China via the Spice Route 2500 BC
Traditional Chinese Medicine (TCM) can be traced back to around 2500 BC. Traditionally its origins are shrouded in myth but today it is considered to be an adaptation of Ayurveda having been introduced to China via the spice route. TCM is similarly based on five elements, three being the same Earth, Water and Fire but the other two replaced by Wood and Metal.
Complementing the basic model of the five elements is the Chinese theory of opposites, yinand yang. According to this, everything in the cosmos both contains and is balanced by its own polar opposite. Yin is seen to be female, dark and cold, while yang is characterized as male, light and hot. In TCM yin and yang need to be in balance to maintain health and many ills can be attributed to a deficiency or excess of either factor. Different parts of the body are also described as predominantly yin or yang: the body fluids and blood are mainly yin, for example, while qi (like the Ayuverdic ojas), the vital energy, tends to be yang. Qi is regarded as flowing in a network of channels, or meridians through the body (like the Ayuverdicchakras) and can be stimulated using acupuncture. These meridians date back more than 5,000 years as seen by tattoos on the frozen body found in the Alps seemingly trapped in an avalanche while following the spice route. By the 19th century Western mission hospitals had begun to represent a real alternative to TCM and only survived when Mao Tse-tung founded five colleges of TCM in the 1960’s as a national standard medical system. In more recent times research has validated TCM and the system is continuously being incorporated in natural therapies.
Further Migration of Theories to Egypt then Greece then Rome 400 BC
The origins of Western Herbalism are found on Egyptian papyri dating back 1700 BC recording that many common herbs such as garlic and juniper have been used medicinally for 4,000 years. Hemp was used for eye problems just as it may be prescribed for glaucoma today, while poppy extracts were used to quieten crying children. By the time of Hippocrates (468-377 BC), European herbal tradition had already absorbed ideas from Assyria and India, with Eastern herbs such as basil and ginger among the most highly prized and the the theory of humours and essential body fluids had begun to be formulated. The Greek model appears to be yet another adaptation of the Ayurvedic five elements but comprising only four elements, dispensing with ether and retaining air, fire, water and earth, relating to the four seasons: spring, summer, autumn and winter and to four fundamental qualities: hot, dry, cold and damp, to four bodily fluids: blood, yellow bile, black bile and phlegm, and to four temperaments:sanguine, choleric, melancholic and phlegmatic. Hippocrates categorized all foods and herbs in this way as hot, dry, cold or damp, and good health was maintained by keeping them in balance, as well as taking plenty of exercise and fresh air.
The Greek physician Pedanius Diosorides mentions about 400 herbs in his classic text De Materia Medica around 60 AD and this remained the standard textbook for a century and a half with many of the actions of herbs described being familiar today. The Greek theories of medicine reached Rome around 100 BC but with the passing of time they became more mechanistic, portraying the body as a machine to be actively repaired, rather than following the Hippocratic dictum to assist diseases to cure themselves until Claudius Galenus ( 131-199 AD), who was born in Pergamon in Asia Minor and became a court physician to the Emperor Marcus Aurelius, reworked many of the old Hippocratic ideas and formalized the theory of humours. His texts soon became the standard medical texts not only of Rome but also of later Arab and medieval physicians.
The Centre of Medicine moves to Persia throughout the Dark Ages
With the fall of Rome in the fifth century AD, the centre of classical learning shifted east and the study of Galenical medicine was focused in Constantinople and Persia.Galenism was adopted with enthusiasm by the Arab world and merged with folk medicine and surviving Egyptian learning. It was this mixture of herbal ideas, practice and traditions that was re-imported back into Europe with the invading Arab armies. Probably the most important text of the time was the Kitab al-Qanun (Canon of Medicine) by Avicenna, firmly based on Galenical principles. By the 12th century it had been translated into Latin and following the Dark Ages when European herbal traditions were greatly submerged, and was imported back into the West to become one of the leading textbooks in Western medical schools.
Re-emergence of European Herbalism in the Middle Ages
Throughout the Middle Ages the church played a significant role in preventing herbal traditions from being completely submerged following the fall of Rome and the Barbarian insurgence. The Barbarian herbal healing traditions were added to Roman practices and was spread with Christianity. Although medical schools spread through Europe (the most famous at salerno was founded in the early 10th century and taught the Hippocratic principles of good diet, exercise and fresh air), healing and herbalism were mainly in the hands of the church. It wasn’t until 500 years later that herbal healing emerged from the Dark Ages and emphasis was gradually again given to the healing skills and principles once taught at the Salerno school.
By the 1530’s Paracelsus born near Zurich in 1493 was revolutionizing European attitudes to healing by returning to simpler herbal medicines and rejected the then popular, complex and often lethal purgatives and emetics prescribed by physicians and apothecaries. Paracelsus lectured in German rather than Latin taking power away from the select few physicians making herbalism available to the public.
In a similar manner William Turner wrote in English so that both apothecaries and “herb wives” that gather herbs could understand. Following Turner, Nicholas Culpeper (1616-54), translated the Pharmacopoeia into English for ordinary people could gather herbs in the fields instead of paying expensive apothecaries and earning the wrath of the newly formed College of Physicians. It is at this time that healing split taking two directions.
Physicians and apothecaries prescribed expensive and complex nostrums often using heroic doses of mercury and antimony , while “herb wives” continued with traditional herbal principles of good diet including medicinal herbs, exercise and fresh air. Battle between physicians, apothecaries and herbalists raged through the 17th and 18th century as medicine came under the control of university trained academic physicians. Throughout this time, separately, the fundamental traditions of herbal healing continued and were added to by great texts such as Gerard (1597), Parkinson (1640) and Culpeper (1653) incorporating numerous new herbs from the East Indies and North America. It is only now, in our time that we are seeing these two groups, the physicians and the herbalists slowly come back together.
The North and South American Influence
European settlers arriving in North America brought with them their familiar healing herbs but before land battles with the plains tribes practically decimated the indigenous population the early pioneers shared much of their herbal lore together and adopted Native American herbs such as golden seal, skullcap, boneset, pleurisy root and purple cornflower (echinacea) to mention a few.
Samual Thompson born in New Hampshire in 1769, after his mother died after being badly attended to by orthodox treatment, founded the Physiomedical movement with the principle that it is possible to strengthen the body’s vital force by keeping both tissues and nervous state in balance.Thompson incorporated North American herbal lore and their use of sauna-like sweat houses, with the key therapeutic treatment involving relaxing or astringing tissues, and then stimulating or sedating nerves with herbs classified as stimulating or sedating, relaxing or astringing to achieve this balance. Following Thompson’s Physiomedical movement were other botanic systems such as the Eclectic school founded by Dr Wooster Beech in the 1830’s which grew to claim more than 20,000 qualified practitioners in the United States combining herbal remedies and Native American healing practices with orthodox medicine.
These two movements were re-introduced back to Europe, Thompsonian Physiomedicalism to Britain in 1838 by Dr Albert Isaiah Coffin, and Eclecticism by Dr Wooster Beech himself in the 1850’s, both movements preaching do-it-yourself guides and remedies which took hold especially in working-class areas. In 1864, they merged with other groups to form the National Association of Medicinal Herbalists that continues today as the National Institute of Medicinal Herbalists.
Herbs in Modern Medicine- from Plants to Pills
It is well to remember that the first drug to be manufactured was aspirin in 1899 by Bayer. Prior to that medical doctors had a more diverse role than today, dispensing herbal remedies and other plant drugs such as foxglove (1785) and morphine (1803), mineral drugs including large doses of heavy metals, as well as tending, cuts and abrasions, stitching wounds, setting broken bones and performing manipulations until then referred to as ‘bonesetting’. In 1775 Dr William Withering, a physician started experimenting with foxglove after a patient recovered from dropsy caused by heart failure after taking a herbal remedy. In 1785 he published “Account of the Foxglove and Some of its Medical Uses”. Withering found that the therapeutic dose was very close to the level at which toxic side effects develop including death.
Today foxglove is the major constituent of one of the largest selling heart drugs in the world. Simularly, in 1803 Friedrich Serturner in Germany extracted crystals from opium poppy known as morphine. Similar techniques soon produced aconitine from monkshood, emitine from ipecacuanha, atropine from deadly nightshade (Solanacae plant family), salicin from willow bark, and quinine from Peruvian bark. All of these compounds, categorised as alkaloids, are extremely potent, and could only be obtained from plants until scientist were able to synthesize them. In 1852 salicin, one of the active ingredients of willow bark was first artificially synthesized, a breakthrough that was, over the next 150 years, to revolutionize our approach to healthcare, from a preventative Hippocratic model to a model of attacking the symptoms of disease, and ‘kill off the bugs with drugs’ model.
In 1899 Bayer launched aspirin, a less stomach irritant form of salicin and thus commenced, for better or worse, the drug revolution we know today. New drugs based on plant compounds or phytonutrients soon followed. Ephidrine from the Chinese herb ma huang for treating chest complaints including asthma, vincristine from periwinkle for leukaemia, pilocarpine from jaborandi for glaucoma, and reserpine an alkaloid from snake for hypertension to mention a few. These synthasized drugs are based on a single plant compound and often have severe side effects not found in the whole herb due to the modulating effect of the symphony of other plant compounds. Snake root for example has been used in Ayurvedic medicine for 40,000 years for snake bite, anxiety, hypertension, headaches, fevers and abdominal pains.
The synthesized drug reserpine prescribed for hypertension as is the herb snakeroot, but which also caused the side effects of severe depression and slowing of the heart beat not encounted with the whole herb. The six stages of disease described by Ayurveda: accumulation, aggravation, migration, localisation, manifestation and finally disruption, where preventative intervention of Ayurveda is aimed at the early stages of disease progression, seems to be more a logical and effective approach, as opposed to the Western model of treating disease in the final stages of manifestation and disruption with powerful drugs. That is not to say that the two approaches are mutually exclusive, quite the contrary, because we need both to co-exist, side by side, in a complimentary way so as to avail mankind to the tremendous advances in modern science in treating such things as trauma victims, hereditary diseases and killer infections such as aids, bird flu, swine flu, equine flu, small pox, malaria and tuberculosis to name a few. The old adage “a ounce of prevention is worth a pound of cure” should be well remembered.