Naturopathy

The German natural healing movement

A historian at Wonkwang University dates the beginning of the German natural healing movement to the early nineteenth century. The movement was ideologically based on naturalism and was critical of industrialization and urbanization, and its varied theories shared holism and vitalism as common features. Hydrotherapy spread through the work of some physicians and of lay healers such as Johann Siegmund Hahn and Vincenz Priessnitz, and its supporters later gathered under the German Society of Naturopathy.

In the late nineteenth and early twentieth centuries the movement merged into the Lebensreform (life reform) movement, which campaigned for temperance, against tobacco and against vaccination. Its central idea, as the same study describes it, was respect for nature and recognition of what adherents saw as the restorative powers of sunlight, air and water.

Sebastian Kneipp

Sebastian Kneipp (1821 to 1897) was a Catholic priest who served at Wörishofen for 42 years from 1855 and practiced hydrotherapy there. His approach rested on five tenets: hydrotherapy, exercise, nutrition, herbalism and the balance of mind and body. Unlike some other proponents of natural therapies, he did not refuse vaccination or medication, and he sought recognition by working with physicians who supported his methods.

A 2014 historical article describes Kneipp as a link between the European natural healing movement of the nineteenth century and American naturopathy. It notes that Kneipp associations, postgraduate qualifications in his methods and more than 60 accredited Kneipp spas and health resorts in Germany continue his approach today.

Founding and codification in the United States

An account by two naturopathic educators states that naturopathy was founded in the United States in 1901 by Benedict Lust, working with other early leaders, and that his journals, including the Naturopath and Herald of Health, are key historical sources. The sources reviewed for this draft do not give a detailed account of Lust's training or his schools.

The same account describes a three-year effort by a select committee of the American Association of Naturopathic Physicians (AANP) that ended in 1989, when the association's House of Delegates unanimously adopted a consensus definition of naturopathic medicine together with six principles.

Naturopathy, naturopathic medicine and Naturheilkunde

Researchers in an international practice study describe naturopathy as a distinct system of traditional and complementary medicine that is defined by its philosophical approach to patient care rather than by the treatments practitioners use. The English terms naturopathy and naturopathic medicine are used for this system, while the German word Naturheilkunde names the older natural healing tradition.

The label covers different kinds of practitioner. A 2019 review notes that practitioners range from self-identified naturopaths in North America to Heilpraktiker in Germany, and to German medical doctors who specialize in naturopathic methods. The same word can therefore describe very different training and practice.

Traditional European Naturopathy

Swiss authors use the term Traditional European Naturopathy (TEN) for the European strand and set it alongside Traditional Chinese Medicine as a medical system with its own concepts. One example they examine is the tonic, which they define as an agent believed to restore or maintain the functioning of an organ system and to produce a sense of well-being, while noting that no exact pharmacological properties of tonics can be given.

Kneipp therapy is often treated as one named form within this strand. A 2014 historical article lists its pillars as hydrotherapy, herbal medicine, exercise, balanced nutrition and what it calls regulative therapy, and a 2023 review describes Kneipp hydrotherapy as characterized by cold water applications.

Principles named by the profession

The six principles adopted by the AANP in 1989 are usually given in Latin and English: the healing power of nature (vis medicatrix naturae), identify and treat the causes (tolle causam), first do no harm (primum non nocere), doctor as teacher (docere), treat the whole person (tolle totum) and prevention. These are statements of professional philosophy and are not findings about how the body works.

Practitioner traditions across countries

A survey of 65 naturopathic organizations in 29 countries, carried out between 2016 and 2019, found that most education programs (68 percent) were delivered through a national framework and that higher education qualifications predominated (60 percent). Professional associations influenced education in 75.4 percent of responses. The authors describe naturopathic education worldwide as highly heterogeneous. Two of the authors are affiliated with the World Naturopathic Federation, a professional body.

In North America the title naturopathic doctor is used; in one Canadian trial led from the Canadian College of Naturopathic Medicine, care was delivered by licensed naturopathic doctors. In Germany, a study of 165 Heilpraktiker schools reported that the qualifying examination tests conventional medical knowledge, that few schools taught complementary methods, and that 83.0 percent of schools did not meet the education requirements set out by Heilpraktiker associations.

What a consultation may involve

In a study of 851 consecutive cases recorded by 56 naturopaths in 14 countries, the most common treatments prescribed or recommended were dietary changes (60.5 percent of cases), lifestyle and behavior changes (56.9 percent), herbal medicines (54.2 percent) and nutritional supplements (52.1 percent). Practitioners knew that 43.2 percent of patients were also seeing a general practitioner and 27.8 percent a medical specialist.

In one Canadian trial, care consisted of individualized health promotion counseling, nutritional medicine or dietary supplements, delivered at seven preset visits in work-site clinics over a year. Kneipp hydrotherapy, by contrast, is characterized by applications of cold water.

Residential programs in India

In India, naturopathy is commonly combined with yoga in residential settings. A 2019 review found that all seven Indian studies it included were inpatient programs of 15 to 30 days in naturopathic hospitals or research institutes, with yoga practiced up to four times a day and a vegetarian diet that often included fasting. A report from one Indian hospital lists hydrotherapy, fasting, sun exposure, mud therapy, enemas, heat treatments, acupuncture and massage among the methods used.

Conditions seen in practice

In the 14-country practice study, practitioners judged that 75 percent of patients had chronic conditions. The most frequent categories were musculoskeletal (18.5 percent), gastrointestinal (12.2 percent) and mental health conditions (11.0 percent). These figures describe why people consulted, not whether the care helped them.

A German study compared 567 patients of Heilpraktiker and of general practitioners. Musculoskeletal problems were the most common reason for attending in all groups (30.2 to 31.1 percent). Heilpraktiker patients more often reported psychological problems and symptoms lasting longer than five years than patients of general practitioners who used little complementary medicine.

How common consultation is

A 2022 systematic review and meta-analysis of 14 population studies estimated that the share of people who had consulted a naturopathic practitioner in the previous 12 months ranged from 1 percent in the World Health Organization Region of the Americas to 6 percent in the European and Western Pacific Regions. The authors report that naturopaths practice in at least 98 countries.

Claims made for the whole system

Authors based at a naturopathic research center concluded in 2019 that whole-system naturopathic care is effective for cardiovascular disease, musculoskeletal pain, type 2 diabetes, polycystic ovary syndrome, depression, anxiety and a range of complex chronic conditions. This is the authors' own interpretation of a mixed body of studies, and the limits of that evidence are set out in the next section.

Reviews of whole-practice research

A 2019 systematic scoping review searched for studies in which naturopathic clinicians delivered two or more naturopathic methods. It included 33 studies with 9,859 participants: 11 randomized controlled trials, 12 prospective and 8 retrospective cohort studies, and 2 case series, from the United States, Canada, Germany, India, Australia, the United Kingdom and Japan.

The reviewers rated the trials as at risk of bias for blinding of participants and personnel and at moderate risk for allocation concealment. Only 4 of 12 prospective and 1 of 8 retrospective studies had comparison groups, clinical heterogeneity was substantial, and the authors noted concern about publication bias because almost all studies were positive. The review did not report on adverse events.

A pragmatic trial in cardiovascular prevention

A Canadian multisite trial randomized 246 postal workers aged 25 to 65 with raised cardiovascular risk to enhanced usual care or enhanced usual care plus naturopathic care. Of these, 207 completed the study. At 52 weeks, the adjusted 10-year cardiovascular risk score was 7.74 percent in the naturopathic group and 10.81 percent in the control group, and metabolic syndrome was less frequent (31.58 versus 48.48 percent).

The outcome was a calculated risk score rather than actual heart attacks or strokes, follow-up lasted one year, and participants and practitioners knew which care was given. The trial tested added counseling and supplements in one workforce and does not show that other naturopathic methods have similar effects.

Kneipp hydrotherapy

A 2023 systematic review of randomized trials of Kneipp hydrotherapy included 20 trials with 4,247 participants. Of 132 comparisons, 46 favored hydrotherapy, on outcomes including chronic venous insufficiency, menopausal symptoms, fever, cognition, emotional function and sick leave, while 81 showed no difference and 5 favored the control group. Risk of bias was unclear in most domains, heterogeneity prevented meta-analysis, and only half of the trials reported on safety.

Herbal products and prescribed drugs

Herbal medicines and supplements are recommended in about half of naturopathic cases, and many patients also receive care from physicians. An overview of 46 systematic reviews found that most herbal medicinal products studied were not linked to severe interactions, but serious interactions were reported for St John's wort and mistletoe, and moderately severe ones for ginkgo, ginseng, kava, saw palmetto and green tea. Anticoagulant and antiplatelet drugs were the most common interacting medicines, and the poor quality of the primary data prevented firm conclusions.

Delayed care, training and treatment harms

German authors who analyzed Heilpraktiker schools argued that gaps in training carry risks of physical harm, delay of necessary treatment and interactions with conventional drugs. This is the authors' assessment based on curricula, not a measured rate of harm.

A report from one accredited Indian yoga and naturopathy hospital recorded 22 adverse events, 5 treatment errors and 5 near misses among 27,237 patients between April 2020 and August 2022. Burns were the most common, followed by allergic reactions to massage oils, fainting, giddiness and vomiting. A person considering naturopathic care alongside a diagnosed condition may need it coordinated with their physician, and it is not a replacement for necessary medical assessment or treatment.

Vaccination

Critical views of vaccination have a long history in the wider movement: the Lebensreform movement campaigned against it, although Kneipp himself did not refuse vaccination. A 2020 analysis of academic literature and Canadian organizational webpages found diverging views among naturopaths, chiropractors and homeopaths, and concluded that their literature cannot be described simply as for or against vaccination.

In a survey of 404 parents at Arizona elementary schools with high vaccine exemption rates, parents who had obtained exemptions were more likely than others to get their health care from a naturopath. This is an association from one setting and does not show that naturopaths caused the exemptions.