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The basis of any complementary therapy should be the recommendation of a healthy lifestyle (diet, nutrition, exercise, stress-reduction), and appropriate self-help techniques (e. g. thermotherapy, herbal OTC-products) aimed at releasing the patients' most debilitating symptoms. For therapy-resistant or strong symptoms, more invasive interventions or medical treatments with an acceptable evidence base can be used (e. g. acupuncture for cancer pain, herbal prescriptions). The effects of any complementary intervention should be controlled for a period of six weeks after its administration. Patients should be advised not to use products or methods with possibly harmful side effects or negative interactions with conventional medications., Competing Interests: Disclosure The authors report no conflicts of interest in this work., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background and Objective: The assessment of the tongue is a crucial diagnostic tool of traditional Chinese medicine. In a series of studies we aimed to investigate to what extent independent raters agree in the description of morphological tongue characteristics., Methods: In two pilot studies (n = 15 each) and one larger study (n= 101) two to three physicians experienced in traditional Chinese medicine assessed morphological characteristics in digital photos of tongues by use of a rating form and under blind conditions. The primary outcome measure was agreement beyond chance (Cohen's kappa)., Results: Kappa values varied strongly in the first pilot study(-0.15 to 0.76) and for many items, agreement was weak or moderate. In the second pilot study which used improved methods kappa values still varied considerably(-0.10 to 1.00), but for 7 out of the 18 items assessed there was an excellent agreement (kappa > or =0.75). In the confirmatory study, kappa values ranged between 0.15 and 0.83., Discussion: The performed studies have to be seen as a first attempt to develop adequate methods in order to systematically investigate the reliability of traditional Chinese tongue diagnostics. The study findings suggest that the description of morphological characteristics within traditional Chinese tongue diagnostics has acceptable reliability., (Copyright (c) 2009 S. Karger AG, Basel.)

Objective: To present a patient care evaluation program exemplified by a rehabilitation clinic for complementary and alternative medicine(CAM) with emphasis on the description of patients and the outcome quality of the facility., Methods: Prospective cohort study on all patients admitted to the hospital over a period of 2 years; physician's questionnaire to assess basic medical data, and patients'questionnaires at admission and at discharge from hospital completed by 3 follow-up queries (at 2, 6, and 12 months after discharge)to assess severity of complaints, health related quality of life, health behavior, demand of medical services, days off work,and patient satisfaction. At the beginning of the intervention, sociodemographic status, basic medical data, experience with CAM and expectations with regard to treatment success were documented., Results: 5,278 patients (83% female, age 54.7+/-11.6 years)with diagnoses mainly out of the domains 'Chronic fatigue' (36.8%), 'Chronic back pain' (19.5%) and 'Chronic headache' (11.9%) were included into the analysis (follow-up return rate 80.6% after 6 months, 73.6% after 12 months). Complaints had persisted for 6 years (median). The intensity of the main complaint decreased from 59+/-25 by an average of 25 points at discharge (19 points at 6-month follow-up) corresponding to an effect size of 0.86 (0.62 at 6-month follow-up). At 6-month follow-up about half of the patients showed a clinically relevant improvement of quality of life (SF-36 sum scores increased by >or=5 points). Intake of drugs was reduced,the number of days off work had decreased after rehabilitation. Patients' satisfaction was 'good' on average, with respect to food satisfaction it was lower. A subgroup analysis regarding the principal diagnosis revealed different emphases in outcome profiles., Conclusions: The patients profile underlines the need of inpatient rehabilitative treatment resembling other patients in CAM care. The outcome profile proved by a representative sample that the majority of patients benefited from rehabilitation with respect to various outcome dimensions at that this benefit still persisted after 6-12 months.

Objective: To present a patient care evaluation program exemplified by a rehabilitation clinic for complementary and alternative medicine (CAM) with focus on aspects of structure quality, steps of quality assurance and interventions administered., Methods: Assessment of previously defined criteria of structure (general characteristics of the facility, staff, medical equipment and constructional features, medical concept, continuing care, internal communication) and measures of quality assurance with the aid of a questionnaire filled in by the management of the hospital. Development of internal guidelines for diagnostics and therapy with respect to relevant diseases., Results: The clinic's structure profile describes the indications and contraindications in effect, the quantity and qualification structure of staff, and the constructional and medical equipment details. Based on a multidimensional bio-psycho-social concept the general objectives of rehabilitation are derived. According to the medical concept the corresponding diagnostic and therapeutic methods are presented. Guidelines for treatment were exemplified by patients with migraine., Conclusion: The structural features do not fully meet the preconditions valid for the various indications in rehabilitation. As CAM hospitals define themselves by the methods of intervention they apply rather than by the indications to be treated they demand for an exceptional position.

This paper describes the concept and realization of a nation-wide observational study which is part of the patient care evaluation programme on acupuncture as part of a model project of German statutory insurance bodies. The study aimed describing medical care with acupuncture to estimate the incidence of adverse reactions as well as the treatment effects of acupuncture in chronically ill patients with headache, low back pain or osteoarthritic pain. It was also intended to analyse relations between treatment effects and specialties of the treating acupuncturists. During the two-year period of report 9,918 acupuncturists took part in the study documenting 503,397 cases. A more comprehensive documentation is available for a sample of 10,366 patients with complete longitudinal data of 6,140 patients. The difficulties with data management and sampling technique are presented with reference to restricted capacities for monitoring. Furthermore the question of generalising of the results is discussed. There were differences in some respects (for example, frequencies of different indications) between the patient sample and the population of all patients included in the project. Patients also differed slightly with respect to the completeness of the longitudinal documentation. The results indicated that we cannot claim global representativeness for the sample-based findings, but there is no reason to assume a "positive" selection.

Background: The German term 'Ordnungstherapie' is one of the five therapeutics which defines naturopathy in German-speaking countries., Objective: Who formed the term Ordnungstherapie in naturopathy and what does it mean?, Material and Methods: Heuristics and criticism of literature of the 20th century as well as database research., Results: Nowadays in German-language medical books Ordnungstherpie belongs to the five therapeutics which define European naturopathy. Yet, the interpretation ranges from health education to body-orientated forms of psychotherapy. The term Ordnungstherapie is often related with the German priest and hydropath Sebastian Kneipp, however, term and definition have been founded by the Swiss physician Maximillian Bircher-Benner. In 1937 he defined Ordnungstherapie as a complex concept of natural healing. It is based upon the rather nosological idea that health is order/harmony in the human body (physically, psychologically), the environment and the daily course. Illness occurs if disorder appears in one of these fields. The therapeutic setting of Ordnungstherapy is defined by 9 rules of conduct to maintain order, which include nutrition, the skin as an organ (exposure to light, air, water), breathing, movement, rhythm of life, and psyche. For all these aspects Bircher-Benner himself uses the terms somatotherapy (dietotherapy, sun and light therapy, hydrotherapy, exercise therapy, breathing technique, order of the rhythm of live) and psychotherapy. He chose these complementary methods subjectively after learning them from 1897 onwards in an eclectic manner and after gaining therapeutic empiricism. Nevertheless his ideas of the Ordnungstherapie correlate with the socio-political context of the 1940ies., Conclusions: The term Ordnungstherapie was introduced by Bircher-Benner as an umbrella term in 1937 to describe a complex concept of naturopathic therapies. It comprises, with certain limitations for phytotherapy, the therapies which nowadays define European naturopathy. Yet, in European naturopathy today Ordnungstherapie is mostly considered as one out of 5 constituents of naturopathy (dietotherapy, hydrotherapy, exercise therapy, phytotherapy, Ordnungstherapie). The classification of Ordnungstherapie as one of the 5 pillars of the Kneipp therapy was only done by Kneipp physicians in the middle of the 20th century and needs to be thought over.

Background: Fasting followed by vegetarian diet has shown to be an effective treatment for rheumatoid arthritis, moreover fasting is frequently used as an adjunctive treatment in chronic pain and stress/exhaustion syndromes. Data on well-being and the frequency of side effects during fasting are mostly retrospective. Mineral supplements are frequently used in order to compensate for fasting-induced tissue acidosis and to reduce side effects. There are only limited data that support this practice., Objective: To study the effects of oral mineral supplements on common side effects and well-being during short-term fasting., Patients and Methods: 209 consecutive inpatients with chronic pain/exhaustion syndromes were recruited. In a controlled non-randomised study design all patients underwent fasting (250 kcal; 3 l fluid intake/day) over 7 days, in study phase 1 without (n = 103) and in study phase 2 with (n = 106) concomitant prescription of standardised oral mineral supplements (3 x 2 to 3 x 3 Bullrich's Vital). Weight, blood pressure and urinary pH were recorded daily. Well-being and mood as well as common side effects (i.e. fatigue, hunger, heart burn, headache) were assessed with standardised self-reports., Results: Baseline characteristics of the 209 patients (mean age 54.7 +/- 10.5 years; 83.3% female) were balanced. Both groups showed a fasting-induced decrease of blood pressure, a slight decrease in mood and well-being on days 3 and 4 with consecutive increase and moderate hunger, i.e. in the evening. Side effects and general tolerability of fasting as well as well-being and mood were not different between the groups. There were no serious side effects in both groups., Conclusions: Short-term fasting in inpatients with pain and stress syndromes is safe and well tolerated, concomitant mineral supplements have no additive benefit., (Copyright 2002 S. Karger GmbH, Freiburg)

"Medical Monitoring" is a software produced for everyday medical practice in order to document data of history, physical and functional status, interventions and outcomes. The electronic patient record has been developed for research purpose within a network of hospitals and primary care physicians specialized in integrative medicine. It should help to realize a comprehensive documentation-system for long-term observations of patients concerning effectiveness, cost, risk and safety. Important components of the program are: a) health record for routine documentation in medicine and nursing b) tools for formal assessment in special indications c) user-support in service and decision-making d) user-support for advising and teaching patients in self-treatment and lifestyle-techniques e) archive-function for diverse findings f) tools for quality assurance g) tools for reimbursement and billing.

Aims: To describe characteristics of in-patients with chronic headache syndromes being treated with complementary methods, short-term effects at time of discharge as well as long-term effects covering a catamnesis of 1 year., Methods: The study was designed as a prospective cohort study with outcome measurements 2 months in advance of admission to the hospital, at admission, and at time of discharge, continued by follow-up queries 2, 6 and 12 months after discharge from the hospital. The parameters for describing the course of headache symptoms were registered by questionnaires and diaries. During the first 6 months in 1996, a total of 424 consecutive patients with migraine or tension-type headache at the 'Migräne-Klinik Königstein' were included., Results: 82.9% of the patients were women, the mean age was 46.3 +/-13.0 years. The median of the duration of the disease was 23 years. At discharge from the hospital there was a marked improvement regarding frequency of headache attacks, intensity of headaches, and concomitant symptoms. 60.5% of the patients were classified as 'responders'. 67.5% responded to follow-up questionnaires. With exception of the duration of headache attacks, a significant improvement regarding the 6-month follow- up compared to base level was observed. Intake of drugs could be diminished and quality of life was improved. Patients suffering from tension-type headache showed smaller effects in general., Conclusions: Taking into account the mean duration of disease of more than 20 years the results suggest a clinically relevant success from the patients' view regarding the short-term as well as the long-term course. The problem of data loss with follow-up queries and missing comparative data reduce the conclusiveness of the results., (Copyright 2001 S. Karger GmbH, Freiburg)

Consequences for Patient Care Medical science and education is dealing with illness, health and healing. But what is health? How does it work? It is a paradox that we know a lot about illness, but in general we do not know much about the effects how to become healthy, how to restore our health. Other sciences gave us more hints for the reasons that are summarized in this article. In order to take care for better circumstances in our social and medical system we should promote all ways to get better informed patients with a sense of responsibility and to give them the right of self-determination. Finally we are giving an example how to achieve patients well trained in conserving or in restoring their health: 'Strukturiertes Gesundheitstraining'., (Copyright 2001 S. Karger GmbH, Freiburg)

Objective of the concept "Quality Management and Research" is to evaluate and optimize Complementary Medicine (CM) within everyday-practice in a network of hospitals and practitioners. In a step by step-strategy the concept should give information about quality on the levels of structure, process and outcome for and about patients and providers. Therefore special profiles of quality should be determined. In a next step preinterventionally defined goals of therapies have to be proofed for being achieved at admission or at the end of the intervention. To enable decision-making for patients, physicians and insurance companies profiles of quality should be compared within the specialized network and/or with mainstream providers. Asking for high evidence it is necessary to conduct randomized controlled trials (RCTs). A main interest of the program is to integrate the concept into routine practice of the network and to build up a data-collection-centre at the university in order to improve the providing system and to create new tools for practice-based medical research.

Background: Measures of heart rate variability (HRV) are widely recognized as being an important indicator method for autonomical function and cardiovascular neural regulation. The low-frequency component in spectral analysis is increased during conditions of raised sympathetic activation, the high-frequency component is closely correlated with vagal activity. Whole-body infrared-A irradiation (WBIAI) according to von Ardenne is a newly developed version of hyperthermia. In clinical use peripheral vasodilatation with significant increases in heart rate and hypotension were noted as acute effects of WBIAI. In order to evaluate the effect of WBIAI on autonomic function, we measured HRV during serial hyperthermias., Patients and Methods: Power spectral density analysis of HRV during the first and the last of 4 serial WBIAI treatments with 30-60 min endurance was performed in 10 patients with chronic pain disorders. Tympanal body temperature was recorded continuously and was supposed to increase by 1 degrees C during treatment. Electrocardiographic monitoring was performed using a Marquette HoIter ECG. RR data were manually edited and standard frequency domain measures of the first and the last 5 min of treatment computed. The subjective efficacy of the treatment was rated by prestandardized interviews., Results: Body temperature increased by 0.9 degrees C during the first treatment and 1.2 degrees C during the last treatment. In all patients the rise in body temperature due to treatment was accompanied by a significant increase in heart rate and a decrease of arterial blood pressure. During hyperthermia a slight decrease of absolute low-frequency and total power as well as a sharp decrease of high-frequency power and a significant increase of the low/high-frequency ratio could be noted. The rise in low/high-frequency ratio during WBIAI was less distinct at the last treatment compared to the initial treatment. Hyperthermia was regarded as a safe, well-tolerable and effective treatment., Conclusion: The results suggest that the cardiovascular response during WBIAI is accompanied by significant changes in autonomic cardiac regulation: A significant decrease of low-frequency power corresponding to depressed vagal activity results in an increase of Iow/high-frequency ratio. During serial hyperthermias the acute response is diminished suggesting an adaption of the autonomic response to hyperthermia. Further studies are necessary to investigate the long-standing autonomic effects of the treatment and include analysis of influencing factors such as the level of physical activity and constitutional individual conditions.

Background and Objective: Whole-body infrared-A irradiation (WBIAI) according to Ardenne is a newly developed version of hyperthermia. In clinical use benefits for patients with chronic infections have been reported. In order to find out more about the immunological background of the method we studied the question whether hyperthermia leads to priming effects in human polymorphonuclear leukocytes (PMN)., Material and Methods: We therefore investigated the production of reactive oxygen radical species (ROS) measured by lucigenin-dependent chemiluminescence after stimulation with N-formylpeptide (FMLP, 10(-6) and 10(-7) M), C5a complement (10(-7) and 10(-8) M) or phorbolester (PMA, 10(-7) and 10(-8) M) in isolated PMN of 8 volunteers undergoding a 60-min hyperthermia treatment with the WBIAI. Blood was drawn 0/60/240/510 min after the start of hyperthermia treatment. In addition, we measured blood pressure, pulse, and temperature., Results: In 5 cases a significant increase in ROS (p < 0.05) could be measured beginning 240 min after start of hyperthermia and further increasing until the 510-min time point. These results suggest a priming effect in PMN lasting far beyond the actual treatment period. The increase of ROS production following stimulation with FMLP, C5a or PMA was 60.4 +/- 21.6, 86.0 +/- 23.3, and 63.3 +/- 15.9% (SEM), respectively. Moreover, in all probands the maximal ROS production in PMN was observed 510 min after the beginning of WBIAI treatment. In 3 cases no difference in ROS could be observed. There was no difference in temperature, blood pressure, and pulse between responders and nonresponders., Conclusions: Our results show a hyperthermia-dependent priming effect of ROS production in PMN, suggesting an increase in immune reaction within the observation period of 510 min. Further investigations are necessary in order to specify responders and nonresponders and to characterize the results in specific diseases and the constitutions of the patients.