The Seven Level Therapeutic Order
Level One – Establish the Conditions for Health
Address Determinants of Health (DOH): inborn, behavioral, social, cultural, environmental and spiritual, as health supporting and promoting factors or as disturbing factors (obstacles to cure). DOH are the “terrain” or the soil, from which healing, health or illness arises. Strengthen inborn factors, remove disturbing factors, and establish health promoting factors. “If one understands health to be the natural state and “disturbance” the original culprit, then identifying and reducing disturbance is the obvious first step, unless there is immediate danger to life or limb, in which case acting to reduce suffering and preserve life or limb is paramount. Generally refers to actions a patient undertakes themselves (vs. any form of medication) and actions people, groups or communities can enact through system change and advocacy. At this level the individual also takes self-responsibility for their well-being.
Level Two – Stimulate the Healing Power of Nature (vis medicatrix naturae) and Self-Healing Processes
Once the terrain is cleared of disturbing factors, inborn needs are supported and health promoting factors are in place, apply general stimulation to engage the global healing response - the self-healing mechanisms. The basis of this approach is recognition of the vis medicatrix naturae as both force and process, the tendency of the body and spirit to be self-healing, the wisdom and intelligence within the system that constantly tends toward the healthiest expression of function, and the healing “forces” in the natural environment (air, water, light, etc.). The body heals itself. The physician can help create the circumstances to promote this. Then, as necessary, the physician stimulates the system. In this regard, we apply agencies such as homeopathy, needling, hydrotherapy, physical medicine approaches, meditation, even exercise, that add nothing of substance, but move or stimulate the energy of the system. When appropriate supervised fasting is encouraged.
Level Three – Support and Balance Physiologic and Bioenergetic Systems
These strategies are used to restore optimal function to an biological, bioenergetic, physiological and mind-body systems (digestion, immune, cardiovascular, detoxification & emunctories, biofield, psychospiritual, endocrine, etc.). Some systems or functions require more than stimulation to improve. Some organs are weakened or damaged (e.g., adrenal fatigue after prolonged stress), and some systems are blocked or congested (e.g., hepatic detoxification pathways) and require extra help. Some systems are overactive and require soothing, while causative factors are identified and addressed. Following assessment, therapeutics involve specific diets, or nutritional, botanical medicine, physical medicine, or homeopathic preparations and counseling, strategies directed at specific organs, tissues and system functions to strengthen and nourish, or soothe them.
Level Four – Address or Correct Structural Integrity
Structural problems originate from and create stress upon internal systems. Structural misalignment may be related to underlying functional disturbances. Simple structural dis-integrity is corrected by physical therapies including simple manipulation, therapeutic massage, acupressure, Rolfing and other forms of tactile therapeutics. Usually the problem of structure is part of the larger problem, and such intervention becomes a fourth-order therapeutic approach. Manipulation, massage, exercise are central modalities. Some systems of exercise are designed to reintegrate and maintain normal structural relationships. Any of these might be appropriate to a specific patient. By approaching the problem in the context of the therapeutic order, one can expect structural corrections to be required only occasionally and for the results to be more or less permanent, if the underlying organic disturbance is corrected.
Level Five – Address Pathology using Specific Natural Substances or Modalities
Use of specific natural or physiologic (found in the body as isolated substances in the same form) substances against specific pathologic states or symptoms. Having gone through the first four steps of this therapeutic hierarchy, most patients improve. The improvement is based on the sound footing of the underlying correction or removal of fundamental causative elements. It is also based on the intrinsic nature of the body to heal itself by using the least possible force. Most pathology improves or disappears under these circumstances. Sometimes it is necessary to address pathology directly with specific therapeutic agents; directed at symptoms or the pathological state, which tends to be the starting point for biomedical treatment. Biochemical or genetic individuality also can demand an emphasis at this level of intervention.
Level Six – Address Pathology using Pharmaceutical or Synthetic Medicines
Use specific pharmaceutical or synthetically created medicines to manage specific symptoms, biochemical pathways or interactions. Pharmaceuticals tend to be “mono” substances. These substances are also not associated genomically or epigenetically with the evolution of the human organism in the broader ecosystem in which plants, animals and people co-develop. Compounds in plants and glandulars work with the human organism and therefore are considered a lower force and more general intervention than prescribed pharmaceutical substances, which are more specific in their interaction and more directive of biochemical pathways. Pharmaceutical substances are associated with a higher rate of adverse events, making this level of the intervention higher force. (Botanical preparations, nutritional supplements and glandular products may also have adverse effects, and can be toxic).
Level Seven – Suppress or Surgically Remove Pathology
Sometimes it is necessary when there is risk of harm to the patient’s health or tissue, or to relieve suffering, to suppress pathology. Conventional medical doctors are especially trained in this art and have powerful and effective tools with which to do this. Unfortunately, suppression, because it does not fundamentally remove or address essential causative factors (such as dietary error) often results in the development of other, often deeper disturbance or pathology. Because much pathologic expression is the result of the actual self-healing mechanisms (e.g., inflammation), suppressive measures, in general, work in opposition to the vis medicatrix naturae. The result of suppression is that the fundamental disturbing factors are still at play within the person, still disrupting function to some extent, whereas the suppression reduces the symptomatic expression and resolution of disturbance. Evidence-based surgical interventions can cure specific pathologies; though it can also exacerbate current and create new pathological conditions.