- Overview of Integrative, Complementary, and Alternative Medicine
- Types of Complementary and Alternative Medicine
- Acupuncture
- Ayurveda
- Biofeedback
- Chelation Therapy
- Chiropractic
- Cupping
- Diet Therapy
- Guided Imagery
- Homeopathy
- Hypnotherapy
- Magnets
- Massage Therapy
- Meditation
- Moxibustion
- Naturopathy
- Reflexology
- Reiki
- Relaxation Techniques
- Scraping
- Therapeutic Touch
- Traditional Chinese Medicine
Integrative medicine and health (IMH) and complementary and alternative medicine (CAM) include healing approaches and therapies that historically have not been included in conventional, mainstream Western medicine.
CAM is often thought of as medicine that is not based on the principles of mainstream Western medicine. However, this characterization is not strictly accurate.
One key difference between CAM and mainstream medicine is the strength of evidence supporting best practices. Mainstream medicine, when possible, bases its practices only on the most conclusive scientific evidence. In contrast, CAM bases its practices on evidence-informed practices—practices based on the best evidence available, even when such evidence does not meet the highest, strictest criteria for efficacy and safety. However, some CAM practices, including use of some dietary supplements, have been validated by traditional scientific criteria.
IMH aims to combine CAM with mainstream medicine when appropriate. Some CAM therapies are now offered in hospitals and are sometimes reimbursed by insurance companies. In addition, a growing number of academic institutions from various countries worldwide have joined the Academic Consortium for Integrative Medicine & Health (ACIMH) in an effort to provide a collaborative platform for academic institutions to advance integrative medicine through research, education, and clinical care (1).
Patient use of CAM therapies varies widely among populations and countries. In the United States, a national health interview survey indicates that commonly used CAM therapies include the following (2):
Mind-body therapy (12.3%)
Chiropractic or osteopathic manipulation (9.1%)
Massage (8.8%)
Movement therapy (6.5%)
Use of other CAM therapies and approaches remains variable and sometimes difficult to quantify (2). In the United States, more than 50% of adults used at least 1 dietary supplement in the past 30 days and such use has increased over the past 20 years (3).
Patients do not always volunteer information about their use of these therapies to health care professionals. Therefore, it is important for health care professionals to ask their patients specifically about use of these therapies (including medicinal botanicals and nutritional supplements) in an open, nonjudgmental way. Learning about patients’ use of CAM can do the following:
Strengthen rapport and build trust
Provide an opportunity to discuss evidence for CAM and its plausibility and risks
Help physicians and other health care professionals (including pharmacists) identify and avoid potentially harmful interactions between medications and CAM therapies or nutritional supplements
Monitor patient progress
Help patients determine whether they should use specific certified or licensed CAM practitioners
Learn from patients’ experiences with CAM
Differences Between Conventional and Integrative Medicine
Factor | Conventional Medicine | Integrative Medicine |
|---|---|---|
Definition of health | A condition of physical, mental, and social well-being and the absence of disease and other abnormalities | Optimal balance, resilience, and integrity of the body, mind, and spirit and their interrelationships |
Definition of illness | Organ dysfunction, disordered biochemical processes, or undesirable symptoms | Symptom and individual based: Imbalance of body, mind, and spirit |
Concept of life force | Life processes that are based on known physical laws and that involve physical and biochemical events | A free-flowing energy that unites mind and body and is the underpinning of health (often called qi, pronounced "chi") |
Understanding of consciousness | Results only from physical processes in the brain | May involve more than physical processes in the brain* Can exert healing effects on the body |
Method of treatment | Any evidence-based intervention, including medications, surgery, radiation therapy, electrical treatments, medical devices, physical therapy, exercise, and nutritional and lifestyle interventions | Includes conventional medicine methods in addition to evidence-informed natural healing practices and the patient's inherent capacity for self-healing |
Reliance on scientific evidence | Stricter reliance on established principles of scientific evidence | More flexible use of scientific evidence; treatments often based on tradition and/or lower quality scientific support |
* Vithoulkas G, Muresanu DF. Conscience and consciousness: a definition. J Med Life. 15; 7(1): 104–108, 2014. | ||
General references
1. Academic Consortium for Integrative Medicine & Health. Accessed September 15, 2025.
2. Falci L, Greenlee H. Multiple chronic conditions and use of complementary and alternative medicine among U.S. adults: Results from the 2012 National Health Interview Survey Volume 13. May 5, 2016. Accessed October 3, 2025.
3. Gahche J, Bailey R, Burt V, et al. Dietary supplement use among U.S. adults has increased since NHANES III (1988-1994). NCHS Data Brief. (61):1-8, 2011.
Efficacy of Alternative Therapies
There are 3 types of evidence that provide support for clinical use of CAM therapies:
Efficacy on clinical outcomes as shown in controlled clinical trials (considered the strongest evidence for clinical uses)
Evidence of effect on established physiologic mechanisms of action (eg, modification of gamma-aminobutyric acid [GABA] activity in the brain by valerian), although such evidence does not necessarily indicate efficacy on clinical outcomes
Historical reports from use over periods of time ranging from decades to centuries (considered lower quality evidence)
In the United States, the National Center for Complementary and Integrative Health (NCCIH ) maintains a list of research outcomes in this field.
A substantial amount of information about CAM is available in peer-reviewed publications, evidence-based reviews, expert panel consensus documents, and authoritative textbooks; much of it has been published in languages other than English (eg, German, Chinese). Many CAM therapies have been studied and found to be effective and/or comparable to conventional treatment, but some have been found to be ineffective, subject to conflicting and inconsistent results, or even potentially harmful. Some CAM therapies have not been tested in definitive clinical trials. Factors that limit such research include the following:
Holistic, or whole system, modalities (eg, healthy diet pattern) encompass a large number of variables, many or all uncontrolled. In contrast, evidence-based medicine emphasizes one or a small number of variables, ideally controlled interventions (eg, medications or procedures).
CAM therapies tend to be low cost and inadequately reimbursed, limiting financial incentive to fund research.
Regulation of CAM products and therapies does not require proven disease-specific efficacy.
The U.S. Food and Drug Administration (FDA), under the Dietary Supplement Health and Education Act (DSHEA) of 1994, allows marketing of dietary supplements and use of CAM devices but significantly restricts efficacy claims. For example, without having to provide evidence for safety or efficacy to the FDA, manufacturers of dietary supplements can claim benefit to the body’s structure or function (eg, improves cardiovascular health) but cannot claim benefit for treating disease (eg, treats hypertension). In 2022, the FDA updated the Draft Guidance for Industry in an attempt to improve disclosure of history of safe use, safety studies, and labeling of dietary supplements.
Research
Designing studies of CAM therapies poses challenges beyond those faced by researchers of conventional therapies:
Therapies may not be standardized. For example, there are different systems of acupuncture, and the contents and biologic activity of extracts made from the same plant species vary widely.
Diagnoses may not be standardized. Use of many CAM therapies (eg, traditional herbal medicine, homeopathy, acupuncture) is based on the patient’s unique characteristics or experiences rather than on a disease or disorder diagnosed by conventional medicine.
CAM treatments may emphasize the whole person and thus include patients who may be excluded from evidence-based medicine randomized controlled trials because they have comorbidities.
Double- or single-blinding is often difficult or impossible. For example, patients cannot be blinded as to whether they are practicing meditation. Reiki practitioners cannot be blinded as to whether or not they are using energy healing.
Outcomes are difficult to standardize because they are often specific to the individual or focused on general health rather than based on objective and uniform measurements (as mean arterial pressure, A1C level, and mortality).
Placebos or control interventions may be difficult to devise in complementary therapies. For example, in massage, the effective component could be touching, the specific area of the body massaged, the particular massage technique used, or time spent with the patient.
From a conventional research perspective, use of a placebo control is important. Placebo effect is complex, particularly when considering self-healing in the concept of care. CAM systems, however, recognize and interpret placebo effect as neurobiologic with mind-body implications, often with significant impact on symptoms and experience of disease (1).
In practice, CAM therapies are intended to enhance the quality of the healing environment and therapeutic relationships and thus optimize the patient’s capacity for healing. Studying the effective components of a CAM therapy against an inert placebo or control in a research setting remains a methodologic challenge.
Despite these challenges, many high-quality studies of CAM therapies (eg, acupuncture, homeopathy) have been designed and done. For example, a systematic review has assessed many of the studies evaluating acupuncture processes and devices for treatment of insomnia (2). By using carefully designed placebos, researchers can isolate the effects of some CAM therapies on the overall clinical response. Evidence supporting the use of CAM includes some results that are more efficacious than placebo or noninferior to conventional treatments. Additionally, some high-quality studies integrate CAM and conventional medicine treatments into IMH therapies (eg, dietary supplements paired to medications that cause known deficiency, for example, vitamin B12 deficiency with long-term use of metformin).). By using carefully designed placebos, researchers can isolate the effects of some CAM therapies on the overall clinical response. Evidence supporting the use of CAM includes some results that are more efficacious than placebo or noninferior to conventional treatments. Additionally, some high-quality studies integrate CAM and conventional medicine treatments into IMH therapies (eg, dietary supplements paired to medications that cause known deficiency, for example, vitamin B12 deficiency with long-term use of metformin).
Efficacy references
1. Finniss DG, Kaptchuk TJ, Miller F, et al. Placebo effects: biological, clinical and ethical advances. Lancet. 375(9715): 686–695, 2010. doi: 10.1016/S0140-6736(09)61706-2
2. Zhang J, He Y, Huang X, Liu Y, Yu H. The effects of acupuncture versus sham/placebo acupuncture for insomnia: a systematic review and meta-analysis of randomized controlled trials. Complement Ther Clin Pract. 41:101253, 2020. doi:10.1016/j.ctcp.2020.101253
Safety of Alternative Therapies
Although the safety of most CAM therapies has not been studied in clinical trials, many of these therapies have a good safety record. Many CAM therapies (eg, nontoxic botanicals, mind-body techniques such as meditation and yoga, body-based practices such as massage) have been used for thousands of years with scant evidence of harm, and many seem to have little potential for harm. However, there are some safety considerations, including the following:
Use of an alternative approach to treat a life-threatening disorder that can be effectively treated conventionally (eg, meningitis, cancer)—perhaps the greatest risk of alternative medicine, rather than the risk of direct harm from a specific therapy
Toxicity from certain botanical or supplement preparations (eg, hepatotoxicity from pyrrolizidine alkaloids, Atractylis gummifera, chaparral, germander, greater celandine, Jin Bu Huan, kava, pennyroyal, or others; nephrotoxicity from Aristolochia; adrenergic stimulation from ephedra)
Contamination (eg, heavy metal contamination of some Chinese and Ayurvedic herbal preparations; contamination of other products, such as PC-SPES and some Chinese herbs, with other drugs)
Interactions between CAM therapies (eg, botanicals, micronutrients, other dietary supplements) and other drugs (eg, induction of cytochrome P-450 [CYP3A4] enzymes by St. John’s wort, resulting in reduced activity of antiretrovirals, immunosuppressants, and other drugs), particularly when the drug has a narrow therapeutic index
As with any physical manipulation of the body (including mainstream techniques such as physical therapy), temporary or permanent injury (eg, nerve or cord damage due to spinal manipulation in patients at risk, bruising in patients with bleeding disorders)
Current alerts about harmful dietary supplements are available at the FDA website (Safety Alerts and Advisories). Historically, the FDA did not tightly regulate the production of dietary supplements, and some have been found to be diluted or contaminated. For example, microbial contamination, particularly with fungi, has been detected in various batches of herbal supplements, which may pose risks to immunocompromised individuals (1). However, newer FDA regulations now require compliance with manufacturing practices that improve quality and safety of supplements, and high-quality products are available through certain manufacturers that comply with FDA Good Manufacturing Practices.
To help prevent injuries due to physical manipulations, patients should look for practitioners who are formally trained and professionally licensed. Rates of complications are very low when chiropractic or acupuncture is provided by practitioners with full credentials.
Safety reference
1. Veatch-Blohm ME, Chicas I, Margolis K, Vanderminden R, Gochie M, Lila K. Screening for consistency and contamination within and between bottles of 29 herbal supplements. PLoS One. 2021;16(11):e0260463. Published 2021 Nov 23. doi:10.1371/journal.pone.0260463
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