What Would Hippocrates Do?

By the fifth century BC, Hippocrates “dissociated medicine from magic.

Before Hippocrates, ancient Greek healers served simultaneously as magicians, priests and cult leaders.1 By the fifth century BC, Hippocrates “dissociated medicine from magic, facts from fiction, histories from lies, healing art from philosophy, and gods from men.”2

In so doing, he transformed the previous theocratic system into one based on rational thought, diagnosis and treatment.3 
Although the Hippocratic tenets of “beneficence with non-maleficence” and vis medicatrix naturae (the healing power of nature apart from medical treatment)4 epitomize holistic medical ideals,5 the battle against irrational mechanisms, miracle potions and charismatic gurus continues today. 

Nonetheless, certain treatments rise to the top in terms of relative safety and value. If he practiced veterinary medicine, what would Hippocrates do?

1. Bloodletting, which predates acupuncture,6 was practiced by ancient Greek, Roman, Egyptian and Arabian physicians.78 Over time in China, affecting pneuma and eliciting neural reflexes replaced the focus on phlebotomy.  

Indeed, Hippocrates may have played a formative role in Chinese medicine. Sinologists suggest that Hippocrates likely inspired the mythical physician Qi Bo in the Han Dynasty medical text “The Yellow Emperor’s Classic of Internal Medicine.”9

Twenty-first century research has established acupuncture’s neurophysiologic basis and the merits of a neuroanatomic approach.10 In contrast, traditional Chinese medicine fails to outperform sham acupuncture.11

2. Hippocrates identified massage approaches and tailored them to his patients’ needs. Contemporary research shows that massage benefits patients suffering from cancer, heart disease, HIV and an array of non-malignant pain problems. 

In horses, massage increases mechanical nociceptive thresholds.12 Dogs with suspected degenerative myelopathy who received massage in conjunction with exercise, hydrotherapy, and paw protection experienced longer survival times.13

In contrast, epsilon-aminocaproic acid, N-acetylcysteine and vitamins B, C and E offered no significant benefit.14 Although expertly performed massage on appropriately chosen patients poses minimal risk, the proliferation of video-based, do-it-yourself canine massage courses is producing a cadre of self-proclaimed, unsupervised dog masseuses who have received little to no personal direction on safe amounts of force and contraindications to massage.

3. Ancient Greek physicians like Hippocrates offered their patients opportunities to recuperate in roofless buildings in order to supply sunlight for accelerate healing.15 Similarly, low-level laser therapy employs light energy to stimulate healing and reduce pain, counter arthritis and limit radiation-induced mucositis.1624 Mitochondria and cell membranes absorb the light’s photon-based energy and store it as ATP. This then provides the cell with more energy to synthesize DNA< RNA, enzymes, and protein that facilitate cell repair.25 
Laser light subdues inflammation by modulating nitric oxide and prostaglandin levels, as well as by lowering TNF-alpha concentrations.2627 The main safety hazard with laser therapy involves retinal damage from eye exposure.

4. The Greek Mediterranean diet supplies both plant- and sea-derived omega-3 polyunsaturated fatty acids.28 N-3 fatty acids reduce oxidative stress and improve the flexibility, fluidity and selective permeability properties of cell membranes.29

They inhibit cognitive decline, improve mood and prolong life.30 They safely help the body actively resolve inflammation31 and may inhibit the development of arthritis32 heart disease and cancer.33

5. In ancient Greece, patients recovering from illness could attend evening performances, presumably musical offerings. Music therapy expanded in the 1800s upon the invention of the phonograph.3435 Today, soothing music played in the post-anesthesia care unit improves comfort and reduces pain.36 It reduces anxiety and pain in patients on ventilators and those undergoing surgery and painful procedures.3740

Research may shed light on rhythms, genres and keys that best match certain species and medical conditions.

6. Herbs constituted the bulk of veterinary drugs until the last century, when synthetic chemicals rose to prominence. Despite their long empirical usage, herbal mechanisms, species-specific toxicities and interactions with other herbs and drugs fall far short of our level of knowledge about contemporary animal drugs. 

A recent report by the National Research Council for the FDA Center for Veterinary Medicine cited the need for consistent data, a good system of adverse event reporting and clarification of dietary supplement regulations.41

Fortunately, a few studies on herbal products for animals have emerged, suggesting clinical value and safety, although several require re-examination using placebo controls. For example, a natural resin extract of Boswellia serrata provided a statistically significant reduction in the severity of pain, lameness and stiffness in dogs afflicted with osteoarthrosis, causing minimal to no adverse effects.42 Ginkgo leaf extract appeared to reduce canine geriatric behavioral disturbances such as disorientation, sleep disturbances and general vitality.43

Echinacea powder afforded significant reductions in clinical signs of upper respiratory tract infections in dogs with faster resolution of illness.44 Silymarin from milk thistle protected dogs against gentamicin-induced nephrotoxicity.45

7. Hippocrates advocated aromatic baths in conjunction with massage.46 Two studies on kenneled dogs with travel-induced excitement point to the relaxing effect of inhaled lavender oil.4748

Although most humans enjoy lavender and similarly find it relaxing, exposing dogs to lavender in automobiles or shelters risks inducing soporific effects in the human workers as well as provoking inhalant allergies or headache.

8. The term “probiotics” arose from the Greek word “for life”; physicians predating even Hippocrates advocated yogurt’s health benefits. These living microorganisms work by improving enzyme, vitamin and antimicrobial production as well as by enhancing immune modulation and gut protection.49

Probiotic preparations specifically designed for veterinary species have appeared on the marketplace but, like herbs, lack regulation and verification of safety and effectiveness.

While most species and genera of probiotic organisms appear safe, a recent report raised questions about enterococci harboring transmissible antibiotic resistance determinants and bacilli producing enterotoxins and an emetic toxin.50

9. Who can argue with Hippocrates’ recommendation for regular, moderate exercise? The unanswered questions about exercise for veterinary patients pertain to how much and how often as well as how soon after surgery or illness. 

Overzealous exercise can lead to repetitive motion injury and acquired muscle contractures.51 Imprudent exercise prescriptions forced on canine rehab patients with spinal instability can worsen neurologic compromise. Staffing rehab clinics with unsupervised or untrained personnel has led to injuries.52

10. “Let food be thy medicine and medicine be thy food.” Would Hippocrates prescribe raw diets for dogs? Whether research ultimately supports or refutes the values of raw food, recognizing that our animals’ physical and emotional health is best served by diverse, wholesome and enjoyable foods is long overdue.5354. <HOME>

Narda Robinson, DVM, DO, Dipl. ABMA, FAAMA, offers an evidential and scientific perspective on the latest trends. She oversees complementary veterinary education at Colorado State University.

FOOTNOTES

1. Orfanos CE.  From Hippocrates to modern medicine.  Journal of the European Academy of Dermatology and Venereology.  2007;21:852-858.

2. Marketos SG. Hippocrates the Koan: The father of rational medicine. In: Okabe H, ed. Hippocrates Symposium. Tokyo: Springer, 1993: 7–14.

3. Orfanos CE.  From Hippocrates to modern medicine.  Journal of the European Academy of Dermatology and Venereology.  2007;21:852-858.

4. McNutt WF.  Vis medicatrix naturae.  California State Journal of Medicine.  1923;21(12):510-511.

5. Katsambas A and Marketos SG.  Hippocratic message for modern medicine (the vindication of Hippocrates).  Journal of the European Academy of Dermatology and Venereology.  2007;21:859-861.

6. Epler DC Jr.  Bloodletting in early Chinese medicine and its relation to the origin of acupuncture.  Bull Hist Med.  1980;54(3):337-367.

7. Katsambas A and Marketos SG.  Hippocratic message for modern medicine (the vindication of Hippocrates).  Journal of the European Academy of Dermatology and Venereology.  2007;21:859-861.

8. Turk JL and Allen E.  Bleeding and cupping.  Annals of the Royal College of Surgeons of England.  1983;65(2):128-131.

9. Unschuld, PU.  Chinese Medicine.  Paradigm Publications, Brookline, MA., 1998.  Cited in Cheng TO.  Did Greeks beat Chinese on blood circulation…Nature.  2000;405(6790):993.

10. Ma Y-T, Ma M, and Cho ZH.  Biomedical Acupuncture for Pain Management.  An Integrative Approach.  St. Louis:  Elsevier, 2005.

11. Haake M, Muller H-H, Schade-Brittinger C, et al.  German acupuncture trials (GERAC) for chronic low back pain.  Arch Intern Med.  2007;167(17):1892-1898.

12. Sullivan KA, Hill AE, and Haussler KK. The effects of chiropractic, massage and phenylbutazone on spinal mechanical nociceptive thresholds in horses without clinical signs.  Equine Veterinary Journal.  2008;40(1):14-20.

13. Kathmann I, Cizinauskas S, Doherr MG, et al.  Daily controlled physiotherapy increases survival time in dogs with suspected degenerative myelopathy.  J Vet Intern Med.  2006;20:927-932.

14. Polizopoulou ZS, Koutinas AF, Patsikas MN, et al. Evaluation of a proposed therapeutic protocol in 12 dogs with tentative degenerative myelopathy.  Acta Vet Hung.  2008;56(3):293-301.

15. Keegan L.  Healing with Complementary and Alternative Therapies.  Cangage Learning, 2000.  P. 295.

16. Yurtkuran M, Sonur S, Ozcakir S, and Bingol U. Laser acupuncture in knee osteoarthritis:  a double-blind, randomized controlled study. Photomedicine and Laser Surgery.  2007;25(1):14-20.

17. Klide AM and Martin BB.  Methods of stimulating acupuncture points for treatment of chronic back pain in horses.  JAVMA.  1989;195(10):1375-1379.

18. Brosseau L, Robinson V, Wells G, et al.  Low level laser therapy (Classes I, II, and III) for treating rheumatoid arthritis (Review).  Cochrane Database of Systematic Reviews.  2005, Issue 4.  Art. No.: CD 002049. DOI:10.1002/14651858.CD002049.pub2.

19. Yurtkuran M, Sonur S, Ozcakir S, and Bingol U. Laser acupuncture in knee osteoarthritis:  a double-blind, randomized controlled study. Photomedicine and Laser Surgery.  2007;25(1):14-20.

20. Gur A, Cosut A, Sarac AJ, et al.  Efficacy of different therapy regimes of low-power laser in painful osteoarthritis of the knee:  a double-blind and randomized-controlled trial.  Lasers in Surgery and Medicine.  2003;33:330-338.

21. Gur A, Sarac AJ, Cevik R, et al.  Efficacy of 904nm gallium arsenide low level laser therapy in the management of chronic myofascial pain in the neck:  a double-blind and randomized-controlled trial.  Lasers in Surgery and Medicine.  2004;35:229-235.

22. Chow RT, Heller GZ, and Barnsley L.  The effect of 300 mW, 830 nm laser on chronic neck pain:  a double-blind, randomized, placebo-controlled study.  Pain.   2006;124:201-210.

23. Maiya GA, Sagar MS, and Fernandes D.  Effect of low level helium-neon (He-Ne) laser therapy in the prevention & treatment of radiation induced mucositis in head and neck cancer patients.  Indian J Med Res.  2006;124:399-402.

24. Bensadoun RJ, Franquin JC, Ciais G, et al.  Low-energy He/Ne laser in the prevention of radiation-induced mucositis.  A multicenter phase III randomized study in patients with head and neck cancer.  Support Care Cancer.  1999;7:244-252.

25. Canapp DA.  Select modalities.  Clin Tech Small Anim Pract.  2007;22:160-165.

26. Ferreira DM, Zangaro RA, Villaverde AB, et al.  Analgesic effect of He-Ne (632.8 nm) low-level laser therapy on acute inflammatory pain.  Photomedicine and Laser Surgery.  2005;23(2):177-181.

27. Aimbire F, Albertini R, Pacheco MTT, et al.  Low-level laser therapy induces dose-dependent reducation of TNFα levels in acute inflammation.  Photomedicine and Laser Surgery.  2006;24(1):33-37.

28. De Lorgeril M and Salen P.  Mediterranean diet and n-3 fatty acids in the prevention and treatment of cardiovascular disease.  J Cardiovasc Med.  2007;8 Suppl 1: S38-S41.

29. Ward OP and Singh A.  Omega 3/6 fatty acids:  alternative sources of production.  Process Biochemistry.  2005;40:3627-3652.

30. Harris WS.  N-3 fatty acids and health:  DaVinci’s code.  American Journal of Clinical Nutrition.  2008;88(3):595-596.

31. Serhan CN.  Novel ω-3-derived local mediators in anti-inflammation and resoluation.  Pharmacology & Therapeutics.  2005;105:7-21.

32. Roush JK.  University Clinical Trials.  Omega-3 fatty acid effects on force plate analysis and clinical signs.  NAVC Clinician’s Brief.  2005;3(4 Suppl):9.

33. Davenport DJ and Roudebush P.  The use of nutraceuticals in cancer therapy.  NAVC Proceedings.  Small Animal – Oncology.2006:777-780.

34. Barrera ME, Rykov MH, and Doyle SL.  The effects of interactive music therapy on hospitalized children with -cancer:  a pilot study.  Psycho-Oncology.  2002;11:379-388.

35. Orfanos CE.  From Hippocrates to modern medicine.  Journal of the European Academy of Dermatology and Venereology.  2007;21:852-858.

36. hertzer KE and Keck JF.  Music and the PACU environment.  Journal of PeriAnesthesia Nursing.  2001;16(2):90-102.

37. Lee OKA, Chung YFL, Chan MF, et al.  Music and its effect on the physiological responses and anxiety levels of patients receiving mechanical ventilation:  a pilot study.  Journal of Clinical Nursing.  2005;14:

38. Twiss E, Seaver J, and McCaffrey R.  The effect of music listening on older adults undergoing cardiovascular surgery.  Nursing in Critical Care.  200;11(5):224-231.

39. Chan MF.  Effects of music on patients undergoing a C-clamp procedure after percutaneous coronary interventions:  A randomized controlled trial. — Heart Lung.  2007;36:431-439.

40. F.M. Kane, E.E. Brodie and A. Coull et al., The analgesic effect of odour and music upon dressing change, Br J Nurs 13 (2004), pp. S4–S12.

41. Scheid JF. NRC publishes report on horse, cat, dog dietary supplement safety. Obtained on October 25, 2008 here.

42. Reichling J, Schmokel H, Fitzi J, et al. Dietary support with Boswellia resin in canine inflammatory joint and spinal disease.  Schweiz Arch Tierheilkd.  2004;146(2):71-79.

43. Reichling J, Frater-Schroder M, Herzog K, et al.  Reduction of behavioural disturbances in elderly dogs supplemented with a standardised Ginkgo leaf extract.  Schweiz Arch Tierheilkd.  2006; 148(5):257-263.

44. Reichling J, Fitzi J, Furst-Jucker J et al.  Echinacea powder:  treatment for canine chronic and seasonal upper respiratory tract infections.  Schweiz Arch Tierheilkd.   2003; 145(5):223-231.

45. Varzi HN, Esmailzadeh S, Morovvati H et al. Effect of silymarin and vitamin E on gentamicin-induced nephrotoxicity in dogs.  J Vet Pharmacol Therap.  2007;30:477-481.

46. Robins JLW.  The science and art of aromatherapy.  Journal of Holistic Nursing.  1999;17(1):5-17.

47. Wells DL.  Aromatherapy for travel-induced excitement in dogs.  JAVMA.  2006;229(6):964-967.

48. Graham L, Wells DL, and Hepper PG.  The influence of olfactory stimulation on the behaviour of dogs housed in a rescue shelter.  Applied Animal Behaviour Science.  2005;91:143-153.

49. Anadon A, Martinez-Larranaga MR, and Martinez MA.  Probiotics for animal nutrition in the European Union.  Regulation and safety assessment.  Regulatory Toxicology and Pharmacology.  2006;45:91-95.

50. Anadon A, Martinez-Larranaga MR, and Martinez MA.  Probiotics for animal nutrition in the European Union.  Regulation and safety assessment.  Regulatory Toxicology and Pharmacology.  2006;45:91-95.

51. Taylor J and Tangner CH.  Acquired muscle contractures in the dog and cat.  A review of the literature and case report.  Vet Comp Orthop Tramatol.  2007;20:79-85.

52. Personal practice experience by the author, along with anecdotal reports from colleagues.

53. Prasad C.  Food, mood and health:  a neurobiologic outlook.  Braz J Med Biol Res.  1998;31(12):1517-1527.

54. Fox MW and Smart ME.  Recommends veterinary consultation prior to feeding weight-reducing diets.  JAVMA.  2008;233(5):707-708.

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