ABSTRACT
Energy medicine includes a broad variety of complementary/ alternative medicine (CAM) therapies, such as acupuncture, kinesiology, and spiritual healing. The term "energy medicine" derives from the perceptions and beliefs of therapists and patients that there are subtle, biological energies that surround and permeate the body. Recent research is confirming that these therapies can be helpful in treating many problems for which conventional medicine may have no cures. Growing numbers of doctors are integrating these therapies in their practices.

BACKGROUND
Energy medicine includes a broad variety of complementary/ alternative medicine (CAM) therapies. (See Table 1) The term, "energy medicine," derives from the perceptions and beliefs of therapists and patients that there are subtle, biological energies that surround and permeate the body. They suggest that these energies may be accessed in various ways through CAM for diagnostic and therapeutic interventions.

Energy medicine may be difficult to understand and even more difficult to accept as a possibly effective intervention without explanation and a review of recent research.

Some of the energy medicine therapies are provided in a manner similar to the delivery of Western medicine. That is, the therapist performs the intervention directly, as in acupuncture and homeopathy.

Most CAM therapies encourage patients to participate in their own healing. This places the therapist in the role of consulting and advising rather than treating patients directly. When these therapists intervene directly, it is to enhance the natural functions of the patient. (See Table 1.)

Various theories are offered as to how such interventions may influence the patient. These propose the existence of a number of biological energies that are alleged to sustain life and through which therapists may treat various illnesses. My own general theory, in Western concepts, is followed by the traditional theories of the CAM modalities.

Spiritual awareness, the inner sense of being a part of something vastly larger and wiser than ourselves, can be an important therapeutic component of energy medicine. This is especially common with spiritual healing and self-healing approaches, and is very much related to the spiritual awareness of the practitioner.(Benor 1996; Benor in press (a)

Patients experiencing energy medicine treatments may report that they feel an inner peace, a spiritual guidance, and a re-connection with their spiritual or religious roots. This may occur with no prompting on the part of the therapist, or may arise out of deliberate questing for a spiritual connection through practices of meditation and imagery. This aspect of energy medicine may be helpful to patients who are dealing with serious or terminal illnesses.

Spiritual awareness may also be a help to the terminally ill and to their families in dealing with dying.

ENERGY MEDICINE THEORY

General Theory for Energy Medicine
Early in the 19^th Century, Einstein proposed that matter and energy are interconvertible, E=mc². Quantum physics has amply confirmed that we can address the world we live in as matter or as energy, even though this contradicts our everyday perceptions of the world of Newtonian physics. While the chair I am one is sitting on feels very solid, Ione knows it is composed of tiny atomic and subatomic particles that are held together by atomic and subatomic forces. Viewed through quantum equations, the chair could also be described in terms of energy.

Modern medicine, based on Newtonian principles, has been slow to consider the possibility that these same principles may apply to biological matter. A living body can be described within quantum theory as energy.

Energy medicine practitioners have been saying for many centuries that there is a physical body and an energy body. They are not mutually exclusive. The bioenergy body is said to surround and interpenetrate the physical body and to interact with it. Energy medicine practitioners report that they provide treatment through the energy body, thereby influencing the physical body, emotions, mind, relationships and spirit.(Benor 2001c; Brennan; Gerber)

In the early years of quantum physics there were many who were skeptical about theories that contradicted those of Newtonian physics. Over the better part of the 20^th Century, these doubts have been dispelled through experiments that confirm quantum theories. We have learned that Newtonian physics is accurate in describing the physical world as perceived by our five senses. However, this is only a limited part of the spectrum of explanations for how the world can be understood. Quantum physics does not invalidate Newtonian physics. It describes the molecular, atomic, and subatomic parts of the spectrum of the world that are outside of our ordinary awareness.

Energy medicine practitioners suggest that the same applies with energy medicine. It does not contradict conventional medicine. It is an extension of our understanding of biological systems on the energy side of Einstein's equation. If this is true, we are in the early stages of understanding and integrating such conceptualizations of the world. Much as it was in the field of Newtonian physics in the early part of the 20^th Century, Newtonian medicine is having a difficult time accepting energy medicine theory.

Until recently, it was difficult to accept even the possibility that there might be energy medicine approaches that could not be explained by Newtonian medicine. Even though many of these therapies had been practiced for several thousand years, they had not passed the test of the randomized controlled trial (RCT). In the past two decades, rapidly growing numbers of RCTs have been published for many energy therapy modalities. A selection of these will be highlighted below.

The mechanism of action of biological energies purportedly utilized by CAM practitioners is unknown. Suggestions include: activation or unblocking of patients' energies, projection of the practitioners' own energies, channeling of energies by the therapist from nature (the earth, cosmic energies), or interventions of spiritual agents (spirits, saints, Christ, Buddha, God).(Benor in press (b); LeShan)

Many CAM modalities have their own variations on these theories that are relevant to their particular approaches. These are considered under each modality.

Alternative General Theories for Energy Medicine
Suggestion or placebo effects are the most obvious alternative explanation. An element of suggestion is present in CAM therapies, as it is in conventional therapies. However, there are randomized controlled trials that suggest that several of the CAM therapies are of significantly greater benefit than the effects of suggestion demonstrated in the mock-therapy control groups.(Benor 2001c; Harrington)

The opposite case may also be possible. Many of the myriads of beneficial effects of suggestion have not been adequately explained. It is conceivable that some of these derive from energy medicine interactions between therapists and patients, or as self-healing.

Spontaneous remission has been proposed to explain away isolated cases of unusual cures.(O'regan) As there is no mechanism proposed for the apparently spontaneous changes occurring sometimes in some illnesses, it is also possible that instances of so-called spontaneous remission represent responses to energy medicine or self-healing interventions that were not reported by the patients or documented by the researchers. This hypothesis is supported by several observations on energy medicine interventions. First, there are cases where improvements occur rapidly following energy medicine interventions, with major improvements or total cures of chronic conditions that had previously been unresponsive to all other therapies.(Kirkpatrick) Second, it is very rare in the literature on spontaneous remission to have investigators ask about energy medicine interventions. A contributing factor is the reluctance of recipients of CAM therapies to mention these to their physicians, fearing criticisms or rejection.(Eisenberg 1993)

Non-local consciousness, in which the awareness of the therapist may connect with the awareness of the patient, is an alternative explanation for some of the effects obtained with energy medicine.(Benor in press b; Dossey 1993) That is, rather than an exchange of energies, there could be an exchange of information. Energy medicine practitioners suggest that the mind, acting through biological energies, can profoundly influence states of health and illness. The therapist may in some way reprogram the patient's disease patterns of perception, behavior, or bioenergy states, thereby promoting changes towards health.

INTEGRATIVE CARE
Recently, more physicians are becoming familiar with energy medicine and related approaches.(Astin et al 1998) Doctors were wary of using therapies that were of unproven value, and little research evidence was available in support of these therapies. Alternative medicine was an appropriate term for these therapies because patients often resorted to these rather than to conventional medical care, and would hesitate to reveal to their doctors that they were using them. David Eisenberg's landmark articles (Eisenberg 1993; 1998) revealed that Americans had more visits with these therapists than with primary care physicians, and were paying almost as many dollars annually out of pocket as were being paid (with the help of insurance) for conventional medical care. As some physicians have become convinced of the benefits of these therapies, they have introduced them as complementary interventions along with standard medical treatments.

Integrative care blends CAM therapies with conventional medical care in a spectrum of combinations. At one polarity are practices where bits and pieces of energy medicine modalities are imported into Western medicine, such as needling certain acupuncture points to assist in pain management, or recommending homeopathic Arnica or Rescue Remedy flower essence for stress. Further along the spectrum, physicians refer patients out to energy medicine practitioners for help with aspects of their problems. With full integration, CAM practitioners are invited to work in the physicians' offices, and physicians may learn to practice energy medicine therapies themselves.

Wholistic medical practice is promoted by many of the energy medicine therapies and by a growing number of physicians. Most of the energy medicine therapies are derived from cultural therapeutic traditions that have developed over many centuries; some over several millennia. They may include cosmologies and theories for underlying mechanisms that are alien to Western ways of thinking.(Benor 2001c) While each has its distinct practices, a common underlying theme amongst most energy medicine therapies is that each person is treated as a unique individual.

Wholistic practice addresses the person who has the disease, not just the disease the person has. Energy medicine promotes awareness of dis-ease as well as disease in body, emotions, mind, relationships and spirit. (This term with a "W" is used to distinguish it from its common usage to indicate inclusion of a smattering of CAM techniques with conventional medical care.) Each person is addressed as an individual. His or her unique personality, life experiences, and current state of being are considered in deciding on therapeutic interventions.

Today, more than half the medical schools include courses in CAM therapies, and growing numbers of doctors are exploring how to make them available to their patients.

ENERGY MEDICINE THERAPIES
Most CAM therapies involve some aspect of energy medicine, although this may not be a prominent component of the intervention. As with suggestion, it may be impossible for a therapist to not have a bioenergetic interaction with a patient, though in many cases this could be entirely unconscious to both participants. The following discussion focuses on CAM therapies where energy medicine is a major component of the intervention.

Spiritual Healing
Energy medicine is illustrated most clearly with various forms of spiritual healing, such as Reiki,(Rand) Therapeutic Touch,(Krieger 1979; 1993) Qigong,(Cohen). Healers may report sensations in their hands such as heat, tingling, vibration, electrical sensations, or cold, and patients may feel similar sensations in the part of their body being treated..(Benor 2001a)

Spiritual healers and many other therapists who are sensitive to bioenergies report they can palpate an energy field with their hands surrounding the body. Some report they also see an aura of color surrounding the body. Various layers of these energy fields are perceived to reflect the physical, emotional, mental, relational, and spiritual conditions of the person.(Benor 2001c) For instance, a healer may feel with her hands a "stickiness" or unusual heat or other sensations over a part of the body that is diseased. The energy fields are also believed to be templates for what occurs within the body, being shaped by genetic, mental, emotional, and environmental factors. As well as sensing people's conditions, healers can enhance people's states of health by interacting with the bioenergy field.

Healers treat with a laying-on of hands, their hands touching or held a few inches away from the body. At the same time, healers hold a mental intent, meditative focus, or prayer for the improvement of the healee. Some healers may direct flows of energy by moving their hands or through mental focus. Other healers believe they are simply channels for healing energies that come through them from nature or from a Divine source. Qigong healers teach self-healing meditations and gentle exercises that also promote a healthy flow of subtle energies.(Benor 2001a)

Healers commonly claim they can treat with equal effectiveness from any distance, even from many miles away. While this stretches Newtonian understandings of the world, recent studies support that prayer healing sent from many miles away can enhance treatments of patients with AIDS (Sicher et al) and of patients hospitalized in cardiac intensive care units.(Byrd; Harris)

Healing often opens therapists and patients to personal spiritual awarenesses. This may include an inner knowing that you a person isare part of a vast, collective consciousness; that angels and spirit guides are there to support youhim; or that Christ or Allah unconditionally accepts and loves youhim.(Benor in press (a)

Research: There are 120 randomized controlled studies in humans, animals, plants, bacteria, yeasts, and enzymes which suggest that spiritual healing can be effective for pain, anxiety, depression, AIDS, hypertension, arthritis, wound healing, and other problems.(Benor 2001a, b)

A study of healing sensations by a ten-year old girl was given wide publicity when it was published in JAMA.(Rosa et al) This study showed that Therapeutic Touch healers were unable to determine when the girl's hand was held about ten inches from the healers' hand. The then editor, George Lundberg, enthusiastically endorsed this study, interpreting it to mean that any claims for the efficacy of spiritual healing were hereby invalidated. An alternate analysis of this study (e.g. Benor 2001a, b, Dossey 1988; Leskowitz 1988) is that it is seriously flawed in several ways. Holding the experimenter's hand still at one steady distance from the healers' hands is totally unlike the clinical practice of healers, who will move their hands laterally around the body, as well as closer to and further from the body. Healers were tested in a laboratory while being videotaped, which could interfere with their mental focus. Healing is generally given when there is a need on the part of the patient for treatment. It is actually unclear whether it is the healer who activates the process by giving healing, or whether the healer merely provides a source of healing from which the patient takes that which is needed. Furthermore, there are 120 other studies showing significant effects of healing (some of which were cited as references in the study of Rosa et al but not discussed). The conclusions of Lundberg that this one science fair study invalidates all claims for effectiveness of healing is patently ridiculous. (Benor 2001a)

Adverse effects: Healing has no serious side-effects. An occasional side effect is that symptoms such as pain may increase in the first few sessions. This is taken by experienced healers as good sign, indicating that the energetic components that lie behind the symptom are being released. When treatment is continued, symptoms usually improves.

Indications:Spiritual healing is an excellent therapy of first choice, because it can be given as a complement to any other therapy, with no side effects or dangerous interactions with other treatments. Almost any problem may respond to healing. Healing may thus be given along with every other treatment.

Craniosacral Osteopathy and Network Chiropractic
Chiropractic and osteopathy classically treat through physical manipulations of the skeleton, particularly of the spine. Craniosacral Osteopathy and Network Chiropractic extend these practices into energy medicine. Using the lightest of touch, and sometimes holding their hands near to but not touching the body, these therapists report they sense and regulate flows of energies, and may direct healing intent or healing energies to the patient. Without a physical manipulation (such as massage or spinal manipulation), profound changes may occur in chronic conditions for which conventional medicine has no cure.(Upledger; Upledger & Vredevogt)

Network Chiropractic produces results without physical manipulations. The therapist uses light touch, bringing about effects that appear to be equivalent to those produced by chiropractic physical manipulations. This treatment is said to be based upon a bioenergy intervention.(D. Epstein)

Craniosacral osteopaths report that they sense with their hands subtle bioenergy pulsations around the head. Through mental intent they alter these pulsations when they intuitively perceive that it is appropriate to do so. This brings about effective clinical changes, though these may be of different quality from those of the physical manipulations, extending to emotional and spiritual responses in addition to physical changes.

Network Chiropractic Research:No studies have been published on network chiropractic. However, a British study of Light Touch Manipulative Technique, a method that closely resembles Network Chiropractic, showed significant effects for back pain.(Dressler)

Craniosacral Osteopathy Research: There has been no research to confirm the efficacy of craniosacral osteopathy.

Adverse effects:As with spiritual healing, there are no known deleterious effects of network chiropractic or craniosacral therapy. Because the touch used in craniosacral work is very light, without physical manipulation, there have been no injuries.

Indications: Clinical reports indicate craniosacral osteopathy can be of help in treatment of problems which conventional medicine may be limited in treating, such as pain in the back and neck; fibromyalgia; frozen shoulder and carpal tunnel syndromes; arthritis; scoliosis; chronic ear infections; hormonal abnormalities; post-injury/illness symptoms of head injury, meningitis and encephalitis; behavioral, developmental and learning disorders in children (sometimes attributed to cranial birth injury); sacral injuries, chronic neuralgia syndrome, high blood pressure; temporo-mandibular joint (TMJ) pain; strabismus; amblyopia; migraine headaches; cluster headaches; trigeminal neuralgia; chronic fatigue syndrome; tinnitis; vertigo; asthma; lymphedema; plantar facitis; shin splints; tennis elbow; and golfer's elbow.(DiGiovanna & Schiowitz). Research has yet to confirm many of these claimed benefits of craniosacral therapy.

Acupuncture
Acupuncture and various derivative therapies identify meridians (lines of energy) running from head to extremities. Along the meridians there are acupuncture points that relate to anatomic parts and physiological functions in various parts of the body. Stimulating these points is said to release unhealthy blocks in energy flows along the meridians, which in turn improves the functions of the related organs. Acupuncture points can be stimulated with needles, physical pressure, electrical stimulation or laser light.

Within acupuncture theory, meridians correspond to bioenergy (biological energy) functions of the body that overlap with but are different from physical organ functions. For instance, the bladder meridian relates to urinary functions, but may also relate to weak legs, brittle bones, and stiffness in the spine. Diagnoses in acupuncture relate to whether bioenergies are flowing smoothly, blocked, or congested. Abnormal activity in one meridian will influence energy flows in other meridians. While such explanations are difficult to understand within a Western scientific paradigm, they have their own coherence and provide a basis for treatment that has been successful for a major segment of the world's population over several thousand years of practice.

Acupuncture is discussed in more detail in another section of this volume.

Related therapies:A number of therapies have been derived from acupuncture. Acupressure, reflexology and shiatsu address problems through finger pressure at various acupuncture points. Applied kinesiology addresses muscle strength in particular muscles as they reflect the energy flows in various meridians..

Applied Kinesiology (AK)
AK is derived from acupuncture theory and practice. Specific muscles are intimately related to each meridian. When there is a dysfunction in that meridian, the related muscles is reportedly weaker than normal. By testing the strength of a series of muscles, AK practitioners diagnose bioenergy dysfunctions in the meridians.(Diamond; Whisenant)

AK practitioners pass their hands around the body to correct the flows of energies in the meridians, in a structured way that relates to the meridians they are addressing.

AK may also be used as a general adjunct to other therapies. When you people are in harmony within your their conscious and unconscious awareness, in relationship to yourself themselves and your their physical and social environment, your their bioenergy system (reflected in your their muscle strength) is good. When you they are out of harmony, your their muscle strength will be weak. General muscle strength (not related to specific meridians) may thus be used as an indication and measure of your their state of bioernergetic harmony. For example, if you they are allergic to wheat and wheat is brought close to your their energy field, the AK practitioner will note whether your their muscles become weaker. This gives the therapist a way of testing what you they might be sensitive or allergic to. Conversely, various remedies may be brought near you them to see whether they strengthen your their bioenergies, as reflected in increased muscle strength.(Ballentine)

In psychotherapy AK may be used to explore whether particular thoughts influence you patients positively or negatively. If you they think of a traumatic incident in the past and your their muscles are weakened, it suggests that emotions attached to this memory may be producing an energetic imbalance. A variety of techniques may be used to help you release the negative emotions, following which you one can again check your muscle strength to see to what extent you these negative influences have cleared yourself. (Gallo1999; 2000)

Research: No research has been published to validate the claims of AK.

Adverse effects: No adverse effects are known.

Indications: AK is claimed to be effective in treating allergies and digestive problems, and stress-related illnesses.

Meridian-Based Therapies
Meridian-Based Therapies utilize pressure points along various acupuncture meridians to release negative patterns of emotional and physical response. Anxieties, post-traumatic stress disorders, fears, pains, and allergies are reported to be alleviated rapidly and permanently with techniques such as Thought Field Therapy(Callahan), Emotional Freedom Technique,(Craig/Fowlie) Tapas Acupressure Technique(Fleming), and other variations on these approaches. These therapies are used under the direction of a therapist, but may be used by patients on their own as self-healing.

Chakra therapies may be used individually or may be included as aspects of other approaches. The chakras (Sanskrit for wheels) are major energy centers said to exist along the midline of the body that channel bioenergies to organs locally as well as throughout the body. Bioenergy therapists report they can sense the chakras with their hands, and sensitive people who see auras may report they see colored disks at the chakra points. These, like the biofield as a whole, are said to reflect your one's condition and provide an avenue for access of healing energies. Healers may direct treatment to particular chakras, or may suggest that you patients hold your their hands over particular chakras for self-healing(Clinton)

Research:There has been no research published to support the enthusiastic clinical reports of patients and therapists who are using these techniques.

Adverse effects: No adverse effects of these therapies are known.

I have personally found the Meridian Based Therapies extremely potent for relieving anxieties, severe emotional traumas, pains and allergies. These techniques have profoundly enhanced my practice of psychiatric psychotherapy, and have been enormously helpful to me personally in dealing with stresses on my job and in my personal life. I have recently started teaching these methods to doctors and other medical staff for stress reduction.

Clinical efficacyIndications: Helpful for Post Traumatic Stress Disorder (PTSD), anxieties, phobias, poor self-esteem, performance enhancement.(Craig)

Eye Movement Desensitization and Reprocessing (EMDR)
EMDR relies on alternating stimulation of the left and right sides of your a patient's body to bring about release of fears and traumatic memories, and to install positive cognitions and feelings. While initially this therapy utilized only right-left-right-left eye movements, it has been found that touching your a patient's right and left sides or making alternating sounds in your her right and left ears can have the same effects.(Shapiro)

In practice, you a person would decide on something that you she wishes to change, such as a fear of speaking in public. You She would assess how strong this fear is on a "Subjective Units of Distress" (SUDs) scale of zero (not at all) to ten (the worst it could be) at the moment you she starts this round of treatment. You She would then focus on the fear while the therapist provides alternating right-left stimulation. After a few minutes you she would pause to reassess the intensity of the negative feelings. In most cases they will decrease. Once they are down to zero, you she can then install a positive perception in a similar manner. You She might say, "I can speak with confidence in front of any crowd," assessing your her level of confidence in this statement. Then the therapist would repeat the alternating stimulation to build up the positive.

Research: An impressive body of research suggests that EMDR can be helpful with post-traumatic stress disorders, even when they are of the severity of those experienced by Vietnam war veterans.(Goldstein & Fenske)

Adverse effects: In the process of releasing negative emotions, painful memories, previously long-buried and forgotten, may re-surface. The patient is encouraged to feel in control through an agreement with the therapist that they will stop processing feelings if the patient feels they are too intense for comfort. These uncomfortable releases usually are transient and melt away as the alternating stimulation is continued. If a person panics and stops in the middle of a session, the feelings may persist.

Clinical efficacyIndications: Helpful for Post Traumatic Stress Disorder (PTSD), anxieties, phobias.

See experiential exercise using a hybrid of EMDR and Meridian-Based Therapies at the end of this chapter.

Research: An impressive body of research confirms that EMDR can be helpful with post-traumatic stress disorders, even when they are of the severity of those experienced by Vietnam war veterans.(Goldstein & Fenske)

Flower Essences
Similar to homeopathy, remedies have been produced from various flowers and plants, based on the symptoms they produce when ingested by normal people. Remedies are made by placing the desired part of the plant in water for a period of time. These remedies tend to be more helpful with psychological and relational issues, but may also help with some physical problems.(Scheffer)

Shamanic herbalists in traditional cultures have reported that plants speak to them, telling the shaman how they can be helpful--both in a generic way and for specific patients. In a similar manner, some highly sensitive healers have developed flower essences intuitively. That is, they psychically sense the spectrum of benefits of a plant and develop an essence from the plant rather than going through the clinical procedures for testing the spectrum of the plant's effects.

Recently, topical applications of flower essences have been found to be helpful for various problems. Various skin zones of the body are said to correspond to internal organs and to different illnesses and dysfunctions. (Dietmar 1995a; 1995b; email@www.livingessences.com.au)

Theory:It is proposed that a biological energy pattern is imprinted in the water. When ingested or used topically, these remedy energy patterns interact with the biological energies of the healee to promote healing.

Research: Cram (1999a; b) reports controlled, double-blind studies on effects of combinations of flower essences that are commonly used for treating stress. Electromyograms, used as a measure of stress, demonstrated significant decreases of tension over the mastoid processes and the chest with the essences compared to placebo. These studies, limited in scope and methodology, are the only available ones to date.

Adverse effects: Occasionally there are temporary worsenings of the symptoms, as the energy patterns of illness are unblocked or released.

Clinical efficacyIndications: Reported helpful in stress, pain, depression.

Imagery
Mental imagery can be used to focus and utilize bioenergies. Healers may visualize that they are projecting healing energies to treat a particular part of the body, to unblock obstructed energy flows, or may visualize that they are withdrawing excesses of energies. (Krieger 1979; 1993) Healers report that if they visualize that they are projecting their own bioenergy they may become tired from energy depletion. To prevent this, and to be maximally effective, they visualize that they are channels for unlimited universal energies. Healers report that when they use these visualizations of channeling energies, they themselves are energized rather than depleted during treatments.

Imagery is used in self-healing.(Achterberg) Patients may be encouraged to visualize that they are inviting healing energies into their bodies to treat their problems. Pains may be imaged as a red color, then pictured as being washed away by the healing energies. Shifts in the color towards pink and then white are common as the pain dissipates. People with allergies may find that imagery of having a bioenergy shield surrounding them like an egg or space suit decreases their allergic reactions.

Immune system activity may be enhanced through imagery.(Pert/Dreher/Ruff; Simonton/Sherman) Patients with cancer have been encouraged to picture that their white cells are sharks, white knights, or "Pac Men" that can eliminate any unwanted cancer cells. It has been postulated that immune cells may communicate directly with brain cells through the dozens of neuropeptides that they share in common.(Pert & Dienstfrey) Another postulated mechanism for mental influence over the immune system is via bioenergies, as described earlier.(Benor 2001c)

Research: Imagery exercises may enhance immune system activity. Steven Locke and Mady Hornig-Rohan reviewed 1,453 professional articles on this subject in an annotated bibliography. Stephanie Simonton and Allen Sherman reviewed numerous studies in which imagery (often combined with psychological interventions, meditation and relaxation) appeared to influence the course of patients with cancer, reducing morbidity and prolonging survival times. More focused studies have demonstrated enhanced immune cell function (Simonton 1994; Smith et al 1981)

Adverse Effects: There are no known adverse effects of imagery.

Clinical EfficacyIndications: While there are no clinical controlled studies of the efficacy of imagery alone to alter disease processes, anecdotal reports indicate imagery can be helpful in treating hypertension, accelerating healing of bone fractures, in decreasing morbidity in cancer and AIDS patients and prolonging their survival.(Dienstfrey; G. Epstein)

Meditation
Meditation may take many forms, all of which help the mind to focus. You One may concentrate on a word or phrase (mantra), prayer, object, visual image, or activity (breathing, sacred dance). By concentrating mental energies on a single point, the mind becomes much more forceful and powerful. Meditation facilitates the practice of energy medicine in several ways. It sharpens focus and concentration, increasing the ability to connect with your one's own bioenergies for self-healing and brings the practitioner into dimensions of awareness where the bioenergetic connection between therapist and patient are facilitated. Meditation helps to connect with spiritual dimensions, connecting the meditator with spiritual inspiration and healing.(LeShan)

Research Meditation can help with pain; stress, substance abuse; hypertension; muscle tension, high cholesterol, and other problems. Extensive overviews of meditation research have been compiled by the Maharishi International University, covering over 500 studies and including a meta-analysis (Orme-Johnson/ Farrow). Michael Murphy and Steven Donovan have published a review of over 600 studies.(Murphy/Donovan) Meditation has been particularly helpful in treatment of hypertension, pain, and stress responses. The practice of meditation has been found to be cost effective, in that those who meditate regularly have reduced health care utilization significantly.(Orme-Johnson 1987)

Adverse effects:Emotional releases may occur spontaneously. People who are marginally compensated are at risk for emotional destabilization if they are not prepared or supported in dealing with such releases. Focusing inward in meditative states may also be confusing or disorienting, and may result in decompensation, so patients with.

Clinical efficacyIndications: Helpful for hypertension, stress, anxiety, pain, substance abuse.

Intuitive assessments and interventions
In the realms of energy medicine, when the therapist connects with the patient, there are times where exchanges of information occur that facilitate the healing. This has been termed non-local consciousness.(Dossey 1993) Energy medicine therapists report they often intuitively know where a patient's pathology is and are guided by intuition to offer bioenergetic interventions. Healers intuitively know where to put their hands, how to direct the energies, and for how long.(Benor 2001a)

Intuition is also reported to be helpful in identifying psychological contributors to physical and emotional problems. Intuitive CAM counselors may know intuitively that patients have suffered specific physical or emotional traumas that have contributed to their symptoms and illnesses. For instance, in giving a 40 year-old woman a laying-on of hands treatment for her headache, the author intuited that she was upset over a relationship with a man who was abusive towards her. She confirmed this and we were able to discuss how she could handle her relationship better, at which point her headache subsided. There are anecdotal reports of similar instances where anxiety, anger, hurt, or depression were released, and simultaneously backaches, stomach aches, or other physical problems rapidly cleared.(Benor 1995; 1996)

Research:A few studies confirm that healers may correctly assess with their hands areas on the body of the healee that are in pain.(Benor 2001a, b) Several pilot studies suggest that the aura perceived by healers can be correlated with physical, emotional, and mental conditions of people they view.(Benor 2001a; b) Healers using Therapeutic Touch, Reiki, and other approaches report that they rely on intuitive perceptions to guide their treatments.

Caution:Many intuitives believe that they perceive "the" state of the person they are "reading."In two pilot studies of several healers who viewed the aura of the same person simultaneously, each healer had different perceptions and interpretations of the meanings of these perceptions. The people being viewed confirmed that most of the various perceptions were relevant to their conditions.(Benor 1992) Intuitive assessments may therefore be accurate, but may relate only to parts of the problems. This is an area requiring further research.

Indications: Intuitive assessment is a non-invasive diagnostic approach with no known adverse effects. It can be a useful complement to conventional assessments.

OTHER ENERGY MEDICINE THERAPIES
Anthroposophic Medicine, Ayurveda, Naturopathic Medicine, Traditional Chinese Medicine

Each of these approaches may include energy medicine as an aspect of their treatments.

Homeopathy, a different form of energy medicine, is described elsewhere in this volume.of Medical Clinics of North America.

GENERAL ISSUES OF SAFETY
Side effects of energy medicine interventions are very limited. The most common one is an increase of symptoms as therapy is initiated and bioenergy patterns are stirred. The increased symptoms are generally viewed as a positive sign that the problem is shifting and prognosticate an improvement with continued treatment.

Delaying other treatments that are potentially beneficial is a conceivable problem. However, we have very little research to clarify which therapies are best for given problems. [I AM UNCLEAR WHY YOU WOULD SUGGEST DELETING THE LAST SENTENCE.] The best approach is often to use both conventional and energy medicine interventions together. Most of these energy medicine interventions are excellent complements to conventional interventions.

Malpractice insurance is carried by many energy medicine practitioners. They have a very low rate of claims.

PROFESSIONAL CERTIFICATIONS AND LICENSING
Acupuncture, chiropractic, and osteopathy are licensed professions in many states. Homeopathy is recognized in some states but limited to physician use. Most of the other energy medicine practices are unregulated and unlicensed.

In Minnesota a law was passed in 2000 permitting CAM therapists to practice without license or restriction, as long as their interventions were not invasive or harmful.

CHOOSING AN ENERGY MEDICINE PRACTITIONER
Personality compatibility variables are as important as knowledge, innate gifts and technical skills. The practitioner is the instrument for providing the treatment. Practical common sense is a very helpful counterbalance to bioenergy, intuitive and spiritual gifts.

Paradigm conflicts may arise between approaches. There may be conventional therapies that are viewed by some energy medicine therapists as potentially harmful.

EXPERIENTIAL EXERCISE
While randomized controlled trials are the gold standard for research, prior to this step it is possible to explore clinical efficacy of treatments through personal exploration and casual clinical trials, particularly when these are easily applied, without risk. You may explore this exercise yourself or introduce it to a patient. It takes about five minutes for a basic introduction.

Pick a problem you'd like to work on. Identify on a scale of zero to 10 how intense your discomfort is when you focus on this problem. Using your index and middle finger (of either hand), alternate tapping on the median end of each eyebrow, across the bridge of your nose. As you do this, recite this affirmation to yourself:"Even though I have this (insert words that identify your anxiety, phobia, or residual emotional distress from a past event), I completely and totally accept and love myself."Take one deep breath and continue to tap your eyebrows while focusing on your problem. After a few minutes, pause and re-assess how intense the negative feelings are. You may continue again in a similar manner until you have brought the feelings about the situation down to zero.

It is then possible to formulate a counterbalancing, positive affirmation to replace whatever negatives you have eliminated. Note on a scale of zero to 10 how strongly you feel the positive. State the positive affirmation while tapping in the same manner. After a few minutes, pause and note how much stronger the positive feels. Continue until you bring it up to a 10 or as high as you can.

SUMMARY
Growing bodies of clinical experience and research suggest there are major benefits for patients, physicians, and CAM practitioners with the integration of energy medicine with conventional medical care.

Conventional medical practice is excellent for infections, surgically correctable problems, hormonal dysfunctions, and for some genetic defects. There are many illnesses for which conventional medicine can offer treatment, with medications and surgerical interventions. Side effects of medications may be troublesome, and Rrisks of allopathic medicine include side effects of medications and surgery, which may sometimes be include fatalities;.

Energy medicine interventions may complement conventional care and have minimal risks. In addition, patients report high satisfaction with energy medicine interventions because perhaps because CAM therapists often offer them significant amounts of time to talk about their problems.

Most energy medicine practitioners are not familiar with conventional medical diagnoses or research methodology. Conventional medical wisdom can inform and enhance energy medicine practice by encouraging further research. Hopefully, the future will bring more collaboration, greater acceptance of integrative care, and greater appreciation of energy medicine.

Table 1. Energy Medicine Modalities

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This article was published originally as

Benor, Daniel J, Energy medicine for the internist, Medical Clinics of North America 2002, 86(1), 105-125

Copyright © Philadelphia, PA: Saunders/Elsevier 2002