The Therapeutic Order

Published on by Rachel Fry

Before I get to talking about the Therapeutic Order, a quick introduction!

Hi! I’m Dr. Rachel Fry, Naturopathic Physician. In my blog posts, I try to condense my natural medicine knowledge into relevant and digestible pieces for you (like a great hydrotherapy wading pool – not too long and not too deep). If you want to know more about a certain topic, I’d love to write about it for you! Send me an email to [email protected] with “Blog Request” in the subject line.

In my last post, we covered the Six Principles of Naturopathic Medicine (check it out here!), and I told you there were a few more ideas that formed the basis for naturopathic medicine philosophy. Let’s dive into them!

The Therapeutic Order

In essence, the Therapeutic Order is a list, in order, from least force interventions to highest force interventions. It is used in context of deciding what level of intervention is needed to start treatment for any particular condition.

Least force (top) to highest force (bottom)

  • Establish the Foundation for Optimal Health
    • Remove obstacles to cure
    • Assess the Determinants of Health
  • Stimulate Self-Healing
  • Tonify Weakened Systems
  • Restore Structural Integrity
  • Address Pathology: use of natural substances
  • Address Pathology: use of drugs
  • High Force Interventions
    • Includes use of surgery
Image of a large, ornate cannon, half-covered in snow, on a pedestal, with a small pile of very large cannonballs in front of it. This is a representation of overkill per the Therapeutic Order, if a lesser force is needed.

Have you heard the expression “killing a mosquito with a cannonball”? In this case, you may consider slapping your hand over the mosquito as the least force killing method. Then, as a higher force, using a fly-swatter; and higher force still, maybe a book. The cannonball is an obviously high-force intervention, and in this case absurdly out of place with the level of necessity to eliminate a single mosquito. Correspondingly, thinking ill of the mosquito is insufficient force to be a killing method.

The Therapeutic Order in Practice

In the same way, there is an order for addressing health and illness. For a similarly absurd example, you wouldn’t remove your head because you have a headache. But consider a more realistic example of high blood pressure. The therapeutic goal is to lower it into safe and normal ranges, but how do you do that and how fast does it need to happen?

For really high pressure, you may need a higher force intervention (like a drug) that works right away, but you still need to mitigate the force at that level by not reducing too much too fast (by adjusting the dose). At the same time, you can also use lower force interventions (like diet and lifestyle) that take more time to show effect. And eventually you may be able to reduce or eliminate the drug, but it did what you needed it to at the time you needed it.

You need to match severity of the condition with high enough force of treatment. A bandage is insufficient if stitches are needed. The Therapeutic Order is a way for NDs to balance where to start treatment for maximal patient safety. It doesn’t mean we are opposed to higher force interventions when needed, but we don’t want to kill mosquitoes with cannonballs when a simple hand slap will do.

See a helpful representation of the Therapeutic Order here.

What’s next?

After all this, you can begin to see why naturopathic medicine looks and operates a little differently. So what does treatment from an ND actually look like? Next time, I’ll cover naturopathic medical education and regulation, which shapes how treatment might look different from one ND to another. In the meantime, check out my Services page for a sampling of naturopathic treatments.