B. Other Alternative Modalities

Apart from modalities that are fully regulated by provider practice acts, alternative health care legislation in the United States also consists of references to specific therapeutic techniques generally incorporated in statutes defining the scope of practice for more comprehensively regulated modalities. As existing statutes typically do not formally define these therapies, the succeeding discussion where necessary refers to nonlegal sources for this limited purpose. Among the therapies included in this category of enactments, however, art therapy, naprapathy, oriental medicine, and reflexology are atypical in that each of these modalities is subject to licensure in its own right in at least one state.[119]


1. Acupressure
In common with acupuncture, acupressure is based on the principle that the body contains energy channels or meridians through which flows a vital life energy or qi. Unlike acupuncture, however, acupressure does not involve the use of needles to stimulate energy points along the meridians, but employs pressure from the fingers and hands for the same purpose. In stimulating the energy points in this way, acupressure aims to remove energy blocks which produce health problems.[120]

State statutes generally treat acupressure as an adjunct therapy to either acupuncture[121] or massage.[122] Acupressure is also referenced in Washington's chiropractic practice act, which prohibits the state chiropractic board from adopting educational standards that mandate the study of acupressure as a requirement of graduation from or accreditation

of chiropractic schools and colleges, or that include this modality in computing the hours required for chiropractic instruction.[123]


2. Alexander Technique
The Alexander technique is predicated on the connection between serious physical problems and faulty posture in sitting, standing, and moving. Through awareness, movement, and touch, the modality aims to interrupt habitual patterns of posture, restore the correct relationship of head, neck, and back, and thereby promote proper balance, posture, and movement in the body, as well as improvement in conditions of disease that have been adversely affected by faulty physical use of the body.[124]

Alexander technique is deemed a method a "massage/bodywork" under the Delaware Massage/Bodywork Practitioner Act and may be taught by schools and teachers that the state Committee on Massage/Bodywork Practitioners recognizes for purposes of the voluntary certification program established by this law.[125]


3. Aromatherapy
Aromatherapy utilizes the medicinal properties of essential oils extracted from plants and herbs through a process of steam distillation or cold pressing.[126] According to one source, "[t]he chemical makeup of essential oils gives them a host of desirable pharmacological properties ranging from antibacterial, antiviral, and antispasmodic, to uses as diuretics (widening blood vessels), and vasoconstrictors (narrowing blood vessels). Essential oils act on the adrenals, ovaries, and the thyroid and can energize or pacify, detoxify, and facilitate the digestive process.''[127] Treatments may be administered through inhalation, external application (e.g., bath, massage, compress, or topically), or by ingestion.[128]

The activities and services of aromatherapists are excluded from the law requiring licensure for counseling professionals in Maine.[129] There appear to be no other statutory references to this modality.


4. Art Therapy
In New Mexico art therapists are subject to licensure under the state Counseling and Therapy Practice Act.[130] The act formally defines the practice of art therapy

as the rendering to individuals, families, or groups, services that use art media as a means of expression and communication to promote perceptive, intuitive, affective and expressive experiences that alleviate

distress, reduce physical, emotional, behavioral and social impairment and lead to growth or reintegration of one's personality. Art therapy services include, but are not limited to, diagnostic evaluation, development of patient treatment plans, goals and objectives, case management services and therapeutic treatment.[131]

The New Mexico act further requires that a professional art therapist be a member of the state Counseling and Therapy Practice Board, specifies educational, experience, and examination requirements for art therapists, and subjects licensees to disciplinary standards in common with other counselors and therapists regulated by the act.[132]

In other states art therapy is not subject to licensure in its own right. Thus, in California art therapists are specifically excluded from licensing requirements applicable to psychiatric technicians,[133] while in Maine an individual who works as an "expressive" art therapist is exempt from licensing standards governing counseling professionals.[134] In the District of Columbia, art therapists are not subject to licensure requirements applicable to other regulated health occupations, provided the therapists work within the standards and ethics of the art therapy profession and do not hold themselves out by title, description of services, or otherwise to be practicing a regulated health occupation.

At the federal level, the Older Americans Act authorizes grants to states to provide art therapy as a supportive service to enable older individuals to attain and maintain well-being.[136] The act defines art therapy as the "use of art and artistic processes specifically selected and administered by an art therapist, to accomplish the restoration, maintenance, or improvement of the mental, emotional, or social functioning of an older individual."[137]


5. Bioenergetics
Bioenergetics, a life force or bioenergy in breathing exercises, talk release repressed emotions form of bodywork that presumes the existence of a the human body, utilizes a combination of deep therapy, massage, and bioenergetic exercises to and associated chronic muscular tensions and bodily rigidity or "armoring."[138] The therapy has been defined as a "system of techniques for mobilizing the energies of people whose forms of expression have become in some way blocked or disturbed. Whereas most existing systems of psychotherapy use primarily verbal techniques for exploring neurotic problems, in bioenergetic therapy we are concerned with the total expressive behavior of a person...with the quality of bodily movements and the fundamental rhythmic processes of the body, especially breathing."[139]

Under the Massage/Bodywork Practitioners Act in Delaware, bioenergetics is deemed a method of massage/bodywork. The act permits the modality to be taught by schools and teachers that the state Committee on Massage/Bodywork Practitioners recognizes for purposes of the voluntary certification program established by the statute. [140]


6. Biofeedback
The federal Health Care Financing Administration defines biofeedback as a therapy that "provides visual, auditory or other evidence of the status of certain body functions so that a person can exert voluntary control over the functions, and thereby alleviate an abnormal bodily condition. Biofeedback therapy often uses electrical devices to transform bodily signals indicative of such functions as heart rate, blood pressure, skin temperature, salivation, peripheral vasomotor activity, and gross muscle tone or light, the loudness or brightness of which shows the extent of activity in the function being measured.[141]

Most state laws that refer to biofeedback authorize the use of this modality in the practice of psychology. The texts of applicable psychology practice acts do not formally define this modality, but occasionally reference its general function. Thus, California and Maryland permit the use of biofeedback instruments that do not pierce or cut the skin "to measure physical and mental functioning."[143] Under Illinois law, biofeedback may be used to prevent or eliminate psychopathology or to ameliorate psychological disorders of individuals or groups. [144]

In three states, biofeedback is included within the scope of practice for physical therapists. [145] The Colorado law permits a physical therapist to use biofeedback as a monitoring instrument "to detect and amplify internal physiological processes for the purpose of neuromuscular rehabilitation."[146]

In New Hampshire, naturopaths may employ biofeedback for preventive and therapeutic purposes and in Washington biofeedback is one of several techniques of "suggestion that a naturopath may use in that

At the federal level, the Health Care Financing Administration authorizes coverage of biofeedback under Medicare only when it is reasonable and necessary for specific muscular reeducation or for treating pathological muscular abnormalities of spasticity, incapacitating muscle spasm, or weakness, and where more conventional treatments (i.e., heat, cold, massage, exercise, support) have not been successful. Moreover, biofeedback is not covered for treatment of ordinary muscle tension states or for psychosomatic conditions.] [149]


7. Bodywork
Alternative modalities involving some form of "bodywork" are increasingly common in alternative health care practice. The emerging state statutory law reflects recognition of this recent development, notably in explicit legislative references to "bodywork" in massage practice acts where bodywork therapy is included in the definition of massage.[150] Uniquely among the various state statutes governing massage therapy, Delaware enacted legislation in 1992 to establish a state entity (the Committee on Massage/Bodywork Practitioners) to administer a voluntary certification program for a variety of bodywork modalities which, in addition to massage, include Alexander technique, therapeutic technique, Feldenkrais, Hellerwork, Oriental bodywork, Rolfing, Trager, bioenergetics, and shiatsu.[151] The statute defines "massage/bodywork" as

...systems of activity applied to the superficial or deep tissue, muscle or connective tissue by means of applying pressure with hands, feet, arms or elbows in nonpathological conditions. Such application may include, but is not limited to, friction, stroking, rocking, tapping, kneading or nonspecific stretching whether or not aided by massage oils. Massage/bodywork practices are designed to promote general relaxation, improve joint mobilization or relieve stress and muscle tension, and to enhance a general sense of well-being in the client.[152]

To the extent that the number of bodywork modalities within the alternative health care field continues to proliferate, other states may be attracted to the concept of regulating these therapies under a composite administrative board along the lines of the Delaware law.


8. Chelation
Chelation therapy is within the scope of practice for homeopathy in Arizona and defined by the homeopathy practice act in that state as "medical therapy to restore cellular homeostasis through the use of intravenous, metal binding and bioinorganic agents such as ethylene tetraacetic acid."[153] The statute further specifies that, except for the treatment of heavy metal poisoning, chelation therapy is an experimental form of treatment.[154]

The medical and osteopathic practice acts in Arizona provide that the use of chelation therapy in the treatment of arteriosclerosis or as any other form of therapy, with the exception of treatment for heavy metal poisoning, is a ground for discipline unless (1) the patient receives adequate informed consent, (2) the treatment conforms to generally accepted experimental criteria (including protocols, detailed records, periodic analysis of results, and periodic review by a medical peer review committee), and (3) the treatment is approved by the FDA.[155]

Statutory tort law in Oklahoma also references chelation therapy and provides that, while the standard of care required of persons engaged in the healing arts in the state is determined by "national standards," this rule does not prohibit the use of chelation therapy.1__ In 1993, South Dakota amended its medical practice act to prohibit the Board of Medical and Osteopathic Examiners in that state from basing a finding of unprofessional or dishonorable conduct solely on the basis that a licensee practices chelation therapy.

Under federal law, the Health Care Financing Administration defines chelation therapy as the "application of techniques for the therapeutic or preventive effects of removing unwanted metal ions from the body."[158] Owing to controversy associated with the use of this modality to treat arteriosclerosis, HCFA denies coverage under Medicare for chelation therapy for that purpose:

...The application of chelation therapy using ethylenediamine-tetra-acetic acid (EDTA) for the treatment and prevention of arteriosclerosis is controversial. There is no widely accepted rationale to explain the beneficial effects attributed to this therapy. Its safety is questioned and its clinical effectiveness has never been established by well designed, controlled clinical trials. It is not widely accepted and practiced by American physicians. EDTA chelation therapy for arteriosclerosis is considered experimental. For these reasons, EDTA chelation therapy for the treatment or prevention of arteriosclerosis is not covered. [159]


9. Dance Therapy
Although dance therapy does not appear to be formally defined by state legislation, federal law specifies that "dance-movement therapy" is a process of psychotherapeutic movement facilitated by a dance-movement therapist to further emotional, cognitive, or physical health.[160]

Dance therapists are specifically excluded from licensure requirements applicable to psychiatric technicians in California.[161] In the District of Columbia, a person who practices dance therapy must register with the Mayor and may use the theories and techniques of this profession in accordance with appropriate ethical standards "to aid in the restoration and rehabilitation of mental and physical functions."162 The Mayor of the District of Columbia is authorized to establish standards of education and experience as a condition of registration and may adopt the standards of recognized national professional associations of dance therapists for this purpose. [163]

The federal Older Americans Act also recognizes the value of dance therapy in authorizing grants to the states to provide "dance-movement therapy" as a supportive service to enable older individuals to attain and maintain well-being.[164]


10. Drugless Therapy
The use of drugless forms of healing is common among alternative health care modalities. Only a few statutes, however, explicitly reference drugless healing or drugless therapy as such. Under a 1980 California law, the designation of drugless practitioner was abolished, but persons who were then authorized to practice drugless therapy may continue their practice and renew their licenses.[165] The statute provides that the state certificate in this field authorizes the practitioner to "treat diseases, injuries, deformities, or other physical or mental conditions without the use of drugs or what are known as medical preparations and without in any manner severing or penetrating any of the tissues of human beings except the severing of the umbilical cord."[166]

Washington law prohibits a person from practicing or representing himself or herself as a "drugless therapist" without a valid license. Moreover, any person who held a license to practice this therapy on January 1, 1988, is deemed licensed under the state naturopathic practice act.[167] In Pennsylvania, a 1986 law provides that drugless therapists who have been licensed by the state medical board may continue to provide this type of treatment in accordance with regulations of the board.[168]

In two jurisdictions, a person who holds a valid authorization from the state as a drugless practitioner is exempt from the requirements of the state massage laws.[169] Elsewhere, isolated statutory references exist which declare or acknowledge drugless therapy or methods to be within the scope of practice of chiropractic170 or naturopathy.[171]


11. Feldenkrais
The Feldenkrais method endeavors to correct habitual negative patterns of movement on the premise that if these patterns are interrupted, the body will function with greater ease and fluidity and thereby improve a person's self-image, awareness, and health. Corrective techniques include the proper use of breath, movement sequences keyed to the client's unique needs to improve mobility, and communicative touch by the practitioner to enhance the client's sense of self-image and movement.[172]

Feldenkrais is a method of massage/bodywork under Delaware's Massage/Bodywork Practitioners Act. The modality may be taught by schools and teachers recognized by the Delaware Committee on Massage/Bodywork Practitioners under the state's voluntary certification program for practitioners in this field.[173]


12. Hellerwork
Hellerwork focuses on the synergistic relationship between the mechanical, psychological, and energetic functions of the body to facilitate structural realignment and an awareness of the mind/body relationship. Techniques utilized by Hellerwork practitioners include deep touch, dialogue incident to the release of unconscious holding patterns in the body, and movement and awareness education in relation to sitting, standing, walking, lifting, and running for purposes of reducing mechanical stress in the body and permitting more efficient use of personal energy.[174]

The Massage/Bodywork Practitioners Act of Delaware recognizes Hellerwork as a method of massage/bodywork for purposes of the voluntary certification program authorized by that statute.[175]


13. Herbology
Statutory authorizations for the therapeutic use of herbs are within the scope of practice for a number of alternative modalities. In Nevada and New Mexico, herbs may be used by practitioners of oriental medicine.] [176] The Nevada law defines "herbs" as "plants or parts of plants valued for medicinal qualities" and indicates that the practice of herbal medicine involves "suggesting, recommending, prescribing or directing the use of herbs for the cure, relief or palliation of any ailment or disease of the mind or body, or for the care or relief of any wound, bodily injury or deformity.''] In New Mexico licensure requirements otherwise applicable under the Acupuncture and Oriental Medicine Practice Act are not enforced against a person who provides information about the general use of herbal medicines. This privilege applies if the person does not hold himself or herself out as a doctor of oriental medicine or as a practitioner of acupuncture or oriental medicine.[178]

The use of herbs is authorized under acupuncture practice acts in California, North Carolina, Oregon, and Texas. In California, a person who holds out publicly as an "Oriental herbalist" or as a "certified herbalist" must be licensed as an acupuncturist.[180] The Virginia acupuncture act, however, states that the practice of acupuncture does not include the use of herbal preparations.[181]

The naturopathy practice acts in several states permit the administration of herbal remedies [182] and Oregon law requires the study of herbology as a condition of naturopathic licensure.[183] In Alaska, herbs are considered a "dietetic" that may be employed by naturopaths.[184] In Washington, "oriental herbology. is exempted from licensing requirements under the naturopathy practice act.[185] Although Montana deems the use of botanical medicines to be within the scope of its naturopathy law, the statute recognizes that the use of herbs is not the exclusive privilege of naturopathic physicians and allows a person who is not licensed in naturopathy to use, prescribe, and administer these substances.[186]

Florida recognizes the application of herbal preparations as within the scope of practice for massage, but exempts persons from the massage licensure requirement if they use herbal wraps to cleanse and beautify the skin or in conjunction with a weight loss program.[187]

Chiropractors in New Mexico may employ herbal remedies,[188] but in Washington the law would permit chiropractors to recommend nutritional supplements only and not medicines of herbal origin.[189]

In Idaho an unlicensed health care provider may administer herbal treatment or provide advice about the use of herbs if the provider obtains from each patient or client an informed consent authorization which provides an overview of the provider's education and states that the provider is not a medical doctor or osteopath nor licensed under the state medical practice act.[190] In North Carolina, an herbalist who provides nutritional information and counseling concerning herbs is exempt from licensure requirements under the state Dietetics and Nutrition law, provided the herbalist furnishes nonfraudulent nutritional information and counseling about the reported or historical use of herbs and does not hold out as a dietitian or nutritionist.[191]

Federal regulation of herbs as dietary supplements under the Nutrition Labeling and Education Act of 1990 and the Dietary Supplement Health and Education Act of 1994 is noted in Part III-8 of this study.[192]


14. Holistic Healing
The holistic approach to health and healing involves consideration of a person's physical, mental, emotional, and spiritual state of being. Statutory awareness of this paradigm is evident in the following statement of legislative purpose for the acupuncture practice act in California:

In its concern with the need to eliminate the fundamental causes of illness, not simply to remove symptoms, and with the need to treat the whole person, the Legislature intends to establish in this [act], a framework for the practice of the art and science of oriental medicine through acupuncture.

The purpose of this [act] is to encourage the more effective utilization of the skills of acupuncturists by California citizens desiring a holistic approach to health and to remove the existing legal constraints which are an unnecessary hindrance to the more effective provision of health care services. Also, as it effects the public health, safety, and welfare, there is a necessity that individuals practicing acupuncture be subject to regulation and control as a primary health care profession.[193]

Recognition of the holistic approach to healing is also reflected in the Professional Psychologist and the Counseling and Therapy practice acts in New Mexico which provide that -these enactments are not to be construed to prevent a holistic practitioner from engaging in nonclinical activities consistent with the standards and codes of ethics of that practice.[194]


15. Hydrotherapy
Hydrotherapy employs water, ice, and hot and cold temperatures through such procedures as full body immersion, baths, saunas, colonic irrigation, and compresses and packs. Treatment by this means has been favorably noted for a variety of health problems involving stress, physical pain, toxic conditions, bacterial infections, and viruses. [195]

Explicit statutory references to hydrotherapy appear most frequently in legislation recognizing this procedure as part of massage practice or coursework [196] or as within the scope of practice for naturopathy.[197] The use of hydrotherapy is also expressly permitted in some states for chiropractors,[198] physical therapists,[199] and occupational therapists.[200] In New Mexico, the right to use hydrotherapy extends not only to massage providers, but to other licensed practitioners of the healing arts generally, including unlicensed persons who do not claim to be physical therapists and work under the immediate supervision of a healing arts licensee [201] In Delaware and South Dakota, athletic trainers may use hydrotherapy.[202]


16. Hypnotherapy
Statutory references to hypnotherapy or hypnosis in the context of health occupations legislation generally do not provide a formal definition for this modality. Exceptionally, Florida's "Hypnosis Law," which recognizes that hypnosis "has attained a significant place as another technique in the treatment of human injury, disease, and illness, both mental and physical,"[203] defines hypnosis as

...hypnotism, mesmerism, posthypnotic suggestion, or any similar act or process which produces or is intended to produce in any person any form of induced sleep or trance in which the susceptibility of the person's mind to suggestion or direction is increased or is intended to be increased, where such a condition is used or intended to be used in the treatment of any human ill, disease, injury, or for any other therapeutic purpose.[204]

Where referenced by statute in a health occupations context, hypnotherapy or hypnosis is predominately declared to be within the scope of practice of psychology.[205] Depending on the state practice rights may also extend to marriage and family counselors,[206] -anesthetists,[207] naturopaths,[208] clinical social workers, [209] mental health counselors,[210] medical practitioners,[211] and healing arts licensees generally.[212]

In Washington, hypnotherapists may register separately under a state credentialing act for counselors. The act expressly recognizes, however, the; the practice of hypnotherapy is not necessarily limited to counseling.[213]

A few states refer to both hypnosis and hypnotherapy in the same statute, but for different purposes. Thus, Missouri specifies that hypnosis is within the scope of practice for psychology, but excludes hypnotherapists from the associated licensure requirement.[214] The Texas psychology practice act, on the other hand, declares that hypnosis "for health care purposes" and hypnotherapy are both within the scope of practice for [215]

The practice of hypnosis may be subject to varying statutory conditions relating to the educational qualifications and clinical experience of practitioners [216] or to prohibitions on the use of hypnosis by dentists, optometrists, podiatrists, chiropractors, osteopaths, and physicians for neurotic difficulties of a patient, as opposed to its use for hypnoanesthesia or for allaying anxiety during health care treatment by these providers.[217] In common with other counselors regulated by Washington's credentialing act for the counseling profession, a hypnotherapist must provide information to a client about the practitioner's practice, education and training, the patient's treatment options, and other matters specified in administrative rules of the state Department of Health.[218]


17. Music Therapy
Under the federal Older Americans Act, music therapy is defined as the "use of musical or rhythmic interventions specifically selected by a music therapist to accomplish the restoration, maintenance, or improvement of social or emotional functioning, mental processing, or physical health of an older individual.''[219]

In California, music therapists are excluded from licensure requirements applicable to psychiatric technicians[220] and in Texas music therapy is deemed a related service (i.e., a noninstructional developmental, corrective. supportive, or evaluative service) for use with disabled students.[221] Under federal law, the Older Americans Act authorizes grants to states to provide music therapy as a supportive service to enable older persons to attain and maintain well-being.


18. Naprapathy
The Illinois naprapathy practice act defines naprapathy as :

...the evaluation of persons with connective tissue disorders through the use of naprapathic case history and palpation or treatment of persons by the use of connective tissue manipulation, therapeutic and rehabilitative exercise, postural counseling, nutritional counseling, and the use of the effective properties of physical measures of heat, cold, light, water, radiant energy, electricity, sound and air, and assistive devices for the purpose of preventing, correcting, or alleviating a physical disability.[223]

The Illinois statute recognizes the application of naprapathy for a variety of health conditions, including the treatment of contractures, muscle spasms, inflammation, scar tissue formation, adhesions, lesions, laxity, hypotonicity, rigidity, structural imbalance, bruising, contusions, muscular atrophy, and partial separation of connective tissue fibers.[224] The law requires naprapaths to be licensed, specifies associated educational and examination requirements, and imposes penalties for infraction by naprapathy licensees of various standards of professional conduct.[225] The state Department of Professional Regulation administers the practice act with the advisory assistance of a seven member Naprapathic Examining Committee which reviews proposed regulations of the department concerning practitioners in this field.[226] A naprapath must refer to a licensed physician, dentist, or podiatrist any patient whose medical condition, at the time of treatment, should be determined to be beyond the scope of practice for the naprapath.[227]

Certification for naprapathy as a limited branch of medicine by the state medical board in Ohio was discontinued after March 2, 1992, but naprapaths certified before that date may continue to practice under rules promulgated by the board.[228]

19. Oriental Medicine
References to oriental medicine often appear in acupuncture practice acts in connection with the legislative definition of "acupuncture,"[229] with requirements concerning the use of professional titles for acupuncture,[230] and as part of educational qualifications for acupuncture practitioners.[231] In Nevada and New Mexico, however, oriental medicine is subject to licensure in its own right. Under Nevada law, oriental medicine is defined as a

...system of the healing art which places the chief emphasis on the flow and balance of energy in the body mechanism as being the most important single factor in maintaining the well-being of the organism in health and disease. The term includes the practice of acupuncture and other services approved by the [B]oard [of Oriental Medicine].[232]

The Nevada statute requires the board to issue separate licenses to practice oriental medicine and acupuncture and designates the licensees respectively as "doctors of oriental medicine" and "doctors of acupuncture."[233] In common with provider practice acts for other health professions, the act also specifies educational and training qualifications for licensure, provides for an examination, enforces disciplinary grounds for unprofessional conduct, and prohibits unauthorized practice.[234]

The New Mexico licensure act for oriental medicine defines this modality as

...the distinct system of primary health care that uses all allied techniques of oriental medicine, both traditional and modern, to diagnose, treat and prescribe [techniques of oriental medicine] for the prevention, cure or correction of any disease, illness, injury, pain or other- physical or mental condition by controlling and regulating the flow and balance of energy and functioning of the person to restore and maintain health....[235]

The techniques of oriental medicine to which the preceding definition applies include diagnostic and treatment procedures, acupuncture, moxibustion, manual therapy (tui na), breathing and exercise techniques, herbal and homeopathic medicine, vitamin, mineral, enzyme, glandular, or nutritional supplements, and dietary, nutritional, and life-style counseling.[236]

Unlike the law in Nevada, the New Mexico practice act authorizes the state Board of Acupuncture and Oriental Medicine to issue only one license and designates the licensee as a "doctor of oriental medicine" (D.O.M.).[237] The Board is further required to specify educational qualifications for licensure, to provide an examination for license applicants, and to enforce disciplinary sanctions against licensees for conduct prohibited by the


20. Polarity Therapy
As is true of a number of bodywork modalities, polarity therapy also reflects an understanding of the nexus between energy blockages in the body and resulting illness. To release these blockages and restore the natural flow of energy, polarity practitioners use such measures as manipulation of pressure points and joints, massage, breathwork, hydrotherapy, reflexology, and the holding of energy points on the body. This modality also employs stretching and other exercises, as well as dietary counseling and emotional balancing techniques.[239]

In Maine, practitioners of polarity therapy are not subject to the requirements of the state massage practice act if the practitioners do not use the title "massage therapist" or "massage practitioner."[240] In North Dakota, however, polarity is declared to be part of the practice of massage for which registration is required under the statute.[241]


21. Reflexology
In 1993, North Dakota enacted the first reflexology practice act in the United States and established an independent administrative board to regulate this modality.[242] The act defines reflexology as "application of specific pressure by the use of the practitioner's hands, thumbs, and fingers to reflex points in the client's hands, feet, or ears using alternating pressure, and such techniques as thumb walking, finger walking, hook and backup, and rotation on a reflex.[243] The law prohibits a reflexology licensee from using lotions, creams, or mechanical devices in the application of reflexology or from diagnosing or treating specific diseases, practicing spinal or other joint manipulations, prescribing or adjusting medication, or prescribing or administering vitamins.[244]

In other states, statutory references to reflexology are limited to including or excluding this modality from the scope of practice of massage. Thus, in Arkansas, reflexology is deemed a massage procedure,[245] while in Washington a practitioner who uses the term "reflexologist" as a professional title or in describing the practitioner's services is treated as a massage practitioner and made subject to the licensure requirements of the state massage practice act.[246] Maine, however, views reflexology as another form of tissue work beyond the purview of the massage practice act as long as the reflexologist does not use the title "massage therapist" or "massage practitioner."[247]


22. Reiki
The modality of reiki functions on the premise of the existence of a universal life energy (ki), the activation of which through the touch of the practitioner's hands serves to balance and replenish personal energy, to remove energy blockages that lead to unhealthy conditions and to maintain a sense of well-being within a holistic paradigm of health.[248]

Reiki is specifically exempted from the requirements of the massage practice act in Maine. The statute declares reiki to be another "form of tissue work exclusive of massage therapy" as long as the reiki practitioner does not use the title "massage therapist" or "massage practitioner."[249]


23. Rolfing
The practice of Rolfing is based on an understanding of the effect of bodily structure on a person's physiological and psychological state. Through the use of pressure applied with the fingers, knuckles, and elbows, the Rolfing practitioner endeavors to manipulate and stretch the body's fascial tissues to reestablish proper physical alignment of the head, torso, pelvis, legs, and feet and to promote associated mental and emotional balance.[250]

The few statutory references to Rolfing occur in the context of the regulation of massage. Under the Delaware Massage/Bodywork Practitioners Act, Rolfing is one of several modalities eligible for voluntary certification by the state.[251] Maine law exempts Rolfing from the requirements of the massage practice act if Rolfing practitioners refrain from using the title "massage therapist" or "massage practitioner."[252] Prior to 1993, Arkansas treated Rolfing as a form of massage therapy under the state massage practice act, but an amendment to the law in that year deleted the explicit statutory reference to this modality in favor of broad language that includes as part of massage "any hands-on bodywork techniques and procedures" that are not regulated by other licensing boards in the state.[253] This expansive language presumably would continue to cover Rolfing as a "hands-on bodywork technique or procedure."


24. Shiatsu
Practitioners of shiatsu apply deep pressure along the acupuncture meridians of the body to stimulate the flow of life energy (chi) to remove energy blockages to healing. Pressure is applied principally by the fingers, but may also be administered through the knees, elbows, toes, heels of the hands and feet, and the pad of the practitioner's foot. [254]

Shiatsu is a method of massage/bodywork eligible for voluntary certification under the Delaware Massage/Bodywork Practitioners Act [255] and

an "equivalent team" for massage therapy under the massage practice act of Louisiana.[256] Maine excludes shiatsu from the requirements of the state massage practice act, provided the shiatsu practitioner does not use the title "massage therapist" or "massage practitioner."[257]


25. Spiritual Healing
State codes contain numerous provisions accommodating spiritual or religious healing practices. The specific nature of the accommodation varies, but often exists as an exemption from licensure or other state requirements[258] or as an affirmative benefit, such as coverage of spiritual healing under a health plan.[259] New Mexico specifically exempts "metaphysical" practitioners from licensure requirements under the state psychology and counseling and therapy practice acts if the practitioner engages in nonclinical activities consistent with the standards and codes of ethics of that practice.[260]

The succeeding discussion treats exemptions enjoyed by spiritual healers from licensure primarily under state medical practice laws. Exemptions of this type are particularly significant in light of the First Amendment's guaranty of the Free Exercise of religion and what would otherwise be an all-encompassing definition of the practice of medicine under the laws of most states.[261]

The most common type of exemption permitted by state medical practice acts for spiritual healing is available only to persons whose healing method is in accordance with the practices or tenets of a "church."[262] In a number of other states, the exemption is further narrowed to apply only to spiritual healers of a particular religious denomination, notably Christian Scientists.[263] Several states explicitly or implicitly recognize the right of both Christian Scientists and persons from other unspecified religious denominations to engage in spiritual healing.[264]

The particular "form" of the spiritual healing technique is significant in some jurisdictions for purposes of the exemption from medical licensure. Michigan, for example, authorizes the exemption only if the practitioner uses "prayer."[265] In Vermont the exemption is not permitted for persons who attempt to cure disease by "faith cure," "mind healing," or the "laying on of hands," but is available to persons "who merely practice the religious tenets Of their church without pretending a knowledge of medicine or surgery."[266]

Oregon law is somewhat ambiguous concerning the form spiritual healing must take to qualify for an exemption from medical licensure as the applicable statute contains both permissive and restrictive standards. On one hand, the law specifies that the exemption is available not only to spiritual healers who use "prayer," but also to persons who employ "other spiritual means." On the other hand, this permissive authorization seems qualified in that the use of either form of healing must occur in accordance with the tenets of a "church."[267] Within this legal framework, however, the same statute contains the following broad disclaimer regarding the selection and use of a particular form or provider of spiritual healing:

Nothing in this [medical practice act] interferes in any manner with the individual's right to select the practitioner or mode of treatment of an individual's choice, or interferes with the person so employed to give the treatment so chosen if public health laws and rules are complied with.[268]

Constitutional and interpretative issues that might arise under some of the preceding laws are less apparent in other states where statutory exemptions from medical licensure seemingly apply whether or not the particular spiritual healing modality constitutes the tenets of a "church," is associated with a particular religious denomination, or assumes any prescribed form. Thus, a number of states, without any further qualifications regarding church tenets, denominational affiliation, or healing technique, have adopted straight forward statutes which broadly authorize the application of the medical licensure exemption for a person who uses prayer or mental or spiritual means. Enactment of similarly permissive exemptions may become increasingly important in other jurisdictions for spiritual healers whose contemporary practices do not fit the restrictive criteria found in many medical practice acts. acts. [269]

In addition to restrictions on spiritual healing that are keyed to denominational or church affiliation or to the form of the healing technique itself, the law in many states, including states whose statutes are otherwise permissive, nevertheless mandates compliance with other conditions to obtain an exemption from medical licensure. In general, these conditions are intended to ensure that spiritual healers avoid the use of medical titles, comply with public health and sanitation requirements, or do not perform surgery or prescribe drugs or other medications.[270]


26. Touch Therapy
Many alternative modalities involve the use of touch in one form or another to achieve therapeutic benefits. Less generically, the specific modality of "Therapeutic Touch" has been described as "a contemporary interpretation of several ancient healing practices in which the practitioners consciously direct or sensitively modulate human energies."[271] Practitioners of the modality known as Therapeutic Touch generally do not actually touch the body of the patient, but endeavor to assess and remove blockages in the patient's energy field through slow and rhythmic movements of the practitioner's hands several inches from the

There are few statutory references to touch therapy as a distinct modality. In the state of Washington, however, a person who designates himself or herself as a "touch therapist" is deemed to be a massage practitioner and subject to regulation under the state massage practice act.[273] "Touch" is noted as a massage procedure by the North Dakota massage practice law [274] and as a form of therapy used nonexclusively by naturopaths in Montana.[275]


27. Trager
Trager therapy uses gentle, rhythmic touch and movement exercises to facilitate awareness and release of tension arising from habitual patterns of posture and movement.[276] Specifically, Trager aims "to us[e] motion in muscles and joints to produce particular sensory feelings, namely positive, pleasurable feelings that enter the central nervous system and begin to trigger tissue changes by means Of the many sensory-motor feedback loops between the mind and the muscles."[277]

The Massage/Bodywork Practitioners Act in Delaware recognizes Trager for purposes of the voluntary certification program authorized by the act.[278] Maine excludes this modality from the requirements of the state massage practice law if practitioners of Trager do not use the title "massage therapist" or "massage practitioner."[279]


119. See infra pp. 16-17 and 26-28.

120. See Alternative Medicine-The Definitive guide 109-110 (1993) (Burton Goldberg Group Comp.) [hereinafter cited as Alternative Medicine] and B. Inglis and R. West, The Alternative Health Guide 133-37 (1983) [hereinafter cited as Inglis and West].

121. See Calif. Bus. & Prof. Code Ann. § 4937(b) (West 1990); Hawaii Rev. Stat. § 436E-2 (1985); and Wash. Code Ann. § 18.06.010(1)(d) (Supp. 1994)

122. See La. Rev. Stat. Ann. tit. 37, § 3552(5) (West Supp.1994) and N.D. Cent. Code Ann. § 43-25-02(3)(1993).

123. See Wash. Rev. Code Ann. § 18.25.025 (1989).

124. See Alternative Medicine supra n. 120, at 99-100.

125. Del. Code Ann. tit. 24, § 5306(1) (Supp. 1992).

126. See Alternative Medicine supra n. 120, at 53-60.

127. Id. (quoting Dr. (rer. nat.) Kurt Schnaubelt, Director, Pacific Institute of Aromatherapy).

128. See Alternative Medicine supra n. 120, at 53-60.

129. Me. Rev. Stat. Ann. tit. 32, §13856(10) (Supp. 1994).

130. N.M. Stat. Ann. §§ 61A-9A-1 to 61A-9A-30 (1993).

131. Id. § 61-9A-3N (1993).

132. Id. §§ 61-9A-7(B)(1), 61-9A-13, and 61-9A-26 (1993).

133. Calif. Bus. & Prof. Code §4507(i) (West 1990).

134. Me. Rev. Stat. Ann. tit. 32, §13856(10) (Supp. 1994).

135. D.C. Code Ann. § 2-3301.3(d)(7) (1994).

136. Older Americans Act of 1965, as amended, 42 U.S.C.A. § 3030d(a)(7) (Supp. 1994) [hereinafter cited as Older Americans Act].

137. Id. §3002(18).

138. See Inglis and West supra n. 120, at 209-11.

139. G. Kogan (ed.), Your body works: A Guide to Health, Energy and Balance (1980), quoted in Inglis and West supra n. 120, at 209.

140. See Del. Code Ann. tit. 24, § 5306(1) (Supp. 1992).

141. 54 Fed. Reg. 34,566 (Aug. 21, 1989).

142. See Alaska Stat. § 08.86.230(6)(B) (Sept. 1991); Calif. Bus. & Prof. Code § 2903.1 (West 1990); Colo. Rev. Stat. § 12-43-301(3)(d) (1991); Fla. Stat. Ann. § 490.003(4) (1991); Hawaii Rev. Stat. § 461J-1(2) (1985); Ill. Comp. Stat. Ann. ch. 225, § 15/2(5) (Smith-Hurd Supp. 1994); La. Stat. Ann. tit. 37, § 2352(5) (West 1988); Me. Rev. Stat. Ann. tit. 32, § 3811(2) (1988); Md. Health Occup. Code Ann. § 18-101(e)(2)(iii) (1991); Mass. Gen. Laws Ann. ch. 112, § 118 (West Supp. 1994); Mich. Stat. Ann. § 14.15 (18201) (1)(b) (Callaghan 1994); Minn. Stat. Ann. § 148.89(5)(2) (West Supp. 1994); Miss. Code Ann. §73-31-3(d) (Supp. 1994); Mo. Rev. Stat. Ann. § 337.015(3) (Vernon Supp. 1994); Mont. Code Ann. §37-17102(4)(b) (1993); N.M. Stat. Ann. § 61-9-3D (1993); Okla. Stat. Ann. § 1352(3) (West Supp. 1994); R.I. Gen. Laws § 5-44-1(a) (Supp. 1994); S.D. Codified Laws Ann. § 36-27A-1(3) (1994); Tenn. Code Ann. §63-11-203(a) (Supp. 1994); Tex. Rev. Civ. Stat. Ann. art. 4512c, § (2)(c) (Vernon Supp. 1995); Utah Code Ann. § 58-61-102(9)(a)(iv) (Supp. 1994); and Wyo. Stat. Ann. § 33-27-113(a)(iii)(B) (Supp. 1993).

143. See Calif. Bus. & Prof. Code § 2903.1 (West 1990) and Md. Health Occup. Code Ann. § 18-101(e)(2)(iii) (1991).

144. Ill. Comp. Stat. Ann. ch. 225, § 15/2(5) (Smith-Hurd Supp. 1994).

145. See Colo. Rev. Stat. § 12-43-301(3)(d) (1991); Hawaii Rev. Stat. § 461J-1(2) (1985); and Utah Code Ann. § 58-61-102(9)(a)(iv) (Supp. 1994).

146. Colo. Rev. Stat. § 12-43-301(3)(d) (1991).

147. N.H. Rev. Stat. Ann. § 328-E:4I (Supp. 1994).

148. Wash. Rev. Code Ann. § 18.36A.020(14) (Supp. 1994).

149. 54 Fed. Reg. 34,566 (Aug. 21, 1989).

150. See Ark. Code Ann. § 17-98-102(1)(H) (Supp. 1993) ("any hands-on bodywork techniques and procedures" not covered under the licensing laws of other boards in the state are covered under the definition of "massage therapy"); Iowa Code Ann. § 152C.1(4) (West Supp. 1994) ("bodywork" or "bodywork therapy" is included in the definition of "massage therapy"); and N.M. Stat. Ann. § 61-12C-4(A) (1993) ("bodywork" is a synonymous term for "massage therapy").

151. The Professional Massage/Bodywork Practitioners Act, Del. Code Ann. tit. 24, §§ 5301-5315 (Supp. 1992).

152. Id. § 5305(5).

153. Ariz. Rev. Stat. Ann. § 32-2901(A)(3) (1992).

154. Id. § 32-2901(B).

155. Ariz. Rev. Stat. Ann. §§ 32-1401 and 32-1854 (1992).

156. Okla. Stat. Ann. tit. 76, §§ 20.1 and 20.2 (West 1987).

157. S.D. Codif. Laws § 36-4-29 (Supp. 1994).

158. 54 Fed. Reg. 34,572 (Aug. 21, 1989).

159. Id.

160. See the Older Americans Act supra n. 136, 42 U.S.C.A. § 3002(23).

161. Calif. Bus. & Prof. Code § 4507(i) (West 1990).

162. D.C. Code Ann. Sec.2-3309.2 (1994).

163. Id. § 2-3309.2(c).

164. See the Older Americans Act supra n. 136, 42 U.S.C.A. §3030d(a)(7).

165. Calif. Bus. & Prof. Code §§ 2502 and 2420 (West 1990).

166. Id. § 2500.

167. Wash. Rev.Code Ann. §§ 18.36.035 (1989) and 18.36A.090 (Supp. 1994).

168. Pa. Stat. Ann. tit. 63, § 422.14(a) (Purdon Supp. 1994).

169. See N.D. Cent. Code § 43-25-04(1) (1993) and Tenn. Code Ann. §63-18-111(a)(1) (Supp. 1994).

170. See Ind. Stat. Ann. § 25-10-1-1(1) (Burns 1991); Md. Health Occ.Code Ann § 3-101(f)(1) (1991); and Wash. Rev. Code Ann. § 18.25.090 (Supp. 1994).

171. See Ariz. Rev. Stat. Ann. § 32-1501(3) (Supp. 1994).

172. See Alternative medicine supra n. 120, at 100-02.

173. See Del. Code Ann. tit. 24, §-5306(1) (Supp. 1992).

174. See Alternative medicine supra n. 120, at 105-06.

175. Del. Code Ann. tit. 24, § 5306(1) (Supp. 1992).

176. See Nev. Rev. Stat. § 634A.020(8) (1991) and N.M.Stat.Ann. §61-14A-3(G) (1993).

177. Nev. Rev. Stat. § 634A.020(5) and (6) (1991).

178. N.M. Stat. Ann. § 61-14A-6(C)(6) (1993).

179. See Calif. Bus. & Prof. Code § 4937(b) (West 1990); N.C. Gen. Stat. § 90-451(3) (Supp. 1993); Ore. Rev. Stat. § 677.757(1)(b)(C) and (2) (1993); and Tex. Rev. Civ. Stat. Ann. art. 4495b, § 6.02(1)(B) (Vernon Supp.1995).

180. Calif. Bus. & Prof. Code §4935 (West 1990).

181. Va. Code Ann. § 54.1-2900 (1994).

182. See, e.g., Alaska Stat. § 08.45.200(3) (1991); Hawaii Rev. Stat. § 455-1 (Supp. 1992); Mont. Code Ann. § 37-26-301(2)(a) (1993) (botanical medicines); and Wash. Rev. Code Ann. §§ 18.36A.020(6) and (10) and 18.36A.040 (Supp. 1994).

183. Ore. Rev. Stat. Ann. § 685.060(1)(b)(2) (1993).

184. Alaska Stat. § 08.45.200(3) (1991).

185. Wash. Rev. Code Ann. § 18.36A.050(4) (Supp. 1994).

186. Mont. Code Ann. § 37-26-302(1) (1993).

187. Fla. Stat. Ann. §§ 480.033(3) and 480.034(4) (1991).

188. N.M. Stat. Ann. § 61-4-2A (1993).

189. Wash. Rev. Code Ann. § 18.25.005(2) (Supp. 1994)

190. Idaho Code § 54-1804(1)(j)(iv) and (v) (1994).

191. N.C. Gen. Stat. § 90-368(10)(1993).

192. See infra pp. 39-44

193. Calif. Bus. & Prof. Code § 4926 (West 1990).

194. N.M. Stat. Ann. §§ 61-9-16(E)(1) and 61-9A-6(A)(2) (1993).

195. See Alternative medicine supra n. 120, at 281-97.

196. See Ark. Stat. Ann. §§ 17-98-102(1)(d) and 17-98-306(e)(3) (Supp. 1993) (within the scope of practice and is required course work); Fla. Stat. Ann. § 480.033(3) (1991) (within the scope of practice); Iowa Code Ann. § 152C.1(4) (West Supp. 1994) (within scope of practice); La. Rev. Stat. Ann. tit. 37, § 3556(B)(1) (West Supp. 1994) (recommended course work); Mich. Stat. Ann. § 18.425(1701)(f) (Callaghan 1990) (required course work); Neb. Rev. Stat. § 71-1,278(1)(a) (1990) (required course work); N.M. Stat. Ann. §§ 61-12C-4(A) and 61-12C-10(B)(5) (1993) (within scope of practice and is required course work); Tex. Rev. Civ. Stat. Ann. art. 4512k, § 2(b)(1) (Vernon Supp. 1995) (required course work); and Wash. Rev. Code Ann. § 18.108.073(2) (Supp. 1994) (may be part of licensing examination).

197. See Alaska Stat. § 08.45.200(3) (1991); Conn. Gen. Stat. § 2034(a) (1989); Fla. Stat. Ann. § 462.01(1) (1991); Mont. Code Ann. § 37-26103(8) (1993); Ore. Rev. Stat. § 685.060(2) (1993) (required course of study); and Tenn. Code Ann. § 63-6-205(1) (1990). Although the practice of naturopathy is generally prohibited under Tennessee law, the restriction does not apply to persons who comply with the regulatory laws concerning the practice of the various healing arts. See Tenn. Code Ann. § 63-6-205(3) (1990).

198. See Alaska Stat. § 08.20.900(8)(c) (Supp. 1994); Me. Rev. Stat. Ann. tit. 32, § 552 (Supp. 1994) (part of licensing examination); N.D. Cent. Code § 43-06-(1) (1993); and Ore. Rev. Stat. § 677.060(2)(a) (1993).

199. See Calif. Bus. & Prof. Code § 2605 (West Supp. 1994) (part of licensing examination); Del. Code Ann. tit. 24, § 2613 (Supp. 1992); and Vt. Stat. Ann. tit. 26, § 2103(b) (Supp. 1994) (part of licensing examination for physical therapy assistants).

200. See Ga. Code Ann. § 84-7103(9) (Supp. 1993).

201. N.M. Stat. Ann. § 61-12-20 (1993).

202. Del. Code Ann. tit. 24, § 2613 (Supp. 1992) and S.D. Codif. Laws § 36-29-1(1) (1994).

203. Fla. Stat. Ann. § 456.31(1) (1991).

204. Id. § 456.32 (1).

205. See Alaska Stat. Ann. § 08.86.230(6)(B) (1991); Colo. Rev. Stat. § 12-43-301(3)(d) (1991); Del. Code Ann. tit. 24, § 3501 (4) (1987); D.C. Code Ann. § 2-3301.2(16)(A) (1994); Fla. Stat. Ann. § 490.003(4) (1991); Ill. Comp. Stat. Ann. ch. 225, §15/2(5) (Smith-Hurd Supp. 1994); La. Rev. Stat. tit. 37, § 2352(5) (West Supp. 1988); Me. Rev. Stat. Ann. tit. 32, § 3811(2) (1988); Md. Health Occ. Code Ann. § 18-101(e)(1)(ii) (1991); Mich. Stat. Ann. § 1415(18201)(1)(b) (Callaghan 1994); Minn. Stat. Ann. §148.89(5)(2) (West Supp. 1994); Miss. Code Ann. § 73-31-3(d) (Supp. 1994); Mo. Stat. Ann. § 337.015(3) and (4) (Vernon Supp. 1994); Mont. Code Ann. § 37-17-102(4)(b) (1993); N.M. Stat. Ann. § 61-9-3(D) (1993); N.C. Gen. Stat. § 90-270.2(8) (Supp. 1994); Ohio Rev. Code § 4732.01(C) (Page 1994); Okla. Stat. Ann. tit. 59, § 1352(3) (West Supp. 1995); Ore. Rev. Stat. § 675.010(4) (1993); R.I. Gen. Laws § 5-44-1(a) (Supp. 1994); Tenn. Code Ann. § 63-11-203 (Supp. 1994); Tex. Rev. Civ. Stat. Ann. art. 4512c, § 2(c) (Vernon Supp. 1995); Utah Code Ann. § 58-61-102(9)(a)(iv) (Supp. 1994); Wis. Stat. Ann. § 455.01(5) (Supp. 1988); and Wyo. Stat. Ann. § 3327-113(a)(3)(B) (Supp. 1994).

206. Calif. Bus. & Prof. Code § 4980.02 (West 1990) and Fla. Stat. Ann. § 491.003(8)(a)(5) (1991).

207. D.C. Code Ann. § 2-3306.5(b)(4)(D) (1994) and Fla. Stat. Ann. 464.012(4)(a)(4) (1991).

208. N.H. Rev. Stat. Ann. § 328-E:4I (Supp. 1994) and Wash. Rev. Code Ann. §§ 18.36A.020(14) and 18.36A.040 (Supp. 1994).

209. Fla. Stat. Ann. § 491.003(7)(a)(4) (1991).

210. Id. § 491.003(9)(a)(4).

211. Hawaii Rev. Stat. § 453-1 (1985).

212. Fla. Stat. Ann. § 456.33 and N.M. Stat. Ann. § 61-3-6 (1993).

213. Wash. Rev. Code Ann. §§ 18.19.020(5) and 18.19.090 (Supp. 1994).

214. Mo. Stat. Ann. §§ 337.015(3) and (4) and 337.020(6) (Vernon Supp. 1994)

215. Tex. Rev. Civ. Stat. Ann. art. 4512c, § 2(c) (Vernon Supp. 1995).

216. See Calif. Bus. & Prof. Code § 4980.02 (West 1990).

217. See Fla. Stat. Ann. § 456.31(2) (1991).

218. See Wash. Rev. Code Ann. § 18.19.060 (1989).

219. Older Americans Act supra n. ?, 42 U.S.C.A § 3002(36).

220. Calif. Bus. & Prof. Code Sec.4507(i) (West 1990)

221. Tex. Educ. Code Ann. § 21.502(2) (Vernon Supp. 1995).

222. Older Americans Act supra n. 136, 42 U.S.C.A. §3030(d)(a)(7)

223. Ill. Comp. Stat. Ann. ch. 225, § 63/15 (Smith-Hurd Supp. 1994).

224. Id.

225. Id. §§ 63/17, 63/20, and 63/110.

226. Id. § 63/50.

227. Id. §63/15.

228. Ohio Rev. Code Ann. § 4731.151(a) (Page 1994).

229. See Iowa Code Ann. § 148E.1(1) (West Supp.1994); Md. Health Occ. Code Ann. § lA-101(e) (Supp. 1994); Mass. Gen. Laws Ann. ch. 112, § 148 (West Supp. 1994); Ore. Rev. Stat. Ann. § 677.757(b)(2) (1993); Wash. Rev. Code Ann. § 18.06.010(1)(;) (Supp. 1994); and Wis. Stat. Ann. § 451.01(1) (West Supp. 1993).

230. See Calif. Bus. & Prof. Code § 4935 (West 1990); Ore. Rev. Code Ann. Sec.677.759(4) (1993); and Utah Code Ann. § 58-12-67(2) (Supp. 1993).

231. See Hawaii Rev. Stat. § 436E-5(b)(1) (Comp. 1993) and Vt. Stat. Ann. tit. 26, § 3405(1) (Supp. 1994).

232. Nev. Rev. Stat. § 634A.020(8) (1991).

233. Id. §§ 634A.020(3) and (4) and 634A.140.

234. Id. §§ 634A.140, 634A.170, and 634A.230.

235. N.M. Stat. Ann. § 61-14A-3(F) (1993).

236. Id. § 61-14A-3(G).

237. Id. § 61-14A-5.

238. Id. §§ 61-14A-10(E) and (F), 61-14A-11, and 61-14A-17.

239. See Alternative Medicine supra n. 120, at 112-13, and Inglis and West supra n. 120, at 212-13.

240. Me. Rev. Stat. Ann. tit. 32, § 14307(2) (Supp. 1994).

241. N.D. Cent. Code. § 43-2542(3) (1993).

242. N.D. Cent. Code §§ 43-4941 to 43-49-13 (1993).

243. Id. § 43-4941(3).

244. Id. § 43-49-11.

245. Ark. Code Ann. § 17-98-102(1)(G) (Supp. 1993).

246. Wash. Rev. Code Ann. 18.108.030(2) (1989).

247. Me. Rev. Stat. Ann. tit. 32, § 14307(2) (Supp. 1994).

248. See generally B. Baginski and S. Sharamon, Reiki-Universal Life Energy (1988); P. Horan, Empowerment Through Reiki (1990); and B. Ray, The Reiki Factor (2ed. 1985).

249. Me. Rev. Stat. Ann. tit. 32, § 14307(2) (Supp. 1994).

250. See Alternative Medicine supra n. 120, at 102-03.

251. Del. Code Ann. tit. 24, § 5306(1) (Supp. 1992).

252. Me. Rev. Stat. Ann. tit. 32, § 14307(2) (Supp. 1994).

253. Ark. Code Ann. § 17-98-102(1)(I) (1992) and id. §17-98-102 (Supp. 1993).

254. See Inglis and West supra n. 120, at 133-37.

255. Del. Code Ann. tit. 24, § 5306(1) (Supp. 1992).

256. La. Stat. Ann. tit. 37, § 3552(5) (West Supp. 1994).

257. Me. Rev. Stat. Ann. tit. 32, § 14307(2) (Supp. 1994).

258. See, e.g., Colo. Rev. Stat. § 25-1-801(3) (1989) (religiously affiliated nursing institution is not subject to statutory requirements concerning disclosure of patient records); Fla. Stat. Ann. § 395.002(b) (1993) (spiritual healing facilities are exempt from health care facility licensing requirements); and Nev. Rev. Stat. § 449.070(1) (1991) (spiritual healing facilities are not subject to the licensing and regulatory requirements of health care facilities).

259. See, e.g., Ind. Stat. Ann. § 12-15-5-1 (Burns 1992) (nonmedical nursing care through prayer and spiritual means is covered by Medicaid); Mo. Stat. Ann. § 103.083 (Vernon 1994) (spiritual healing by prayer is covered as comparable care under the state employee medical benefits program); and N.Y. Workers Comp. Law § 205(2) (McKinney 1994) (worker's compensation benefits are available to a religious adherent who is under the care of a spiritual healer accredited by the adherent's church or denomination).

260. N.M. Stat. Ann. §§ 61-9-16(E)(1) and 61-9A-6(A)(2) (1993).

261. Concerning the broad definitions of the practice of medicine in state medical practice acts, see L. Andrews, Deregulating Doctoring: Do Medical Licensing Laws Meet Today's Health Care Needs? (Peoples Medical Society 1984).

262. See Alaska Stat. § 08.64.370(3) (Supp. 1994); Del. Code Ann. tit. 24, § 1703(e)(6) (1987); D.C. Code Ann. § 2-3301.3(d)(1) (1994); Fla. Stat. Ann. § 458.303(1)(9) (1991); Ga. Code Ann. § 84-906(b)(2) (Supp. 1993); Ind. Stat. Ann. § 25-22.5-1-2(a)(6) (Burns Supp. 1994); Kan. Stat. Ann. § 65-2872(c) (1992); Me. Rev. Stat. Ann. tit. 32, § 3270 (Supp. 1994); Neb. Rev. Stat. § 71-1,103(3) (Supp. 1994); N.M. Stat. Ann. § 61-617(J) (Supp. 1994); N.Y. Educ. Law § 6527(4)(b) (McKinney 1985); Ore. Rev. Stat. § 677.060(6) (1993); R.I. Gen. Laws § 5-37-15 (1987); S.C. Code Ann. § 40-47-60(2) (Law. Co.-op. 1986); Tex. Rev. Civ. Stat. Ann. art. 4495b, § 3.06(a) (Vernon Supp. 1995); Vt. Stat. Ann. tit. 26, § 1312 (1989); Va. Code Ann. § 54.1-2901(14) (Supp. 1994); and W.Va. Code Ann. § 30-3-13(b)(5) (1994).

263. See Ark. Code Ann. § 17-93-203(4) (1992); Conn. Gen. Stat. Ann. § 20-9 (Supp. 1994); Hawaii Rev. Stat. § 453-2(b)(1) (1993 Comp.); Ky. Rev. Stat. Ann. § 311.550(11) (Baldwin 1988); Md. Health Occ. Code Ann. § 14-102(a)(2) (1991); Mo. Ann. Stat. § 334.150 (Vernon 1989); Mont. Code Ann. § 37-3-103(1)(h) (1993); Ohio Rev. Code Ann. § 4731.34 (Page 1994); S.D. Codified Laws § 36-4-10 (1992); Tenn. Code Ann. § 63-6-204(a)(3) (Supp. 1994); and Wis. Stat. Ann. § 448.03(6) (West 1988).

264. See Colo. Rev. Stat. Ann. § 12-36-106(3)(9) and (h) (1991) ("religious worship" and "Christian Science"); La. Stat. Ann. tit. 37, § 1291(5) (West 1988) ("Christian Science" or "religious rules or ceremonies as a form of religious worship, devotion, or healing"); Mass. Gen. Laws Ann. ch. 112, § 7 (West 1983) ("clairvoyants" or persons practicing "magnetic healing," "mind cure," "Christian Science," or "cosmopathic method of healing"); Minn. Stat. Ann. § 147.09(11) (West Supp. 1994) ("Christian Science" or "other person who endeavors to prevent or cure disease or suffering exclusively by mental or spiritual means or by prayer"); Nev. Rev. Stat. § 630.047(1)(d) (1991 ) (healing by "faith" or by "Christian Science"); and N.D. Cent. Code § 43-17-02(6) (1993) ("Christian Science" or "other religious tenets or religious rules or ceremonies as a form of religious worship, devotion, or healing").

265. Mich. Stat. Ann. § 14.15(16171)(d) (Callaghan 1994).

266. Vt. Stat. Ann. tit. 26, § 1312 (1989).

267. Ore. Rev. Stat. § 677.060(6) (1993).

268. Id.

269. See Ill. Comp. Stat. Ann. ch. 225, § 60/4(4) (Smith-Hurd 1993); N.H. Rev. Stat. Ann. § 329:21(X1) (1984); N.J. Stat. Ann. § 45:9-21(f) (West Supp. 1994); N.C. Gen. Stat. § 90-18(5) (1993); Okla. Stat. Ann. tit. 59, § 492(B)(9) (West Supp. 1994); Pa. Stat. Ann. tit. 63, § 422.2 (Purdon 1994); and Wyo. Stat. Ann. § 33-26-103(a)(vi) (Supp. 1994).

270. See Conn. Gen. Stat. Ann. § 20-9 (Supp. 1994); Del. Code Ann. tit. 24, § 1703(e)(6) (1987); D.C. Code Ann. § 2-3301.3(d)(1) (1994); Hawaii Rev. Stat. § 453-2(b)(1) (1993 Comp.); Ind. Stat. Ann. § 25-22.5-12(a)(6) (Burns Supp. 1994); Kan. Stat. Ann. § 65-2872(c) (1992); Mass. Gen. Laws Ann. ch. 112, § 7 (West 1983); Mich. Stat. Ann. § 14.15(16171)(d) (Callaghan 1994); Mo. Stat. Ann. § 334.150 (Vernon 1989); Neb. Rev. Stat. § 71-1,103(3) (Supp. 1994); N.J. Stat. Ann. § 45:9-21(f) (West Supp. 1994); N.M. Stat. Ann. § 61-6-17(J) (Supp. 1994); N.C. Gen. Stat. § 9018(5) (1993); N.D. Cent. Code § 43-17-02(6) (1993); Ohio Rev. Code Ann. § 4731.34 (Page 1994); Ore. Rev. Stat. § 677.060(6) (1993); R.I. Gen. Laws § 5-37-15 (1987); S.C. Code Ann. § 40-47-60(2) (Law. Co.-op. 1986); S.D. Codified Laws § 36-4-10 (1992); Tex. Rev. Civ. Stat. Ann. art. 4495b, § 3.06(a) (Vernon Supp. 1995); Utah Code Ann. § 58-12-30(5) (1994); Vt. Stat. Ann. tit. 26, § 1312 (1989); Va. Code Ann. § 54.1-2901(14) (Supp. 1994); and Wyo. Stat. Ann. § 33.26-103(a)(vi) (Supp. 1994).

271. See Krieger, "Therapeutic Touch: An Ancient but Unorthodox Nursing Intervention," 6 J. N.Y. State Nursing Assoc. 6-10 (Aug. 1975), quoted in Alternative Medicine supra n. 120, at 111.

272. See Alternative medicine supra n. 120, at 111.

273. Wash. Rev. Code Ann. 18.108.030(2) (1989).

274. N.D. Cent. Code § 43-25-02(3)(1993).

275. Mont. Code Ann. § 32-26302(1) (1993).

276. See Alternative medicine supra n. 120, at 106.

277. Julian, "The Trager Approach," The Trager Journal 1-3 (Fall 1987), quoted in Alternative Medicine supra n. 120, at 106.

278. Del. Code Ann. tit. 26, § 5306(1) (Supp. 1992)

279. Me. Rev. Stat. Ann. tit. 32, § 14307(2) (Supp. 1994).