Darmnosoden allgemein anthroposofisch
‡ Chamomilla, Radix w
= Chamomilla e radice wa
Spastisches
Colon, Vorbereitung zur Koloskopie
Verbesserung
der abführenden Maßnahmen und der nachfolgenden Untersuchung durch
spasmolytische Wirkung.
Dosierung:
Während der letzten abführenden Vorbereitung zur Koloskopie 2–3 Amp. Rh D2 s.c.
in ca. stdl. Abstand in die Bauchhaut injizieren. Die letzte Amp. unmittelbar
vor der Untersuchung.
Wirkungseintritt:
Sofort. Bemerkungen: Erfolgreiche Beobachtung bei über 1000 Anwendungen.
Anwendungsgebiet:
Eingliederungsstörungen der Empfindungsorganisation im Stoffwechselsystem,
besonders bei Krampfzuständen
der
glatten Muskulatur und bei Unruhe- und Erregungszuständen. ‡
[Aart van der Stel]
(Translated from the Dutch Anthroposophic Physician's Newsletter.
English by A.C. Barnes) Aart van der Stel JAM Vol. 12, Nr. 3
Introduction
When someone says that he has problems expressing himself properly, one
seldom thinks of his bowel function being the part having difficulty expressing
what he is inwardly concerned with.
Yet it makes sense to take what the speaker says literally [translator's
note: the Dutch word for "express" means also "have a bowel
movement"] and, as his physician, to enquire about his metabolism. Not
infrequently the patient proves to be afflicted, to a greater or lesser extent,
with a spastic colon problem.
In the course of this account it will become clear what the connection
is between the large intestine and someone's ability to put his ideas across.
Pathology
There follows a description of the clinical picture as it is usually
presented.
The spastic colon (irritable bowel syndrome, colitis mucosa, emotional
diarrhea) is a chronic or irregularly occurring familial illness due to changes
in the motility of the large intestine. According
to the literature we are confronted with this affliction in
approximately 30% to 60% of all gastrointestinal troubles. The colic pains of
the nursing infant and constipation in the young child also
belong here though we
are more familiar with the problem in young adults. It occurs more frequently
in women than in men.
The diagnosis, for which the history is most important, is based on the
following symptoms:
1. Pain mostly on the left side and sometimes on the right side low in
the abdomen, of a character ranging from gnawing to nagging, radiating out to
the back or chest. There are pain-free periods.
2. Frequent production of small quantities of feces that are of variable
consistency; large quantities of gas. After defecation and release of
flatulence the pain decreases or even ceases. The pain increases again in
consequence of a meal or emotional stress.
3. Little or no feeling of illness or loss of weight, etc.
4. Often occurs with another psychosomatic symptom such as premenstrual
complaints, tension headaches or hypoglycemia.
5. Mood usually depressive.
Physical investigation reveals the patient to be in remarkably good
condition. The abdomen is sometimes diffusely swollen; percussion gives a
tympanitic tone. In the painful region the bowel is swollen in a sausage-like
shape, mobile relative to the under layer. The abdominal wall often feels cold
to the touch above the spastic section of the bowel.
Faeces
This problem demands a thorough investigation be made of the quality of
the stools. The indigestible fiber proves to play an important part in this.
The proportion of fiber in food has fallen drastically in this century.
Over a hundred years ago about 600gm of bread was consumed per head of
population; at the present day it is barely 200gm. In addition to this it must
be pointed out that nowadays we are dealing with highly refined flour, i.e.
flour with the fiber removed, as a result of which the fat and sugar content of
our food has risen from 15-20% in earlier times to 55-60%. Hence the modern
diet contains very little fiber.
This fiber is important. The more fiber present in the food, the faster
the chyme is passed through the intestine. With an increase in fiber, the
quantity of feces also increases. It has been found that primitive peoples
produce 3x as much stool in volume as Europeans. It has also been found,
connected with this, that problems such as constipation, diverticulosis of the
colon, cancer of the rectum, hypercholesterolemia, appendicitis and
gall-bladder troubles are significantly less frequent among these peoples or
even do not occur at all.
In summary, there seems to be a connection between our culture (or diet)
and a number of bowel disorders, including spastic colon. The advice in a case
of spastic colon is to increase the proportion of fiber in the diet. The
question remains whether this will entirely solve the problem.
The Organ
The colon is a large, hollow organ that garlands the rest of the
digestive tract (stomach, duodenum, small intestine). It is about 1.5 meters
long. Its wall contains (as does that of the small intestine) longitudinal and
circular muscles, but those of the colon (in contrast to those of the small
intestine) are arranged in three bands (taeniae coli).
The colon is divided into 3 parts - the ascending, the transverse and
descending in that order - going from the end of the small intestine (the
ileum) to the sigmoid, situated before the anus.
It is striking that in its journey through the abdomen the colon closely
approaches almost all the organs of importance for metabolism in the following
order:
right ovary, liver and gall-bladder, right kidney, pancreas, stomach,
spleen, left kidney, left ovary.
The colon ends in the anus, which can be consciously relaxed and
contracted. In the whole digestive tract this is only found elsewhere in the
mouth: we can affect the digestive flow by conscious effort only at the
beginning and the end.
Colonic Movement
The large intestine has no peristalsis, unlike the small intestine. The
are two kinds of contractions:
1. Mass contractions/ where a large section of the bowel contracts, and
the portion situated distally from this relaxes. These contractions shift
slowly (1cm per second). They occur a few times daily.
2. Haustrating contractions, which have a mixing and kneading effect but
only extend over a small area and can last several tens of seconds.
The colon is an easily-irritated organ that reacts to all kinds of
substances such as gastrin and cholecystokinin, which are responsible for the
gastrocolic reflex, to substance P and enkephalins, which increase motility,
and to glucagon and secretin, which act to reduce motility. Apart from this it
is interesting that very little is known about the movements of the large
intestine, especially in connection with the sympathetic and parasympathetic
nervous systems, which are present in such abundance in the bowel wall, and the
relationship between the feces and the movements of the bowel.
Comparative Anatomy
R.S.: points out that a relationship exists between the development of
the colon in successive kinds of animals, in terms of their stage of
development, and the development of the forebrain. The study of the various
metabolisms reveals that it is only with the coming of warm-blooded animals
that such a thing as a colon comes into existence; that the more highly
developed the animal is the longer the colon; and that particularly the
ruminants develop an enormous cecum, which in man finally achieves
"normal" proportions - the appendix is, in fact, a shrunken cecum. It
is further of interest that the colon "grows into" the body from its
distal end (the anus) towards its dorsal end. Finally, let us remember that in
the course of development the place where the ileum connects with the colon has
become displaced: in the most highly developed creatures the ileum empties into
the colon from the side through the ileocecal valve (valvulae Bauhini).
When one looks at the large intestines of the various creatures side by
side, then the human colon looks the most harmonious. It is as though the organ
has found its ultimate destination in man.
Significance
The colon has no peristalsis, which indicates a lesser influence from
the etheric body than one observes in the small intestine. The continuous
firming up of the faecal flow also tells us this. What we have here is a hollow
organ that is very sensitive to stimuli. The bowel wall contains a great deal
of vegetative nerve tissue, and the bowel itself can be consciously closed at
its end. These are features that suggest a powerful influence from the astral
body and ego-organization respectively. Just think, for example, of the
significance in child development of the child's learning to hold back its
stools. The child could not be prouder (more aware of its growing ego)! The
relationship with warm-bloodedness (where is the body temperature most
accurately measured?), the occurrence of intensified movements of the colon
associated with emotions or biographical problems, and the dependence on
cultural influences with regard to the product, reinforce the feeling that what
we have here is a sense organ rather than a constructive metabolic organ.
Life can continue normally without a colon. A number of years ago there
were over 70,000 stoma-patients without a colon in West Germany. The more
highly developed an organ is, i.e. the more spiritual its function in the body,
the more easily one can do without it in whole or in part. Compare Steiner's
observations on the spleen.(5)
In summary, the colon is an organ that, although it belongs to the
metabolism, shows a high level of ego and astral activity and above all seems
to have an observing function. So what does it observe? m order to answer this
question it is necessary to understand something of the metabolism as such.
Metabolism
R.S.'s Occult Physiology, however difficult and inscrutable, is a good
key to understanding the metabolism. The central theme in this work is the
"preparation" of the blood as ultimate bearer and instrument of the
ego. All organs contribute something to it, and this whole process of
preparation may be called "metabolism".
Food undergoes a long journey of digestion from outside to inside, which
is marked by a number of confrontations. Steiner speaks of "aussere
Regsamkeiten" and uses the example of stubbing a toe on a table leg, which
gives rise to two processes, one directed outwards and the other directed
inwards. Outwardly the table leg (and the same would be true of a portion of
food or a sense impression) is pushed away, overridden, excreted (Absonderung).
Inwardly consciousness arises of the pushed-away object (the external world and
all it embraces) and of one's own person: my toe hurts, and I have only become
aware of it by stubbing it. Steiner speaks in this connection of the
"Ernährungsstrom" (nutritional flow). The pushing away is not
complete because then the pushed-away object could not have been noticed and
remembered; the table leg as it were comes a little into us. One develops one's
inner world in response to the world outside. After stubbing one's toe a few
times one learns that one must be careful in the dark because one has built up
an internal notion of table legs. It is the same with food: one digests sugars
in order to construct sugars inwardly. In this the organs play an important
role. The organs are little bits of internalized external world and can be seen
as the serving-hatches of cosmic, planetary forces. Thus the kidneys are linked
with Venus, the spleen with Saturn, etc.
This is how man with his blood-in-the-making figures between two
external worlds: the physical, visible world which has become earth and which
man confronts with matter or substances (what the matter looks like, what form it
has), and the invisible world of the planets that enables him to see which
formative forces the substances originate from. The former world comes to us
through food, breathing and the senses; the latter world through the organs,
the access-gates of the world of the planets.
Nutrition
If the blood (the human being, the ego) is to be formed in the right
way, a concept must be formed of the best way to achieve that. This can be
compared to making a cupboard: what kind of wood, what methods of joining the
components, what hinges and fastenings, what shape shall I give it? Substance
(Latin for "what stands underneath") and form are the elements which,
brought into an individual combination by the ego, make the blood into our own
personal blood as the center of our personality. Every foodstuff contains, for
example, carbohydrates (material aspect), but in different foodstuffs these
carbohydrates take on a different appearance.
In the process of breaking down, of observing, the ego, astral body and
etheric body take control of this in such a way that in the external world,
viz. the bowel cavity, the material and formal aspects of the foodstuff
disappear, and its physical remains are removed (Absonderung), while at the
same time an inward awareness of the material and formal aspects of a
carbohydrate comes into being, which must contribute to the building up of
one's own (blood-)sugar (Ernährung). The ego continues to play a mediating,
regulating and identifying role throughout.
The process which takes place in the vicinity of the bowel wall could be
described as transsubstantiation. This process continues from the mouth to
approximately the ileocecal valve, during which time the contents of the
alimentary tract undergo a constantly increasing process of breaking down or
destruction. Into the cecum comes an amorphous mass of material, which in many
animals then leaves the body since there is nothing more to be got from it. In
the human body and that of other highly developed animals it then goes on to
receive its maximal form before the exhausted material finally leaves the body
as feces.
Two Gestures
In order to understand the function of the colon one may think in terms
of two gestures in the intestinal tract. The first gesture is visible in the
descending flow of ingested food, which gradually (and, for the ego,
productively) loses its outward form and turns into lifeless matter. This is
the observing gesture. The other gesture, directed more towards construction,
is expressed in the acquisition of form by the fecal mass, which is maximally
observable in the sigmoid and is less and less apparent as one looks higher and
higher up in the bowel cavity. This form belongs not to the material but to
ourselves as the originators of this form. In this way two formative processes
flow contrary to one another: from above the external formative process
belonging to the external world and fading away as it moves lower, and from
below the formative process that comes outwards from within and is caused by
what: the ego or the organs?
That we have two gestures is apparent from, among other things, the two
movements of the colon described above: a steady, more or less peristaltic
movement which conveys the exhausted matter to the exit, and an
antiperistaltic, haustrating gesture that brings the material flow to a halt
and, as it were, kneads it and so gives it a definite form.
In this way the colon makes visible what sort of formative processes are
taking place in the body, how the body offers resistance to formative processes
from the outside, and how it can express itself in matter.
But does one need such a long colon for this purpose? It is interesting
to look again at the location of the colon and to realize that there are three
parts to be distinguished: the ascending, transverse and descending portions.
One could, in a somewhat associative way, say that the ascending portion, in
which the fecal flow is upward (towards the liver) corresponds to the effective
area of the etheric body, that the transverse portion, extending between the
kidneys, has to do with the astral body (think also of all the other organs
that the colon passes here), and that the descending portion from the spleen
onwards, in which the feces assume their final form and are "shown"
to the external world, lies in the effective area of the ego. In this way the
formative capacity of the human being at the levels of etheric body, astral
body and ego-organization would become visible and hence observable in the
corresponding parts of the colon respectively.
When we look at the faeces we can also distinguish a material aspect and
a formal aspect:
a.
how
well can we break down (catabolize)?
In the occurrence of a lot of gas in the intestines +/o. the finding of
undigested remains of food in the stools indicates an inadequate breaking down
or observation of the external world. Gas in particular indicates an excess of
uncommitted astrality not brought under the control of the ego.
b.
how
well can we build up (anabolize)?
In cramps, diarrhea and constipation indicate disturbed forming
pro-cesses. "Kraempfe zeigen die Unmoeglichkeit dass Ich-Organisation und
Astralleib
in physischen und Aetherleib hineinfahren" (Cramps are a sign that
the ego- organization and astral body cannot penetrate the physical and etheric
bodies).
It can be seen from the feces how well the human being is able to manage
earthly reality in such a way that it leads to the building up of one's own
inner reality. Always valid: the better the destruction the better the
construction.
What is here described for the ego vis-a-vis the physical would also be
valid for the astral vis-a-vis the etheric. In this connection Steiner mentions
colon and bladder in the same breath.
That there is "a lot of ego" in the feces is also expressed in
the reply that Steiner gives to a question about the wisdom of using human
manure in agriculture. Steiner advises that no more should be used than what
the farmer and his family produce. There is too much "ego" in the
feces for one to be able to make excessive use of it; this applies not at all,
or much less, to animal dung which bears an imprint not so much of the earthly
and individual as of the cosmic and astral.
It would seem that the large intestine is a sense organ that is intended
for the observation of how far the human ego is capable of manifesting itself
in the metabolism, which shows an interplay of construction and destruction
that must lead to the blood formation which is the ultimate expression of the ego
in the physical. With this we can make a transition to the pathology, where the
question arises as to why someone cannot express himself in keeping with his
potentialities, his biographical mainsprings, etc.
Pathology
On the basis of the above we can now understand what is the matter with
a person with a spastic colon. There are 3 possibilities, which may occur
separately or in combination in one and the same person:
1. There is something wrong with the
destruction flow
2. There is something wrong with the
construction flow
3. There is something wrong with both
The correct form is not being produced due to too much or too little
observation, or ditto construction, or (as an expression of a general ego-
weakness) an inability to synthesize. The relationship to the external world is
experienced too emotionally; the astral body is stronger than the ego-
organization in observing and constructing.
The person who cannot manifest himself fully feels himself
over-addressed or rushed off his feet by the external world. His body, his
psychic circumstances or the social climate do not allow him enough space to
manifest himself in his full individuality. As a reaction to this, the person
gets trapped either in too much construction, a desperate need to do everything
without enough substance or careful thought (diarrhea) or else in too much
destruction, endlessly analyzing and working things out analytically before he
finally gets down to actually doing something (constipation).
Causes
The situation described - not being able to achieve one's own form for
one's own existence - can have various causes:
1. Constitutional. Here, the organs come into
the picture. It is interesting to look into the question of which constitutions
are most associated with spastic colon. An important role is probably played by
the spleen, the liver, the lungs and the kidneys.
2. Diet. The importance of fiber has already
been mentioned. Note that fibers are polysaccharides, which underlines once
again the role played in the spastic colon problem by the ego
"Wo Zucker ist, ist
Ego-organisation..." (Where
there is sugar there is ego organization...). Fiber forms an "aussere
Regsamkeit" of the first order.
3. Biographical. This involves mainly young
adults where it is, of course, a matter of ego birth. But later situations in
life where a powerful manifestation of the personality is required can
also give rise to a spastic colon. The
relationship with other psychosomatic illnesses is also seen here.
Therapy
It is remarkable how little advice on therapy for problems of the large
intestine is to be found in anthroposophical medical literature. It would seem
that in the period when Steiner saw patients with Ita Wegman there was nobody
walking around with a spastic colon. There are a few patients whose problems
are not far removed from this one, although these are mainly in connection with
Carpellum mali (see below). Nor has much been written on the subject
subsequently. Husemann suggests only a few remedies, having first specifically
mentioned "psychiscne Fuehrung" (psychological guidance).
During therapy it is important first and foremost to build a picture of
the problem with the patient and to check whether he recognizes anything of his
own situation in it. Our account of the problem as given above is based on
numerous occasions when we have discussed the formation problem with patients.
It is essential to help these always rather tense people to begin to see things
in perspective. If the tenseness, the feeling - for whatever reason - that they
cannot assert their individuality is deeply entrenched, some form of
psychotherapy is always necessary.
It is a matter of learning to see things in perspective ("I'm
actually only an ordinary person") and to be objective ("What can I
do?" instead of "What is expected of me?"). I often advise the
patient to take a kind of retrospective look at the end of each day on the
theme, "When have I really been myself today?"
A supportive role in this growth process of the ego in the face of
massive astrality is offered by artistic therapy, especially clay-modeling and
curative eurythmy. Sounds such as R, M, N, B, I and A and above all the
"seelische Uebungen" (spiritual exercises) are very effective.
Regarding medication, there are all kinds of possibilities.
Directly working antispasmodics: Tab. (= Nicotiana), Cham., Carbo and
Cuprum. Mercurius in one form or another is often effective. When one has clear
ideas about which organs are having a disruptive effect, one naturally directs
one's medicinal therapy in that direction, supplementing what one is already
doing with the above-mentioned Cuprum. Apis, Aurum and Stibium are particularly
ego-strengthening, as is the prescription of a fiber-rich vegetarian diet. It
will sometimes happen that a too sudden and rigorous change of diet brings on a
depression. This can then be used as a point of departure for subsequent
therapy.
Excessively cerebral types must be made to take up something physical
such as walking, cycling or swimming, though without feeling that they have to
achieve great things.
The Remedy - Carpellum mali
A remedy with which I have recently been working on the advice of
Machteld Huber (personal communication) is Carpellum mali, viz. applecore.
Steiner advised this for a hypochondriac, melancholy woman of 37 who is afraid
of becoming pregnant again and complains of "dauerenden Druck der sie
alles falsch anfassen lasst" (a constant pressure which always makes her
go about things in the wrong way). Here we can recognize much of the patient
with a spastic colon. She has in the past suffered from constipation. Steiner
says that the bowel and especially the colon is too narrow (haustration,
ileus?). Carpellum mali is "zusammengeflickt" (patched together) with
Juglans regia, the walnut. These are imitations of the astral body of the large
intestine and the lungs respectively. Steiner relates depression and bowel
problems, which may at the same time have been responsible for the (earlier?)
difficult pregnancy.
In cases described elsewhere, Carpellum mali is used in the treatment of
patients with sub-ileus + diarrhea or constipation and a tendency to depression
or melancholy. These case-studies also involve diverticulosis coli.
It would seem worthwhile to gain experience of the remedy (Carpellum
mali comp. w) in a wider context. My
initial experiences are encouraging, to say the least. It is certainly
necessary to formulate a clear list of indications.
Vorwort/Suchen Zeichen/Abkürzungen Impressum