Darmnosoden Anhängsel

 

http://www.narayana-verlag.de/homoeopathie/pdf/Notes-on-Miasms-Heredity-and-Nosodes-Filip-Degroote.08245_3Bowel_Nosodes.pdf

[Russell Malcolm]

Therapeutic Guidelines

The dysbiotic case is a blocked case. Patient’s whose intestinal ecosystem is significantly disordered have an on-board source of immunological and physiological chaos. If the symbiotic homeostasis

is not corrected, the patient will be incapable of responding to a classical similimum. Or the response will be weak and short-lived.

One of the most important considerations for the physician is whether there are clinical features of dysbiosis. For the very experienced medical homeopath it may run against the grain to reduce the

dynamics of a complex case down to a diagnostic label. If the diagnosis of intestinal dysbiosis is missed, however, the reactive features will not be enough to identify a cure for the case. There are

a number of features in the case history to look out for.

Key indications for the bowel nosodes

1. Aetiology: infection, antibiotics or both

2. Never well since... (Acquired intrinsic blocks to cure)

3. Physiological / metabolic / immune corollaries (signs of fatigue, debility, toxicity and vulnerabilty to infection). Prominent ‘generals’.

4. Self-perpetuating illness state (see dysbiosis – systemic cycle below) Systems-distubances.

5. Evidence of altered surface immunity (inflammatory conditions skin, mucus membranes, or internal integuments eg. synovium)

6. Symptoms referable to GI, GU, respiratory tracts and body orifices (although there are often persistent bowel symptoms, these can be surprisingly minor in comparison with the systemic corollaries)

7. Insidious block to cure (cases which are failing to respond to well chosen remedies, or where the patient consistently fails to build on an early response)

8. Bacteriological evidence of reduced lactose fermenting anaerobes, or evidence on stool culture of significantly increased populations of delayed/non lactose fermentors or pathogenic enterobacteraceae.

 

After a remedy there is an increased presence of non-lactose fermenters in the stool.

Paterson’s Clinical Guidance

“...with regard to the change in the bowel flora [after a remedy]. The appearance of non-lactose fermenting organisms, I regard as evidence of the action of the defensive body mechanism.

Their percentage in relation to B. coli and their persistency in point of time may be used as an indication upon which to base treatment at any period of the disease”.

“If the percentage is high (80-100%) clinical experience has shown that the potentised vaccine (nosode) does definite harm”. [May ‘block’ an acting remedy.]

“Now with a positive stool yielding 20% or less, I should not hesitate to use the corresponding nosode or autogenous vaccine, provided the patient does not show other evidence of improvement”.

The general consensus in the literature is that the Bowel Nosodes do not stand repetition. They are given as stat doses, or split stat doses, over one or two days.

The author prefers three stat doses, in rising potencies, over twelve hours. The traditional advice is then to wait, and to avoid repetition of the nosode within 3 months.

In my experience the patient usually some shows some evidence of a response within 10-14 days after a good prescription. (Sometimes earlier)

Where the bowel nosode is used on its own account, as the main therapeutic input, I would leave the resolution to unfold in an open-ended way (weeks), if they are showing

ongoing improvement.

In uncomplicated cases the patient’s intrinsic block to cure will resolve and they will become responsive to a classical remedy.

The indicated similimum should be given if they plateau in their clinical response.

The diagram opposite is a representation of resolving dysbiosis after a bowel nosode, showing the threshold beyond which a remedy response can occur.

When the bowel nosode is being used to resolve a block to cure, or augment the response to a partially effective remedy, I would leave 14 days or more between the nosode and the related remedy.

My rationale for this is that many chronic cases show two or more main cycles of causation, and these may need to be resolved sequentially to achieve progress.

In some cases if you wait too long after the nosode to introduce the similimum, the systemic disturbances will re-evoke the intestinal dysbiosis. If you do not wait long enough between nosode and similimum

the dysbiosis will continue to block the remedy response. In children the time lapse is shorter than in adults. Adults with longstanding active bowel symptoms and debility should be left longer to respond.

A well chosen bowel nosode does not appear to be blocked in its response by a well chosen similimum. However, a well chosen similimum which is slowly resolving a long-standing illness, may be blocked by

early repetition of itself, or of its related nosode.

In cases which you have successfully ‘unblocked’ and which are resolving with the similimum, it is best to follow the traditional advice and avoid repetition of the nosode, unless there are clear indications that

the bowel symptoms are re-emerging and the patient is deteriorating clinically.

NB Discharges, catarrhs and eruptions in the post-similimum phase of treatment are not indicators of worsening surface immunity. These features are all too frequently treated by orthodox prescribers with

antibiotics - often rendering the patient dysbiotic once again and returning them to their state of fatigue or debility.

In infective acutes the early use of the correct similimum will prevent dysbiosis emerging subacutely. In sub-acute infective cases, the indicated nosode can be used alternately within a series of similia, in high

potency, which reflect the dynamic changes in the current state of the patient. Many patients showing signs of dysbiosis have had two sequential courses of antibiotics within a short time frame. (usually with

different spectra of antibactial activity). If they have also had treatment with antipyretics they may show signs of thermostatic instability and fatigue. In this event use a physiological similimum at an early

stage of treatment. (See rubrics for fever suppressed/remittent; or rubrics relating to the abuse of quinine.)

There is plenty of room for error in the selection process for a bowel nosode on purely clinical features. Even careful symptom-analysis using a bowel nosode repertory like the one given in this book can lead

to the wrong choice of nosode.

 

The materia medica of the bowel nosodes has been worked out in the clinic over the course of several working lives. A major element in the treatment of chronic cases is in the process:

* clinical exploration

* development of models for the illness

* engagement with the available treatment data

* selection and timing of treatment

* re-evaluation and adjustment of models, analyses and treatment

* feedback into the fund of clinical data and teaching of others

These cycles of clinical feedback generate information of potential value to other prescribers. In studying and using the bowel nosodes, there are several ways in which historical clinical information can be helpful:

* providing additional information governing choice of nosode

* understanding the relationship of the nosode to other treatments

* informing their timing and placement within the treatment programme

In the early days, the bacterial composition of the stool was an important factor in guiding treatment choices. Stool composition changes under the influences of:

* illness

* diet

* drug treatment

* the clinical homeopathi

* similimum

* the indicated nosode

In the ill patient with bowel dysbiosis, use of the clinical similimum or constitutionally based remedy appears to evoke host responses and a shift in the surface immunity in the bowel.

In the clinical experiments of Bach and Paterson, the number of non-lactose fermenting organisms was frequently observed to increase in the stool, for a time after homeopathic treatment (perhaps as bacterial

surface adherency diminished). This shift in flora was associated with clinical improvement.

The observed shift in the bacterial composition of the stool appeared to bear some relationship to the remedy used. As time went on, this quasi-objective information

was collated and became the first major influence on remedy-nosode relationships.

It is clear that much of the existing data suffers from some obvious limitations in mid 20th century microbiological knowledge, and all these basis hypotheses need to be reinvestigated. It is also clear that many

other variables may be operating in these complex clinical situations, and control group comparisons are not available, so we have to be careful not to rely entirely on these observed associations.

As the body of knowledge and experience increased, clinical outcomes became the main method of establishing remedy-nosode relationships. ‘Blocked’ cases or cases

which had plateaued in their response would be found to improve after the use of an appropriate nosode. Their response to the similimum or constitutionally based treatment would then improve, and the empirical

relationship between nosode and remedy would be documented.

Clinicians like Wheeler, Dishington, Griggs and Elizabeth Paterson have been very influential in reporting cases and gradually extending these clinical relationships. I have found this information very useful in

the clinic and there appears to be more than a little truth in these observed relationships, although proving them statistically is an entirely different matter!

Looking at the remedy list it is obvious that there are hundreds of remedies in general use among experienced homeopaths, for which a nosode relationship is not established. Today we have access to remedy

data that was much more difficult to access in years past. So it is possible to synthetically repertories on the key clinical information available for each nosode and explore possible relationships further. It is

also interesting to see whether ‘known’ relationships are bourne out by the repertory.

On the pages that follow there are a series of experimental repertorisations.

Symptom information from ‘A survey of the bowel nosodes’ by Elizabeth Paterson has been entered in various combinations and the rubrics analysed.

Symptom groupings have been analysed on various rationale:

* ‘totality’ (selection of the most consistent contextual information)

* ‘essence’ (key mind rubri* and consistent contextual and local information)

* ‘pathological’ (key rubrics for surface-immunity, system or locality)

The resulting analysis for each nosode usually contains ‘established’ clinical relationships and also lists a variety of possible relations that have not yet been confirmed clinically.

Some nosodes (most notably Proteus) do not align very convincingly with established relationships and a short impression for each analysis is given on the pages that follow.

The rest of this section is made up of a series of tables which bring together ‘established’ and ‘notional’ relationships. I have annotated the entries to show those that have been ‘confirmed’ in my experience,

together with some theoretical relationships bourne out of the repertory search. A few of which are annotated to show which of these ‘unknown’ relationships appear to have worked for my patients.

Bowel Nosodes and the Mind

There is little doubt that homeopathy has tended to place the mind at the centre of the case since the time of Kent. The prescribing data should be placed in the context of the prevailing Kentian methodologies

of those who did most of the seminal work on them. This raises several questions on the nature of the mind symptoms attributed to the bowel nosodes:

Do the mind features represent attributes that drive the case towards a particular kind of dysbiosis?

Does overgrowth of a particular organism accentuate certain mental/emotional symptoms?

Are there any psycho-immunological models that help to explain mind phenomena associated with these nosodes?

Have the mind symptoms in the literature been projected onto the bowel nosodes from those of their apparently related remedies?

Most of these questions are difficult to answer in a concrete way. We will briefly examine some possible immunological models for some of the central effects that occur in infective and dysbiotic states. It is

thought that a number of cytokines have neuro-endocrine effects which may alter mood and the pituitary adrenal function.

Some gram negative organisms (including several implicated in dysbiosis) release lipopolysaccharides which induce TNF, interleukin-1.

The presence of these compounds is associated with bacteriologically mediated inflammatory responses and if their levels are chronically raised, as a result of dysbiosis, they may reduce immunological efficiency

and predispose to secondary infection.

IL-1 stimulates pituitary function and evokes a biochemical stress response. In the acute infection a short term positive increase in adrenal function is probably immuno-stimulatory.

However, protracted increases in adrenal activity ultimately inhibits cellular immunity. We observe the same phenomenon in people who are chronically stressed.

The question of whether emotional disturbance predisposes to dysbiosis appears to tenable in terms of mind-body relationships and the foregoing observations. Whether certain mental/emotional themes predispose

to specify kinds of dysbiosis is a tantalising but purely speculative idea at the present time.

Here are some thoughts:

Bacillus 7 - driven by material ambition or fear of insolvency - work

Bacillus 10 - driven by fear of aging or losing sexual allure - sex

Dysenteria co. - driven by anxiety of conscience - self worth

Gaertner - driven by awareness of frailty and the need to make a mark - creativity

Proteus - driven by unremitting environmental stress - chronic autonomic overdrive

Sycotic co. - driven by shame (try to compensate for their dirtiness) - infected

Morganiae - driven by greed for the good life

Faecalis - driven by the desire for understanding

Bowel Nosodes and the Repertory

At first glance, the remedy data for the bowel nosodes seems too vague and general to be of clinical value. The leading symptoms and keynotes can rarely be classed as ‘strange’, or ‘peculiar’.

So bowel nosodes are not usually ‘jumped to’ on the basis of a single strong feature in the case. A variety of inductive methods (based on the context) are required. It may also be necessary to undertake some form

of analysis using the available clinical data.

Empiricism

The data for the remedies themselves is highly empirical. Most of the patients, for whom they have been prescribed in the past, have been chronically unwell, or at least sub-acute.

The remedies themselves cannot be said to have undergone a standard proving, although clinical observation and stool culture data lends some objectivity to Paterson’s case series.

The priorities of Bach and Paterson were, as far as possible, to establish a scientifi* basis for the selection of bowel nosodes. Whether it was this priority, or a general lack of keynotes,

(in what was a chronic and often debilitated patient sub-population), we find that ‘leading symptoms’ for the bowel nosodes are in short supply. However, what information there

is, is in my opinion, more reliable than much of the proving data in the materia medica as a whole.

Repertories

Modern repertories have imported the bowel-nosodes into their rubrics, but no one appears to have marked up the rubri* entries as they are clinically verified, in spite of the considerable number

of cases that have appeared in the journal literature over the last fifty years. As a result, the nosodes have never been elevated above ‘normal type’ in the standard repertories of the day.

This low-key representation, together with the small overall number of symptoms, means that these nosodes never turn up in a totality analysis.

‘Broad sweep’ repertorisations, which analyse only large headline rubrics, do not bring them out. Expert systems and family group searches fail to show them up, even in those patient analyses where they are clearly

indicated and ultimately shown to be effective.

Given this poor representation, it is wise to do two repertorisations in those cases where the bowel nosodes are clearly indicated.

- in one repertorisation you would use traditional methodology (whether it be totality, thematic, pathological or synthetic) and establish the range of potential similia.

- in the other repertorisation you would use a nosodes repertory to assess which remedy is most likely to address the systems disturbances relating to the patient’s dysbiosis

As you become more familiar with the nosodes, these two repertorisations will inform one another. So, for example, if your ‘traditional’ analysis yields Phosphorus, Silica or their salts,

you will probably use the nosodes analysis to assess whether Gaertner is indicated.

With experience you will come to use these empirical relationships to good effect, using the remedies sequentially to ‘unblock’ the case or augment the response of each to the other.

We have included a recompiled bowel nosode repertory (on page #), which uses the search-word and chapter conventions of modern clinical repertories. Because the listings are short, it takes

only a few minutes to do a hand repertorisation on the nosodes.

Analysis methodology

Unless you are very clear that an uncommon symptom is unique to a remedy you would be wise to keep the analysis general and favour the head rubrics. The more unusual the feature,

the more likely that the data is derived from a single case study, and potentially the same symptom could arise from time to time in patients who are sensitive to a different nosode.

So beware, don’t use small rubrics to exclude remedies. Use them only to lend support. Nosodes which do not appear in the listing for a common feature are easier to exclude.

Beware that ‘small’ nosodes like Bacillus-10 are severely underrepresented, even in a highly selective bowel nosode repertory like this. It has been used very rarely and has therefore generated much less data than its

counterparts. If an analysis throws up three points of contact with Bacillus-10, as opposed to six for Morgan pure, you should consider Bacillus-10 quite carefully and read the materia medica of the remedy.

 

Bowel Nosodes and the Mind

There is little doubt that homeopathy has tended to place the mind at the centre of the case since the time of Kent. The prescribing data should be placed in the context of the prevailing Kentian methodologies of

those who did most of the seminal work on them. This raises several questions on the nature of the mind symptoms attributed to the bowel nosodes:

Do the mind features represent attributes that drive the case towards a particular kind of dysbiosis?

Does overgrowth of a particular organism accentuate certain menta/emotional symptoms?

Are there any psycho-immunological models that help to explain mind phenomena associated with these nosodes?

Have the mind symptoms in the literature been projected onto the bowel nosodes from those of their apparently related remedies?

Most of these questions are difficult to answer in a concrete way. We will briefly examine some possible immunological models for some of the central effects that occur in infective and

dysbiotic states. It is thought that a number of cytokines have neuro-endocrine effects which may alter mood and the pituitary adrenal function.

Some gram negative organisms (including several implicated in dysbiosis) release lipopolysaccharides which induce TNF, interleukin-1.

The presence of these compounds is associated with bacteriologically mediated inflammatory responses and if their levels are chronically raised, as a result of dysbiosis, they may reduce immunological efficiency

and predispose to secondary infection.

 

With experience you will come to use these empirical relationships to good effect, using the remedies sequentially to ‘unblock’ the case or augment the response of each to the other.

We have included a recompiled bowel nosode repertory (Repertory of the Bowel Nosodes by Dr Russell Malcolm), which uses the search-word and chapter conventions of modern clinical

repertories. Because the listings are short, it takes only a few minutes to do a hand repertorisation on the nosodes.

Analysis methodology

Unless you are very clear that an uncommon symptom is unique to a remedy you would be wise to keep the analysis general and favour the head rubrics. The more unusual the feature,

the more likely that the data is derived from a single case study, and potentially the same symptom could arise from time to time in patients who are sensitive to a different nosode.

So beware, don’t use small rubrics to exclude remedies. Use them only to lend support. Nosodes which do not appear in the listing for a common feature are easier to exclude.

Notice that ‘small’ nosodes like Bacillus-10 are severely underrepresented, even in a highly selective bowel nosode repertory like this. It has been used very rarely and has therefore generated much less data than its

counterparts. If an analysis throws up three points of contact with Bacillus-10, as opposed to six for Morgan pure, you should consider Bacillus-10 quite carefully and read the materia medica of the remedy.

 

Indications for the use of Bowel nosodes:                           [Dr. V. R. Agrawal (1981)]
Researched by Dr.Edward Bach
/first isolated by Elisabeth Bach and John Patterson

1. Bowel nosodes are deep acting remedies and so case taking must cover the totality of symptoms from the mental to the physical/should be given and selected as any other homoeopathic remedies in accordance

with the homoeopathic principles.
2. The nosode should only be given when the patient’s symptoms correspond to it.
3. If the given homoeopathic remedy is working well and eliciting the desired result there is no need for a nosode. However, if the case should lag in any way an appropriate bowel nosode may give the necessary

impetus for the patient to continue to progress.
4. In a new case where the patient has not had homoeopathic treatment before time ago) if there is a definite symptom picture pointing to a remedy [constitutional prescribing], then the patient should be given the

indicated remedy and not the nosode. In cases where it is difficult to make the choice among many probable remedies a nosode may be given.
5. An old case where a patient may be under homoeopathic treatment, but is not responding to it, an appropriately selected bowel nosode can be given.
6. Potency selected in accordance with the  homoeopathic laws. Paterson often used the nosode in high potency and the related remedy in low (Syc-co. C 1000 in 1 dose + Nat-s C 6 2x daily).

They are prepared from cultures of non-lactose fermenting flora of intestinal tract.

Deep acting remedies can be used at any time if the symptomps agree.

Where there is a group of remedies indicated but no clear picture of any - if the group of remedies is related to a bowel nosode than that nosode can be given to help clarify the picture. Can also be given when the

indicated remedy fails

Bowel nosodes can take up to 3 months before they take full effect. After 4 - 6 weeks the picture should start to get clearer. Do not prescribe another bowel nosode or repeat within 3 months.

As usual in Homoeopathy, the more obvious the mental picture, the higher the potency, but lower the potency if marked pathological symptoms are present. But between these two extremes use

the 30th potency (in a combination of acute and chronic state).

    * Proteus acts best in high potency          

    * Gartner will not work in low potency

Do not repeat a bowel nosode within 3 months, instead prescribe the homeopathically indicated similimum from the group of remedies (previously given) related to the bowel nosode.

 

Indications for use of Bowel Nosodes         [Dr. K.N. Mathur]

By symptom similarity. When the apparently indicated remedy fails to act. When several drugs seem indicated, but none is clearly the simillimum. In an old case where several remedies have helped

but none has cured.

The selection of potency is guided by the same principles as other remedies. When the patient has received a homeopathic remedy within the preceding month, it is safer to give a low potency.

In advanced pathology the C 6 can be given daily. When used in high potency, it is wise not to repeat a bowel nosode within 3 months.

 

1. Dr.Edward Bach (1886 - 1936): discovered that certain intestinal germs belong to non lactose fermenting gram negative coli typhoid group has close connection with chronic disease and its cure/

it is present in healthy and diseased individual but in the latter it is pathogenic. Isolated bacilli given back to the patient in the form of an autogenous vaccine and claimed to cure disease with this method.

Years later he potentised the vaccine according to the homoeopathic principle and administered it this way, and cured so many patients. First full preparation of clinical proving was done in 1929

by Thomas Dishington on Dysentry.co.

2. John Paterson (1890- 1955)

A co-worker of Bach concentrated the research after 1929. He studied more deeply the characteristics of the bowel flora (in health, disease and drug proving). He examined more than

20.000 stool specimens and conducted research over 20 years. He came to the following conclusions
The non lactose fermenting non pathogenic bowel flora (B.coli) undergo definite changes in the disease condition. While this alternation in the nature of bowel flora might be a more concomitant

to the disease condition, this is reason to believe that the B.coli actually can turn pathogenic.
Bowel flora is out of balance distributed in disease. Similar changes are also observed in drug proving.

He advocated specific recommendation on potency/dose/repetition of Bowel nosodes/He related each of the Bowel nosodes to a group of remedies.
Bach found that the non lactose fermenting was closely associated with the symptoms collectively called Psora by Hahnemann. Paterson believed that gram negative diplococcic was directly related

to the sycotic miasm.
He grouped and typed the flora by continues experiment and observation. He was able to detect a definite relationship between certain drugs and certain type of bowel flora. When particular drug

was administered in potencies the bowel flora was altered in a particular way.
He divided the Morgan group of bacteria into 2 sub classes on bacterilogical grounds and thus created nosodes: Morgan pure and Morgan gaertner.
Paterson continued the incubation of agar solution for specimen of the Morgan group until 72 hours after inoculation, some specimens were unchanged in their fermentation reaction, while others

showed fermentation reaction in tubes in which they have produced no change at 18 hours. This made him to classify Morgans into 2 categories.

In1933 Paterson presented a paper on Sycot.co/in 1950 he published summary of his accumulated experience/After his death in 1954, his wife, continued the research.

 

[Christiane Petras]

Darmnosoden kommen viele Behandlungen zum Einsatz, oft sogar als wichtigstes Element, zur Unterstützung der Leistungsfähigkeit in jedem Sinne, also auch organisch. Sie haben eine tiefgehende Wirkung, auch auf die Gemütsebene und das Nervensystem, in diesem Bereich finden sich viele charakteristische Hinweise für ihre Anwendung. Sie lassen sich gut kombinieren, ergänzen einander und arbeiten oft Hand in Hand. Nur selten werden sie über längere Zeit einzeln gegeben, meistens erscheinen Symptome, die den kombinierten Einsatz verschiedener Darmnosoden fordern.

Wahrscheinlich ist dieser Umstand auf unsere moderne Lebenssituation zurückzuführen. Abgesehen von gesellschaftlichen Zwängen ist unsere organische Arbeit auch durch medizinische Maßnahmen, wie Impfungen oder Medikamente, oder durch äußere Einflüsse, wie z.B. Elektrosmog, schadstoffreiche Ernährung, Strahlenbelastung, psychischen oder sozialen Stress usw., in seiner Organisation beeinträchtigt. Wir werden deshalb wohl kaum noch ein Mittel finden, das alle diese Störfaktoren, einschließlich der ererbten Krankheitsbelastung, gleichzeitig erreichen kann.

 

New cases:

1. In a new case where a definite symptom picture points to a remedy, that remedy should be given, not the nosode.

2. In cases where the choice may be from a number of possible remedies, eg. Sulph. Calc. Graph. and it is difficult to select a remedy from this, Morgan pure can be considered to cover the totality

of symptoms by referring to the table of related remedies.

Old cases:

An individual who has had Homoeopathic treatment over a period of time and received a considerable number of remedies in various potencies. These are difficult cases, there is no available

evidence from stool culture to give a clue to the group of remedies likely to be useful, or indications as to the phase in which the patient is at the moment.

If the percentage of non lactose fermenting bacteria in the stool is greater than 50% the administration of bowel nosode is contraindicated, the nosode given at that time produces a negative phase

with a corresponding period of vital depression in the patient. In such cases use a nosode in C 6 potency in the first instance to avoid the chance of violent negative reaction.

 

Bowel Nosode Group: -- Bodily Systems: -- Conditions:

B stands for Bacillus; Co. for compound (made from a number of specific germs):
1. B. Morgan Co. (Bach):

two subtypes of Morgan Pure (Paterson) and Morgan Gaertner (Paterson).
2. B. Proteus (Bach)
3. Mutable (Bach)
4. Bacillus No. 7 (Paterson)
5. Gaertner (Bach)
6. Dysentery Co. (Bach)
7. Sycotic Co. (Paterson)
8. Faecalis
9. Bacillus No. 10 (Paterson)
10. Cocal Co. (Paterson)


Bowel Nosode Group:                                                        Bodily Systems:                                Conditions:

Morgan Group:                                                                     Portal System                                                 Sluggish - Congestive
                       Morgan (Bach)/Morg-p/Morg-g.

Sycotic Group:                                                                      Mucous:                                             Serous Proliferative Catarrhs
Gaertner Group:                                                                    Intestinal                                            Nutrition
Proteus Group:                                                                      Vascular                                             Nervous Strain, Spasm/Oedema
No. 7 Group:                                                                         Skeletal Muscular                              Weakness, Aging
Dys. Co.
Group:                                                                    Autonomic                                         Apprehensive Tension

Source: Agrawal

 

Folgendes hat anthroposofische Einschlüße

[Aart van der Stel]

              Pathology

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 into 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, 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 amount of stool 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 (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. 2 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 a day.

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.

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.

R.S. speaks in this connection of the "Emahrungsstrom" (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 (Emaehrung). 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.

              Faeces

When we look at the feces we can also distinguish a material aspect and a formal aspect: (a) how well can we break down (catabolize) and (b) how well can we build up (anabolize)?

In (a) the occurrence of a lot of gas in the intestines and/or 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.

In (b) cramps, diarrhea and constipation indicate disturbed forming processes. "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.(8) 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 three 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 are Nicotiana, Chamomilla, 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

 

[Aart van der Stel, M.D., Rotterdam, Netherlands]

A remedy with which I have recently been working on the advice of Machteld Huber (personal communication) is Carpellum mali (= applecore). R.S. advises this for a hypochondriac, melancholy woman of 37

who is afraid of becoming pregnant again and complains of "dauerendem 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.

 

Folgendes hat anthroposofische Einschlüße

Frei nach: Heinz-Hartmut Vogel

If we consider the digestive tract in its polarity between 1. head/senses/nerves, the beginning of the digestive tract is subject to a Sal process/the neurosensory Sal pole with secretion and excretion, Sal process was

the term for degradation and elimination of matter, coupled with the emanation of vital energies as the basis for sensory perception;

2. metabolism/limbs/the metabolic pole of the digestive tract to the Sulfur principle;

The digestive tract may be seen as taking up the processes connected with senses and nerves and accompanying them all the way down to the rectum, The term Sulfur covered the synthesis and incretion of matter and

the development of organs. The vital organization moves into the synthesis of matter. Metabolic Sulfur pole with incretion and synthesis;

Conversely, the digestive tract takes the metabolic processes upward, connecting them with the sensory process which is active in the region of head, throat and mouth.

Between these poles we have the actual process of conversion of matter as a middle process, in Paracelsian terms this middle process is the Mercury principle. Sal, Mercury and Sulfur are thus the vital principles on

which the whole digestive tract is based.

 

Except for its very first part (oral region) and its end (anal region), the digestive tract has developed from endoblast (endoderm). The essential parts thus belong to the substance pole in the organism, embryologically

deriving from the yolk sac.

The anterior part of the oral cavity and the anal part of the rectum derive from the ectoblast, the bearer of the sensory organization. Relatively speaking, this gives the beginning and end of the digestive tract

"sense organ character“. Morphologically, sense organ development (arising from the mesenchymal system) includes the evolution of a plexus of veins. Thus, the eyeball is surrounded by the vorticose veins, the base of

the brain by the mighty transverse and cavernous sinuses, the spinal marrow by the internal vertebral plexuses.

The beginning and end of the intestinal tract are similarly surrounded by dense venous plexuses - the pharyngeal and esophageal-pharyngeal venous plexuses in the region of mouth and pharynx, and the pterigoid

plexus in the anterior buccal cavity, with the internal nasal, deep temporal and meningeal veins draining into it, the latter intensely related to the cavernous sinus. This establishes the developmental and topographic

relationship to the ectoblast and, later, the anterior buccal cavity.

At the opposite pole, in the rectal region, the ectodermal sensory organs of the outer skin extend into the rectum for a distance of about 2 cm. This is, above all, the site of the rectal venous plexus, which has an internal

and an external part. The internal plexus essentially drains into the portal vein, the external part into the lower vena cava. The rectal muscles also show this dual aspect, with an inner layer of smooth involuntary muscle

and an outer one of striated muscle under voluntary control. The rectal venous plexus communicates with the important pelvic plexus, the vesical venous plexus and, above all, the uterine and vaginal plexuses, a situation

similar to that seen in the buccal cavity. Equivalent venous sinuses exist for the male pelvic organs.

The rest of the gastrointestinal tract has no comparable venous plexuses nor the kind of giant capillaries seen in the papillary layer of the skin or the parietal pleura in the lung.

Passing reference may be made to venous nature taken to the point of stasis in the area surrounding a sense organ and to the significance this has in the physiology of the senses. Exhalation of live carbon dioxide in the

area around a sense organ goes hand in hand with a process of "liberation", mainly of light and warmth ether forces that prove the basis for sensory activity. Wherever this process is found we are able to speak of sense

organ-type "perception". Here, an organic function may be mentioned that is connected with the generation of live carbon dioxide in the sphere of renal function. Incomplete vitalization of carbons in connection with

internal renal function causes adequate amounts of live energy to be liberated as carbon dioxide is given off at the periphery of sense organs. We thus have a double exhalation in the sphere of the sense organs - carbon

dioxide in the process of becoming physical on one hand, and living etherization on the other.

Beyond the oronasopharyngeal space comes the "actual" digestive tract - esophagus, gastric cardia, pyloric and duodenal region, jejunum, ileum and large intestine.

Let us now consider glandular functions. The salivary glands are still part of the head and senses pole of the digestive tract. In the same way we have sweat and sebaceous glands in the ectodermal part of the rectum,

and mucus-producing glands deep down in the folds of the mucosa. These may give rise to anal fistulas, which may be seen as a degenerative form of "sense organ development" (Sil.: anal fistulas).

The salivary glands in the oral vestibule, in the early stages of development extending to the base of the skull as the primordium of the inner ear or tympanic cavity develops (the oral aperture runs from primordial ear to

primordial ear and to the angles of the mandibles at the early embryonic stage) develop from the ectodermal part of the buccal cave - submandibular, parotid and major sublingual glands. The epithelium grows inward

from outside. Because of this, efferent ducts are sometimes well away from the main gland, as in the parotid. In the present context, it is important that nerve supply, gustatory and salivary gland nerves, above all the

chorda tympani and the intermediate nerve, run with the facial nerve through the tympanic cavity. The "gustatory nerves" (facial and vestibulocochlear nerves) above all supply the sublingual and palatine glands and

also the tear glands. The chorda tympani (sensitive sensory and secretory) owes its name to the course it takes and to immediate vicinity to the medial wall of the ear drum. Sense of taste and sense of hearing thus

come close functionally and in sensory terms. R.S. spoke of the "chemical" or "sound" ether. From this point of view, the soul principle and the conscious mind intervene into the chemistry of substances via the salivary

glands when we taste things. The sound ether is released in the ear.

Saliva (1 or 2 liters produced daily) has a high concentration of bicarbonate which makes it alkaline up to pH 10, especially if the vagus or the chorda tympani is stimulated. Saliva production is thus closely bound up

with the emotional life. Greater alkalinity results in "parasympathetic", thin saliva, sympathetic tone in mucous saliva. The pH may show daily variation from 5 to 8,5 (muscarine/pilocarpine/physostigmine/choline/nicot.

cause increased secretion).

Taste sensations cover mainly sweet and salty. The range seems typical for ego activity in the sense of taste. A spontaneously occurring bitter taste is already pathologic. Dryness and increased salivation point to psychosomatic swings of the pendulum with a bias to either sympathetic tone or parasympathetic tone.

Let us now turn to the colon at the opposite pole of the digestive tract. The pH of normal stools in adults is between 7 and 8,7. Secretion of fluids is reduced (100 ml/day). Absorption of fluids is dominant, with the intestinal contents driven in the physical, mineral direction. Apart from undigested food particles (above all cellulose) stools contain 30% of bacteria (up to 42% of the dry matter). In healthy breast-fed infants, the large intestine still shows the same conditions as the small intestine, with a slight lactic acid milieu due to dominance of bifidus flora which plays a part in symbiotic production of vitamin B (aneurine) (betalactose encourages the bifidus flora). We may say, therefore, that the whole of the large intestine and - as we have seen - above all the rectum take the intestinal contents into a physical, mineral state, and it would be reasonable to say that the vital processes of the chemical and life ethers are dominant. Secretion gives way completely to "incretion". This reflects the suction exerted by the chemical ether deriving from the liver. The whole of the large intestine is thus subject to the distant action of the liver process. Extremes such as loss of fluids from the large intestine and its opposite, extreme drying up of its contents, indicate disorders of the liver process. Chemical processes, which in the sphere of the salivary glands provide the basis for the secretion of large volumes of fluids, have the opposite effect in the large intestine, with the as yet fluid intestinal contents taken into the liver via the portal vein system. This reflects the interiorizing function of the liver. As a "vitamin B producer" (chemical ether) the liver is the etheric basis of nerve development and processes of consciousness. Early emphasis on, and challenge of, powers of conscious awareness in early childhood can increase the forces of the chemical and life ethers in the organism and hence hepatic function so such an extent that the vital processes taking place in the fluid sphere are withdrawn from the organism (liver-based drying out of the organism; homeopathic drug pictures of Lycopodium and Alumina).

The esophagus - The length of the esophagus from the pharynx, the narrowest part, to the cardia is 22 - 25 cm in adults (mouth to stomach 37 - 41 cm). The opening (os) is reminiscent of sensory function in so far as there is a particularly dense venous plexus beneath the mucosa at this point. Mucous glands continue the salivary gland function in the upper part of the esophagus, though now without taste sensation, Innervation: glossopharyngeal nerve forming a plexus with vagus and sympathetic nerve.

Similarly to the small intestine, the esophagus is in constant motion at its commencement. The rhythmic peristaltic movement, running through the esophagus like a contractile wave on deglutition, reveals the interplay of contraction and expansion, of the soul principle coming in more strongly (contraction) and emphasis on the etheric (expansion).

This dual process also predominates in gastric function and, above all, the whole of the small intestine. The large intestine finally stabilizes the rhythm even to the point of haustration. This gives expression to the physical space and form principle taking effect in the large intestine.

The stomach - In the region of the mouth and oral glands, the etheric, fluid principle and, therefore, weak alkalinity predominate, In the gastric region, the sentient organization intervenes more strongly in the fluid process and acids are produced. Gastric activity consists primarily in partial digestion of proteins with pepsin in an environment of pH 1,5. Secretion is mainly from the chief cells of the glands in the fundus. Cathepsin activity at pH 2,0 – 5,0. Mucus production at pH 5,0 - 7,0. Calcium, magnesium, sodium and potassium secretion is subject to similar conditions as in the blood. Characteristically gastric acid production in the stomach increases with the changes that occur in the soul at puberty and decreases with old age. Dependence of gastric acid production on the psychological state is characteristic of the stomach.

 

Psychosomatics of the stomach

It is known that gastric function, gastric juice production as a whole and acid production in particular depend on the emotional state. The question is whether the stomach is an independent organ or if its development and function are governed by a principal metabolic organ. Considering the whole symptomatology of gastric function, we note the characteristic influence of the sentient organization. Emotions and psychological stresses result in characteristic gastric symptoms. The stomach becomes an organ for the perception of the whole sentient organism. This, in turn, is closely bound up with, and has organizing functions in, the arterial blood processes and, beyond this, in the sphere of the kidney organization. The whole respiratory human being - both external respiration and internal tissue respiration - is closely connected with kidney function. Acid production is an expression of this, rather like footprints left by the soul principle. Gastric acid production and acid production connected with minor changes in tissue pH are, thus, polar to each other, going in opposite directions (muscular rheumatism frequently goes hand in hand with gastric sub- or even anacidity).

 

Hyperacidity must, therefore, be seen in conjunction with kidney function. Extreme ultrafiltrate production in the kidneys and resorption of this into the blood can lead to secretion, above all in the gastric region, in the sense of Volhard's "pronephros  nieren. This is connected with continuous loss of connective tissue fluid from the blood. The symptom goes hand in hand with loss of tone in the sphere of the blood (LOW blood pressure/sometimes vertigo/peripheral cardiovascular disorders/THIRST). The stomach may be said to be an organ that reacts to renal function. Whereas the walls of the stomach lie loosely against each other in a healthy subject, a bladder form develops in this case, and corresponding symptoms of a gastrocardiac syndrome. Air in the stomach - and in the intestinal tract - with increased eructation and singultus are kidney symptoms. Treatment: if these symptoms go hand in hand with general pallor and cyanosis, especially of the lips, treatment of the kidneys with Carbo vegetabilis and/or Veratrum album is indicated. The connection between excessive gastric juice production and ultrafiltrate, in some cases 8,10 or even 15 liters a day, also derives from the above-mentioned electrolyte content which, in the renal ultrafiltrate, too, is equivalent to that of blood serum.

Duodenum - In a rhythm, the laws of which become apparent in successive sections of the digestive tract, the acid stomach environment is followed by the relative alkalinity of the duodenal contents. This is largely due to the 1 - 2 liters of pancreatic juice produced daily. The optimum pH of the pancreatic enzymes is: lipase pH7, amylase pH6, proteins pH 8 -11.

The thin pancreatic juice contains proteins, its overall pH is 8 - 9, the taste salty. The average daily 500 ml of bile produced contributes to the duodenal alkalinity in spite of the 1 - 2 g of bile acids it contains (produced from 20 - 70 mg/100 ml of cholesterol, the mean pH being 8 (biliary fistula).

A physiologic polarity exists between bile and pancreatic enzymes. With the pancreatic enzymes, active chemistry goes out into the duodenal region, with the bile, substances that have dropped out of life in erythrocyte degradation are eliminated into the intestine. According to R.S. both processes, fourfold pancreatic secretion and biliary secretion to the outside, reflect primary "ego activity". The destruction of red cells and liberation of, above all, heat energy in the internal and external bile ducts is a physiologic warmth-ego process (temperature in the gallbladder distinctly above that of the blood). The fourfold pancreatic secretion and the high bicarbonate concentration (salts), on the other hand, reflect comprehensive, immanent activity of the whole vital life organization governed by ego activity.

Let me add at this point that embryologically the hepatic and biliary system, on one hand, and internal secretory and excretory pancreatic system on the other each derive from two endodermal structures. This is a process of organogenesis which also applies to the rest of the organism. One principle here produces an excretory and an incretory organ development. In the case of the pancreas, this is clearly reflected in the development of the acinous head and part of the body, on one hand, and the incretory activity located mainly in the tail on the other. In the case of the liver and gallbladder, an excretory organ develops that begins with the hepatic parenchyma and extends to the gallbladder, whereas the liver itself becomes the largest "incretory" organ in the organism.

"Incretion" here means synthesis and anabolism; "excretion", in this case into the intestine, the degradation and destruction of matter.

The duodenum is, thus, the mid-region of the whole digestive tract, governed by the ego organization in two respects.

Jejunum and ileum - As the digestive process passes into the jejunum and ileum, we reach the actual Mercurial part of the digestive system as a whole. This is also apparent from the motility and contractility or capacity for expansion in the whole of the small intestine. Another characteristic of the small intestine is the very slightly acid environment created by the Acidophilus flora. Acidophilus bifidus predominates in breast-fed infants, which gives the stools a pleasant, slightly acidic, yoghurt-like odor (anaerobic lactobacilli play a role in aneurine (vitamin B) production.) A healthy intestinal flora is, therefore, physiologic in the small intestine.

Comparing lengths: duodenum circa 30 cm, adult jejunum and ileum 5 meters on average. We shall not go into the specific glandular situation at this point - Brunner's glands, glands of Lieberkuehn.

Jejunum and ileum are the Mercurial region of the whole digestive process in the small intestine. The fluid principle is dominant, with some emphasis on the "sulfuric" character of this intestinal region. This covers the production of chyme, liquefaction of intestinal contents and first stage of absorption into and through the villi which considerably enlarge the surface area of the intestinal wall. The sulfuric character is also evident from the fact that the number of white cells - "sign of inflammation" - increases in the intestinal walls and villi as digestion proceeds. The daily volume of intestinal fluid is estimated to be three liters. Appearance: turbid, milky, because of the presence of white cells, epithelial cells and mucus. The fluid is approximately isotonic with blood. The high sodium bicarbonate concentration makes the environment slightly alkaline in the ileum. In breast-fed infants, the bifidus flora makes the contents slightly lactic. In adults, the contents of the small intestine should give a neutral reaction. A move to the alkaline range suggests infiltration by coli bacteria. The pH is thus distinctly acid (6,2 - 6,7) in the region of the jejunum and neutral or just slightly alkaline at the transition from ileum to large intestine. The intestinal motility throughout the small intestine is characteristic of Mercurial activity. It is a rhythmic pendulum swing within the individual segments. In purely external terms this leads to intense mixing of chyme and digestive juices. The movements of the villi are also rhythmic. The mixing movements are said to be up to 10 a minute, continuing for up to 6 hours. The filling of the intestine is governed by the parasympathetic, emptying and immobilization by the sympathetic system. The term autorhythmia is used. After a period of circa 6 hours (see above) the small intestine empties through the ileocecal valve into the large intestine, which happens in portions. The underlying dynamics of the whole digestive process may be seen as follows.

Upper part of mouth, esophagus and stomach: gradually decreasing sensory perception as regards both glandular function and neuropsychologic dependence.

Duodenum: polar function of ego activity, giving impulses to the whole of etheric activity (extreme degradation via the biliary system, with mineralization of live matter; on the other hand ego activity entering into the whole of pancreatic glandular activity). The day and night rhythms in both bile production and pancreatic islet function have significance as ego rhythms. Chyme production in the jejunum and ileum is dominated by Sulfuric activity, which is metabolic in the true sense, but in terms of a Mercurial physiologic function relating a) to pendulum swings and b) to dissolving, absorptive vital activity. The influence of absorptive hepatoportal activity and a dominant lymph organization govern digestion in the small intestine. Starting from the lacteals in the intestinal villi and continuing with large chyle vessels and intestinal lymph glands as far as the thoracic duct, the lymphatic system comes to the fore in the region of the small intestine. It, and the production of chyme and chyle, may thus be seen as the Mercurial principle in small intestinal digestion. The increase in white cells also relates to this.

Generally speaking, small intestinal digestion has its "head" in the duodenal region and its "end" in the region of the ileocecal valve, between the opposite poles of the stomach with its highly acid environment and the large intestine with its on-the-whole distinctly alkaline character.

The Mercurial character of the whole small intestine - duodenum, jejunum and ileum - bases on interaction and Mercurial blending of the chemical, fluid and psychological, airy elements. The etheric and sentient organizations interpenetrate, similar to the process seen with saponins in nature, and emulsify the chyme. Separation of fluid and airy principles indicates Mercurial weakness. Mercury has the dual quality of droplet formation and sublimation, i.e. transition into the gaseous state at normal temperatures. This range in physical properties seen in the element mercury is reflected by the emulsication of small intestinal contents - between "droplet formation" (aqueous phase) and generation of gases. Taking an overall view, the small intestinal processes lie between the concentrative fluid phase connected with the liver process and the breathing psychological phase dominating the small intestine, too, from the kidneys. Pathologic generation of gases, weak/pathologic kidney function and pathological production of fluids indicate failure of the emulsifying process which is governed by the ego organization. Inactivity of the sentient organization in the gastrointestinal region signifies excessive perceptive activity and consciousness of the organization in the sphere of senses and nerves.

Apart from the main symptom of increased generation of gases and a tendency to thin, liquid stools there must therefore also be corresponding signs of excitation in the sphere of senses and nerves: restlessness, hyper-sensitivity to sense impressions, neurasthenic symptoms. Treatment must be in accord with this. Generally speaking, medicines relating to both kidneys and nerves should induce the sentient organization to become involved in the fluid process, above all in the intestinal region. Two examples are Khus toxicodendron and Chamomilla. The function of the ego organization, above all in the duodenal region as described above, needs to be strengthened. This can be done by stimulating both biliary and pancreatic functions. Example: Cichorium/Pancreas/Stibium comp.  

The colon

The colon is 1 - 1,4 meters long (cecum circa 7 cm) and marks the beginning of the part of the intestine which, unlike stomach and small intestine, is no longer involved in the actual process of digestion. Secretory process occur here (mucous glands secreting dense mucilage with the relatively high, alkaline pH 8,4). The thickening of the intestinal contents is essentially with reference to water and salts. Almost the whole (500 ml) of 600 ml water is absorbed.

Characteristic structures in the colon are the longitudinal bands known as taeniae coli, the haustra, the vermiform appendix and the epiploic appendices (tabs of fat). We have already referred to haustration in conjunction with the nature of peristalsis in the esophageal region where every bite swallowed is pushed along by itself, as it were. The situation is similar in the large intestine, but more in the direction of spatial development, with the haustra presenting as a kind of static, tied-off element. Rapid peristalsis causes folds to develop in the inner large intestine that, from outside, appear as haustra. They divide the intestinal contents into portions. Together with re-absorption of water and the increasingly physical nature of the intestinal contents, the process in the large intestine is, functionally speaking, a Sal process. As already stated, this comes to a culmination in the tendency to develop sense organs in the rectum. The stomach may be seen as an organ reacting to the kidneys; the whole small intestine as interaction between fluid, etheric (lymph) and psychological, breathing organization (emulsincation) and, therefore. Mercurial; and the whole large intestine as a distant organ of the hepatic and portal system. The motility, i.e. movements of the large intestine showing extreme partial contractions, shows interaction between expansion and contraction, like all peristaltic movements, emphasis on etheric and sentient organism activity, though in the large intestine this reaches the borderline of physical organ development. The fluid content or, conversely, the drying out of large intestinal contents is connected with the portal and hepatic system's power of interiorization (incretion). Raccidity, especially of the large intestine, may go as far as atony or poor rectal development (megacolon) and indicate weakness of shape and form even in the liver region. Because of this it is possible to treat atony in particular with a "liver medicine" such as Stannum. The uniform liver process within a highly fluid principle is then subject to imposition of form (see also cirrhosis). The three taeniae coli and the haustration express the process of becoming physical anatomically and physiologically. Compared to inadequate ensoulment and breathing-through of the small intestine), the choice of medicaments must take account of the connection with the liver. We have already mentioned two characteristic liver medicines connected with drying out of large intestinal contents: Lyc. Alum.

In differential therapeutic terms, a very different pathologic situation has to be considered if there is a tendency to diarrhea. This is because the small intestine, with its emphasis on etheric, fluid, lymph-related function, is particularly liable to develop "nerve development in the wrong place". Ars.

              Summary

The whole digestive tract has been considered against the background polarity of neurosensory and metabolic organization. The interaction of etheric and astral organization thus comes to expression in the different sections of the digestive tract. The whole digestive tract is framed, as it were, in polar fashion by a tendency to develop sense organs in the region of mouth and pharynx, on one hand, and in that of the rectum on the other. Different pH levels in the sections also reflect intervention of soul principles (acidity) or etheric principles (alkalinity). The warmth organization of the ego is involved in this interaction, starting from the duodenum at the center of the digestive tract where we have the functional polarity of biliary and pancreatic activity. The "actual" digestive principle is active in the small intestine, where the Mercurial character of the whole digestive process is dominant -emulsification of intestinal contents (chyme) through interaction between fluid, etheric and psychological, airy principles. Digestive disorders essentially reflect the organic function of the section concerned:

Duodenum: polarity between biliary and pancreatic function.

Jejunum and ileum: lymphatic system relating to portal and hepatic function on one hand and respiration in conjunction with renal function on the other.

The large intestine has been presented to show resorption of water and salts to be under the distant influence of the liver, so that one-sided developments in large intestinal function may initially be treated via the liver.

           

 

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