Schmerzmittelgruppe
Anhang
ZEIT ONLINE
Gesundheit
[Harro Albrecht]
Jahrgang: 2015
Ausgabe: 08
Schmerzen: Es kommt auf den Kopf an
Sein Erweckungserlebnis war purer Zufall. Eines Tages beobachtete Ronald Melzack, wie in einem Laborkeller der McGill-Universität im kanadischen Montreal einige Scottish Terrier aus ihren Käfigen freigelassen wurden. Die Hunde waren gut gefüttert und versorgt, aber isoliert aufgewachsen. Ihnen fehlten die Alltagserfahrungen normaler Tiere. Melzacks Doktorvater, der berühmte Psychologe Donald Hebb, wollte ihr Verhalten studieren, und Melzack machte eine merkwürdige Beobachtung: Als die Terrier neugierig den engen Raum erkundeten, stießen sie ihre Köpfe immer wieder gegen frei liegende Rohrleitungen. Doch statt zu winseln, gaben sie keinen Laut von sich – ganz so, als spürten sie keinen Schmerz.
Neugierig entzündete Melzack ein Streichholz und ließ einen Terrier daran schnuppern. Der zuckte reflexartig zurück – doch nur, um danach wieder und wieder seine Nase
an der Flamme anzusengen. Offenbar erregte ihn dieser ungewohnte Reiz so sehr, dass er sich auch von der unangenehmsten Empfindung nicht abschrecken ließ. Möglicherweise -schoss es Melzack durch den Kopf- haben die Hunde in ihrer reizarmen Umgebung einfach nicht gelernt, das Warnsignal des Schmerzes angemessen zu interpretieren. In diesem Moment beschloss der angehende Doktorand, dem Phänomen Schmerz auf den Grund zu gehen.
Dabei galt das Schmerzproblem schon als gelöst, als der Psychologe um 1950 seine Beobachtung mit den Hunden machte. Die Mediziner kannten eine Reihe wirksamer Schmerzmittel und konnten selbst stärkste Krebsschmerzen mit Opioiden lindern. Allerdings gab es noch immer einige Schwierigkeiten: Manche Patienten litten aus unerfindlichen Gründen dauerhaft unter Schmerzen, trotz der Verschreibung stärkster Präparate.
Andere klagten über Schmerzen, obwohl die ursprünglichen Verletzungen längst verheilt waren. Selbst amputierte Gliedmaßen schienen manchmal fürchterlich wehzutun. Zugleich stellten die Mediziner irritiert fest, dass Menschen auf vergleichbare Reize sehr unterschiedlich reagierten – wo die einen kaum etwas spürten, schrien andere vor Pein.
Melzack war rasch klar: Das übliche Modell vom Schmerz stimmt nicht. Die damals vorherrschende Vorstellung ging im Wesentlichen auf jenes mechanistische Konzept zurück, das der Philosoph René Descartes schon 1632 formuliert hatte: Wenn irgendwo am oder im Körper etwas zwackt, leiten Nerven dieses Störsignal über das Rückenmark bis in das Gehirn weiter, wo dann der Alarm "Schmerz" ausgelöst wird. Das schien so simpel und überzeugend, dass kaum jemand daran zweifelte.
Es dauerte 333 Jahre, bis Melzack und sein Kollege, der exzentrische britische Physiologe Patrick Wall, es wagten, Descartes zu korrigieren.
Vor fünfzig Jahren, im November 1965, veröffentlichten Melzack und Wall einen bahnbrechenden Artikel im Fachblatt Science, in dem sie erstmals ihre neue Theorie skizzierten: Derzufolge leitet das zentrale Nervensystem nicht einfach nur Schmerzen weiter, sondern beeinflusst und modifiziert diese zugleich. Mit anderen Worten:
Der Weg des Schmerzes ist keine Einbahnstraße, es gibt auch eine Gegenfahrbahn.
Als entscheidende Schaltstelle entpuppte sich dabei das sogenannte Hinterhorn. Hier, im Rückenmark, wo jeweils zwischen den Wirbeln die Nerven eintreten, werden
nämlich alle einlaufenden Nervensignale inkl. Schmerzreizen verarbeitet. Je nachdem, über welche Nerven die Reize eintreffen, werden die Signale gehemmt oder verstärkt weitergeleitet. Im Rückenmark öffnet oder schließt sich gleichsam für die Schmerzsignale ein Schleusentor, weswegen die Forscher auch von der Gate-Control-Theorie sprachen. Melzack und Wall hatten im wahrsten Sinne das Tor zu einem neuen Schmerzverständnis aufgestoßen.
Wie so oft in der Geschichte der Wissenschaft war die erste Ideenskizze vom November 1965 noch fehlerhaft. Doch ihr Grundgedanke war zutreffend. Später korrigierten und verfeinerten die beiden Forscher ihre Theorie.
Sie beschrieben genau, wie das Gehirn über einen Rückenkanal Stärke und Empfindung des Schmerzes reguliert, und machten damit deutlich: Der menschliche Körper bewertet nicht nur Schmerzreize; er verfügt auch über eine eingebaute Schmerzbremse, die maßgeblich aus dem Gehirn gesteuert wird.
Im Endeffekt bedeutete Melzacks und Walls Konzept nichts anderes, als dass die Empfindung des Schmerzes von Persönlichkeit, individuellen Erfahrungen, Emotionen, gesellschaftlichen und kulturellen Einflüssen bestimmt und geformt wird. Und dabei handelt es sich nicht bloß um eine Wahrnehmungsänderung oder eine Art Selbstbetrug. Vielmehr geht es um handfeste, naturwissenschaftlich messbare Modifikationen der schmerzhaften Nervenimpulse durch die Psyche. Dass die Hunde in Donald Hebbs Labor unerfahren und aufgeregt waren, dämpfte ihr Schmerzsystem extrem.
Schmerz ist körperlich, psychisch und kognitiv
Die Erkenntnis der vielfältigen Einflüsse auf den Schmerz ermunterte nun auch Psychologen, Anthropologen und Soziologen, sich in die Schmerzdebatte einzumischen.
So wich allmählich die simple Theorie des Descart der Klingelleitung dem "biopsychosozialen" Modell: Schmerz hängt nicht nur vom Zustand unseres Körpers ab, sondern ebenso von unseren bewussten und unbewussten Gedanken. Zugegeben, diese Vorstellung ist eine intellektuelle Herausforderung. Sie ist fast so verwirrend wie die quantenphysikalische Erkenntnis, dass atomare Objekte je nach Experiment mal als Welle, mal als Teilchen auftreten. Auf ähnliche Weise ist Schmerz sowohl körperlich existent als auch psychisch und kognitiv.
Wie schwer man sich mit diesem Konzept tun kann, belegt die offizielle Definition der Internationalen Gesellschaft zum Studium des Schmerzes. Dort wird Schmerz nicht einfach als körperliches Warnsignal beschrieben, sondern als "ein unangenehmes Sinnes- oder Gefühlserlebnis, das mit tatsächlicher oder potenzieller Gewebeschädigung einhergeht oder von betroffenen Personen so beschrieben wird, als wäre eine solche Gewebeschädigung die Ursache". Mit anderen Worten: Erst die Bewertung eines Reizes durch das Gehirn ruft das unangenehme Gefühl und möglicherweise auch das Leiden am Schmerz hervor. Die Empfindung des Schmerzes ist damit etwas
völlig anderes als der reine Störreiz, den Physiologen auch Nozizeption nennen.
[Hans Wolff]
Schmerz ist für viele eine unendliche Geschichte geworden, so als ob der Schmerz ein eigenes Krankheitsbild darstellt, ist er aber nicht, aber irgendwie kann er das doch sein, z.B. wenn bei einer irreversiblen, destruktiven Krankheit zum Schluss nur noch begleitend der Schmerz behandelt wird, z.B. durch Opiate, Morphine und dadurch der Abschied erleichtert wird.
Schmerzen sind Sinneswahrnehmungen unterschiedlicher Qualität (stechend/brennend/ziehend/drückend/erkennen).
Wohlbefinden ist gestört, der Körper reagiert darauf und zeigt durch den Schmerz nur, das ursächlich etwas nicht in Ordnung ist - also eine Ursache hat.
Die Symptome, die wir erkennen zeigen uns, dass der Körper in Wirklichkeit mit eigener Kraft seine Gesundheit wieder erlangen will. Das ist wichtig zu verstehen!
Behandeln wir aber nur das Symptom oder den Schmerz so verlieren wir das Ursächliche aus den Augen. Und was noch schlimmer ist, dem Körper wird die Möglichkeit genommen Selbstheilungskraft zu aktivieren.
Es ist unglaublich, welche Kraft in der Natur liegt sich selbst zu heilen.
Genau das versuchen die homöopathischen Mittel zu fördern und zu unterstützen.
Dieser Weg über die Selbstheilkräfte, funktioniert leider in der Regel nur noch in den jungen Jahre. Vieles ist nicht mehr normal, ist nicht mehr natürlich durch unsere Art zu leben, die Art, wie wir unsere Berufe ausüben (müssen) der natürliche Rhythmus fehlt. Die Art, wie wir uns ernähren.
Älter werdend, verlieren wir zunehmend die Gabe, auf unseren Körper zu hören, denn er will uns eigentlich über das Symptom (Schmerz) etwas sagen.
Hören wir nicht auf unseren Körper und machen uns etwas vor, wird uns der Körper oder die Psyche irgendwann die rote Karte zeigen.
Unterschied zwischen akuten Schmerz und chronischen Schmerz.
Chronisch (mehr als 6 Monate bestehender) Schmerz, der dauernd oder rezidivierend sein kann.
Diese chronischen Schmerzen - Beschwerden sind das eigentlich große Problem.
Akute Schmerz ist wesentlich leichter zu behandeln.
Aber warum machen uns die chronischen Schmerzen, die chronischen Krankheiten solche Schwierigkeiten? Warum lassen sie sich so schwierig behandeln?
Hahnemann: Miasmenlehre.
Eine Art von Genetik, die er 40 Jahre vor Mendel begründete (mendel’schen Gesetze sind Vererbungslehre). Seine Therapie oder Behandlung nahm nun Rücksicht auf den Hintergrund der in der Familiengeschichte gehäuft aufgetretenen Krankheiten.
D.h. er behandelte in seinen Patienten die Krankheiten ihrer Ahnen, mit dem Erfolg, dass chronische, schleichende Krankheiten endlich für ihn zu behandeln waren.
Hierbei möchte ich auf die Begriffe reversibel, irreversibel aufmerksam machen. Fast jede chronische Krankheit überschreitet irgendwann die Grenze zwischen reversibel und irreversibel.
Hierzu ein Beispiel:
Die Alkoholkrankheit.
Oft erleben wir in unserer Nähe einen Menschen, der an dieser Krankheit leidet und wir wundern uns, dass dieses Geschehen oft 10, 15, 20 Jahre sein kann.
Der ganze Körper ist aufgedunsen, aufgeschwemmt, die Leber wird zu Fettleber, und irgendwann entsteht Leberzirrhose. Dies ist der Übergang zum Irreversiblen.
Ab hier kann man, das Geschehen nicht mehr zurückholen.
Wir sind nicht nur das Ergebnis von Vater und Mutter, sondern einer ganzen Kette von Ahnen. Alle Stärken, alle Schwächen, alle Veranlagungen, ja jede Art und Weise mendeln in uns rum.
Es ist das einzige Erbe, auf das wir uns verlassen können!
In der Therapie oder Behandlung der homöopathischen Miasmenlehre floss nun bei Hahnmann folgendes ein:
1. Die vererbten Merkmale, dies war die Sensation, das Geniale.
2. Die Gesamtheit der individuellen Merkmale geistiger, seelischer und körperlicher Art
3. sowie der spezifischen Reaktionen auf Einflüsse von Aussen
Aber wir müssen trennen:
1. das Geerbte und
2. das Persönliche - Individuelle
Das Geerbte = Blockierende muss gelöst werden. Erst dann kann man den Patienten in seinen individuellen Merkmalen behandeln.
‡ Folgendes hat anthroposofische Einschlüße ‡
[Christa-Johanna Bub-Jachens]
Analgesics with peripheral action - non-steroidal anti-inflammatory and
antipyretic drugs
The dangers of painkillers are often not fully recognized. They are
widely advertised, but potential consequences are only rarely made known.
Painkillers are widely used in the highly industrialized countries, with
analgesic-induced nephropathy remarkably common. 20% of patients requiring
dialysis present with analgesic-induced renal failure (
At the dialysis center in
"Phenacetin
kidney" was first described in 1950. In 1986, the registration of drugs
containing phenacetin was canceled. Concerning the history of phenacetin: large
quantities of p-nitrophenol were obtained as a byproduct in the manufacture of
certain pigments; the search for an industrial use led to the development of
phenacetin.
Anilines (Aniline, phenylamine or aminobenzene is has the formula C6H5NH2.)
have analgesic, anti-inflammatory and antipyretic properties but proved too be
too toxic. Acetanilide (an antipyretic), obtained by acetylation, was in use
for a long time before it was banned for causing methemoglobinemia. In was
known as early as 1887 that acetanilide converts to paracetamol [N-(4-hydroxy-phenyl)
acetamide] in the organism. "This substance is much more effective and is
better tolerated. Wanting to 'detoxify' paracetamol still further, chemists
produced phenacetin. Today we know phenacetin is converted into paracetamol in
the body“. The February, 1986 issue of Arznei-telegramm states: "The
pharmacological and toxicological data establish the same kind of nephrotoxic
and carcinogenic risk as for phenacetin. Epidemiological data that might go
against this are not available“.
Today, we know that paracetamol, which has taken the place of
phenacetin, is no less nephrotoxic than phenacetin (combined with
acetylsalicylic acid +/o. coffein).
All non-steroidal anti-inflammatory agents cause renal damage. The
histology shows non-purulent interstitial nephritis followed by papillary
necrosis. There is no dose-effect relation. Some patients taking large doses of
analgesics do not show damage, whilst others may develop nephropathy after even
relatively low doses. Generally speaking, it is true to say that renal damage
is all the more likely the higher the cumulative dose. Non-steroidal antirheumatic
drugs also play a considerable role in both chronic and acute renal failure.
We note that drugs have been produced from waste products.
R.S.: "It is not admissible simply to try substances out... without
considering what is revealed to the world in them. People test aspirin... or
phenacetin, etc., giving them to patients. If they give one after the other
like this, there is no need to activate the soul.“. He spoke of the way
medicines were found by Intuition in the past, when people observed the inner
connections. Today scientists experiment and try substances out on a number of
people.
R.S. pointed out that such an approach would have negative consequences
in due course, though these would not have been noted by the initial
experimenters. Chemical analysis in the modern sense will not reveal the world
mission of a substance. R.S. showed that it is important to know and perceive
the relationship between macrocosm and human being and that there is less and
less such knowledge (in medicine). "I went through the martyrdom of the
intellect and of sentience when phenacetin was tried out. This method of trying
something out, without anything to guide one,
shows that science has lost not only the spirit but also its
seriousness. .. Today we must clearly distinguish where we have caricatures of
a science and where true insight is gained out of the spirit“. These words were
spoken in 1908! Consider how long it took until scientists discovered and
admitted to facts which R.S. had known through the science of the spirit.
Analgesics with peripheral action inhibit prostaglandin synthesis and
thus prevent sensitization of pain receptors. Prostaglandins are hormone-like substances involved in many processes, e.g.
inflammatory processes and platelet aggregation.
The question is, why do peripheral analgesics and anti-inflammatory
drugs cause kidney damage leading to kidney failure and urothelial carcinoma?
The kidney is a secretory organ which enables the human organism to become a
self-contained entity capable of self experience. Processes of conscious
awareness are connected with the kidney.
The kidney is also the organ from which the astral body radiates, which
makes it the organic basis for sentience. Pain signifies increased awareness in
the organic region concerned. It is experienced in astral body and ego. [The
pain vanishes as soon as ego and astral body depart (sleep/coma) even if the
wound is still there].
If we see pain as something that brings awareness, waking us up, we may
also consider it to be our helper, a chance to perceive the need for specific
measures both externally and inwardly. If this awareness-creating symptom is
simply suppressed, with no other suitable measures taken, this may create
deep-seated problems for the individual concerned.
Apart from kidney damage, potential side effects of all the types of
drugs mentioned above include hypersensitivity (skin reactions/asthma) and
changes in blood profile (agranulocytosis). It is evident that a shift occurs
in the astral body's direction of action and also an attack on the
ego-organization.
The above-mentioned drugs not only eliminate pain but also have
anti-inflammatory and antipyretic properties. Relative to reduced awareness,
the suppression of inflammatory reactions and the effect on the warmth
organization are of much greater account. They add to the damaging effects of
modem civilization, increasing the diseases of our time.
The question is, what is the effect of drinks containing paracetamol
used to treat colds? They sound so harmless and are used with terrible
frequency. What does it mean if we use acetyl-ac. to treat inhibition of
platelet
aggregation, which is a common practice today?
[LR. Twentyman]
The descriptions of migraine from classical times show the same features
as today/can manifest from childhood to old age.
Start is the characteristic feature of one-sidedness (can be
two-sided)/may always be on same side/may start on one side and move to the
other/may alternate in different attacks from side to side.
What does this marked asymmetry point to?
The human bodily organization is not fully symmetrical; l. and r. do not
fully mirror one another. Where does the twist come from?
The brain is initially symmetrical; the distinctions between l. and r.
are built into it from the use of the limbs. In early childhood it is still
possible to determine l. or r. handedness. One gains the impression that the
symmetry of the body stems downwards from the head. If we were only head we
would be symmetrical. Logical head-bound thinking wants to have everything and
all arguments balanced and symmetrical. This is the typical male sort of
thinking, and it finds the twist in things difficult to put up with. Nature is
always twisted; even in crystals we find dextro or laevo rotatory forms.
If symmetry stems from the head, from where comes the twist in
asymmetry? Our abdominal organs show the twist early in embryological development.
The alimentary tract begins to coil, the stomach moves to the l., the liver to
the r., the spleen and pancreas to the l.. The kidneys retain a symmetrical
relationship, consistent with their origin as pronephros in the head region,
but the suprarenal glands sitting on the top of the kidneys show asymmetry, the
l. having a halfmoon shape. This twist builds itself upwards into the thorax
where the heart comes to lie slightly to the l. and the l. lung has two lobes
whilst the r. has three. Moreover the blood vessels develop so that the aortic
arch in mammals and man persists on the l., the r. arch atrophying, whilst in
birds on the contrary it is the r. aortic arch that persists. In this way the
arteries in man come to be centrifugal to the l. and the veins centripetal to
the r. In the brain it seems that the functional distinctiveness of l. and r.
hemispheres is built into it from the use of the limbs. In this way we have
come to be a wonderful balance of two spatial principles, and we can find these
two aspects sculptured in the inner ear.
The semi-circular canals, at r. angles to each other, manifest the
tendency to symmetrical order, r.-angled and r.-minded regularity of the 3
dimensions of space. The cochleae, the snail shells within our ears, on the
other hand are spirally formed.
The one-sidedness of migraine headache seems, then, to point to
processes arising in the metabolic, abdominal pole of our organization and
overwhelming the true nerve-sense processes in the head pole. For consciousness
to wake up in our heads, the life processes must withdraw. When the
constructive, up-building forces of the metabolism push up into the brain we
lose consciousness, as for instance when we fall asleep. During waking life,
when we can think and reflect, the dying processes in the nerves predominate.
The brain is only a true brain functionally when we are awake and thinking. We
wake up in our sense organs when the metabolic life processes withdraw from
them and allow the outer world to penetrate. In the migraine attack the senses
are disturbed, most dramatically in vision. The loss of half of the visual
field, usually l. or r., but sometimes the upper or lower half, is fairly
common. Tunnel vision and effects like snowstorms add to the bewildering and
varied phenomena of the visual aura or migraine.
Hemiplegias, to be interpreted as loss of the sense of motion and
position, vertigo, disturbances of hearing or smell or taste, may also herald
the onset of the attack. Most sufferers from migraine would also agree
that during the attack thinking is disturbed and, when circumstances permit,
the best thing to do is to sleep.
Some attacks of compulsive sleepiness seem to bear the signature of
migraine rather than narcolepsy. Could we also approach Menieres syndrome as
another aspect of the same process?
Emmanuel Swedenborg, swedish philosopher-scientist, drew attention to
the peculiar way in which the arteries lead into the skull. Both the vertebral
and internal carotid arteries supplying the brain enter the inner sanctuary
of the skull with a sort of 'S' shaped
twist. In this way, Swedenborg suggested, the full drive of the pulse-beat is
held back and the brain can take its blood in freedom. Altogether the head
rises poised and balanced freely on the top of the vertebral column; it should
not be held rigidly as a mere appendage like an animal's head. Many migraine
sufferers have stiff
or stuck necks, and one wonders whether the success of osteopathic
manipulation of the neck in some of these patients is due to the freeing of the
head from the trunk, freeing the brain from the surging forces of the blood.
The liberating action of the serpentine entry of the arteries into the skull
becomes frozen in these necks until it is again released.
So far we have been considering the one-sidedness of migraine as an
expression of the upper, cephalic, pole being overwhelmed by the dynamics of
the lower abdominal pole. Processes which should run their course in the
digestive and metabolic organs may for various reasons be incomplete. Then the
brain may be called upon to complete vicariously the digestive and metabolic
processes, functions for which it is not suited. Certain foodstuffs are not, in
some individuals, overcome in the digestion and then pass as foreign and still
undigested foreign substances into the brain: chocolate and cheese are
well-known examples. These food sensitivities are not really allergic but
rather poisonings. They may arise on the basis of specific enzyme deficiencies.
We can now more easily pass on to the migraine phenomena related to
menstruation.
It has been said in an aphorism that migraine is cephalic dysmenorrhoea
and dysmenorrhoea uterine migraine, and in psychoanalytical circles migraine
has sometimes been understood as symbolic labor pains. The old Greek story of
the birth of Pallas Athene from the head of Zeus expressed this in the
pictorial language of mythology. Zeus had become aware of the fact that his
spouse Hera had conceived without male help. He developed a headache diagnosed
by the midwives of
We are here faced with the polarity of the uterus and skull. In the one
the brain, in the other the embryo-fetus float. In the one case man conceives
thoughts in the head, in the other woman conceives babies in the uterus. These
features again lead us to look at the architecture of the human organization.
From the top cervical to the lowest lumbar vertebra the architecture is
predominantly segmental. Each segment is based essentially on a vertebra with
posterior spine, two transverse processes and two ribs, a five-fold star (Aster.). In the neck and lumbar regions
of man, the ribs appear lost, but they reappear, in metamorphosis, in the
limbs, the five suppressed ribs coming to visibility in the fingers and toes.
But in the skull and pelvis the segmental character is almost completely
overcome by the spherical form. The radial, segmental architecture of the spine
is replaced by the dome of the head, and the head of the fetus fits almost
perfectly into the containing dome of the pelvic cavity.
The sea-urchins among the echinoderms echo this metamorphosis.
In nature we find two animal phyla in which these architectural
principles find expression. In the Arthropods., coming to highest expression in the
insects, we find segmentation carried to its limit. The body is rigidly divided
into segments, the appendages are segmented; even the life history is divided
into segmented stages, egg, caterpillar, chrysalis, butterfly or imago. These
stages are sharply separated from each other. At another level of animal
organization, the snakes carry segmentation to another extreme, with up to 450
vertebrae. The great contrast to these articulated creatures is found in the
molluscs, and again amongst the reptiles the tortoise stands in polarity to the
snake.
Poppelbaum emphasized the molluscs as corresponding to the head/Jaworski
emphasized more the molluscan note in the female genital organs and functions.
The same note which is sounded in the formation of the uterus and vagina sounds
again in the realm of the cephalopods (squid/cuttle fish/octopus). Homeopathy
has the remedy Sep. (= ink of the cuttlefish/= a outstanding for
migraine) and it has an INfluence on the uterus and gynecological functions.
Most migraine attacks in women are associated with menstruation, and
Sep. helps in the treatment of these patients and in understanding the dynamics
of the condition. Jaworski further traced the asymmetry, as a female note, so
marked for instance in the spiral of the snail-shell, r. back to the asymmetry
in the process of oogenesis
(= Entwicklung einer befruchtungsfähigen Eizelle). In the divisions of
the oocyte (= weiblicher Keimzelle) leading to the formation of the ovum, the
cell divisions do not lead to two equal cells. Instead, small so-called polar
bodies are cast off. Cell division leads to unequal cells, ovum and polar
bodies = female. In spermatogenesis = male on the contrary, cell division
results in equal sized cells of the next generation.
Lyc. + Sang. + Chel. r.-sided action and related to the liver and gall
systems.
Spig. works mostly on the l. side of the head and has strong affinities
with the heart.
These instances help us to see into the way in which, in migraine, the
processes of the lower genital and metabolic organizations come to obtrude into
the head organization. Can we characterize these polarities any further? The
distinction mentioned between the conception of babies in the uterus and
thoughts in the head points to another aspect of this polarity. In the womb,
real, live babies are conceived, but in the head only those shadowy images we
call thoughts. These thoughts have more the quality of mirror images; they are
not substantial but image realities. It is within the world of images which
arise in our heads that we can wake up in freedom; they do not compel us. But
we live into the realm of substantially real metabolic activities and
metamorphoses found in our lower functions and then actively transform these
processes. In doing so we lose our awake consciousness, we enter the realm of
the unconscious, a sleep consciousness. We can, even if at first only as a
guess, begin to see how here we enter the realm of the will over against the
awake life in that hall of mirrors we call our head, the realm of the image
life of our thinking.
A typical feature of migraine = periodicity. All life activities have a
rhythmic quality: night and day, lunar month, seasons of the year and other
rhythms manifest themselves
in living organisms. Migraine often obtrudes into ordinary life,
interfering forcibly with our consciously held wishes and intentions, and does
so periodically. In between the attacks life proceeds normally. We have already
mentioned the association of migraine with menstruation and in women the
monthly rhythm usually comes to dominate the migraine periodicity. In men the
periodicity seems more related to stress. The weekend headache comes on to
spoil the pleasures of recreation after a heavy week's work dominated by the
objective demands of imposed duty. The nightly renewal of the brain during
sleep cannot keep pace with the accumulating deposits, the debris of our
over-concentrated waking activity. The attack comes as a weekly spring
cleaning. It can come on when the repressive force of conscious concentration
on a task is relaxed. Attacks can be associated with some special occasion or
event. They nicely come to prevent the fulfilling of the arrangement, duty or
other obligation. A certain hysterical element here enters into the attack
whose occurrence may certainly seem purposive and useful.
In these phenomena is a polarity on one hand excessive digestive,
metabolic processes overwhelm the processes in the nerves and senses (incl. the
hysterics) and on the other hand overexertion of nervous and sensory activity
leads to the need for a periodic curative clean-up and renewal in the brain and
senses. Our conscious waking life is purchased at the expense of catabolic
breakdown processes in the brain. If these are not cleared up during sleep and
periods of recreation, they build up until a crisis point is reached. The
migraine attack is curative. In the former type of cases, a surplus of
incompletely digested metabolic substances breaks through into the nerve-sense
processes. These two types of migraine phenomena often play into each other
today.
At this point we can approach the conditions sometimes known as migraine
substitutes. If we can grasp the archetypal process in migraine in a sort of
picture, if we can begin to approach it, then we can hope to find this same
archetype in related phenomena. We can proceed to grapple with the riddles of
migraine by the methods of amplification rather than by reductionism. This is
not to decry the researches which unearth the fine mechanisms which play their
part in illness and health. But just as a study of the chemistry of ink is only
one aspect of the deciphering of a written page and must be complemented by
study of the letters of the alphabet, of spelling, of the building up of
sentences and paragraphs until with a leap we reach the very heart, mind and
soul of the author, so must we try again and again to read the meanings of
symptoms in addition to the chemical mechanisms in which they are written.
We have already considered migraine and dysmenorrhoea as substitutes,
and problems of menstruation can throw light on related aspects of migraine.
Fluid retention is common before menstruation. It may assume major importance
in severe cases of premenstrual syndrome. In many cases of migraine a similar
fluid retention builds up before the attack which passes off with diuresis.
Some decades ago this led to the treatment of migraine with urea which was used
to promote the diuresis. In homeopathy Gels. is
mentioned in connection with migraine ending in diuresis/anticipatory anxiety
and confusion and to paralytic and anesthetic phenomena, pointing to the
hysterical pole of these conditions. No doubt hormonal influences are
integrated into these manifestations.
Gout: deposits of urates in the cartilage and tissues (around joints).
Attack of acute gout: joints red/swollen/hot/exquisitely painful. After the
attack the deposits (in tophi), may be reduced in size; the attack has been
curative. Prof. F. Wood Jones: observations based on his own experience. He
came to the view that in the attack arterio-venous anastomoses (= Verbindung
2er Strukturen) around the joint opened up and brought about a greatly
increased blood flow. One might describe such phenomena as vicarious
menstruation, remembering that gout is mostly a disease of men, female menstruation
protecting women from it.
In children various aspects of the periodic syndrome are fairly common
and tend to develop at puberty into frank migraine. But quite typical migraine
also occurs in childhood.
Syndrome occurring periodically: bilious attacks with vomiting and
abdominal pain or recurrent fevers (with inflamed throats). In adults:
abdominal migraine, in which recurrent attacks of pain, nausea and sometimes
vomiting occur (+ headaches) and the diagnosis is easy. Often, however, it is
only the overall picture of the recurrent attacks which leads to a diagnosis,
together with the exclusion of so-called organic disease of gall bladder,
kidneys and pancreas in particular.
Pseudo-angina in the chest has also been recognized as a migraine
substitute.
Some years ago I had occasion to record and comment on some cases in
which the migraine process seemed to appear in a limb. One of these cases was a
woman who had had a cancer of the l. breast for ten years. She had always
refused treatment for it. It had now reached the stage when multiple skin
metastases were present over the l. breast and shoulder and upper arm. She told
the story of how, over the years, at periodic monthly intervals, she would have
an attack which she called her fever attacks. One day she would feel
particularly well, and she came to expect next day to pay for it. Then next
morning she would wake with a high fever (up to 103 o F.) and the whole breast
and arm area red, swollen, angry. On occasions when doctors had seen it, they
had wanted to give antibiotics, but she had always told them not to be silly
and go away. Next day she was quite recovered. These attacks always came
together with a severe l.-sided migraine. It was as if one could actually see
the same process both in the head as pain and in the trunk as an inflammatory
reaction.
If we relate this to the conception that a cancer is a misplaced sense
organ we may guess that these attacks were indeed curative processes. Incidentally,
she also said that after radiation therapy for a metastasis in the cervical
spine the attacks stopped for six months. Did the radiation suppress the
curative reactions?
We have suggested that the unilateral aspect of migraine points to an
origin in the metabolic processes and organs. In the homeopathic tradition of
medicine various remedies have been observed to have a particular relationship
to migraine. These remedies often point to disturbances of other organs and
functions in addition to the headache.
Puls: uterus and headache. Iris-v. acts IRRitative on the
gastrointestinal tract (acts on the pancreas as well?)/migraine with nausea,
vomiting and abdominal pain/produces intense SALivation. Sulph.: whole
metabolic process (liver).
Kidneys system in so far as it relates to migraine. Following the
anthroposophical school kidneys and suprarenal glands are taken together. The
last sitting like caps on the kidneys catch to some extent the kidney radiation
and mediate it into the circulation. Swedenborg discussed these 2 glands and
attributed endocrine functions to them. He
showed their close connection with the kidneys. This connection has been
developed in anthroposophical medicine. The kidneys perform a lot of work in
separating the urine from the blood, and as a consequence there is backthrust
into the organism. R.S. discussed this backthrust under the term kidney
radiation. It works to arouse the organic processes from vegetable to animal
existence. The relationship of the kidney to N metabolism indicates this;
vegetable life is based on C-metabolism, animal life on protein and where
protein enters into vegetable life it indicates that this has been touched by
the animal level of existence. Protein has interiorized the N-processes. It is
significant that Cofin. and barbiturates are closely related to urea in molecular structure. The one
acts to awaken, the other as a hypnotic. The kidneys are also involved in blood
pressure control through renin, angiotensin and related processes, and the
suprarenal glands reach a high polarity of action in the contrasted pictures of
Addison's disease and Cushing's syndrome. In Addison's disease the patient lies
inert, pale, pigmented, the Na level in the blood is reduced and the blood
pressure is very low. But in Cushing's syndrome,
the patient is hyperalert, restless, florid, with high blood pressure
and raised Na level relative to K. Na characteristic of animal, and K of
vegetable physiology.
John Paterson: Proteus. He found a common thread running through the
drug pictures of these remedies which he expressed as "brain storms."
The main remedy in this group is Nat-m., an outstanding homeopathic remedy
for migraine. I have no doubt that this group is related to the kidney, as the
group associated with the Morgan bacillus was related by Paterson to the liver
and the group associated with the dysentery organisms with the heart and
epigastrium. These were empirical clinical findings. Now in this group
associated with salt, Nat-m. we find Sec. Cupr-met. Cact. together with Ign.
and Con. (which brings in attacks of vertigo as well). In the picture of Nat-m.
we find long exhausting periods of strain followed by sudden outbursts of
disease manifestation such as migraine or even herpes simplex.
The evolutionary origins of the kidney as pronephros from the cephalic
pole already points to a close connection between this organ and the nervous
system. It is interesting to find that these empirical confirmations and the
whole range of symptoms of these remedies share a common style. It is this
style, which
The style of the attacks points to a common ground in the kidney and
related nervous disturbance. A feature of some migraine attacks, already
touched on, may find an explanation in the kidney dynamics. It is not uncommon
for patients to refer to a feeling of well-being, a high, the day before an
attack. Sometimes it takes the form of ravenous hunger and then the headache is
attributed to the orgy of overeating, whereas in reality the overeating is the
first symptom in the whole ritual of the migraine attack. Starting with a
general exhilaration arising from an overactive kidney radiation, the process
goes on to the overwhelming of the brain function and the typical migraine
headache.
Senses weak or exhausted/unable to defend themselves against the
battering of the modern world: Sil. Prun. and Phos.
Migraine expresses itself as a confrontation between these two poles:
the nerve-sense pole and the metabolic pole and
a failure of the rhythmic system in its function of healing
intermediation.
The form-giving upper pole cannot succeed in straightening the
turbulence of the metabolic processes. The nourishing metabolic pole cannot
refresh the dying nervous system but erupts against it as a pseudo-
inflammation. In the natural rhythm of sleep and waking we can see the healthy
interworking of the two poles mutually interpenetrating and balancing each other.
In the meeting of breathing rhythm and pulse beat, these two again work into
and through each other; the breathing rhythm leads the nervous and the pulse
beat the metabolic processes into harmonious relationship with each other
through the interplay of these two rhythms.
Ferr-met. works in 3 functional realms: 1. as healer and strengthener of
nervous tissue, 2. relates to the biliary system, restraining the
overexuberance, 3. working in the rhythmic cycles/the to and
fro of taking up and giving O by the hemoglobin is an example of this rhythmic
activity of iron. In the vaguely developed homeopathic drug pictures of
Ferr-met. and its salts, something of all this
is visible. Instability of the circulation/orgasms of blood/flushings
which are combined with sensitivity of the senses particularly of hearing, and
indigestion, vomiting and an intolerance of eggs.
All of this with hammering headaches and a marked r.sidedness in the
symptoms show the relatedness of iron to the whole migraine disturbance. The
anthroposophical remedy for migraine: Bidor.
Migraine in relation to other diseases:
First stage: prodomal herniplegia ordinarily resolving in ½ hour, the
hemiplegia will on occasion be found to be persisting and permanent. The
migraine has passed over into a stroke.
The dynamics of migraine as they have been presenting themselves to us
can be found again in the more serious and tragic condition of multiple
sclerosis. Here the dying of nerve tissue, something which paradoxically can
almost be called the life of the nerve processes, gets too advanced. It
provokes the blood to an inflammatory response, in an attempt to reincorporate
and re-enliven the disintegrating myelin sheath.
Vorwort/Suchen Zeichen/Abkürzungen Impressum