Darmnosoden Anhängsel
[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.
“...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 xmx
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
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 specifi*
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 - chroni* autonomi* 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
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
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.
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, especially their behavior
in health, disease and in 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 out that the non lactose fermenting was closely associated with the
symptoms collectively called Psora by Hahnemann.
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.
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.
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;
1. B. Morgan Co. (Bach):
two subtypes of Morgan Pure (
2. B. Proteus (Bach)
3. Mutable (Bach)
4. Bacillus No. 7 (
5. Gaertner (Bach)
6. Dysentery Co. (Bach)
7. Sycotic Co. (
8. Faecalis
9. Bacillus No. 10 (
10. Cocal Co. (
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 ‡
Frei nach: 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.
Feces
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
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
Rudolf Steiner's Occult Physiology,
however difficult and inscrutable, is a good key to understanding the
metabolism. The central theme in this work is the "preparation" of
the blood as ultimate bearer and instrument of the ego. All organs contribute
something to it, and this whole process of preparation may be called
"metabolism".
Food undergoes a long journey of
digestion from outside to inside, which is marked by a number of
confrontations. Steiner speaks of "aussere Regsamkeiten" and uses the
example of stubbing a toe on a table leg, which gives rise to two processes,
one directed outwards and the other directed inwards. Outwardly the table leg
(and the same would be true of a portion of food or a sense impression) is
pushed away, overridden, excreted (Absonderung). Inwardly consciousness arises
of the pushed-away object (the external world and all it embraces) and of one's
own person: my toe hurts, and I have only become aware of it by stubbing it. Steiner
speaks in this connection of the "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.(6)
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.
Feces
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 pro-cesses. "Kraempfe zeigen die
Unmoeglichkeit dass Ich-Organisation und Astralldb in physischen und Aetherleib
hineinfahren"(7) (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.(4)
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,(9) although these are mainly in connection with Carpellum
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
A remedy with which I have recently
been working on the advice of Machteld Huber (personal communication) is
Carpellum
In cases described elsewhere,(11)
Carpellum
It would seem worthwhile to gain
experience of the remedy (Carpellum
Aart van der Stel, M.D.,
Rotterdam, Netherlands
‡ 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.
Vorwort/Suchen Zeichen/Abkürzungen Impressum