Wednesday, November 13, 2013

Direction of Disease Progression and Cure

                   It seems that medical world has grossly accepted that acute diseases are curable, many infections and infestations could be eradicated and all chronic diseases are manageable with medical and/or surgical interventions. Everyone in medical world talks about treating condition of patient. They detail case, analyze it and prescribe as per their interpretations, sometimes with good result, sometime with no result or sometime worsening of condition due to progress of disease or as a result of treatment! 
The term disease is loosely used to indicate various altered conditions of health. After years of researches and treatment for a single cause for an altered condition of health medical fraternity to some extent has recognized that any alteration in health is outcome of interaction of many factors. But it is still far away to consider the pivotal role of the host in a disease condition and continuing to blame one or more external factors. Disease is considered as an event. A patient if improved of one condition one event is over. The same person when presented with some new condition during the treatment or in consequence or after a short time the physician  treats it as a separate disease entity and does not think about any correlation between the two occurrences. In spite of the best treatment as time passes and person grows older he get affected with deeper and more serious disorders. Thereby be it simple  pimples on face or increased blood sugar, thyroid activity, some autoimmune process, degenerative diseases as multiple sclerosis, cancer etc. or some mental condition, in spite of good management of specific condition the disease goes on uninterrupted and patient is not reverted to normal. Is it not then the appearance and occurrence of symptom complex or pathological conditions or involvement of organs/systems one after the other is a part of a greater process instead of some events in the life process infancy to old age – from womb to grave? Then what is disease?  How does this altered condition of health occur and progress?

THE DISEASE
Human is our subject of study and treatment. Human has three level of existence – Body, Mind and Spirit. So far the spirit has been talked in religious parlance only as a subject of metaphysical existence but recent researches in science have proved that it is the part and the base of life (refer to the article - BESIDES PHYSIQUE). The physical body of an organism is composed with combination of various  elements and chemicals which remains unchanged after death.  From gross to fine level if we proceed we find body, systems in the body as (here listed in decreasing order of importance) nervous system, cardio-vascular system, endocrine system, digestive system, respiratory system, excretory system, reproductive system, muscles and bones (musculo-skeletal system) and skin beside the five specific sense organs. Each system has one or more organs, organs are formed of tissues which in turn are formed from variety of cells. A cell is known as a unit of organism. Cells are formed from various chemicals as proteins, carbohydrates, fats, vitamins, minerals and water which themselves are composed of some basic units of element and molecules. Life processes in a cell are governed by a dynamic without which a cell has no life. It is this dynamic which make an organism living, keeps the different systems operational coordinating and adapting in the way to achieve the maximum period of survival. This dynamic is termed as vital force.
In the healthy condition of man, the spiritual vital force (autocracy), the dynamis that animates the material body (organism), rules with unbounded sway, and retains all the parts of the organism in admirable, harmonious, vital operation, as regards both sensations and functions, so that our indwelling, reason-gifted mind can freely employ this living, healthy instrument for the higher purposes of our existence.
Mind is that faculty of a living organism which is manifested especially in thought, perception, emotion, will, memory and imagination.
What is healthy condition? The accepted definition of health by World Health Organization (WHO) is “Physical, mental, social and spiritual fitness of a person is healthy condition.”
This fitness depends and results from the balanced interaction of the man with his environment, internal as well as external. As this interaction involves multiple factors and is not static therefore balance is also not static and changing continuously with time and the environment. It is the vital force which keeps harmony in all vital operations of the organism with the ever changing environment. In the process it affects its environment and is being affected by the environment and makes alterations and adaptations to the best possible way for survival. These alterations and adaptations are reflected in the form of altered sensations, functions and structure on mental, emotional and physical level for example increased length of small intestine in vegetarians than non-vegetarians. Increased muscle mass of an iron smith and weight lifter etc. So long these adaptations are within the limits of health the person does not fall sick. For example, someone had to drive on motor cycle, in a cold winter morning. After driving a few kilometers his eyes and nose started watering because of cold air. He reached at destination and rubbed off the tears and blew away the nose water. Thereafter he does not get coryza or sore throat or ear pain or headache or conjunctivitis etc., similarly a person gets diarrhea and vomiting from some alteration in diet and recovers automatically. This was adaptation within the limits of health where a person is exposed to some odd or extreme condition/s and recovered automatically from the effects. These types of reactions are termed as indisposition manifested by one or more trivial symptoms.
The vital force has its own range of adaptation and a threshold below which it keeps various parts to body in a harmonious functioning order, preserves the body from decay, disintegration and death and reacts through defense system with an attempt to repair any influence which threatens the integrated existence of the organism.

Adaptation of the vital force beyond this threshold is derangement  which activated defense mechanism manifested as sickness that is a train of abnormal sensations and functions at all the three levels – body, mind and spirit, usually recorded as signs and symptoms (Natural Disease). Such alteration is termed as disease. These alterations in the vital force are of two types –
1.       The rapid morbid processes of the abnormally deranged vital force, which have tendency to finish their course more or less quickly but always in a moderate time and end in either recovery or death of the organism. These are termed as acute diseases.                      Or
2.      The changes are of such a character that the dynamics enters in new adaptations beyond the threshold with a small or imperceptible beginning, dynamically derange the vital force of the living organism, each in its own peculiar manner, and cause it gradually to deviate from the healthy condition in such a way that the automatic life energy (dynamic - vital force), only opposes them at the commencement and during their progress with  an imperfect, unsuitable, useless resistance and unable of itself to extinguish them, but must helplessly suffer (them to spread and) itself to be ever more and more abnormally deranged, until at length the organism is destroyed. These progressive derangements are termed as chronic diseases. They are caused by infection with chronic miasm. It cannot be reverted or eradicated even by the most vigorous or robust constitution or could be overcome by the healthiest diet or by healthy order of life.  

Disease is merely a dynamic disturbance of vital force, ever changing life process initially expressed as changed sensation and function represented by signs and symptoms. This derangement in dynamic brings changes in movement and synthesis of certain chemicals at biochemical level which in turn is resulted in changes in functions cells and hence tissues and organs and structural changes in cells, tissues and organs follow if the functional changes persist long enough. Functional changes always precede the structural changes. This is not based on the theory of evolution but on the fact that energy is primary existence and matter which is actually condensed form of energy is just a secondary manifestation.
Thus dynamic disturbance of vital force expressed as altered functions and sensations at mental, emotional and physical level may or may not ultimate in gross tissue changes. It has been observed that morphological and histo-pathological changes do not necessarily always hold pace with the disturbed functions and vice versa (only in very rare typical cases do the clinical diagnosis and autopsy finding fully coincide). The pathological changes are but the expression of the end results of diseases whereas the symptoms are expression of the progress of the diseases. As the tissue changes are not essential part of the disease but only the end results of the disease therefore as such are not and should not be the object of treatment. Disease is a phenomenon in a person the patient. It consists of the individual himself therefore there are as many different diseases as patients.

Dr. Hahnemann asserted that health and disease are mental abstractions and convenient fictions and not concrete realities. Thus disease is a mental concept the factual reality is the diseased person. Also that disease is not a morbid entity (a rigid, unchanging sequence of characteristic events) and is not comparable with animal or botanical species. The mental process of classification of disease is essential to arrange the facts and retain them in memory but in an actual treatment a concrete individual is to be treated therefore individualization of the disease condition is necessary.
The disease manifestation – the altered sensations and functions, signs and symptoms related to the mind and body are actually work of defense mechanism of the vital force of the individual to survive with no or minimal damage. For example, repulsiveness of a person is actually an effort to be away from the undesirable environment. Also starting from a noise, slowness or cautiousness, domineering talks, easy weeping etc. are but a form of defense to some anticipated danger.

If the defense mechanism is strong enough the disease symptoms would be expressed at the remotest and least important part of the person to save the rest or in the part which has a faulty tendency or strong propensity for the affection. For this reason different people get different affections in spite of being exposed to the same conditions. For example, if force of injury and the site of injuries in body in three persons are same, the three persons may not be affected in the same way. One may get his bone fractured while the second person may get muscle ruptures and the third may get bruises and blue spots (ecchymoses) due to rupture of blood vessels. With the same level of blood pressure or blood sugar levels or prostatic enlargement not only different person would suffer differently but the course of the disease would also be different. This depends on propensity of person governed by genetic code at physical level.

Direction of Disease
Books of modern pathology advocated that first derangement always occurs at cellular level through changes in biochemistry of the cell. Basically, there are three types of pathological processes –  
1. Functional changes or Inflammatory pathology,
2. Proliferative or accumulative pathology and
3. Degenerative or destructive pathology.
These are result of process adapted by the defense mechanism of the person:

Functional or Inflammatory Defense process or Pathology – The process in which reversible functional and biochemical changes occur. It is preceded by increased sensitivity and irritation. Besides mental and emotional changes, the changes at physical level are manifested as inflammatory processes in response to environmental influences to heal and reconstitute the damaged tissue. Cellular and tissue changes in these conditions are minimal and very primary type and could be reversed with the help of appropriate medicines. These in homoeopathy are termed as manifestation of miasm Psora. For example – boils, dermatitis, otitis, tonsillitis, conjunctivitis, rhinitis, bronchitis, asthma, gastroenteritis, urethritis, osteitis, myositis, rheumatic arthritis, anemias, lymphangitis, labile hypertension, angina pectoris, pleurisies, nephritis, thyroiditis, neuritis also diabetic neuritis, epilepsy, neurosis, schizophrenia etc.

Proliferative and Accumulative type of defense process – Besides corresponding mental and emotional changes here at physical level various chemicals e.g., proteins, lipids, uric acid, melanin etc. start accumulating in cells and tissues to create a barrier to the influencing force so there is hypertrophy or hyperplasia of cells or tissues. These processes including tissue changes are mostly reversible if properly treated in time. These are termed as manifestations of miasm Sycosis. For example – excrescence, corns, warts, follicular tonsitiltis, quinsy, cataracts, adenoids, polyps, sycotic asthma, stones in various systems, lichen planus, psoriasis, calcaneal spur, exostoses, bony tumors, gouty and rheumatoid arthritis, spondylitis, leucocytosis, acute myeloid leukemia, Hodgkins disease, atherosclerosis, ischemic heart disease, valvular stenosis and prolapse, enlarged heart, thickened pleurae, nephrosis, hypo and hyperthyroidism, neurofibromatosis, cancers, autoimmune disorders, hypercholesterolemia, hypernatremia, hyperuricemia etc.

Destructive and degenerative type defense process – Besides corresponding mental and emotional changes here at physical level cells and tissues degenerate and die in specific locations to save the rest of the organism for survival. These are termed as manifestations of miasm Syphilis. This negative approach of defense mechanism is observed in the forms of ulceration, degeneration, destructions, perforations etc.  in various organs, as ulcerative tonsillitis, perforated ear drum, corneal ulcers, alopecia universalis, cirrhosis of liver, osteomyelitis, osteomalacia, osteoarthritis, myopathies, infarctions and necrosis, cavitations from abscesses in lungs etc., interstitial fibrosis, bone marrow depression, chronic renal failure, diabetes mellitus, leucoderma, Parkinson’s disease, Alzheimer’s disease,  ulcerative cancers, gangrenes, SLE, chronic myeloid leukemia etc.

Above mentioned are some of the pathological conditions in which the disease processes may ultimate. But much earlier to these end results the processes or the defense action is indicated by functional signs and symptoms at various levels of mind and body. In progression of disease or cure of the disease after treatment instituted these three processes can take any direction from Psoric to Sycotic to Syphilitic that is from inflammatory to degenerative, or from Psoric to Syphilitic or from Sycotic to Syphilitic and vice versa. 
There is one more category of disease that is purely surgical disease. Here the organism is primarily inflicted by some external force of violent nature as various injuries, fractures etc. because of natural or otherwise accidents. After these conditions being treated surgically their remaining effects require medicinal treatment.

A cell has its own individuality but it born and works as a part of tissue. So it has two fold functions – first generating energy from nutritive elements and second synthesizing amino-acids, proteins, enzymes, neurotransmitters etc. not only for self existence but for the existence of the whole. Hence a cell therefore tissues and organs have to function conscientiously and responsibly in order to keep the whole organism healthy. Thus an organism is a social order of 100 trillions of cells to live in harmony so that the organism can prosper.
Likewise, considering mind if a man has to be in health he has to work conscientiously and perform the assigned work which will gain him his daily bread and butter and prosperity to society. Working for a cause selflessly is a psoric trait, not working for needs but for materialistic gains and greed is a sycotic (accumulative) trait while working without caring for life with uncontrolled desires is a syphilitic (destructive) trait.     

The extent to which the disease process has progressed indicates that how badly the vital force has been deranged and the life processes have been affected. It has been observed that if expression of derangement is improperly treated and removed from the site through a process other than cure, the disease force is diverted to affect deeper and more important tissues and organs. Every manifestation of disease has some significance to indicate sickness and demanding appropriate treatment (includes medicines and management), beside the system’s effort to survive. For example, inflammation has five prominent symptoms – pain, heat, redness, swelling and loss of function of the affected part. It is general assumption that other things are tolerable but pain is unacceptable and it should be stopped anyhow. So, pain killer and anti-inflammatory drugs are used, the guarding stiffness is treated with muscle relaxants. This is something like tying the mouth of the watch dog by its owner when it starts barking by seeing a thief, because it disturbed his sleep! Therefore, pain subsides and the part becomes mobile but the natural process of inflammation is altered or hampered. Thus, repair and healing does not take place (because vascularity and inflammatory cellularity has been changed) and in an arthritic joint for example, damage to cartilages, bones and covering membranes etc. continued.

If the dynamic adapts the second defense mechanism, with the related symptoms there may develop tumor or polyp or other type of hypertrophy.  This must again be clear that these tumor, cysts or polyp etc. are not actual disease but end results of the disease process therefore, treating these does not solve the problem. In spite of removing these growths the disease process continues. So mostly there is recurrence or in case the defense mechanism is disrupted due to the effect of drugs or removal of these growths which were actually barricades to progression of disease, the disease continues to progress attacking new organs or systems in the body of the patient either in the same or in a new form of expression. This can be termed as metastasis which if not treated correctly will continue to complicate the situation and the dynamic may adapt to degenerative defense mechanism. The affected cells and tissue start dying and the damage may become irreversible. If instead of some medicine to revert the process the condition is dealt with one which suppresses that is diverts the diseased force, the disease process continues to damage one after the other organs and systems and the patient dies of one or the other or multiple organ failure.
This is the most simplified description of disease progression.  Modern researches suggest that diseases have some direction of progression from one to other organ or system or levels in mind body complex of man. Some of the known paths are –

1.      Different type of cancers have characteristic organs to metastasize –
a.       Breast cancer to regional lymph nodes, then lungs, bones and brain.
b.      Prostate cancer to the lymphatic system and bones of pelvis and then to the spine.
c.       Lung cancer to local nodes, central nervous system, long bones, kidneys, the adrenal glands and skin.
2.      Auto-immune disorders characteristically affect certain tissues to exclusion of others –
a.       Rheumatic fever and rheumatic disorders of other type produce Streptococcal pharyngitis, heart valve degeneration, glomerular nephritis, rheumatoid arthritis etc.
b.      Lupus erythematosus produces characteristic skin eruptions, nephritis, colitis, arthritis, hepato-splenomegaly and pericarditis.
c.       Reiter’s syndrome includes gonococcal urethritis, mono-articular arthritis and uveitis.
3.      Then Psycho-somatic medicine has noticed many correspondences between emotional state and physical ailments –
a.       Suppressed irritability correlates with peptic ulcer,
b.      Suppressed anxiety is commonly seen in ulcerative colitis patients,
c.       Melancholy corresponds to liver dysfunction,
d.      Anal retentive personality type(a person who pays such attention to detail that the obsession becomes an annoyance to others, potentially to the detriment of the anal-retentive person) tends to suffer from constipation and hemorrhoids,
e.       “Type A” personalities (Type A individual as ambitious, rigidly organized, highly status conscious, can be sensitive, care for other people, are truthful, impatient, always try to help others, take on more than they can handle, want other people to get to the point, proactive and obsessed with time management. People with Type A personalities are often high-achieving workaholics who multi-task, push themselves with deadlines, and hate both delays and ambivalence) have a particular blood type and increased incidences of hypertension and early myocardial infarction,
f.       Compulsive personality (is characterized by a preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency) with suppressed anger tends to be cancer prone.
Such correlations are known but precisely what determines the pathways of these correspondences is not known. In some instances it is speculated that circulatory system or nervous system could be the pathways for metastasis.
Acupuncture the system of treatment in Chinese medicine based on centuries of observations has developed quite specific correlations between particular organ and particular acupuncture point as well as correlation between specific organ and mental and emotional state.

The Hierarchy
There is always a sense of direction in progression and cure of disease as there is a natural hierarchy of various tissues, organs and systems in human body. These correlations have not been studied in medical sciences except to some extent in homoeopathy. However, it further needs a thorough and vast research work.
Whenever a person is affected by a disease that is alteration in his dynamic corresponding changes occur at mental, emotional and physical level but it is innate characteristic that for survival of the whole the disease would be first expressed in the most susceptible and possibly the least or lesser important region of the mind and body. The three factors important in deciding direction of disease and the part to be affected are
1.      Hereditary strength or weakness of the defense mechanism,
2.      Intensity of morbid stimuli and
3.      Interference by suppressive or curative treatments.
Hierarchy in the body, mind and spirit complex could be studied and understood in various ways.

Hierarchy I – Mind body complex
The mind and body hierarchy could be represented as a diagram:



[This diagram represents three layers of human in three dimensions. The central most is the mental layer. Next and peripheral to mental layer is the emotional layer and the outermost is the physical layer. Note that top and bottom of each layer do not correspond one to another.
At any given moment, the centre of gravity of disease expression tends to rest at a particular location. With time, further morbid stimuli and/or treatment (either suppressive or beneficial) the centre of gravity may move higher or lower in the same layer or it may move more centrally or peripherally to higher or lower levels of correspondence.]

Hierarchy II – Embryological
Each person begins life as a single cell “the zygote”. Through progressive cell division it gradually develops in an orderly fashion into enormous numbers of cells. As this process advances, three different layers of cells Ectoderm, Mesoderm and Endoderm develop and become the primordial structures from which rest of the organism grows. Study of Embryology and development of various tissues and organs from the three primordial layers can help us to find out various possible pathways of disease progression.  From embryological point of view the various tissues and organs are interrelated as follow: 

1.      Organs derived from Ectoderm –
Skin and its appendages, specially, epithelium of skin, hairs, nails, sweat glands sebaceous gland and mammary glands.
Epithelium lining – the beginning and end of gastrointestinal tract as epithelium and glands of lips, gums, floor of mouth, palate and cheeks, and mucus membranes of nasal cavities and para-nasal sinuses, also epithelium of the lower part of the anal canal and terminal parts of urinary tract and genitals. Outer part of tonsils.
Nervous system tissues – entire central nervous system including retina, peripheral nervous system, sympathetic and parasympathetic fibers, adrenal medulla and neurolema sheath cells, sensory epithelium of olfactory and auditory organs.
Anterior part of pituitary. Lens of eye, anterior epithelial layer of the cornea, and muscles of iris, external auditory canal and the outer layer of the eardrum.
2.      Organs derived from Endoderm –
Epithelium of gastro-intestinal tract, except its terminal parts, and the parenchyma of glands derived from it (liver, pancreas, thyroid, parathyroid and thymus).
Lining epithelium of larynx, trachea, bronchi and alveoli.
Epithelium of urinary bladder, of most female urethra and part of male urethra, plus the glands derived from them (prostate) and lower part of vagina.
3.      Organs derived from Mesoderm –
Epithelial derivatives – visceral and parietal linings of peritoneal, pleural and pericardial cavities.
Cortex of adrenal gland.
Mesenchymal derivatives – Mesenchyme form three layers from which develop the somites and coverings – 1. Dermatome the outer most layer – from this develops dermis.
                      2. Myotome the intermediate layer gives rise to muscles.
                      3. Sclerotome the inner most layer give rise to cartilages and bones.
Connective tissue, cartilages and bones including dentine. Myocardium and visceral musculature, including blood vessels. Endocardium and endothelium of blood vessels.
Lymph glands, lymph vessels and spleen.
Blood cells.
Connective tissue sheath of muscles (fascias), tendons aponeuroses and nerve endings and the synovial membranes of joints and bursae.
It could be under stood that different organs and systems have a specific affinity for each other due to their common origin in one of the three primordial tissue layers which could be important factor in deciding the direction of symptoms and pathological changes into deeper regions of the body as health deteriorates or disease progresses.
A physician has to keep in mind that during treatment or otherwise if disease manifestation is shifted from ectodermal tissues or organs to endodermal or mesodermal tissues or organs or from a less important to more important organs, indicating failure of treatment or progression of disease to a deeper level. In order of importance there exist ectodermal organs, endodermal organs and mesodermal connective tissues and organs. Above all these there exist Neuro-endocrine control system. While nervous system central or peripheral originates from neuro-ectoderm most of the endocrine glands contain cell from ectoderm and endoderm. Some of the endocrines contain cell from mesoderm also. The endocrine cells are found in different parts of body called as defused endocrine system secreting hormones like Atrial Naturetic Hormone, erythropoietin, histamine, insulin like growth factors, melatonin, rennin-angiotensin system, somatostanin,vitamin D (calcitriol) and neurotransmitters.
Neuro-endocrine control system is supreme next to genes and mind. If in a patient signs and symptoms indicate involvement of one or the other part of neuro-endocrine system it means that disease has progressed too deep. The deepest disorders are reflected at the level of genes and mind.
(It is proposed that for every expression or manifestation of life – in health or disease, there exist a gene. Activation or deactivation of gene decides the form, type and level of manifestation. One thing must be understood that life is a form of energy and it is limit of human being that we cannot perceive expression of energy without a medium of matter. So for human perception every expression of energy requires a via media of some or other form of matter).
This is a conceptual description because multi-level disorders are often observed. But if history is explored to full extent it would be found that the first disease expression was on surface of skin or mucus membrane (the ectoderm) as some eruption thought to be dangerous (!) for one or the other reason, may it be a pimple or aphthae or enteritis etc. which were removed innocently from the surface followed by other ailments. For example if relief of dermatitis or boils is followed by enteritis or hyperacidity or asthma, it means disease has shifted its effect from ectoderm to endoderm. Even if relief from dermatitis is followed by falling of hairs or psoriasis or pains in muscle and joint or anemia it means that from ectoderm disease has shifted to mesoderm (connective tissue say dermis, musculo-skeletal system or blood).

Hierarchy III - At the level of Organs and Systems
The functional and structural hierarchy in man could be understood at the level of organs and systems based on the importance of the organ for the survival and existence. It can also be measured by degree of damage to the organism produced by a particular amount of injury to the organ. For example, a scar on the brain will have a more damaging effect than an equal sized scar on the heart or the skin. The organs in decreasing order of importance are as follow –
1.      Brain (1)
2.      Heart (1)
3.      Pituitary gland (1), Endocrine system though has many glands and each gland has a specific function.  Pituitary being the master gland is the most important in hierarchy.
4.      Liver (1)
5.      Lungs (2)
6.      Kidneys (2)
7.      Testes/ovaries (2)
8.      Vertebrae (28)
9.      Bones ( many)
10.  Muscles (many)
11.  Skin (vast).
The number in bracket indicates the number of organs in body.

Hierarchy IV – At the level of Mind
Beside hierarchy at physical plane there exists hierarchy at emotional and mental planes also and degree of deviation from normal indicates the severity and depth of affection. For example at mental level forgetfulness is more serious than the absent mindedness and paranoid ideas indicate a more severe disorder than the delusions. Similarly at emotional level anguish indicates a disorder of greater depth than phobias while sadness (depression) indicates still a deeper disorder than the anguish. Here it is arranged in increasing order of degree of derangement –
Mental plane –
1.      Absent-mindedness
2.      Forgetfulness
3.      Dullness as difficulties in reasoning, calculating, interpreting etc.
4.      Lethargy
5.      Delusions
6.      Paranoid ideas
7.      Destructive delirium
8.      Complete mental confusion.
Emotional plane –
1.      Dissatisfaction,
2.      Irritability,
3.      Anxiety,
4.       Phobias,
5.      Anguish,
6.      Sadness,
7.      Apathy,
8.      Suicidal depression.

Direction of disease and Time Axis
One more relationship indicating direction of disease on the axis of time (though not linear and needs further studies). As time passes and age advances disease manifestations go to deeper level.
Most of the disorders during infancy are related to ectoderm e.g., rashes, conjunctivitis, taenia, ring worm, thrush, otitis, ear drum perforation etc. Adolescence disorders prominently affect endodermal organs e.g., rhinitis, tonsillitis, bronchitis, hepatitis, deviated nasal septum, nasal polyps, asthma etc. Between age 20-40 years mostly disorders are related to endodermal and mesodermal organs as arthritis, synovitis, muscle and bone pains, ulcerative colitis etc.
Between the age 30-50 years people suffer with diseases like anxiety disorder, angina, hyperlipidemia, atherosclerosis, ischemic heart disease, varicose vein, nephritis and nephritic syndrome, tuberculosis etc. The patient gets specific treatment but further develops diabetes or other endocrine disorder, various tumors, neuritis and other neuropathy, multiple or disseminated sclerosis, Parkinson’s disease, Alzheimer disease etc., various cancers, loss of mental acuity, concentration and calculation ability etc. as the age advances.
Thus with the journey of a person in time i.e., growing age disease is manifested at higher and more important levels as cardio-vascular, endocrine and nervous system and mind.

Direction of Cure –
Dr. Hahnemann has defined the cure in the simplest words - The physician's high and only mission is to restore the sick to health, to cure, as it is termed.
He also defined the highest ideal of cure - The highest ideal of cure is rapid, gentle and permanent restoration of the health, or removal and annihilation of the disease in its whole extent, in the shortest, most reliable, and most harmless way, on easily comprehensible principles.
Homoeopathy talks of cure and ideal of cure but homoeopaths do not pay heed to it. Allopathy is content with managing the nosological disease condition/s which is/are fragment/s of the disease process.
Now, a patient is always bothered about the most troublesome or painful change (symptom) in his system his is always ignorant to the minute changes or symptoms occurring simultaneously and so is the physician, hence most of the time these symptom remain unwarranted. To cure a person only and only way is to bring the altered dynamics to its normal and all the changes at mental, emotional and physical level would be reverted with normalization of dynamics. This could at the best be achieved through dynamic stimulation of the dynamics through dynamic homoeopathic medicine. The treatment instituted to bring some chemical changes in the organ of prominent manifestation of disease may relieve the patient for sometime but cannot bring cure or permanent restoration of health.

I – Understanding the dynamic of patient –
To prescribe a curative homoeopathic medicine physician has to understand the characteristics of the changed dynamic reflected in signs and symptoms which indicate the type of alteration and adaptation the dynamic of the patient required to survive the adverse environment. The characteristics unique to the individual patient are the signs and symptoms representing the inner most and the integral of the person at all levels. At higher levels – as changes in moral, character, mental and emotional functions. Change in his general stamina and desire to perform and get involved in various activities. Changes in those physical functions which are related to whole of the organism as appetite, thirst, desire and aversion, sex, sleep and dreams, sweating, menstruation in females.
General physical and mental tolerance to the environmental factors as - Time, periodicity; seasons; moon phases, temperature and weather; bathing (hot, cold or sea), local application (hot, cold, wet or dry), rest or motion (slow, rapid, ascending or descending, turning in bed, exertion, walking, on first motion, after moving a while, while moving, after moving), car and sea-sickness, position: standing, sitting, (knee-crossed, rising from sitting), stooping(rising from stooping), lying (on painful side, back, right or left side, abdomen, head high or low, rising from lying), leaning head backward, forward, side-wise, closing or opening eyes, any unusual position such as a knee-chest, External stimuli; Touch, hard or light, pressure, rubbing, constriction(clothing etc), jar, riding, stepping, light, noise, music, conversation, odours, eating: in general(before, during, after hot or cold food or drinks), swallowing (solids, liquids, empty), acids, fats salt, salty food, starches, sugar and sweets; green vegetables milk eggs, meat, fish oysters, onions, beer, liquor, wine, coffee, tea, tobacco, drugs etc.
Changes he/she experience through different situations in life, type of discharges and types of pathologies.

The totality of signs and symptoms which helps individualizing the patient to make a homoeopathic prescription, may be summarized as follow –
A.     Cause –
1.      Fundamental cause – miasmatic process to be determined from anamnesis and hereditary (family history) consideration.
2.      Exciting cause – some environmental factor/s directly involved in initiating the process of disease.
3.      Maintaining cause – factor/s in life and living, presence of which help in persistence of the disease.
B.     Peculiar, Queer, Rare, uncommon and Concomitant symptoms.
C.     General Symptoms –
1.      Mental Symptoms – Related to will, moral and character, understanding and intellect.
2.      Emotional Symptoms – related to love and hate, fear etc.
3.      Physical generals – the physical symptoms related to whole of the patient as desire- aversion, sex, appetite, thirst, sleep and dreams, menses in females, sweating and other discharges, general reaction to environmental factors etc.
D.     Particular symptoms – the physical symptom related to specific system, organ or tissue could be described as characteristic and completed in terms of (a) Cause, (b) Prodrome -  onset, pace, sequence, duration, (c)Character, location, laterality, extension and radiation of pain or sensations.(d) Concommitants and alterations.(e) Aggravation or amelioration.
E.      Past history (chronological) of the patient including his life and living.
F.      Family history.
G.     Pathological generals – the pathological symptoms indicating general propensity of the patient.

II Dynamics of Drugs or Medicines and Cure
This is a proved fact that any substance be it a food or some drug or poison or otherwise brings some changes in the living system (human here). The books of pharmacology are full of such evidences and only for this reason doses of all drugs are set to maximize the effect and minimize the so called side effects which are actually undesired effects of the substance. These effects and so called side effects are studied in fractions as changes in biochemistry of animals and human.
Another fact is that every substance extensively affects all level of the organism by bringing changes characteristic to the substance, in the dynamic of the organism. This is the point where homoeopathy differs from other therapeutic systems. No two substances bring same kind of changes. Therefore, the changes brought by one substance could be distinguished from the changes brought by any other substance by comparing the characteristics of changes brought by those substances. These changes are termed as artificial diseases (c.f., page 2 for natural diseases). All these changes are reflected as changes in functions and sensations as signs and symptoms at all levels that is body, mind and spirit. However, allopathic pharmacology studied the changes in laboratory and not in human being who are more than mere composition of certain chemicals beyond the body. Homoeopathy has studied how various substances affect whole dynamics of healthy human (Provers). Homoeopathic pharmacology (Materia medicas) has extensive record of effects of individual substance on human (provers) of different sex and age groups.
 The alterations in dynamic are translated on the physical instrument, the body of man where these are expressed as a function of defense mechanism in three forms –
a.       Functional or physiological defense,
b.      Constructive, accumulative or growth defense,
c.       Destructive defense.                                                                                                                   
Cell is the unit of life and body of organism so changes in dynamic are first reflected as changes in functions of cell to counter the influence of the environmental factors by adaptation or elimination. In this mechanism the dynamic brings changes in movements and formation of certain chemicals and thus changes in dynamic are reflected in changes in function of cell. The function of an individual cell is regulated by genes but every cell in the organism work for the well being of the organism. Therefore, under adverse situations each cell fights back at its own level conjointly with other cells.
Inflammation is primary defense response to any type of invasion. Inflammation is preceded by increased sensitivity and irritation. It is brought about by temporary changes in biochemistry of the cell and neighbouring tissue.
It is important to know that acute inflammatory process is intermingled with the process of repair or healing. Beside destroying and diluting the effects or injury inflammation setup a sequence of events to heal and reformation of the damaged tissue. Without inflammation wound would not heal.
In treatment of chronic manifestation for example recurrent inflammations as colitis, tonsillitis, neuritits, arthritis etc. the physician has to deal with tendency of inflammation than the immediate problem of inflammation, because any agency be it biological or otherwise can not affect until unless there is propensity in the patient. Therefore these agents could not be fundamental cause of sickness and unless the derangement in dynamic is healed disease would persist and recur.
For example – anti - inflammatory drugs given to get freedom from pain and to stop inflammatory process do not resolve the cause of sickness and gives a different direction to the force of deranged dynamic which has to find a new adaptation and expresses the sickness in some other tissues or organs.
Thus in the present medical line of treatment the cause of disease manifestation is not dealt with at dynamic level. Treatments are rather patch work dealing with one or the other prominent sign and symptom as by the treatment expressions of altered dynamic are blocked or stopped due to medical (through chemicals or drugs) or surgical intervention as removal of growths as polyp, cysts, tumors, fissure, stones etc. which are actually work of defense mechanism to save other more important physiological functions or tissues or organs or systems. Thus, the force of dynamic is diverted to express the sickness through other tissues or organs. Therefore, physician should be cautious that relief of immediate problem of patient should not be followed, sooner or later with serge of new symptoms and signs in more deeper or important tissues or organs or systems.
As there is certain direction of progression of disease likewise there is definite direction of cure. Long back Dr. Constantine Hering pronounced the laws of direction of cure as follow –
The cure always takes place
1. From inside out that is from centre to periphery or more important to less important organs.
2. From above downward.
3. In reverse order of appearance of symptoms.
d.      From Syphilitic to Sycotic or Psoric miasm that is from destructive to non-destructive process.
To these three rules a fourth rule is added by Dr. Praful Vijayakar
The life is product of consciousness and desire. The centre of any activity in life is desire and stamina to work. Therefore, first sign of improvement is normalization of desire to work and stamina to work. If a patient of gall colic or otitis or fever of any origin becomes free from pain or fever but he/she still does not like to attend office, school or kitchen and if he/she attended work it was only under compulsion without desire and stamina. This indicates that the treatment only palliated some of the symptoms and the patient was not on the way to cure. If control or decrease in blood pressure/diabetes/blood urea or creatinine level or relief in sciatica etc. is not accompanied with feeling of increased stamina and normalization of desire to work, a feeling of fitness and well being then surely the patient is not in the process of cure.
With the onset of the curative process patient’s mental confusion, dullness, lack of concentration, anxiety, irritability, restlessness, fear etc. would also reduce to disappear. Appetite and sleep and his/her tolerance to environmental factors as heat, cold, air draft, light, noises etc. would improve.
Symptoms will travel from more to less important organs in a direction reverse to the appearance during disease progression. However, appearance of symptoms during this reverse journey would not be as violent as actual disease rather they would be transient phases. Still sometimes this causes panic in the patient, his/her attendant or the treating physician himself as the patient asks how this old disease has reappeared.  Here physician must observe the direction. For example, improvement in ulcerative colitis is followed by gastritis or stomatitis, also relief in pneumonia is followed by tracheitis or laryngitis etc., improvement in nephritis followed by bronchitis, or improvement in arthritis followed by alopecia etc. show that the patient is in the process of cure. However, these are very preliminary observations and need much research and confirmation.
Also cure should take a course from above to downward. Improvement in vitilgo on foot or ankle is followed by appearance of vitilgo on knee or arm certainly indicates wrong direction and progress of disease. Mind it that vitiligo is not a simple problem but it indicates destructive process (destruction of melanocytes) that is Syphilitic miasm in the system.
When cure takes place patients system leaves destructive/degenerative (Syphilitic) functioning and switches to sycotic or psoric functioning as signifies the following case –
The patient had complaints of severe pains in right tibia worse at night for about two years. She passed several sleepless nights due to pain. It was diagnosed as periosteitis and osteomyelitis. X-ray showed inflammation in periosteum of right tibia and her ESR was 110. With other symptoms she had history of intrauterine death of fetus due to complication of hypertension during first pregnancy, cesarean delivery from second pregnancy two and half years back, an abortion during 3rd month of pregnancy two years back and then not conceiving due to lack of ovulation in spite of all treatments for last two years. All these indicate SYPHILITIC MIASM which implies degeneration and non-generation. Her pains were relieved by indicated medicines SYPHILINUM and two doses of KALI SULPH after one year of treatment. During the same period she was trying to conceive but the ovulation was not there as shown by ultra sono-graphic study of ovulation. After reviewing the case four doses of MERCURIUS SOL. 200 were given weekly in December 2011, she conceived in February 2012 and delivered normally, a healthy baby on 8th December 2012. Her ESR and X-ray findings became normal. There appeared a corn in sole of right foot and few small, brown warts in both axilla. Important was the shift from destructive SYPHILITIC to constructive SYCOTIC MIASM.

Conclusion –
Presently, the medical science considers body of man not different than a machine and has divided human being in so many parts and each part is understood to fall sick independently so treated separately (by separate specialist)! Even mind is treated as an entity separate from body which has no obvious effect on body physiology! All this is done at the expense of integrity of the man who is suffering.
In the light of facts discussed above in the article the concept of disease and cure in the present medical science needs a thorough review, extensive research work relating to origin (onset) of disease, its progression and different types of manifestations their sequences and their interrelation.
Concepts of treatment of chronic disease should also be reviewed in the light of failure of any treatment in curing especially chronic diseases.

Acknowledgement –
1.       Organon of Medicine – Dr. Hahnemann
2.      Chronic Diseases and their Nature – Dr. Hahnemann
3.      Science of Homoeopathy – Dr. George Vithoulkaus.
4.      Theory of Suppression – Dr. Praful Vijayakar.
5.      Commentary on Organon of Medicine – Dr. B. K. Sarkar.
6.      Pathologic Basis of Disease – Robbins and Cotran.
7.      Wikipedia.
                         
                      
Dr. M. K. Tyagi
D.H.M.S., Dip. N.I.H.
Research Officer, Sewa Mandir
Mobile: +91-9829157926

Email:sewamandir.ajmer@gmail.com, manju_mkt2003@yahoo.co.in