Dr Bushra Khan
Why vital force is said to be unintelligent and why medicinal help is required in chronic cases but not necessarily in acute one…an explanation to this concept.
KEYWORDS : Homoeopathy, Organon of Medicine, Vital Force, Chronic Miasm, Chronic Disease, Modern Medicine, Progressive Pathology, Renin Angiotensin Aldosterone System, Frank Starling Law, Cardiac Remodeling
ABSTRACT
Hahnemann years ago, in his book Organon of Medicine described about vital force, its qualities, its role in health, disease and cure. Hahnemann described one quality of vital force as being unintelligent and he also mentioned that medicines are required in chronic diseases whereas not necessarily in acute diseases. This is an interesting question why Hahnemann addressed vital force as unintelligent and what actually happens in chronic diseases. This is a concept of deep understanding of Hahnemann views regarding vital force and to enquire, how beautifully it is reflected in light of modern concept of medicine. What we use to witness today through very our own eye by peeping into modern investigations, laboratory reports, pathology reports, imaging, Hahnemann had already discussed about that in his books Organon of Medicine and Chronic Diseases around 250 years ago. It is very important to dive deep into the Hahnemann’s concept about chronic diseases and explore threads of profound knowledge he was undoubtedly blessed with.
INTRODUCTION
In aphorism 9-18 of Organon of Medicine, Hahnemann described about the vital force , its qualities and role of vital force in health, disease and cure. The five qualities of vital force he mentioned about are; autonomous(self-acting), autocratic(self-powering), spiritual(life-like force), unintelligent(no power of reasoning), dynamic(force in action)[1]. Among above described, qualities of vital force one is being unintelligent, what does Hahnemann mean by that? Also, Hahnemann in his book Chronic Diseases says, “As I have elsewhere shown, it is undeniable, that our vital force, without the assistance of active remedies of human art, cannot overcome even the slight acute diseases (if it does not succumb to them) and restore some sort of health, without sacrificing a part (often a large part) of the fluid and the solid parts of the organism through a so-called crisis. How our vital force effects this, will ever remain unknown to us; but so much is sure, that this force cannot overcome even these diseases in a direct manner, nor without such sacrifices. The Chronic Diseases, which spring from miasms, cannot be healed unaided, even by such sacrifices, nor can real health be restored by this force alone.” [2] Let us understand this concept of Hahnemann in depth through glasses of modern medicine.
ACUTE CRISIS AND PHYSIOLOGY
If there is an acute condition for example blood loss due to accident or hemorrhage, body start compensating for low blood volume and low blood pressure by activation of renin angiotensin aldosterone system(RAAS)[3]. There is a whole mechanism under which our body, organs and brain works, let us understand about it in more details.
Loss of blood from body causes low renal perfusion, when this low volume blood passes through glomeruli it is sensed by specialized modified smooth muscle cells present in afferent arteriole of each glomeruli which act as baroreceptor(blood measuring device) known as polkissen cells. These polkissen cells start secreting renin into blood thus acting as a small endocrine gland by releasing hormone into blood. When the low volume filtrate moves through proximal convoluted tubule(PCT), due to low luminal flow more sodium is reabsorbed there and when this low sodium volume reaches beginning of distal convoluted tubule there is another group of specialized nephron cells called macula densa, they act as chemoreceptors(sodium sensing device) and senses low sodium level, macula densa then releases nitric oxide and prostaglandin which in turn stimulates polkissen cells to secrete more renin into blood. Polkissen cells from afferent arteriole and mucula densa cells from nephron along with some connective tissue together forms the juxta glomerular apparatus and serves for intrarenal secretion of renin[4].Here, extra renal mechanism still left to work where when this low volume blood passes through carotid sinus(baroreceptor), it stimulates vasomotor centre in medulla oblongata and through sympathetic nerve fibers neuron releases nor-epinephrine, this nor-epinephrine binds with beta 1 adrenergic receptors on juxta glomerular apparatus thus stimulating for more release of renin into circulation hence contributing in extrarenal secretion of renin.
This renin travels in systemic circulation through renal vein and reaches liver where it converts angiotensinogen to angiotensin I, when angiotensin I reaches lungs, it is converted into angiotensin II by angiotensin converting enzyme(ACE) secreted by endothelial cells of pulmonary capillaries. This ACE also serves one very important function of inhibiting bradykinin which is a vasodilator.
Now, this angiotensin II serves multiple functions, first constriction of veins by binding with angiotensin II receptors present on smooth muscle of veins which increases venous return to the heart, which in turn increases end-diastolic volume resulting in increase of end-diastolic pressure. Now, ventricle stretches more and according to Frank-Starling law more it stretches more ventricles will contract (but up to a physiological limit) hence increases stroke volume which increases cardiac output and finally increases systolic blood pressure. Meanwhile, angiotensin II also acts on arteriolar smooth muscle and contract them thus maintaining blood pressure in arterial tree and increasing diastolic blood pressure. Secondly, it also stimulates zona glomerulosa cells of outer adrenal cortex to release aldosterone, aldosterone acts on principal cells of nephron, activates genes in principal cells to form proteins (Na-K ATPases ,Na -Channels and K-Channels) which helps in sodium reabsorption into blood and potassium efflux into tubule.[4] Water is also reabsorbed along with sodium which ultimately increases blood volume, this increased blood volume contribute in increasing venous return to the heart and increases cardiac ventricular filling thus increasing systolic blood pressure. This angiotensin II thirdly, also stimulates hypothalamus in central nervous system, hypothalamus stimulates post pituitary to release anti diuretic hormone(ADH) which acts on last part of nephron, the cells there are more permeable for water so water get reabsorbed in collecting duct due to hyperosmolality of interstitium, which increases blood volume and cardiac ventricular filling resulting in increase in systolic blood pressure. This angiotensin II is also a super-stimulator of sympathetic nervous system which increases whole parameters of increasing blood volume and blood pressure to manage the ongoing crisis, it also activates thirst centre in brain and patient will instantly feel thirsty which is also one of the mechanism to increase blood volume by intake of water if the patient is conscious. Hence, by all these mechanisms renin angiotensin aldosterone system(RAAS) is trying to elevate blood volume and blood pressure which is a physiological action of RAAS.[3]
CHRONIC CRISIS AND PATHOLOGY
Now , let’s say this blood loss becomes chronic due to an underlying clinical condition or any pathology causing long term poor cardiac function (maybe glomerulonephropathies causing IHD or coronary atherosclerosis). There will be low cardiac output leading to low renal perfusion. Decrease in renal blood flow for long term will result in chronic activation of renin angiotensin aldosterone system(RAAS), chronic sympathetic system activation, and chronic release of angiotensin II . These all chronically elevated factors will chronically work on myocardial and fibroblast cells and activates the protooncogenes, myocardial cells start producing growth factors which works on myocardial cells themselves resulting in pathological hypertrophy of heart, at the same time myocardial cells and fibroblasts start producing extra amount of connective tissue and extracellular matrix which under chronic influence led to alteration in geometry of heart known as cardiac remodeling. The heart has now become more poor contractile machinery resulting in progressive cardiac failure. Likewise, chronically elevated angiotensin II and aldosterone also acts on smooth muscles of vessels causing pathological changes there.[5] Hence, we can understand how our own body in process of healing caused greater damage to us and we can say that vital force is unintelligent, it compensated the functioning and anatomy of our body parts in this long process of healing and in lack of medicinal aid it will only do greater harm , it can’t be left on nature to cure by its own (vis medicatrix naturae).
In conventional system of medicine, they try to help patient at this stage by prescribing them antihypertensive medicine, angiotensin converting enzyme(ACE) inhibitors, angiotensin receptor blockers(ARB), diuretics, injecting erythropoietin and many other methods. In this regard, Hahnemann in this Organon of Medicine,6th edition in aphorism 22 very clearly says that, “As I have stated elsewhere, this method plays with the life of the patient irresponsibly and murderously, with its massive doses of dangerously violent drugs of unknown action chosen upon mere conjecture, its painful procedures that are supposed to divert sickness to other parts its exhaustion of the patient by emptying him from above and from below, by making him sweat or salivate, but worst of all, in accordance with the present fashion, by blindly and relentlessly wasting his irreplaceable blood… All this is done on the pretext that the physician has to imitate and assist the efforts that diseased nature makes to restore itself, and without the understanding that it is senseless to try to imitate and assist the very imperfect and most often inappropriate efforts of the purely instinctive and unreasoning vital force. The vital force was given to us to sustain our life in harmony as long as we are healthy, not to heal itself when diseased, for if it possessed an ability so worthy of imitation, it would never allow the organism to fall ill. When afflicted by disease agents, our vital force can express its untunement only through disturbances in the normal functions of the organism and only through disturbances in the normal functions of the organism and through pain, whereby it calls for the help of a wise physician. If such help is not forthcoming, it tries to save itself at all costs by increasing the suffering and especially by violent evacuations, often at the cost of tremendous sacrifice, sometimes at the cost of life itself.[5] Hence it’s obvious before us what he meant by addressing vital force as unintelligent.
Hahnemann has also mentioned the classification of diseases and what acute and chronic disease are, how they occur in his Organon of Medicine. Also, in Organon of Medicine,6th edition in aphorism 72 Hahnemann says, “Those we call acute are rapid disease processes of the abnormally untuned vital principle. They characteristically run their course and come to an end more or less quickly. The others, insignificant and often unnoticed at the beginning, dynamically untune the living organism, each in its own way, and remove it from health gradually, in such a way that the automatic vital energy (vital force, vital principle) intended for the preservation of health can offer only imperfect, inappropriate, ineffective resistance to them, both at their start and as they continue, and can never extinguish them; on its own with its own power, so that it must impotently let them flourish while it becomes ever more untuned, until the organism is finally destroyed. We call these chronic diseases; they arise from the dynamic contagion of a chronic miasm.[6] Here, again Hahnemann is very clear about his concept of chronic diseases and using correct homoeopathic medicines in chronic cases and why one should depend on medicines for complete cure not on nature alone.
CONCLUSION
Hence, we saw how an acute crisis or acute condition could be well handled by our vital force in managing sudden crisis without the aid of medicines, that is the normal functioning or physiology of our body governed undoubtedly by our brain as what has done by our very own Renin Angiotensin Aldosterone System. And we also witnessed the grave pathology caused by our own unintelligent vital force while coping with the chronic crisis an individual went into, and what is meant by chronic disease how fatal they could prove to us human when comes in long run and why homoeopathic medicines are required in combating them and accomplishing the complete restoration of health as termed by Hahnemann in aphorism 1 and 2 of Organon of Medicine[7]. This also explains why Hahnemann said that in acute diseases there is no need of medicinal aid, vital force is self-sufficient to cure of its own whereas in chronic diseases medicinal aid is required for complete cure.
REFERENCES
- Nagendra Babu, Dr G. Comprehensive Study of Organon an Attempt to Understand the Organon of Medicine as a Scientific Treatise. Gardners Books, 2009.
- Hahnemann, Samuel. The Chronic Diseases. 1904.
- K Sembulingam. ESSENTIALS of MEDICAL PHYSIOLOGY : With Free Review of Medical Physiology.L., Jaypee Brothers Medical P, 2019.
- Hall, John E, and Arthur C Guyton. Guyton and Hall Review of Physiology. Edinburgh, Elsevier Saunders, 2005.
- Harsh Mohan. Pathology Quick Review and MCQs : Based on Textbook of Pathology 7th Edition. New Delhi, Jaypee Brothers Medical Publishers, 2015.
- Hahnemann, Samuel. Organon of Medicine. Translated by Jost Kunzli, First ed., 1982.
- Hahnemann S. Organon of Medicine. [trans.]DudgeonR.E.5th& 6th.
Dr Bushra Khan PG Scholar
Email : itsdrbushra@gmail.com
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