“Nothing can bring you peace, but yourself.” – Ralph Waldo Emerson
INTRODUCTION
Immunology concerns with multifaceted aspects that revolve around the clinical challenges of defense of the host, several mechanisms that are involved in the fight for survival, tumor immunology, allergic reactions, transplantations and auto-immunity.
Golub and Green (1991) defined immunology as the “Science of self/non-self-discrimination”. This definition, although small, focuses on how important is the concept-of-self. In addition to defensive and restorative processes, the immune system engages itself in information processing and cognition, active interaction with the environment for maintaining equilibrium and for symbiotic relationship, so essential for living in this prodigious universe. This gives rise to two orientations; first the biological system concerning the insularity of the organism and immunity for the sake of protection and second, the ecological context concerning the organism’s dynamic entity while interacting with the environment at large.
In short, the field of immunology is related to the organism as a whole that comprises of biological identity, individuality of the organism and several physiological processes utilized in a continual effort to maintain homeostasis in relation with variable situations.
Autonomous entity and organismal collectivity
Every ‘self’ has its identity. Every self needs security. The self has to be protected by all means possible given the biological structure and it will negotiate with every cell to participate. Immunity is not just protection. It extends well beyond the protective motif to include mediation of exchange processes with the environment. The immune identity has to be in ‘fluid’ state to accomplish coping up with internal and external stimuli that continuously harp upon the system as a process of dynamic interaction.
Identification is the process of recognizing the self. A role is a comprehensive pattern of behaviour and it serves as a strategy for coping with critical situations. Roles emerge from interactions, but these interactions are shaped by the structural system in which they occur. Roles are crucial for identification. Each organism has its own identity but the roles define the quality of identity. Roles change under the dimensions of time and space. Different challenges are brought up with the changing roles, Thus the challenges are accepted and dealt with and the theme of symbiosis is thoroughly followed; for, without symbiosis, the organism has no ‘quality identity’.
The self is an autonomous entity. It is a complex consortium and has a well-equipped supply of sophisticated type.
Through the host of physiological processes, with innumerable functions, the immune system establishes and maintains the organismal identity. This is an on-going process from birth until death.
There is an in-built surveillance system that monitors and recognizes the harmful agent. In order to deal with the harmful agent, the immune activities are arrayed and various kinds of reactions are produced.
The spectrum of these reactivities determines the character of immunity. If the immunity brings on to the fore many of the reactivities, then these reactivities must be balanced.
The whole issue concerns about the autonomous individuality and the organismal collectivity that work in an integrated manner to maintain the homeostasis.
AGAINST THE HOST
The immunity designates antibodies as antitoxins. The antigen is designated as an invading agent, of a pathogen, or an allergen (of a harmful substance or stimulus.)
Auto-immunity is the misdirected immune response to the host. There is a deranged identification of an innocuous substance as immunogenic.
Auto-immunity refers to a breakdown in the immune system’s ability to maintain self-tolerance, resulting in an immune response directed against self-components of the body.
Auto-immunity attacks not only the body but also the immune defenses and redirects the system to the future ‘to-come.’
Auto-immune diseases are characterized by chronic inflammation in which the rate of tissue damage exceeds the body’s ability to repair the damage.
It is generally accepted that the cause of any given auto-immune disease is multifactorial and that environmental and genetic factors play a role in susceptibility (Tizard, 1995).
ADs are generally divided into two types: organ-specific, where the immune response is directed toward a target antigen that is specific to a single organ or gland and systemic, which involves a response directed across a broad array of organs and tissues.
CHARACTERS OF AUTOIMMUNE DISEASES (AIDs)
1. Recognition problem
In order for the immune system to protect the body against attack by foreign organisms, it must be able to distinguish between the body’s own proteins (autoantigens) and proteins from foreign cells (foreign antigens). When the immune system turns against autoantigens, thus attacking its own tissues, the resulting condition is an autoimmune disease.
Let us take an example of the army. There is the central administration with rules and regulations and every soldier follows the discipline to work in symbiosis. But some soldiers start taking the antagonistic stand and turn against the system itself; it’s like a coup.
2. Surveillance problem
Immune surveillance is an aspect where the immune system patrols the body to recognize and destroy, not only invading pathogens but also host cells that become cancerous. Perhaps potential cancer cells arise frequently throughout life, but the immune system usually destroys them as fast as they appear. There is some evidence for this attractive notion. There is also evidence that the immune system mounts an attack against established cancers although it often fails.
The intelligent immune system carefully watches every happening in its laboratory. This monitoring of the behavior of each cell in the body is the basis for homeostasis, disposition of living beings to keep on functioning at an optimum level, despite changes in the environment within certain limits. Remember, homeostasis employs feedback mechanisms to maintain the dynamic equilibrium of a self-regulating system.
A. Immune surveillance in the central nervous system
CNS is continuously monitored by resident microglia and blood-borne immune cells (macrophages, dendritic cells and T cells) to detect damaging agents that would disrupt homeostasis and optimal functioning of these vital organs.
B. Immune surveillance by the liver
The liver contains numerous, innate and adaptive immune cells that specialize in detection and capture of pathogens from the blood. Further, these immune cells participate in coordinated immune responses leading to pathogen clearance, leucocyte recruitment and antigen presentation to lymphocyte within the vasculature.
3. Internalization
If we look at the type of inflammation that goes deep and causes damage to tissues of vital organs, internalization becomes an important character of ADs.
In autoimmune inflammations, the onset of symptoms is caused by the reaction of the immune system. But because the reaction is directed against the self, it becomes an internalized process of destruction.
In autoimmune inflammations, there is a hindrance to the free expansive use of the immune system resulting in restriction of its ability to eliminate wastes and toxins, which as a result are retained and provoke irritation/inflammation in the physical body.
4. Destruction
The failure of the surveillance mechanism and consequent development of aberrant immune response leads to the process of destruction, unless aided by the treatment modality based on the Law of Similars.
Suicidal
The immune system becomes helpless as if paralyzed and cannot cope up with the continuation of the aberrant immune response. The system takes on the path of self-harm.
MORE CHARACTERS
Painful: Most of ADs cause pain at both physical and mental level.
Terrifying: The situation becomes often terrifying during the course of AD.
Strange behavior: Yes, acting against the self, going from harmony to disharmony is strange behavior.
As if paralyzed and helpless: The system becomes a mute spectator of AD process if it goes on relentlessly.
Self-sacrificing: The whole process seems to be related to the sacrifice of the system.
Non-acceptance: I don’t accept the harmony, so much of symbiosis.
Antagonism with self: Does the system become bitter, antipathic and aggressive and wants to punish itself?
Battling against self: The battle begins for survival. During the battle, there are ups and downs, exacerbations and remissions. There can be a loss of function or of the structure of a single or multiple organs.
PSYCHOLOGICAL PROFILE AND IMMUNITY
It is well known that psychological distress leads to deleterious effects on immune and neuroendocrine functioning. The research suggests that the personality, psychological and/or social supports are the stronger determinants of response to illness.
Psychological distress represents the patient’s interpretation of stress and their perceived impact can be considered as an intermediate measure in the relationship between stress and illness.
Psychological distress can impact health both indirectly, through health behaviors (e.g., compliance to medical regimens, poorer sleep, poorer nutrition) or directly through alterations in the central and autonomic nervous systems, immune, endocrine and cardiovascular systems.
In most patients with auto-immune illness, significant stress was found in childhood and more importantly, an inability to adequately act out, express and externalize the stress, in other words, the inadequate catharsis of the feeling. Hindrance in externalization à internalization à altered immune response.
It is necessary, hence, to elicit a thorough history of the patient to know the life experiences and how they have influenced the person as a whole. The personality itself is the sickness. The search of the homeopathic physician should be to define what leads to the development of autoimmunity.
Exploration of inter-personal relationship is very important.
Some research findings have been offered here in connection with ADs. Remember, homeopathy has already recognized the importance of the relation between mind and body in ADs.
- Elevated levels of psychological distress have also been reported in Scleroderma and Sjögren’s syndrome patients. Valtysdottir, Gudbjornsson, Lindqvist, Hallgren and Hetta (2000) examined the levels of anxiety, depression and well-being in 62 patients of Sjögren’s syndrome and compared with separate groups of healthy individuals and further compared with control group of RA patients. The results indicated significantly higher levels of anxiety and depression and reduced physical and mental well-being in Sjögren’s patients compared with healthy controls. The Sjögren’s patients also reported significantly more symptoms than RA patients.
- Matsura and Colleagues (2003) evaluated 50 patients with scleroderma for factors associated with depressive symptoms using the beck depression inventory (BDI; Beck, 1967). Forty-six percent of the sample reported depressive symptoms ranging from mild to severe. Regression analyses revealed that high levels of hopelessness and low sense of coherence (coping ability and resilience in the face of stress) were the best predictors of depressive symptoms in this sample.
- In ADs, the relationship between emotions, psychological distress, immune and neuroendocrine functioning and disease manifestations are of particular interest.
- There is considerable evidence to suggest that emotional states can produce alterations in the immune response. It is currently accepted that the brain and the immune system share bidirectional communication and exert important regulatory control over one another. The existence of such neural-immune interactions provides a pathway by which psychological processes can influence and be influenced by immune function (Maier, Watkins and Fleshner, 1994). Additionally, immunological alterations have been reported across a wide range of psychiatric disorders (Kiecolt-Glaser et al., 2002).
- A growing body of evidence suggests a role for psychological distress in inducing, exacerbating, and affecting outcomes in SLE (Shapiro, 1997).
LIST OF AUTOIMMUNE DISEASES
AUTO-IMMUNE DISEASES AND MIASMATIC ASSESSMENT
Psoric miasm
It is necessary to understand that almost all autoimmune disorders present themselves, in the initial phase, the functional zone which is characterized by symptoms, sensations, pains etc. but with no obvious structural changes. This functional phase can last for months or even for a few years and it depends on the type of auto-immune activity and the host response.
The psoric phase may mimic the diagnosis of the ADs as there are no organic changes; however, some blood chemistry reports may give clues to the aberrant immune response.
The quality of life is maintained at large in a psoric subject but the psoric miasm sets the platform for structural changes to supervene under the rein of autoimmunity with the activation of the tubercular and syphilitic miasmatic activity.
Vitiligo cases with no subjective symptoms or any correlation with autoimmune pathogenesis, (esp. when there are only small spots of vitiligo) are psoric in nature.
Sycotic miasm
The problems of the immunity as to the surveillance, recognition and confusion as to the identity and with consequent role defining identification issues are indicative of sycotic miasm. It is due to sycotic miasmatic activity that the reasoning faculty of discrimination is affected. Confusion has a big role to play in autoimmune disorders and hence sycotic miasmatic dominance is seen at large.
The involvement of the Reticulo-Endothelial System (RES) is obvious in ADs and the problem of recognition-of-self and non-self is developed at RES level through three characters – excessive, defective or absent. The tissue changes begin and proliferate in ADs under the influence of sycotic miasmatic activity. So you get a well-delineated entity of a specific auto-immune disease with the investigations confirming the nosological diagnosis of the disease.
Slow development of the disease process and gradual shrinking of the physiological functions of the affected organs tell upon the economy in terms of quality of life. Indolence, fatigue, sluggishness and weakness characterize sycosis.
Inflammation is a major component of autoimmune disorders. This ongoing process of inflammation is a major concern in the management of ADs. Type of inflammation with resultant pathology and stage of the disease will help a homeopath in categorizing the respective miasmatic state into Sycosis, Tubercle and Syphilis.
Example: In cases of rheumatoid arthritis, with slow and gradual development with class I (no restriction of ability to perform normal activities) and class II (moderate restriction but adequate for normal activities), with no sclerosis in the joint, Sycotic miasm is dominant.
Tubercular miasm
It is characterized by erraticity, suddenness, heightened sensitivity and the rapid pace of the disease process.
All ADs beginning as acute active diseases but definitely heading towards destruction are indicative of Tubercular miasm.
Graves’ disease (Thyrotoxicosis), associated with emaciation, excessive perspiration, excess stool, persistent tachycardia or atrial fibrillation indicates the Tubercular miasm.
Juvenile onset (Type I) Diabetes mellitus, which destroys the insulin-producing beta cells of the pancreas, resulting in an inability to regulate blood sugar along with emaciation is a tubercular miasmatic process; however, irreversible complications are indicative of Syphilitic miasm.
Syphilitic miasm
The stepped in pathology finally leads towards destruction and if unaided, irreversible changes occur in the tissues, organs and systems. The worst fear for any patient of autoimmune disorders is to land into the zone of destruction. It is the duty of a homeopathic physician to see that the destruction is suspended in acute or chronic cases of ADs.
Examples
Class III of rheumatoid arthritis (marked restriction, inability to perform most duties of usual occupation or self-care) and class IV (incapacitation or confinement to a bed or wheel-chair), with changes of sclerosis, indicate Syphilitic miasm.
Systemic Lupus Erythematosus (SLE), characterized by inflammation of different organs associated with the production of antibodies reactive with nuclear, cytoplasmic and cell membrane antigens which attack Deoxyribonucleic acid (DNA), causing widespread destruction in vital organs viz. kidneys, heart, lungs, skin etc. indicate Syphilitic miasm.
Drug miasm
ADs are treated with immuno-suppressive chemical drugs and they have huge side-effects. Although immuno-suppressive therapy can be of use in tiding over the acute crises, it is not helpful to cure the ADs. Immuno-suppressive drugs should not be abruptly stopped and careful monitoring is necessary through the entire management.
In addition to the totality which has been elicited, it is necessary to add side-effects of the drugs.
Following rubrics should not be overlooked.
Generalities; intoxication, after; medicaments: acon aloe ARN ars bapt camph carb-v carc cham coff coloc com cupr hep hydr kali-i lac-f lob lyc mag-s nat-m nit-ac NUX-V op paeon ph-ac PULS sec sep sil SULPH teucr thuj torul
Generalities; sensitiveness; drugs, to: acon arn cham coff lyc neod-br nux-v PULS sal-ac sep sil SULPH
REPERTORIAL PERSPECTIVE OF ADs
The following rubrics should be considered in autoimmune disorders. However, thorough case history and consequent selection of appropriate rubrics has no exemption.
- Mind; confusion of mind; identity, as to his (31): Agath-a Alum Anac Anh Arg-n Bapt Calc-p Camph Cann-i Crypt-n Daph Eryth Gels Lach Leon LSD Nelu Niob Nux-m Petr Phos Plac Psor Pyrog Sals-t Stram Syph Tril Valer Verat Xan
- Mind; antagonism; oneself, with (26): Acon Anac Ant-t Aur Aur-s Bar-Ar Bar-C Bute-J Cann-I Caps Clad-R Culx-P Irid Irid-M Kali-C Lac-C Lach Lim-B-C Mobil-Ph Naja Nelu Salx-F Sep Taosc Uran Verb
- Mind; destructiveness (106) apis ars bell bufo camph canth carc chel cimx con cupr hyos ign iod kali-p lil-t meli nat-s nux-v oena phos plat sol-t-ae stram sulph tarent tub verat
- Mind; destructiveness; self-destructive (12): aur cer-o cimic herin kali-br mand nat-s plb psor syph thul tub
- Mind; mania, madness; suicidal (13): agn ant-t ars aur hyos naja nit-ac orig pic-ac rhus-t spig thea verat
- Mind; killed, desires to be (8):
- Mind; mutilate his body, tendency to (48)
- Mind; self-torture (8):
- Mind; suicidal disposition (214)
- Mind; confusion of mind (697)
- Mind; confusion of mind; emotions, about: clem HOCH polyst pter-a
- Mind; confusion of mind; identity, as to his (131)
- Mind; confusion of mind; identity, as to his; boundaries, and personal (5):
- Mind; confusion of mind; identity, as to his; depersonalization (11)
- Mind; confusion of mind; identity, as to his; own, as if it were not his (6)
- Mind; confusion of mind; reality, cannot tell what is real and what is not: calx-b carc lant lant-c nelu scorp staph
- Mind; mistakes, making; perception, of (177)
- Boger’s general analysis; perception changed, mental, visual (20): acon arg-n ars bar-c bell calc cann-i hyos kali-br lac-c lach merc nux-m op ph-ac phos plat stram sulph verat
- Mind; handle things anymore, cannot, overwhelmed by stress (131)
- Mind; self-control; loss of (119)
- Mind; self-deception: act-sp arist-cl iod op
- Mind; self-punishment: aids nat-m plat
- Mind; senses; confused (91)
- Mirilli’s themes; antagonism (348):
- Clinical; auto-immune diseases (416):
- Clinical; auto-immune deficiency syndrome, aids (17): ars-i ars-met aur-m calo chion cinnb cory jac kali-i nit-ac plat-m staph still thuj thul thul-c tub
- Generalities; vaccination; after, ailments from (44)
CLINICAL CASES
A CASE OF GIANT CELL ARTERITIS
Mrs. K.S.R., aged 55 years, consulted me on 27-10-1999. My allopathic friend referred the case due to the side-effects of steroids.
The case presented with both local and systemic manifestations. Inflammation of temporal artery with spells of a severe and sudden headache; swollen and tender artery. Recurrent fever. No weight loss. No vision problem. Pain in jaws while masticating. Pain and stiffness in the joints esp. Knees, pelvic region and shoulder girdle (Polymyalgia rheumatica).
Pallor+. Malnourishment, the main factor.
She was put on Prednisolone 50 mg per day by an allopath, then he started tapering off. But as omission resulted in recrudescence, steroids were restarted. When she consulted me, she was on prednisolone 10 mg per day.
Homeopathically
Appetite: Poor. Desires sweets3 and cold food3. Warm-blooded. No major events in life. IPR good. The patient comes from low economical strata.
Dispositional characters: Anxiety3. Wants company. Sentimental. I received a few characteristic symptoms – tenderness of the whole body, esp. of scalp, < touch, even of clothes and a sense of discomfort here and there.
Selection of remedy
Under Kali-i. (Absolute MM), we have given the following data: Diffused sensitiveness or soreness of surface/skin; of area around affected part. Generalized tenderness of whole body and limbs to touch or jolts (or vibrations). Mild gooseflesh from the touch of linen. A vague, indescribable feeling (discomfort, uneasiness or distress) in head, epigastrium, chest etc.)
I understand Kali-i. through the word ‘giant’. It has giant urticaria, giant cell arteritis, giant stubborn pathologies, giant syphilitic miasmatic dimensions – overall a giant remedy.
In addition, I thought of
- Warm-blooded thermal state
- Dominant syphilitic miasm
- Malnutrition as the cause (all iodides are nutrition remedies)
- Chronicity
Treatment
Kali-i. was prescribed in frequent repetition schedule from low to high and I was able to omit Prednisolone. ESR was 54 mm and was increased to 70 mm after steroid omission. But Kali-i. lowered it and kept it within the range of 20-24 mm.
There was considerable relief in symptoms. Headache was better in frequency and intensity. Jaw pain disappeared.
A CASE OF PRIMARY BILIARY CIRRHOSIS
A homeopathic physician, Dr. HVS, aged 61 years, consulted for primary biliary cirrhosis, suffering since 3 years. The LFT were exorbitantly raised and in view of bad prognosis, a liver transplant was advised. But in view of diabetes and hypertension, a liver transplant was risky and hence avoided. Due to profound weakness, ascites and recurrent hematemesis from esophageal varices, he had to abandon his homeopathic practice.
Life space
Father died when the patient was 9 years old. He was the eldest in a family of 4 brothers, 4 sisters and mother. He had to struggle in the life due to poverty and he took responsibility of the entire family. He got married to a homoeopathic doctor at the age of 25 and they have two daughters, both have pursued post -graduation in modern medicine.
One of the reputed doctors of the city, he has a flourishing practice and often associated with noble deeds such as helping the poor.
Dispositions: Caring. Affectionate. Sensitive. Ambitious. Decisive. Highly responsible. Benevolent. Sympathetic.
Throughout the interview the patient was frequently reproaching, “God is punishing me”.
P/H: Nil.
F/H: Fa: IHD àMI. Mo: Ca oesophagus. Maternal aunt: DM.
Treatment
Carc 30 once every month as an intercurrent and Aurum-mur in LM2 daily once as a chronic constitutional remedy exerted significant healing influence. Aurum mur was later on ascended to LM3 and LM4 in frequent repetition schedule.
Reasons for the selection of remedies
Both Carc and Aur-mur are known for self-reproach. A strong family history of cancer and fundamental miasm of syphilis were at the base to predispose the patient towards the disease. Carc as an intercurrent was necessary to be interpolated in a frequent manner, as the disease process was due to activation of basic miasm and it was intrinsic in view of no external causes like alcohol or defective life-style were available. Further, Aurums are known for their nobility and kindness.
‘Absolute materia medica’ lists the following under Aur-mur, “Liver: Syphilitic liver diseases; cirrhosis; inflamed, indurated, enlarged, with ascites, dropsy; with heart disease, albuminuria; fatty; waxy; cirrhosis”.
Follow-up
Ascites diminished, LFTs showed improvement, no bleeding episodes and the patient started attending the clinic.
A CASE OF ERYTHEMA NODOSUM
A young lady of 28 years consulted for persistent dry cough, breathlessness and recurrent episodes of reddish-purple bumps on the skin.
She was diagnosed for Erythema nodosum and sarcoidosis. She developed the illness after her husband’s death five years ago.
It was a picture of Nat-carb in view of inability to communicate properly, ailments from grief, chilly thermal state, aversion to milk and a high sense of responsibility.
Nat–carb did a nice job but then failed to act. After Nat-carb, the case turned to Conium as she became more sheepish, more anxious and began complaining of a deprivation of sex. Conium helped her in > of coughing, bumps disappeared, fatigue was less and she fairly maintained her stability with all daily activities.
A CASE OF FIBROMYALGIA
A middle-aged woman consulted for pains in many parts of the body, many tender points, constant fatigue, anxiety and depression.
The complaints began after constant ‘over the years’ tussle with the mother-in-law. After marriage, patient and her husband lived separately due to husband’s job. But the husband was transferred to the same city and patient’s in-laws came to stay with the family. Initially, it was fine, but both patient and M-I-L always wanted to win. Once M-I-L humiliated our patient badly and she developed hatred against M-I-L. She stopped talking with in-laws and became indifferent and abusive.
Nitric acid was a fitting reply to her auto-immune process that was initiated with the mental disturbance. Chronic discontented state landing into anxiety and depression is a common feature of Nit-ac.
Nit-ac. helped her to adapt to the family as a whole. She became more sympathetic (which is also a character of Nit-ac.). Her constant dwelling on ‘M-I-L’ and ‘pains’ reduced and she was able to find the joy of her own. The two poles of M-I-L and pains were strongly influencing her identity with consequent suffering and Nit-ac. helped her to be at peace, within and without.
CONCLUSION
Every disease is intrinsic and pertains to the patient as a whole and must be treated internally.
The concept of ADs is interesting for a homeopath in the sense that cases of ADs need a holistic approach in the management and homeopathy meets that integrated modality comprising of mental and physical consortium, the genetic milieu and the massive influx of environmental variables that constantly exert influence over the fragile immune system that is confused and has become haywire.
The homeopathic treatment redirects the journey, allows to find the lost identity and renders a healing touch necessary for harmony and synthesis!
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About Author
Dr AJIT KULKARNI M.D. (Hom.)
- Director, Homeopathic Research Institute, Pune
- A veteran homoeopath, an academician and a famed international teacher
- A classical Homeopathic physician practicing since the last 35 years
- Co-Author: Absolute Homoeopathic Matera Medica & Five Regional Repertories: AIDS, DM, Thyroid, HTN and Trauma
- Author: Body Language and Homeopathy, Homeopathy through Harmony and Totality (Three volumes), Law of Similars in Medical Science, Homeopathic Posology, Family and Its Relations, Homeopathic Covidoscope (published by Amazon), More than 100 publications on various aspects of homeopathy & Many papers and books translated in several languages
- Award of ‘Excellence in Homoeopathy’
- Award of ‘Homoeo-Ratna’
- ‘Life achievement Award’
- ‘Dr B. Sahni Memorial Award’
- Member, Editorial Board, National Journal of Homeopathy, Mumbai