Georg Ivanovas From Autism to Humanism - systems theory in medicine

5.3 Hippocratic Medicine

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a) poise and inflammation – the old and may be the new paradigm

Hippocratic medicine is based on a theory of humours. Although it seemed to have followed the four valued system of blood, phlegm, yellow and black bile (The nature of man IV, Hippocrates IV: 11), this system was handled much more pragmatically than in later centuries. The correct mixture of the humours (krasis) is health. “Balance is a sign of health, imbalance, a harbinger of disease” (Hanson AE).

The idea of an inner balance, of a milieu intérieur, as Bernard called it, is well in line with modern thinking. However, our concepts are more complicated. We know a lot of different humours, and inner balance comprises also cellular and neurological organisation. The four valued system of the Roman medicine has no equivalent to our concepts. We see mainly an antagonistic principle (smpathicus/parasympathicus, osteoblasts/osteoclasts, polarisation/depolarisation, Th1/Th2 helper cells) that might form cascades (as in blood clotting or immune response) or is embedded in circular networks with a lot of positive and negative feedback mechanisms.

Many, if not most diseases arise when this ‘humoural’ balance is distorted. However, it is not too common to describe diseases as an imbalance. Stress theory was an important step towards this direction. But today stress has become an explanatory principle and is hardly used as a specific description.

Stress theory and Hippocratic medicine – both based on the concept of an inner balance and its disturbance – resemble even in details. Both see the cause for imbalance and disease in unusual inner and outer events such as climatic changes, too much eating, drinking or exercise. Only their pathophysiological models differ.

In Hippocratic medicine an imbalance arises when one fluid prevails in its pure, unmixed form. Then it becomes noxious. The presence of such a ‘crude’ substance can be seen in bleeding from the nose or intestines, in vomiting yellow bile etc. This crude substance is able to move inside the body (rhume). It has to be evacuated in order to regain inner balance, what is best done by ‘cocting’ it before. The catarrhally discharge of the nose would be such an evacuation of a cocted fluid. If coction is not possible, the body has to store the fluid somewhere. This so called apostasis has been translated with abscession. But this is only partly the right word. Abscession is already a purification, an attempt of the body to cocte the apostasis.

The coction, especially in apostasis is always associated with a crisis. „Coctions signify nearness of crisis and sure recovery of health, but crude and uncocted evacuations, which change into bad abscessions, denote absence of crisis, pain, prolonged illness, death or a return of the same symptoms“ (Epidem I. XI; Hippocrates I: 163-165).

If evacuation is successful than health will be restored. If evacuation is incomplete a relapse can be expected. If the body is not able to bring the crude substance under control or if the abscession is in a prognostic bad part of the body, then the patient dies. The process leads either to a restitution or to death according to the disturbance and the inner stability of the patient.

If we try to compare the Hippocratic concepts with modern physiology it is striking how much coction resembles the notion of inflammation. Inflammation is a structural determined reaction of the body for healing purposes and became a central issue in recent years, “leading us to rewrite medical textbooks” (Phillips 2003a). Many chronic diseases as all kind of autoimmune disease, asthma, rheumatoid arthritis, heart attacks, Alzheimer's disease and cancer are associated or contributed to inflammation.

The old macroscopic definition of heat, swelling, pain and impaired function has made room for the microscopic process of apoptosis. Apoptotic cells commit ‘suicide’ in order to induce the inflammatory process and are cleared away making this process self-limiting.

Chronic diseases occur when the normal course of apoptosis fails. Then apoptotic cells are not cleared away as soon as normal, maintaining inflammation. An aim of new therapies is to speed up the resolution of an inflammation (overview: Holmes 2004). But speeding up inflammation to avoid or resolve prolonged apoptosis, or speeding up coction to avoid or resolve apostasis is much the same process, the one on a microscopic, the other on a macroscopic level. Both even possess the notion of evacuation.

That inflammation plays such a crucial role in many diseases can be seen in the beneficial role of NSAIDs, especially of salicylic acid. It has a preventive effect in arteriosclerosis, heart attack (Phillips 2003a), strokes (Morgan 2004), all kind of cancers (Terry et al 2004, Marx 2004c), cataract (Crabbe 2004), Alzheimer’s disease (Etminan et al 2003) and others.

Salicylic acid is part of the natural diet and a nutrition high in salicylic acids is correlated with lower incidences of diseases attributed to chronic inflammation (Morgan 2004).

The low content of salicylic acid of modern diet might be one factor for the shift from acute diseases in ancient times to more chronic diseases that mainly happened in the 19th and the first half of the 20th century. It might even be possible that in Hippocratic times the processes of inflammation was slightly different and more acute. This would explain why no chronic diseases are mentioned in the Hippocratic texts.

There are, however, other explanations. Chronic diseases might had been of no concern in Hippocratic times, the respective texts might have been lost or people died so early that there was too little time to develop a chronic disease. All these reasons have their justification. But the study of Hippocratic medicine provides more evidence why chronic disease prevails nowadays.

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