Georg Ivanovas From Autism to Humanism - systems theory in medicine

5.3 Hippocratic Medicine

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b) critical days and chronomedicine

Coction is associated with certain critical days. These are the days where a disease might become better or worse. “Fevers come to a crisis on the same days, both those from which patients recover and those from which they die” (Prognostic XX; Hippocrates II: 43). These days are

4., 7., 11., 14., 17., 20., 34., 40., 60.

But slightly differing critical days have been observed as well (Epidemics I, V; Hippocrates I:155-157).

No part of Hippocratic medicine has provoked so much disapproval by modern scholars as these critical days. They have been called a mysticism of numbers inherited from archaic times or just an extrapolation of the rhythms of malaria to other types of fever (Lichtenthaeler: 130). It would be an interesting task to investigate how such and similar misjudgements arise. How should it be possible that a precise observer like Hippocrates would make such severe mistakes? Indeed, critical days exist.

In chronobiology and chronomedicine exactly these types of rhythms have been described. A circaseptane periodicity can be seen in the swelling of wounds and others (Hildebrandt et al 1998: 33). In psychosis a circaseptan rhythm is common, but a periodicity of 14 and 21 days is seen as well (Hildebrandt 1998: 32). All kind of complications arise in a circaseptan periodicity such as the rejection of transplanted organs (Hildebrandt, 1998: 119) or in scarlet fever (Hildebrandt,1998: 118).

The circaseptane rhythm starts with the disturbance or (in a therapeutic context) with the therapeutical stimulus (Hildebrandt 1986: 214) .

Except of a circaseptane rhythm chronobiology also demonstrated a circadecane rhythm, further supporting the observations of Hippocratic medicine. The circaseptane rhythm is more ergotrope, the circadecane rhythm is more trophotrope (Hildebrandt 1986: 192). However, there are some slight differences between Hippocratic perception and chronobiology. E.g., for chronobiology the first critical is the 3rd, for Hippocratic medicine the 4th.

On critical days a diseases should change. “In all cases where fevers cease neither with signs of recovery nor on critical days a relapse may be expected” (Prognostic XXIV; Hippocrates II: 49). This is not true for fever alone, but also for other kinds of inflammation such as erysipel (Prognostic XXIII; Hippocrates II: 47). If there is no change on critical days then the prognosis is bad. This, again, is in line with the observations of chronobiology. A more prominent periodicity in an infectious diseases indicates a good prognosis (Hildebrandt et al: 33).

Modern physicians do not observe these rhythms because they have no according theory. But this is not the whole explanation. As most Hippocratic rhythms are associated with fever, these rhythms cannot be observed today, because they are suppressed by antipyretics.

This is a very crucial point. What happens to all these suppressed rhythms? Do they still exist, but unseen? Is their pattern changed? What does this mean for cybernetic circles, for the processes of the disease?

Experiments have shown that fever enhances the immune response (Chen et al 2006) and children with high fever before the age of one are less likely to develop allergic sensitivity later (Williams 2004). May be the suppression of fever through antipyretics contributes to the development of chronic disease. In fact, the use of paracetamol in the first year of life and in later childhood is associated with an increased risk of asthma, rhinoconjunctivitis, and eczema at age 6 to 7 years (Beasley et al. 2008).

Although there are only a few theoretical concepts how suppression in general is able to lead to more severe states (chap. 6.8), in the case of inflammation there is some evidence that the use of NSAIDs might harm. For exapmle, they inhibit the healing of a tendon-to bone operation in animals (Cohen et al 2004). Also some gliomas are more frequent under an anti-inflammatory therapy (American Association for Cancer Research 2006). Probably they prolong apoptosis. That is, the same drug which prevents chronic disease is harmful in acute disease. And even in chronic disease the results are sometimes mixed

May be it is the lack of the crisis, suppressed by current therapy, which leads to chronification? There is some probability for this assumption as in chronic diseases, prevailing nowadays, there are no rhythms nor time structures (Hildebrandt et al: 33).

Indeed, the loss of the circadian rhythm due to modern life is held responsible for a lot of chronic diseases, even for cancer and bipolar disease (Phillips 2009).

Rhythms might reappear. This has been observed mainly during balneological treatments in spas. This reappearance, again, follows exactly the Hippocratic pattern of critical days. That is, complications in spas arise with the typical periodicity (Hildebrandt: 191) (1).

Adverse Reactions


Psychological Deviation


Use of Analgesics


Complications


Acute Abscess of Teeth


Deaths


Days of Therapy in Spa



This reappearance of rhythms is known in practically all methods of CAM which aim to restore the inner regulation. In CAM this phenomenon is called as ‘initial deterioration’ or ‘initial adverse reaction’ and means that at the beginning of a regulative therapy the symptoms might get worse and/or old conditions of disease might reappear (chap. 6.11). This is seen as a favourable development, just as the critical days in Hippocratic medicine.


(1) Illustration by courtesy of Springer Verlag, from: Hildebarndt G (1986): Chronobiologische Grundlagen der Ordnungstherapie, in: Brüggemann W (ed.), Kneipptherapie, Springer, Berlin, page 191

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