Additional patho- physiological concepts from Homoeopathic standpoint 

In Homoeopathy, following alteration observed in the patient are categorized and put under pathophysiology.

Sensitivity –

The human system belongs to the biological world. One of the attributes of it is the ability to respond or react to environmental stimuli.  These responses are in tune with other basic properties of biological system like maintenance, growth and reproduction. These responses occur due to sensitivity.

Sensitivity is a property of a thing to get affected by any change within or without. The expression of sensitivity is the impact produced on the system through these changes.

One may say that it is there in the non living world also. Yes, but there is a difference. The living system reacts while interaction proceeds while in the non living system it is only the interaction which results into something. This ability to react is possible through controls and we have seen in chapter 2 this appears to be a complex control mechanism in human system.

If the sensitivity is of a proper order then the responses will be adequate as regards to quantity, quality and time and state of health results. The assessment of sensitivity is therefore important in study of human system.

As the reactivity denotes sensitivity is the study of this, both at mental and physical level, should give us idea of sensitivity. Sensitivity at the mental level will be considered later while dealing with mental symptoms. On the physical side, in terms of time it may be quick indicating heightened sensitivity. For example the suddenness of the response as in the remedy likes Aconite or quick reaction to all sensory inputs as in Phosphorus.  It may be slow as in Bryonia, Graphites etc which signifies lower sensitivity.

With regards to quantity drugs like Belladona, Chamomilla exhibit high sensitivity with violence as a feature in its manifestations while drugs like Carbo-veg, Psorinum are marked lower sensitivity with poverty of response. It is the concept of time is closely linked with quantity it may not be possible always to make discrimination in terms of these two.

Coming to quality, allergic reactions signify exaggerated sensitivity. We also have qualitatively poor response which is again difficult to differentiate from quantitative. For example in drugs like Graphites the fibrous tissues which is laid down after any inflammation or irritation is of poor quality. This is qualitatively lowered sensitivity.

Other variety of responses indicates peculiar forms of sensitivity as exemplified by auto immune disorders. This can be called as aberrant sensitivity.

Neuromuscular disturbances –

Spasms – convulsions

Spasm is a sudden, powerful involuntary contraction of muscle. It can occur anywhere e.g. tics, titanic spasms, spasmodic torticollis etc. Smooth muscles of respiratory, gastro intestine or urinary tracts can also have spasmodic movements giving rise to pain and certain other symptoms.

Cramp is similar to spasms but associated with pain. Everyone is familiar with cramp especially in foots or leg. Certain pathological conditions like tetanus produce cramps of severe type. Writer’s cramp is another familiar condition.

 Convulsion means a violent involuntary contraction either prolonged or spasmodic of a skeletal muscle. Besides seizure or epilepsy of various types certain other medical disease are associated with convulsions like bacterial meningitis, uremia, febrile convulsions in children etc. certain other forms of movements like jerks, tremors, chorea etc. can also be included under this category.

Relaxation – Paresis – paralysis

Relaxation is likely to occur with overstraining as in women the muscles of the back or poor nutrition or in old age as visceroptosis of abdominal organs.

The term paralysis indicates an abolition of function either sensory or motor. The word paresis is used where the loss is mild.

Type of disease process –

At the outset, let it be clear that we are not considering here the concept of disease nor its classification. We are looking at the disease process as a clinician, taking into consideration its relevance in the management of a case. The main areas of study of any process are the time span, the rate and the direction.

Time span

Broadly the division can be made as acute and chronic disease. Acute has a limited period during which it will end either in recovery or death. In acute, it can be acute proper as typhoid, measles etc. or it can be acute exacerbation  of chronic e.g. acute attack of RA, bronchial asthma etc. we also get hyper acute as exemplified by attack of coronary thrombosis, Shock syndrome and so on.

Chronic, by contrast, have much longer duration and the course is progressive. In the beginning it may be functions and as time passes, it travels towards structural alterations. Many of the structural disorder become irreversible in due course of time. Periodic disorders such as epilepsy, bronchial asthma and alternating states such as asthma alternating with eczema represents another form of chronic processes.

Rate

It is a commonplace experience that a disease may be slowly progressive in one individual while in another the progress may be fast. Thus we have a low, moderate or fast progress of the disease.

Direction

If we think of the human system, skin and mucous membrane can be considered as the external covering then come the various organs and inner most is the controlling apparatus, nervous system. Skin and mucous membranes is thus the convenient outlet for the system to throw away the responses. Next comes the various organs with changes in metabolism and secretions of endocrine and exocrine glands, alteration in blood, lymph and other body fluids. Changes in the functioning of nervous system with its effects at mental level indicate that the process has reached the core itself. We can look at the phenomena from another angle. The disease process restricted to skin and mucous membranes perhaps involves few controls than organ and metabolic disturbances. The disturbances at the level of nervous system and mind may be connective of loss of controls of greater magnitude and therefore signify deeper affection.

The observation made by early homeopathic physician is worth noting. It is observed that when the disturbances manifest at the level of skin or membrane it has better prognosis, than the metabolic or organ disturbances. The altered functioning at the level of nervous system and the mind carry a poor prognosis. Similarly while reading the remedy response, if the expression of the disease changes from mental to organ disturbances or from organ to skin and mucous membrane, the response should be regarded as favorable. All the 3 parameters of the process the time, rate and direction are important in remedy.

Age Group –

From phenomenological perspective human system has a beginning, growth and maturation and ultimately decline and death. These stages as well as transitional periods are marked by changes at all level which consequently has an impact on normalcy and disease patterns of an individual. Pediatrics has already been established while the entry of geriatrics and recently the adolescent medicine is a testimony to this.

Age group is one of the important factors in the consideration of totality in homoeopathic practice. We shall try to point out briefly its significance by indicating some of the physiological changes and common pathological alterations occurring during these stages.

Childhood

This is a major period of life for growth and development. Growth implies changes in the size while development also includes changes at intellectual and emotional level. Various abnormal patterns result, which need medical care. Nutritional disorders demand supplementary therapy along with the indicated Homoeopathic remedy.

Through the new born is immunologically quite competent, the demands made on him due to the environmental changes are high and various types of immune disorder as well as infections are common. Structural and functional peculiarities of the respiratory system reflect itself in characteristics disease pattern. For example, small size of bronchial lumen in first two years gives rise to bronchiolitis with respiratory infections. Various congenital malformations are recognized in childhood. Diseases like Glomerulonephritis or Rheumatic fever begin more commonly in the childhood.

Adolescence

This is marked by reproductive maturity, bodily growth and psychological development. Puberty refers to a period when sex glands become active. Adolescence covers the whole process and the period between the onset of puberty and attainment of maturity.

This is associated with increase in height and weight the ‘growth spurt’, changes in the amount of distribution of fat, increase in size and strength of musculature, heart weight nearly doubles while lung size and capacity increases. There is also increase in blood volume, R.B.C and hemoglobin. The maturation of reproductive system is the major event of this period. Neuroendocrinal changes initiate many of these alterations. Psychologically it becomes a labile period.

This gives rise to certain disorders more common at the age, e.g. Puberty goiter, certain gynecological problems like primary dysmenorrhoea, behavior disorders marked by mood changes etc.

Adulthood

Only recently adulthood is being looked upon as a district phase in life having its own discernible changes. The work done so far appears to be restricted to psychological zone.

Climacteric

Just as puberty marks the period of activation of several glands, climacteric denotes the regression of its activity. This is characterized by hormonal alterations which have repercussions in other areas. In females, menopause is characterized by such changes. In males, it is not accepted uniformly.

Old age

With the practice of geriatrics, as a specialty, information regarding the physiological and pathological consequence of old age is available. Thus, primarily muscle and nerve cells are not replaced when lost. Intercellular collagen and elastin increased and these changes at the arterial level give rise to hardening. Myocardial hypertrophy and fibrosis set in. The decrease in number of nephrons produces reduction in filtration rate and renal blood flow. Reduced cough efficiency increased dead space and decreased ciliary activity favors complications of respiratory infections. Gastric motility may be altered. Liver may show changes of atrophy. Immune surveillance is decreases and Osteoporosis increases.

With these changes occurring, complication of acute diseases, dementia, depression, urinary incontinence, delayed repair of fractures are some of the common problems encountered in the elderly people.

Sex –

Physiological as well as pathological states are obviously altered due to sexual differences. Besides sex glands and related structural and functional difference, the impact is also seen on other systems. That is how some of the normal laboratory values vary in males and females, e.g. Blood volume, Hemoglobin, acid output of GI tract etc.

The differences are seen in pathological processes also. Genital diseases are obviously different. Other diseases also show such variation. e.g. Rheumatoid Arthritis is more common in females.

Suggested further reading for Section III

Pathophysiology

1. Robbins and Cotran, Pathologic Basis of Disease, South Asia Edition.