“Nothing can bring you peace, but yourself.”
– Ralph Waldo Emerson
PLAN OF PRESENTATION
- Against the host
- Characters of autoimmune diseases
- Psychological Profile and autoimmunity
- List of autoimmune diseases
- Miasmatic assessment
- Repertorial perspective
- Clinical cases
Immunology concerns with multifaceted aspects that revolve around the clinical challenges of the defense of the host, several mechanisms 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 the equilibrium and for symbiotic relationship, so essential for living in this prodigious universe. This gives rise to two orientations: 1. The biological system concerning the insularity of the organism and immunity for the sake of protection. 2. 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 organism as a whole, biological identity, individuality of the organism and several physiological processes utilized in a continual effort to maintain the homeostasis on the face of variable situations.
Every ‘self’ has its identity. Every self needs security. The self has to be protected by all means possible, given the biological structure and self 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 a ‘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 identifying the self. Roles are crucial to identification. Each organism has its own identity but the roles define the quality of identity. Roles change under the dimensions of time and space. With the changing roles, coping up brings on the level of a different challenge. Thus the challenge is 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 mechanisms. 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 a 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 also be balanced. The whole issue concerns 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; in other words, of a harmful substance or stimulus. Autoimmunity is the misdirected immune response to the host. There is a deranged identification of an innocuous substance as immunogenic. Autoimmunity 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. Autoimmunity attacks not only the body but immune defenses themselves and redirects the system to the future ‘to-come.’
Autoimmune 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(ADs)
- 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 and rules and regulations and every soldier follows the discipline and works in symbiosis. But some soldiers start taking the antagonistic stand and turn against the system; it’s like a coup.
- Surveillance problem
Immune surveillance is a theory that the immune system patrols the body not only to recognize and destroy 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, a 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.
- Immune surveillance in 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.
- 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.
If we look at the type of inflammation that goes deep and causes damage of tissues of vital organs, internalization becomes an important character of ADs. There is nothing like superficial pathology either in acute or in chronic. 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 are then retained and provoke irritation/inflammation in the physical body.
The failure of the surveillance mechanism and consequent development of the aberrant immune response leads to the process of destruction, unless aided by the treatment modality based on the law of similars.
The immune system becomes helpless and as if paralyzed and cannot cope up with the continuation of the aberrant immune response. The system takes on the path of self-harm.
4.B. 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 a strange behavior.
As if paralyzed and helpless: The system becomes a mute spectator of AD process if it goes relentless and unabated.
Self-sacrificing: Whether it is the sacrifice of the system and sacrifice for whom?
Non-acceptance: I don’t accept the harmony, so much of symbiosis.
Antagonism with self: Does the system becomes hatred, bitter, antipathic and aggressive and wants to punish itself?
Battling against self: The battel begins for survival, for winning and in the battle there are ups and downs, exacerbations and remissions. There can be a loss of function or of structure of single or multiple organs.
- PSYCHOLOGICAL PROFILE AND IMMUNITY
It is well known that the psychological distress leads to deleterious effects on immune and neuroendocrine functioning. The research suggests that personality, psychological, and/or social supports factors are the stronger determinants of response to illness. Psychological distress represents patient’s interpretations of stress and their perceived impact can be considered 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, poor nutrition) or directly through alterations in the central and autonomic nervous, immune, endocrine, and cardiovascular systems.
In most patients with autoimmune illness, it is found that there was significant stress in childhood and, more importantly, an inability to adequately act out, express and externalize the stress, in other words, inadequate catharsis of the feeling. Hindrance in externalization à internalizationà telling upon the economy. It is necessary, hence, is to elicit the thorough history of the patient to know the life experiences and how they have affected the person as a whole. The personality itself is sickness. The search of the homeopathic physician should be to define what lead to the development of autoimmunity. Explore the inter-personal relationship of the patients. Some research findings have been offered here in connection with ADs. Remember, homeopathy has already recognized the importance of relation between mind and body and the role of mind 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 levels of anxiety, depression, well-being, and symptoms in 62 Sjögren’s patients compared with a group of healthy controls and a group of patient controls with RA. 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, & Fleshner, 1994). Additionally, immunological alterations have been reported across a wide range of psychiatric disorders (Kiecolt-Glaser et al., 2002a).
- 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
- Addison’s disease
- Alopecia areata
- Ankylosing spondylitis
- Anti-GBM/Anti-TBM nephritis
- Antiphospholipid syndrome
- Autoimmune hepatitis
- Autoimmune inner ear disease (AIED)
- Axonal & neuronal neuropathy (AMAN)
- Behcet’s disease
- Benign mucosal pemphigoid
- Bullous pemphigoid
- Castleman disease (CD)
- Celiac disease
- Chagas disease
- Chronic inflammatory demyelinating polyneuropathy (CIDP)
- Chronic recurrent multifocal osteomyelitis (CRMO)
- Cicatricial pemphigoid
- Cogan’s syndrome
- Cold agglutinin disease
- Congenital heart block
- Coxsackie myocarditis
- CREST syndrome
- Crohn’s disease
- Dermatitis herpetiformis
- Devic’s disease (neuromyelitis optica)
- Discoid lupus
- Dressler’s syndromeEndometriosis
- Eosinophilic esophagitis (EoE)
- Eosinophilic fasciitis
- Erythema nodosum
- Essential mixed cryoglobulinemia
- Evans syndrome
- Fibrosing alveolitis
- Giant cell arteritis (temporal arteritis)
- Giant cell myocarditis
- Goodpasture’s syndrome
- Granulomatosis with Polyangiitis
- Graves’ disease
- Guillain-Barre syndrome
- Hashimoto’s thyroiditis
- Hemolytic anemia
- Henoch-Schonlein purpura (HSP)
- Herpes gestationis or pemphigoid gestationis (PG)
- IgA Nephropathy
- IgG4-related sclerosing disease
- Immune thrombocytopenic purpura (ITP)
- Inclusion body myositis (IBM)
- Interstitial cystitis (IC)
- Juvenile arthritis
- Juvenile diabetes (Type 1 diabetes)
- Juvenile myositis (JM)
- Kawasaki disease
- Lambert-Eaton syndrome
- Leukocytoclastic vasculitis
- Lichen planus
- Lichen sclerosus
- Ligneous conjunctivitis
- Linear IgA disease (LAD)
- Lyme disease chronic
- Meniere’s disease
- Microscopic polyangiitis (MPA)
- Mixed connective tissue disease (MCTD)
- Mooren’s ulcer
- Mucha-Habermann disease
- Multiple Sclerosis
- Myasthenia gravis
- Neuromyelitis optica
- Ocular cicatricial pemphigoid
- Optic neuritis
- Palindromic rheumatism (PR)
- Paraneoplastic cerebellar degeneration (PCD)
- Paroxysmal nocturnal hemoglobinuria (PNH)
- Parry Romberg syndrome
- Pars planitis (peripheral uveitis)
- Parsonnage-Turner syndrome,
- Peripheral neuropathy
- Perivenous encephalomyelitis
- Pernicious anemia (PA)
- POEMS syndrome
- Polyarteritis nodosa
- Polymyalgia rheumatica
- Postmyocardial infarction syndrome
- Postpericardiotomy syndrome
- Primary biliary cirrhosis
- Primary sclerosing cholangitis
- Progesterone dermatitis
- Psoriatic arthritis
- Pure red cell aplasia (PRCA)
- Pyoderma gangrenosum
- Raynaud’s phenomenon
- Reactive Arthritis
- Reflex sympathetic dystrophy
- Reiter’s syndrome
- Relapsing polychondritis
- Restless legs syndrome (RLS)
- Retroperitoneal fibrosis
- Rheumatic fever
- Rheumatoid arthritis
- Schmidt syndrome
- Sjogren’s syndrome
- Sperm & testicular autoimmunity
- Stiff person syndrome (SPS)
- Subacute bacterial endocarditis (SBE)
- Susac’s syndrome
- Sympathetic ophthalmia (SO)
- Takayasu’s arteritis
- Temporal arteritis/Giant cell arteritis
- Thrombocytopenic purpura (TTP)
- Tolosa-Hunt syndrome (THS)
- Transverse myelitis
- Type 1 diabetes
- Ulcerative colitis (UC)
- Undifferentiated connective tissue disease (UCTD)
- Wegener’s granulomatosis (or Granulomatosis with Polyangiitis (GPA))
- AUTO-IMMUNE DISEASES AND MIASMATIC ASSESSMENT
7.a. 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. with no obvious structural changes. This functional phase can last for months or even for few years and it depends on the type of the autoimmune disease. This psoric phase may mimic the diagnosis of the ADs as there are no organic changes; however, some blood chemistry reports may give some clues as to the aberrant immune response. The quality of life is maintained at large 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 any subjective symptoms or any correlation with autoimmune pathogenesis, (especially when there are only small spots of vitiligo) are psoric in nature.
7.b. 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 as large. The involvement of 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 the sycotic miasmatic activity. So you get a well delineated entity of a specific autoimmune 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 the quality of life. Indolence, fatigue, sluggishness and weakness characterize Sycosis. Inflammation is a major component of autoimmune disorders. This ongoing process of the inflammation is a major concern in the management of ADs. The type of inflammation with resultant pathology and the 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 indicate the sycotic miasm.
7.c. Tubercular Miasm
It is characterized as erratic, suddenness, heightened sensitivity and rapid pace of the disease process. All ADs either beginning as acute active diseases but definitely heading towards destruction are indicative of the tubercular miasm. Graves’ disease (thyrotoxicosis), associated with emaciation, excessive perspiration, hyperdefecation, 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 inability to regulate blood sugar with emaciation is a tubercular miasmatic process; however, irreversible complications are indicative of syphilitic miasm. Systemic lupus erythematosus, characterized by inflammation of different organs associated with the production of antibodies reactive with nuclear, cytoplasmic and cell membrane antigens which attacks deoxyribonucleic acid (DNA), causing widespread destruction in vital organs viz. kidneys, heart, lungs, skin etc. indicates syphilitic miasm.
7.d. Syphilitic miasm
The step 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 in the zone of destruction. It is the duty of a homeopathic physician to see that the destruction is halted in acute or chronic cases of ADs. Can you imagine an acute SLE? The rapidity with which the disease progresses and cause havoc in multiple vital organs is a point of note how the self-destruction occurs under the influence of syphilitic autoimmunity.
Example: 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 the 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 stopped abruptly and careful monitoring is necessary for the entire management. In addition of the totality which has been elicited, it is necessary to add the side-effects of the drugs.
The 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, a thorough case history and consequent selection of appropriate rubrics has no exemption.
- Mind; confusion of mind; identity, as to his (31): agath-aALUMANAC ANH ARG-N BAPT CALC-P camph CANN-I CRYPT-N DAPH eryth GELS LACH leonlsdneluniob 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 (4):
- 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): aconarg-n ARS bar-cBELLcalccann-iHYOSkali-brlac-c LACH mercnux-m OP ph-acphosplatSTRAMsulphverat
- 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 her owing to side-effects of steroids. The case presented with both local and systemic manifestations. Inflammation of the temporal artery with spells of 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 regions and shoulder girdles (Polymyalgia rheumatica).