The Theory of Endobiogeny: Volume 4: Bedside Handbook

By Kamyar M. Hedayat, Jean-Claude Lapraz and Ben Schuff

The Theory of Endobiogeny Volume 4: Bedside Handbook concisely presents core elements of the theory and practice of clinical Endobiogeny. It is an essential reference for Endobiogenists and for integrative medicine practitioners looking to expand their practice. Signs, symptoms and biology of function indexes are correlated to each other according to principles of integrative endocrinology and physiology. Over 20 common illnesses are succinctly summarized to be read in under 10 minutes conveying the essence of neuroendocrine causes, mechanisms and effects, followed by prioritization of Endobiogenic treatments based on 40+ years of clinical experience. Finally, for exemplary prescriptions, alternate plants are proposed based on the context of the specific illness. A succinct materia medica summarizes the essence and key role of nearly 80 medicinal plants used in clinical Endobiogeny, offering new insights for experienced prescribers and clear guidance for those new to the usage of medicinal plants.

The Theory of Endobiogeny Volume 4 provides clinicians and researchers with a concise handbook covering the application of Endobiogeny in current clinical practice.

• Quick reference for over 20 common illnesses with suggested Endobiogenic treatments
• Identification of key biology of functions indexes, signs and symptoms for each disorder
• Materia medica with essence and summary of nearly 80 medicinal plants plus trace minerals
• Endobiogenic diets and lifestyle recommendations

• Language: English
• Publisher: Academic Press
• Release date: Nov 23, 2019
• ISBN: 9780128173336

Kamyar M. Hedayat

Kamyar M Hedayat is a global leader in research and training in Endobiogeny and protégé of Dr. Lapraz. A Stanford-trained critical care physician, he has been practicing endobiogenic medicine since 2008. Drs. Hedayat and Lapraz are cofounders of the American Society of Endobiogenic Medicine and Integrative Physiology and copresidents of the Systems Biology Research Group.

Book preview

The Theory of Endobiogeny

Volume 4: Bedside Handbook

First Edition

Kamyar M. Hedayat

Jean-Claude Lapraz

Ben Schuff

Table of Contents

Cover image

Title page

Copyright

Dedication

Preface

Introduction

Section A: Theory and foundation of clinical practice

Chapter 1: Theory of Endobiogeny

Abstract

Introduction

General theory of complex living systems according to Endobiogeny

Key elements and function of the terrain in practice

The endocrine system: A brief review

Corticotropic

Gonadotropic

Thyrotropic

Somatotropic

Endocrine regulation

Adaptation syndromes and adaptability

Endocrine loops

Using the five ways of knowing in practice

Chapter 2: Art of the history

Abstract

Introduction

Present illness

Review of systems

Past history

Autopathogenecity and initiating factor of structure

Temperament, personality, and physiopsychology

How to approach the history in daily practice

How to interpret information from the history

Clinical Pearl: Correlating historical findings: Alzheimer’s disease

Conclusions

Chapter 3: Art of the physical examination

Abstract

Introduction

Methods of evaluation

Summary of key examination approaches by system

Approaching the examination in daily practice

Interpreting information from the examination

Conclusions

Chapter 4: The Biology of Functions in clinical practice

Abstract

Introduction

Key concepts in formation of indexes of physiologic activity

Formation of direct indexes

Formation of indirect indexes

Biology of Functions in clinical practice

Using the Biology of Functions

Conclusions

Chapter 5: Medicinal plants in clinical practice

Abstract

Introduction

Parts used

Galenic forms

Routes of administration

Recommending phytotherapy

Dosing considerations with medicinal plants

Plant-drug interactions

Conclusions

Chapter 6: Therapeutics in Endobiogeny

Abstract

Introduction

Rational clinical therapy

Therapeutic aim

How to prescribe medicinal plants

Oligoelements

Alimentation (diet)

Other therapies

Conclusions

Section B: Essentials of history, physical exam and Biology of Functions

Chapter 7: Clinical Essentials of the Autonomic Nervous System

Abstract

Introduction

Quick review

Clinical pearl

Key historical findings relating to the ANS by system

Key physical examination findings relating to the ANS by system

Biology of Functions indices related to the ANS

Treating the Starter index

Conclusion

Chapter 8: Clinical Essentials of the Corticotropic Axis

Abstract

Introduction

A brief review of key hormones

Historical findings by system

Evaluation of the Corticotropic axis

Biology of Functions indices related to the Corticotropic axis

Conclusions

Chapter 9: Clinical Essentials of the Gonadotropic Axis

Abstract

Introduction

A brief review of key hormones

Pathophysiology

Historical findings by system

Evaluation of the Gonadotropic axis

Biology of Function indices related to the Gonadotropic axis

Conclusions

Chapter 10: Clinical Essentials of the Thyrotropic Axis

Abstract

Introduction

A brief review of key hormones

Pathophysiology

Clinical pearl

Symptoms related to the Thyrotropic axis

Evaluation of the Thyrotropic axis

Biology of Function indices related to the Thyrotropic axis

Conclusions

Chapter 11: Clinical Essentials of the Somatotropic Axis

Abstract

Introduction

A brief review of key hormones

Pathophysiology

Symptoms related to the Somatotropic axis

Evaluation of the Somatotropic axis

Biology of Function indices related to the Somatotropic axis

Conclusions

Chapter 12: Spasmophilia: A key to many disorders

Abstract

Introduction

Origins of spasmophilia

Role of ANS

Role of endocrine system and emunctories

Types of spasmophilia

Evaluating spasmophilia

Diagnostic studies

Differential diagnosis

Structuro-functional spasmophilia

Functional spasmophilia

Sample treatments

Iatrogenic causes of fragilization of terrain

Principles of treatment

Conclusions

Chapter 13: Hepatic insufficiency

Abstract

Introduction

Insufficiency and congestion

General overview of function

Historical findings related to functional exocrine hepatic insufficiency

Physical exam findings

Biology of Function indices related to Hepatic insufficiency

Therapeutics: General considerations

Conclusions

Chapter 14: Exocrine pancreas

Abstract

Introduction

Structure, function, units of function

General approach to assessment

Historical findings related to exocrine pancreas

Physical exam findings

Biology of functions: Somatostatin index

Therapeutics: General considerations

Conclusions

Section C: Assessment and treatment of common disorders

Chapter 15: Acne

Abstract

Summary

Treatment goals

Terrain in detail

History and BoF findings

Physical exam and BoF findings

Treatment

Chapter 16: Asthma, allergic type

Abstract

Summary

Treatment goals

Terrain in Detail

Treatment

Exemplary prescriptions

Chapter 17: Asthma, intrinsic

Abstract

Summary

Treatment goals

Terrain in detail

History and BoF findings

Physical exam and BoF findings

Treatment

Chapter 18: Acute bronchitis, dry cough

Abstract

Summary

Treatment goals

Terrain in detail

History and BoF findings

Physical exam and BoF findings

Treatment

Chapter 19: Acute bronchitis, wet cough

Abstract

Summary

Treatment goals

Terrain in detail

History and BoF findings

Physical exam and BoF findings

Treatment

Exemplary prescriptions

Chapter 20: Burping (eructation), borborygmus, flatus

Abstract

Summary

Treatment goals

Terrain in detail

Treatment

Chapter 21: Constipation, normal transit

Abstract

Summary

Treatment goals

Sample treatment

Terrain in detail

History and BoF findings

Physical exam and BoF findings

Treatment

Chapter 22: Constipation, slow transit

Abstract

Summary

Treatment goals

Sample treatment

Terrain in detail

History and BoF findings

Physical exam and BoF findings

Treatment

Chapter 23: Colitis, Crohn’s

Abstract

Summary

Treatment goals

Sample treatment

Terrain in detail

History and BoF findings

Physical exam and BoF findings

Treatment

Chapter 24: Colitis, ulcerative

Abstract

Summary

Treatment goals

Sample treatment

Terrain in detail

History and BoF findings

Physical exam and BoF findings

Treatment

Chapter 25: Diarrhea, malabsorptive

Abstract

Summary

Treatment goals

Terrain in detail

History findings

Physical exam findings

Treatment

Chapter 26: Diarrhea, rapid transit

Abstract

Summary

Treatment goals

Sample treatment

Terrain in detail

History and BoF findings

Treatment

Chapter 27: Diarrhea, Secretory

Abstract

Summary

Treatment goals

Terrain in detail

History findings

Physical exam and BoF findings

Treatment

Chapter 28: Dysbiosis

Abstract

Summary

Treatment goals

Terrain in detail

History and BoF findings

Physical exam and BoF findings

Treatment

Chapter 29: Eczema

Abstract

Summary

Treatment goals

Terrain in detail

History findings

Physical exam and BoF findings

Treatment

Chapter 30: Esophageal varices

Abstract

Summary

Treatment goals

Terrain in detail

Treatment

Chapter 31: Gastroesophageal reflux disease (GERD)

Abstract

Summary

Treatment goals

Terrain in detail: Type 1 GERD: Lower esophageal sphincter

History and BoF findings

Physical exam and BoF findings

Treatment

Terrain in detail: Type 2 GERD: Pyloric sphincter

History and BoF findings

Physical exam and BoF findings

Treatment

Chapter 32: Menstruation, normal cycle

Abstract

Summary

Follicular phase

Luteal phase

Conclusions

Chapter 33: Menstruation disorders: Metrorrhagia

Abstract

Summary

Treatment goals

Terrain in detail

Treatment

Chapter 34: Menstruation disorders: Oligomenorrhea

Abstract

Summary

Treatment goals

Terrain in detail

Treatment

Exemplary prescriptions

Chapter 35: Menstruation disorders: Polymenorrhea

Abstract

Summary

Treatment goals

Terrain in detail

History and Physical exam findings

Biology of Functions

Treatment

Chapter 36: Premenstrual syndromes (PMS)

Abstract

Summary

Treatment goals

Terrain in detail

History and BoF findings

Physical exam and BoF findings

Treatment

Chapter 37: Otitis media

Abstract

Summary

Treatment goals

Terrain in detail

History and BoF findings

Physical exam and BoF findings

Treatment

Chapter 38: Prostate enlargement with lower urinary tract obstruction (LUTO)

Abstract

Summary

Treatment goals

Terrain in detail: Prostate adenoma

History and BoF findings

Physical exam and BoF findings

Treatment

Terrain in detail: Prostate edema

History, Physical exam, and BoF findings

Treatment

Chapter 39: Prostatitis

Abstract

Summary

Treatment goals

Terrain in detail

History and BoF findings

Physical exam and BoF findings

Treatment

Chapter 40: Rhinopharyngitis

Abstract

Summary

Treatment goals

Terrain in detail

History and BoF findings

Physical exam and BoF findings

Treatment

Chapter 41: Sinusitis

Abstract

Summary

Treatment goals

Terrain in detail

History and BoF findings

Physical exam and BoF findings

Treatment

Chapter 42: Tonsillitis

Abstract

Summary

Treatment goals

Terrain in detail

History and BoF findings

Physical exam and BoF findings

Treatment

Section D: Essentials of therapeutics

Chapter 43: Materia Medica

Abstract

Introduction

Medicinal plants

Alchemilla vulgaris (Lady’s mantle)

Arnica montana (Arnica)

Avena sativa (Milky Oat)

Eleutherococcus senticosus (Eleuthero)

Hamamelis virginiana (Witch hazel)

Lamium album (White Deadnettle)

Malva sylvestris (Mallow)

Medicago sativa (Alfalfa)

Urtica dioica, root (Stinging nettle)

Urtica dioica, leaf (Stinging Nettle)

The special role of medicinal clay

Section E: Essentials of alimentation

Chapter 44: Endobiogenic diets and nutrition

Abstract

Introduction to alimentation according to Endobiogeny

A general guide to healthy eating

Special regimens

Monodiets

Nutrient-rich foods

Appendix 1: Essential physical exam images

Abstract

Introduction

Oral

Abdomen

Leg

Appendix 2: References and resources

Introduction

Articles

Books

Index

Copyright

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Notices

Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary.

Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility.

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Dedication

This book is dedicated to our students, whose questions and enthusiasm has helped us refine our teaching of Endobiogeny. This book is our gift to you to share with all those who come seeking health and healing. This book is also dedicated to all those who seek to be heard, understood and engaged in the affirmation of Life and daily choices for health and healing.

Preface

Kamyar M. Hedayat; Jean Claude Lapraz

The knowledge of Endobiogeny makes it possible to understand the path traveled, to predict its future, and to anticipate in unaffected individuals the installation of a pathological state, spontaneous or as the consequence of repeated or prolonged use of aggressors. Be it food, habits, drugs or medication, this condition becomes predictable thanks to risk assessment of each individual.¹

Christian Duraffourd

Endobiogeny is a theory of terrain first presented by Dr. Christian Duraffourd in 1983. As a theory of terrain, it presents a new approach to medicine based on a complex systems approach to human physiology. What you hold in your hands is a distillation of treatment approaches to common medical conditions seen in clinical practice derived from the genius and originality of Dr. Duraffourd’s theory. The goal of this book is to assist the physician trained in Endobiogeny by recapitulating the essential aspects of the disease, its terrain, assessment, and treatment.

While Endobiogeny is a theory of terrain, it is not a theoretical or abstract approach to medicine. To the contrary, it was developed in response to empirical observations and a keen sense of pattern recognition during years of medical practice. Endobiogeny does not supplant the current scientific approach to medicine—far from it. It expands and deepens the scientific approach to medicine. It brings the sensibility of systems theory to human biology and physiology. It integrates the essential elements of the terrain that regulate material life in its formation, regulation, restauration, and deinstallation. At its core, clinical Endobiogeny is a humanistic approach to medicine. Central to our approach is respect for human life, and the experience of life through health and illness by the patient. More broadly, there is respect for all life, for it is from medicinal plants and other products of the earth that the therapeutic approach of Endobiogeny is based.

Never before has the practice of Endobiogeny been so succinctly summarized for the benefit of both physician and patient. This work represents the foundational work of Dr. Duraffourd, the elaborative and clarifying approach of Dr. Jean-Claude Lapraz and his working group in SIMEPI, and the expanding contributions of Dr. Kamyar M. Hedayat to the categorization of disease and utilization of medicinal plants. While Dr. Duraffourd is no longer with us, his ideas live on in his students and in published works such as this one. From a single flame many candles have been lit. May it light the way for you in your practice.

December 2018

Reference

1 Duraffourd C., Lapraz J.C. Traité de Phytothérapie Clinique: Médecine et Endobiogénie. Masson ed. Paris: Masson; 2002.

Introduction

These things are not explainable in detail. From one thing you learn a thousand things. When you have acquired the Way of Strategy there will not be a thing that you cannot understand. You must study hard.¹

This book was written to be a convenient and quick reference for students and practitioners of Endobiogeny. However, experienced practitioners not trained in Endobiogeny may find it instructive. We hope it inspires you to study Endobiogeny in depth. Very often, in our courses, students would feel like Icarus, only to have their wings melted by the fiery demands of bedside clinical decision making. How can one organize the information contained in three volumes of writing into a concise and accessible reference while seeing patients? It became increasingly clear to us that, what was needed, was a mentor by their side, and a friend in their pocket. This book is that mentor and friend. It is a definitive reference during patient care and a reliable study guide for material presented in The Theory of Endobiogeny, Volumes 1–3. To paraphrase the master Samurai Musashi, you must study hard and frequently to practice Endobiogeny well. You must practice Endobiogeny frequently and seriously to understand the theory well.

This book is divided into five sections. They offer a link from the grand theoretical concepts of Endobiogeny to its clinical applications. Section 1: Theory and Foundation of Clinical Practice is a brief review of essential theoretical concepts. Section 2: History, Exam and Biology of Function reviews key elements of practice: history, physical examination, and Biology of Functions indexes. Section 3: Assessment and Treatment of Clinical Disorders summarizes assessment and treatment of over 30 common clinical disorders, many of which can be read in 5-10 minutes for a quick review. Section 4: Essentials of Therapeutics and Section 5: Essentials of Alimentation offer concise resources to the selection and indication of medicinal plants mentioned in this volume, and key diets and approaches to nutrition.

This is a how-to book. It omits the why of Endobiogeny fully discussed in our seminars, scientific publications, and The Theory of Endobiogeny, Volumes 1–3. It omits differential diagnosis and best practices in medicine with respect to imaging studies, laboratory work ups, pharmaceutical treatments, etc. We assume that you have this knowledge and are consulting this book to enhance your evaluation of treatment according to the theory of Endobiogeny. The practitioner must determine the severity of illness and capability of recovery when selecting the optimal levels of treatment (c.f. Section A, Chapter 6: Therapeutics in Endobiogeny).

Reference

1 Musashi M., Ashikaga Y. Book of earth. In: Brant R., ed. Book of Five Rings. Astrolog Publishing House; 2003.

Section A

Theory and foundation of clinical practice

Chapter 1

Theory of Endobiogeny

Abstract

The theory of Endobiogeny is a global systems approach to medicine. The chapter summarizes the key concepts of Endobiogeny: the human is a complex system. The totality of all elements is the terrain. Metabolism is the expression of Life, of the terrain. The neuroendocrine system is the manager of metabolism, hence the terrain. The role of key elements of the terrain: autonomic nervous system, endocrine system, immunity, and emunctories is discussed, as well as the relationship between them. The role of key hormones, organized by lines of function, called endocrine axes is presented. Throughout the chapter, clinical pearls are presented to relate theoretical concepts to daily clinical practice.

Keywords

Endobiogeny; Endocrine system; Autonomic nervous system (ANS); Central nervous system (CNS); Cortisol; Estrogen; Thyrotropin releasing hormone (TRH); Insulin; Glucagon

We no longer neglect the biological reality of each individual. We respect his endogenous functioning—his endobiogeny.

Christian Duraffourd¹

Introduction

The theory of Endobiogeny stands at a unique juncture in the history of medicine. It is based on modern notions of physiology. It is rooted firmly within the Western scientific tradition. It is a son who departs from an increasingly stern father. Its departure is not a rejection of its foundation, but growth beyond the limitations of an increasingly reductionist approach to life.

Nourishing the scientific foundation of Endobiogeny is systems theory. To be more specific, it is a global systems approach to living systems. While the practitioner is focused on practical clinical applications of Endobiogeny, it is nevertheless important to keep in mind the essential elements of theory. This section offers a brief review of these essential elements to benefit the practitioner in their daily practice.

General theory of complex living systems according to Endobiogeny

Complexity theory states that a unit of function is a system unto itself containing smaller subunits and a subunit of a larger system. For example, the liver is a unit unto itself. It contains within itself subunits called hepatocytes. It is a subsystem of the global organism. In turn, a single hepatocyte, subunit of the liver, is a whole unit unto itself containing its own subunits: ribosomes, mitochondria, DNA, etc. Endobiogeny is a global complex systems theory because it evaluates the relationships within a part, between the parts, and of the whole (global) living being (systems). It evaluates the complexity of relationships based on levels and hierarchies, qualities, intensities, duration of interaction. In clinical practice, an individual symptom must be contextualized to an organ, tissue, or system. You focus on the system expressing the symptom, but also the other organs, tissues, or systems that interrelate to it. This is the global systems approach of Endobiogeny.

Example: Wet bronchitis

A patient has a productive cough. What produces the mucous in the bronchus that makes the cough wet? It depends on its thickness and color, which implicates certain levels of function of the neuroendocrine system and pancreas. Why did the mucous develop in the first place? Inflamed bronchi. What global neuroendocrine and emunctory factors are most implicated in that? Find your answer and you will find the path to treating the patient who has the disease, and not the disease the patient has, to paraphrase Hippocrates.

Key elements and function of the terrain in practice

Definition of terrain

The terrain is the sum of all the structural and functional elements of the organism. Structure refers to material elements: mitochondria, organelles, cells, tissues, organs, etc. It is derived from the genetic inheritance and modified by epigenetics to become phenotype. Function refers to dynamic expression of structure: structural, structurofunctional, and functional metabolism. Each terrain is the unique expression of structure and function in space and time.

Clinical pearl: Treating the terrain

In Endobiogeny, personalized medicine is treatment of the person according to their phenotype, not genotype. It is a treatment of the dynamic structurofunctional activity at that moment in time and space.

Endocrine system: Regulator of terrain

Terrain is everything. It is the ceaseless and dynamic metabolism of material and energy. The system that regulates the terrain is our area of greatest focus. If you regulate the regulator, you regulate the terrain. The regulator of the terrain must have met three criteria: (1) ubiquity of action—for the terrain is all and everywhere, (2) regulations of the elements of metabolism, (3) autoregulation. The endocrine system is the sole system of physiology that meets all three criteria. This is how Endobiogeny places the greatest emphasis on an integrative understanding of the endocrine system.

From the unitary concept of metabolism arises the duality of catabolism and anabolism. In the sequential regulation of metabolism, there are four lines of endocrine function, alternating in catabolic and anabolic predominance in a sequential manner (Fig. 1.1). Each endocrine axis also relates to a specific type of nutrient mobilization and/or utilization, and, emunctory (cf. below) as well. In this way, the endocrine system is completely integrated into basal metabolism, adaptation syndromes, and recovery from adaptation.

Fig. 1.1 Integrated neuroendocrine management of metabolism. Alpha sympathetic (αΣ) stimulates and calibrates the intensity and duration of the endocrine management of metabolism. At the cellular level, parasympathetic (πΣ) stimulates the general cellular anabolic tendency through influence on the rate of production of elements, alpha sympathetic calibrates it and beta sympathetic (βΣ) completes it. (© 2015 Systems Biology Research Group.)

Clinical pearl: Importance of endocrine assessment

No matter whether a disorder is acute, chronic, genetic, acquired, somatic, or psychological, the endocrine system will be the heart of assessment and treatment. Evaluate it carefully: its potential at birth, its expression during development, and its current state.

Autonomic nervous system: Calibrator of the regulator

The autonomic nervous system (ANS) originates in the brain stem and functions in the peripheral and central body. Its role is to stimulate and calibrate function including that of the endocrine and central nervous systems (cf. below). The ANS is ubiquitous, dynamic, and ceaseless in its actions. It is not self-regulating, which is why it cannot be the regulator of the terrain.

Key to ANS function is the notion of autacoids. Assess autacoids in your intake and address them in your treatment of the patient. The autacoid of parasympathetic (para: πΣ) is serotonin. Serotonin prolongs the time of para by delaying the onset of alpha sympathetic (alpha: αΣ). Recall that > 90% of all serotonin is in the intestines or peripheral expression of the ANS. Vagotonia and other hyperparasympathetic states are part of the pre- and critical terrain of numerous disorders. The autacoid of alpha is histamine. Histamine prolongs the duration of αΣ. Hyper-alpha states are responsible for initiating or sustaining critical terrains of disorders of adaptation. Beta sympathetic (beta: βΣ) has no autacoid owing to its rapid and brief action. What is key to understand about the ANS are three things:

1.ANS function is timed and sequential (Fig. 1.2)

Fig. 1.2 Normal peripheral autonomic sequencing-activity graph. The sequence starts with parasympathetic (πΣ) and its autacoid serotonin, which delays alpha-sympathetic activity. In effect, serotonin prolongs para activity. With the onset of alpha (αΣ), activity increases, then is sustained thanks to histamine, which prolongs alpha. The activity of beta (βΣ) brings a brief peak of activity, followed by a sudden drop below the baseline level. What follows is the recovery phase back to baseline. (© 2014 Systems Biology Research Group based on the work of the SIMEPI, based on the work of SFEM, based on the concepts of Christian Duraffourd.)

2.Autacoids calibrate ANS intensity and duration

3.ANS is so indispensable for proper functioning of the endocrine system, the term neuroendocrine system is used in Endobiogeny instead of merely endocrine system

Ultimately, autacoids regulate the ANS regulation of the endocrine system. In Endobiogeny, the notion of the ANS has been extrapolated to the general concept of sequential and timed relationships (Table 1.1) beyond the function of neurons that excrete acetylcholine (para), noradrenaline (alpha), and adrenaline (beta).

Table 1.1

CNS, central nervous system; ENS, enteric nervous system; PNS, peripheral nervous system.

Clinical pearl: ANS assessment

Remember that para and alpha adapt themselves to each other. The more one rises, the greater the other does in turn. When assessing the level of ANS function, assess both the quantitative and qualitative relationships. An example of a quantitative determination is to conclude that both para and alpha are elevated. An example of a qualitative assessment is that given that both are elevated, alpha is greatly predominant to para. An example of this would be a 52-year-old man who has a wet mouth and is hungry upon waking (elevated para), but, has a gastric ulcer, incomplete urination, enlarged prostate and labial herpes outbreaks when stressed, and cold hands and feet (elevated alpha).

Emunctories

Emunctories are the organs of drainage and detoxification. The emunctories are the liver, gallbladder, kidney, intestines, lung, and skin. While not technically an emunctory, exocrine pancreas is included because of its implication with the hepatobiliary unit. The corticotropic axis utilizes the skin, kidneys, bladder, liver, and intestines. The thyrotropic axis utilizes the lungs, liver, and intestines.

Consider emunctories in three ways:

1.Catabolic axes: they remove catabolic products

2.General: within each endocrine axis, they support general function

3.Relationship to specific disorders (Table 1.2)

Table 1.2

ENT, ear, nose, and throat.

Congestion of emunctories plays an important role in many disorders and diminishes the buffering capacity of the patient. The adaptive role of congestion is to prolong the exposure of blood to an organ. This can be for an emunctory role, i.e., hepatic metabolism of catabolic byproducts, or, nonemunctory, i.e., hepatic glycogenolysis. In either case, congestion compromises tissue functions. Each branch of the ANS can play a role in active or passive congestion.

Clinical pearl: When in doubt, drain

Each emunctory plays numerous other roles. Emunctories are related to the precritical and critical terrains of every illness. When in doubt about the critical neuroendocrine terrain, institute therapeutic drainage. Decongesting an emunctory can take the patient out of a critical state and relieve symptoms in a short period of time. For example, one type of gastroesophageal (GE) reflux disease involves elevated para tone on the GE sphincter. If the patient does not tolerate fatty foods, suspect gallbladder congestion. In this case, draining the gallbladder will diminish para tone, even if you do not use a parasympatholytic, because improving cholagogy and choleresis will reduce the need for para. This in turn restores normal GE tone, resolving the reflux. A good example of an efficient drainer is Taraxacum officinale (dandelion leaf), which is a hepatobiliary drainer, cholagogue, and choleretic. It can be administered 20–30 min before a fatty meal.

Immunity: Recognition, defense, and offense

The immune system is not a primary regulator of the terrain. Its creation and function are managed by the neuroendocrine system. The immune system is the third element of adaptation, along with the endocrine system and the ANS. The more dysfunctional the latter two are, the greater the predominance of the immune system must become. This notion is essential when treating all allergic and autoimmune disorders.

The immune system is involved in distinguishing self from nonself, and, placing every material element into one of three categories: safe, neutral, and harmful. Inflammation is a key aspect of how elements of the immune system transfer from humoral and lymphatic spaces to tissular spaces. Regulation of the immune system can be an important element of treatment, but it remains a reactive, symptomatic treatment. One must always return to addressing the neuroendocrine elements that have dysregulated immunity: be it the production, mobilization, utilization, or end of immune action.

Clinical pearl

For acute symptomatic relief use antiinflammatories, e.g., topical clay, essential oils of rosemary and lavender, or turmeric. For remission, use polyvalent plants that address two or more of the following: ANS, endocrine, immune, emunctory activity. Three good examples are Viola tricolor (antiinflammatory, contains salicylates, polyvalent drainage), Zea mays (antiinflammatory, contains salicylates; anti-TSH (thyroid-stimulating hormone), hepatorenal drainer), or, Thymus vulgaris (antiinflammatory, broad-spectrum antimicrobial, parasympatholytic, adrenal cortex stimulant).

Gastrointestinal tract: Quotidian junction of all other elements of terrain

In some approaches to integrative medicine, the gastrointestinal (GI) tract is first among areas of treatment for all disorders. It is our opinion that the merit is well placed but the reasoning is in error. The GI tract is the place where all other key elements of the terrain meet.

1.Neuroendocrine: regulation of digestion, distribution of nutrients for metabolism

2.Immunity: largest network of immune cells

3.Emunctory: key role of liver, gallbladder, exocrine pancreas in digestion

4.Buffering capacity: core elements of buffering capacity are within the splanchnic bed (cf. below)

5.Central nervous system: influence of emotions on enteric nervous system effects enteric immunity, digestion, and adaptation capabilities

6.Patient autonomy: alimentation is the aspect of self-care most easily controlled but least frequently managed by the patient

Buffering capacity

The buffering capacity is the ability to immediately respond to adaptation demands without having to institute the production of new elements. Buffering capacity can be achieved through the following ways:

1.Redundancy: Two lungs, two kidneys, two adrenal glands, etc.

2.Flexibility: Alternate and redundant metabolic pathways: glucose vs lipid oxidation for ATP production

3.Excess: > 90% of circulating hormones inactive, but ready for use at any time

4.Sequestration: Leukocytes, platelets, immune factors stored and ready to be mobilized near instantaneously

5.Storage: Nutrients stored (glucose as glycogen, amino acids in muscle, calcium in bones) and ready for instantaneous liberation and distribution

Clinical pearl: When in doubt, drain and restore

When a patient easily, rapidly, or frequently succumbs to imbalance or illness, or has a prolonged or insufficient recovery, address the buffering capacity in the follow order: 1st: improve sleep, hydration and stress management, 2nd: drain the liver, 3rd: alkalize the diet then 4th: use oligoelements (trace minerals) such as magnesium, sulfur or boron.

Central nervous system: Information processing

The central nervous system (CNS) is not key for human survival. A patient may be brain dead but body-alive. One cannot by body-dead and cogitate. The CNS is a servant leader. It serves at the demands of the periphery. It is an information-processing center that evaluates the internal needs and adapts those needs to internal and external demands. It directs and creates hierarchies of importance. For example, in the summer time, adrenal cortex activity reaches its nadir. However, if one has a summer sinusitis, the priority is to relaunch cortisol to resolve the infection. The CNS plays a role in perception of values, if an event is considered good or bad. It conveys information to the neuroendocrine unit, indirectly affecting other key elements of terrain (Fig. 1.3).

Fig. 1.3 The central nervous system (CNS—upper left) is the locus of various perceptions, emotions, memories, and assessments of physiologic state. It creates a milieu or context which alters the threshold or amplitude of neuroendocrine response. For example, alpha sympathetic (αΣ) stimulates TRH, which in turn stimulates (1) the thyrotropic axis (far right, vertical), (2) the limbic area (upper left) affecting memory and emotions, (3) liberation of glucose (bottom panel, right to left). A patient with chronic rumination, activating the limbic area, may have an exaggerated alpha response. (© 2014 Systems Biology Research Group.)

Clinical pearls: Mindset in practice

The mindset of the patient should be assessed in each evaluation. In daily practice, most disorders, no matter how insignificant may appear to be, are precipitated or prolonged by the patient’s emotional reaction to internal or external events, or to the illness itself. An assessment of the cognitive-emotional state can be addressed in indirect or subtle ways in order to avoid giving the impression of performing a psychiatric evaluation, which is not the purpose of this assessment. Observe facial expression and tone of voice. Is the tone flat, animated, or restrained? Observe the rate, regularity, and depth of breathing, related to ANS and emotional states. Is it rapid and shallow or, slow with pauses and sighs? Simple inquiries can reveal important information that contextualizes the patient’s illness to something larger in their life: Have any relationships changed in your life recently? Or, Is this time of year significant for you in any way?

The endocrine system: A brief review

For the species, the most important role of the hormones is reproduction, but for the individual it is differentiation and adaptation. It becomes increasingly more obvious, furthermore, that the principal medical application of endocrinology is not the treatment of the primary but secondary diseases of the endocrines. [Primary endocrinopathies] are rare diseases in comparison with the hormonal derangements resulting from maladaptation to stress.

Hans Selye²

As the theory of Endobiogeny posits, the endocrine system is the true manager of the terrain. To manage disease, learn to manage the endocrine system. Endobiogeny has developed from its theory a complex, nuanced, and sophisticated approach to applied endocrinology that cannot be fully summarized here (cf. The Theory of Endobiogeny, volume 1). Our purpose here is to recapitulate the most valuable concepts for the clinician.

Overview

A hormone is a chemical information unit. It transmits information through signaling. The information transmitted relates to regulation of metabolism by one of two general mechanisms. The first is nongenomic. The action occurs within minutes within the cytoplasm. The second is genomic. The action occurs over 12–36 hours based on regulation of DNA transcription. There are five classically described types of hormonal function summarized in Table 1.3, where Region refers to the site of action as compared to the site of excretion of a hormone.

Table 1.3

The theory of Endobiogeny further considers the effects of hormones on metabolism. When evaluating indexes of the Biology of Functions, understand what level of hormonal effect is being described (Table 1.4).

Table 1.4

Pineal

Overview: Epiendocrine gland with supracontrol function. Through its primary hormone melatonin, it is the, axel around which all axes turn and unfold in chronobiologic functioning.

Essence: Protects the organism from exterior aggressions (e.g., ultraviolet light) during the day, repairs the interior during the night (Fig. 1.4). NB: It does not induce sleep, rather, it diminishes diurnal physiology.

Fig. 1.4 Summary of melatonin activity. (© 2014 Systems Biology Research Group.)

Regulation

●Stimulation:Secretion: αΣ, excretion: πΣ

●Inhibition: Adrenocorticotropic hormone (ACTH), cortisol

●Regulation: Oxytocin

Indications for addressing

●Seasonal disadaptation: Allergies, migraines, bronchitis, cancer metastasis, etc.

●Neuropsychiatric: Insomnia, seizures, autism

●Aging

Treatment options

●Endocrine: Exogenous: melatonin; Endogenous: to increase melatonin, either reduce cortisol and ACTH, and/or increase oxytocin activity.

●Lifestyle: Sleep before midnight,