Medical

Hypotheses

5: 237-246,

PSYCHOSOMATIC

1979

DISEASE

AND

ACUPUNCTURE

School N.D. Cook, Sendai Akamon Acupuncture 61 Kawauchi Kawamae, Sendai, Miyagi, 980 Japan ABSTRACT The medical philosophy implied by a "mind-body unity" hypothesis is outlined and the type of therapy appropriate to special the stage of development of disease is discussed; reference is made to the place of acupuncture within a moderr Starting from the premise that mind is the medical program. primary causal force determining neural states, it is concluded that the highest level medical art would be "psychosomatic The next highest form of therapy would deai psychoanalysis." directly with nerve impulses (acupuncture, etc.), followed by drug therapies directed at intra- and extracellular fluid composition, hormone and macromolecule manipulation, and finally minor and major surgery. psychosomatic

disease,

acupuncture,

limbic

system

INTRODUCTION Although the mind-body (mind-brain) problem is most appropriately discussed in philosophy journals, the two fundamental points of view are so radically different that fundamentally different views of medical practice are implied. The first and, in the West, traditional position is that, despite the spatial coincidence of mind and brain, they are basically unlike, unrelated entities and their diagnosis and treatment should be similarly unlike and unrelated. Needless to say, the extreme position of complete disparity between the two realms is now untenable in light of the various psychic disturbances which are known to be induced by specific brain trauma, chemicals, etc. and in light of the somatic disturbances closely related to (and arguably caused by) psychic/mental phenomena. Yet, the simplistic duality which frees both the psychiatrist and the general practitioner from worrying about the other's complex terminology, not to mention diagnostic and therapeutic methods, is still pervasive. Within that school of thought there are many variations, but the underlying premise is that, regardless of some overlap, mind and brain operate in largely 237

The second school of thought, one traditional separate realms. in the East, is that mind and body are essentially one an unhealthy body reflects a disease of the mind and, likewise, a disturbed mind will bring forth physical symptoms in the body. position is no longer tenable in light of Again, the extreme the known effects of various types of trauma, poisons and congenital defects which can have little or no effect upon the mind despite severe bodily harm, but the fundamental view of human life that the internal and external phenomena are related is still tenable. The gradual development of psychosomatic medicine in the West and the rapid elucidation of the mechanisms of internal hormonal secretions via the pituitary and hypothalamus have brought strong support for considering at Nonetheless, least a close interaction between mind and body. a systematic philosophy of medicine has yet to be developed in This is regrettable in so far as the light of this knowledge. practitioner of either traditional Eastern or traditional Western medicine fails to appreciate the areas of validity of the other tradition and, more importantly, fails to see the need for therapeutic methods regardless of tradition that are appropriate to the stage of development of the disease. In this paper, a frame of reference for medical practice is outlined from the perspective of a "unified mind-body" with special reference to the place of acupuncture. philosophy, by Sperry The basic philosophical position is that described given a certain genetically determined organ(1,2) in which mind is seen as the primary causal factor in ic substrate The implications of determining nervous states in the brain. this philosophical stance are discussed with regard to the varying from transitory neurological etiology of disease abnormalities to more severe organic lesions. THE

PSYCHOSOMATIC

BASIS

UF

DISEASE

Assuming that the mental events which take place in the brain and which are, for the most part, chosen by the individual are the primary causes of the brain's neural events, it follows that a wide variety of other physiological phenomena The most are strongly influenced by those mental events. obvious of these effects is hormonal secretion from the brain. It is known that oxytocin and vasopressin are manufactured in the paraventricular and supraoptic nuclei of the hypothalamus, It has also become apparent that all of the respectively. hormones of the anterior lobe of the pituitary are released and/or inhibited by stimulation from specific loci within the Although it cannot be said that the endohypothalamus (3). crine system is under conscious control, there are both cortico-hypothalamic fibers and extensive ccnnections between the cingulate cortex and portions of the temt701factory cortex," (4). poral lobe and the hypothalamus via the limbic system conscious or unconscious, it is inevitable that Consequently, minds can the neural patterns which we choose in our conscious

have not only neural effects within the brain, but also somatic This is of course common knowledge with regard to effects. various autonomic nervous system responses (blushing, sexual excitation, tachycardia, sweating, etc.), but the same logic implies that the entire endocrine system is under similar neural control via the hypothalamic-pituitary axis. Despite the fact that the precise mechanisms of higher cortical control are to recognize that some see!: not now known, it is important control is likely. The hormonal effects on the growth, differentiation, and neoplastic growth (5) of cells are becoming known in great Not only for those diseases which are known to be the detaii. direct results of hypo- or hyperactivity of the pituitary, but also for diseases which arise as secondary or tertiary effects of pituitary malfunction, it is apparent that a primarily neurai malfunction in the hypothalamus of the brain has its final effects upon internal organs. Precise mechanisms are but what were once thought to be known for only a few diseases, systemic abnormalities due to lesions in specific glands have now been traced back to abnormalities of the pituitary and thyroid diseases). ultimately the hypothalamus (e.g., certain experimental excision or stimulation of portions Furthermore, of the hypothalamus and limbic system in animal species (6) fully support the idea that quite specific disturbances of internal organs can be brought about by specific brain events. A related, if less specific, mechanism of disease is seen in Selye's "stress response" Although specific tissue-organ (7). lesions are not always predictable from the nature of the stres s-inducing events, specific endocrine responses followed by a general susceptibility to disease is consistently found. Following the endocrine imbalance caused by "stress," microbial infection is common due to a greatly lowered resistance to external invasion. In summary, although there appears to be no causal connection between mental states and specific viral or bacterial infections, there most certainly is a causal connection between mental. states and an organic condition susceptible to microbial invasion. - within the framework of a As such, it is possible mind-body unity hypothesis to consider virtually all diseases excepting trauma and congenital defects present from birth as being psychosomatic in origin. THERAPY

APPROPRIATE

TO THE

STAGE

OF DISEASE

Such a contention is not, however, merely an exercise in philosophy, for the course of disease necessarily proceeds from relatively mild neurological dysfunction through molecular and macromolecular abnormalities of cells to their microbial deTherapy will therestruction, necrosis or neoplastic growth. fore depend not only upon the type of lesion, but also upon its stage of development. Western medicine acknowledges Currently,

239

only a limited range in the course of disease - generally only gross histological changes - and ignores antecedent psychological, neurological and often hormonal stages. The fact, however, that the course of disease cannot be fully explained in terms of such macroscopic lesions is evident in the frequent use of the term "idiopathic" to cover virtually all etiological questions. As expressed in Figure 1, the type of therapy to be employed depends primarily upon the level of material organization to be treated. Generally speaking, the types of therapy from surgery to hormone treatment are included in modern medical practice and no particular hierarchy among them is recogIt is obvious, however, that the targets of therapy nized. proceeding from surgical operations to hormone injections are increasingly more rarefied: the grossest therapy being the excision of entire organs and the most subtle therapy being slight molecular adjustments, which ultimately have effects on At least two additional types of cells, tissues and organs. therapy are theoretically possible and indeed highly desirable. The first is therapy based upon specific nerve stimulation, which in turn results in intra- and extracellular fluid changes and/or hormonal secretions. Subsequent effects would be similar to direct drug (hormone) administration, except for the fact that the dangers involved in injection of exogenous substances are not encountered. Despite the fact that acupuncture therapy has not yet been systematized in Western scientific terms and regardless of the possibility that it may not be systematized in any meaningful way within the framework of "Oriental medicine," there are now a large enough number of individual acupuncture treatments which show significantly consistent results that such a theoretically conceivable realm of medical therapy should be given Not only is there the long tradition of acuserious study. puncture in the East, and at least a small number of repeatable stimulatory and depressant effects obtainable through nerve excitation, but the entire logical framework of the "mind-body unity" hypothesis implies that treatment at a neural level is Whether or not the next higher form of medical therapy. current or future acupuncture will actually allow for specific stimulation applicable to a wide range of diseases is open to debate, but in addition to the evidence which current acupuncture itself offers, the known characteristics of the central Specifinervous system offer considerable indirect support. cally, there are known sensory areas on thefcerebral cortex at both the primary and secondary somesthetic areas and on the More importantly, the thalamus, which is cerebellar cortex. the first CNS integrating station for all perceptual modalities except smell, is connected with the hypothalamus and limbic system mainly through its anterior nuclear group (4). Whether or not specific somatic stimulation can induce specific pituitary secretions, as claimed by the Chinese, is in need of fur240

X

Mind

x

x

x

x

x

x

x

x

x

Nerves

Hormones Intra

&extra cellular fluids Cells

x

x

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x

x

X

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x

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x

x

Tissues

X

X

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Organs

)(

x

x

/

TYPE of THERAPY

Surgery

I

I

I Radiation therapy

Drugs with Antibiotics specific and effects anticancer on growth drugs and differentiation

I Hormone therapy

Nerve stimulation (acupuncture)

I Psychosomatic psychoanalysis

i-l

I Modern

Medicine

Occult

Therapies

Psychic Healing ^L_

Figure 1: The principle varieties of medical therapy and the target for which the therapy is aimed. )( primary target, secondary target, x tertiary target. It follows frorn X the assumption that mind is a causal determinant of neural activity that if the primary target can be successfully treated, then secondary and tertiary levels will also be favorably affected. The higher level forms of therapy remain unsystematized, but are potentially the next steps in the development of scientific medicine.

241

ther experimental demonstration, but the neural pathways certainly exist. Less exotic, but with greater empirical support, are the acupuncture therapies which stimulate specific tissues (the adrenal cortex, thyroid, etc.) by means of simple spinal reflexes (8). Rather than therapy being aimed at the center of neuroendocrine control, the hypothalamus, hormonal changes can be induced in a more round about fashion by intervening somewhere within the system of hormonal feedback...with eventual effects on pituitary function. Whereas nerve stimulation therapy has a long and controversial history in the practice of acupuncture, the next level of medical therapy, psychosomatic psychoanalysis, is still If indeed the system of classifialmost entirely theoretical. cation outlined in Figure 1 is valid, in other words, if the mind-as-causal-force hypothesis is justifiable, then we are inevitably led to the consideration that any disease, whose cause can be reasonably traced back to cytological abnormalities caused by hormonal abnormalities, can be said to be caused originally by the malfunction of hypothalamic and higher nerAt the present time, we can only note the theovous centers. retical possibility, but it therefore follows that the first line of defense in preventing and the first line of attack in In other words, medicine curing disease is the psychological. of the future would presumably be able to treat disease at the earliest stage of functional irregularity before organic The significance of this type of lesions have developed. treatment is that only psychoanalytic therapy which can restructure the neural events leading to unhealth can have effect All other therapeutic upon the primary causes of disease. methods are nothing more than treatment of symptoms - suppression of which may often enough be sufficient to coax the body back into normal rhythms, but unless the highest levels are properly functioning reappearance of the disease is likely. Assuming the general validity of the classification in Figure 1, it can then be said that the most appropriate medical treatment will differ according to the stage of development of the disease (Figure 2). Advanced lesions, in which severe damage to tissues and organs has been incurred, will require excision or functional avoidance (shunt operations) which can Less severe be accomplished only through major surgery. lesions and limited malignant growths will more frequently be amenable to radiation therapy and strongly suppressive drugs. Such drugs are also appropriate for the majority of viral and bacterial diseases, which can be controlled by way of specific With still milder histological lesions, the drugs antibiotics. with specific effects upon growth and differentiation may be Of a related nature are the various natural or syneffective. thetic hormones which can be administered to bring functionally Generally speakdisturbed tissue to a state of near normalcy. ing, surgery and drug administration constitute the realm of Its undeniable strength is that the current Western medicine. 242

psychosomatic. psychoanalysis

x

x

0

0

0

l

X

)(

X

0

0

0

.

.

X

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0

0

.

.

.

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.

x

l

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acupuncture,

hormone, therapy drug. therapy minor

surgery

major

surgery.

_

.

X

.

I

I Chronic

Mild tissue damage

Organ damage

Hormonal abnormalities

neurological malfunction

Severe tissue damage .... . . . . . . . . . . . .._________________ ____ Microbial

---m_ Functional

_

__

Invasion

__.... - . . . .... ......t...............-_____

Disturbances

Organic

Disturbances

Therapy appropriate to the stage of development of Figure 2: the disease. X - most appropriate therapy, x - second most inappropriate therapy, and l appropriate therapy, . As theoretically appropriate, but currently unknown therapy. one's state of health deteriorates, increasingly drastic therapeutic measures are necessitated.

243

mechanisms of both disease and therapy are generally well-understood. Particularly with regard to the acute stages of disease, these powerful physical and chemical methods are often necessary, but the weakness of modern medicine lies in the fact that such therapy is often capable of nothing more than alleviating symptoms - the fundamental pathological condition remaining unchanged or even worsening. Especially for diseases which have not progressed to a point where symptoms have become unbearable or whose symptoms do not yet entail irreversible tissue damage, the next higher forms of therapy, specific nerve stimulation or psychosomatic psychoanalysis, should be appropriate. Needless to say, a therapeutic program would proceed in precisely the opposite as soon as functional disorders are apparent, psychoorder: analysis together with or followed by acupuncture should be If the disease has proceeded to a point where such attempted. therapy is ineffective, traditional pharmaceutical and surgical measures must be relied upon. It is fundamentally mistaken, however, to rely upon therapies which entail massive pharmaceutical or gross surgical intervention, if there is still the possibility of recovery utilizing the body's own innate The patient carried in on a stretcher in a comatose resources. state is hardly a suitable subject for psychoanalysis, but in so far as there are at least a small number of documented cases of "miracle cures" - spontaneous healing of malignant cancers, psychic cures, etc., the potential for high level cures of even advanced lesions should not be overlooked. The course of disease outlined in Figure 2 is not meant as any given disease may the inevitable route for all diseases: culminate at any given point between mild functional and severe Nonetheless, the progression beginning in organic disease. normal health and going as far as organ damage is the likely Particularly the early stage psychocourse for many diseases. neurological abnormalities are not well-defined and must be considered controversial at this time, but it is beyond question that organ diseases are normally preceded by more limited tissue disorders, which are in turn preceded by cellular irregularities usually brought about through (macro) molecular If the mechanisms of preceding hormonal and neural events. irregularities are as yet ill-defined, it is nonetheless a logical necessity that still more rarefied forms of matterenergy, ultimately culminating preceding causal steps. PSYCHOSOMATIC

in "mind"

DISEASE

AND

THE

or "spirit,"

are

the

ACUPUNCTURIST

The importance of Figures 1 and 2 for the acupuncturist is that they put acupuncture-style nerve stimulation therapy within the context of a more comprehensive medical program which includes both Eastern and Western techniques, as well as providing a frame of reference with respect to still higher, psychoanalyyet undeveloped medical arts, i.e., psychosomatic

244

sis. While it is true that acupuncture is itself at the fringe of accepted medical practice (so that any such "higher" disciplines must now be regarded with some skepticism), it is nevertheless important for any serious medical practitioner to give Thus, some thought to the root questions concerning etiology. not only must we acknowledge the value and importance of the surgeon's knife once disease has gotten out of hand and brought irreversible histological changes, it is important to understand that pharmaceutical medicine is a somewhat higher art, particularly as it approaches endocrinology and neuroendocrinology, and a form of therapy which should be applied prior to Furthermore, orce we the development of gross organic lesions. have sifted the grain from the chaff and determined just which of the various acupuncture treatments are scientifically valid, which are - if effective - simply placebo-like effects, and which are without value, then we will be able to say with some assurance that acupuncture, as a form of nerve stimulation therapy, is itself a higher form of medicine than drug therapy in so far as the acupuncturist deals at a more fundamental (f7higherft)level of control - the nervous - than the druggist Again, this is not to say that the other medical or surgeon. arts are unnecessary, but a superior form of therapy woulc! allow for the detection and correction of nervous (and subsequently hormonal and histological) irregularities before they have become chronic and unmanageable by the normal self-correcting tendencies of the organism itself. Finally, the Figures give some indication of the limitations of even scientifically systematized acupuncture - not only with regard to the morbid diseases which only the surgeon can properly deal with, but more importantly with regard to The self-evident fact still higher forms of medical therapy. that such higher arts are, at best, in their infancy and do not constitute a program upon which to rely should not affect our Unless we choose a attitude toward their future potentiality. philosophy of medicine based upon a fundamental duality between mind and body, we are inevitably led to conclude that there must be significant influences of a psychic kind on our physiAs such, even without being cal states Of health and unhealth. able to describe more than a handful of mechanisms of psychosomatic phenomena, we are obliged to acknowledge the reality of pervasive psychosomatic events which, quite unrelated to our In our ignorance, we may ignorance of same, certainly occur. be forced to work at secondary or tertiary levels in treating physical disease, but we should be cognizant of the fact that these secondary (nervous), tertiary (hormonal) and lower levels are heavily influenced, if not fully controlled, by a primary psychic level. CONCLUSION From the perspective of a philosophy which views mind as the causal force behind neural events, the theoretical justification for including acupuncture within a modern medical 245

program is quite strong. The necessity for developing psychoanalytic theories which are, above all else, grounded in the known facts concerning the limbic system and psychosomatic disease is also clear. In fact, there are currently considerable difficulties in extrapolating from results in animal experiments on the limbic system to the human mind due to significant species differences (6) and the added complexity of hemispheric lateralization in man (91, but there may be grounds for seriously considering MacLean's remark that the psychoanalyst of the future will be a specialist in the limbic system. Moreover, as disorders of the limbic system (and hypothalamus) are further correlated with somatic diseases, medicine as a whole will gradually come to coincide with what is now generally considered to be a rather narrow and bewilderingly complex neurological speciality. Once having achieved this level of understanding, it is likely that the majority of medical therapies will be limited to psychoneural treatment which does not necessitate physical assault on the body with exogenous substances. REFERENCES 1. Sperry RW. A modified concept cal Review 77: 585, 1970.

of consciousness.

Psycholoqi-

2. Sperry RW. Mental phenomena as causal determinants functions. Process Studies 5: 247, 1975.

in brain

3. Reichlin S, Baldessarini RJ, Martin JD, eds. The Hypothalamus, Raven Press, New York, 1978. 4. Carpenter MB. Core Text of Neuroanatomy, kins, Baltimore, 1972. 5. Furth J. Pituitary cybernetics tures 63: 47, 1969. 6. Isaacson

RL. The Limbic System.

Williams

and neoplasia.

and Wil-

Harvey Lec-

Plenum Press, New York,

1974. 7. Selye H. The Stress of Life. McGraw-Hill,

New York, 1956.

8. Mann,

F. Acupuncture - The Ancient Chinese Art of Healing and How It Works Scientifically, Random House, New York, 1971.

ND. Concept and verbal ability as related to the cerebral hemispheres. Perceptual and Motor Skills 45: 555, 1977.

9. Cook

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Psychosomatic disease and acupuncture.

Medical Hypotheses 5: 237-246, PSYCHOSOMATIC 1979 DISEASE AND ACUPUNCTURE School N.D. Cook, Sendai Akamon Acupuncture 61 Kawauchi Kawamae, Sen...
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