PATHOLOGY IN GREEK MEDICINE
The Origins and Causes of Disease
Pathology is the study of disease, or how the normal, healthy physiology and functioning of the organism can become unbalanced, dysfunctional or corrupted. To properly understand pathology, which is a deviation from the normal state of health, we must first have a clear understanding of exactly what constitutes health..
In Greek Medicine, the normal, healthy physiology of the body and the normal state of its organs and tissues is defined by the Seven Natural Factors. Pathology involves an imbalance, dysfunction or breakdown of one or more of these Seven Natural Factors.
Etiology is the study of disease origins and causes. Although illness and disease may also be caused by accidental or exogenous factors like microbes, seasonal or climactic overexposure, injury or trauma, or be congenital or inherited, Greek Medicine maintains that most disease and pathology is due to repeated errors and transgressions of hygiene. And that involves the Six Hygienic Factors.
States of Health and Disease
Most people would simply assume that you're either healthy or you're sick. But actually, health and disease exist on a contimuum. There are intermediate stages in between the extremes of absolute health and total disease, in which illness varies in severity, or health and illness coexist side by side.
At the top of the scale is total, absolute, radiant health. Actually, very few people enjoy this exalted state of total health and euphoric wellbeing, which is usually only accessible to those who take the time and effort to cultivate and attain it.
The vast majority of healthy people experience normal or average good health. This state is characterized by the absence of any overt signs or symptoms of disease, discomfort or dysfunction. The robust health and energy and euphoric wellbeing of total or optimum health is conspicuously missing, however.
Disease usually starts with minor discomforts or complaints like sneezes and sniffles, aches and pains. If these are ignored or suppressed without any effort to treat their underlying root cause, this opens the door to more serious illness later on.
Health and disease can also coexist side by side. The body may be diseased or dysfunctional in one part, but healthy in all others; examples of this are deafness or blindness. Or, health and disease can alternate, as in illnesses of repeated onsets and remissions, or seasonal maladies that appear in one season and disappear in the next.
Health and disease can coexist, with neither being total or complete. Such states exist among the aged or constitutionally frail or infirm, as well as in those convalescing from serious disease.
At the very bottom of the spectrum is total or overt disease, which may go on to become chronic, degenerative, and finally terminal or irreversible. Such states are usually the result of continued abuse or neglect.
Greek Medicine acknowledges the healing power of Nature, and that the human organism is endowed by Nature with a remarkable resilience and ability to recover, heal and regenerate itself. And so, most diseases tend to be of limited duration, or self-limiting. Terminal or irreversible disease only happens when the body's innate healing and regenerative mechanisms have broken down.
Types of Disease
There are many types of diseases and infirmities, with many types of causes. They can also involve many different systems or aspects of the organism. Greek Medicine utilizes many different parameters for analyzing and differentiating disease.
Disorders of temperament involve an imbalance, either localized or systemic, of one or more of the Four Basic Qualities - Hot, Cold, Wet or Dry. They are usually exogenous or adventitious in nature, attacking the body from without.
Humoral disorders are metabolic in nature, and involve imbalances and/or corruptions of one or more of the Four Humors. Humoral disorders can either be quantitative - excess or deficiency - or qualitative; or, they can be both simultaneously. Most humoral disorders are endogenously created, due to inherent imbalances in the metabolism. Generally, metabolic disorders are either those of excess or anabolism, such as diabetes or high cholesterol, or wasting/catabolic in nature, like hypoglycemia or anemia.
Discontinuities are disorders caused by accidents, injuries or trauma. An accident comes along and disrupts or discontinues the normal flow of life, and deranges the normal structure of the body in some way. At the site of the trauma, rupture or discontinuity, there is usually pain.
Congenital or inherited diseases are those we were born with, such as birth defects, or those which are genetically passed on from parent to offspring. Many diseases, especially chronic or degenerative ones, are constitutional in nature, and tend to run in the family.
Structural disorders are those involving abnormalities in the size or structure of one or more organs or parts of the body. They typically involve swelling, hypertrophy or enlargement; atrophy or wasting; hypotonia, or excessive laxness or dilation; hypertonia, or excessive tension, constriction, narrowing and stenosis; displacement, or deviation from normal form or position; and obstruction, or blockage.
Primary diseases are differentiated from secondary diseases, or their sequelae or complications. And so, one disease may become the cause or parent of another. The primary disease can be likened to the roots of a tree, with the secondary spinoffs being its branches.
Constitutional Medicine and Pathology
Greek Medicine is constitutionally based, and rooted in the doctrine of the Four Temperaments. In Greek Medicine, all disease and pathology is seen as the result of the coming together of two basic factors: the exogenous pathogen, stress or risk factor; and the inherent vulnerabilities and predispositions of the individual, according to his/her constitutional makeup of humor and temperament.
When one accepts this constitutional dimension of health and disease, many things become clear. For example, smoking two packs of cigarettes per day for 30 years is enough to cause emphysema or lung cancer in most people, but not in everyone. There are still some individuals who don't succumb, and these are individuals whose lungs and respiratory tracts are constitutionally very strong and resistant. The fact that you can't make simplistic equations between causative factor frequency or intensity and disease outcomes is due to constitutional differences.
Constitutionally, each one of us is a unique individual, with our own unique makeup of humor and temperament, and our own unique set of inherent strengths and weaknesses, or vulnerabilities. Because of individual constitutional differences, no single disease will develop or progress in exactly the same way in any two individuals. Although, for diagnostic purposes, we may categorize or name a disease, each individual's disease, or disease process, is unique to him or her.
Knowing one's constitutional nature and temperament and living in accordance with it is the key to all health maintenance and disease prevention in Greek Medicine. It's impossible to go through life without encountering any pathogenic stress or risk factor. But knowing one's constitutional nature and its limitations and vulnerabilities will help us avoid the really serious or critical ones, and enable us to take the right remedial measures to compensate for these stresses and risks.
In evaluating the condition of the patient, the Greek physician distinguishes between conditions that are more endogenous and self-generated versus those that are more acquired or adventitious. Endogenous and self-generated conditions usually involve inherent constitutional predispositions and vulnerabilities of humor and temperament. Generally, the more deeply constitutional vulnerabilities and predispositions are involved, the more recalcitrant and difficult the disease will be to treat.
Pathology and the Six Hygienic Factors
Errors and transgressions of proper hygiene are the usual causative factors in most diseases. This is particularly true of the types of complaints that lead one to seek the help of a natural holistic healer like the Greek physician. The more longstanding, repeated or serious the abuse of hygiene, the more grave the resulting disease or disorder.
In Greek Medicine, errors of hygiene involve one or more of the Six Hygienic Factors:
Ambient Air: Poor choice of living environment, insufficient ventillation. Excessive or unwise exposure to the elements. Air pollution. Insufficient or improper breathing habits. Seasonal or environmental illness.
Food and Drink: Poor or unbalanced diet, poor food choices. Unhealthy or immoderate eating habits. Insufficient fluid consumption, dehydration. Eating junk food or impure, adulterated foods. Not following the dietary guidelines for your constitutional type.
Exercise and Rest: A sedentary lifestyle. Poor exercise habits. Immoderate or excessive exercise. Insufficient rest and relaxation. Excessive stress and overwork.
Sleep and Wakefulness: Irregular hours, staying up too late. Excessive sloth, somnolence. Jet lag.
Retention and Evacuation of Wastes: Poor cleanliness habits, insufficient bathing. Poor bowel habits, chronic constipation, irregularity. Autointoxication, alimentary toxemia. Chronic diarrhea or excessive urination. Suppression of natural urges.
Perturbations of the Mind and Emotions: Poor mental and moral hygiene. Negative or erroneous thinking. Excessive stress or worry. All diseases and pathologies involve the mind and emotions in some way, and create mental anguish. The essence of all dis-ease is discomfort, pain and suffering, both mental/emotional and physical.
The Disease Process
Modern allopathic medicine, with its formidable arsenal of technological weapons, fights disease by attempting to kill or eradicate it; if this should prove to be impossible, then every aspect of the disease will be attempted to be controlled and managed. Modern medicine tends to view the host organism as the neutral or passive battleground on which the doctors fight the disease.
Greek Medicine, on the other hand, sees the patient, or host organism, as a valuable ally, an active participant in the battle against disease. The human organism is endowed by Nature's Creator with an amazing ability to resist or throw off disease and heal itself. The physician's highest purpose is to assist and enhance these natural healing responses of the organism by timely and appropriate intervention.
Hippocrates took medicine out of the realm of the supernatural and established it as a rational science. Disease, he said, was a natural process, subject to natural law. The signs and symptoms of any given disease were generated or manifested from the body's own self-healing mechanisms in their struggle to throw off the pathogenic factor or agent.
The human organism encounters many potentially pathogenic stresses and factors in the course of daily living, but most of these it is able to successfully resist or shrug off in the incipient stages. It is only when the natural resistance and healing/adaptive responses of the organism have become weak or compromised in some way that we become sick. Either the overall strength and virulence of the pathogenic factor overwhelms the resistive powers of the host organism, or the pathogenic factor, according to its nature, is able to exploit a specific weakness in the host resistance. This is symbolized by the demise of the mighty warrior Achilles, who met his end when a poisoned arrow struck him in his vulnerable heel.
And so, the disease process is essentially one of struggle and catharsis, in which the host organism actively throws off and purges itself of the offending pathogenic factor, whatever it may be. This process typically happens in four stages, as follows:
Onset: The disease or pathogenic factor makes its entrance and gains a foothold in the organism. The body's struggle against the disease begins as the malady's signs and symptoms make their appearance.
Buildup: The struggle of the host organism against the disease intensifies as the signs and symptoms of the disease intensify. An all-out struggle ensues.
Climax: This is the acme or acute crisis stage of the disease. It's the final showdown or moment of truth in which the host organism either overcomes the disease or is overcome by it. If the catharsis of the climax is successful and complete, the climax is followed by a period of recovery and resolution. If the climax is unsuccessful, and the resistive powers of the host organism are finally broken down completely, demise and death ensue. If the catharsis is only partially successful, a residue of the disease or pathogenic factor remains in the organism, and goes on to create chronic or recurring pathologies.
Resolution: After the catharsis of the climax, the body's inherent healing and regenerative processes take over to restore health and balance. This resolution or recovery period may either be shorter or longer, depending on the severity and extent of the damage done by the disease. Quick resolutions, usually from acute diseases, are called recovery; longer resolutions, usually from more serious or debilitating diseases, are called convalescence.
It's also possible for some diseases, according to their nature, to have multiple climaxes and resolutions. Such diseases are called intermittent or periodic; the intermittent fever of malaria is a good example.
The Four Stages of Pathology
Disease manifestations, caused by the struggle of the host organism against the pathogenic agent or factor, are of four basic types. These are the four basic phases, or stages, of pathology.
Acute diseases are the manifestation of an all-out struggle, a decisive, short term battle between the host organism and the disease. They are generally of short duration, and follow the classic four stage progression of onset, buildup, climax and resolution outlined earlier. The host resistance and immunity are basically strong and intact, although a critical flaw or weakness permitted the intial invasion and onset of the disease. The signs and symptoms of this all-out struggle are usually strong and vehement.
Subacute diseases can either be the secondary reactions or complications of an acute disease that has been imperfectly or incompletely resolved, or the milder, more subdued manifestations of disease caused by a host resistance and immunity that have been moderately dulled or blunted by previous acute episodes. They can also be caused by the eruption or catharsis of pathogenic toxins and factors held deeply or chronically in the organism, which offer opportunities for greater healing and purification.
Chronic diseases are like long, drawn-out sieges or ongoing battles against one or more pathogenic factors which permit no easy or decisive resolution. In most all chronic cases, host immunity and resistance have been significantly compromised, and the host organism has resigned itself to living with the disease. Although chronic conditions can be greatly ameliorated or remedied with regular, persistent treatment, a final eradication or definitive resolution is often elusive.
Chronic diseases can also be recurring, with multiple remissions and relapses. Certain conditions and circumstances, according to their nature, will bring them on, whereas contrary ones will resolve them. The scales of nature and disease are tipped back and forth by the alternating tides and exogenous influences of life.
Degenerative diseases are those in which the normal, righteous function and structure of the organism starts to break down under the burden of a chronic or unresolved disease process. Characteristic of these diseases are degenerative changes in the organs and tissues. Generally, pathology starts out as being more functional and energetic in nature; finally, in the later stages, organic or structural changes in the organs and tissues set in. When these changes become pernicious and irreversible, pathology has entered the degenerative stage. Finally, when there is no longer any hope of survival, the disease becomes terminal.
Conditions of Stress and Tone
Apollo was the Greek god of health and healing. He was also the god of physical culture and conditioning, which are symbolized by his lyre and bow.
The muscles, organs and tissues of the body all need a certain basic tone, or state of dynamic tension, to be healthy, responsive and adaptable. The healthy body should be like a well tuned lyre, with all its parts, or strings, in tune at just the right degree of dynamic tension. Tune the string too high and it will break; keep it too loose and its tone will be muddled. The bow should be strung tight enough to shoot an arrow with power and precision, but not so tight that it breaks.
Hypotonia is a condition of insufficient tone and excessive laxness in the organs and tissues. Atony refers to a complete lack of tone. The organ, tissue or system affected is unable to respond with sufficient strength and vigor, and hypofunction prevails.
Conversely, hypertonia is a state of excessive tension or constriction. This is also undesirable, because this excessive tension and constriction chokes off the proper circulation and flow of the humors and vital principles.
Dystonia is a state in which a whole bodily system is out of whack, out of kilter. The various opposing yet complementary forces are out of their proper adjustment and alignment, and need to be adjusted and brought to bear in their proper places.
Today, much is made of the deleterious effects of stress, but all stress is not necessarily a bad thing. Moderate stress, of the right kind, at the right time, and in the right amount, can serve to condition the body and keep it in shape; then, it is called eu-stress. Proper observance of the lifestyle related hygienic factors, like Exercise and Rest, and Sleep and Wakefulness, helps us regulate our lives and manage our stress levels.
When physical activity or wakefulness become immoderate or excessive, they create dys-stress and fatigue. Dys-stress and fatigue can also set in when the body suddenly undergoes a stress to which it has not become conditioned or accustomed; this implies a lack of the proper tone and physical conditioning. Knowing our constitutional limitations and level of physical conditioning means knowing the first signs of stress and fatigue which, if persisted in, can lead to the breakdown of disease.
The aging process is one thing that generally robs our bodies of the proper tone they need for optimum functioning. Parts that should be loose and supple become too tense, stiff and rigid, and parts that need to be firm and well-toned become too lax and flabby.
Disease as a State Contrary to Nature
In the world of Nature, all living beings do their best to live in balance and harmony with each other, and within themselves. Health is a state in which the physis, or organism as a whole, exists in a balanced, whole and uncorrupted state.
Taking this as his initial point of reference, Galen defined disease as a state contrary to Nature. Diseases can be those of repletion, in which something excessive or superfluous is there which should not be in the organism in its healthy, natural state. Diseases can also be those of depletion, or deficiency, in which some needed part or element is deficient or missing.
Or, diseases can also be those of corruption, which can basically be of three types. The corruption may be a functional disorder, or it may be structural, involving some physical defect or deformity. Or, the corruption may be qualitative, involving one or more of the Four Basic Qualities, or a morbid or corrupt humor.
As long as the disease or disorder persists, there will be signs and symptoms manifested as the organism struggles to regain health, harmony and balance. Once the balance, harmony and wholeness of health are re-established, the signs and symptoms disappear, as they are no longer necessary.