Visceral (Internal Organ) Disease
The intimate relationship between the spine/nervous
system and health has been a part of healing for thousands
of years and has been the basis of chiropractic since its
inception.
Scientific discoveries continue to dissolve the borders
between the different body systems: between the mind and
the body, and between body matter and body energy. We are
rediscovering the ancient wisdom that we are holistic beings,
and that true healing cannot ignore this relationship.
An interesting
paper on the relationship is: Thalamic Neuron Theory: Theoretical
Basis for the Role Played by the Central Nervous System (CNS)
in the Causes and Cures of All Diseases by T.-N. Lee in Medical
Hypothesis 1994; 43: 285-302.
From the Abstract:
The Thalamic Neuron Theory (TNT) postulates
that the central nervous system (CNS) is involved in all disease
processes, as the CNS not only processes incoming physical
and chemical information from the periphery, it also sends
out physiological commands to the periphery in order to maintain
homeostasis for the entire body. Inherent in its capacity to
learn and adapt (i.e. to habituate) is the CNS’ ability to learn
to be sick (pathological habituation) by looking in certain
deranged central neural circuitries, leading to chronic disease
states.
These pathologically habituated states can be reversed
by dehabituation through manipulation or modulation of the
abnormal neural circuits by physical means (physical neuromodulation)
like acupuncture, or by chemical means (chemoneuromodulation)
such as Chinese medicine, homeopathy or other modern medical
techniques in a repetitious manner to mimic the habituation
process….the entire CNS functions like a composite
homonculus which controls the physiological functions of
the entire body. TNT further postulates that the master homunculus
takes the shape of a curled up embryo with its large head
buried close to its pelvic region, with its chain in the
homunculus representing acupuncture points in the periphery.
The neuronal chain itself represents a meridian and Chi is
nothing more than the phenomenon of neurotransmissions…Many
difficult to explain clinical observations in modern medicine,
Chinese herbal medicine, acupuncture and homeopathy can now
be adequately explained using TNT. Based on this model, new
therapeutic techniques can be launched to combat a whole
host of intractable diseases.
The relationship between health
and the neuro-musculoskeletal system has been explored by
Professor Irvin M. Korr, Ph.D. Among his many papers: Osteopathic
principles for basic scientists Journal Of The American Osteopathic
Association, July 1987, 87(7) is a must read for all chiropractors
and chiropractic students. This short (less than 3 pages)
article reflects a lifetime of researching human physiology
and well describes the empirical or vitalistic therapeutic
philosophy from which chiropractic, osteopathy, acupuncture
and homeopathy spring as opposed to the mechanistic or rationalist
therapeutic philosophy of orthodox medicine.
The most thorough
discussion of the vitalist/empirical versus the mechanistic/rationalist
approach through history is found in the work of Harris L.
Coulter, Ph.D. in his four volume opus Divided Legacy A History
of the Schism in Medical Thought Vols. 1-4 (Washington, DC:
Center for Empirical Medicine and Berkeley, CA: North Atlantic
Books).
Dr. Coulter, a medical historian, writes of the ancient/modern
philosophical split as only a master could. Fluent in nearly
a dozen languages, Dr. Coulter reviews original writings
to take the reader on a 2,500 year historical journey through
the world of healing.
An early twentieth century study correlating
visceral disease to spinal column distortions was by Henry
Winsor, M.D.
Henry Winsor, MD was inspired by chiropractic and
osteopathic literature to dissect human and animal cadavers
to see if there was a relationship between any diseased internal
organs discovered on autopsy and the vertebrae associated with
the nerves that went to the organs. As he wrote:
The object
of these necropsies [dissections] was to determine whether
any connection existed between minor curvatures of the spine,
on the one hand, and diseased organs on the other; or whether
the two were entirely independent of each other.
The University
of Pennsylvania gave Dr. Winsor permission to carry out his
experiments. In a series of three studies, he dissected a total
of seventy-five human and twenty-two cat cadavers. The following
are Dr. Winsor’s results:
221 structures other than the
spine were found diseased. Of these, 212 were observed to belong
to the same sympathetic [nerve] segments as the vertebrae in
curvature. Nine diseased organs belonged to different sympathetic
segments from the vertebrae out of line. These figures cannot
be expected to exactly coincide . . . for an organ may receive
sympathetic filaments from several spinal segments and several
organs may be supplied with sympathetic [nerve] filaments from
the same spinal segments.”
In other words, there was nearly a 100% correlation between “minor
curvatures” of the spine and diseases of the internal
organs. Let us examine some of these disease categories:
Stomach
Diseases: All nine cases of spinal misalignment in the mid-dorsal
area had stomach disease.
Lung Disease: All twenty-six cases
of lung disease had spinal misalignments in the same spinal
area.
Liver Disease: All thirteen cases of liver disease had
misalignments in the same spinal area.
Gallstones: All five
cases with gallstone disease had spinal misalignments in the
same spinal area.
Pancreas: All three cases with pancreas disease
had spinal misalignments in the same spinal area.
Spleen: All
eleven cases with spleen disease had spinal misalignments in
the same area.
Kidney: All seventeen cases with kidney disease
had the same area out of alignment.
Prostate and Bladder Disease:
All eight cases with prostate and bladder disease had the lower
back vertebrae misaligned.
Uterus: The two cases with uterine
conditions had the second lumbar misaligned.
Heart Disease:
All twenty cases with heart and pericardium conditions had
the upper five thoracic vertebrae misaligned.
Dr. Winsor summarized
his research in two studies: The Evidence of the Association,
in Dissected Cadavers, of Visceral Disease with Vertebrae Deformities
of the Same Sympathetic Segments. Winsor H. Sympathetic segmental
disturbances—II. The
Medical Times, Nov. 1921, 49:267-271 and
The Prevalence of minor
curvatures and deformities of the spine in man. Also in other
vertebrates. appeared in The Medical Times, Oct.1921, pp.237-239.
Studies
with similarities to Winsor’s appear below:
Osteophytes
of the spine compressing the sympathetic trunk and splanchnic
nerves in the thorax. Nathan H. Spine, 1987;12:527-532.
A wide
variety of visceral symptoms may originate from vertebral osteophytes
compressing sympathetic nerves.
In this study the presence of
osteophytes compressing sympathetic structures (sympathetic
nerves, sympathetic trunk nerves and ganglia, rami communicantes)
in the thorax was found in 655 (65.5%) of 1000 cadavers. In
60.4% of the affected cases, compression was on the right side,
and in 36.9%, it was bilateral, although the right side was
more severely affected. In 2%, compression was on the left
side only. According to the authors, this could account for
a wide variety of visceral symptoms seen in the elderly population.
Paraspinal
autonomic ganglion distortion due to vertebral body osteophytosis:
a cause of vertebrogenic autonomic syndromes? Giles G, Journal
of Manipulative and Physiological Therapeutics, Vol 15,No.
9, Nov/Dec, 1992.
In order to determine any relationship between
autonomic nerves, nerve ganglia and spinal body growths (osteophytes).
Giles examined the lumbosacral spines of three elderly cadavers.
The author wrote:
Recent scientific studies have suggested that
a relationship may exist between abnormal vascular changes
and neural tissue degenerative changes within the intervertebral
foramen, and these findings may well go far toward explaining
what has been observed by chiropractors, osteopaths and medical
manipulators that, following spinal manipulation for spinal
pain of mechanical origin, some patients report having noted
relief from visceral dysfunction...."
Other studies exploring
mechanisms relating spinal relationship to visceral and physiologic
function include:
Effects of a chiropractic adjustment on changes
in pupillary diameter: A model for evaluating somatovisceral
response. Briggs L., Boone WR. Journal of Manipulative and
Physiological Therapeutics 1988; 11:181-189.
Author’s
abstract:
The relationship between a cervical chiropractic adjustment
in subluxated vs. unsubluxated subjects and autonomic response
monitored as change in pupillary diameter was evaluated in
15 subjects.
The results indicate that:
a) a successful adjustment elicits
either a parasympathetic or sympathetic response;
b) the vertebral
level at which the adjustment is administered has undetectable
specificity for the parasympathetic or sympathetic input to
the pupil;
c) unsubluxated subjects generally exhibit no change
in pupillary diameter following a sham adjustment and
d) subluxated
subjects exhibit variable readjustment papillary diameters
with significant pupillary diameter changes in response to
an adjustment. These data suggest that autonomic input to the
pupil may be influenced by subluxation, as well as the magnitude
and direction of the force exerted during the chiropractic
adjustment. An anatomic pathway through which the observed
responses may occur is proposed.
Comment by Dr. Koren: This
work is significant for a number of reasons. The sympathetic
and parasympathetic nervous systems (autonomic nervous system)
are in a state of dynamic balance to permit the body to maintain
homeostasis so it may adapt to its environment.
Also, the spinal
analysis located specific subluxations and the adjustment was
specific, that is, a certain vertebrae was adjusted after it
was determined to be subluxated. While an obvious requisite
for chiropractic care and research, such a procedure is often
absent in the chiropractic research literature. Instead non-specific “manipulations” are
too often performed, irrespective of whether the involved
segment was truly subluxated or merely compensating for subluxations
located elsewhere.
Spinovisceral reflexes evoked by noxious
and innocuous stimulation of the lumbar spine. Budgell B. Hotta
H. Sato A. Journal of Manipulative and Physiological Therapeutics
3:122-131, 1995.
From the paper:
There is a wealth of anecdotal evidence that
biomechanical disorders of the spine can affect the functions
of visceral organs. However, although some relevant work has
been performed on peripheral joints, there is a striking paucity
of research concerning the spinovisceral reflexes, which are
hypothesized to cause or facilitate visceral symptomatology
accompanying spinal complaints. In the present study, both
saline (0.9% NaCl) and capsaicin, a potent chemical algesic
were injected into the lumbar interspinous ligaments and facet
(zygapophyseal) joints to make Wistar rats generate reflex
cardiovascular responses. Responses elicited from the interspinous
ligaments and facet joints differed in both qualitative and
quantitative terms. In particular, in central nervous system
(CNS)-intact animals, noxious chemical stimulation of the interspinous
ligaments caused a pronounced elevation of mean arterial
pressure (MAP) and a prolonged depression of sciatic nerve
blood flow (NBF).
Lantz CA: The vertebral subluxation complex.
International Review of Chiropractic. Sep/Oct 1989 pages 37-61.
Korr
IM (ed): The neurobiologic mechanisms in manipulative therapy.
(Plenum Press: New York) 1978.
The Chiropractic Theories. Leach
RA: Williams and Wilkins. Baltimore, MD. 1980.
Cauwenbergs P:
Vertebral subluxation and the anatomic relationships of the
autonomic nervous system. In Gatterman M (ed): Foundations
of Chiropractic Subluxation. (Mosby-Year Book, Inc.: St. Louis)
1995.
Wiles MR, Diakow P. Chiropractic and visceral disease:
a brief survey. J Can Chiro Assoc 1982; 26:65-68.
Wiles MR:
Visceral disorders related to the spine. In Gatterman M (ed):
Chiropractic Management of Spine Related Disorders. (Williams
and Wilkins: Baltimore, MD) 1990.
Comment by Dr. Koren: Irvin
Korr, Ph.D., has written about the possible mechanisms of how
spinal distortions can cause disease. Korr’s model discusses increased firing of
the sympathetic nervous system - or facilitation of sympathetic
pathways leading to “high sympathetic tone.” This
reminds us of D.D. Palmers statement: “life is an expression
of proper tone.” Indeed, Palmer states in his book,
The Chiropractors Adjuster, that chiropractic was “founded
on tone.”
Korr described sympathetic facilitations as being caused
by “lesioned” segments of the spinal cord (the
osteopaths like to use the term spinal lesion.) This increase
in sympathetic firing of the nerves to viscera and blood
vessels that go to the viscera “May alter organ and
tissue responses to hormones, infectious agents, and blood
components. It alters cellular metabolism and may eventually
lead to serious pathologic changes.” Korr IM: The Andrew
Taylor Still memorial lecture: research and practice -- a
century later. J Am Osteopath Assoc 1974 73(5):362.
The reflex
effects of spinal somatic nerve stimulation on visceral function.
Proceedings of the scientific symposium of the World Chiropractic
Congress. May 4-5, 1991. Toronto, Canada.
Sato has shown evidence
that mechanical pressure applied to rat spines caused alterations
in blood pressure, pulse rate, renal and adrenal sympathetic
nerve activity.
The reflex effects of spinal somatic nerve stimulation
on visceral function. Sato A. Journal of Manipulative and Physiological
Therapeutics, Jan. 1992, 15(1).
From the abstract:
This paper studies somatovisceral reflex
responses in the cardiovascular organ, gastrointestinal tract,
urinary bladder and adrenal medulla in anesthetized animals
after eliminating emotional factors following somatic sensory
stimulations....
Viscerosomatic reflexes: A review. Beal MC.
Journal Of The American Osteopathic Association, 1985; 85:786-801.
From
the author’s abstract:
The concept of viscerosomatic reflexes
is presented and supporting documentation from the basic and
clinical sciences is reviewed. The somatic manifestations of
visceral disease, including their autonomic segmental reference
sites, are described. Also discussed are the palpatory findings
that are consistent with diagnosis of a viscerosomatic reflex,
as well as their predictive value. In addition, the principles
and results of manipulative treatment for visceral disease,
as well as the effect of surgery on viscerosomatic findings
are reviewed. The study of viscerosomatic reflexes is reviewed
from an osteopathic perspective. The rationale for manipulative
therapy in visceral disease is discussed.
The above two papers
deal with one of the more researched mechanisms of somato-visceral
stimulation, the reflex. Originally pioneered by Irvin Korr,
Ph.D., the concept of the spinal cord reflex following adverse
afferent sensory bed stimulation (one of the components of
the vertebral subluxation complex) is one of the more popular
somato-visceral mechanisms discussed today.
Pathogenesis of
visceral disease following vertebral lesions. Burns L, Chandler,
LC, Rice RW. Chicago, American Osteopathic Association, 1948,
pp.226-233.
Neurologic basis for the practice of medicine by
Speransky. This classic text discusses the role that the C.N.S.
plays in the organism’s defense against disease. Among
his experiments, Speransky, working with animal models to lesion
the nerves going to the viscera, observed the formation of
disease processes in various internal organs.
Man’s nervous
system and disease. Wolf HG. Archives of Neurology, Sept. 1961,
5:17-25. Discussion of the nervous system relates to all categories
of disease. The term psychosomatic is an artificial one and
should be properly investigated in relation to the nervous
system.
New perspectives in medicine: the role of the nervous
system in disease. Wright HM. Journal Of The American Osteopathic
Association, Aug. 1963,62:1057-1063.
Discussion of the relationship
between every organ and tissue of the body and its anatomical
and physiological relationship to the neuro-musculoskeletal
system. Disease is not a local entity but the manifestation
of a breakdown in our homeostatic mechanisms. Also discussed
is manipulative therapy’s
role in eliminating critical impediments to the function
of the nervous system.
Functional considerations of spinal manipulative
therapy. Brunarski D. ACA Journal of Chiropractic, May 1980,14:
S-63.
A good literature review documenting research on the relationship
between visceral disease and the nervous system.
Orthopedic
Medicine - A New Approach to Vertebral Manipulations by Robert
Maigne, R M.D. Translated and edited by W.T. Liberson, M.D.,
Ph.D., Professor Physical Medicine and Rehabilitation, Abraham
Lincoln Medical School, University of Illinois, Chicago, then
also Vice President, North American Academy of Manipulative
Medicine. Published by Charles C. Thomas: Springfield, IL,
1972.
Robert Maigne, the French leader in the science of “manipulation,” was
founder of the French Society of Manual Medicine, President
of the International Federation of Manual Medicine, Director
of Physical Medicine and Rehabilitation Service, Hotel Dieu
Hospital, Paris, and lectured on the Faculty of the affiliated
University of Paris School of Medicine. Conditions, from
a medical perspective, which Maigne claims respond to “manipulations” include: “maintenance
treatment, cervical pain/Barre-Lieou Syndrome/Vertigo(p.160
and pp.192-193), discal sciatica (p.162), cervico-osteoarthritis
(p. 207), headache (pp.181-182), migraine (pp.188-189), “functional
reactions” including constipation, digestive pains,
pseudo-ulcers, asthma, false asthma in infants and mastodynia
(pain in breast) (p.164 and p.153-155).
Mobilization of the
Spine, Grieve, GP Churchill Livingstone, London/New York,
4th edition, 1984. P.22-23.
All those experienced in manipulation can report numerous
examples of migrainous headaches, disequilibrium, subjective
visual disturbances, feelings of retro-orbital pressure,
dysphagia, heaviness of a limb, extra segmental paraesthesia,
restriction of respiratory excursion, abdominal nausea and
the cold sciatic leg being relieved by manual or mechanical
treatment of the vertebral column.” P. 22-23.
“While these effects are noted, and the underlying mechanisms
investigated with the purpose of understanding better what
we do, they are insufficient reason to put the cart before
the horse. In other words, the prime impulse for physical treatment
of the vertebral column is properly vertebral column disorder,
and not visceral disorder. “
Functional Disorders of Internal Organs Due to Vertebral
Lesions, Kunert W (1965) CIBA Symposium 13(3): 85-96.
Kunert,
a German cardiologist has written that spinal examination should
be performed for individuals with presumed cardiac pain. As
he wrote
“Lesions of the spinal column…are perfectly
capable of simulating, accentuating or making a major contribution
to organic diseases. There can…be no doubt that the
state of the spinal column does have a bearing on the functional
status of the internal organs.”
Commission of Inquiry
into Chiropractic. Chiropractic in New Zealand. Government
Printing, Wellington, New Zealand, 1979 P.57-58.
“A number of medical experts told the Commission that
the results chiropractors and their patients claimed in Type
O (organic) cases were unlikely to be the results of spinal
manual therapy…However, at the same time no medical
expert was prepared to say that such results were impossible,
simply because knowledge of neurophysiology had not advanced
to a point where the possibility of such results from spinal
manual therapy-however remote he might think they were-could
positively be excluded.”
Manipulative Therapy in Rehabilitation
in Locomotor Systems by Karel Lewit, MUDr. Doc, Dsc. Butterworths:
London and Boston (1985).
This Czechslovakian M.D. is one of
the most famous medical manipulators of Eastern Europe. Some
quotes from his text include:
“...There are both somatic and autonomic responses
to pain...The somatic response consists mainly of muscle
spasm...at the central level it may affect respiration, the
cardiovascular or the digestive system. These central effects
are understandable for pain is also a stress factor.”(p.2).
“...There is a strong case to be made for manipulative
treatment (for the purpose of prevention) in children, physically
very exposed individuals, etc.” (p. 182 and p. 350). “Manipulative
treatment is indicated if there is movement restriction (blockage)
of a joint or a spinal mobile segment, and if this is considered
relevant to the patient’s symptoms...No specific disease
or complaint need be indicated for manipulation (headache,
lumbago, etc.) but only a pathogenic lesion (i.e. lesion)
which should, however, be relevant to the patient’s
problem.” (p.178). Other conditions that Lewit mentions
are tonsillitis, respiratory problems, heart disease, digestive
problems, gynecological disorders, migraine, vertigo/dizziness.
p. 336-342).
Lewit also sees manipulation as valuable for health
maintenance:
“The possibility of indicating manipulation for the
purpose of prevention must also be considered. True, manipulation
is indicated only if we think the movement restriction is
clinically relevant...there is a strong case to be made for
manipulative treatment, for example, in children, physically
very exposed individuals, etc.” (p.182).
Copyright 2004
Koren Publications, Inc. & Tedd Koren,
D.C.
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