OVERVIEW OF EMPHYSEMA

I. Physiological Considerations

    Emphysema is classified as an obstructive lung disease which is probably best defined in pathological terms as a replacement of normal lung tissue by coarse air spaces of variable size.¹ Clinically, the patient with emphysema experiences increasing exertion because of shortness of breath and he has difficulty in exhaling.  This produces a gradually increasing barrel-type chest as accessory muscles of the chest are called into play.  Other problems arise sequentially.

    Historically, there has been a close relationship between chronic bronchitis, asthma, and emphysema, and some theories hold that the mucus produced in chronic bronchitis predisposes to obstruction and thus loss of normal tissue in the lung distal to the obstruction.  This mechanism is unlikely since destructive emphysema occurs infrequently in patients with allergic bronchial asthma.  In addition, emphysema often occurs without any evidence of predisposing bronchitis.  In destructive pulmonary emphysema, there are often areas of normal lung tissue as well as areas of destruction of the lung tissue.  This and other factors add to the confusion that exists in differentiating between chronic bronchitis and pulmonary emphysema, and some observers believe that true differentiation can occur only with pathological examination.

    As the destructive process begins in pulmonary emphysema, the normal tissue loses its elasticity and its normal structure, the circulation to those areas becomes severely diminished, and increased resistance to air flow is brought about by a narrowing of the bronchial lumen by mucus and swelling of the mucosa, and also by the unequal ventilation of various portions of the lung.  Progression of the disease brings further destruction of lung tissue and the findings and symptoms which are typically found in this disease.

    In the Cayce readings only one case is suggestive of emphysema, and this is not a clear diagnosis from the material available.  This 3 1 year-old man, [5642], had epilepsy as a result of a World War I shell explosion, which caused a fracture of the skull.  He also apparently had emphysema, or the beginning stages of this condition.

    It is inferred here that the autonomic nerve supply to the lungs was too "relaxed," but other physiological inferences are difficult to come by. Work done by Nakayama, Overholt, Phillips and others² during the past 20 years seems to bear some relationship to Cayce's comment regarding the nerve supply.  In more than 10,000 cases of asthma and emphysema, these men removed one carotid body, which is a nerve ganglion situated at the bifurcation of the common carotid artery.  This carotid body, Phillips felt, is sort of a relay station in the autonomic nervous system from the mid-brain to the bronchial tree, and by removing it he felt he was interrupting the spastic element to the bronchial tree.

    Throughout the body, a balance is achieved in the functioning of an organ through the influences of the antagonistic sympathetic and parasympathetic nervous systems, which are part of the autonomic nervous system.  If, indeed, the lung is under the control of nervous impulses, then either excessive spastic impulses from the parasympathetic or a weakening (relaxation) to an excessive degree of the sympathetic would bring about a process within the lung tissue which could conceivably be the beginning of emphysema.  There is no doubt that hormonal influences also play a significant role in the maintenance of a normal function within the lung tissue.  The readings do not discuss this.

    It is an obvious fact that early cases of emphysema can be treated more successfully than far-advanced ones, in the event a reasonable therapeutic program can be achieved.  The further advanced the disease is, the more the deterioration of function and tissue.

    Secondary problems would arise as the emphysematous process progresses.

II.  Rationale of Therapy

    In approaching therapy, we should remember that the body has a capability of normal function:

    Thus, we would administer those activities which would bring a normal reaction through these portions, stimulating them to an activity from the body itself, rather than the body becoming dependent upon supplies that are robbing portions of the system to produce activity in other portions, or the system receiving elements or chemical reactions being supplied without arousing the activity of the system itself for a more normal condition.  (1968-3)

    It should be kept in mind that most people with asthma develop emphysema.  Thus it would be helpful to consider the objectives already developed relative to therapy in asthma.  The following is an extract from the asthma commentary:

    Asthma, when viewed as a condition which has its origin and basis in the nervous system, should then be approached in therapy with the objective in mind to remove the stimulatory factors in the nervous system and to correct those adjunctive, correlated and resultant imbalances that may prevent a return to normal function.
    Since pressures are present in the dorsal and sometimes the cervical ganglia, these should be relieved osteopathically and treatments should be continued long enough to allow continuance of normal nerve function.  The eliminations should be restored to normal, and assimilation should be balanced with the elimination.  The deep and superficial circulation which is often disturbed should be restored to a balance of coordination.  The glands of the body should be brought to a balance, and the resistance of the body should be stimulated through improvement of assimilation and function of the Peyers patch area of the intestines.³

    In [5642], the apparent purpose of therapy is to bring about a diet which will supply easily digested food so that the assimilative needs of the body will be met, but not overloaded.  The nervous system and the lymphatics are treated with massage, and substances are added to the body which improve the breathing capacity and utilization of substances taken in through the lungs.  The bowels are kept active so that eliminations might be balanced with the assimilation, and later on an inhalant is used which, like the first prescription given, improves the lung functioning.  Finally, the capacity of the body to assimilate and utilize food substances needs to be increased.

    The rationale for therapy in both asthma and emphysema is based on the concept that the autonomic system as a whole must be balanced in its relationship to the lungs.  Once this is achieved and the circulation to the lungs is improved, then the lung tissue can conceivably begin rebuilding.  It would seem reasonable to assume that the readings recommend bringing the body from a homeostasis of disease to a balance consistent with normal health.

III.   Suggested Therapeutic Regimen

    It becomes quite obvious that far-advanced emphysema cannot be treated as was [5642], who had no evidence of a progressed condition.  However, it is interesting to look at the various phases of therapy suggested here, perhaps as a basis or as a springboard for further therapy in the chronic emphysematous patient.

    This man's first course of therapy was a diet, easy to digest, with predigested foods and liquids, and a caution not to overload the stomach at any time; and medication for a period of 12 to 14 days-a capsule taken every other day each containing the following:

• Eucalyptol, 1 minim
• Canadian balsam, 1/2 minim
• Rectified oil of turpentine, 1 minim
• Benzosol, 1 minim
• Heroin, 1/60th grain

(This makes three capsules at a time.)

    During this two-week period, a massage was suggested over the entire back and spine with an equal mixture of olive oil and tincture of myrrh, as much as would be absorbed.  The oils should be mixed at the time of use.  The olive oil should be heated and then the myrrh added.  At least half an ounce should be applied every night.

    A second course of therapy followed this and came from a subsequent reading:

1. A vegetarian diet was suggested since meat was not considered to be good for the body in its present condition.
2. Enemas were suggested for constipation rather than cathartics at any time.
3. The olive oil and myrrh mixture was to be used as a massage every two or three days.
4. An inhalant was to be prepared and used twice a day.  This was to be placed in a jar at least twice the capacity of the ingredients.  To four ounces of grain alcohol was added the following in order:
   1. Eucalyptol, 20 minims
   2. Rectified creosote, 3 minims
   3. Balsam of fir, 5 minims
   4. Compound tincture of benzoin, 5 minims
   5. Rectified oil of turpentine, 5 minims
   6. Tolu in solution, 30 minims
      (To be inhaled only after shaking.)
5. A substance was suggested to be taken 20 or 30 minutes before meals and at bedtime in doses of one teaspoonful, which would provide what Cayce said would be an "active force" for the stomach and the digestive system.  It is prepared as follows:
   1. Take a half gallon of distilled water.
   2. Add eight ounces of wild cherry bark and reduce by simmering, not boiling, to one quart.
   3. Add four ounces sugar.
   4. Reduce again to 11/2 pints, then add:
      1. Sarsaparilla comp., 1/2 ounce,
      2. Tincture or essence of yellow dock root, 1/4 ounce,
      3. 10% potassium iodide solution,
      4. 1/4 ounce Elixir of celerena: essence of celery,
      5. 1/2 ounce Tincture of capsici, 3 minims (Shaken before using.)

    Massages were often used interchangeably with osteopathic manipulations.  Rest from massages might be advisable after a period of two to three months on such therapy, and then, after two or three weeks, a series of osteopathic manipulations.  It would be advisable to continue the inhalant for a long period of time while particular attention is paid to the assimilative process and the eliminations.

    For weakness, beef juice was often suggested (although it is not found in this particular reading).

    Particularly where asthma has been present, it would be consistent in the readings to advise Atomidine in series.  This could be given one drop in a half glass of water, on first arising in the morning, daily for five days.  Then rest two days, then repeat over a period of two to three months.  Then a rest from the drops should be taken and the cycle started again.

    An important concept from the Cayce readings says that any therapy should be given for a period of time, then a rest should be taken by the body.  It is well to remember also that patience, consistency, and perseverance or persistence are necessary elements for the patient and the doctor to observe and use as the body is being rebuilt and brought back to a normal balance.

    Keep up what we have given.  Be a little patient, but know that there is being brought about those conditions that will correct the disturbances in this body, and that the body's strength - the body-physical and the body-mental - is gaining.  Set before self, mentally, that the body would attain.  Make it high, and keep the mental lifted in that direction; for to heal the physical alone, and to have the mental still distorted-would only be the return of the conditions when activities would be renewed physically.  But make the body physically fit, that the body-mental may act through same and make the efforts to bring about that as is desired, in a mental and  physical body - but make it high!  Don't be satisfied with less!  (5545-2)

References:

Cecil-Loeb: Textbook of Medicine, 12th ed., P.B. Beeson & W. McDermott (ed.), Philadelphia: W.B. Saunders Co., 1967, Vol. 1, 502-507.

Nakayama, Komei: "The Surgical Significance of the Carotid Body in Relation to Bronchial Asthma," J. Thorac.  Surgery, 39: 374-389 (No. 4), 1963.

Overholt, R.H.: "Resection of Carotid Body (Cervical Glomectomy) for Asthma," JAMA, 180: 91-94 (No. 10), 1962.

Phillips, J. R.: "Removal of the Carotid Body for Asthma and Emphysema," S Med J, 57: 1278-1281 (Nov.), 1964.

Read, C.T.: "Glomectomy: A Survey," Annals of Thor Surg I.- 590-606 (No. 5), 1965.

"Commentary on Asthma," based on readings 5642-1, 2, 3.

[Note: The preceding overview was written by William A. McGarey, M.D. and is excerpted from the Physician's Reference Notebook, Copyright © 1968 by the Edgar Cayce Foundation, Virginia Beach, VA.]