The Concept of Regulation

[NOTE: THE FOLLOWING SECTION IS EXCERPTED FROM PRINCIPLES & TECHNIQUES OF NERVE REGENERATION  BY DAVID MCMILLIN]

      During Edgar Cayce's lifetime, osteopathic and neuropathic treatment consisted of two definite approaches to treatment. The most obvious emphasis was on finding structural problems with the body and correcting anatomical abnormalities (lesions).  On the other hand, manual therapy was also used to regulate the physiological processes of the body (e.g., coordination and drainages).  Regulating treatments focused on re-establishing equilibrium and balance among the various systems and processes of the body.  Thus, the two aspects of treatment were (1) correction of structure (anatomy) and (2) regulation of function (physiology).
      In practice, these two aspects were often addressed by the same treatment. For example, correction of a spinal subluxation would naturally remove a source of incoordination and assist the body in re-establishing equilibrium and coordination.  Here are a couple of quotes from Cayce's era which acknowledges the two basic approaches to manual therapy as exemplified by traditional osteopathy.  Note Hazzard's reference to "centers along the spine," a key concept for understanding regulation as the basis for coordination and drainages:

    In our treatment of a spine there are two points which we may take into consideration; two objects which we may have in view.  In the first place, we may wish to TREAT THE SPINE ITSELF [anatomical correction].   In the second place, we may wish to REACH, BY TREATING THE CENTERS ALONG THE SPINE, THE VISCERA TO WHICH THESE NERVES RUN [physiological regulation]. It is not always possible to disassociate these in your practice.  I have divided these points thus simply for convenience in the consideration of them.  (Hazzard, 1899, p. 32)

    Osteopathic manipulation is applied for two broad purposes; first, for the correction of spinal and other articular lesions, and second, for its ability to effect alterations in tissue pathology.... In actual application, no clear distinctions can be made between measures applied solely to correct lesions and those used for reestablishing physiological balance [regulation/coordination] through other means, for it is probably that many of the manipulative procedures used accomplish both objectives at the same time. (Long, 1938, p. 440)

    Although much has been lost in the clinical knowledge of the regulatory type of osteopathic treatment, there are still a few practitioners who are familiar with this lost art of osteopathy:

    The majority of DOs [doctors of osteopathy] do not use manipulation.  Many of those physicians who do so, use it primarily for treating musculoskeletal complaints.  They do not use manipulation for its homeostatic benefits [regulation] to the body's physiology.  (Kuchera, 1991, p. 117)

    The neuropathic profession also emphasized the importance of physiological regulation as well as specific anatomical adjustment.  Here is a brief example from the writings of A. P. Davis, M.D., D.O., the self-professed founder of neuropathy:

    Starting at the base of the brain, at the atlas, we regulate all the nervous system involved by our particular treatment in the adjustment of the atlas.... Our adjustment affects the pneumogastric nervous system [parasympathetic], the phrenic nervous system, the circulation of blood, and regulates the heart's action ... The upper portion of the cervical region we denominate the vasomotor area; hence our adjustments in that region regulate the circulation of the blood, not only the arterial, but the circulation of all the fluids in the body as well....  Still further down, from the first to the fourth dorsal, we have influences, through the nervous system in that area, over the pyloric end of the stomach and lungs; and from the fourth to the twelfth dorsal influences are carried to the pneumogastric nervous system [parasympathetic] in the abdominal viscera, and neutralizing excess of acid or alkaline secretion by the union of the footlets of the two systems of nerves in that area.... Still lower down in the lumbar area, including all the dorsal nerves in the lumbar region, by our treatment called adjustment, we regulate the action of all the region or regions to the treatment in the middle and lower area of the lumbar nerve-area.... All conditions of irritability, excessive nervousness, may be avoided by first regulating the circulation of the blood in the vasomotor area and at the fourth and eighth dorsal, for the reason that the first regulates the circulation of the fluids and lessens irritation, and the second unites the forces and equalizes the secretion, resulting in a normal or natural condition.  (Davis, 1909, pp.  58-62)

    This brief excerpt from the neuropathic literature contains six specific references to physiological regulation as the focus of treatment.  Like the osteopaths, neuropaths also assessed and corrected abnormalities in the structural components of the system by specific adjustment.
    Edgar Cayce often recommended both types of treatment (structural correction and functional regulation) in his readings.  Typically he spoke of "specific adjustments" and "coordinating treatments."  For example, he would frequently suggest that the clinician make the specific correction of a spinal lesion and then go on to assist the body in establishing coordination.  Here are some excerpts from the Cayce readings illustrating these concepts.  As with the previous quote from Hazzard, note the frequent references to "centers."

    While the adjustments have in a measure been at times helpful, these have not been - as we find - as correctly given as some that have been had heretofore.  To make simply an adjustment and not coordinate same with the sympathetic centers along the spine at times makes for a strain and a lack of coordination, see?  In making these adjustments, then, we would make an adjustment in the upper cervical - as in the 1st, 2nd, 3rd and 4th cervical; and then massage, by rotary movements, the nerves and centers and the muscular tendons that react from same in the head, the jaw, side of the face and the like, see?  especially the vagus nerves and the 5th and 6th nerves that come to portions of the head ... Also, as indicated, it is necessary to make some adjustments or rather movements in the lower dorsal and throughout the lumbar area.  These we would coordinate with the muscles and nerve ends about the coccyx end, or along the lower spinal end, see?  close to the orifices that make their connections with the cerebro[spinal] and the sympathetic nervous systems in the brush end of the spine.    (567-7)

    First, then, we would apply corrections in the lumbar and the cervical areas as specific.  A coordination of the centers along the cerebrospinal system, between the sympathetic and the cerebrospinal system.  As indicated, in the 4th lumbar area - coordinated, of course with the 2nd and 3rd.  The upper dorsal area or through the brachial plexus area.  The more specific in the hypogastric and pneumogastric plexus in the upper cervical areas.  These made to coordinate; not so much by adjustments, but by using the structural portions as the leverage for not irritating but relaxing the ganglia that make for coordinations in these conditions.       (657-1)

Q.  Have the corrections been made properly in the 6th, 7th, 8th and 9th dorsals?
A.  These have been corrected in a much better manner than was indicated when we had the body here before, - but those conditions existing in the 11th and 12th dorsal and the first of the lumbars need to be corrected, so there is perfect alignment....
Q.  Should the osteopath treat only those areas, or give a general treatment?
A.  Those areas would be specifically treated, but coordinating all of the reflexes from same.  For, the one who gives the osteopathic treatments, if thoroughly acquainted with his business (though many think they are when they are not!), will find that there are centers or areas from which both the cerebrospinal and the sympathetic or vegetative nerve system form conjunctions.  If specific treatments are given and there is not a coordination of those plexus or areas where the specific conjunctions are made, these may tend to contract the body rather than relax same.  Hence there should be the consideration of all of these when treatments are given.       (2094-2)

    While both types of manual therapy are important, the concept of regulation is being emphasized here because Cayce's requirement for manual therapy ("coordination WITH drainage") is explicitly a regulatory form of treatment.  Furthermore, both Cayce and the osteopathic literature agree that osteopathic regulation is achieved by influencing the nerve centers associated with vegetative processes.