Because of the incompleteness of the follow-up information and the inexactness with which the treatments were followed in the cases where such information was available, the adequacy of the treatments can only be ascertained by biological experiments to test the mechanism suggested and by extensive and well-controlled clinical trials of the treatments suggested.
 

I.  Physiological Considerations

    In the 79 cases of Groups I and II (see "Case Breakdown by Groups" at end), two interrelated types of lesions predominated as the basic cause of the conditions: lacteal duct lesions and spinal lesions.  Lacteal duct pathology was described in about half (39) of the cases. This ratio is the same in both Group I (23 out of 46 cases) and in Group II (16 out of 33 cases).  Mechanical, circulatory, or neurological lesions located by reference to a spinal segment are specifically mentioned in 31 cases (19 from Group I and 12 from Group II).  The incidence of these two classes of lesions would have been higher if a lesion were assumed to be present because of the type of treatment recommended.  For example, specific manipulation was indicated in 51 cases, and castor oil packs were suggested in cases where lacteal duct lesions had not been specifically described.  A relationship seemed to be indicated by means of nerve reflex action via the autonomic nervous system between the lacteal duct area and certain spinal segments.

    An initial lesion was described in the lacteal duct area in 23 cases; and an original injury was located by reference to a spinal segment in 23 other cases.  That the readings assumed there was a definite relationship between the two types of lesions was shown from the fact that in 37 of the 39 cases in which lacteal duct pathology was mentioned, the presence of a lesion in a spinal segment or segments was either directly described or indirectly indicated because of specific treatments consisting of manipulations and massage on and around the spinal column.  Therefore, it can be assumed that in almost half the cases these two types of lesions were considered as occurring together.

    The most common cause given for the lacteal duct lesion (when a specific cause was described) was reflex action from an initial injury to a spinal segment, particularly in the sacral-coccygeal region.  Direct trauma to the right upper quadrant of the abdomen or in the region of the umbilicus during or after birth was also repeatedly described (e.g., cases [3801 ] and [5732].  Post-natal infection in the umbilical area was also given as a cause for [2441].  In case [2019], prolonged fasting in the past produced some sort of injury to the umbilical and lacteal autonomic plexuses so that a tautness was produced in the lacteal ducts periodically.  A sudden drop in a fever without sufficient water in or activity of the alimentary canal was described as the cause in [2153].

    The basic lesion in the lacteal duct area was an interference in the flow of chyle.  This seemed to be in some cases caused by an actual constriction or narrowing of the lacteal vessels by adhesions or thickening, and in other cases by some type of spasm.  It is hard to understand anatomically how the lacteal ducts themselves could constrict since they have no smooth muscle.  A spasm of the smooth muscle in the walls of the jejunum and ileum could conceivably cause such a blockage of the flow of chyle in the lacteal ducts.  According to the readings, this basic lacteal duct lesion had far-reaching effects in the body by reflex action via the autonomic nervous system.  Interference with elimination through proper functioning of the large and small bowels was repeatedly stressed (e.g., case
[1980]).  There was an interference and decrease in the hepatic circulation (see [4091], [5642], [567]).  In case [1025], an interference with oxidation in the body was mentioned.  This could conceivably come about as a slowing of metabolic reactions by almost complete stoppage of fat absorption.  Also in [1025] a disturbance to the liver and pancreatic secretions was described.  All these conditions described a malfunctioning of the digestive system.  Also by autonomic reflex, lesions in spinal segments were set up - most commonly in the sacrococcygeal region, ninth and tenth dorsals, and first, second and third cervicals.

    The lesions in the spinal segments and the lacteal duct lesion produced what was described as an incoordination between the cerebrospinal nervous system and the autonomic nervous system.  From the data above, it can be implied that there was a type of reciprocal action between lesions in the spinal segments and the lacteal duct lesion.  Where the lacteal lesion was produced first, these lesions in the spinal segments developed by reflex action and vice versa.

    The endocrine glands were involved in 21 cases - also by reflex via the autonomic autonomic nervous system - with the adrenals and gonads and triggering a response in the pineal and pituitary glands.  The mechanism of this reaction was not given in detail.  No specific hormonal relationships were described.  It was indicated, however, that one way to influence the pineal and pituitary glands was via nerve reflex in the autonomic nervous system which would affect centers in the medulla oblongata.  The readings suggested that these glands have reciprocal relationships with the brain, particularly the autonomic centers.  Thus, the basic incoordination between the cerebrospinal and the autonomic nervous systems was caused by reflex action from the lacteal duct and spinal segment lesions via the nervous system and the glands.  The end result of these disturbances was an overflow of neuronal discharge via the central nervous system in the case of grand mal seizure or the temporary loss of consciousness in a petit mal seizure.

    Such an explanation is a somewhat general and rather incomplete description with many statements which have not been verified by present medical knowledge.  The readings were more concerned with treatment than cause and usually gave only as much theory as was necessary to understand and carry out the treatments.  The theory presented above was pieced together from various readings.

    "As indicated, the lesions - or adhesions and lesions - in the lacteal ducts are the basic cause for the disturbance in the nervous system.  And these arise from the inability of the assimilating system to function with the sympathetic nervous system in its reaction to the nerve reflexes or impulses.  For these conditions, as we find, exist:
    When there is an expression or activity from the sympathetic nervous system, or the sensory system that responds through the sympathetic nerve system, we find there is movement or impulse to and from the brain centers themselves.  Then with a lesion or adhesion the impulse is cut off - or deflected.  For, as indicated, we have a lesion in the lacteal duct area, from an injury there in times back; this is the right side, just below the liver area.
    Hence we have first an intestinal disturbance through the activity of the assimilating system, producing at times disturbances to the liver; at others producing to the pancrean secretions, at others to the activities through the peristaltic movement; not only in the lower intestinal tract but to those activities through the jejunum itself
    Then this coordinating or connection with the solar plexus nerve centers, making for an incoordination with the cerebrospinal nerve system, produces at the base of the brain - or through the medulla oblongata - an incoordinant reaction...
Q-7.  Do you find any condition existing in the brain, or is it reflex?
A-7.  As we rind, and as indicated, the accumulations that have been there are rather reflex - and are produced by the condition in the lacteal duct area.
Q-8.  Of what nature was the injury, that caused or brought about this condition in the lacteal area?
A-8.  This was a pressure, or a lick [a blow]."  (1025-2)

    "These as we find are hidden, in a nature, and the causes arise from an injury received some years ago, in the coccyx area, and then a contributory cause later in the area above the lumbar axis.
    These caused a slowing of the circulation through the areas of the lacteal ducts, thus producing a cold area there, that has produced a partial adherence of tissue.
    With the activity of the lymph through the area, we find that periodically, when there is the lack of proper eliminations through the alimentary canal, there occurs a reflex to the coordination between sympathetic and cerebrospinal system area; that takes the governing of the impulse, as it were, to the brain reactions; or a form of spasmodic reaction that might be called epileptic in its nature.
    If this is allowed to remain, or if there are the attempts to allay by or through the applications ordinarily in such cases, we will not only continue this reaction but cause greater destructive forces in the areas along the impulses to the sympathetic and cerebrospinal centers in lumbar and coccyx area; thus increasing and making more severe the attacks that occur from this deflection of impulse...
Q-2.  What was the nature of the original accident?
A-2.  Striking the end of the spine - on banister."   (1980-1)

    "As has been indicated - and should be noted by the masseur or osteopath - the lesions that cause attacks are in the lacteal duct and those areas about the assimilating system and the upper portion of the jejunum and caecum.
    There are no brain lesions, but there is that which at times hinders the coordination between the impulses of the body and the normal physical reactions - or that break between the cerebrospinal and the sympathetic or vegetative nerve system, that coordinates from the lacteal duct through the adrenals and their reaction to the pineal; causing the spasmodic reaction in the medulla oblongata, or that balance at the base of the brain...
    There are, to be sure, lacteal ducts.  There are the strings or ducts all through the upper portion of the alimentary canal, or jejunum; but the larger patch or area is that lying just below the lower end of the duodenum, and where same empties into the jejunum, see? This patch is not only an internal activity, but an external, that makes for the production of assimilation.
    The adhesions in these ducts here were produced by an excess temperature, which the body suffered at some period when there was too sudden dropping of the temperature (which they may check and find to be correct), and not sufficient water, or manipulations, or activity, through the alimentary canal.
    This has gradually caused the disturbances to the general breaking of coordination in the nerve systems, and brings about - for this body - the source of the attacks."   (2153-4)

    As was indicated above, in only about half the cases was lacteal duct pathology described.  Of the remaining cases brain damage was described as the cause in seven cases.  In others, the pathological description was complicated by the existence of another disease present along with epilepsy.  For example, case [3521] had both epilepsy '  and multiple sclerosis.  Other cases combined epilepsy with mental retardation.  It might be assumed that lacteal duct pathology (although not specifically described) and related mechanism led to the production of convulsions in some of the remaining cases because of the similarity in the treatments suggested.

    Although the Edgar Cayce readings gave as the etiologic factors a lacteal duct lesion in association with a spinal segment lesion in slightly less than half the cases (37), these were the largest group of cases with a consistent mechanism and type of treatment.  For example, in 29 of these cases castor oil packs were recommended and in 22 of these same cases incoordination between the autonomic and cerebrospinal nervous systems was specifically mentioned as a definite factor.  If it is taken as a presupposition that this type of pathology and the mechanism of pathologic physiology described above is the etiology in some types of epileptic conditions, an explanation could be suggested for a portion of the 50% of all cases of epilepsy which are now termed idiopathic.

    It is interesting to note the diagnostic sign which was given in six of the cases where lacteal duct lesion was described - a cold spot on the skin of the right upper quadrant.  This sign was usually only present at the time of the seizure.  Another possible diagnostic sign noted in the correspondence of case [561 ], which resulted in a complete cure of the condition, was an occasional feeling of pressure or a "stitch" in the right side.  Trouble with eliminations also seemed to be present fairly consistently.
 

II.  Discussion of Treatment

    Treatments aim at the elimination of the basic causes and restoration of the normal functioning of the body.  All the treatments were somewhat interrelated in their actions and effects.  In order to break up the lesions and adhesions in the lacteal duct area, a combination of hot castor oil packs, massage, olive oil taken internally, and spinal manipulations was employed.  In addition, proper elimination and diet also were supposed to have their effect upon the lacteal area.  Hot castor oil packs were usually given in a three-day series and were kept on for from one to three hours over the entire right abdomen, both anterior and posterior from the right costal margin to the crest of the ileum and covering the area of the caecum and umbilicus.  These hot packs were said to start the breakup of the lacteal lesions and adhesions.  The heat alone would certainly tend to increase the circulation of the area.  It was also implied that the castor oil itself would have a beneficial effect by absorption through the skin.  In many cases a period of abdominal massage and kneading of the right side of the abdomen was instructed immediately after the removal of the packs, to help in the breakup of the lesions and adhesions.  This massage was recommended with either peanut oil or a mixture of olive oil and myrrh, and sometimes with a combination of all three.

    The olive oil, given internally (usually two tablespoonfuls), was to be taken at bedtime on the last day of the series of packs.  As a fat it would be absorbed through the lacteal ducts and might help to increase the flow through them.

    Osteopathic massage and manipulation on and around the spine followed the series of castor oil packs.  The relationship mentioned above between spinal and lacteal lesions is significant here.  The manipulative treatment was supposed not only to correct any mechanical abnormalities in spinal segments, but also to stimulate the autonomic nervous system to help overcome the imbalance between it and the cerebrospinal nervous system.  The effect upon the lacteal duct area was to aid in the elimination of the lesions and/or adhesions by an increase in circulation and a relief of nervous tension or spasm induced via the autonomic nerve plexuses in the abdomen.  The hot packs seem to be an essential preliminary step, so that the manipulations would have their maximum effect on the lesions and adhesions in the lacteal duct regions.  Elimination of the lesions would in turn have a reciprocal effect upon the spinal segment lesion and vice versa.
"It is necessary that there be sufficient of the castor oil packs taken to relax the lacteal duct area, the caecum and the central portion about the umbilicus center.

    Also in giving the adjustments necessary from the 9th dorsal to the lumbar axis, or 4th lumbar, there must be the massage - or the kneading, gently, of the whole right portion of the abdomen, specifically.  And then there must be the relaxing of those centers also in the coccyx area."   (1025-2)
"Have sufficient periods of the castor oil packs.  To be sure, they are disagreeable, but they will break up lesions as no other administrations will.  The best time to take these is the evening, to be sure.  These should be given in series; applied for an hour each evening for two or three evenings before each osteopathic adjustment is to be made, see?...

    Keep these up until this coldness and the lesion in the right side is removed - which is just a hand's breadth below the point of the rib, or over that area of the ducts. . .

    The idea of the treatments, of course, is to correct those subluxations, or tendencies, which exist; deep in some areas, superficial in others, along that area given; but mostly to eradicate - causing the system to assimilate - the tautness, coldness and the lesions in the right side of the body, in the areas indicated."   (2153-4)

    Stimulation of the autonomic nervous system by manipulation would also affect the functioning of the glands which in turn would have an effect upon the brain by the mechanism that the readings suggested.

    The problem of inadequate elimination was addressed from a number of different angles.  The olive oil, a natural laxative, also acts as lubrication in the intestines.  Other laxatives were sometimes suggested, such as Fletcher's Castoria, or Innerclean.  Colonics were recommended for those who seemed to have a particularly difficult problem with elimination.  Manipulations would presumably also help here.  Proper functioning of the alimentary canal was aided by a diet designed to include food as easily digestible as possible.  This in turn would aid eliminations.  The diet was low-fat in nature, definitely prohibiting fried foods, pork, fat meats, and sweet milk.  Alkaline-forming foods and vegetables were recommended, but most tuberous vegetables were excluded.  Acid-producing foods such as meats, sugars, starches, and condiments were discouraged.

    A boiled concentrate which was prepared in a definitely prescribed manner from the passion flower was recommended to replace the use of sedatives.  Although the readings occasionally approved the temporary continuance of sedatives such as dilantin or phenobarbital, the ultimate goal of successful treatment was the elimination of the need for such drugs which act as poisons in the system.  The passion flower fusion was described as a non-habit-forming herbal compound and not a sedative itself.  It was supposed to have a calming action on the nervous system and to aid the eliminations, as well as to help retard muscular contractions.

    Exercise in the open was recommended both for a means of helpful outlet of physical energy and as a means of securing physical relaxation of the body during rest.

    "To be sure, the body should take as much physical exercise - and in the open - as is practical each day, not to be overstrenuous.  Calisthenics, or anything which has to do with the general movements of the body in the open, is well.  Walking is one of the best of exercises; walking, swimming, anything that has the calisthenics; tennis, handball, badminton; any of those activities for the body.)   (2153-4)

    The readings stressed the importance of a balanced program of treatment, with equal stress on all phases.  The importance of completeness, continuity, and consistency was emphasized.  In most cases, treatment had to be continued for a considerable period of time, at least six months.
 

III.  Recommendations

    1. The medical literature for the last 50 years should be reviewed to determine if there is any experimental work which throws any light on or gives any evidence for the mechanisms suggested in the readings.  For example, the action of the chemical ingredients of castor oil; the action of castor oil on adhesions; or any instances of gastrointestinal pathology, particularly in the lacteal duct area, which have caused convulsions.

    2. The suggestions for the mechanisms involved in the lacteal duct type of epilepsy referred to in the readings would furnish leads for experimental research.  For example, the passion flower fusion compound could be analyzed and its chemical compounds checked for pharmacologic activity.

    3. Pathologists could be alerted to the possibility of gastrointestinal pathological conditions of epilepsy.  Port-mortem examinations of known epileptics could include a special concentration on examination of the gross and histological specimens from the lacteal duct area in the jejunum and ileum as well as from the mesenteries to these regions of the small intestine.

    4. A controlled clinical trial of the most frequent and consistent types of treatment could be undertaken on a selected group of epileptics at the same time and place under the supervision of qualified physicians.  The number of patients in such a study should be large enough to make the results statistically valid.  Both the patients receiving the Cayce treatment and the control group should be divided according to the type of epilepsy (grand mal, petit mal, or psychomotor) to determine the effectiveness on each type.  The 79 cases in Groups I and II were not able to be adequately separated into types because of the meagerness of the case history data available.

    With the presupposition that there is an intestinal type of epilepsy with a lacteal duct etiological factor, the treatment could be expected to be effective only in such cases where such pathology is present.  Obviously, the most satisfactory trial would be on a group of epileptics of this type.  At present, the only guides which can be used to separate this type of case are the cold spot described above, discomfort in the right abdominal region, or disturbances in eliminations from the digestive tract.  If such a selected group could not be found and the treatments were tried on a general group of epileptics with no apparent brain damage, it should be remembered that in no more than 50 percent of the cases (Groups I and II) were lacteal duct lesions described as an important etiological factor.

    With the possibility of such a clinical trial in mind, the following treatment outline has been prepared.  The suggestions given below occurred repeatedly and fairly consistently in the readings.  All patients in such a trial should have a complete medical workup for epilepsy, including an electroencephalogram.  Definite brain pathology would presumably rule out the possibility that a type of intestinal pathology was the cause of the convulsions and that the treatment could be expected to be effective.

    In general, treatment involves the application of castor oil packs for three-day periods in conjunction with daily massages of the right abdominal and spinal area.  The osteopathic manipulations are to follow the three-day series of packs on the fourth day.  During the first six weeks of treatment, osteopathic manipulations are to be given twice weekly, each following a three-day series of packs.  The packs, massages, and manipulations follow a cyclical schedule with three weeks of treatment followed by one week of rest, etc.  Starting with the third three-week treatment period (i.e., the eighth week), only one osteopathic treatment is to be given each week, following one three-day series of packs.  In addition to these treatments, the passion flower fusion is given, but only after the packs and manipulations have been started.

    The above mentioned basic treatment should be supported and given in conjunction with strict attention to diet, exercise, daily regularity and full eliminations from the digestive tract.  The complete treatment should be carried through.  The greater part will be done by the patient but, at the time of the manipulations, progress can be checked and persistence in all phases of treatment encouraged.  A detailed daily written report of treatments administered and diet followed should be kept and turned in by each patient.  Six months is suggested as the minimum period of treatment.
 

IV.  Treatment Outline

    1. Hot castor oil packs: One to one-and-a-half hours daily for each three-day series.  The pack should be applied preferably in the evening, so that the patient can go to sleep immediately after the pack and associated massages have been finished.

    2. Massage of the abdomen and spine: After the packs have been removed and the area sponged off with soda solution, the right abdominal area should have a thorough massage with deep kneading movements.  This massage should last for at least 15 minutes and be given with the fingers dipped into a solution made of equal portions of olive and oil and tincture of myrrh. (This oil solution should be prepared by heating the olive oil and then adding the tincture of myrrh.) After the abdominal massage, a 15-minute massage of the spine and the back muscles along the side of the spine should be given from the base of the brain to the tip of the spine with same oil solution.

    3. Olive oil.- Two tablespoonfuls by mouth at bedtime after each three-day series of packs (i.e., on the evening of the third day).

    4. Osteopathic manipulation: Twice weekly for the first six weeks of treatment and once weekly thereafter (except during the one-week "rest" periods every fourth week).  This osteopathic treatment should be both general and specific.  In addition to general massage and manipulation of the spine, special attention should be paid to the sacro-coccygeal area and the first three cervicals, as well as the ninth to the eleventh dorsal segments.  The coccyx and the sacro-coccygeal junction should receive special attention.  An osteopathic massage should be given to the abdominal areas from the liver to the caecum and include the umbilical area.  Each manipulative treatment should be preceded by the three-day series of packs.

    5. Passion flower fusion: One teaspoonful four times daily, one half hour before meals and one half hour before retiring.  This treatment should be started during the fourth week of therapy - i.e., at the start of the first one-week rest period.  This compound is intended to reduce the amount of sedative needed to control the epilepsy.  Sedatives which the patient is already taking should be decreased gradually in accordance with the following schedule: At the time of the second one-week rest period, decrease total dosage by one third.  At the time of the third one-week rest period, decrease another one third; and by the time of the fourth one-week rest period, discontinue sedatives entirely so that the patient is taking only the passion flower fusion in the above dose.

    Note: Reduction of sedatives must be undertaken in accord with the individual patient's response and only upon the recommendation of the supervising physician.  The goal should be complete freedom from sedatives by the end of the six-month treatment period.

    6. Diet: The diet should generally contain foods of a nonconstipating and easily digestible nature.  Overeating should be avoided.

• Sugars and starches: Use honey for sweetening.  Cut down on starches.  Avoid sugars and condiments.
• Fruits: All in abundance except raw apples, bananas, large prunes, plums, cranberries.
• Vegetables: Especially stress raw, green vegetable salads.  Leafy vegetables in abundance rather than tuberous vegetables (except carrots, beets, and oyster plant).  Avoid potatoes, turnips, legumes, and rhubarb.  Eat Jerusalem artichokes one or two times per week, and okra frequently.
• Cereal products: Whole wheat, cracked wheat, or pumpernickel bread.  Dry cereals, whole wheat or steel-cut oats (not rolled oats) as cooked cereals, but not at the same meal with citrus fruits.  No nuts, except filberts and almonds in moderation.  Ovaltine as a beverage, rather than coffee or tea.
• Meats: Seafoods in abundance but never fried.  Fish, fowl, lamb, calves' liver (broiled, never fried), no rare meat, no beef except beef juice regularly, no fat meats, no pork except crisp breakfast bacon occasionally.  Use gelatin frequently - e.g., in fruit and vegetable salads.
• Dairy products: Eggs, but only the yolk.  Cheese only in moderation.  Avoid sweet milk (use Bulgarian buttermilk, dry skimmed milk, or soybean milk).
• Miscellaneous: No carbonated beverages.  No alcoholic drinks.  No smoking unless already an addict, then decrease to a minimum.

    In summary the treatment follows a cyclical pattern with a rest period every fourth week.  A schedule based on the plan of treatment given above is as follows:

• First three weeks: Castor oil packs plus massages each evening - Sunday, Monday, Tuesday.  Olive oil at bedtime following the treatment on Tuesday.  Manipulative treatment on Wednesday.  Repeat series of packs plus massages each evening on Wednesday, Thursday, Friday.  Olive oil following the treatment at bedtime Friday.  Manipulative treatment on Saturday.  This same schedule is followed each week.
• Fourth week: None of the above treatments but start passion flower fusion by mouth and continue four times daily throughout the remaining periods of treatment.
• Fifth, sixth and seventh weeks: Same as first three weeks.
• Eighth week: Rest from all treatment except passion flower fusion, diet, and control of eliminations.
• Ninth, tenth and eleventh weeks: Each week one three-day series of castor oil packs and massages, plus the olive oil as before, followed by a manipulative treatment on the fourth day.
• Twelfth week: Rest as during the eighth week.  Repeat patterns of weeks nine through twelve for the remainder of the six-month treatment period.

    This report has been a preliminary step in the study of the treatment given for epilepsy in the Edgar Cayce readings.  No conclusions can be drawn as to the worth of the treatments without further research.  Suggestions for such research have been presented.

[Note: The preceding commentary was provided by Walter Pahnke, M. D. and is excerpted from The Physician's Reference Notebook Copyright © 1983 by the Edgar Cayce Foundation, Virginia Beach, VA.]