Download Overview-and-historical-significance

Overview and historical
significance of inflammation
DrLindaMayerandProfRashidBhikha
November2013
GeneraloverviewofInflammation
Thephenomenonofinflammationhasbecomingmoreimportantoverthelastfewyears,as
werealizeitsextensiveinvolvementinmoreandmoredisorders.Bronchialasthmawas
identifiedasaninflammatorydisorderabout20yearsago,followedbyvariousother
allergies.Sincethenmanyothers,suchasdiabetesI,Alzheimer’s,variouscancers,some
heartdiseasesandevenageinghavebeenidentifiedaseitheracuteorchronicinflammatory
disorders(Glynn,2013).
Tibbisverymuchcentraltothis,asthenormalinflammatoryresponse,Physisand
inflammationarecloselymeshedwithlifestyle,especiallydiet.Oneofthemostprevalent
underlyingbeliefsabouthealthintheWesternworldisthatillnessisamistake,andthat
symptomsofadiseasemustbeeradicatedonordertorestorehealth.Whatisdefined
negativelyas‘pathology’bywesternmedicineisoftenthebody’sattempttoreachfor
health.
Mistrustingthebody’sabilitytoself-heal,resultsinadeepandwidespreadfearofillness.In
ordertochangetheparadigmofadisease-basedapproachtoaperson-centredone,a
consciousshiftisneeded,fromfearingsymptomstounderstandingandembracingthe
innatehealingabilityofPhysistorestoreinternalbalance.
Thesourceoftheinflammationneedstobefoundbyidentifyingthetriggerfactorswhich
causetheinflammation,whichincludesphysical,environmental,emotional,chemical,and
mostimportantnutritionalfactors.
Understandingtheimportantroleandstagesofinflammationintheprocessofhealingis
fundamentaltopreventchronicanddebilitatingdiseasesformoccurring.Theprevailing
signsandsymptomsofanacuteinflammatoryresponsearebothwarningandprotective
mechanismsofthebody,whichenablestheimmunesystemtorespondaccordingly.Any
attemptstoimpedethisnaturalprocesswillinterferewiththeinnatehealingabilityof
Physis.
Inflammationisanimportantmanifestationofthenaturalbody’sresponsetoinjury,which
isanecessaryrequisitetohealing.Variousapproachestomanaginginflammationvary
accordingtotheconventionalallopathicorothercomplimentaryhealthdisciplines.
Interferingwiththenaturalinflammatoryresponsecanresultinpathologyandchronic
inflammation.
Theunderlyingcausesformanydiseaseshavetheiroriginsinpoorlifestylechoices,which
mayresultinchronicsystemicinflammation,suchasobesity,diabetes,highbloodpressure,
andgout.Hiddeninflammationisnotaseasilydetectedasanacuteinflammatoryresponse,
anditisalothardertocontrolandmanage,especiallybecauseoftheincreasingpropensity
oflifestyle-induceddiseases.Chronicsystemicinflammationisanunderlyingcauseofmany
seeminglyunrelated,age-relateddiseases.However,theyareallrelatedbyanimbalanceof
theinternalenvironmentinthebody.
Theconventionalapproachtoinflammationfacilitateshealingbyintroducingtreatment
methodswhichcontrolsandeveninhibitstheinflammatoryprocess,mainlywith
medication.TheTibb’sapproachtoinflammationistomaintainthehumanbodyinastate
ofbalance,harmonyandvigour,byallowingPhysistogothroughthevariousstagesofthe
inflammatorystagesandprocessinordertofacilitatehealing.Thephysical,mental,
emotionalandspiritualforcesofhumanlifeneedtoberespected,astheyareall
contributoryfactorstotheoutcomesofhealthanddisease.
TheTemperamentofanindividualdeterminesthespecificeliminativetherapywhichwillbe
adoptedtomaintainandrestorehealth,andinthepreventionandmanagementof
inflammationandanyotherdisease.Tibbalsounderstandthatthelifestylefactorsplaya
pivotalroleinthisprocess.Thisincludesenvironmentalairandbreathing,foodanddrink,
movementandrest,sleepandwakefulness,emotionsandeliminationandretention.
InTibbtherelationshipofheat,moistness,coldnessanddrynesshasadirectbearingonthe
healthstatusofanindividual.Heatisgenerallymorefavourablethancoldformaintaining
theproperbalanceandgeneralhealthofthebody.Healthwillonlybemaintainedaslong
astheoverallqualityofthehumoursisinharmonywiththeoverallqualityofthe
individual’stemperament.
DefinitionsofInflammation
Inflammationisassociatedwithheatviathesymbolofaflame.Thewordinflammation
comesfromtheLatin"inflammo",meaning"Isetalight,Iignite"or“inflammare(toset
alight).TheancientGreeksreferredtoinflammationasa“hotthing.”TheGreekword,
“phlegmon"wasusedtodescribeinternalinflammatorylesions(Nordqvist,2012).
Thedefinitionofinflammationdependsonwhetheroneviewsthisfromaclinical,cellularor
molecularperspective,butisclearthatitembracesagreatvarietyofbiologicalprocesses,
whichismodulatedbymanyfactorsinthecell’senvironment(Scottetal,2004).The
definitionofinflammationhaschangeddramaticallysinceitwasfirstusedbyCelsusnearly
2000yearsago.
Defininginflammationaccordingtoclinicalsignsandsymptomshasmajorlimitations,asin
mostcasesthecellularprocessesandsignalsthatunderliethecardinalsignsoccurata
subclinicallevelanddonotgiverisetoanyheat,redness,swelling,orpain.Forexample,
theinflammationofdelayedonsetmuscularsorenessmaycausetendernessonpalpationor
milddiscomfort,butnorednessorswelling.Thedefinitionalsodependsontheparticular
perspectiveoneisviewinginflammation-whetheritbeclinical,cellular,ormolecular(Scott
etal,2004).
Inflammationisalocalisedprotectiveresponseelicitedbyinjuryofdestructionoftissues,
whichservestodestroy,dilute,orwalloffboththeinjuriousagentandtheinjuredtissue
(Saunders,2007).Itisanormalresponsetodisturbedhomeostasiscausedbyinfection,
injury,andtrauma.Thehostrespondswithacomplexseriesofimmunereactionsto
neutralizeinvadingpathogens,repairinjuredtissues,andpromotewoundhealing(Pavlov,
etal,2003).Itisaphysiological,protectiveresponsetoinjuryortissuedestruction,whichis
self-limiting;however,pathologymaydevelopifthenaturalhealingresponseofPhysisis
tamperedwith.
Inflammationisacomplexprocessinvolvingthecirculatorysystemandblood-borncells.It
isanaturalbodyresponsetoaninjury,beitofphysical,chemicalorinfectiousorigin,andit
isanecessaryprocessforhealing(MerckAnimalHealth,2013).
Thecommonsorethroat,rashesorasprainedankleareprotectiveresponsesofthebodyto
inflammation,whichcommunicatesdistressinthebody.Theproblemariseswhen:
•
•
Thereisanoverreactionoftheimmuneresponse,inconditionssuchasallergies,
asthma,autoimmunediseasesorrheumatoidarthritis.
Thereisnoovertorvisiblesignofinflammation,whichisattherootofallchronic
diseases,suchindiabetes,heartdisease,cancer,dementiaanddepression.This
inevitablyresultsinachronic,smoulderinginflammationthatslowlyinterfereswith
optimalfunctioningbydestroyingtheorgans,leadingtorapidageing(Hyman,
2012).
Thenaturalanti-inflammatoryresponsethatensuesafteracuteinflammationtendsto
reversetissuehomeostasistowardsnormality,andshouldthereforeberegardedasatrue
defensivereactionoftheaffectedtissue.Inflammationisnowrecognizedasatypeof
nonspecificimmuneresponse.”“Inflammationisthebasicprocesswherebytissuesofthe
bodyrespondtoinjury.”Allsignshavebeenregardedassecondarytooneprimary
pathophysiologicalevent–enhancementofvascularpermeabilityasadirectconsequence
oftissueinjury(Stankov,2012).
IncidenceandPrevalenceofInflammatoryDiseases
Immune-mediatedinflammatorydiseasesareagroupofcommonandhighlydisabling
chronicconditionsthatshareinflammatorypathways.ItsestimatedprevalenceinWestern
societyis5%-7%(Gabalawyetal,2010).Inflammatorydisordersareincreasingduetopoor
lifestylechoices,especiallydiet,andincludeallergy-relateddisorders,suchasasthma,
diabetes,heartdiseases,certaincancers,Alzheimer’sdiseaseandevenageing,amongsta
hostofotherconditions.
AccordingtotheMarshallProtocolKnowledgeBaseforAutoimmunityResearchFoundation,
in2004133millionpeople(halfofallAmericans)livewithchronicconditions.Thisaccounts
for83%ofthehealthcarespending,andthosewith5ormorechronicconditionshavean
averageof15physicianvisitsperyear,withmorethan50prescriptionsperyear(Wood,
2004).TheJournaloftheAmericanMedicalAssociationpublishedapaperin2010,
highlightingtherateatwhichchronichealthconditionsamongchildrenintheUnitedStates
increasedfrom12,8%in1994to26,6%in2006(VanCleaveetal,2010).
AccordingtotheInternationalJournalofEndocrinologytheglobalemergenceofobesity
increasestheriskofdevelopingchronicmetabolicdisorders,whichisassociatedwith
chronicsystemicinflammation.From2005-2006ithasshownthat33.3%ofmenand35.3%
ofwomenwereobese(Hernandezetal,2013).
TheincidenceandprevalenceofInflammatoryboweldiseasereincreasingwithtimeandin
differentregionsaroundtheworld(Molodeckyetal,2012).Inoneofthelargeststudies,
baseduponninemillionhealthinsuranceclaims,theprevalenceofulcerativecolitisin
adultsintheUnitedSateswas238per100,000population,andtheprevalenceofCrohn's
diseasewas201per100,000population.
Rheumatoidarthritis(RA)andosteoarthritis(OAO)arethetwomostcommonrheumatic
diseases,accountingforalargepercentageofdisabilityworldwide,creatinghugehealth,
socialandeconomicburdens(Sanga,2000).
Goutisthemostprevalentformofinflammatoryarthritis. TheAmericanCollegeof
RheumatologyhasshownthattheprevalenceofgoutintheU.S.hasrisenoverthelast
twentyyearswhichcurrentlyaffects8.3million(4%)Americans.Thismaybeassociated
withahigherincreaseinobesityandhypertension(Wiley-Blackwell,2011)
AHistoricaloverviewofinflammation
InfectionscausedbyGroupAStreptococcus(GAS)isahumanpathogenwhichisresponsible
formanydiseases,rangingfromstreptococcalpharyngitistoimpetigo.Infectionswhich
werecausedbyGAShavebeendocumentedasfarbackas6500BC.Inthelate17thcentury,
ThomasSydenhamclinicallydistinguishedscarletfeverfrommeasles(Leday,2006).
RecordsofholisticmedicinegobacktotheEgyptiangodofmedicine,Imhotep,wholivedin
2980BC.TheoriginsofEgyptianmedicinelieinreligionandspirituality,anditwasbelieved
thatthegodsintervenedinmattersofhealthanddisease.Atthattimeitwasrecognised
thatbloodwasthenutritiveandregulatorysubstanceandtheheartwasthecentreofthe
circulatorysystem.Itwaswidelyrecognisedthatrespiratorypatternsinfluencedblood
circulation.
Earlyconceptsaboutinflammationwerelargelyderivedfromintuitionratherthancareful
scientificinvestigation,butwhichprovidedtheframeworkforcriticalexperimentationinthe
latercenturies.ThehistoryofinflammationdatesbacktotheancientEgyptianandGreek
cultures.In1650theancientEgyptiansrecordedtheearliesttranscriptsonpapyrus
(Nordqvist,2012).
Hippocrates(460-370BC)introducedtheterm,‘woundputrefaction’(‘sipsi’–makerotten),
meaningenzymedecomposition,especiallybyproteins,withtheproductionoffoul-smelling
compounds(Saunders,2007).
Galen(130-201AD)viewedinflammation,particularlypus,aspartofthebeneficialreactive
responsetoinjury(Phlogosis),ratherthanasuperimposedpathology(Scottetal,2004;
Silva,1978).
Avicenna(979-1037BC)observedthatthecoincidenceofbloodputrefaction,namely,
septicaemiawasusuallyaccompaniedbyfever.
Thedoctrineofthefourcardinalsignsofinflammation,namely:redness(rubor),swelling
(tumor),heat(calor)andpain(dolor),wasoriginallytermedbyAulusCorneliusCelsusinthe
1stcenturyAD(Rather,2012).
TheFrenchchemist,LouisPasteur(1822-1895)discoveredthattinysinglecellorganisms
causedputrefaction.Hecalledthembacteriaormicrobesandcorrectlydeductedthatthese
microbescouldbecausingdisease(GermanSepsisSociety,2013).LouisPasteurlinkedthe
decayoforganicsubstancestothepresenceofbacteriaandmicroorganisms,whichwere
killedbyheating.
RudolphVirchow(1821-1902)wasaGermanphysician,anthropologist,politicianand
founderofthefieldofcellularpathology.Heviewedinflammationasinherently
pathological.Hestressedthatmostofthediseasesofmankindcouldbeunderstoodin
termsofthedysfunctionofcells(Edwards(2013).Histheoryofcellularpathologybecamea
basisfortheunderstandingandfightagainstpathologicalprocessesinlivingorganisms.
Virchowdescribedtheinflammatoryprocessashavingbeenderivedfromtheincreased
activity(nutritiveirritability)ofthecelltofindtheappropriatesourceoffoodinthe
surroundingtissues.Heconcludedthat‘theinflammatoryreactionisaconsequenceofan
excessiveintakebyinterstitialcellsoffoodfromtheliquidpartoftheblood,filtering
throughthevesselwall’,whichwouldresultinhypertrophy,ordegenerationofthecells,
whichwouldmultiplytoformaninflammatorytumour(Silva,1978).
Virchowcreatedthenewparadigmofcellularpathologywhenhecriticallyanalysedthe
meaningofthefourkeysymptomsofinflammationandproposedthatinflammation
constitutesvariousinflammatoryprocesses.Heisalsosaidtobeaccreditedtohave
introducedthefifthcardinalsign–“functionlaesa”,orlossoffunction,wherebyheviewed
inflammationasinherentlypathological.Hehighlightedtheimportanceofthe
inflammatorystimulus(Heidlandetal,2006).IncontrastwithGalen,Virchowviewed
inflammationasinherentlypathological(Scottetal,2004).
ElieMetchnikoff(1845-1916)isconsideredtobethefatherofnaturalimmunity,and,
togetherwithPaulEhrlich,theywerethepioneersofcellularandhumoralimmunology.
Metchnikoffisrecognisedforthebiologicalsignificanceofleukocyterecruitmentand
phagocytosisofmicrobesinhostdefenceagainstinfection,inflammationandimmunity
(Gordon,2008).Heobservedthatneutrophilgranulocytes(microphages)wereremoved
fromtheinflamedsitebybeingingestedbymacrophageswhilestillintact(Savill,1997).
SirJosephLister(1827-1912),theFatherofmodernsurgery,introducedtheantiseptic
methodbydisinfectingwithcarbolicacid,whichwasalsousedduringthisperiodasan
effectivedisinfectantinsewers.Healsosprayedtheairwithcarbolicacidtokillairborne
germs.Listerisquotedtohavesaid:‘Anyonetryingtowirethebrokenpiecestogether
withouttheantiseptictechniquewouldbefacedwithaninfectedkneeandhospital
gangrene’(Lamont,1992).Healsointroducedsterilisedcatgutforinternalsutures.
FriedrichDanielvonRecklinghausen(1833-1910)characterizedthepuscellsinacute
inflammation,andheshowedthatpuscellscouldmigratefromtheplacesoftheiroriginin
theinterstitiumtoothertissuesandepithelialcells.Healsocontributedtotheconceptof
phagocytosis(Heidlandetal,2009).
JuliusFriedrichCohnheim(1839-1884)observedthedilatationofthearteriesandveins,
adhesionofcolourlesscellstotheendothelialcells,andthesubsequenttransmigrationfrom
thecapillariesandvenulesintotheinterstitialspace(Heidlandetal,2009).Cohnheimwas
Virchow’spupil,producedmanyobservationswhicharetheantecedentsofmodern
conceptsininflammation.Heshowedthattheoriginsofpuscellsarefromthebloodand
notfromlocaltissueelements,asVirchowbelieved(Prichard,1961).
IgnazSemmelweis(1818-1865)deductedthatchildbedfeverwascausedby"decomposed
animalmatterthatenteredthebloodsystem".Heintroducedhandwashingwitha
chlorinatedlimesolutionbeforeeverygynaecologicalexamination,butthehygienic
measureswerenotacceptedatthattime(GermanSepsisSociety).Semmelweisobserved
thesignificanteffectofhygienicmeasuresondecreasingthemortalityofwomenduring
childbirth(Rittirschetal,2008;Kubendiran,2011).
HugoSchottmüller(1867-1936)explained:"Sepsisispresentifafocushasdevelopedfrom
whichpathogenicbacteria,constantlyorperiodically,invadethebloodstreaminsuchaway
thatthiscausessubjectiveandobjectivesymptoms."Healsomaintainedthat:"Atherapy
shouldnotbedirectedagainstbacteriainthebloodbutagainstthereleasedbacterial
toxins’(GermanSepsisSociety).
RogerC.Bone(1941-1997)definedsepsisas“aninvasionofmicroorganismsand/ortheir
toxinsintothebloodstream,alongwiththeorganism'sreactionagainstthisinvasion."He
influencedthedevelopmentofnewtherapeuticstrategiesbyhavingelucidatedthevarious
stagesorphysiologicalterationsthatoccurinthesepticpatient(Balk,2011).
AboutacenturyagoPaulEhrlichproposed“horrorautotoxicus”asimmunereactivity
againstself,whichisnowcalledautoimmunity.In1957Burnetandothersdemonstrated
thepresenceofautoantibodiesandprovidedatheoreticalbasisforautoreactivity(Amagai
&Matsushima,2010).
Advancesinmicroscopyandcellbiologyinthe19thcenturygaverisetocellbased
definitionsofinflammation.Researchersbegantoquestionwhetherinflammationwasa
singleprocess.Inthemiddleofthe19thcenturyscientificmethodswerevigorouslyapplied
toascertainthecausesofmanyinfectionsbygermsandviruses.Bytheendofthe19th
centuryitwasacknowledgedthatchangingcellpopulationsarisingfromboththebloodand
localproliferationwereakeyfeatureofmanymodelsofinflammation(Scottetal,2004).
Summary
Thepioneersofindividualswhorecognisedandunderstoodtheprocessesandmechanisms
ofinflammationhaveledtomanyadvancesinthefieldofinflammatorydiseases.However,
theglobalincreaseofdisordersassociatedwithpooreatinghabits,smoking,lackofexercise
andsleep,arejustafewexamplesofincreasingincidencesandprevalenceofchronic
inflammatorydiseases.
Theroleoflifestylefactorsplaysapivotalroleintheoverallhealthandwellbeingofan
individual.Thisincludessensiblechoicesforlivinglifeashealthyaspossiblewithinthe
parametersofeachperson’sidealTemperament,whichconsiders:environmentalairand
breathing,foodanddrink,movementandrest,sleepandwakefulness,emotionsand
eliminationandretention.Otherinterventionstoliveahealthyanti-inflammatorylifestyle,
ortoassistthebodytorestoreitbacktohealth,includeTibbherbalmedication,herbal
stimulants,vitamins,aswellastissuesalts.
Inordertochangetheparadigmofadisease-basedapproachtoaperson-centredone,a
consciousshiftfromfearingsymptomstounderstandingtheinnatehealingabilityofPhysis
torestoreinternalbalanceisneeded.TheaimistoassistPhysisinthehealingprocessand
nottostoporinterruptitsprogress.
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