Constipation, slow transit

Chapter 22

Constipation, slow transit Summary Essence: A hyper alpha-sympathetic state impairing intestinal motricity. Terrain (1) ANS overactivity with Alpha ≫ Para at the level of intestinal motor complex resulting in (2) slowed intestinal peristalsis, thus reduce frequency of defecation resulting in (3) Constipation

Treatment goals Symptomatic: Enemas, Insoluble fiber Terrain: ●

● ● ●

ANS: ⇓ Alpha, adapt Para to re-establish a proper Para-Alpha relationship, ⇑ Beta (to resolve spasmophilia as indicated) ID: Correct dysbiosis as indicated GI: Supper proper choleresis DRAIN: Hepato-biliary-exocrine pancreatic complex

Sample treatment Adult with yearly prespring constipation with adrenal fatigue pattern (cf. end of chapter for pediatric treatment) 1. Neuroendocrine: 4 mL AM, 4 mL at 4 pm January 18 to March 18 (Table 22.7) Passiflora incarnata MT 80 mL, Ribes nigrum GM 80 mL, Quercus pedunculata GM 80 mL + Satureja montana EO 3 mL 2. Drainage: 3  mL before lunch, 4  mL before dinner (Table 22.8) Raphanus niger MT 60 mL, Carduus marianus MT 80 mL, Agrimonia eupatoria MT 80 mL + Mentha piperita 2.5 mL, Rosmarinus officinalis EO 1 mL 3. Oligoelements: Magnesium chelate 250  mg AM, 250 mL before bed 4. Diet: 4 cups leafy green vegetables per day, cooked or in smoothie, 1 serving of root vegetable per day, fruit or fruit smoothie as desired 5. Lifestyle: If chronic, especially since childhood: Behavioral counseling, biofeedback The Theory of Endobiogeny. https://doi.org/10.1016/B978-0-12-816965-0.00022-6 © 2020 Elsevier Inc. All rights reserved.

Terrain in detail Precritical terrain The primary level of dysfunction is ANS hyperfunctioning at the level of the gastrointestinal tract. This impairs production and excretion of digestive juices, sequencing of actions, and adaptability of motricity. There are numerous permutations of dysfunction. The most impactful are: 1. ANS: overfunctioning alpha and para, with normal or compensated beta at the level of the intestinal tract 2. Emunctory stress: individually or in some combination a. Liver metabolic b. Gallbladder choleresis > cholagogy c. Exocrine pancreas 3. Fragilized regulation of intestinal microbiotic, viz. intermittent a. Flatulence b. Bloating c. Post-prandial fatigue 4. Endocrine: may be overfunctioning

Agent The aggressors are numerous but typically include one or more of the following: 1. Adaptative stressors: major and/or persistent a. Physical trauma b. Grand phase transitions: post-natal, growth spurt, adolescence, gonadopause, etc. c. Seasonal and circannual adaptation 2. Adaptive or adaptative stress: Emotional and/or mental 3. Adaptive or adaptative requirement for nutrients a. Small intestines: Hydrolysis b. Large intestines: Absorption (cf. Appendix 1: Essential physical exam images and The Theory of Endobiogeny, Volume 3, Chapter 10) 4. Insufficient intake of insoluble fiber

Critical terrain 1. ANS: Hyperfunctioning Alpha ≫ Para; Beta: blocked or delayed (spasmophilia)

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Mechanisms 1. Delayed motricity of intestines at the level of motor complexes and musculature 2. Impaired excretion of digestive juices, further delaying motricity to allow time for digestion

Result Constipation: prolonged transit time with excess absorption of moisture from stool: strained defecation < 3 per week

History and BoF findings During acute constipation, the patient will have had 2 or less stools in 1 week, with no sense of urgency. There will be increased strain during defecation, with complaint of lower abdominal fullness, and sometimes, a feeling of “toxicity.” Some possible correlations between precritical symptoms and Biology of Functions are presented in Table 22.1.

Physical exam and BoF findings During presentation with slow transit constipation, there are four levels of evaluation to be performed in the following order (Table 22.2): 1. ANS hyperfunctioning: local, regional, or global.

TABLE 22.1  Precritical terrain symptoms and Biology of Functions correlations. Area

Finding

Terrain

Stool Frequency

Less than 3 bowel movements per week

cf. above

Defecation quality

Difficult to pass with straining

cf. above

Abdomen

Abdominal fullness, colo-rectal fullness

Large or hardened stool distending colon

ANS

Alpha: anxious, emotionally sensitive; History: GERD, gastritis, constipation, insomnia Para: Introverted, shy, timid, increased salivation, lacrimation, sweating

⇑ Alpha

BoF

↑/↓ LMI, ↓ PMI

⇑ Para

Key: LMI: Leukocyte mobilization index; PMI: Platelet mobilization index.

2. Emunctory digestive gland dysfunction (cf. Appendix 1: Essential physical exam images) 3. Colon tenderness: indicative of central endocrine dysfunction (cf. Appendix 1: Essential physical exam images) 4. Endocrine dysfunction: a. Adaptative or adaptability: cortico-thyrotropic response to alpha-sympathetic b. Dysfunctional response by individual or coupled axes (The Theory of Endobiogeny, Volume 1, Chapter 10) according to the adaptive needs of specific types of tissues and the associated endocrine axis For evaluations 1–3, exam finding with some possible Biology of Functions correlations (Table 22.2) is presented. For the fourth level, refer to Section 2: Essentials of history, exam and Biology of Functions and The Theory of Endobiogeny, Volume 2, chapters 1,2, 10, and, Volume 3, chapters 3 and 6).

Treatment In the treatment of normal transit constipation, there are numerous symptomatic treatments, focused primarily on evacuating the stool already formed and difficult to pass. They can be stratification based on severity of symptoms (Table 22.3). Based on an Endobiogenic reflection, an elaboration of this approach to treatment is as follows: 1) Urgent a. Stimulant laxatives i. Short-term relief from constipation, can cause bloating, gas, spasmophilia. b. Glycerin suppository i. Hyperosmotic lubricant, for occasional use in all ages, up to 3 times per week c. Treatment of anal fissures: i. Ingredients: 1 tsp peanut oil, diatomaceous earth to make paste 1. Burning pain: add 1 pinch Sodium bicarbonate 2. Infection: add 1 drop Lavandula angustifolia EO ii. Instructions: Anus: clean, pat dry, apply 2–3 times per day after defecation 2) Timely a. Hydration: i. Lemon juice treatment (see The Theory of Endobiogeny Volume 3, Chapter 10) ii. Insoluble fiber: fruit and vegetable smoothies (with skin pulp): 8–16 oz (240–480 mL) per day in divided doses: b. Monodiets (cf. Chapter 44: Endobiogenic diets and nutrition) i. Grape cure ii. Apple-sardine iii. Fruit-Vegetable-Brown rice diet

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TABLE 22.2  Critical terrain signs and Biology of Functions correlations. Area

Finding

Terrain

BoF

ANS local

Mouth: Saliva stringy ± dilated opening of canal of Stensen; Colon: Palpable stool in distal colon; abdominal distension

Alpha ≫ Para

⇑/⇓ LMI

ANS regional

Pelvic congestion: Feet cooler than hands

Alpha ≫ Para

⇑/⇓ LMI, ↓Pelvic congestion

ANS global

Skin: Pale, cool, moist; Eyes: spiculated rosette; Lips: dry; Palate: pale; Hands or feet: cool ± moist

Alpha ≫ Para

↑ Thyroid relaunching, ↑ Thyroid relaunching corrected

Liver

Tender, superior-medial Tender, inferior-lateral

Vascular hepatic congestion Metabolic hepatic congestion

⇑/⇓ LMI ⇑/⇓ LMI

Gallbladder

Tender: Murphy’s point, left superior tibia

Congested

Pancreas

Tender, above umbilicus Tender, right of umbilicus Tender, left of umbilicus

Congestion: general Over-solicitation: exocrine Over-solicitation: exocrine

N/A ⇑/⇓ Somatostatin N/A

Colon

Tender: reflection points

Colon over-solicited

Varies

Key: LMI: Leukocyte mobilization index; PMI: Platelet mobilization index.

TABLE 22.3  Overview of symptomatic treatment based on severity of symptoms. Priority

Symptoms

Treatment

Rational

Urgent

Feeling of toxicity, aggravation of other conditions Complications, e.g., anal fissure

Laxative Hyperosmotic Cicatrizant

Stimulate contraction of colon Hydrate stool Heals wound

Timely

Chronic, discomforting but tolerable

Monodiet, Hydration

Acutely increase fiber and fluid intake

Chronic

Intermittent or frequent

Diet Lifestyle Medicinal plants

Regulate the Endobiogenic terrain

3) Chronic a. Regulate ANS (Table 22.4) b. Regulate Endocrine terrain (varies) c. Diet i. High-insoluble fiber foods 1. Fruits: with skin and pulp, raw or as compote 2. Vegetables: root (sweet potatoes, yams, carrots, parsnips, etc.), leafy green raw or lightly steamed ii. Fermented foods (for dysbiosis) d. Long-term regulation of stool quality (cf. Chapter 21, Table 21.5) e. Drainage (cf. Chapter 21, Table 21.6) f. Regulation of dysbiosis (cf. Chapter 21, Table 21.7) g. Lifestyle: regulate autonomic tone and colon motricity

i. Movement: biofeedback, exercise, yoga, meditative movement ii. Sleep: Restorative, before midnight, 6.5–8 h per night

Exemplary prescriptions Based on an Endobiogenic approach to slow transit constipation, a number of prescriptions can be derived. Two sets of exemplary prescription are presented, one each for child and adult. 5-year-old girl: Constipation, anger issues, insomnia 1. ANS: 2 mL, 3 times per day: AM, after school, before bed (Table 22.5) Tilia tomentosa GM 50 mL, Rosmarinus officinalis GM 10 mL

162 SECTION | C  Assessment and treatment of common disorders

TABLE 22.4  Medicinal plants for ANS regulation. Plant

Alpha-lytic

Antihistamine GI

Matricaria recutita MT, EO

•

•

Rosmarinus officinalis EO

•

•

Citrus aurantium (Neroli) EO

•

Melissa officinalis MT

•

Origanum majorana (Marjoram) EO

•

Anthemis nobilis EO

•

Agrimonia eupatoria MT

•

Plantago major (Plantain)

•

Fumaria officinalis (Fumitory) EO

•

Para-mimetic

Beta-mimetic

•

Syzygium aromaticum (Clove) EO

•

Mentha piperita EO

•

Satureja montana (Savory)

•

Cinnamomum zeylanicum

•

Key: EO: Essential oil, GM: Gemmomacerate, MT: mother tincture.

TABLE 22.5  ANS prescription for children. Plant Tilia tomentosa GM 50 mL

Replacements and alternatives Ilex aquifolium GM, Crataegus oxyacantha GM

Rosmarinus officinalis GM 10 mL

TABLE 22.6  ANS-drainage prescription for children. Plant

Replacements and alternatives

Agrimonia eupatoria 40 g BH

Plantago major

Matricaria recutita 40 g BH

Rosmarinus officinalis

Mentha piperita 40 g BH

Fumaria officinalis, Matricaria recutita

2. ANS-Drainage: ½ tsp of mixture steeped 4–6 minutes in 120 mL water, drink three times per day in divided doses before meals (Table 22.6) Agrimonia eupatoria 40g BH, Avena sativa 40g BH, Mentha piperita 40g BH 3. Topical Essential oils: Apply to abdomen twice daily: AM and before bed in a centripetal motion from umbilicus, then in a “U” shape following the anatomical

progression of the colon from ileocecal valve to sigmoid colon. Perform each sequence three times before starting the next Origanum majorana EO 2 drops, Lavandula angustifolia EO 1 drop, Rosmarinus officinalis EO 1 drop in 2 tsp carrier oil. 4. Diet: Inulin fiber added to food or drink, Fruit compote for desert 5. Lifestyle: (a) If power struggle with parent over stooling: dyadic behavioral counseling; (b) General: Bodysensing and awareness skills to avoid with holding Adult with yearly prespring constipation with adrenal fatigue pattern 1. Neuroendocrine: 4 mL AM, 4 mL at 4 pm January 18 to March 18 (Table 22.7) Passiflora incarnata MT 80 mL, Ribes nigrum GM 80 mL, Quercus pedunculata GM 80 mL + Satureja montana EO 3 mL 2. Drainage: 3 mL before lunch, 4 mL before dinner Raphanus niger MT 60 mL, Carduus marianus MT 80 mL, Agrimonia eupatoria MT 80 mL + Mentha piperita 2.5 mL, Rosmarinus officinalis EO 1 mL 3. Oligoelements: Magnesium chelate 250  mg AM, 250 mL before bed 4. Diet: 4 cups leafy green vegetables per day, cooked or in smoothie, 1 serving of root vegetable per day, fruit or fruit smoothie as desired 5. Lifestyle: If chronic, especially since childhood: Behavioral counseling, biofeedback.

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TABLE 22.7  Neuroendocrine prescription for adults. Plant

Replacements and alternatives

TABLE 22.8  Drainage prescription for adults. Plant

Replacements and alternatives

Passiflora incarnata MT 80 mL

Matricaria recutita MT, Scutellaria latiflora MT

Raphanus niger MT 80 mL

Cynara scolymus MT 40 mL + Secale cereale GM 40 mL

Ribes nigrum GM 80 mL

Eleutherococcus senticosus MT

Carduus marianus GM 80 mL

Taraxacum officinale MT

Ribes nigrum GM + Rosa canina GM

Agrimonia eupatoria GM 80 mL

Plantago major MT

Quercus pedunculata GM 80 mL

Mentha piperita 2.5 mL EO

Carum carvi EO

Satureja montana 3 mL EO

Cinnamomum zeylanicum EO

Rosmarinus officinalis 1 mL EO