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  The Digestive Tract In Relation To The Threefold Nature of the Human Organism
  

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By: Heinz-Hartmut Vogel
(Original title: Der Verdauungstrakt in seiner Beziehung zur Dreigliederung des menschlichen Organismus. Merkurstab 1995; 48:396-404. English by A. R. Meuss, HL, MTA.)

Dr. Vogel crossed the threshold on 2 August 1995. This essay, revised for print by Dr. Vogel himself, is published in gratitude for all the work he has done and the impulses he has given the field of anthroposophic medicine.

The symbol of Asclepius' staff, the golden rod of Hermes with the two serpents twining around it, one up and one down, provides a background which may help us to understand the function of the digestive tract as it is presented in this essay. If we consider the organism in its polarity between head, senses and nerves at one extreme and metabolism and limbs at the other, the digestive tract may be seen as taking up the processes connected with senses and nerves and accompanying them all the way down to the rectum.

Conversely, the digestive tract takes the metabolic processes upward, connecting them with the sensory process which is active in the region of head, throat and mouth.

In the language of Paracelsus, the pole of senses and nerves and, hence, the beginning of the digestive tract is subject to a Sal process, the metabolic pole of the digestive tract to the Sulfur principle. Sal process was the term for degradation and elimination of matter, coupled with the emanation of vital energies as the basis for sensory perception. The term Sulfur covered the synthesis and incretion of matter and the development of organs. The vital organization moves into the synthesis of matter. We thus have two polar opposites - the neurosensory Sal pole with secretion and excretion, and the metabolic Sulfur pole with incretion and synthesis. Between these poles we have the actual process of conversion of matter as a middle process, m Paracelsian terms this middle process is the Mercury principle. Sal, Mercury and Sulfur are thus the vital principles on which the whole digestive tract is based.

Except for its very first part (oral region) and its end (anal region), the digestive tract has developed from endoblast (endoderm). The essential parts thus belong to the substance pole in the organism, embryologically deriving from the yolk sac.

The anterior part of the oral cavity and the anal part of the rectum derive from the ectoblast, the bearer of the sensory organization. Relatively speaking, this gives the beginning and end of the digestive tract "sense organ character."

Morphologically, sense organ development (arising from the mesenchymal system) includes the evolution of a plexus of veins. Thus, the eyeball is surrounded by the vorticose veins, the base of the brain by the mighty transverse and cavernous sinuses, the spinal marrow by the internal vertebral plexuses.

The beginning and end of the intestinal tract are similarly surrounded by dense venous plexuses - the pharyngeal and esophageal-pharyngeal venous plexuses in the region of mouth and pharynx, and the pterigoid plexus in the anterior buccal cavity, with the internal nasal, deep temporal and meningeal veins draining into it, the latter intensely related to the cavernous sinus. This establishes the developmental and topographic relationship to the ectoblast and, later, the anterior buccal cavity.

At the opposite pole, in the rectal region, the ectodermal sensory organs of the outer skin extend into the rectum for a distance of about 2 cm. This is, above all, the site of the rectal venous plexus, which has an internal and an external part. The internal plexus essentially drains into the portal vein, the external part into the lower vena cava. The rectal muscles also show this dual aspect, with an inner layer of smooth involuntary muscle and an outer one of striated muscle under voluntary control. The rectal venous plexus communicates with the important pelvic plexus, the vesical venous plexus and, above all, the uterine and vaginal plexuses, a situation similar to that seen in the buccal cavity. Equivalent venous sinuses exist for the male pelvic organs.

The rest of the gastrointestinal tract has no comparable venous plexuses nor the kind of giant capillaries seen in the papillary layer of the skin or the parietal pleura in the lung.

Passing reference may be made to venous nature taken to the point of stasis in the area surrounding a sense organ and to the significance this has in the physiology of the senses. Exhalation of live carbon dioxide in the area around a sense organ goes hand in hand with a process of "liberation", mainly of light and warmth ether forces that prove the basis for sensory activity. Wherever this process is found we are able to speak of sense organ-type "perception". Here, an organic function may be mentioned that is connected with the generation of live carbon dioxide in the sphere of renal function. Incomplete vitalization of carbons in connection with internal renal function causes adequate amounts of live energy to be liberated as carbon dioxide is given off at the periphery of sense organs. We thus have a double exhalation in the sphere of the sense organs - carbon dioxide in the process of becoming physical on one hand, and living etherization on the other.

Beyond the oronasopharyngeal space comes the "actual" digestive tract -esophagus, gastric cardia, pyloric and duodenal region, jejunum, ileum and large intestine.

Let us now consider glandular functions. The salivary glands are still part of the head and senses pole of the digestive tract. In the same way we have sweat and sebaceous glands in the ectodermal part of the rectum, and mucus-producing glands deep down in the folds of the mucosa. These may give rise to anal fistulas, which may be seen as a degenerative form of "sense organ development" (Silica treatment of anal fistulas).

The salivary glands in the oral vestibule, in the early stages of development extending to the base of the skull as the primordium of the inner ear or tympanic cavity develops (the oral aperture runs from primordial ear to primordial ear and to the angles of the mandibles at the early embryonic stage) develop from the ectodermal part of the buccal cave - submandibular, parotid and major sublingual glands. The epithelium grows inward from outside. Because of this, efferent ducts are sometimes well away from the main gland, as in the parotid. In the present context, it is important that nerve supply, gustatory and salivary gland nerves, above all the chorda tympani and the intermediate nerve, run with the facial nerve through the tympanic cavity. The "gustatory nerves" (facial and vestibulocochlear nerves) above all supply the sublingual and palatine glands and also the tear glands. The chorda tympani (sensitive sensory and secretory) owes its name to the course it takes and to immediate vicinity to the medial wall of the ear drum. Sense of taste and sense of hearing thus come close functionally and in sensory terms. Rudolf Steiner spoke of the "chemical" or "sound" ether. From this point of view, the soul principle and the conscious mind intervene into the chemistry of substances via the salivary glands when we taste things. The sound ether is released in the ear.

Saliva (1 or 2 liters produced daily) has a high concentration of bicarbonate which makes it alkaline up to pH 10, especially if the vagus or the chorda tympani is stimulated. Saliva production is thus closely bound up with the emotional life. Greater alkalinity results in "parasympathetic", thin saliva, sympathetic tone in mucous saliva. The pH may show daily variation from 5 to 8.5 (muscarine, pilocarpine, physostigmine, choline and tobacco cause increased secretion).

Taste sensations cover mainly sweet and salty. The range seems typical for ego activity in the sense of taste. A spontaneously-occurring bitter taste is already pathologic. Dryness and increased salivation point to psychosomatic swings of the pendulum with a bias to either sympathetic tone or parasympathetic tone.

Let us now turn to the colon at the opposite pole of the digestive tract. The pH of normal stools in adults is between 7 and 8.7. Secretion of fluids is reduced (100 ml/day). Absorption of fluids is dominant, with the intestinal contents driven in the physical, mineral direction. Apart from undigested food particles (above all cellulose) stools contain 30% of bacteria (up to 42% of the dry matter). In healthy breast-fed infants, the large intestine still shows the same conditions as the small intestine, with a slight lactic acid milieu due to dominance of bifidus flora which plays a part in symbiotic production of vitamin B (e.g. aneurine) (betalactose encourages the bifidus flora). We may say, therefore, that the whole of the large intestine and - as we have seen - above all the rectum take the intestinal contents into a physical, mineral state, and it would be reasonable to say that the vital processes of the chemical and life ethers are dominant. Secretion gives way completely to "incretion". This reflects the suction exerted by the chemical ether deriving from the liver. The whole of the large intestine is thus subject to the distant action of the liver process. Extremes such as loss of fluids from the large intestine and its opposite, extreme drying up of its contents, indicate disorders of the liver process. Chemical processes, which in the sphere of the salivary glands provide the basis for the secretion of large volumes of fluids, have the opposite effect in the large intestine, with the as yet fluid intestinal contents taken into the liver via the portal vein system. This reflects the interiorizing function of the liver. As a "vitamin B producer" (chemical ether) the liver is the etheric basis of nerve development and processes of consciousness. Early emphasis on, and challenge of, powers of conscious awareness in early childhood can increase the forces of the chemical and life ethers in the organism and hence hepatic function so such an extent that the vital processes taking place in the fluid sphere are withdrawn from the organism (liver-based drying out of the organism; homeopathic drug pictures of Lycopodium and Alumina).

The esophagus - The length of the esophagus from the pharynx, the narrowest part, to the cardia is 22-25 cm in adults (mouth to stomach 37-41 cm). The opening (os) is reminiscent of sensory function in so far as there is a particularly dense venous plexus beneath the mucosa at this point. Mucous glands continue the salivary gland function in the upper part of the esophagus, though now without taste sensation, Innervation: glossopharyngeal nerve forming a plexus with vagus and sympathetic nerve.

Similarly to the small intestine, the esophagus is in constant motion at its commencement. The rhythmic peristaltic movement, running through the esophagus like a contractile wave on deglutition, reveals the interplay of contraction and expansion, of the soul principle coming in more strongly (contraction) and emphasis on the etheric (expansion).

This dual process also predominates in gastric function and, above all, the whole of the small intestine. The large intestine finally stabilizes the rhythm even to the point of haustration. This gives expression to the physical space and form principle taking effect in the large intestine.

The stomach - In the region of the mouth and oral glands, the etheric, fluid principle and, therefore, weak alkalinity predominate, In the gastric region, the sentient organization intervenes more strongly in the fluid process and acids are produced. Gastric activity consists primarily in partial digestion of proteins with pepsin in an environment of pH 1.5. Secretion is mainly from the chief cells of the glands in the fundus. Cathepsin activity at pH 2.0 - 5.0. Mucus production at pH 5.0 - 7.0. Calcium, magnesium, sodium and potassium secretion is subject to similar conditions as in the blood. Characteristically gastric acid production in the stomach increases with the changes that occur in the soul at puberty and decreases with old age. Dependence of gastric acid production on the psychological state is characteristic of the stomach.

Psychosomatics of the stomach
It is known that gastric function, gastric juice production as a whole and acid production in particular depend on the emotional state. The question is whether the stomach is an independent organ or if its development and function are governed by a principal metabolic organ. Considering the whole symptomatology of gastric function, we note the characteristic influence of the sentient organization. Emotions and psychological stresses result in characteristic gastric symptoms. The stomach becomes an organ for the perception of the whole sentient organism. This, in turn, is closely bound up with, and has organizing functions in, the arterial blood processes and, beyond this, in the sphere of the kidney organization. The whole respiratory human being - both external respiration and internal tissue respiration - is closely connected with kidney function. Acid production is an expression of this, rather like footprints left by the soul principle. Gastric acid production and acid production connected with minor changes in tissue pH are, thus, polar to each other, going in opposite directions (muscular rheumatism frequently goes hand in hand with gastric sub- or even anacidity).

Hyperacidity must, therefore, be seen in conjunction with kidney function. Extreme ultrafiltrate production in the kidneys and resorption of this into the blood can lead to secretion, above all in the gastric region, in the sense of Volhard's "pronephros function". This is connected with continuous loss of connective tissue fluid from the blood. The symptom goes hand in hand with loss of tone in the sphere of the blood, with extremely low blood pressure, sometimes vertigo, peripheral cardiovascular disorders, and extreme thirst. The stomach may be said to be an organ that reacts to renal function. Whereas the walls of the stomach lie loosely against each other in a healthy subject, a bladder form develops in this case, and corresponding symptoms of a gastrocardiac syndrome. Air in the stomach - and in the intestinal tract - with increased eructation and singultus are kidney symptoms. Treatment: if these symptoms go hand in hand with general pallor and cyanosis, especially of the lips, treatment of the kidneys with Carbo vegetabilis and/or Veratrum album is indicated. The connection between excessive gastric juice production and ultrafiltrate, in some cases 8,10 or even 15 liters a day, also derives from the above-mentioned electrolyte content which, in the renal ultrafiltrate, too, is equivalent to that of blood serum.

Duodenum - In a rhythm, the laws of which become apparent in successive sections of the digestive tract, the acid stomach environment is followed by the relative alkalinity of the duodenal contents. This is largely due to the 1 or 2 liters of pancreatic juice produced daily. The optimum pH of the pancreatic enzymes is      lipase pH7, amylase pH6, proteins pH 8 -11 (!)

The thin pancreatic juice contains proteins, its overall pH is 8-9, the taste salty. The average daily 500 ml of bile produced contributes to the duodenal alkalinity in spite of the 1-2 g of bile acids it contains (produced from 20-70 mg/100 ml of cholesterol, the mean pH being 8 (biliary fistula).(1)

A physiologic polarity exists between bile and pancreatic enzymes. With the pancreatic enzymes, active chemistry goes out into the duodenal region, with the bile, substances that have dropped out of life in erythrocyte degradation are eliminated into the intestine. According to Rudolf Steiner both processes, fourfold pancreatic secretion and biliary secretion to the outside, reflect primary "ego activity". The destruction of red cells and liberation of, above all, heat energy in the internal and external bile ducts is a physiologic warmth-ego process (temperature in the gallbladder distinctly above that of the blood). The fourfold pancreatic secretion and the high bicarbonate concentration (salts), on the other hand, reflect comprehensive, immanent activity of the whole vital life organization governed by ego activity.

Let me add at this point that embryologically the hepatic and biliary system, on one hand, and internal secretory and excretory pancreatic system on the other each derive from two endodermal structures. This is a process of organogenesis which also applies to the rest of the organism. One principle here produces an excretory and an incretory organ development. In the case of the pancreas, this is clearly reflected in the development of the acinous head and part of the body, on one hand, and the incretory activity located mainly in the tail on the other. In the case of the liver and gallbladder, an excretory organ develops that begins with the hepatic parenchyma and extends to the gallbladder, whereas the liver itself becomes the largest "incretory" organ in the organism.

"Incretion" here means synthesis and anabolism; "excretion", in this case into the intestine, the degradation and destruction of matter.

The duodenum is, thus, the mid-region of the whole digestive tract, governed by the ego organization in two respects.

Jejunum and ileum - As the digestive process passes into the jejunum and ileum, we reach the actual Mercurial part of the digestive system as a whole. This is also apparent from the motility and contractility or capacity for expansion in the whole of the small intestine. Another characteristic of the small intestine is the very slightly acid environment created by the Acidophilus flora. Acidophilus bifidus predominates in breast-fed infants, which gives the stools a pleasant, slightly acidic, yoghurt-like odor (anaerobic lactobacilli play a role in aneurine (vitamin B) production.) A healthy intestinal flora is, therefore, physiologic in the small intestine.

Comparing lengths: duodenum c. 30 cm, adult jejunum and ileum 5 meters on average. We shall not go into the specific glandular situation at this point - Brunner's glands, glands of Lieberkuehn.

Jejunum and ileum are the Mercurial region of the whole digestive process in the small intestine. The fluid principle is dominant, with some emphasis on the "sulfuric" character of this intestinal region. This covers the production of chyme, liquefaction of intestinal contents and first stage of absorption into and through the villi which considerably enlarge the surface area of the intestinal wall. The sulfuric character is also evident from the fact that the number of white cells - "sign of inflammation" - increases in the intestinal walls and villi as digestion proceeds. The daily volume of intestinal fluid is estimated to be three liters. Appearance: turbid, milky, because of the presence of white cells, epithelial cells and mucus. The fluid is approximately isotonic with blood. The high sodium bicarbonate concentration makes the environment slightly alkaline in the ileum. In breast-fed infants, the bifidus flora makes the contents slightly lactic. In adults, the contents of the small intestine should give a neutral reaction. A move to the alkaline range suggests infiltration by coli bacteria. The pH is thus distinctly acid (6.2-6.7) in the region of the jejunum and neutral or just slightly alkaline at the transition from ileum to large intestine. The intestinal motility throughout the small intestine is characteristic of Mercurial activity. It is a rhythmic pendulum swing within the individual segments. In purely external terms this leads to intense mixing of chyme and digestive juices. The movements of the villi are also rhythmic. The mixing movements are said to be up to 10 a minute, continuing for up to 6 hours. The filling of the intestine is governed by the parasympathetic, emptying and immobilization by the sympathetic system. The term autorhythmia is used. After a period of c. 6 hours (see above) the small intestine empties through the ileocecal valve into the large intestine, which happens in portions. The underlying dynamics of the whole digestive process may be seen as follows.

Upper part of mouth, esophagus and stomach: gradually decreasing sensory perception as regards both glandular function and neuropsychologic dependence.

Duodenum: polar function of ego activity, giving impulses to the whole of etheric activity (extreme degradation via the biliary system, with mineralization of live matter; on the other hand ego activity entering into the whole of pancreatic glandular activity). The day and night rhythms in both bile production and pancreatic islet function have significance as ego rhythms. Chyme production in the jejunum and ileum is dominated by Sulfuric activity, which is metabolic in the true sense, but in terms of a Mercurial physiologic function relating a) to pendulum swings and b) to dissolving, absorptive vital activity. The influence of absorptive hepatoportal activity and a dominant lymph organization govern digestion in the small intestine. Starting from the lacteals in the intestinal villi and continuing with large chyle vessels and intestinal lymph glands as far as the thoracic duct, the lymphatic system comes to the fore in the region of the small intestine. It, and the production of chyme and chyle, may thus be seen as the Mercurial principle in small intestinal digestion. The increase in white cells also relates to this.

Generally speaking, small intestinal digestion has its "head" in the duodenal region and its "end" in the region of the ileocecal valve, between the opposite poles of the stomach with its highly acid environment and the large intestine with its on-the-whole distinctly alkaline character.

The Mercurial character of the whole small intestine - duodenum, jejunum and ileum - bases on interaction and Mercurial blending of the chemical, fluid and psychological, airy elements. The etheric and sentient organizations interpenetrate, similar to the process seen with saponins in nature, and emulsify the chyme. Separation of fluid and airy principles indicates Mercurial weakness. Mercury has the dual quality of droplet formation and sublimation, i.e. transition into the gaseous state at normal temperatures. This range in physical properties seen in the element mercury is reflected by the emulsication of small intestinal contents - between "droplet formation" (aqueous phase) and generation of gases. Taking an overall view, the small intestinal processes lie between the concentrative fluid phase connected with the liver process and the breathing psychological phase dominating the small intestine, too, from the kidneys. Pathologic generation of gases, weak/pathologic kidney function and pathological production of fluids indicate failure of the emulsifying process which is governed by the ego organization. Inactivity of the sentient organization in the gastrointestinal region signifies excessive perceptive activity and consciousness of the organization in the sphere of senses and nerves.

Apart from the main symptom of increased generation of gases and a tendency to thin, liquid stools there must therefore also be corresponding signs of excitation in the sphere of senses and nerves: restlessness, hyper-sensitivity to sense impressions, neurasthenic symptoms. Treatment must be in accord with this. Generally speaking, medicines relating to both kidneys and nerves should induce the sentient organization to become involved in the fluid process, above all in the intestinal region. Two examples are Khus toxicodendron and Chamomilla. The function of the ego organization, above all in the duodenal region as described above, needs to be strengthened. This can be done by stimulating both biliary and pancreatic functions. Example: Cichorium/Pancreas/Stibium comp.(2)

The colon
The colon is 1-1.4 meters long (cecum c. 7 cm) and marks the beginning of the part of the intestine which, unlike stomach and small intestine, is no longer involved in the actual process of digestion. Secretory process do, however, occur here (mucous glands secreting dense mucilage with the relatively high, alkaline pH 8.4). The thickening of the intestinal contents is essentially with reference to water and salts. Almost the whole (500 ml) of 600 ml water is absorbed.

Characteristic structures in the colon are the longitudinal bands known as taeniae coli, the haustra, the vermiform appendix and the epiploic appendices (tabs of fat). We have already referred to haustration in conjunction with the nature of peristalsis in the esophageal region where every bite swallowed is pushed along by itself, as it were. The situation is similar in the large intestine, but more in the direction of spatial development, with the haustra presenting as a kind of static, tied-off element. Rapid peristalsis causes folds to develop in the inner large intestine that, from outside, appear as haustra. They divide the intestinal contents into portions. Together with re-absorption of water (v. s.) and the increasingly physical nature of the intestinal contents, the process in the large intestine is, functionally speaking, a Sal process. As already stated, this comes to a culmination in the tendency to develop sense organs in the rectum. The stomach may be seen as an organ reacting to the kidneys; the whole small intestine as interaction between fluid, etheric (lymph) and psychological, breathing organization (emulsincation) and, therefore. Mercurial; and the whole large intestine as a distant organ of the hepatic and portal system. The motility, i.e. movements of the large intestine showing extreme partial contractions (haustration), shows interaction between expansion and contraction, like all peristaltic movements, emphasis on etheric and sentient organism activity, though in the large intestine this reaches the borderline of physical organ development. The fluid content or, conversely, the drying out of large intestinal contents is connected with the portal and hepatic system's power of interiorization (incretion). Raccidity, especially of the large intestine, may go as far as atony or poor rectal development (megacolon) and indicate weakness of shape and form even in the liver region. Because of this it is possible to treat atony in particular with a "liver medicine" such as Stannum. The uniform liver process within a highly fluid principle is then subject to imposition of form (see also cirrhosis). The three taeniae coli and the haustration express the process of becoming physical anatomically and physiologically. Compared to inadequate ensoulment and breathing-through of the small intestine (v. s.), the choice of medicaments must take account of the connection with the liver. We have already mentioned two characteristic liver medicines connected with drying out of large intestinal contents - Lycopodium and Alumina.

In differential therapeutic terms, a very different pathologic situation has to be considered if there is a tendency to diarrhea. This is because the small intestine, with its emphasis on etheric, fluid, lymph-related function, is particularly liable to develop "nerve development in the wrong place". A specific such as Arsenicum album needs to be considered in that case.

Summary
The whole digestive tract has been considered against the background polarity of neurosensory and metabolic organization. The interaction of etheric and astral organization thus comes to expression in the different sections of the digestive tract. The whole digestive tract is framed, as it were, in polar fashion by a tendency to develop sense organs in the region of mouth and pharynx, on one hand, and in that of the rectum on the other. Different pH levels in the sections also reflect intervention of soul principles (acidity) or etheric principles (alkalinity). The warmth organization of the ego is involved in this interaction, starting from the duodenum at the center of the digestive tract where we have the functional polarity of biliary and pancreatic activity. The "actual" digestive principle is active in the small intestine, where the Mercurial character of the whole digestive process is dominant -emulsification of intestinal contents (chyme) through interaction between fluid, etheric and psychological, airy principles. Digestive disorders essentially reflect the organic function of the section concerned:

Duodenum: polarity between biliary and pancreatic function.

Jejunum and ileum: lymphatic system relating to portal and hepatic function on one hand and respiration in conjunction with renal function on the other.

The large intestine has been presented to show resorption of water and salts to be under the distant influence of the liver, so that one-sided developments in large intestinal function may initially be treated via the liver.

Heinz-Hartmut Vogel, M.D.

Notes
1 Vogel HH. Die Bauchspeicheldruese. Die Leber. Wala publications.
2 Cichorium/Pancreas comp. (Wala). See Wege der Heilmittelfindung. Eckwaelden: Natur Mensch Medizin.





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