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  The Premenstrual Syndrome

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By: Joop van Dam, M.D. and Bob C. Witsenburg, M.D.
pgs. 59-65.doc

On the Treatment of the Premenstrual Syndrome, Marjoram Comp. (Menodoron) and the Menstrual Cycle-A Report (Originally printed in the Dutch Weleda Information far Physicians. English by A.C. Barnes.)

In the last two years frequent complaints have been made by patients of what may be characterized as "premenstrual syndrome." They have complained of headache, a feeling of heaviness, and tiredness; they have felt empty, dark, depressive, despairing, almost suicidal; sometimes there have been feelings of depersonalization; and finally there has often been abdominal pain. Ego and astral body lose their healthy relationship to the physical and etheric bodies. In view of the point of time at which the complaints occur, this disharmony of the four bodies must be sought specifically in the processes of the uterus and ovaries.

It became apparent that certain remedies were almost always effective, so that we were led to experience them as specific for this syndrome. Pulsatilla was used as the first remedy, mostly as D12. It is a plant in which light and darkness are in competition: the flower that first hangs down and later straightens up again. The bell-shaped, dark-colored flower shows a profound influence from the astral. The plant is known in homeopathy as a gynecological remedy particularly for women who need to weep a great deal. The light-organism (astral) regulates the fluid- organism (including tears).

This was later joined by Hepar/Magnesium D4 dil. This brilliant idea from Treichler and Wolff has convincingly proved its effectiveness in the treatment of particular forms of depression, being especially helpful in those depressions where there is an underlying lack of vitality or exhaustion. Light (magnesium) and life are restored to the fluid-organism, in particular to that of the liver, and this then extends to affect the rest of the metabolism.

Finally Tormentilla D30 dil. In the ninth case in Steiner and Wegman's Fundamentals of Therapy, the root of this plant (which is of a remarkable size) is regarded as a specific in its effect on the relatively independent part of the ego-organisation that primarily regulates the reproductive organs. Where the relationship of the ego and astral body to the etheric and physical bodies has become blocked (expressing itself, for instance, in amenorrhea and cramps), Tormentilla in high potencies can break through this blockage via the ego-organisation.

Pulsatilla D12/Hepar-Magnesium D4/Tormentilla D30 dil. ana 15 gtts. a.d. TID during the week before menstruation brought about a good alleviation of the premenstrual syndrome in the approximately fifty patients given this treatment.

For marked fluid retention (often with increased headaches), Betula/ Gummi Cerasi 10 gtts. TID was given. When a migraine headache came to the fore. Cyclamen europaeum D3 was indicated.

Here (as with Tormentilla) we have an impressive rootstock, an intense odor, and a number of phenomena indicating a conflict in the plant between light and darkness (purple color and a stem with downward curvature at the end followed by upward-pointing petals). In addition to the medication mentioned above as used in the week before menstruation. Marjoram comp. (Menodoron) was also given, as well as 10 gtts. TID during the second and third weeks of the cycle. In order to clarify the rationale behind this, there now follows a discussion of Marjoram comp. and then of the menstrual cycle itself.

Marjoram comp. (Menodoron). The recipe was conceived by Rudolf Steiner in 1921:

(1) Achillea millefolium (Flores)

(2) Capsella bursa-pastoris (Herba)

(3) Majoran (Fructus)

(4) Quercus rubra (Cortex)

(5) Urtica dioica (Flores)

Decoct or infuse according to the part of the plant used and then take 20% of (1), 15% of (2), 30% of (3), 25% of (4) and 10% of (5). 20% of this mixture in the final preparation. Approximately 25% of alcohol is added to the solution as a preservative. Indications for use: menorrhagia and metrorrhagia. The five plants come from different families:

Achillea millefolium is a composite, an aromatic composite like Calendula and chamomile, but with a strong emphasis on the form. The etheric oil is blue, as is also the case with chamomile. In both cases the blue color can be experienced as an expression of the dominant force, which works upon the metabolic processes. The metabolic processes are aroused but simultaneously given form. Rudolf Steiner calls Achillea a "miracle" of the plant-kingdom for the way in which the sulphur works together with other substances in it, particularly the potassium.

Capsella bursa-pastoris is a crucifer which, compared with other members of the family, is physically not very substantial and only becomes clearly noticeable in its flowering stage and in the subsequent seed-setting stage. The plant has great vitality and grows on bare patches of soil.

As with the other crucifers, the sulphur-process plays an important role, though in this case accompanied by a powerful silicon-process that gives the plant sturdiness.

Origanum majorana is a labiate, a warmth-plant. It is on the watery side within its family: peppermint and balm are drier, while dead-nettle is even wetter. It begins to bloom in late June, and the flowers appear progressively lower on the stem. The astral forces sink deeper and deeper into it, lignifying the stem downwards. The odor is warm but somewhat astringent. The substances of interest are mainly the etheric oils.

The oak belongs to the amentiflores, the catkin-bearers. It occupies a special position among the five plants used in Marjoram comp. (Menodoron) only by virtue of its being a tree. A great power resides in the oak, yet a restrained one. It comes into flower late in the year, the leaves lose their color late, and the foliage is retained for a long time. The restraint is to be seen also in the shape of the leaf. This form of life is expressed substantially in the substances, viz. tannic acid and calcium. The calcium moderates the life- processes where these threaten to get out of hand (see also Ch. XVII of Fundamentals, which discusses the role of calcium in menorrhagia).

Finally, Urtica dioica is a plant of strong rhythmic structure, where the emphasis is on the leaf. "Sie musste eigentlich den Menschen urns Herz herum wachsen, denn sie ist in der Natur draussen in ihrer inneren Organisation eigentlich aehnlich demjenigen, was das Herz im menschlichen Organismus ist" (It should actually grow around the human heart, for it is, in the natural world outside, actually analogous in its inner organization to what the heart is in the human organism.)

The rhythmic man is being addressed, but in his relation to metabolic processes. The sulphur-processes, together with silicon, potassium and especially iron, bring about this alignment. The flowers of the stinging-nettle are used, and the stinging-nettle effect is conducted to the metabolism, to the rhythmic organ in that sphere, the uterus. Rudolf Steiner speaks of the interdependency of heart and uterus in the Course for Young Doctors.

In order to determine the mutual relationships of the plants, or the way in which they complement one another, one may investigate their relationship to the ether-types. Marjoram has, like all labiates, a powerful warmth-ether effect. In Capsella, representing the crucifers, the chemical ether plays an important part. The oak has in its bark the earth aspect of the life-ether. In Achillea, with its deeply-indented leaf ("millefolium" means "thousand-leaved"!), the light-ether is particularly noticeable.

The stinging-nettle has all four ether-types united in it: the life-ether in the lignifying quadrilateral stem, the chemical ether in the typical metabolic processes in the leaf, the light-ether in the sharply-indented leaves, and the warmth-ether (among others) in the exploding seed of the flowers.

As a diagrammatic aid we can place the five plants on the points of a pentagram, with the all-inclusive Urtica at the top:

One could equally imagine a hand with its five digits, each having its own separate and different function, where there is a clear difference between the four fingers and the thumb, just as the oak-bark has a function in the preparation that is clearly different from the four herb-plants.

What all five plants have in common is that they have great vitality and that their life-cycle, in contrast to that of many other herbs, extends over a large part of the year. They arouse powerful, enduring, constructive life- processes. In view of this characteristic, one is led to allow Marjoram comp. (Menodoron) to continue working for quite a long time (months on end).

Decoctions and infusions are made of the plant substances, and these are administered on a percentage basis; both principles indicate that the effect is directed at the metabolic sphere.

The menstrual cycle
In order to get a clear view of the menstrual cycle and its irregularities, we shall attempt to describe it as the result of the action of the upper and lower poles upon the reproductive system.

At the end of the first week of the cycle, the endometrium begins to build up (proliferative phase) as a result of an increase in the estrogens.

At the end of the second week ovulation occurs, with a slight rise in temperature and in progesterones, and the endometrium enters the secretory phase.

At the beginning of the fourth week estrogens and progesterones decrease, and the endometrium begins to become ischemic due to the contraction of the spiral arteries, until on the 28th day the endometrium is shed and excreted into the external world as menstruation, and then at the end of the week the process begins again.

From a hormonal point of view we may regard estrogens and progesterones as construction-initiators of the female reproductive system. The construction begins at the end of the first week and continues until the beginning of the fourth week, i.e. roughly covering the second and third weeks. The destruction phase, expressed hormonally as (among other things) the decline of the two hormones mentioned, covers therefore the fourth and first weeks. Ovulation and menstruation occur in the middle of these two phases respectively.

What can these two phenomena tell us? In the Carpentry-shop Lecture (Der uebersinnliche Mensch in Uns. Das der Therapie zugrunde liegende Pathologische, 1923), Rudolf Steiner urges us to see all processes and events in the body as an interaction between, on the one hand, nerve-sense processes working from above downwards and from outside inwards and, on the other hand, metabolic processes working from below upwards and from inside outwards. As soon as one process threatens to become too powerful, a re- harmonizing or healing occurs, caused by a rebelling reaction from the other pole. Or, as we can see from the example of the splinter, where initially the nerve-sense or destruction processes dominate (splinter in the skin-sphere as being in the domain of the upper pole), the metabolic system subsequently rebels and conveys the broken-off matter outwards (centrifugally) as a suppuration. A physiological example of this is what can happen when one looks into the sun: the impact of the excessively powerful light-processes on the body is brought into balance by an equally powerful reaction from the metabolism, e.g. sneezing. An example from pathology would be damage to the intestinal mucosa, whether by a virus or by a toxic substance, where the metabolism shows a reaction to this intensified destruction process in the form of an excretion to the outside as diarrhea.

Conversely, if initially the metabolic or construction processes dominate (deeper inside the organism, as being in the domain of the lower pole), the nerve-sense system subsequently rebels and conveys the excess of construction materials inwards (centripetally) out of the blood as an incapsulation. In his notebook for that day Rudolf Steiner calls this "being on the way to disappearance from the physical world"! An example of such an encapsulation would be any calculus-formation or sclerosis. Excessive metabolic processes, as exemplified for instance by cholesterol (see Husemann), are excreted inwards by the rebelling upper pole. Like an encapsulated splinter it remains thereafter in the body as an attempt to restore the balance, be it only temporarily.

If we now try to see the phenomena of the cycle as a special case of the above dynamic system, we come to the following conclusions:

m the fourth week when the ischemic phase begins, it takes several days before the destruction has proceeded far enough for a "falling out of life" to be achieved (as a suppuration), and for the metabolic processes, as a result, to have rebelled far enough for them to arrange for an outward excretion in the form of menstruation, so making an appearance in the physical world outside. Conversely, after the second week when the construction has reached a certain strength, there follows a rebelling reaction from the upper pole, leading to an ovulation, i.e. an expulsion (or rather, inward impulsion) into the free abdominal cavity. This cavity is actually not a cavity at all, but a virtual space, an absorbent space, a non-physical, i.e. etheric, space.

Ovulation is actually a disappearance from the physical world (see the splinter case terminology!). It is not without significance that it is precisely with the disappearance from this physical world that a cosmic world becomes accessible (fertilization).

Just as a fever is an intensified activity of the lower pole (reaction) following upon an impulse from the upper pole (action), so is the rise in temperature consequent upon ovulation to be seen as a result of this intensified interaction between upper and lower poles. A normal menstruation, a healthy excretion, without troublesome premenstrual phenomena, can occur only if the lower pole has had its full force in the preceding weeks. If this is not so, the destruction phenomena (feeling of heaviness, fluid-retention, depression, headache) will be observed at the moment that they begin, i.e. at the beginning of the fourth week. (This is analogous to early waking at 3 a.m. when the anabolic phase of the liver has not been powerful enough and the beginning of the catabolic phase simultaneously brings awakening with it. As is well known, Fragaria Vitis comp. (Hepatodoron) is an excellent hypnotic in this case.)

From the above we may now conclude that a healthy cycle can occur only if construction and destruction both have their full force and alternate cyclically with one another.

Hence, a cycle-therapy means a strengthening of the construction in the construction phase in the second and third weeks and a strengthening of the destruction in the destruction phase in the fourth and first weeks.

For these reasons we have given up administering Marjoram comp. (Menodoron) through the whole cycle or in the second half and now give it in the second and third weeks, while Pulsatilla and Tormentilla are given in the fourth and first weeks. This provides a foundation for further individual development of treatment

hi the past year we have treated 26 women along these lines, and most of the complaints by far disappeared during treatment. After stopping the treatment for several months the complaints returned for about three- quarters of the experimental subjects. We realized from this that we must in any case advise a much longer use of this treatment. We must wait and see whether a lasting cycle-regulation will yet be achieved by this means.

Finally, we are well aware that the above is only the beginning of an attempt to see the influence of the four bodies on the cycle and its disturbances in the light of the approach urged in the Carpentry-shop Lecture. We look forward to further discussion and study.

Joop van Dam, M.D.
Julianalaan 21C
Zeist Holland

Bob C. Witsenburg, M.D.
Raamsingel 28
Haarlem Holland

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