Ласточек нужно столько, сколько нужно

А сколько нужно, не ответит никто. Хотя я могу ответить:"Нужно столько, сколько людей будет вовлекаться в ласточкины орбиты". И причина проста - никто не учится на ошибках чужих.
Поэтому ошибки будут и будут повторяться, и каждый раз сначала.

Сколько еще нужно этих ласточек?

Очередная "ласточка" прилетела из J Am Geriatr Soc 2008; 56:1853-1859.
Оказывается, для пожилых лучше, когда систолическое артериальное давление больше 140 мм рт ст и хуже - когда меньше 120 мм рт ст. Во втором случае растут частоты деменции, сердечной недостаточности и смерти.
Оно и понятно, но не понятно, почему непонятно, что хотя "любви все возрасты покорны", в каждом возрасте она (любовь) своя, или по своему. Как больше нравится.
Медленно и пока еще неуверенно "наш паровоз" поворачивает в сторону возрастной нормы, которая, ой как отличается у лиц старшей возрастной группы.
Что еще надо сделать, сколько еще нуно ласточек, чтобы миром правил его величество случай?!

Unknown in English Media View on Mechanisms and Management of Acute Myocardial Infarction

Unknown in English Media View on Mechanisms and Management of Acute Myocardial Infarction
Yabluchansky Mykola (Nikolay)
Internal Diseases Dept. of School of Fundamental Medicine of Kharkiv Karazin National University (Ukraine)

The object of this publication is to present unknown in English media my understanding of acute myocardial infarction (AMI), that was developed at last two decades of previous century. This understanding is based on insight on AMI as one of types of acute inflammation.
Definition
AMI is a disease or a clinical syndrome accompanying other diseases, which is represented by acute coronarogenous aseptic inflammation of the part of a heart wall, and clinically correlates with stress reactions of body control systems and is determined by the extent, localization, nature, and stage of structural transformations in the infarction zone, as well as circulation changes, and their consequences.
'Myocardial infarction is coronarogenic myocardial necrosis', this inaccurate formulation travels with small variations from one book to another.
In terms of pathology, it may still be true. Though, even there, it is far from being accurate - infarction equals myocardial necrosis only if an inflammation reaction is absent and a necrotic tissue is never substituted with the granulation one. So, a patient dies early. But what we can say about the rest of patients? Is it not infarction any more? For example in case a patient dies during sub acute period AMI only granulations are found in the place of necrosis [1].
Everybody agrees that AMI goes clinically through the most acute, acute, sub acute, and post myocardial infarction periods. This is reflected in circulatory disturbances in the infarction zone, ischemia, first still reversible, then irreversible, necrosis, and the connective substitution of a necrotic myocardium with cicatrisation (of course, through inflammation, what can be the other way?) [3, 13, 15]. And it everything is tinted (and how) with stress-intermediary systemic reactions, secondary disturbances of biomechanics of heart functions, and intracardiac and central hemodynamics [9, 11, 12].
It is clear that this definition reflects the heart of the matter.
Etiology
As follows from the definition of AMI, it develops, when local coronary circulation disturbances as a triggering mechanism cross the time threshold and make the ischemia irreversible. Strictly speaking, acute ischemia that already crossed the threshold is just the formal cause of a further chain of events that results in pathology and the clinical picture of the disease.
All other causes are the sources not of AMI itself, but of the above mentioned 'local' triggering mechanism.
Mechanisms
The mechanisms of AMI should naturally be examined at systemic and local levels. They were selected by evolution. They are aimed at providing most favorable of possible courses of the disease [22]. Therefore, its complications can be understood only in terms of philosophy of failure of these mechanisms.
We should pray that, as often as possible, AMI followed mechanisms established genetically and selected by Nature. And the number of disturbances in them was as small as possible.
Systemic level
The response of organism systems to AMI is realized through stress and clinically manifests itself as brain mediated sympathetic activation and increased functional activity of a hypothalamic-pituitary an adrenal system with the change of functions of all target organs. For a favorable course and outcome of the disease, all other conditions being equal, an adequate organization of stress (eustress) becomes of primary importance.
Stress is switched on at the very beginning of ischemia. Its causes are different. These are changes in the interception of blood vessels and tissues in the infarction zone. It is also the entry of metabolic products from the infarction zone to the systemic circulation. Spasms of pain, sympathetic activation, hormones entering blood, blood leukocyte reactions, hyperdynamic circulation are the first manifestations of the stress [5, 19]. The pain signals an emergency. Besides, it makes the patient forget all other problems to devote attention to his health in real earnest.
Leukocyte reactions are important for the further development of the process, though they are usually considered to be of secondary importance. These reactions are triggered by the ejection of leukocytes from the depot to the systemic blood flow. Since the depot mainly contains neutrophils, leukocytosis appears as the shift in cell count, neutrophils are activated and migrate to the infarction zone by positive chemotaxis. Infarction zone products getting in the blood flow play the role of attractants for them. The activation of neutrophils appears as hyperenzymemia (transaminase, etc.), higher contents of eicosanoids, leukotrienes in particular, protein-carbohydrate complexes, and other biologically active agents.
Stress is changing as the process develops. Nervous and humoral regulations are regained. Leukocytosis declines, and the leukogram changes. Granulocyte counts decrease, and their functional activity is suppressed, while agranulocyte counts and their activity increase. The structural change of the leukogram is the result of controlling effects of infarction zone products getting in the blood flow. Thus, neutrophil decay products from the infarction zone are repellents for neutrophils and attractants for agranulocytes. An enzyme level in blood falls, while the proteins and protein-carbohydrate complexes content grows. These are the systemic manifestations of an inflammation process in the infarction zone. Thus, even such a special case as hyperfibrinogenemia is not a sign of the activation of blood coagulation system but is the evidence that the situation with AMI takes a satisfactory turn. Here, it is important to remember that great hopes, placed in anticoagulant therapy, were not justified. These lost hopes cost life to many patients. It was long ago…
With the termination of an AMI phase, regulation problems disappear and not a trace remains of the stress. I would ask to take notice of the fact that we speak of a natural uncomplicated pathologic process.
Local level
The local level is the heart. The components of a pathologic process at the local level are not only changes in the infarction zone and recovery of heart shape and sizes but also adaptive changes of biomechanics of heart functions.
Infarction zone
Here everything is clear. All that happens is inflammation. Special, aseptic, alterative but still inflammation.
Let us look at phase processes. The first one is ischemia, reversible myocardial changes. Strictly speaking, it is the precursor of AMI, the state of pre-infarction. It is fully reversible . But if…. AMI, of course.
The transfer to irreversible changes marks the onset of necrosis. Necrosis is a lesion. General pathology teaches that in the location of the lesion there is always inflammation [2, 3, 16]. The lesion is the cause of inflammation. Thus, with the transfer from ischemic changes in the infarction zone to the necrotic ones, the inflammation starts in accordance with its traditional scheme. The necrotized myocardium undergoes destruction, and decay products are removed through the peri-infarction zone. It is specifically destroyed by neutrophil getting by chemotaxis from blood into the infarction zone and producing cathepsins. Their migration rate is rather high, about 2-4 mm per hour. It is easy to calculate that even the largest possible infarction is infiltrated by neutrophils in 6 hours at the most. At the same time, fibroblast precursors enter the infarction zone and the recovery process begins. It is impossible to separate necrotic and recovery processes, to look at them as the individual ones. They are synchronized and interconnected not only at the level of the infarction zone itself but also at the systemic blood level.
An absolutely false view raised to the level of dogma exists: necrotic and recovery processes in AMI are separated, the recovery processes following the necrotic ones. If this were true, all patients would be dead. Most likely, because of heart rupture. If not because of heart rupture, then because of acute vast aneurysm, for sure.
Necrosis is destruction, tissue gangrene [16]. The tissue loses its functions, not only contractile characteristics but also strength properties [4]. If infarction were necrosis, the heart wall in the infarction zone would have raveled out as a rotten shirt. But it does not happen in the case of an uncomplicated process. The strength properties of the myocardium in the infarction zone do not decrease. Moreover, for various reasons they even increase during the acute period. The retained strength of the heart wall in the infarction zone demonstrates that infarction in survived patients is not necrosis but inflammation accompanied with synchronized necrotic and reparative processes.
The result of a natural inflammation course in the infarction zone is the formation of a full-fledged scar in the place of necrosis. Maturation of a granulation tissue results in its consolidation followed by a decrease in infarction zone sizes. Depending on conditions, they can decrease by 25% or more.\ We should remind those who want to strongly intervene in the infarction zone that the phenomena occurring there (inflammation, compensatory and adaptive responses) are protective reactions originated as the result of evolution. On the whole, it is clear. We may intervene but carefully.
Peri-infarction zone
Systemic mechanisms and the infarction zone are interconnected through the peri-infarction zone, first of all, through its microcirculatory bed. Wastes from the infarction zone are removed through it, and the products necessary for reparative processes enter there the same way.
The larger the infarction–peri-infarction zone interface, the better the mutual effect of the infarction zone and systemic control. The peri-infarction zone cannot be smaller than that required for uncomplicated healing of the infarction zone [1, 5]. Therefore all the efforts to restrict it were doomed to failure.
Heart shape and size
In the case of infarction, a part of a mycrocardium becomes disabled. Disabled forever. And the functions of this part should be compensated. Hypertrophy of an intact myocardium develops. Healing of the infarction zone accompanied with the consolidation of scar leads to a decrease in its size. At the same time, corresponding changes occur in the intact myocardium [4, 9]. The heart shape is remodelled in such a way that its anatomic proportions are restored to favour its pumping functions. In the best case, the traces of infarction are difficult to reveal, even after thorough investigations.
Heart biomechanics
As everything, it is governed by processes controlling the course of the disease. During early phases, poststress rigidity of an intact myocardium is developing as a response to stress. Diastolic filling of ventricles diminishes, and the heart force drops. Minute blood volume is maintained by an adequate heart rate growth. A drop in ventricular ejection, along with regulatory effects on vascular tension mediated by stress, result in a decrease in peripheral resistance. The heart load decreases. As a result, biomechanics is improved and a sufficient systemic blood flow is maintained. In the case of an uncomplicated process we cannot find defects in this system as well.
Complications
Frequency
AMI is a complex and vulnerable process. In the most optimistic estimations, its complications are observed somewhere in a quarter of cases [10, 14, 22]. Of course, if it is diagnosed and treated correctly.
Immediate cause
Lets start with predisposing factors. However many we can name, all of them hit one target. The immediate cause of complications is inadequate stress. In other words, distress. Have little patience, and we would see how distress is realized as complications.
Risk factors
AMI can happen in a practically healthy person. Then, there is a good chance that it would take a favorable course. If such serious factors as vast infarction zone size, involvement of a cardiac conduction system and serious cardiac rhythm disturbances do not appear.
Vast infarction determines hyperreactive distress with possible torpid phase of true cardiac shock, or it causes an initially hyporeactive course, most likely with a short and therefore missed hyporeactive phase. Small infarction induces systemic wave reactions, and there is danger of its spread.
But it is not all. Even under most favorable conditions, a natural cataclysm (e.g. magnetic storm at the Sun) may happen, and as a result, stress out steps the limits of adaptive changes.
Risk of complications is higher in young and elderly persons. The coronary system of young patients is not trained, thus, vigorous stress reactions are highly possible, and it is not so difficult for them to turn into hyperreactive distress. On the contrary, elderly patients have problems with regulatory processes and, thus, with sufficiency of stress.
The following previous diseases are of great importance: diabetes mellitus, arterial hypertension and hypotension, immunodeficiency, particularly in the form of chronic immunopathologic processes. The above and other predisposing factors are multiplied in their interaction in such a way that the effect of sum exceeds the sum of effects. Comments are needless.
Standard mechanism of complications
We would remind that the cause of complications is distress. It is hyperreactive, hyporeactive or intermittent. The mechanism of complications, irrespective of a distress type, is always the same, viz. desynchronization of necrotic and reparative processes.
Desynchronization of necrosis and reparation leads to the loss of heart wall strength in the infarction zone. It is but a step from here to the stretching with cardiac aneurysm or heart rupture outcomes. 'High arterial pressure is a threat of rupture', we are frightened. The threat, of course, if the heart wall strength in the infarction zone falls to a critical level.
The strength of a heart in the case of uncomplicated myocardial infarction as in healthy people is 'a hard nut to crack', even for the highest pressure. Since biomechanical properties of the infarction zone differ from those of the intact myocardium, healing of the infarction zone is complicated not only due to the loss of heart wall strength but also due to the concentration of stresses along its boundary. Their magnitude grows when other unfavorable factors are superimposed. Thus, the areas of marked curvature of inner heart ventricular surfaces (transition of an interventricular septum onto other ventricular walls, transition of ventricular walls onto papillary muscles, etc.) are anatomic stress concentrators. If the infarction zone boundary is close to such a concentrator, the loss of strength contributes to its easier rupture. Major factors of stress concentration along the infarction zone boundary that contribute to its rupture.
Hyperreactive distress is excessive activation of all its determining systems. The result is intensive and rapid migration of polynuclears to the infarction zone. Necrosis and destruction are accelerated. Reparative processes lag behind. There is the desynchronization. If the infiltration of polynuclears to the infarction zone is excessive, their decay products retard the entry of reparative agents. In such cases a pathologist finds classical myocardial infarction: nothing but coronarogenic necrosis. Fast destruction of myocardium in the infarction zone has one more consequence, viz. high concentration gradients of all products formed in it along the boundary with the peri-infarction zone. Why not a condition for the electric instability of a heart? As a result, arrhythmia.
In the case of hyporeactive distress, everything develops slowly. Systemic reactions are sluggish or are absent at all. Thus, there are problems with the infiltration of polynuclears to the infarction zone. As a result, the necrotic phase is slow, which leads to the delay of reparative processes and their slow development. So, the desynchronization.
Hyperreactive distress leads to more commonly seen arrhythmia, earlier cardiac aneurysm and heart rupture. Hyporeactive distress with a sluggish disease pattern determines large sizes of aneurysm. As a rule, heart rupture occurs in the thinnest area of aneurysm.
- 'Intermittent distress, what happens?'
- 'Superposition of the above mechanisms by the formula: 'out of the frying-pan into the fire'. Everything becomes much more dangerous.'
The result of healing complications accompanied with distress of any type, as it was already mentioned, is aneurysm (acute and chronic, naturally) and heart rupture. They happen earlier upon hyperreactive distress but cover much larger areas in other stress cases. Acute aneurysm is most often acute cardiac insufficiency, and chronic one is chronic cardiac insufficiency. It is difficult to imagine heart rupture without cardiac shock. Arrhythmia upon hyperreactive distress, especially in the hyperreactive phase of intermittent distress, is quite natural.
During subendocardial myocardial infarction, healing complications with retarded necrotic processes are ready to turn into thromboendocarditis. Just dare say that it is not a patch, protection from the loss of strength in the infarction zone? Thrombus formation disturbances give rise to thromboembolism [5].
We can continue this topic. But it is already clear that the share of healing complications is growing like a 'snow ball' in the complications of the disease in general.
Compensatory processes
AMI is a disease or a clinical syndrome accompanying other diseases. All that occurs simultaneously with infarction is highly pathologic but not physiologic. But it, in terms of Voino-Yasenetsky's philosophy [2], corresponds to current requirements and, therefore, is normal. Inflammation, the typical pathologic process underlying the disease, is just that by definition.
Let us remember transitional atrial flutter accompanying large acute myocardial infarction. Whatever they say, a decrease in heart preload is an extremely precise mechanism. Of course, if this arrhythmia is normosystolic, and what is more, at a rate within upper limits of the norm. Try to restore sinus rhythm in such a patient, and his heart would start to 'choke'. Have you ever met such a situation?
We have already discussed compensatory functions of naturally formed thromboendocarditis. But if this process is disturbed? Of course, when we actively intervene in blood coagulability with the purpose of treatment. Or let us remember coronaroactive drugs for improving the blood supply in the peri-infarction zone. It appeared that they robbed it. Simply, because Nature did it the way that in the case of infarction, the vessels of the infarction zone are dilated as much as possible. There is nowhere to dilate them any more. We administer coronaroactive drugs and dilate the vessels of an intact myocardium. Blood flows out of the peri-infarction zone. It is an old story.
The conclusion is simple. Before improving something, one should first think for a while. And no more than that.
Clinics
Uncomplicated and complicated AMI’s are entirely different phenomena. We have good reason to make such a conclusion. Uncomplicated infarction is an evolution-selected and practically realizable strategy of the best healing of the infarction zone with the most qualitative recovery of a patient. Complicated infarction is the result and manifestation of disturbances in the realization of this strategy [6, 7]. Its clinical picture is different. And the clinical picture of uncomplicated infarction is a standard for its complicated forms [5]. If so, lets start with the standard.
Uncomplicated acute myocardial infarction
Just because it is uncomplicated, it does not create problems either for a patient or for his doctor. Of course, there are clinical manifestations of stress and the local processes described above (at the level of the infarction zone and heart as a whole). There is no getting away from them, myocardial infarction nevertheless.
The clinical picture of uncomplicated healing: pain is rapidly reduced by rather moderate measures, and higher levels of hormones, leukocytes, enzymes, proteins, protein-carbohydrate complexes in blood accompanied with phase changes correspond to infarction zone size (not very low and not excessively high, just fit perfectly well). The spectral analysis of cardiac rhythm demonstrates its tendency to metronomization with the redistribution of regulatory effects in favour of humoral immunity and a sympathetic nervous system. However, heart rate variability increases very soon, and the contribution from parasympathetic regulation also grows. An enzyme level reaches its maximum by the 18th hour from the beginning of the AMI and then decreases regularly. A level of protein-carbohydrate complexes starts growing from the 2nd day and reaches its maximum no later than by the 5th day. Blood analysis: moderate leukocytosis with neutrophilia that in a day gives place to constantly growing agranulocytic reactions.
All this is the evidence of satisfactory control and synchronized necrotic and reparative processes in the infarction zone. As the saying goes, we are waiting for a good scar in the place of necrosis. The electrocardiogram exhibits AMI signs but with expected evolution: the ST segment rapidly returns to the isoline.
Ultrasound reveals segmental disturbances of myocardial contractility, but the thickness of the heart wall in the infarction zone is retained. A heart rate increases, a stroke volume falls, but a minute volume is adequate to current requirements. Even if there are rhythm disturbances, they are perceptible only on the first or the second day at the latest. These extrasystolae are not dangerous and will not require any measures.
Patients feel well and become more active very early. Such behaviour not half worsens the prognosis, it favours more rapid recovery. Let us be honest, we often fear not the early activation of patients but our responsibility. And that is the most irresponsible treatment of the problem.
Complicated acute myocardial infarction
Though its clinical picture is rather diverse, certain regularities are evident. It would be unjust to lose the chance. Distress is the precursor of a trouble, therefore, this is far and away that we should establish its possible causes in a patient, determine the contribution from each of them.
A threatening sign of serious complications is a recurring, difficult-to-stop pain. Levels of hormones, leukocytes, enzymes, proteins, and protein-carbohydrate complexes in blood are growing. But those growths are insufficient or exceed any reasonable bounds. Phase changes are always associated with certain problems. They are too late or are taking such features… Their most degenerated forms are clear evidence of intermittent distress. Cardiac rhythm is metronomized, its rate falls rapidly. The contribution from humoral regulation to the energy spectrum is incommensurably growing. A parasympathetic component is suppressed almost completely. In the most serious cases, the result of metronomization is an equally low level or almost complete absence of all parts of the energy spectrum [8].It is white noise instead of regulation.
These changes appear long before other clinical complications and retain enviable stability. A level of blood enzymes reaches its maximum very early, during the first 12-14 hours, or with a considerable delay, in a day or more. In contrast to this, in both cases a level of protein-carbohydrate complexes starts growing with a delay, in four or more days from the beginning of the catastrophe. Blood exhibits undeveloped or excessive leukocyte reactions, without neutrophilia or with almost total predominance of neutrophils over cellular forms. The change from granulocytic to agranulocytic reactions as well as a growth of protein-carbohydrate complex concentrations is also late.
All these are clinical manifestations of desynchronization of necrotic and reparative processes. Heart rupture, acute or chronic aneurysm are not far distant. This implies an emergence of different forms of acute cardiac insufficiency, from true cardiogenic shock to cardiac asthma attacks, the development of chronic cardiac insufficiency. The electrocardiogram does not display any evolution of the ST segment, and only a frozen monophase curve is seen (naturally, in the most dramatic cases).
Ultrasound can easily reveal aneurysm, rupture of papillary muscles with valvular insufficiency, defects of an interventricular septum, other signs of complications of the major (inflammatory!) process in the infarction zone. Even if a heart rate grows, it cannot compensate a drop of a stroke volume under all circumstances. Regulatory systems can 'get frustrated’, and then a small ejection is multiplied by bradycardia. Patients can give bradycardic reactions instead of tachycardic ones.
The dilatation of cardiac cavities with the slowing down of intracardiac flows, especially in the case of clumsy intervention in blood coagulation systems is a good precondition for the disturbance of thrombogenesis (with thromboembolism).
Rhythm disturbances are another matter. They are resistant to interventions; they appear when they are not waited for, especially, as regards the states threatening the life of a patient. The clinical picture answering hyperreactive distress includes early rhythm disturbances.
Pathologic remodeling of heart chamber shapes during the formation of postmyocardial infarction aneurysm increases diastolic rigidity of a myocardium. Cardiac insufficiency becomes systole-diastolic.
The growth of stresses in a heart wall as the result of pathologic remodeling is the source of tardy persistent arrhythmia. It arises in the development of complications by any of possible mechanisms, but it should be treated carefully. Sometimes this is compensatory extrasystole, e.g. atrial flutter observed in critical patients.
Defects in the immune system controlling an inflammatory process in the infarction zone result in immunopathologic reactions by a Dressler's syndrome type.
It is easy to come to the conclusion that the specific feature of any clinical picture of complicated infarction in a patient is the deviation of the inflammatory process in the infarction zone from its natural course. The cause of this deviation is problems with regulation and interaction of regulatory systems with the infarction zone.
Differential diagnosis and prognostication
It is important to differentiate not only uncomplicated infarction from its complications but also among its complicated forms. It is even more important not to simply differentiate but to foresee them. Only in this case, we get the real opportunity to control the process, from simple observation to intervention with bringing to uncomplicated conditions. Criteria of differentiation and prognostication are summarized in Table 1. AMI with intermittent distress can start from any form cited in Table 1. These criteria are tentative and correspond to infarction zone sizes of about 10-20% of the corresponding camera.
Management of patients
The approach to a patient with AMI has its specific features. But how can it be otherwise? We are dealing with the catastrophe. Any catastrophe first of all implies the introduction of urgent measures, adequate in letter and in spirit. Naturally, everything is important, including regimen. And everything [5, 15, 18] should happen in good time.
Urgent measures
The very first urgent measure is naturally resuscitation, especially if a patient is in the state of clinical death. The next question: does his state satisfy the criteria (indications and contraindications) of thrombolytic therapy? If yes, it should be started as soon as possible [12]. Both resuscitation and thrombolysis exert a direct influence on regulatory systems, and we should always expect the transformation of eustress into distress in such patients if it were not already there. Resuscitation measures include adrenergic drugs activating stress. Successful thrombolysis accelerates the entering of infarction zone products in the systemic blood flow. This is a natural mechanism of activation of regulatory systems, therefore, stress increases as a rule. A postreperfusion syndrome is not only the evidence of successful thrombolysis but also the danger of the transfer from eustress, if the disease started in such a way, to hyperreactive distress with known consequences. Likely life-threatening arrhythmia is only an episode. But successful thrombolysis can additionally regulate control systems if the disease started with hyporeactive distress. On the contrary, it would have disastrous consequences if we cannot solved the problem of hyperreactive distress following thrombolysis [5, 22]. Urgent measures also include the control of pain. Pain informed about the catastrophe. But here its constructive role comes to an end. Further, it is only the overstrain of regulatory systems, thus, hyperstress and hypostress that follows it. By alleviating pain, we can reduce stress reactivity, transform hyperreactive distress into eustress, eustress into hyporeactive distress, or aggravate hyporeactive distress even more.
Thus, urgent measures require one to control the state of regulatory systems and to intervene in case of necessity bringing them to eustress conditions. Therefore on hyperreactive distress, narcotic and nonnarcotic analgetics, alpha and beta adrenoblockaders, nonsteroid anti-inflammatory agents are usually used. Upon hyporeactive distress, they are alpha- and beta-adrenostimulants, corticosteroids, leukopoiesis stimulants. Doses and administration periods are determined by the transformation of distress into eustress, activity levels in its approach to eustress parameters.
Regimen
At the very beginning of the disease, physical activity should be restricted. It is the necessary condition for ensuring mechanisms and processes to be effected for a favourable outcome of the disease. The first two days are sufficient time in the uncomplicated case. After that, physical activity is extended. You need not be afraid, the safety margin of a heart is high enough even as regards the infarction zone, and in these cases, it never drops below the level for a healthy person.
If there are prognostic signs of complications or the complications are present, physical activation is delayed. In the case of complicated acute myocardial infarction, the strength of the heart wall in the infarction zone decreases. Here early physical activation enhances the formation or extension of aneurysm, or possible heart rupture. But even in the worst cases, the time sufficient for the substitution of a granulation tissue for the necrotized one is no more than 12-16 days, thus, it is beyond reason to postpone activation till later. Everything should be done in proper time.
As regards the diet, its quantity and caloric value should be limited during the first days, divided into frequent small meals. It is important to follow digestion, avoiding constipation and meteorism. All this exerts a negative influence on the state of a heart, blood circulation, and regulatory systems.
Regimen is one of the most important components of patient management. We cannot diminish the importance of psychotherapeutic assistance. In this connection, we should emphasize the necessity of simple personal contacts that are always insufficient for a patient and that favour common success to a very great extent [7, 17, 20, 21].
Drug Therapy
The uncomplicated course of the disease does not require any measures. Only observation. In complicated cases, we cannot do without pharmaceuticals. Regulatory systems and processes, occurring in the infarction zone, should be brought to the state when the development of complications becomes impossible. A sudden decrease in the energy spectrum of heart rate variability and its parasympathetic component can be controlled by small doses of belladonna preparations. Upon a simultaneous decrease of a sympathoparasympathetic component, small doses of blockaders of an angiotensin-converting enzyme (ACE) are prescribed for long periods.
Upon hyperreactive distress and accelerated necrotic processes, our aim is to decrease the former and to retard the latter, using beta blockaders and anti-inflammatory drugs administered enterally and/or parenterally.
Hyporeactive distress and retarded necrotic processes require the prescription of alpha -and beta-adrenostimulants, bacterial and leukocytic pyrogens, leukopoiesis stimulants, using several ways of administration.
Upon intermittent distress, the attitude should be even more careful to prevent wave recurrence of necrotic processes.
As the optimization of distress of any type is approached, pharmaceuticals, promoting reparation in the infarction zone, should be added. These are leucopoiesis stimulants, steroid and nonsteroid anabolics.
If the therapy is optimized, clinical complications do not develop or are not so serious. It refers to possible heart rupture, acute and chronic aneurysms, giving rise to acute and chronic cardiac insufficiency, arrhythmia, and other complications.
When necrotic and reparative processes are seriously desynchronized and we cannot expect the complete restoration of synchronization, additional measures are necessary. We can try and prevent the development of aneurysm or the formation of a scar of large sizes, reducing terminal diastolic filling and postload on heart cameras. Here the choice is the combination of ACE blockaders with depot-nitrates and nitrites.
Special attention should be paid to patients with immunopathologic reactions and states to avoid the development of a postmyocardial infarction syndrome. Here immunomodulators would be useful.
If a heart rate does not exceed its upper level by more than 10%, with a decrease in peripheral resistance and cardiac output, sinus tachycardia is certainly of compensatory nature, and it should not be intervened. Our attitude to it should also be the same in the case of aneurysm development. Any intervention would be more detrimental. If it is necessary to intervene in tachycardiac reactions, this intervention should be administered in such a way that a decreasing heart rate would still be retained at the upper level of a physiological norm.
Rate disturbances, even if they are associated with the involvement of conduction system elements in the infarction zone, require careful treatment all the same. Diuretics prescribed for a short period would probably shorten the exudative phase of inflammation, and as a result, conduction would be improved. An external pacemaker would also be useful for a short time. It would solve the problem precisely, and this is inaccessible for any pharmaceuticals.
Extrasystole and paroxysmal tachycardia during the most acute and acute periods of the disease are the evidence of possible hyperreactive distress and accelerated necrosis. Their correction reduces risk and frequency of arrhythmia. In this case, beta-blockers are anti-arrhythmic drugs with a pronounced antistress effect.
Sinus tachycardia as well as other forms of arrhythmia can be not only pathologic but also compensatory. Extrasystole accompanied with pronounced bradycardia requires pharmaceuticals increasing a heart rate, such as atropine, belladonna preparations, etc. Arrhythmia accompanying the development of acute and chronic aneurysms is caused by high pressure of left ventricle filling. Anti-arrhythmic measures decrease heart preload and effectively reduce diastolic ventricular filling. Ectopic substituting rhythms are the problem of a sinus node. Therefore, one should think first before their suppressing. Normosystolic atrial flutter, suddenly appearing on cardiac insufficiency, causes a local decrease of heart preload. And probably, with the improvement of hemodynamic status, it would disappear by itself.
Direct anticoagulants should be treated with care. Surgeons know well that these drugs retard the healing phase of a wound process, and thus, the reparative phase of acute myocardial infarction. Those who went through the enthusiasm for direct anticoagulants remember that the main cause of the death of patients was associated with thromboembolic complications. It is quite clear; Nature always takes vengeance for clumsy steps, e.g., the development of uncontrollable disseminated intravascular coagulation. Nowadays this enthusiasm has disappeared. And we can see that from the results, thank goodness. Even after thrombolysis, it is better to exclusively use heparins followed by small doses of anti-aggregants that also exhibit an anti-inflammatory effect.
There is one more danger in using direct anticoagulants. AMI with the involvement of an endocardium is accompanied with thromboendocarditis. A forming thrombus is the additional and effective way of penetration of agents ensuring and maintaining inflammation, thus, more effective reparation in the infarction zone. The thrombus formed is also a 'patch', protection from possible aneurysm and heart rupture. Direct coagulants disturb thrombogenesis. In this case, bulky, unconsolidated thrombi are formed. Why they should not tear and become the cause of thromboembolic complications? There are many things to think about, especially if you use your own experience of patient management. Maybe, a thrombus absent in transmural myocardial infarction is the cause of aneurysm or heart rupture.
The problem of coronaroactive drugs as basic therapeutic means does not require any discussions. The times have passed when it was considered that they improved circulation in the peri-infarction zone and favoured its healing. Thus, they are used only in accordance with strict indications.
It is desirable to recommend to hypodynamic patients with an atonic anterior abdominal wall to administer laxatives for a certain period of time. In the case of meteorism, enteral adsorbents are good.
Conclusion, or the most important principles
Everything is good in its season, therefore any measure should be well-timed. You cannot afford to be late. The human organism possesses such remarkable properties that any newly initiated process, including AMI and its complications, is subject to external therapeutic effects only for a certain period of time. As soon as the process is self-organized, it stops to be subject to those effects.
One of physician's percepts is festina lente. Not in the sense that you should not be in a hurry to respond. But in the sense that you should not be in a hurry to modify some or other functions and processes. You should be a good hand in 'transferring' a patient from hypertensive crisis to hypotensive one, from tachycardia to bradycardia, etc., what is more with AMI. This is 'out of the frying-pan into the fire'. Rapid actions are necessary only in the case of the catastrophe or for the period of the catastrophe.
After finding new syndromes and symptoms in a patient, the first thing you should do is to think. Why this syndrome all of a sudden? Of course, everything that happens in the case of AMI is pathologic. Here we refer to Voino-Yasenetsky again [2]. He was quite right that an appearing syndrome, maybe, met the requirement of the situation and, therefore, is normal. On the whole, you should measure thrice but, maybe, you will not have to cut.
Many physicians prefer the parenteral administration of drugs. And it is good. Still nobody can live without preferences. But for catastrophic health disorders, all the processes in a patient develop not so quickly. And problems with a digestive system is most likely an exceptional case, thus, there are no grounds to refuse it credence in the transport of drugs to the blood flow. Why not give preference to enteral forms of drugs?
The most important thing in AMI as in any other disease is that it is the mechanism of withdrawal from the catastrophe. In a specific way, losing a part of a contractile myocardium and substituting it with a connective tissue through inflammation, or through other irretrievable losses. We have already discussed them. Nevertheless we have nowhere to go. We have to go through the disease. And the most important thing: it should take the best of all possible courses, i.e. the optimum course. The task of a physician is to lead a patient through the disease, to lead a patient with AMI through his own AMI. Here the best strategy is the optimization of complicated forms of the disease bringing them to uncomplicated conditions.
This strategy is based on the disease optimum principle [6, 7], in accordance with the latter, the optimum is minimum health resources spent for recovery.
Principle components as applied to AMI:
• identification of its optimum for a patient;
• determination of an extent and nature of its deviations from the optimum;
• verification of a diagnosis in accordance with the above;
• determination of the global target of the disease optimum as the best possible outcome with maximum full-fledged substitution of a connective tissue for the necrotic one in the infarction zone;
• treatment of a patient by bringing the disease to its optimum depending on a mechanism and extent of deviations as well as time of therapy initiation;
• solution of local problems by methods that do not contradict the global aim.
The optimum management of a patient with AMI is within power of a real physician.
References
1. G. G. Avtandilov, N. I. Yabluchansky, K. D. Salbiev, and L. M. Nepomnyashchikh. Quantitative Morphology and Mathematical Simulation of Myocardial Infarction (in Russian), Nauka, Moscow, 1984.
2. M. I. Voino-Yasenetsky. Biology and Pathology of Infectious Processes (in Russian), Nauka, Moscow, 1981.
3. I. V. Davydovsky. General Human Pathology (in Russian), Meditsina, Moscow, 1969.
4. B. Ya. Kantor, N. I. Yabluchansky, and V. E. Shlyakhover. Nonlinear Cardiobiomechanics of a Left Ventricle (in Russian), Naukova Dumka, Kiev, 1991.
5. L. T. Malaya, N. I. Yabluchansky, and M. A. Vlasenko. Uncomplicated and Complicated Forms of Myocardial Infarction Healing (in Russian), Zdorovie, Kiev, 1992.
6. N. I. Yabluchansky, L. G. Vasilieva, and Yu. L. Volyansky. Disease Optimum Principle (in Russian), Osnova, Kharkov, 1992.
7. N. I. Yabluchansky. Optimum Management of Somatic Patients (General Approach) (in Russian), Osnova, Kharkov, 1995.
8. N. I. Yabluchansky, A. V. Martynenko, and A. S. Isaeva. Basics of Practical Application of Blood Circulation Variability Technology (in Russian), Osnova, Kharkov, 2000.
9. E. Braunwald. Approach to the Patient With Heart Disease. In: Harrison's Principles of Internal Medicine, 11th Ed., McGraw-Hill, New York, 1987.
10. P. F. Cohn. Silent Myocardial Ischemia and Infarction, 4th Ed., Dekker, New York, 2000.
11. T. E. David. Mechanical Complications of Myocardial Infarction, Chapman & Hall, New York, 1996.
12. G. S. Francis and J. S. Alpert. Coronary Care, 2nd Ed., Little Brown, Boston, 1995.
13. B. J. Gersh and S. H. Rahimtoola. Acute Myocardial Infarction, 2nd Ed., Chapman & Hall, New York, 1996.
14. K. Jennings. Acute Cardiac Care: Community and Hospital Management of Myocardial Infarction, Oxford University Press, New York, 1994.
15. D. Julian and E. Braunwald. Management of Acute Myocardial Infarction, W. B. Saunders, Philadelphia, 1994.
16. M. Kissane. Anderson's Pathology, 9th Ed., Mosby, St. Louise, 1990.
17. W. L. Morgan and G. L. Engel. The Clinical Approach to the Patient, W. B. Saunders, Philadelphia, 1969.
18. S. Nash and V. Fuster. Efficacy of Myocardial Infarction Therapy: An Evaluation of Clinical Trials, Dekker, New York, 1999.
19. H. Selye. The Stress of Life, McGraw-Hill, New York, Toronto, London, 1956.
20. P. A. Tumulty. The Effective Clinician: His Methods and Approach to Diagnosis and Care, W. B. Saunders, Philadelphia, 1973.
21. H. R. Wulff. Rational Diagnosis and Treatment: An Introduction to Clinical Decision Making, Mosby, St. Louise, 1981.
22. N. I. Yabluchansky. Acute Myocardial Infarction Strategy, Osnova, Kharkov, 2000.

The Principle of Disease Optimality: Orthodox Therapy or Homeopathy

The Principle of Disease Optimality: Orthodox Therapy or Homeopathy

M. Yabluchanskiy
L. Vassilieva
S. Vassiliev



“The greatest tragedy of science is the collapse of an excellent
hypothesis, because of an abominable fact”
Huxley


INTRODUCTION

The field of internal diseases therapy is one of the fundamental areas of medicine. The sphere of its influence includes all medical practice. For this reason interest is great and its progress is zealously followed.

Today the field of internal diseases therapy is going through a crisis.

What is the reason for this? How can we explain growing indifference to one of the main trends of medical activity? It is today that the internal diseases discipline has reached such heights in diagnostics and treatment, which yesterday were believed almost improbable!

Nuclear magnetic resonance, computer X-ray tomography, ultrasound equipment, immune-fermentation analysis and other methods have revolutionised diagnostics. Never has a doctor had such an opportunity to get answers to nearly all questions concerning functions and constitutions of organs and systems of man. New classes of medical substances reproducing precise regulatory systems of human organism and thus allowing to have "pure" influence on specific processes, having certain space and time localisation, have put therapy on the level of regulatory systems of human organism.

The progress which the internal diseases discipline has gone through over the last few decades changed its contents too quickly and the therapy forms lagged behind it, leading it to a crisis. Our understanding of disease and its intricate mechanisms were constantly widened and modified in the course of developing fundamental sciences and clinical applications. But the approaches to treatment, or rather, methodology of treatment continued to remain unchanged. The attempts at treatment modification were perceived as a mere pinprick, absolutely insensitive though unpleasant.

With every coming year we increasingly understand that the disease is not something foreign to a patient, that it is the essence, the condition of a patient. We increasingly understand that to treat a sick man is not to fight a disease, it is not to overcome a disease but to take him through the disease. It's because disease consists of two indivisible mechanisms, patho- and sanogenetic, thus to “eradicate” disease is to “eradicate” a sick man himself.

We should not forget the old saying “Il n’y a pas des maladies seulement des malades” that is “ there is no sickness, only sick people, no diseases, only diseased people”.

Unfortunately, this understanding of a disease is at its most somewhere on a subconsciousness level. Today in our consciousness, in our everyday practical work we still keep to, whether we want it or not, a simplified system of views where disease is something that requires suppression and at last, its removal. We compare the structures of a sick man with the structures of a healthy man and thinking little over the fact why they differ, we think it necessary to lead them at any cost to the structures of a healthy man. We have little interest how much they correspond to natural optimum course of the disease, but we are interested how much they differ from characteristics of a healthy man and we have a strong desire to correlate them. One of the prices we pay here accounts for the decline of authority of modern clinical medicine. Numerous examples will be given below.

But, inside the study of internal diseases therapy a fruit is ripening as a result of its crisis. This fruit has to solve this crisis, to fill it out with new contents and to open it to new breathing. This is our above-mentioned understanding of disease. As well as health, disease not only can, but must, be considered from the point of view of specific conditions of the organism of a sick man. It cannot and must not be considered as an object requiring (illogically) a forced change, arranging the structures in accordance with the structures of a healthy man. This is because disease "takes" a man, aiming toward recovery, say, in the case of acute disease, or aiming towards transfer into the remission phase and compensation of lost functions, for instance, in case of chronic disease.

The essence of outlook arising in this discipline is the principle of disease optimality. The main point is that there are optimum ways of disease course which lead to the best quality and complete recovery from acute diseases and a favourable course of chronic diseases and deviation from them - all of these are the forms which require interference. Here the problems of control, or rather optimum control, of the disease and arrangement of it in accordance with the conditions of optimum development arise.

From our point of view this new understanding of disease will settle the crisis of the internal diseases therapy and revolutionise it. As it will be shown below the principle of disease optimum gives rise to new problems, gives them new meaning to what is most important, and gives clues to their solution. But, to discuss these questions is beyond the province of the introduction and will be discussed below.

The bases of a new approach have been preceded by the works of Dr. Hans Selye, I.V. Davydovsky, A.D. Speransky, N. Rashevsky, R. Rosen. Touching upon these researches R. Rosen had put forward the principle of optimality in biology and N. Rashevsky had defined the similar principle of optimum designing.

Fortunately nearly all activities of therapy are the basis for the new approach. We have already mentioned and we mention again a popular expression of Zemstvo (old fashioned rural) doctors who said that a sick man should be taken through the disease. In other words, take him through the disease, but not treat. Working mostly with chronic diseases a physician has a good idea that diseases can last during all the lifetime of a sick man. So the most correct thing to do here is to optimise the disease. On the other hand, these ideas are not yet realised and have not yet become an active instrument.

Philosophic analysis of the problem from the point of view of the category of health measure and disease is given in our previous publications. As regards to them, it was shown that there was a dialectical relation to health disease measures. As in the measure of health we can distinguish some norms in disease measure. We propose to consider the disease norm as a course, which in the case of acute disease provides the quality of recovery and in the case of chronic disease pays minimum price, for the disease in the patient.

In therapy measures this approach was applied to acute myocardial infarction. On its basis the forms of non-complicated and complicated healing were described, forming the optimisation program of the complicated forms by their arrangement in accordance with the conditions of non-complicated healing.

Considering new ways of the internal diseases field of development, we naturally come to the necessity of discussing the orthodox therapy (OT) and homeopathy (HT) and the relationship between them. In homeopathy OT is called allopathy, keeping in mind principal differences in the bases of their medical approaches which existed at the early age of their formation. Now the medical approaches of OT are much broader so we cannot preserve its name.

The crisis of therapy in the internal diseases field which we spoke about, has a direct relation to OT. It has been simultaneously accompanied by the growing interest to HT.

Is this a reaction to OT crisis or merely a natural movement towards it?

We are deeply convinced that it is a natural process, resulting from all logical development of modern therapy, conventionality of OT and HT formation, which, although seemingly at opposition, have been approaching each other continuously over the last few decades.

Discussed later in detail, OT, in spite of its triune approach, including etiologic, pathogenetic and symptomatic treatment, does not provide the doctor however, at least completely conceptually, with the methodology of regulation and its realisation in the form of specific methods and means of patient treatment.

The principle of disease optimum and strategy of treatment through optimum control requires methods based on regulation.

HT unlike OT is based on the ideas of regulation. HT principles of similarity and small doses can work because homeopathic medicines first of all have a regulatory action. We are convinced of this not only from HT practical experience accumulated by treatment of the patients, but also from the data of both modern physiology and biochemistry that give us numerous examples, partially discussed below.

We will present data showing that OT can come to the regulatory level when it begins to work with doses of medicines corresponding to the doses in HT, naturally, when we speak about reasonable dilution.

Advancing progress of OT and HT, in our understanding can favour fast introduction of the disease optimum principle.

In the case of a substantial deviation of the disease from the optimum course we think it natural to use first, medicines, which today are understood as medicines of OT, with consequent transfer to medicines related by logic to HT means. This is solely our personal point of view.

In the next chapters we consistently consider strong and weak aspects of OT, strong and weak aspects of HT, the principle of disease optimality and resulting problems of modern therapy.

We have aggravated the situation in OT, we probably were too lenient regarding HT. We have a mutual understanding on this, to say the least. All the ideas of OT and HT are dear to us, as well as the ideas of therapy in their essence. But nevertheless, we acted so and honestly because historically HT suffered more from OT, for until recently OT has been in a privileged position. The correct stresses here from our point of view will be useful for a balanced situation in OT and HT.

In the course of our exposition we will often repeat some facts. In doing so we simply want to make the logic of the events more explicit, to show their internal ties.

If we did not believe in the future and propagation of a new therapy based on the principle of disease optimality, we would never have written this book full of metaphors, speculations and the like.

Our aim is to attract attention to and accelerate the formation and development of a new therapy, which we believe, has already begun. Additionally, our aim is to open the conformism ways for OT and HT.

We mean this book to be primarily for medical workers and specialists in the field of internal diseases therapy.

Not everyone will agree with our ideas, there will be adherents as well as opponents. This will be perfectly natural because development is possible only through formation and solution of contradictions. The main thing is to take into account the bitter social experiences of our century and settle all disputes by civilised methods. Violence, as we have already realised, does not do any good, even if it is based on wonderful slogans.

Critical remarks on the book will be taken as evidence of interest in the discussed problems and as desire to join their solution.

“The Golden Rule is that there is no Golden Rule”
George Bernard Shaw


1. STRONG AND WEAK ASPECTS OF ORTHODOX THERAPY

Orthodox therapy is one of the widest medical subjects and currently occupies a worthy place in medical practice. It consists of therapy with its branches, including cardiology, pulmonology, rheumatology, gastroenterology, nephrology, other specialities, skin, eyes, nerves and other diseases.

Progress that we observe in medicine is to a certain degree due to OT. Early and effective diagnostics with effective therapy gave the required results, one of these being the decline of mortality rate resulting from heart-vascular diseases, infection diseases, diseases of respiratory organs, digestive organs and other systems. These disease processes are of irreversible character and are closely connected with OT development.

OT has at its disposal powerful research centres, well equipped clinics, and a large number of doctors. This potential is nearly the largest in modern medicine and ensures its leading positions.

In the course of development and its everyday activity OT is guided by the achievements of fundamental sciences. Moreover, they have a close interrelation where more often OT becomes the customer for fundamental sciences, influences decisively their development and guides the trend of their research. For example, research in the field of antithrombolytic therapy which had a revolutional influence on the rise of survival and decrease of mortality from myocardial infarction were claimed by OT and later were corrected and controlled by it.

A striking success by OT has been reached recently. It is connected, first of all, with the introduction of new modern non-invasive methods and immunoferment diagnostics into medical practice. Simultaneously, new classes of drugs having high specificity and wide range of therapeutic action such as beta-blockers, non-glycoside inotropic means, inhibitors of angiotensin reducing enzymes, H2-hystamin receptor blockers, synthetic analogues of prostaglandines and neuropeptides have been developed, tested and introduced or are being introduced into practice. The list of achievements is far from complete and more importantly, the avalanche of research and their results in OT are growing.

Until recently and currently OT uses drugs in doses, which in comparison with those used by HT, are rather large. The contents of drugs in a medicinal form used by OT can exceed by tens or more orders of corresponding doses for HT. This, undoubtedly, gives a quick therapeutic effect of OT drugs. Used purposely, antiaggregate drugs definitely lower aggregation of regular blood elements, febrifuges lower the body temperature, hypolipidemic drugs lower the level and structure of blood lipids. This list can be continued.

OT has its limitations and problems, drugs are usually prescribed for their individual capacities to act upon specific parts of the body, it follows that several different drugs might be prescribed to treat the various symptoms of one individual. And, of course, it then follows that additional drugs would be needed to control the side effects of one or more of the other drugs being taken.

Although exerting a pronounced therapeutic effect, OT causes pathologic conditions connected with the side effect of drugs. These side effects give rise to many allergic conditions and autoimmune processes.

Cases of chronisation of acute diseases, a complicated cause of acute and chronic diseases by OT intensive treatment methods, cannot always be explained by the primary seriousness of the patient's condition or by his imperfect sanogenetic mechanisms. Every practical doctor probably has his own list of patients whose intensive treatment by OT methods aggravated their conditions, even led to rapid deterioration and only resolute refusal from any drugs at all saved the situation with the patient recovering. The patient or rather his organism, solved the problems of the disease and OT complications.

Complications of a patient's treatment by OT methods are difficult to predict in many cases. However, taking into account that these side effects happen quite frequently, in the majority OT methods considerably relieve a patient's condition, making the course of the disease more bearable. The majority of acute diseases end by recovery, acute conditions of chronic diseases stop suddenly, the condition of the affected organ and the patient's organism as a whole improve; so OT puts up with such complications.

The problems arising here are connected with usefulness and effectiveness of the treatment conducted. A patient sees a doctor and is treated by OT methods. His condition improves. And here a natural question arises, why? Was it because a conducted therapy really assisted the recovery or was the disease developing according to natural means guaranteeing the recovery? The answer is not so simple.

A disease develops through the dialectics of patho- and sanogenesis. The means of recovery are not all good and if they are good, than not in one and the same manner. Can we say the result is better when the patient recovered faster?

Can we say that elimination, or rather weakening, of some syndromes assists the improvement of the course and the result of the disease?

To answer these questions, let us illustrate with the problem of hypolipidemic drugs administration with hyperlipidemic patients. This problem is one of the most important OT problems today. Numerous primary and secondary prophylactic investigations carried out in different countries of the world showed that persons with so-called hyperlipidemia experienced the increased risk of atherosclerosis and ischemic heart disease. Naturally there was a necessity to use medicinal interference "normalising" the level and structure of blood lipids. Tyroler H.A. formulated a rule according to which change of cholesterol level by 1% ALLOWS TO DECREASE RISK OF ischemic heart disease by 2%. The modern pharmacological industry offers to a doctor hypolipidemic drugs of quite different groups with different mechanisms of action. These drugs lower the triglycerids level. They are fibrates (clofibrate, bezafibrate, phenofibrate, gemfibroxyl), nicotine acid and macsepa. These drugs lower cholesterol level, among which there are anion exchange resins (cholestyramin, cholestypol), beta-cytosterin, neomicyn, probukol, inhibitors GOA - Koe reductase or monocalines (lovastatin, symvastatin, and pravastatin). Doses in which those drugs are used and the dosage period needed to reach a planned effect of “normalisation” level and structure of blood lipids are quite alarming. For clofibrate it is 1.6 gr./day, bezofibrate 0.6 gr./day, nicotine acid 2-6 gr./day, cholestyramin and cholestypol - up to 20-30 gr./day, betacytosterin - up to 6 gr./day, neomicyn 1gr./day and so on. At present the principles of these medicines used as prophylactics against atherisclerosis and ischemic heart disease and treatment of ischemic heart disease patients, are considered to be clearly determined and immutable. The regime of using hypolipidemic means have been tested and proposed, taking into account hyperepidemic type and seriousness of hyperlipidemic “disturbance”. The regime of a combined use of medicines has been also developed. So, it seems there is little to be done. We just need to clarify whose approach to hyperlipidemic treatment is better, for example, American or European schools of cardiologists…

But at the VI International Conference on Heart and Vascular Pharmacotherapy from F.Gutzwiller and M.Oliver reports we were informed that the approach formed in this field probably was not sufficient. Now it is clear that hypolipidemic therapy is definitely necessary but only for the persons with substantial deviations in lipids exchange. In all the rest of the cases we should act with care. Prior to making a decision on hypolipidemic therapy in such cases, we should give the patient the right to choose from what to die?! If from tumour diseases, then the hypolipidemic therapy should be conducted and if from atherosclerosis and its complications, then such therapy should not be conducted.

By this example we show a situation typical in many respects in OT. From this example it follows that “DEEP” knowledge of the phenomenon does not guarantee the correct decision. And is it problematic if it is actually “deep”?

The whole universe is governed by laws: Astronomy and Meteorology are based on the scientific calculations and laws of the mathematician and physicist; but Homo Sapiens himself is content to leave the treatment and cure of his bodily ailments to chance. Medicine and medical therapeutics are a law unto themselves by having no laws: Medicine is an art – you are told, and depends on the art of the diagnostician. Diagnosis is everything: find out what is wrong with the patient and the patient will be cured ipso facto! But is that really so?

Touching upon the problem of atherosclerosis today more and more facts accumulate giving evidence that hyperlipidemics are an external aspect of the phenomenon. The latest data shows that in the basis of hyperlipidemics are deviations on the cell level, namely, in the system of mononuclear leucocytes, and hyperlipidemics are only the reflection of the fact. It is not clear whether they are either pathogenesis or sanogenesis manifestations or defensive, compensation-adaptive reactions on the pathologic deviations in the same system of mononuclear leucocytes.

What has happened in this case? On the basis of population investigations laws of level distributions and blood lipids structure have been formulated. Everything is correct here. But the next step postulates that everything higher than the average in a population, (with some approximation), exceeds the normal level. We have already studied that. An abstract norm (why should an individual norm be equal to the population norm and the average meaning for the population when the parameters of its distribution (?) are ignored, are thought the population norm), abstract pathogenesis, abstract rules of therapy, a deplorable result.

Touching upon hypolipidemic therapy, we think it appropriate to apply a new class of drugs-monocalines, the action of which in cases of atherosclerosis was compared by G.Tompson, the author of “Manual on Hyperlipidemics” to the action of penicillin on infectious diseases. As for their side effect an increase of transaminase level is shown. In the majority this increase is not very large and only 2% of patients have a distinct rise, during the first week, in 3-16 months or some other terms of treatment. The doctor is recommended not to pay attention to this as it turns out to be transitory. We should not like to be so carefree. In our understanding a transitory increase of the transaminase level gives evidence not of its being inessential, but of the organism coping with the effect of drugs producing a new level of homeokinase. But we have some doubts as to its harmlessness because it broke the balance within the organism prior to the drugs prescription, transferred this balance to a new level of regulation, possibly unknown to the organism, as well as the drug itself. Moreover, this level of regulation is not really very stable if repeated episodes of rising blood enzymes levels are possible.

The above mentioned example allows discussion of the problem of dogmatism in clinical medicine. OT accuses HT of dogmatism. We cannot say that there is no dogmatism in OT or that there is less there. But unlike HT, which has preserved its structure and thus its primary dogmatism during centuries, OT gradually differentiates into new sub-branches and creates new dogma inherent in each of them.

But dogma of a new level quite naturally refutes a dogma of the past or modifies or subordinates it. This creates the effect of absence or at least narrow-mindedness of the dogma. On the other hand dogma can be reconsidered and even radically changed. This is connected with those strong aspects of OT, which are included into well-known assimilation mechanisms of the new achievements in fundamental-sciences, first of all in physiology, biochemistry and morphology in a broad sense. OT is very sensitive to these new achievements of fundamental sciences. The assimilation time of these new achievements has been reduced several times during the last fifty years. Each such step is connected with the revision of previous methods and, consequently, with the dogma that caused it. Nevertheless, though OT is closely connected with fundamental sciences with close investigation we can find dogmatism in it in one form or other.

One of the peculiarities of dogmatism in OT is that it is not always (and maybe even in its majority) identified with the personality who gave birth to the dogma but with the system of ideas that is somehow camouflaging.

Causes of dogmatism in OT are likely to be seen in man's natural inclination to idolise a leader. To find examples we need not go far. These are the above-mentioned European and American schemes of hypolipidemic therapy, when a doctor having a free choice, as it may seem, follows them due to the very existence of these schemes. Otherwise, when some doubts arise in the tested schemes the situation would probably not be possible.

An example of such dogma or rather sequence of dogma, can be the case of coronaroactive drugs and indirect coagulators used in the therapy of acute myocardial infarction.

We can remember when coronaroactive drugs and indirect anticoagulators were considered obligatory in treatment of AMI.

As to coronary active drugs, there was a strong belief that their prescription through the widening of the coronary vascular system improved blood circulation in the heart, including infarction and near infarction areas, assisting faster and more qualitative healing of the infarction area. After some time the dogma proved to be wrong.

Suddenly, not for the first time (!) and again without any lesson for ourselves, we have learnt that without our elevated intellect AMI itself solved the problem. It was found that the products of deviated catabolism coming from the infarction area into microregulatory canal of near infarction area exert the strongest vasodilatation action. As a result, properties of intact myocardial vessels are not changed in the simplest case and those of near infarction area are widened. Thus, this pathological process in the heart of an AMI patient exerts such regulatory effect on the blood circulation system of the heart that the blood flow is redistributed into the infarction area. Here it is the selective and local action of “drugs” desired by us all! Giving a patient a coronary active drug we widen the vessels of the intact myocardium (in near infarction area they are widened to maximum) and blood starts leaving the infarction zone, giving birth to the sequence of unfavourable effects leading to AMI complications and a worsening of the patient's condition. This is the dogma known to everyone working with AMI patients since 1980!

The authors of AMI anticoagulation treatment therapy probably felt bitter disappointment. It started during the period of cardiologist service formation. Organisational measures, as we understand now, (stages of treatment and specialised teams), assisted in the abrupt decrease of mortality. But at that time the anticoagulation therapy was beginning, so naturally the success of the organisational measures was thought merited as well. Otherwise the anticoagulation therapy will not exist long in separate disciplines even at the present time. The first stage in it to follow it strictly. Any book on AMI treatment contained a detailed description of anticoagulation therapy principles. If the doctor wanted to vary the choice of drugs, programme of their use, as regards the therapy itself, the dogma did not give any choice. It demanded to conduct the anticoagulation therapy and to follow it strictly. Later, in 7-10 years in similar books or the same but republished, corrected, and supplemented it was reported that there were different views on AMI anticoagulation therapy. Some believed it was necessary, some did not. The principles of the therapy were given for those who were reluctant to violate the dogma. But today we are aware of the fact that, because of our refusal of the dogma we do not have any problems with thromboembolisms. At that time (it was strange to see the anticoagulation therapy used and the terrific frequency of thromboembolic complications!) nature took vengeance on the aggressive interference into its organism, and not for the first time thromboembolisms produced frequent severe AMI complications, one of the widespread reasons for patient mortality. The abolition of the therapy's dogma by indirect anticoagulants had positive results, also.

Additionally the infarction zone healing improved and the frequency of post infarction aneurysms and heart ruptures lowered.

Today, from the point of view of our understanding AMI mechanisms as an alternative aseptic inflammation, the principles of the infarction zone's improved healing when we refuse indirect anticoagulants are clear. The infarction area heals in the same way as any other tissue after its damage, being similar to healing of post-operational lesions. The surgeons noticed long ago that when they used indirect anticoagulants the process of lesion healing slowed down and became complicated.

Speaking about the lesions healing process, it is necessary to stress a very interesting fact having much in common and importance in OT. We mean scarring of the post-operational lesion. If we accelerate this process the quality of the scar worsens. The cell structures are more numerous than fibres. The properties of fibres and the main cell substances change.

But the most interesting fact is in the motives of the anti-coagulant therapy's dogma formation and their reasons.

AMI patients suffer from higher level of proteins and proteincarbohydrate complexes including fibrogene, and as a result some other properties including viscosity, change. At first view it would seem that the higher fibrogene level would result in thrombosis and the frequency of thromboembolisms would increase. In this case we lose sight of the fact that fibrogene is necessary among the other factors to develop a post-infarction scar instead of necrosis. Here we do not trust the patient's organism, mechanisms of recovery of which are well known, genetically fixed and, certainly, copes not only with a pathologic process, but sometimes with our unskilled medical measures, though etiologically and pathogenetically grounded.

Some interesting investigations in this respect are known in the field of rheumatology when it became clear that coagulatory properties of blood intensified in cases of active rheumatism, but that anticoagulatory properties increased also. Organisms at a certain stage of disease could raise the level of structures, having desirable properties among after-effects as well, such as coagulatory ones.

At present it adequately changes proper systems which are known in physiology and pathologic physiology as homeokinesis, that is transition from one to another homeostatic level. In our case we, following a simplistic approach, pull out one concrete fact and absolutise or rather dogmatise it.

Examples of OT dogmatism are numerous. Returning to AMI, approximately at the time when aspects of anticoagulaton therapy were not longer considered positive, and when negative aspects were becoming more and more obvious, clinical microcirculation applications were adopted. During the most acute periods of AMI doctors suddenly realised that the aggregation of regular blood elements sharply increased, border thrombocytes were standing in the microcirculatory canal, and sludge, microthrombosis, etc. were observed. Naturally, a quite correct conclusion was made that such conditions of microcirculation do not correspond to a healthy man and so it is wrong. Not thinking about the situation of AMI, and its phase course, we decided to replace the anticoagulation therapy by the antiaggregatory one. Drugs having such mechanism of action are quite numerous. AMI patients are prescribed antiaggregants, including nonsteroid anti-inflammatory drugs.

In conclusion, we would like to mention from the positions of unity of the infarction area healing mechanisms and the lesion process course, that some papers have been published showing that indomethacyne hinders healing of experimentally received fracture of a rat’s thigh bone.

We can give numerous examples where there are quite opposite views in OT based on one and the same ideas and mechanisms of pathologic conditions development of diseases on the whole, beginning with diagnostics and finishing with therapy. To be sure, contradictions are the eternal power of progress, and in our case it is our science. Different schools are bearers of different ideas. But, how can we attain a principally different understanding of things having the apparently same basis, especially when speaking about treatment of patients with serious forms of diseases?

Perhaps this is the reason why doctors increasingly refuse medical interference into the course of serious diseases. Thus, in the “Traditional Medicine” section of the Journal "Vrach"(N5, 1991) L.Agasarov published an article "Therapy of men's sex dysfunction'' in which he wrote, “It should be noted that widely used today a medicinal regime including hormone therapy for sex dysfunction, is not always efficient. Moreover, in some cases when the doctor's actions are not correct it may lead to the development of pharmacological castration. Many specialists are inclined to use exo- and endoprosthetic appliances doing this without considering the structure of sexual pathology itself. Such actions cannot be considered justified - in such a manner it can be recommended to conduct vascular surgical operations at cardialgies”. This is one of the examples confirming OT crisis today. Examples of this kind are becoming more numerous.

OT reproaches HT with surface description of aetiology, pathogenesis, clinical manifestations of various diseases and so on. Reading books on HT, the scantiness of data strikes you. Namely, achievements used by HT are in the field of objective application methods (instrumental, clinical-laboratory, biochemical, immune-enzyme and others). This topic will be discussed separately. But concerning OT we can not satisfy by the way in uses these results and approaches. For example, in OT the mechanisms of diseases regard pathogenesis in detail but OT reduces sanogenesis or even loses sight of it. Involuntarily, the doctor gets the impression that everything connected with the disease is bad and consequently, should be treated.

There is a wide gap between the explanation of fundamentals, mechanisms of the development of a specific disease, and its clinical picture. For instance, phase (corresponding to the successive stages of the disease development) modifications of objective and other diagnostic data are not given. The phase development of the disease is poorly taken into account while describing medicinal measures. To say nothing of the fact that they are methodologically wrong, aiming the doctor not to lead the disease to a respective norm, but to the norm of a healthy man. These are absolutely incompatible. And the approach is vicious. We are still too far from understanding a disease norm, and the principles of disease optimisation (in its true sense) are not known to OT, to be honest.

We can refer to M.N.Voino-Yasenetsky who said regarding the processes in the lungs tissues with pneumonia that infiltration of the lung tissue with pneumonia by leucocytes was deeply pathologic in its essence but it corresponded to the moment requirements, so it was normal. Where are those books on OT using this approach?!

OT has not yet formed its outlook or rather has not built a foundation on which some medicinal approaches devoid of dogmatism, or, at least based on a healthy dogmatism, could be developed.

The reasons for this are different:
a) disease pathogenesis mechanistic perception as regards the dialectics of patho- and sanogensesis;
b) sanogenesis ignoring;
c) disease therapy poor understanding regarding its optimal course and its deviations;
d) phase development of objective data corresponding to the trends of the disease development;
e) an even more mechanical approach to the treatment of diseases;
f) imperfection of our knowledge in fundamental sciences, (however the world is recognisable).

We shall forgive ourselves the criticism as we do this only to sharpen the problem, to define new ways of its investigations, and to become more tolerant of our surroundings and ourselves.

A weak aspect of OT, as any therapy in general, is its rather conditional relation to the basic disease process, to which medicinal measure are directed first of all.

For example, consider an inflammation. It is a typical process through which the majority of diseases are realised. Let us consider a more particular case, namely, acute inflammation. It is well known today that an inflammatory process, as it proceeds, is very susceptible to external influences including medicinal measures, during a limited period of time. If medicinal interference is conducted during this period of time, we should expect any unplanned principal influence on the development of an inflammatory process. For example, we can influence the cell reactions of blood and through them change to a certain extent the structure of inflammatory infiltrate with resulting after-effects. But if this time has already been missed to do something considerable will be very difficult. As it turns out the process is not susceptible to external influence, developing according to its own inner program.

We should not flatter ourselves ascribing the received results to medicinal measures irrespective of our influence on it, our estimation of its course and result. The process went in such a manner because it did not correspond to our directions expressed by prescription of drugs. In our practical work medical measures are often long-term and a natural course of the disease to exclusive perfection of the patient’s sanogenetic mechanisms are considered by us solely as the treatment results. It is human nature to claim a desirable thing as a real one!

This example is quite typical in OT. We cannot say that always, but frequently, we plan treatment measures on the basis of the hypotheses that do not have any real foundation. That is not because the modern state of science allows us to develop these hypotheses but because we did not even put such tasks before it. Only today we begin to understand the importance of this problem and Goethe's principle of following nature begins to possess our minds.

The results of experimental research are often used as a basis of drugs clinical prescriptions used by OT. Irrespective of the fact that doctors in research can persuade clinicists in the correctness of models and thus in pharmacokinetics and pharmacodynamics of drugs tested on these models, it does not mean, that being prescribed to a patient, this drug will lead to the expected results. There are some reasons for this, among them an individuality of human organism, an exclusive peculiarity of each specific variant of the disease course and, not the least, superposition of these individualities.

On the other hand, even if the pharmacokinetics and pharmacodynamics of a drug are experimentally tested in accordance with the phase development of a modelled process we should not think that a model phase development would correspond to a real picture of a patient. First of all, for example, we deal with the patient's superposition of process development phases. As an example, we may take data according to which drugs favour vasdilatating of microcirculatory canal influencing endothelium give absolutely contrary results when the endothelium is damaged and they get opportunity to affect directly smooth muscle cells of microvasculars. Not having information about the endothelium of the vascular canal state and prescribing a drug to the patient with one aim, the doctor can get an absolutely unpredictable result. Moreover, on the parts of the vascular canal with damaged and non-damaged endothelium, different even diametrically opposite drugs can have a more paradoxical effect. Here we once again have a case when a seemingly good knowledge of fundamental data of the problem does not guarantee a successful result of treatment.

In its classic variant OT is based on the principle of interference addition directed to the removal of etiological and pathogenetic factors and influence on specific syndromes of a disease. This scheme cannot always be followed. The aetiology of the disease is often not clear, the pathogenesis is not fully understood, the syndromes of the disease are difficult to compare and so on. But in any case, the doctor tries to keep to the scheme as close as possible. And yet, we are surprised that with all this in mind the treatment is not often correlated with its main aim.

This aim is quite simple. First of all, we should not do any harm to a patient. Furthermore, if we cannot cure him then we should at least relieve his suffering. However, if we can cure a patient or even if we can only relieve his suffering, we must not do it at any price.

In considering what the ideal therapeutic system should be, the famous homeopath, Right Livelihood Award-winner, George Vithoulkas wrote “It must be effective, but it must be effective with minimal or, ideally no risk to the patient. Its effectiveness must be based upon not merely the alleviation or the absence of symptoms but on the enhanced constitutional strength and wellbeing of the individual – on the increased ability of the individual to live to the fullest. It should not be prohibitively expensive, of course, and it should be readily accessible and understandable to all members of the population”. *

Thus, the aim of our treatment is to be a maximum help to a patient. We should know how to help him in every specific case, even though it may be absolutely different in every case. If we deal with acute pneumonia, the task will be only to make the patient recover. If it is AMI, then it is the healing of the infarction area by the full value scar. Such aims are global as regards the final result of the treatment and all the other aims should correlate with them.

We can aim to reduce the time of treatment of the acute pneumonia, to reduce the infarction area size and any other proper aim. And we can try to get results. But we have to correlate the results of achieving every specific aim with the strategic aim. There will be very little sense in the reduction of the infarction zone, if the frequency of postinfarction aneurism increases!

The therapy should give maximum effect at a minimum loss. But do we often follow this principle? Not often undoubtedly. Moreover, from our point of view it is more often an exception to the rule.

There is no need to give further examples. About indirect anticoagulants in AMI speaking we meant their influence on the thrombotic blood properties, coronaroactive drugs, i.e. vasodilating influence on the heart coronal arteries. But none of these cases of the above-mentioned measures were correlated with the AMI final result, quality of scarring of the infarction area nor connected with this measure of medicinal and social rehabilitation of the patient. That is why these methods of treatment died out. Only the scars have been left on the OT body.

It must be acknowledged that there is a continuing evolution in medicine. OT medicine from 50 years ago is considered today quite primitive and by comparison the medical care of 100 years ago, barbaric. OT therapies not fitting within present day theories of health and disease should not be so dogmatically excluded by physicians and scientists, bearing in mind that in the near future our so called OT today could be considered primitive or even barbaric in another generation.


The problem of the OT method is that we don't see the forest for the trees. We cannot distinguish between specifics and generality or correlate our local aims with the strategic ones. But the difficulty is in the fact that we don't usually perceive it as the problem. Moreover, there is a serious argument of mastering fundamental knowledge of a disease, its causes and moving forces. We think that our reader has already understood the importance of this argument from the above-mentioned examples.

The ideas of regulation, optimisation, consideration of the pathological process of the disease from the positions of biological expediency arise in the OT, but only on the conceptual level. It is strange, but these ideas proved to be closer to the specialists of exact sciences who carry out medical research. Such are the works by G.I.Marchuk and V.A.Lishchuk. One of them showed this on the example of mathematical modelling of the immunity and its application to hepatitis, acute pneumonia, acute appendicitis and so on. The other gave the example of the mathematical modelling of the postoperational rehabilitation of hemodynamics with the surgical correction of the heart disease. In the therapeutic clinic the works on the optimisation of the complicated forms of AMI healing can be an example of such research. But such examples are very few!

We looked through the examples of wrong methodology of the treatment of patients as a result of mechanistical ideas of patho- and sanogenesis of the therapeutic diseases. But the treatment methods in OT point to other concerns related first of all to the side effects of drugs. We have already noticed that these side effects are not multiple and that the doctor has to ignore them, putting forward the noble aim of the patient's recovery. This topic does not need substantial discussion. It is well studied in the OT. There is a special section of OT named "SIDE-EFFECTS OF DRUGS”. Nevertheless, we will mention the main types of the drugs side effects.

Long, repeated use of drugs leads to the development of tolerance, where to get the same effect we must increase its dosage approaching toxicity with known after-effects. In the clinic while treating seriously ill patients we often come across relative overdoses of drugs. This can be explained by the fact that when the disease is serious, some organs when playing an important role in the drugs elimination decompensate. When they can not perform their functions the drug dosage accumulates in the patient's organism.

An example was described in a study done by Smith J.W. where nine hundred hospitalised medical patients were surveyed over one year for adverse drug reactions. Reactions were detected in 10,8%. Reactions most common were in serious ill patient who received many drugs. Patients with abnormal renal function, infections, or with previous drug reactions appeared predisposed to drug reactions. ***

The organism’s reactions to repeated injections of one and the same drugs can be unusual or rather unexpected. There we can expect intensification, weakening or distortion of their action. This problem becomes increasingly urgent due to some reasons. On the one hand ecological disturbances lead to the decrease of non-specific resistivity, immune reactivity of a man and frequently to their distortion. On the other hand, the pharmacoindustry development has as its consequence more serious logical interference into the human organism, a result of this being the violations of the most important homoeostatic functions of the organism.

Genetically stipulated individual incompatibility of the patient's organism with drugs can be observed. This problem is connected with the above-mentioned one, as we understand it now, because ecological disasters result in man's genotype deviations. Examples of theratogenic and mutagenic influence of ecological disasters lately have often been mentioned in the press.

Use of drugs in OT can result in immediate reactions like an anaphilactic shock, oedema, nettle-rash, haemolitic crisis, asthma attacks and so on. Many drugs cause specific side effects, such as disbacteriosis, dispepsia, acute ulceration and so on. Some of them such as antimethabolites result in the depression of the major vital functions of the patient's organism. The organism becomes addicted to some psychotropic drugs.

Dana Ullman in “Discovering Homeopathy” gave a remarkable example of overdose and drugs side effects. When Elvis Presley died, coroners discovered nine different drugs in his body. In an effort to prevent embarrassment, one of his physicians sought to reassure the public that there were “sound, rational medical reasons” for all nine drugs. This reassurance may have protected Elvis from embarrassment, but it ultimately indicted OT medicine for its presumption that there could ever be “sound, rational medical reasons” for giving nine different drugs to at one time. She made an interesting conclusion: “Side effects from drugs are not really “side” effects but are an integral and often predictable direct effect of the drug upon the human organism. People usually assume that the beneficial effects from a drug are its actions, and that its negative effects are what are called its “side” effects. Actually, drugs simply have effects, and we arbitrarily distinguish those we prefer from those we don’t.”

The majority of OT drugs are contra-indicated in the treatment of pregnant women as they have mutagenic and theratogellic action. Pregnant women give many examples when routine measures are quite sufficient for the successful treatment of acute diseases and acute phases of chronic diseases. With antibacterial drugs some inflammatory diseases are quite often cured without etiologic treatment. Of course, when pathogenetic mechanisms are opposed to the effective sanogenetic mechanisms, when the logic of the disease development is not violated then its course is really optimal. But a young woman has to have sufficient health and rehabilitative reserves to combat a disease in the optimum way.

OT is a creation of our time. Its real value is not only in its achievements, achievements not demanding advertisement. Its real value is in the problem it has put forward. For us these problems are primarily, understanding the fact that not each truth turns out to be true, the necessity to reconsider the truth and the existing philosophy of a disease, a new understanding of a disease and lastly, new approaches to the diagnostics and treatment. But prior to the discussion of these problems we should turn to homeopathy.


“The greatest mistake is to theorise without any facts”
Conan Doyle

“One of the best ways to understand one’s own culture is to visit another”
Dana Ulman


2. STRONG AND WEAK ASPECTS OF HOMEOPATHY

HT as OT has its own history, its experience and its achievements. As OT it continues to develop and recently these processes have increased.

The growing interest in HT in a considerable measure, is connected, though it may seem strange, not only with HT development itself but with OT development as well. The principles of HT, which were and are, criticised by the representatives of OT are the moving forces of growing interest in it. These are small doses of drugs used by HT and the fact that the majority of them are natural in their origin, as well as there is individual approach in treatment of patient. It is here that many people find the HT advantages. *

Medicine is at its best when it incorporates the scientific method and the art of healing. Homeopathic medicine is a profound and powerful means to stimulate, initiate a person’s healing response. *

The law of similar is in the basis of HT. It was coined by Hahnemann – “Like Cures Like” - Similia Similibus Curentur. Produce a totality of symptoms in a healthy human substance being can that totality of symptoms in a sick human being. It consists of the fact that a patient is prescribed a drug in large doses leads to similar disturbances as the disease itself gives. The drug is in such a small dose that it is incomparable to the dose, which causes the aforementioned disturbances in the human organism. This idea becomes clear to us today when we have studied regulatory mechanisms of the organism properly, when we have realised that biological regulators in small and large doses have opposite effects. Small doses used by HT render the possibility to consider specific regulatory action to work by stimulating the person’s immune and defence system without any side effects.

It is an approach that is widely recognised to be safe, unlike OT medicine, which acts primarily by having direct effects upon physiological processes suppressing a person’s symptoms. This is the principal difference between HT and OT. HT is a regulatory therapy, which helps the person re-establish health and prevent diseases.

The law of similar has a global and historical basis in healing. In the 4-th century B.C. Hippocrates said: “Through the like, disease is produced, and through the application of the like is cured”. The Delphic Oracle proclaimed the value of the law of similar, stating: “That which makes sick shall heal”. Paracelsus, a well-known 15th – century physician and alchemist, used the law of similar extensively in his practice and referred to it in his writings. His formulation of the “Doctrine of Signatures” spoke directly of the value in using similar in healing. He affirmed: “You there bring together the same anatomy of the herbs and the same anatomy of the illness into one order. This simile gives you understanding of the way in which you shall heal.”

We think it necessary to stress that HT has its own terminology as to drugs doses. These are the so-called low, average, and high dilutions, low dilutions provide higher doses and higher doses, respectively, provide lower concentrations of drugs in the remedies. The difference between low, average and high dilutions is characterised by the values order and in this respect they are not analogous to small, average and large doses in OT.

The effect of HT doses, as we may expect, are linear and thus are well correlated to simultaneous prescription of some drugs as many homeopaths do in their practical work. These effects, as they are small and linear with regard to their action, are simply summarised. The same cannot be said about OT because with large drug doses their action is far from being linear and due to the same reason their sum effect will never be equal to the sum of the effects. That is why in OT the problem of simultaneous prescription of several drugs is so complicated and as yet unsolved. This problem has been given a specific name, polypragmasia. Claims to the homeopaths from OT as regards simultaneous use of several drugs, when critics have in mind larger summary dose, have no grounds. Even sums of several HT drugs due to their individual small doses do not lead us beyond homeopathic doses.

Doses of drugs used in HT are significantly less than OT doses. In connection with this, HT does not have to deal with side effects of drug therapy, a complex problem in OT. Instead of giving one medicine for a person’s headache, another for his constipation, another for his irritability, and yet another to counteract the effects of one or more of the medicines, the homeopathic physician prescribes a single medicine at a time that will stimulate the person’s immune and defence capacity and bring about an overall improvement in that person’s health.

The fact that in his practical work a homeopath assumes as fundamental the principle of likeness which requires him to investigate disease pathogenesis, to know well the pathogenesis of the drugs used, to put into practice this principle and, in accordance with it, get the expected result. International classification gives us numerous different diseases classifying them according to aetiology, affected systems and other signs. But irrespective of aetiology, all of them are united by a rather limited quantity of typical pathologic processes. Each disease irrespective of the affected organ and other signs is realised at this point through the superposition of these typical pathologic processes. And here as we see it, 'DRAWBACKS' of HT which do not make a great difference between diseases of various systems, such as nervous and skin, are in practice its advantages.

Returning to OT, no matter how many diseases of the connective tissue there are, what their names are, or which systems are affected; their therapy is principally similar. These are non-steroid and steroid anti-inflammatory drugs, immunomodulators and cytostatics. Examples of this kind are exceptionally numerous. These examples reflect only the unity of such multitudes of diseases, principally the same nucleus, or the same typical pathologic process in their basis.

We can object that a specialist in the field of OT using this (from his point of view pathogenetic) therapy, considers organs specific features of disease and so on. But doesn't a homeopath act similarly?! Being more free in his actions as concerns specific nozology, division of diseases according to organs involved or something else, homeopath relies on generalised mechanisms of disease and so his therapy proves to be more systematic.

The advantage of HT is that it takes into account geno- and phenotypic peculiarities, and a patient’s personality. These are the key factors in treatment choice. Not only disease pathogenesis, but also geno- and phenotype of a patient are important for the homeopath. Therapy of one and the same disease with exceptionally similar pathogenesis with two patients having principal differences in genotype will be different. Fair-haired, light skinned, dark-haired, dark-skinned with different shades, hypo- and hyperstenic body build, choleric and sanguine persons (all these signs probably are coded by genes) will require prescription of different drugs. HT more than OT pays attention to heredity and, besides examination of a patient thoroughly, collects related anamnesis. By providing a diagnostic system that assesses the whole organism rather than simply its parts, and by being a therapeutic system that works by stimulating a person’s own immune and defence system rather than by simply controlling or suppressing symptoms, homeopathy will inevitably become an integral part of health care.* This approach has the same origin, history and basis as HT on the whole. That is why HT preserved many out-dated descriptions of gene-and phenotype of patients and drugs pathogenesis corresponding to them.

OT representatives think this to be a weak point in HT and they never fail to mention it when criticising HT. But is it a weak point if OT has just begun realisation of the geno- and phenotypic approach, since serious investigations in OT have been carried out only recently?

A descriptive example in HT is the bromide-type, usually a young blond man of average build, bright-eyed with thin fair hair and fine delicate skin. Apparently, this description should be formalised and correlated with modern scientific medicine language. We expect this will be done. Theoreticians will meet here terra incognito. But the problem of having these out-dated modes of descriptions is, what is better? Not to know them, not to possess, nor to use them or to know them, to possess and to use them without being on good terms with modern terminology?

The principle of likeness or pathogenetic principle forming the HT basis in OT terms has an important name in a generalised approach. It is a generalised approach that is believed to be the key achievement of medicine for the last few years. With its understanding revolutionary transformations are expected in medical science. It is connected with the fact that, irrespective of disease type, its local or general manifestations etc., the disease is realised in the organism singly and indivisibly, (not only anatomically but also functionally and socially), with this indivisibility of the organism defining indivisibility of the disease.

Disease goes through the dialectics of patho-and sanogenesis, being a disease only in the integral organism. If this principle is HT inner contents, we cannot say the same about OT where we gave numerous examples of rather strongly rooted simplistic mechanicism. In OT some separate signs or sets of signs (symptoms and syndromes) of disease are absolute, and eventually they and only they define medicinal strategy and its failures.

The special property of systemic approach in HT mentioned by us is in its personification and correlation with an individual person and in the indivisibility with the disease.

In its work HT uses the long ago developed study of miasmata, which are interpreted from the point of view of different chronic disease models. Three types of miasmata are distinguished: psora, cycosis and syphilis. Under psora we understand the usually depressed reaction of a patient to disease development and the course of lingering disease. On the contrary, in the case of exceeding reaction with obvious clinical manifestations we deal with cycosis and in the case of unnatural reaction we can speak about syphilis. In these descriptions of miasmata it is not difficult to see their direct connection with reactivity and, moreover, the forms of reactivity. Psora corresponds to hyporeactivity state, cycosis to hyperreactivity and syphilis to unnatural reactivity.

The notion of reactivity is extremely important in modern medicine. Its disturbances, deviations from the typical disease picture with complications of its course, in case of hyporeactivity and lingering disease and even chronicity, in case of hyperreactivity - predomination of destructive processes over constructive ones. Different variants of complicated development and course of disease are possible with unnatural reactivity. This is why miasmata in HT are one of its systemic and personification bases. The use of modern terminology here can also assist mutual understanding between OT and HT doctors.

Modality is one of important factors, which HT takes into account while solving problems of definition of patient's disease pathogenesis and choice of drugs. Under modality we understand modifying influence on clinical symptoms of external and internal factors such as meteorological conditions, specific psychical and physical state of patients and so on. We cannot say that OT does not consider modality. For example, if a doctor learns that, stenocardia attacks are provoked by sharp temperature changes, say, when the patient goes outside from a warm room he will be undoubtedly recommended to prolong his exit or to take coronaroactive drugs before going out. But in HT modality plays an exceptional role when its own influence on clinical symptoms of disease is important in the drugs choice but not the clinical symptoms themselves.

In this respect we should look into the evaluation in HT of the symptoms and syndromes that provide us with the only way of perceiving how the defence mechanism functions. Symptoms such as itching, cough, fever, pain and a range of emotional reactions are actually attempts on the part of the organism to heal itself. Each person’s individual responses are the defence mechanisms’ attempt to produce a cure, rather than themselves being the problems. Hahnemann state this concept clearly in Aphorism 7:“The totality of the symptoms must be the principal, indeed the only thing the physician has to make note of in every case of disease and to remove by means of his art, in order that the disease shall be cured and transformed into health”.

In studying all symptoms in their totality, those of importance to the homeopath are modal symptoms, i.e. those which are the most highly individualised to that patient. *

In the case of modality to a homeopath, not only are extremely important syndromes themselves revealed, but their individual properties as well. It is in the individuality of syndromes that a homeopath tries to find an individual drug for the patient. Treatment of two patients with the same syndromes and anatomo-constitutional data, the same reactivity and modality, but with different syndrome nuances, will be principally different. This is one more example of individual treatment in HT with the consideration of regulatory mechanisms. Regulation is true only when it is as such, when it corresponds to this subject only and to this proper state. Otherwise it will be quite approximate.

Touching upon HT principles the so-called law of Guering is of interest. The law postulates the dynamics of rehabilitation process of disease. The important thing in it is the fact that the rehabilitation process goes the reverse way as regards the course of disease and during this process not only the affected organs are changed but all the rest of the organs and systems as well, in other words, the whole organism. It should be noted that these changes are the latest in systems performing detoxicating function. By this fact HT explains the latest rehabilitation processes in skin diseases which cause its transformations. HT demands to be rather considerate in treatment and not to try to achieve quick results especially as regards organs performing detoxicating functions.

It is not difficult to see that such ideas are in good harmony with the idea that to treat well is not to treat quickly.

A homeopathic physician is a qualified doctor who in his practical work uses HT principles. This fact is important to trust such a doctor, as it is understood that he is a highly qualified specialist, he is guided by the achievements of medical science as a whole.

There are two types of HT critics as there are probably two types of homeopaths. One of them is criticised for not using in their work OT methods when it is necessary. There is even a perception that when a doctor from OT becomes a homeopath, he must refuse OT methods in his work. The others are criticised for sometimes using in their work, and even for a short time, OT methods and means. Here some see the imperfection of HT. But on the one hand, OT today in this respect differs from HT very little, as it has to use, when it's necessary, invasive treatment methods such as plasmaphoresis, immunosorption and others. On the other hand, inside OT there is no unity as to approaches and treatment methods of patients with the same disease having very similar clinical picture. Third, as we have already noted, OT only starts to use drugs the prototype of which are regulatory systems of human organism and that's why their doses are similar to homeopathic drugs.

Evidently, we should be more tolerant to each other so our swords should cross only on the practical field. The example of criticism from OT representatives of HT should be a lesson for both where they have similar schools and similar battles. Yes, they are necessary but only the facts should direct them.

One of the peculiarities of HT is the canonisation of its founder, though there is nothing bad in this. There is one god, he consolidates, already he has become an idea, and so he cannot directly influence the specialists working in HT. This cannot be said about OT when dogma in their natural change confirmed by their material bearer whose influence could be very serious. Thus, a homeopath more free is in the decision-making unlike the OT doctor. Though he is considered to follow the original HT principles and in this point homeopaths are seriously criticised by OT specialists: “However, having become a homeopath a doctor should follow homeopathic dogma and due to this he breaks his ties with scientific medicine, failing to keep up with its achievements”.

Careful analysis of HT bases does not give us any reason to see dogmatism there. You cannot find anywhere in the original sources that homeopaths should not use the contemporary medicine achievements, be objective in their diagnostics, control the treatment results and so on.

But nevertheless, the problem is that homeopaths in their majority do not properly use the achievements of modern medicine, do not integrate them into their theory and methodology and in this respect fell behind OT doctors. It is a sacred duty to follow HT fundamentals. But we have an impression that those who follow them follow not only the fundamentals, but also the currently adopted forms. The whole history of society tells us that form is conservative and must be seriously modified in the course of its content development. Here we notice dogmatism caused by those who develop HT but not by those who have created it. Together with principles, rather often the form is idealised and today this form turns out to be the Achilles heel of HT. In other words, a critical approach to HT fundamentals should play a conservative role.

To discover this Achilles heel in HT is very important because it means to basically transform the situation in HT, to revolutionise HT and to lead it to the free-range modern science. Medicine is based on fundamental sciences. Its development is closely connected with the development of fundamental sciences. Concerning diseases, fundamental sciences give us nothing else but aetiopathogenesis of diseases, though, in their objective account, specification and inner conformity. The problem is to explain pathogenesis of diseases in the light of the state of modern fundamental sciences and on this basis to build the strategy of homeopathic treatment.

Already this problem has become urgent. In the preface to the Russian Keller’ “Homeopathy” translation L.Ya. Sklerovsky and A.M. Shepelenko write: “It should be noticed, however, that as in all publications on homeopathy the given book does not give any account of the relation with modern medical science achievements, and it is exactly here where the guarantee of mutual enrichment of practical and scientific medicine lies”.

According to C. Scott: “Homeopathy is more scientific than orthodoxy, for the latter is always changing its drugs and ideas. As against that, homeopathic remedies, which cured patients a hundred years ago, will as efficiently cure patients today if rightly selected. And that is the real test of what is scientific or otherwise.”

OT blames HT for the fact that it does not present correct and convincing data from OT positions, which confirm the efficiency of HT treatment methods. Drugs used by OT give immediate controlled effects. When the patient takes febrifuge, his body temperature (if it is high) lowers, when he takes antiarrhythmic drugs, the frequency of heart systoles falls, and when he takes hypotensive drugs, arterial blood pressure falls.

It is quite reasonable to agree with OT representatives that the above-mentioned drugs possess a therapeutic effect and if prescribed to a patient with certain disturbances will lead to definite changes in systems connected with these disturbances.

All this is true. But where are guarantees against the fact that the aim of treatment is to reduce these or other disease symptoms and that only through reduction of such manifestations can patients be treated? We have shown above the error in such an approach and the resultant disappointment.

Medicine of recent years is more and more influenced by the ideas of optimisation. Generally speaking, the main point of these ideas is that there are many solutions ensuring control, but not all these solutions are equivalent and not all of these solutions lead to one and the same final result.

From the point of view of acute disease treatment probably the most optimum is such strategy of treatment which provides complete physical and social rehabilitation of his health at minimum losses (energetic or any other) for recovery. This strategy, this way, however, should not or moreover, cannot be reduced to the task of the fastest recovery of a patient. Fast and full recovery is very different tasks to be reached simultaneously.

In the basis of any disease lies a respective pathologic process. It is realised on the level of organism, different subsystems of the organism are included in it, it has a definite development strategy corresponding and distinguishing it from any other pathological processes. Because pathological process in our understanding performed through dialectics of patho- and sanogenetic mechanisms, we are inclined to think that not every temperature fall, not every decrease of heart systoles frequency, not every fall of arterial pressure, etc., will correspond to optimal treatment.

All this is true that OT gives us many, even too many, examples when these or other drugs give true (statistical) results. But it is not clear why this result should not only be optimum, corresponding to the given stage of disease development but, moreover, correct!

For instance, Mercury was considered to be the specific drug for syphilis for many years, based on the scientific method of mass observation, then Salvarsan, discovered by Ehrlich, replaced Mercury, also based on the scientific control method. Lately Salvarsan or 606 has been found, and other chemicals for the time being are used in mass experiments. Thus, by using the scientific statistical methods large numbers of invalids, already weakened by disease, are further disharmonized by huge doses of potent drugs.

Recall transitory ciliary arrhythmia at acute myocardial infarction. Usually it complicates extensive myocardial infarctions of the left ventricle. Such infarctions are due to an insufficient pumping function of the left ventricle and one of the most important ways of therapy here is to decrease the preloading of the left ventricle. Arising ciliary arrhythmia by reducing the auricle systoles (left and right) decreases preloading of the heart. In this situation what do our antiarrhythmia measures which are quite effective due to OT drugs, look like?! These kind examples numerous, some were given above.

This is all true. Some additional tasks appear during this specific patient treatment. They have to be solved. But nobody told us that we have rights if not to neglect that, then at least, to forget the final aim of treatment and expected final results.

It is the neglect of the aims of final treatment that is responsible for bitter disappointment in the majority of unjustified OT methods. Touching upon myocardial infarction, let us recall a series of works, including those dedicated to the restriction of MI area by using steroid hormones.

The aim of MI area restriction is very attractive. But how is it correlated and how can we make it correlate with the fullest recovery aim, namely, formation of a full value scar as concerns its structure on necrosis area? This problem is still unsolved by those who have convincingly proved the possibility of MI area restriction by steroid hormones.

The objection can be made that OT itself has understood everything, condemned everything and made correct conclusions. Probably it is so. But who can explain why we should now restrict the near infarction area? Near infarction area is the way by which the infarction area communicates with the organism and the MI area, and the other way. Should we attempt to prove the opposite? We think that for a good course of MI, these communications should be quite sufficient. One can certainly reduce the near infarction area, and in this respect one can even present convincing data. But why should the statistically reliable thing be expedient?! It is absolutely impossible to understand.

Contrary to the OT philosophy, homeopaths in their work follow the old adage “Il n’y a pas des maladies seulement des malades” that is “ there is no sickness, only sick people, no diseases, only diseased people.” The aim of Homeopathy is to cure a person, rather than eradicating a disease. By Homeopathy there is no cure for Pneumonia, Influenza or Malaria as such; but a cure for individual people, suffering from Pneumonia or Influenza or Malaria or any other disease.

It follows, that we cannot compare the results of treatment by OT and HT methods to a degree of transformation of some or other organism functions because it is necessary to compare them by the final result, i.e. the quality of recovery. Some or other ill patient functions different from a healthy one. They must not be changed in any way, especially not by the way of the fastest correlation with the functions of a healthy man but only in such a manner when the complete recovery is provided at minimum losses for patients.

The main homeopathy principle Hahnemann described in his “Organon” textbook. Author wrote: “This is the right and proper way to cure: the highest ideal of cure is a rapid, gentle and permanent restoration of health or removal and annihilation of diseases in their whole extent, with the shortest, most reliable and most harmless way on comprehensible principles”.

As regards HT the acuity of disease under treatment is often not the evidence of this treatment’s inefficiency or, a manifestation of its error, but reflects the efficiency of the treatment.

A reasonable question arises, can we compare OT and HT efficiency according to current changes of disease manifestations alone? We are deeply convinced that it is impossible. The only measure here is the end result of treatment.

OT medicine is based on the study and application of a collection of so-called facts obtained by the irrational method of mass experiments, which are constantly being altered and added to. There is no continuity, no fixed law, no appeal to pure reason, the structure of scientific medicine is based on the quicksands of experimentation on animals, and results obtained from test tubes in laboratories far removed from actual contact with the complicated functions of the human body.

An experimental approach used by OT can be criticised not only as regards HT but OT as well. Experiments on animals give us disease models. But every disease as we have already discussed above is realised through the dialectics of patho- and sanogenesis and according to this its optimum and non-optimum forms must exist apriori. We have also discussed that optimum forms of disease course do not need treatment. Treatment of non-optimum forms of diseases must be realised by the way of optimisation. The majority of experiments carried out by OT do not follow this principle and that is why their results cannot always be taken as correct. Mistakes accumulated in OT, as it is not difficult to show, are caused by incorrect methodological approaches. A disease was modelled, as such. As the idea of optimum and non-optimum disease development has not yet seized OT, experiments were carried out on optimum forms of disease course. But the results were applied to its complicated forms as well.

HT treatment verification method is undoubtedly necessary. Its principles not only in HT, but also in OT, should be absolutely similar. Non-complicated and complicated forms of disease development should be identified. Quality of complicated forms treatment in HT and in OT should be estimated as to their quality of correlation to non-complicated course. Only that way we can compare the results of therapeutic interference by HT and OT methods. We think that as a result both methods will be recognised, only the spheres of their use including their combinatory use, will be defined more clearly. Speaking about HT it should be noted that used by it anatomoconstitutional approach and teaching of miasmata or as we believe, reactivity, are parts of such approach to therapy.

Homeopaths in their work use objective methods. But their number is incomparably small in comparison with that used in OT. This is a grave drawback of HT. Some reasons follow. Firstly, considering disease pathogenesis and drugs pathogenesis, the principles of HT treatment based on drugs selection, the pathogenesis best corresponding to the pathogenesis of the patient's treatment; we have no doubts that the patients were objectively and carefully examined. Besides, clinical practice supplies us with numerous examples of the disease course, symptom-free at stages, while the functions of organs and systems involved in pathologic process are compensated. Examples are chronic hepatitis, tumour diseases and other conditions. When the clinical picture becomes clear the sense in our treatment can be very, very little indeed. Time is often lost. Irreversible organic changes have come and interference can be rather palliative. Further on, there is no mutually single correspondence to real disturbances of vital functions and/or systems and disease manifestations.

That is why the integration of modern functional diagnostic methods in the homeopath' s work will optimise his diagnosis, assist more in exact and full determination of disease pathogenesis thereby leading to the rise in quality of treatment. Another point is that methods of objective diagnostics in HT must be stated first from the positions of the approach used by it, namely, disease pathogenesis. Nowadays, the diagnostic method can be performed since we have enough theoretical facts and their applications to the change of different functions and systems of sick organism as concerns their relations with pathogenetic disease mechanisms. The results will be used quite expediently as a homeopath has OT background and its methods are not unknown to him.

We have already discussed problems of HT form and content. We think it important to consider one more HT principle, i.e., drugs pathogenesis. Considering this we understand not the pathogenesis of these or other organism disturbances after administration of these drugs, (naturally in toxic doses) but symptomocomplex of these changes. In this case description of this symptomocomplex is not dynamic but static. Symptomatics is described without its development sequence. So to say, we mean not pathogenesis as it is, but its projection on the surface of symptomocomplexes. The time aspect is missed here.

Reconsideration of homeopathic drugs pathogenesis from the point of view of symptomocomplexes development sequence probably would help to open a new trend in this field. To be more just we should stress that drugs used by OT have time action as well and they have their phase pharmacodynamic characteristics which, however, are often not well described and even more rarely understood and used in practise.

The range of HT activity or rather its influence, is less in the world than OT. There are many objective and subjective reasons for that. HT has never had as much governmental support as OT, and as a result has never had good possibilities to develop, to be understood and to use its experimental base.

During many years HT underwent severe suppression from OT. In their polemics we see the irreconciability of OT and the conformism of HT. There was no desire to meet from OT irrespective of the fact that today not all its truths, not all its approaches are of single meaning and, moreover, as concerns HT criticism. OT created a distance between itself and the doctor applying HT from its method. Homeopaths had to accept such conditions in the past. Due to the mentioned objective transformations the situation today is changing drastically and let's hope that a new dialogue will assist further development of medicine and its role in human society.

HT is often reproached for the limits of its clinical applications. Lists of diseases were defined when patients could not be treated by homeopaths. For example, tumour diseases are included into this list. As we have mentioned above every disease method has its own recommendations and restrictions. HT was born inside clinical medicine and so is one of its methods. As one of its methods it has to have its own application area. But on the other hand, HT treats not only therapeutic diseases but also nervous system diseases, skin, endocrine system diseases etc. as well. In this respect its scope of activity is quite wide. Further, we must agree with those HT specialists who recommend even in the cases of tumour diseases to add homeopathic drugs to treatment methods accepted in OT, explaining that they affect the regulation process of the patient's organism which is very important for its increased resistivity and other rehabilitational mechanisms.

OT is suspicious of the HT dilution principle, especially high dilutions. In reality we have an impression that the effect of high dilutions actually occurs. When solutions are highly diluted OT views the original substance as being totally absent. If it is so than what can be expected of the non-existent factor. A man of materialistic outlook is difficult to persuade that an absent thing can act in some way. Any ideas on fields un-identified by modern science seem unconvincing.

Additionally, homeopaths, when they consider the extremely small doses in HT drugs, stress principles of potentiality taken as a principle of drug preparation. The idea of this principle is in the special method of shaking the dilutions to the number of concentrations used in drug preparation. Unfortunately, objective data allowing verification of this principle are absent.

Discussing the dilution problem in HT we should refer to OT, to see the real situation. The situation is quite simple, it can be formally characterised in the following way.

Official pharmacology in its research tends to develop drugs similar in their original structure or even corresponding to the active substances in the regulatory systems of the organism. Such drugs as prostanoids, vasoactive peptides and some others are the examples used today. A distinguishing feature of active substances in the regulatory systems of the organism is their astronomically small size and their astronomically small concentrations in which they have a regulatory effect. For prostanoids it is fractions of picomoles and in HT terms this corresponds to high dilutions. Prostaglandines, leucotriens, neuropeptides and some other OT drugs are the example of drugs, doses of which differ very little from HT doses.

By this we see that OT pharmacology in its development tends to such active substance concentrations in drugs which are actually homeopathic. If we take into account that HT uses mainly drugs of plant or animal origin, and these active drug substances can correspond to similar substances in animals including the human organism, shouldn't we then think that by refuting HT, OT tends towards it. Once again through the materialistic principle of the denying of denial, it takes time for us to understand everything.

Critics blame HT for its approach, conditioned by its principles to test new drugs in toxic doses based on the necessity of their use by volunteers. It is because a specific homeopathic drug can be used to treat a specific disease only when in toxic doses its active substance causes a clinical picture in a healthy person, which corresponds to this specific disease’s clinical picture. The closer the conformity of the clinical picture (pathogenesis manifestations) of a disease and homeopathic drug, the better the treatment results should be from the HT point of view.

The Delphic Oracle gave this injunction: “Man, know thyself” and the Pope re-affirms it with these words: “The proper study of mankind is man,” both in health and in sickness.

Touching upon this approach of HT to drugs testing, the following (originating at the dawn of HT), should be noted. It was born not in HT itself but in the depths of medicine as a whole and widely used to make aetiology of infectious diseases clear.

When this principle was used at the dawn of science and by the part of medicine, which is considered the origin of OT, it was called in literature dramatic, or even heroic, medicine. So it was. One had to be a really heroic person, to be able to self-sacrifice for the sake of science. But why what is white in one branch of medicine is black in another?

At present, HT widely uses data received from toxicology in the development of new drugs.

It should be stressed that investigations on volunteers are still carried out from time to time in OT. For example, A.S.Loginov with his co-authors in his article on the campilobacteriosis role in chronic gastritis aetiology refers to the work of B.J.Marshall et.al. in which they obtained direct evidence on a volunteer with hystologically normal gastric mucous membrane. The volunteer was injected with 10E9 colony-forming units of campilobacter into his gastric cavity and, as a result, chronic gastritis developed.

Reading guidebooks on modern HT one does not find any indication of the necessity of using this approach for the expansion of homeopathic drugs pharmacopoeia. The doctor is only recommended to find in his every day work the cases of (forced) poisoning by some drug or other to make their pathogenesis and thus to expand the volume of homeopathic drugs.

Hahnemann taught that observation of sickness and the course of an illness at the bedside were necessary for the healing and cure of disease by means of medical remedies. The cause and the cure of disease could only be found by studying man in health and in disease and by observing the effects of a drug on man in health. Thus he could and did find the right, prompt and painless way of restoring the sick man to health. *

From our standpoint, in its practice HT can widely use OT drugs, keeping in mind that the toxicology and, consequently, pathogenesis of each of them, have been carefully tested during experiments. Possible ways of resolving this issue will be discussed later.

Recognised medical studies give examples, which can indirectly testify to the real benefit of use of the HT principles namely, “like cures like”, and "high dilutions". Many examples are discussed in homeopathic literature. Here we will give two more principles, which, in our viewpoint, are even more demonstrative and, what is more important, show significant commonality.

In the course of development the result of inflammatory process cell reactions and the initial polymorphnonuclear cell reactions take an extremely important place. As it turns out, the one and the same products of the metabolism of polymorphnonuclear cell leucocytes can perform the functions of positive and negative chemotaxis. The concentration of the products is likely to be the most important thing. If concentrations of these products are small, they appear in the role of positive chemotaxis factors for polymorphnonuclear cell leucocytes, stimulating their coming into the inflammation area. It is remarkable that these concentrations quantitatively correspond to the concentrations used in HT. If their concentrations are higher, these products play the role of negative chemotaxis factors for polymorphnonuclear cell leucocytes. In the same way given cell forms entering the inflammation area are regulated and in compliance with their participation in the inflammatory process as well.

The same can be said about another phenomenon, namely, influence of pancreas enzymes on secretory function. In small quantities they stimulate it, but in large quantity depress it. OT uses large doses of enzymes as recommended now, exceeding several times exceeding the recommended ones. Their application is meant to compensate the external secretory function of the pancreas. This function is compensated but depressed also. Here a question arises, would it not be better to follow nature, by giving patients with lowered external secretory pancreas function, the same drugs in small doses, which stimulate organ secretion?

This example shown for neutrophylic leucocyte kinetics and dynamics in inflammation areas and for the pancreas’s secretory function is a typical regulation principle for a living organism, which is realised through the mechanisms of direct and reverse communication. Here we can easily distinguish HT origins. To stimulate inflammatory process small doses of drugs are necessary. To impair it to a certain degree, large doses of these drugs are necessary. To stimulate pancreas secretion it is necessary to use the appropriate enzymes but in small doses and so on.

The works by L.Kh.Garkavi et.al., and F.Z.Meyerson show that small doses which perform regulatory and adaptive functions, favour organism stability and rise to pathologic states development if pathologic states have already begun, their quick, qualitative elimination.

According to G.Vithoulkas “In homeopathy, we have a therapy which has profound value for the future of our societies. Not only is it a therapy which can effectively cure chronic diseases, but it is a method of stimulating the defence mechanism and balancing the constitution of patients. It is capable of enhancing the degree of productivity, creativity, and serenity of people by removing the susceptibility to disturbing influences.”

Thus, analysing the situation in HT we come to the conclusion that as recently noted, it continues to develop with especial intensive growth. Criticism of HT in the light of modern science achievements cannot be regarded as objective. HT as well as OT has its weaknesses, especially as regards explaining modern data on diseases mechanisms, terminology, use of modern diagnostic complexes in everyday practice by doctors etc. These problems are likely to be resolved with current scientific methods providing all reasons to overcome them. The only thing needed is to have sufficient motivation and dedication! Undoubtedly the main advantage of HT is in providing and using the regulatory principle of interference in the patient's organism. In any case, the time has come for OT to re-evaluate its understanding of HT.

Gay Gaer Luce, two-time winner of the National Science Writers Award, has proclaimed that “homeopathy is a highly developed health practice that uses a systematic approach to the totality of a person’s health. Anyone seeking a fuller understanding of health and healing will find homeopathy extremely important and applicable.”

One cannot help but agree with Dana Ullman in that as we enter the 21-st century, a new type of comprehensive health care will emerge, one in which various natural healing practices and conventional medical treatments play an integral role. It will emerge not only because people will realise that it is the rational alternative, but also because is necessary for physical, mental, and spiritual health.

“In the past practices used to be different, but
we have changed all that and now practical
medicine is a completely different method”
Moliere


3. OPTIMUM TREATMENT STRATEGY IN INTERNAL DISEASES THERAPY

The internal diseases field in its wide understanding is one of the main trends in modern medicine. To distinguish in it OT and HT or, moreover, to compare them at the present stage of treatment development seems not to be so rational as before. Both trends have one and the same object of investigation, one and the same aim. HT as the OT has grown from one root – ancient medicine. Many general HT regulations make up the nucleus of modern fundamental sciences, i.e. physiology and morphology which OT apriori regards as its own.

Having analysed in general, the modern status and correlation of OC and HT, we arrive at the expected results, saying that both these clinical trends are more united by common problems than separated by particular problems. First, what was criticised in HT by OT representatives is not so wrong. Second, OT principles are not so undeniable. The principal fact is that OT and HT are united by the same problems where they can unite their efforts and assist further qualitative perfection of treatment.

Analysing the two previous chapters the reader may doubt our straightforward point of view regarding OT and HT correlation. Quite a different approach to the explanation of the strengths and weaknesses of OT and HT is truly evident. There were different points stressed in these chapters. We actually repeated that all was done from the positions of symmetry. We underplayed the weaknesses of OT aspects and tried to find stronger aspects in HT to balance their interrelations. In other words, to show that not everything is so good in OT and so bad in HT, both strong and weak aspects of OT and HT were caused by the same reasons, here only the single approach must be an important condition of further progress.

One of the most important problems put before the internal diseases field and medicine as a whole can be formulated as a correct disease understanding. Physicians and patients often assume that person’s symptoms are the disease and that simply treating these symptoms is the best way to cure the patient.

It is generally believed that disease symptoms are something heterogeneous and hostile to the sick person. PeopleThey think, one has to eradicate and suppress them. That is why, all actions of OT are aimed at suppressing the symptoms of the disease and a consequent restoration of lost functions, by the way of introduction into the organism of suitable chemical substances, supposedly necessary for the full return to health. If on the other hand, one analyses the origin of word symptom, it becomes evident, that it comes from a Greek root and refers to “something that falls together with something else.” Symptoms, then, are a sign or signal of something else, and treating them does not necessarily change that “something else”.

The display of first symptoms of disease signifys the possible response by symptoms to the morbific stimulus occurs at the intensity of the stress, the first disturbance occurs on the dynamic, well balanced pato- and sanogenetic mechanism of the body.* This concept was first enunciated by Samuel Hahnemann in Aphorism 11 in The Organon of Medicine “This vital force is the one which is primarily deranged by dynamic influences upon it of a morbific agent.”

Walter B. Cannon in his “The Wisdom of the Body” details the impressive and sophisticated efforts that the body deploys to defend and heal itself. The father of stress theory Dr. Hans Selye has taken Cannon’s work further, recognising that symptoms are actually efforts of the organism to deal with stress or infection. He sees symptoms as defences of the body that attempt to protect and heal it.

Modern concepts of cybernetics demonstrate a fundamental principle which applies to the human organism as well as to other systems: any highly organised system reacts to stress always by producing the best possible response of which it is capable in the moment. In the human being, this means that the defence mechanism makes the best possible response to the morbific stimulus, given the state of health in the moment and the intensity of the stress.

Concepts in new physics offer further support for the notion that living and nonliving systems have inherent self-regulating, self–organising, and self–healing capacities. This ongoing effort to maintain homeostasis (balance) and to develop higher levels of order and stability has been described in detail by Nobel Prize – winning physicist Ilya Prigogine in “Order Out of Chaos”, by Fritjof Capra in “The Turning Point” and by Erich Jantsch in “The Self–Organising Universe”.

It is well known today that fevers represent an effort of the organism to try to heal of itself. Fever usually accompanies bacterial or viral infection by increasing white blood cell activity and stimulating the production of interferon. The cough has long been known as a protective mechanism for clearing breathing passage, diarrhoea to be a defensive effort of the body to remove pathogens or irritants more quickly from the colon. Discharges are understood as the body’s way of ridding itself of mucus, dead bacteria, viruses and cells.


The implications of recognising that symptoms are efforts of the body to defend itself are significant. Disease is not something foreign to the person’s organism The implications of recognising that symptoms are efforts of the body to defend itself and from this position an aggressive attitude is required for its eradication, weakening and so on.

Disease is not something exclusively pathologic. It is the essence of the patient's condition that is realised not only through pathogenetic mechanisms, but also through the dialectics of patho- and sanogenetic mechanisms. The same disease symptoms are simultaneously the manifestations of pathogenetic and sanogenetic mechanisms as are the two sides of a coin. Development and realisation of disease is determined by this correlation and to a great extent determines its results. Genetically, the human organism has as its foundation a thirst for life, thirst and recovery mechanisms. That is why any disease is realised through the dynamics of patho- and sanogenesis and consequently, in most cases, the patient's organism governs the logic of these processes creating the most favourable conditions for possible disease result. Only disturbances in rehabilitation mechanisms can define the disturbances of patho- and sanogenetic processes and prevailing of pathogenetic mechanisms over sanogenetic ones with complications in the course of disease or rather deviations from optimum expedient way of development.

This approach was well recognised by GT.H. Coulter in his book “Homeopathic science and modern medical knowledge” Coulter writes: “Homeopathy regards the living organism as continuously reacting on its environment system trying to repel danger and to restore its damage. Consequently, what is called “DISEASE” in reality reflects the organism striving for health”.

In modern therapy first of all we should move from disease description in its patho- and sanogenesis, therapy, diagnostics, treatment and prophylactics to the description of its optimum and deviated course of disease development, with identification of causes and mechanisms of disturbances of optimum development of the disease. It is apparent, that if disease develops in an optimum way with its patho- and sanogenetic mechanisms balance, if the best way to develop sanogenetic mechanisms is found (by the organism itself) then our interferences are unlikely to be expedient. In the best scenario they will not influence internal organisation of disease, but in the worse case . . .

We hope it is clear now that examples from the OT field were taken, not only to support HT but to show the depravity of OT approach adopted today or when a doctor's philosophy becomes higher than the philosophy of a patient's organism. If the natural course of disease for some reason is disturbed, our interference is undoubtedly necessary, but it should be directed to optimise its course or, in other words, to find conditions providing the most favourable recovery.

While selecting complicated and non-complicated variants of disease development and course, we think it natural to find their internal mechanisms and dialectics of their patho- and sanogenesis. It is apparent that the number of most optimum disease development paths is limited, their deviations and naturally, their mechanisms vary extremely. Distinguishing the optimum path of disease development and its inner mechanisms, we should find and describe in the same manner disease course deviations and variants, explaining their mechanisms. Only in such a case can we construct the correct treatment strategy based on optimisation of deviated forms from the variant course of disease.

This task is not easy. The first question arising here is connected with the understanding of the optimum disease course. What is an optimum disease course? Which of disease course variants, for example, in case of its acute forms, recovery, is the most optimum? Is the disease course the same when recovery is the fastest? We have mentioned the only answer in the previous chapters discussing strong and weak aspects of OT and HT. The optimum disease course can be recognised as that which requires the least price. Treatment periods can hardly be the price! This price is minimum structural and functional consequences of disease area and patient's organism as a whole.

Leading to the solution of the tasks connected with the optimum disease course and its deviations, the issues associated with the global aim take priority. This global aim expressed as “the least losses” has its own definitions for each disease and must be clearly identified at all times. Today, mistakes accumulated in treatment are in many respects associated with the fact that in our actions we did not only trust the patient's organism, the perfection of its inner mechanisms but forget about, this single strategic aim while we substituted our private aims.

Identifying optimum and non-optimum disease course paths, defining the main idea of the optimum disease course, describing mechanistic disturbances in disease development, we naturally come to the aims connected with regulation of these deviated forms and correlation to conditions of non-complicated or optimum course. It is apparent that the contents of this regulation will be defined by a specific form of the deviated course, the extent of its deviation from the optimum course and phase development. At each stage of disease our possibilities as regards its optimisation degree are quite different. For each stage methods used must be different also, they should be correlated with the phase development of the disease. All this is yet to be understood, thus requiring fundamental scientific investigations.

In accordance with the disease and its dialectics of patho- and sanogenetic mechanisms, treatment should be reconsidered. We should have a clear understanding of clinical manifestations of optimum and non-optimum disease course forms, their relations with specific disturbances in the course optimum, taking into account the extent of these disturbances and development stages of the disease. We should also understand how these or others symptoms and syndromes of the disease are connected with its patho- and simultaneously, sanogenetic mechanisms. This understanding is extremely important, otherwise we will not be able to estimate any remote consequences of our interference. We do not know whether this interference will work for the global aim or will worsen the deviated disease course.

With such an approach, problems of reconsideration of many disease syndromes and symptoms both subjective and objective arise. First and foremost concerns objective symptoms, which allow determining in a single way the disease development, its non-complicated and complicated forms. Purposeful investigations are necessary to describe all the multitude of disease symptoms in their relation to these forms of disease. The doctor must know which values and at what stage of disease development of non-complicated and complicated forms acquires. Each of used him indices in diagnostics, otherwise he has only one criterion - the extent of deviation of this index value from sex, age and other norms of a healthy man. But disease is disease and as well as in health it has its norms. On the one hand disease norms are more dynamic and on the other hand, never correspond to health norms.

One of the possible fruitful approaches proposed by G.T. Marchuk. He devised a method that allows use of one single index for the whole complex of syndromes, subjective and objective symptoms, as well as their variety taken together. It may be a clinical index for clinical data, biochemical one for biochemical data, functional for functional data and lastly a generalised one for the multitude of clinical, biochemical, functional and other data. Further, optimum and non-optimum disease course forms are unique and for each of them there is an index or/and indices dynamics. When we know the dynamics of indices which correspond to optimum and non-optimum forms of disease and define their value on any stage of disease of a specific patient, the doctor can determine which kind of index corresponds to optimum variants or deviations from it.

For every disease in its acute, subacute and chronic course extremely important is detailed identifying dynamics of objective and subjective syndromes, clinical, laboratory, biochemical, immunological, functional and other indices according to the non-complicated course as the standards to which the doctor should orientate himself in his medical therapy.

Disease as such exists in the whole organism. Neither mechanisms of patho- nor sanogenesis, nor local, nor organism systems are subdivided in it. Regulatory systems are organising systems in disease development, determining its course and results. They are also manifestations of the disease and are distinguished only in our mental models as well as patho- and sanogenetic, local and global notions. These regulatory systems must be the primary object of our investigation as they play an extremely important role in disease development trajectory, since through them we can interfere efficiently with disease.

Having defined optimum and non-optimum disease forms and treatment aims as the aims of optimisation and correlation of a specific disease course variant to its optimum form, we begin to understand the aims of clinic as the tasks of optimum control. Because of this they can be achieved, first of all, by affecting regulatory disease mechanisms. We cannot help but to apply to HT the aim which is to interfere in regulatory disease mechanisms, again only at the regulatory level, taking into consideration the patient's specific individual features or to be more exact, his geno-and phenotype as well as current reactivity state.

Not only treatment but also all logic of fundamental research including pharmacokinetics and pharmacodynamics should be subordinated to this approach. Experimental models on animals should be correlated with optimum and non-optimum forms of disease course. Methods of treatment, or rather methods of optimisation and of optimum control should be devised for the models of deviated forms of disease course. The quality of treatment should be checked on the models of non-complicated forms in order to assess how this therapy has optimised the course of deviated disease course form or rather how close it has correlated its course to a typical model of non-complicated disease variant.

It's quite clear that reduction of treatment time, quick elimination of some syndromes criteria must be discarded as principally wrong, contradicting the notion of optimum disease course.

All multitudes of diseases comprising the core of internal diseases treatment can be conditionally divided into three parts, namely acute, subacute and chronic diseases.

Between these subdivisions of disease there are principal differences. This means that acute disease can have the outcome of ultimate recovery, acquire subacute state or pass on to chronic form. Subacute disease like acute can be cured by recovery, at a higher price, but more often than acute, it develops into chronic disease. Chronic disease stays with the patient for a lifetime. Both subacute and chronic diseases can develop through pre-existing disease forms or primarily start as such.

In accordance with this the treatment strategy of the three disease subdivisions has its own peculiarities. Acute and subacute diseases require the strategy, which ensures the recovery of the patient. For acute disease to reach this aim is more possible than for subacute. For a chronic disease that is currently incurable and remains with the patient for a lifetime we should strive to ensure its course by the least price in biological and social aspects. It will require active treatment during the acute stage when its strategy on the whole corresponds to such acute and subacute diseases. The only difference is that all previous disease history is taken into account. At the remission stage the most efficient action of compensatory mechanisms should be ensured. These general ideas, however, must include specific contents as regards the specific groups of diseases and nozologic forms.

Chronic and acute disease forms with existing principal differences, nevertheless, have a principal likeness. Chronic disease goes through acute and remission stages. Acute stages can be presented as a sequence of acute diseases with remission stages, as periods of time before the next acute diseases. It is convenient to demonstrate this idea in the example of chronic inflammation, which is one of important general pathologic processes through which the majority of chronic diseases mechanisms are realised.

Chronic inflammation can be presented as sequence of a acute inflammatory processes and next, of which in clinical terms, is an acute stage of disease with intervals between acute inflammatory processes understood as remission stages. Each acute phase, as well as acute inflammatory processes, is completed in accordance with the results of acute inflammation and in a favourable case is structurally shown as connective tissue which replaces damaged tissue during the necrotic stage of acute inflammatory processes. The main difference of the acute stage of chronic inflammation from acute inflammatory processes is that during further acute conditions the connection with the primary etiologic factor is lost. Their courses are modified by defects in structural mechanisms and are revealed through experience gained by immune and other systems of organism vital functions control without which chronic inflammation would not exist.

In the inflammation process realisation of any localisation, of primary importance are not only local, but system-forming mechanisms as well. Among them are systems of cambium cells and cells with heralds of marrow for leucocytes. Leucocytes are the cell nuclei in the realisation of inflammatory processes at all stages, beginning with early cell reactions and finishing with organisation of developed and matured connective tissue scar on the damaged area. Leucocyte functions are ensured by cell kinetics and dynamics through which we can observe redistribution of cell pulls, change of chemotoxical and other functions manifested in the increase of enzymes and proteins of acute phase, leucotriens, and other factors in blood. Chronic inflammation realisation is determined by the patient's genotype, by interrelation of etiological factors, local and organism mechanisms and is reflected in the forms of non-specific resistivity and immunological reactivity. In the course of inflammatory processes development more and more organ tissues are substituted by connective tissue. Due to this the volume of parenchematosis tissue structures decrease, and at that level inflammatory processes can be realised. When disease progresses inflammatory process symptoms can reduce. In this situation manifestations of specific functions of the organs involved in inflammatory processes decrease.

A clinical physician has to solve the task of reflecting the whole process structure as clinical diagnosis, by which later prognostic, diagnostic and prophylactic tactics are determined in accordance with the mechanisms of inflammatory nature producing the basis of chronic disease. The state of non-specific resistivity and immunologic organism reactivity, inflammatory processes development phase, its activity, character, peculiarities and degree of organs specific functions disturbance involved in inflammatory processes should be evaluated, that is the patient's organism state should be estimated.

Therapy must be based on the inflammatory processe idea as a defensive compensatory adaptive organism reaction to damage. In connection with this its aim should not be depression of inflammatory processes, but direction of its course, correlation with favourable conditions with minimum structural consequences for the affected organ and organism as a whole. Among these measures are optimisation of resistivity and organism reactivity, affecting inflammatory processes course phase, stimulation or rehabilitation of lost functions of the organ involved in the inflammatory processes etc. Prophylactics should use measures directed to increase strength reserve of organism regulatory systems, elimination or decreasing the level of initiating inflammatory process factors.

Since the defence mechanism is already responding with the best possible response and the activity of the defence mechanism originates on the dynamic plane, the most logical therapeutic approach would be one which enhances and strengthens this level, thus increasing the effectiveness of the organism’s own healing process.

These approaches have been well mastered by HT. It is HT that takes into consideration gene- and phenotype of the patient in their unity and the manifestations of the patient’s reactions as a whole characteristic not only of a localised given process but the total process as such. Homeopathy is a medical approach that respects the wisdom of the human body. It is an approach that individualises medicines according to the totality of the physical, emotional and mental symptoms, that stimulate the body own immune and defence systems to initiate the healing process. Regarding OT, its activity is more directed toward clinical syndromes than the disease and a person as a whole, especially concerning chronic diseases, when the etiologic factor as such is not identified.

The above discussion gives us reasons to expect more conformism between OT and HT. In the light of ideas on optimum and non-optimum ways of disease course, on therapy as a method of disease optimisation, correlation of disease course to optimum variant we think it justified combine OT and HT methods. OT important use in cases of serious deviations of the disease course threatened by serious consequences. Use of HT can supplement OT methods in the stages of correlation to optimum disease course when a smooth state of change is required as in the majority of disease forms, and when deviation from optimum course variant is not grave.

In any case, the principle of disease optimality and resulting optimum disease control with a deviated course, correlation to these optimum conditions which give more reliable results, put serious tasks before us not only on the level of methods but primarily on a methodological level. There is much work to be done.

Speaking of synthesis of OT and HT and the experience discussed here, this approach should be distinguished from the trend called homotoxicology. The latter has been presented as a possible bridge between OT and HT. Homotoxicology, as we see it, in some way sums up OT and HT approaches. Diagnostics in homotoxicology is similar to OT diagnostics as it is based on anatomical and clinical findings. However therapy utilises HT fundamentals such as low potentialities, rehabilitation of life energy, and balance of biological regulatory systems.

Currently we should reconsider our past experiences. We have to reconsider all disease philosophy, beginning from aetiology, patho- and sanogenesis and concluding with treatment and prophylactics. We should study all diseases from the very beginning. We should find, identify, and master their non-complicated and complicated ways of disease course.

We should find the most optimum ways of non-complicated course. We should identify the reasons and mechanisms of deviation from these ways. We should devise prophylactic measures of development and disease course complications. We should develop measures to optimise the correlation of definite functions not to the norms of a healthy man, but to the values most suitable for non-complicated disease course and, moreover, most favourable to the ultimate recovery of a patient.

It is natural to entitle the ideas stated here the principle of disease optimisation. This terminology has already been presented in the introduction. It directly or indirectly has been used through the whole book. We hope that the idea is correctly perceived and will be supported by you, our dear Reader. In the principle of disease optimisation we have included everything from patho- and sanogenesis, clinic, diagnostics, differential diagnostics and lastly, treatment to prophylactics. The main point of this principle is a new clinical outlook, new clinical tasks and consequently, a new impulse for its development. We believe that, at least, at this stage of therapy this principle will play a key role to progress through the crisis and reach new heights which it, undoubtedly, deserves. We should like to hope that definite tendencies in OT and HT integration would develop and positively influence this process.

And now the most important. The principle of disease optimality today is more philosophy than the instrument of action. Some of its seeds that appear from time to time, which surprise us by their wonderful results will undoubtedly strengthen and yield good harvest. But we should not wait till the harvest time, all of us should assist this process by all our efforts whether in a scientific library or in the field of practical medicine.

“At least once we shall remember this thing with pleasure”
Virgil

CONCLUSION

Our book is finished. We have attempted to give in it our understanding of achievements and problematic areas in the OT and HT, their causes, and possible ways of further development.

We think that the main reason of treatment stagnation is the erroneous understanding of the disease. Until the present time disease has been regarded as something foreign to the human organism, requiring resolute interference.

Having analysed OT and HT, we have formulated the principle of disease optimality, realisation and mastering of which solve the problems born by the crisis, and the paths of further clinical development.

A successful movement forward requires, among other ideas, realisation of the conformism necessary for OT and HT. Both branches of the internal diseases field of treatment make their contribution to the solution of the problems that we have discussed and we hope they will be used.

The authors hope that the present book will be useful for those who carry out research in this field of treatment and for practical doctors as well.

LITERATURE

1. Agasarov L., Therapy of sex disfunctions of men.-“Medicina” Publishers, “Vrach” – 1991, N5, p.31-33.

2. Avtandilov G.G., Yabluchansky N.I., Salbiev K.D. Quantitative morphology and mathematical modelling of myocardial infarction. –Novosibibirsk; NAUKA, 1984. –288p.

3. Cannon W.B., The Wisdom of the Body (New York: Norton, 1942).

4. Capra F., The Turning Point. (New York: Simon, Schuster, 1982).

5. Dana U., Discovering Homeopathy: Medicine for 21-st Century. North Atlantic Books. Berkeley, California. 277p. 1991p.

6. Davydovsky N.V., Problems of cause in medicine.-M.Medgiz, 1962, 176p.

7. Dylman Y.M., Four models of medicine. – L. Medicine, 1987, 287p.

8. Farrington Z., Homeopathic clinical pharmacology – M.; B.I.1963, 653p.

9. Ganeman S., Organon of Medicine. Sixth edition. B. Jain Pablishers, New Delhi, 1979 – p.314.

10. Garkavi L.Kh., Kvakina Y., Ukolova M., Adaptable reactions and resistivity of the organism.-Rostov; Rostov Univ. Publishers,2 and supplimented edition, 1979, 128p.

11. Gritsyuk A.I., Guatua N.A., Sledzevskay I.K. Myocardial infarction. Kiev; Zdorovya, 1979, 272p.

12. Ivanyshkin A., Homeopathy and modern medicine. – 1988, n4, p.76-82.

13. Jantsch E., The Self-Organizing Universe. (Oxford, England: Pergamon, 1980).

14. Kakhetelidze M.G., Kurbanova G.N., Prigozhina T.A., On the role of disintegration products of granulocytes in the regulation of leucopose/All–Union congress of homoeothologists and transfusiologists. Baku, 1979, p.164.

15. Keller G., Homeopathy. M.Medicine, 1989 – 592p.

16. Kent J.T., Lectures on Homoeopathic Philoslphy (Berkeley: North Atlantic Books, 1979).

17. Kogan D.A., Homeopathy and modern medicine. –M. Medicine, 1964,p.13-20.

18. Loginov A.S., Aruin L.I., Smotrova I.A., Meaning of campilobacter pyloridis in the etyology of gastritis and ulcer disease. Clinical medicine. 1987 - 8, 20-25.

19. Malaya L.T., Vlasenko M.A., Miklayyev I.Y., Myocardial infarction. M. Medicina, 1981, 488p.

20. Malaya L.T., Yabluchansky N.I., Vlasenko M.A., Mechanisms of development and the problem of the myocardial infarction healing optimum. / Clinical medicine. – 1988, N2 p.20-26.

21. Malaya L.T., Yabluchansky N.I., Pressing problems of gastroenterology from the positions of chronic diseases. Theses of report. Scientific and practical conference “Chronic inflammation and diseases of digestive organs”, 1991, Kharkov – 1991 – p.20.

22. Marchuk G.I., Mathematical models in immunology. M. Nauka. The main editirial staff of physico-mathematical literature. – 1980, 264p.

23. Morozov M.N., Yabluchansky N.I., Methologic bases of applicability of the notion “norm” in the pathology theory. / Methodologic and social problems of medicine and biology. Collection of scientific works. M., 1985 – 176p.

24. Popova T.D., Materia Medica. Homeopathic drugs; A reference book. The homeopathic centre of Ministry of Health Ukr. SSR, NVC “LAMO”, 1991 – 192p.

25. Popova T.D., Simeonova N.K., Homeopathy as system of treatment / Vestnik AMS USSR. – 1991, p.52-55.

26. Prigogine I., Stengers I., Order Out of Chaos (New York: Bantam, 1984).

27. Rashevsky N., Some medicinal aspects of mathematic biology; M; Medicina, 1966 – 243p.

28. Rozen R., Volosova V., The principle of biological optimum. Transl. from English. M. Mir – 1969 - 216.

29. Selye H., On the level of the whole organism. M. Nauka, 1972 – p.100

30. Selye H., The Stress of Life, revised edition (New York: Mc Graw-Hill, 1978), p.12.

31. Shvabe V., Homeopathic drugs. Under the editorship of V.I. Rybak. B.; I. 1967. –373p.

32. Shepherd D., A physician’s posy. – C.W. Daniel Company Limited; 1993, 256p.

33. Skuya N.Y., Diseases of pancreas. – M. Medicina. 1986 – 260p.

34. Smith J.W., et al., “Studies on the Epidemiology of Adverse Drug Reactions. V.Clinical Factors Influencing Susceptibility”.

35. Smith J.W., et al. Studies on the Epidemiology of Adverse Drug Reactions. V.Clinical Factors Influencing Susceptibility. Annuals of Internal Medicine 65: 629-640 (Oct. 1966).

36. Speransky A.D., Constraction elements of medicinal theory. – M.L.; VIZI, 1937 p.280 – 283.

37. Vinogradov A.V., Differential diagnosis of internal diseases. – 2nd supplemented edition. M.; Medicina, 1988. – 592p.

38. Vinogradov A.V., Vykhert A.M., Dorofeyeva Z.Z. / Under the editorship of Y.I.Chazov/. Myocardial infarction. - M.Medicina, 1971, 312p.

39. Vithoulkas G., The science of Homoeopathy. – Thorsons; 1986, 331p.

40. Voino-Yasenetsky M.V., Biology and pathology of infections processes./ AMS USSR.- L.Medicina, 1981-208p.

41. Votchal B.E., Sketches on clinical pharmacology. –2nd revised and supplemented edition – M. Medicina, 1965 –491p.

42. Warshavsky V.I., Practical homeopathy (treatment of internal diseases) –M.; Medicina, 1989 – 174p.