Notes from the Field July 2022
Nature Cure Clinical Pearls
JARED L. ZEFF, ND, VNMI, LAC
The following is not an article prepared for a medical journal. Not every statement of fact is cited or referenced. This is a commentary on the medicine, a running set of observations about practice in the field. It’s not meant to be a peer-reviewed presentation; rather, these are notes and thoughts from a practicing naturopathic physician, a primary care doc in general practice.
A Trio of Difficult Diseases
Not long ago I had a new patient present with a very complex case of coccidioidomycosis, commonly known as “valley fever.” This is a pulmonary disease caused by the fungus Coccidioides immitis. Although usually easily cured with an antifungal such as fluconazole, some cases become progressive. Untreated, if the disease disseminates, it is fatal. In immunocompromised individuals, the mortality rate exceeds 70% even when treated. Although it generally begins in the lungs, it can affect the meninges and can travel up the spinal meninges into the brain. If it enters the brain, it is fatal. X-ray studies show coin-like lesions in the lungs. The disease is endemic to parts of the southwestern United States, especially the Central Valley of California (for which it is named) and western Arizona. More generally, valley fever can be found throughout the desert regions of the southwestern US and northern Mexico, from Texas to California, and in similar geologic and climatic areas in South America. It is acquired by inhaling dust containing the spores of the fungus, which then grow in the lungs, generating a pneumonia-like disease.
My patient, a 58-year-old woman, acquired valley fever while traveling in central California. She had driven through a dust cloud passing over the highway that was created by some adjacent agricultural work. Once she became ill, she spent many months in the hospital. She had returned to the hospital over 40 times with complications of this illness. Her symptoms included fatigue, joint pain, and shortness of breath with paroxysms of coughing. Moreover, she had developed an abdominal hernia from coughing. To help with the hernia she was given a gastric bypass last year, which had caused weight loss and significant digestive difficulties. She was treated for 2 years at a valley fever center in Arizona. When she came to see me, she was better than she had been; she was stable but still chronically ill with fatigue and debility, and still experienced occasional paroxysms of coughing and severe pain. She could no longer work due to her illness.
When she moved into my area, she was referred to me by a colleague in Arizona who had been treating her with several therapies, including homeopathic Kali carbonicum, which helped her back pain. She also had leg pain with swelling below the knee and was taking warfarin to prevent blood clots in her legs. She had an embolus several years ago, which prompted her to begin the warfarin. She was also given adrenal support for her fatigue, which she found very helpful. Fluconazole made her worse, so she was not taking any antifungals.
How does a doctor approach such a case? As a vitalist, I tend to focus on the process of healing rather than the pathology. I generally spend about 2 hours with a new patient like this. I begin with a detailed recording of the chief complaint and do a detailed review of systems. I get a dietary summary. I go through the patient’s health history (what I call a “pathobiography”), usually in 5-year intervals. I discuss both physical and emotional trauma history. I look at family history. I record all medications the patient may be taking. I do a physical examination, a “Bates”-type physical with naturopathic additions, such as pulse evaluation, reflex point analysis, iris examination, acoustic cardiography, and other such functional examinations. I do some evaluation of digestion, toxemia, and “vitality.”
After my history, she was sitting across from me in obvious pain. She had run out of the Kali carbonicum from the doctor in Arizona. I gave her a dose of 30C, and her pain eased a bit. When I gave her a dose of a numbered drainage remedy, her pain eased more. I proceeded through a few other sequential drainage remedies, and each remedy eased her pain even more. I planned to give her a diet in a few days based upon Dr Otis G. Carroll’s method of determining foods that cause toxemia and recommended that she start on a series of constitutional hydrotherapy treatments. I also gave her a simple bitter tonic formula for her digestion. I provided more adrenal support. She was to follow this protocol for a month, after which we would reassess.
A few days later, a 32-year-old man came to see me for the first time. He was diagnosed with severe rheumatoid arthritis (RA) at the end of a 3-year stay in Indonesia where he was a teacher. He came to me after 6 years of treatment with sulfasalazine, several biologic agents, and steroids. These did not help him very much. He was on abatacept and methotrexate at the time of his visit. They helped somewhat, but he still experienced severe flares every 3-6 months. Experimenting with diet, he found that an anti-inflammatory diet helped a bit, so he followed that, but it was difficult to restrict so many foods. His previous naturopathic physician did a joint aspiration looking for infection but found none. He had all his upper teeth replaced a couple years prior after a long-standing infection was found in his upper jaw. It was suggested that this infection might contribute to the arthritis, but he received no relief after this was done.
I followed almost the same procedure with this patient as with the valley fever patient, and began treatment the same way, though this patient did not get Kali carbonicum. Given his history in Indonesia, we chose to do a parasite test. The rest of the evaluation was the same, as was the basic treatment approach.
A couple of days before this arthritis patient came in, I saw a new female patient who came with a diagnosis of stage 3 chronic kidney disease (CKD). This level of kidney disease is diagnosed when the estimated glomerular filtration rate (GFR) is 30-59, indicating moderate kidney damage. Her estimated GFR was 55, which placed her in the 3a substage of between 45-59. An estimated GFR of 30-44 would indicate a stage 3b. Her blood urea nitrogen (BUN) was 23 (normal = 8-25 mg/dL) and her creatinine was 1.06 (normal = 0.6-1.10 mg/dL). There is no direct treatment for stage 3 CKD. She was told to adopt a low protein/low sodium diet, exercise, stay healthy, and keep her weight down. In conventional medicine, the primary treatment for CKD is dialysis when the kidney function gets low enough to warrant it, and ultimately, a kidney transplant if the underlying pathology warrants it.
I proceeded to examine her in the same manner I described above for the valley fever patient and the RA patient. I recommended the same basic treatment, with an individualized diet to reduce toxemia, hydrotherapy, and a bitter tonic for digestion, but I gave her a kidney restorative botanical combination: equal parts of Lespedeza, Parietaria, Astragalus, and Centella, 50 drops in water twice daily. I also added Secale 6C to take nightly, due to her Raynaud’s syndrome. She fit the picture of Secale rather well. Note that there are no significant ways within the conventional medical system to help heal or restore kidney function. There are several different ways within traditional naturopathic medicine. I got the above formula, or a formula rather like it, from Eric Yarnell, ND, a preeminent teacher of botanical medicine.
Restoring Health Over Treating Illness
What I have tried to outline above is that I am approaching the treatment of 3 very different diseases in a very similar way. I seek specific dietary information to correct digestion and reduce toxemia, which generally drives underlying inflammation. In my opinion, addressing toxemia is key to reversing chronic disease. I apply constitutional hydrotherapy to help drive the healing process. I usually give a botanical digestive stimulant: a bitter tonic to improve stomach function. I probably give a drainage remedy set to open the emunctories and help with detoxification and reducing inflammation. Then I will give a specific homeopathic medicine as the case indicates, and similarly, a botanical medicine. Regardless of the disease, I proceed the same way. Why?
In general, I am not treating the disease entity. Arguably, sometimes I am. I’m giving the CKD patient a kidney restorative, as well as a specific homeopathic medicine that will likely ease or resolve the Raynaud’s. I am looking into a possible parasitic cause for the RA. But the underlying attempt at cure is not directed against the pathology – it is applied to restore the health of the patient and to stimulate the patient’s vitality, the vis medicatrix naturae. The kidney restorative alone will not cure the CKD, though I am hoping that it will help. Cure will be effected, if possible, through changing the underlying conditions in which the disease manifested. That is accomplished with the dietary change and the hydrotherapy, aided by the homeopathic and botanical medicines. The vis does the healing. All these conditions are considered incurable; that is, there is no known curative treatment in the conventional medical system. But I expect cure. I don’t always see it, but I expect it.
Henry Lindlahr, MD, taught us that there are 6 general causes of disease1:
- lowered vitality due to overwork, night work, excesses, overstimulation, poisonous drugs, and ill- advised surgical operations
- abnormal composition of blood and lymph due to the improper selection and combination of food, poor digestion, and especially the lack of organic mineral salts and other essential nutritional elements
- accumulation of waste matter, morbid matter, and poisons due to the first 2 causes, as well as to faulty diet, overeating, the use of alcoholic and narcotic stimulants, drugs, vaccines, accidental poisoning, and to the suppression of acute diseases (nature’s cleansing and healing efforts) by poisonous drugs and surgical operations
- hereditary and constitutional taints of sycosis, scrofula, psora, and syphilis; pharmaceutical effects (ie, mercurialism, cinchonism, iodism); and many other forms of chronic poisoning
- fevers, inflammations, skin eruptions, chronic sinus discharges, ulcers, abscesses, germs, bacteria, parasites, etc
- mechanical subluxations, distortions, and displacements of bony structures, muscles, and ligaments
Lindlahr then presented his “6 horses” to help reverse these causes1:
- establishing normal surroundings and natural habits of life in accord with nature’s laws
- economizing one’s vital force
- building up the blood on a natural basis; that is, supplying the blood with its natural constituents in right proportions
- correcting mechanical lesions
- promoting elimination of waste matter and poisons without in any way injuring the human body
- arousing the individual in the highest possible degree to the consciousness of personal accountability and the necessity of intelligent personal effort and self-help
In my assessment, I am looking for causes like those Lindlahr suggested. My goal is rarely to diagnose their pathology. That has usually been done beforehand, though occasionally I may question a diagnosis and reevaluate a patient. In my treatment, I am attempting to remove or reverse these causes, and only rarely to direct treatment at the pathology. A patient’s pathology will usually resolve when the conditions that created it have resolved. Therefore, I choose methods and means that should accomplish that. Appropriate dietary change addresses both the toxemic cause and the nutritional correction to normalize the constituency of the blood. Hydrotherapy drives enhancement of the vitality, as does appropriate homeopathic medicine. Drainage methods reduce the accumulation of morbid matter and toxins, assisted by the hydrotherapy. Appropriate hygienic advice, when followed, helps establish normal surroundings and habits and helps economize the vital force. I may need to manipulate the patient to correct mechanical lesions. I will encourage my patient, through explanation, education, and other methods, to increase their engagement in their health recovery.
When a practitioner follows such a methodology, the health of the patient almost always improves. How could it not improve? These methods are vitalizing, not vitiating. We do not always succeed, but it would be very rare, indeed, that a patient would be made in any way worse off by such methods. The body is self-healing. Such methods as these stimulate and support the self-healing tendency of the body. The result, more often than not, is resolution of the pathology with which the patient presents. This is the old naturopathic vitalism. It is a joy and a privilege to participate in this process.
Jared L. Zeff, ND, VMNI, LAc[REF]
- Lindlahr H. Nature Cure: Philosophy & Practice Based on the Unity of Disease & Cure. Charleston, SC: BiblioBazaar; 2006.
Jared L. Zeff, ND, VNMI, LAc is a licensed doctor of naturopathic medicine and a licensed acupuncturist. In addition to functioning as Medical Director at the Salmon Creek Naturopathic Clinic in Vancouver, WA, Dr Zeff taught on the faculty at National University of Natural Medicine in Portland, OR, where he was also Dean from 1988 to 1993, and holds a professorship in Naturopathic Medicine. Dr Zeff is a graduate of the University of California, NCNM, and the Emperor’s College of Traditional Oriental Medicine. He, along with Pamela Snider, is the author of the AANP’s Definition of Naturopathic Medicine, and the Therapeutic Order concept.