Notes from the Field: December, 2019
Nature Cure Clinical Pearls
Jared L. Zeff, ND, VNMI, LAc
The following is a 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.
Some Days are Tough
I really like my work. I am energized and elevated by watching people heal through my little interventions. The daily miracles we see, as Jim Sensenig would say, are my real paycheck. I am grateful that I have been able to make a living through this work and be paid by people for this thing I love to do; however, the real pay is when I get to see hope restored, pain resolved, chronic disease reversed, and all of this through these interventions that work with the body’s inherent wisdom and healing intelligence. No side effects. No iatrogenesis.
But some days are hard to get through. Like the day when, though the “book” was full, 3 patients called and cancelled; and those who did come in were not any better; and one wanted a detailed and referenced justification for the homeopathic medicine and hydrotherapy I was using in his treatment, because he found on the internet that Lachesis is a deadly poison, and why would I want to prescribe a deadly poison for him? (so he did not take it); and the next person said that her MD told her that there is no relationship between diet and Crohn’s disease, so she did not follow my dietary advice; and another patient informed me that Dr Google did not agree with my recommendations either. Days such as these occur. I do not really get depressed, but such days drag on my spirit, and when I get home, my beautiful wife Lauren asks me, “What’s wrong? You seem depressed.”
One of the most common problems I see in my practice is depression, and usually what I more accurately call “depression/ anxiety.” This is a fairly common chief complaint. I would like to explore this here. How does one treat depression? In the Middle Ages, depression was understood to be a consequence of “black bile,” or Melan-Cholia (ie, melancholy). The humors were presumed to be imbalanced, and depression – or “melancholy” – was due to an excess of black bile. The “Ancients” understood physiology and metabolism to be the product of 4 elements and 4 humors. These concepts probably originated with the Egyptians. There are Ayurvedic writings along these lines, and Chinese as well, but the first detailed discussions we have on the elements and humors come from the Greeks, around 500 BCE. Matter is composed of the 4 elements (earth, fire, air, and water), and living matter functions through the balance of the 4 vital fluids of life, the 4 humors: blood, phlegm, yellow bile, and black bile. Health is defined as the condition in which these constituent substances are in the right balance or proportion and are well-mixed. Disease occurs when 1 or more of these is deficient or in excess, or is separated out of the mix. Bleeding, purging, or the addition of balancing substances would be considered appropriate treatment. (I used to teach medical history.)
Modern treatment of depression includes chemicals prescribed to affect neurotransmitters and/or various forms of psychotherapy. In 1890, Christiaan Eijkman, MD, a Dutch military physician, discovered that rice polish contained a factor that cured beriberi, and he received the Nobel Prize in 1929 for the discovery of vitamin B1. Thiamine was found to be useful in the treatment of depression, and was used in the 1930s for this purpose. Electroconvulsive, or electroshock, therapy has been used to treat severe depression. Electrodes are attached to the head and an electric shock applied to the brain under general anesthesia, causing a brief seizure. This technique was introduced in 1938 and practiced regularly through the 1960s. It is considered a safe and effective treatment for severe depression, though its mechanism of action is not fully understood.
At the same time, Naturopaths were treating depression with hydrotherapy. The great hydrotherapy spas (SPA stands for sanitus per aquam – health through water) were major healing centers around the country where tuberculosis and mental illness were treated with hydrotherapy and diet. These places were called sanitariums, the name deriving from the Latin word for health: sanitus.When streptomycin was introduced in the 1950s as the first effective drug treatment for tuberculosis, these health and hydrotherapy hospitals lost their tuberculosis patients and almost exclusively became places for the treatment of mental illness – hence our current understanding of the term “sanitarium” as a hospital for the mentally ill. Hydrotherapy was an effective treatment for much mental illness. As more effective pharmaceuticals for mood disorders were introduced in the 1970s – fluoxetine and lithium and others – these sanitaria began to close. I have long dreamed of finding one of these places with a grand old hotel and healing waters. What a great naturopathic hospital that could be.
A Depressed Young Man
But this brings me to the case of a young man, age 12, who was brought to me in August of 2014. His mom said his depression began a year ago. He did not like school. Now, I remember middle school (which we called “junior high” back in the last century), and I remember it as a brutal place. This young man’s parents took him out of middle school and began to home-school him, but his depression and moodiness just got more severe. He complained of sore muscles and began having meltdowns. He had multiple breakdowns daily, with tears and sobbing. He would be unreachable. It got to the point where he was depressed all the time. As a younger kid he was goofy and sociable, outgoing. He liked basketball and swimming. But now he was depressed, didn’t want to leave the house, didn’t want any company, and would get lost in video games.
He was sent first to a counselor, and then a psychiatrist. He was tested for endocrine and metabolic disorders, but all was normal. His diet was reasonable: not too much sugar, and plenty of protein and vegetables. He was taking 10 000 iu of vitamin D weekly. But his joints were hurting, he suffered from growing pains and muscle weakness, and he could not be awakened easily. He complained of stomach aches.
My physical exam revealed upper digestive disturbance and signs of adrenal fatigue. His temperature was low-normal. As he sat in my office with his mother, I tried to interview him, but he would not look at me and wouldn’t talk. His mother answered my questions. I gave him a dose of Aurum 200C. He rapidly became more at ease, and even began to talk with me. I gave him a dose of Thyroidinum 12X, and he became more animated. I sent him home with Aurum 1LM, to take each morning, and ½ grain of USP thyroid to take daily, along with betaine HCl to take with meals. I also gave him instructions for daily constitutional hydrotherapy. The next day I gave some dietary recommendations; I had determined that he was milk intolerant.
I saw him about a month later. His mom reported significantly fewer meltdowns and much less body pain, and said that his stomach aches were gone. She was using the Aurum as needed for such events, and said that he would respond immediately. He went from multiple meltdowns daily to 1 or 2 per week – a dramatic improvement – and both parents reported that they were now able to talk with him. His temperature had increased by a degree, but he still had little energy. I added 200 mg of adrenal cortex to his regimen, and continued him on the Aurum 1LM, HCl, and thyroid.
I saw him 2 months later. His mom reported that he was much improved that first month, and somewhat more improved the second month, but in the third month she saw no improvement. He was back in school and able to function there now. The Aurum still helped immediately if he needed it, but his energy was still low. I increased the adrenal cortex to 300 mg each morning, and added a combination of vitamin C (250 mg), vitamin B6 (5 mg), methyltetrahydrofolate (667 µg), methylcobalamin (550 µg), calcium pantothenate (130 mg), iodine (68 µg), tyrosine (200 mg), 5-HTP (50 mg), Eleutherococcus (50 mg), GABA (50 mg), and Rhodiola (50 mg), to be taken twice daily.
I saw him a month later, and he was much improved. He was happier, feeling much better, was more talkative, and had been having no meltdowns at all. His energy was significantly better as well. I saw him 2 more times in 2015. He continued to do well, but continued to need the Aurum, HCl, adrenal support, and the combination with the methylated vitamins. He no longer needed the thyroid support. If he skipped his “meds” for a couple days he would get moody, but the Aurum would clear that immediately. My last report was that he was doing well in school, was not depressed, was socially engaged, and was even playing basketball again.
A Depressed Older Man
Eighteen months ago, a 71-year-old man came to see me – a Vietnam vet suffering with depression and PTSD. He was sexually abused as a child. He also had a diagnosis of diabetes and stage-3 kidney failure. He described the depression as intermittent. It would hit him suddenly, and he would want to stay in his bedroom, alone. This happened every 2 weeks or so and might last for days. He was married, and was brought in by his wife. The diabetes had been slowly worsening for years. He had been diagnosed with COPD 8 years prior. He suffered from heartburn most of the time. He would get dizzy if he got up too fast. His sinuses were always clogged, which made it harder to breathe. He has arthritis in his hands and knees, which was worse in the morning when he got out of bed. He had suffered an MI and a stroke, which had left him somewhat weakened.
I gave him a dose of Staphysagria 200C, and noticed that within a couple of minutes he sat up straighter in the chair and began talking more. He became somewhat more animated, though was still quite negative.
I took him into my exam room for a physical exam. His blood pressure was low (117/60 mm Hg). His temperature was 97 °F. His lung sounds were diminished. His O2 saturation was 96%, with a peak flow of 200 (normal: 500). Blood glucose was 173 mg/dL, and HbA1c was 8.5%. We went back into my consultation office, and I developed more of his health history. After a bit, I gave him a dose of Aurum 200C, and his negativity seemed to fade. He brightened up and actually began to smile. There was a lot going on here, but I like to begin at the beginning. So I started him with a dietary recommendation and constitutional hydrotherapy, and I sent him home with Aurum 1LM to take each morning, a bitter tonic for digestion, some drainage remedies, and Staphysagria 1LM to take before bed.
I saw him a month later. He reported that he had not felt the need to hide in his bedroom and snarl for the whole month, and that he had even smiled. He said that his breathing had improved. He had more energy, was awake more during the day and was sleeping better at night. His blood pressure was normal. His blood sugar was now 110 mg/dL. I rechecked the A1c, which had reduced to 7.4% within 1 month. His wife concurred with his reporting and was very grateful for the improvement. She said he was happy again, something she never thought she would see.
These 2 cases do not run the gamut of the variations of depression; I commonly treat this problem, and every case is different. But my approach to depression is pretty much the same, and my approach to illness is always more or less the same, in general, whether I am treating autoimmune disease, cardiovascular disease, interstitial cystitis, or any other chronic malady. Lindlahr taught us that there are 3 primary causes of disease: lowered vitality, abnormal composition of blood and lymph, and the accumulation of morbid matter and poisons. As we address these – with dietary changes, hydrotherapy homeopathy, botanical medicine, and occasionally some specific nutrients – health improves. And as health improves, disease begins to resolve.
I think that next month I want to address this underlying theory in more depth and greater detail.
Jared L. Zeff, ND, LAc, VNMI
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 teaches 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.