INTRODUCTION

“The body achieves what our mind believes.”

The mind-body connection has fascinated clinicians and researchers for

centuries. In prehistoric times, there was the belief that disease was caused
by evil spirits and illness could be cured by prayers or magic. People of
ancient civilizations believed that the mind had great power over the body
and that the body could not be cured without curing the head. During the
middle Ages, religious influences dominated medicine and reinforced the
beliefs that physical illness could be caused by psychic power. The
understanding of the relationship between the mind and the body continued
to evolve during the centuries that followed.

There is deep interconnection between mind and body. The mind is

expressing itself in each and every action of the body. According to every
thought and emotion, body gives some reaction, e.g. feeling of happiness
or embarrassment is reflected on body as blushing. Here, the reason for
blushing is the feeling of happiness or embarrassment which leads to
dilatation of blood vessels of head and neck which in turn increase blood
flow over there. We all know that not everyone falls sick when “the flu is
doing the rounds,” and that a disease does not have the same effect on every
afflicted person. The reason for it could be different mindset of everyone.

In today’s modern world, where social, technological and economical

advances are happening at faster rate, people thrive on performance,
competition, earning more money, getting more facilities etc., which in
turn disturbs the peace of their mind and lead towards negative thoughts
and emotions like stress, anxiety, frustration, tension, fear, guilt, etc. This
negative approach of mind is responsible to bring the disease.
Mind could influence the initiation and progression of the physical
disorders. These kind of physical disorders that are caused or made worse
by mental factors are called “psychosomatic disorders”. Psychosomatic
disorder is a condition where psychological stress adversely affects
physiological functioning to the point of distress. Man being a
psychosomatic organism is naturally prone to psychosomatic disorders.
The disease pattern is shifting form communicable to lifestyle disorders
like cardiovascular disease, chronic respiratory disorders, diabetes, etc. In
these kind of non-communicable lifestyle disorders, the mind plays an
important role.

By modern research and with the help of advanced diagnostic tools it have
been possible to identify specific neurochemical and hormonal
mechanisms that can account for some physical conditions that are affected
by psychological factors and for psychological symptoms that are caused
by medical conditions.

Homoeopathy is unique rational therapeutic system of healing art

discovered by Dr. Samuel Hahnemann. According to homoeopathy, the
disease is a total affection of mind and body, the disturbance of the whole
organism. Homoeopathy believes in holistic and individualistic concept.
According to Dr. Hahnemann, the mission of physician is to “restore the
sick to health” and not just “disease to health”. Homoeopathy views the
health as the harmonious state of the body and the mind. The concept of
health is not limited up to any physical part only but it includes mental
health along with its physical and social component. Role of mind in state
of health is vital one and any disturbance in harmony of mind reflected by
the body as a disease. Hence, it is necessary to understand the influence
of mind on the body.

Homoeopathy always examines patient’s mental and emotional make-up

in all cases and remedies are given acting on mind and body together thus
disease is completely eradicated. No other system of medicine has such an
approach of treating disorders. Hence, it can be much easier to manage the
psychosomatic disorders with homoeopathy. It could give better results
compared to other system of medicine as no other system of medicine has
such an integrated approach of treating disease. Dr. Samuel Hahnemann in
his 6th edition of Organon of Medicine mentioned psychosomatic
disorders in aphorism 225-227 under mental disease and given guidelines
for their treatment.

Psychosomatic disorders are a growing concern and require an immediate

attention nowadays. Understanding regarding psychosomatic disorders
among the practitioners is require an improvement. The research in this
area is also scanty. The present literature, which had explained its
importance and management of psychosomatic disorders need a detailed
study for further understanding and better management. There is a need to
gather more evidence to reliably assess the possible role of homoeopathy
in psychosomatic health conditions. Hence, there is a scope to evaluate
the effectiveness of homoeopathy in psychosomatic disorders.
 Review of Literature
Health is a state of complete physical, mental, and social well-being and
not merely the absence of a disease or infirmity. According to this
definition homoeopathy is the only system of medicine, which have an
integrated approach in understanding the role of mind in health and
disease. Dr. Hahnemann has given stress on the importance of mental and
emotional factors as being most valuable for the maintenance of health.

Dr. Samuel Hahnemann, the founder of homoeopathy was perhaps the first
man, who also highlighted the importance of mind in the disease process,
and stated that disease starts in the mind. It is the patient who is sick and
not his organs. According to homoeopathy the disease first affects the inner
man (mind, emotions, intellect) as denoted by change in his mental
disposition, thought structure and nature. These may be termed the
“symptoms of the individual.’’ The inner is always the first to be sick
before the disease filters into the plane of the physical body. Homoeopathic
treatment is based on building a complete picture of the patient’s physical
and mental well-being.

Dr. Hahnemann first use the word “mind” in organon of medicine in

aphorism 9 (6th edition):

In the healthy condition of man, the spiritual vital force (autocracy),

the dynamis that animates the material body (organism), rules with
unbounded sway, and retains all the parts of the organism in
admirable, harmonious, vital operation, as regards both sensations
and functions, so that our indwelling, reason-gifted mind can freely
employ this living, healthy instrument for the higher purpose of our
existence.
According to this aphorism health is a state in which vital force controls
the harmonious functioning of the organs of the body and rules over the
material body in such a way that there is perfect cooperation between mind
and body. Here the master mentioned the mind as the instrument for higher
purpose of our existence. Only with the healthy mind one can feel ease and
comfort and health can be maintained.

According homoeopathy disease is derangement of vital force. Dr.

Hahnemann in aphorism 11 mentioned that the vital force is deranged by
dynamic influences. And this internal derangement of vital force is
reflected outwardly by the body as morbid signs and symptoms. These
signs and symptoms are the disease itself. This dynamic influences could
be thoughts (negative) of mind. For restoration of health all morbid
phenomena should be removed (aphorism – 12). That means the negative
state of mind should also be removed.

In aphorism 15 master mentioned:

The affection of the morbidly deranged, spirit-like dynamis (vital

force) that animates our body in the invisible interior, and the totality
of the outwardly cognizable symptoms produced by it in the organism
and representing the existing malady, constitute a whole; they are one
and the same. The organism is indeed the material instrument of the
life, but it is not conceivable without the animation imparted to it by
the instinctively perceiving and regulating dynamis, just as the vital
force is not conceivable without the organism, consequently the two
together constitute a unity, although in thought our mind separates
this unity into two distinct conceptions for the sake of easy
comprehension.
Through this aphorism master said that the vital force and body is the unity.
They are functioning in harmony to maintain the state of health. The vital
force and the body are inseparable and interdependent and thoughts of
mind are the bridge between them.
In footnote number 9 to aphorism 16 of his Organon of Medicine (6 th
edition) he mentioned:-

“Most severe disease may be produced by sufficient disturbance of the

vital force through the imagination and also cured by the same
means.”

Here Dr. Hahnemann mentioned that thoughts (negative) of mind may

derange the vital force and produce the severe disease. And this
derangement could be restored by the same means – by controlling the
thoughts of mind (by positive approach).
Without the mind, the body cannot perform the functions properly, in fact
every action first originates in the mind first as an imagination. “The organs
are not prior to the man but the man is prior to the organs. Man consists in
what he thinks and what he loves and there is nothing else in man.” said by
Dr. Kent.
Modern research is now confirming what Dr. Hahnemann and other
homoeopathy followers has observed long before that - the state of the
mind directly affects physical illness.
Advances in technology have made it possible to demonstrate that
connections between the mind and the body are real. Today, the new aspect
of medicine called psychosomatic tells us how frustrations and fears, anger
and hatred form the etiologic background for most of the chronic diseases,
which our master has told many years ago.
The Mind-Body Connection
The mind and body are but different manifestations of one and the same
entity. They work as a unit. The integration of the mind and body is always
reflected in the state of health and disease.
Mind is a functional unit of the brain where thoughts and emotions
originate. The mind and the body are connected with each other through
the psychoneuroendocrine and the reticuloendothelial systems. These
systems have sensors, which scan the external environment for cues and
effectors that can bring about changes in the functioning of the organs.
Certain influences tend to preferentially manifest themselves on the mind
while some on the body; and some on both at the same time.

Interconnection between mind and body (Karren et al., 2014)

Mind impacts the body organs through an amalgamation of three

interrelated components: neural, hormonal and immunologic. The brain
plays a key role in translating the content of the mind. The brain is the
physical manifestation of the mind. The brain translates the content of the
mind into the chemicals, which carry all the information of the mind
throughout the body, potentially impacting every system of the body.

The work of psychologist Robert Adder, whose key experiments laid the
foundation for the field of mind-body research, gave the following
evidence for their connections with each other:

 The central nervous system is linked to both the bone marrow and the
thymus (where immune system cells are produced) and to the spleen
and lymph nodes (where such cells are stored).
 Scientists have found nerve endings in the tissues of the immune
system. The lymphoid organs, such as the spleen, are thoroughly laced
with nerve fibers.
 Changes in the brain and spinal cord affect how the immune system
responds.
 When researchers trigger an immune response in the body, there are
changes in the way the brain and spinal cord function.
 Researchers have discovered that lymphocytes respond to hormones
and neurotransmitters and that they can produce hormones and
neurotransmitters. Receptors for neuromodulators and hormones have
been found on the T lymphocytes.
 Emotions trigger the release of hormones into the system, including
adrenaline (also known as epinephrine), noradrenaline (also known as
norepinephrine), endorphins, glucocorticoids, prolactin, and growth
hormones, etc.
 Cells that are actively involved in an immune response produce
substances that send signals to the central nervous system.
 The body’s immune response can be influenced by stress and other
psychosocial factors can make the body more susceptible to infectious
 diseases (such as the common cold), autoimmune diseases (such as
arthritis), or cancer.
 Immune function can be influenced and changed by psychoactive drugs,
including alcohol, marijuana, cocaine, heroin, and nicotine.

During the past few years there has been a growing body of research
showing how the mind and body respond to each other, clearly
demonstrating how emotional and psychological states translate into
altered responses in the chemical balance of the body.

Every thought and emotion has an energy which is reflected on the physical
body. According to the thoughts and emotion, there is production of
neuropeptides and endorphins by the brain. Each positive thought of mind
makes brain to secrete endorphins which are responsible for feeling of
happiness and well-being, while negative thought deplete the brain to
secrete the chemical required for happiness and feeling of well-being.

Positive Negative
interpretation interpretation
(thought) (thought)

Normal secretion of Altered endorphin

endorphins secretion

Health (Feeling of Diseases/illness

happiness, well-
being)
A growing body of evidence now indicates that virtually every illness -
from arthritis to migraine headaches, from the common cold to cancer is
influenced, for good or bad, by how we think and feel.
Psychosomatic disorders

The term psychosomatic is derived from Greek work “Psyche” means mind
and “soma” means body. The term literally refers to how the mind affects
the body. The term psychosomatic disorder mainly used to mean - physical
disease that is thought to be caused or made worse by mental factors. Most
of the diseases are psychosomatic, which involves both mind and body.
Every physical disease has some aspect of mental component and how an
individual reacts and copes with it varies significantly.

A psychosomatic illness is one in which a bodily ailment is at least in part,

attributable to emotional factors. The role of thought and emotional
derivatives is a key concept of psychosomatic medicine. Clinical studies
have shown the temporal relation between the course of a patient’s disease
and the emotional vicissitudes of his life. The bodily reactions that
accompany emotion serve a useful purpose when the emotion is temporary
and appropriate. Fear or anger for example in the face of external danger
or threat arouses a defensive response. Once appropriate action has been
taken, the physiological and emotional changes that have enabled the
individual to reach into his reserves of strength usually subside. However,
when the emotions are not discharged, due to being unconscious and part
of a basic personality conflict, or because the person is involved in a
repetitive and inescapable situation, the physical effects persist. Tissue
changes in an organ may be the end results. Thus the psychosomatic
symptoms are the instruments that a patient has unconsciously adopted to
handle some difficult situations. Although he consciously desires relief
from his physical suffering, he will unconsciously resist these safety
mechanisms.

While this psychosomatic approach to medicine is relevant to all illness,

there are a particular group of disorders, the psychosomatic disorders, in
which the relationship between psychosocial disturbance and the
occurrence of illness is particularly clear. In these conditions genetic
factors are important, and disturbances of the neuro-endocrine and
neurovegetative system are believed to play an important part in the disease
manifestation. Bronchial asthma, migraine, peptic ulcer, forms of colitis,
mucous or ulcerative, certain types of hypertension and of musculoskeletal
disorder, rheumatoid arthritis, eczema and dermatitis, dental conditions
such as Vincent's angina and periodontitis, disturbances of menstrual and
sexual function, and endocrine disorders such as thyrotoxicosis, and
perhaps some cases of diabetes, all come into this group.

History of psychosomatic medicine research

Major conceptual trends in the history of psychosomatic medicine:

1. Psychoanalytic
 Sigmund Freud (1900): Somatic involvement occurs in conversion
hysteria, which is psychogenic in origin—e.g., paralysis of an
extremity. Conversion hysteria always has a primary psychic cause
and meaning; i.e., it represents the symbolic substitutive expression
of an unconscious conflict.
 It involves organs innervated only by the voluntary neuromuscular
or the sensorimotor nervous system. Psychic energy that is dammed
up is discharged through physiological outlets.
 Sandor Ferenczi (1910): The concept of conversion hysteria is
applied to organs innervated by the autonomic nervous system; e.g.,
the bleeding of ulcerative colitis may be described as representing a
specific psychic fantasy.
 George Groddeck (1910): Clearly organic diseases, such as fever
and hemorrhage, are held to have primary psychic meanings; i.e.,
 they are interpreted as conversion symptoms that represent the
expression of unconscious fantasies.
 Franz Alexander (1934, 1968): Psychosomatic symptoms occur only
in organs innervated by the autonomic nervous system and have no
specific psychic meaning (in contrast to conversion hysteria) but are
end results of prolonged physiological states, which are the
physiological accompaniments of certain specific unconscious
repressed conflicts. Presented first conceptualization of the bio-
psychosocial model.
 Helen Flanders Dunbar (1936): Specific conscious personality
pictures are associated with specific psychosomatic diseases, an idea
similar to Meyer Friedman’s 1959 theory of the type A coronary
type.
 Peter Sifneos, John C. Nemiah (1970): Elaborated the concept of
alexithymia. Developmental arrests in the capacity to identify and
express conflict-related affect result in psychosomatic symptom
formation. Concept of “alexithymia” modified later by Stoudemire,
who advocated the term “somatothymia” that emphasized cultural
influences on use of somatic language and somatic symptoms to
express affective distress.
2. Psychophysiological
 Walter Cannon (1927): Demonstrated the physiological
concomitants of some emotions and the important role of the
autonomic nervous system in producing those reactions. The
concept is based on Pavlovian behavioral experimental designs.
 Harold Wolff (1943): Attempted to correlate life stress to
physiological response, using objective laboratory tests.
Physiological change, if prolonged, may lead to structural change.
He established the basic research paradigm for the fields of
 psychoimmunology, psychocardiology, and
psychoneuroendocrinology.
 Hans Selye (1945): Under stress a general adaptation syndrome
develops. Adrenal cortical hormones are responsible for the
physiological reaction.
 Meyer Friedman (1959): Theory of type A personality as a risk
factor for cardiovascular disease.
 Robert Ader (2007): Beginning in the 1970s, established the basic
concepts and the research methods for the field of
psychoneuroimmunology.
3. Sociocultural
 Karen Horney (1939), James Halliday (1948): Emphasized the
influence of culture in the development of psychosomatic illness.
They thought that culture influences the mother, who, in turn, affects
the child through her relationship with the child e.g., nursing, child
rearing, and anxiety transmission.

Since the mid-20th century, research in psychosomatic medicine and

consultation psychiatry has taken two interconnected paths. Psychosomatic
medicine research has generally focused on understanding
psychophysiological mechanisms underlying mind–body relationships.
Consultation research, however, has largely been directed at understanding
psychiatric problems among clinical populations with medical illnesses.

In the early 20th century, there are two hypotheses to explain the
relationship between “Psyche” and “Soma.”

1. Specific hypothesis suggests that specific emotions led to specific cell

and tissue damage. If a specific emotional conflict or stress occurred, it
expressed itself in a specific response or illness in genetically
predetermined organ. After stress is suppressed through the autonomic
nervous system, however the sympathetic responses may remain alert for
heightened aggression or flight or parasympathetic nervous system
responses may be altered for increased activity. Such prolonged alertness
and tension can produce physiological disorders and eventually pathology
of organs or viscera. e.g., peptic ulcer.

2. Non-specific hypothesis suggests that generalized stress created the

preconditions for a number of not necessarily predetermined diseases.
According to this hypothesis four types of reactions takes place due to
stress:

 Neurotic: In which alert signal of anxiety is too great, the defense

fails.

 Psychotic: On which alarm may be misperceived or even ignored.

 Healthy Normal: On which alertness is followed by an action of

defense.

 Psychosomatic: In which defense by the psyche becomes ineffective

and alertness is translated into somatic symptoms causing changes
in body tissue.

Etiological theories

Experimental and clinical evidence has shown that the emotional

disturbances could be responsible as predisposing, precipitating and
maintaining factors in this illness. Several etiological theories have been
suggested:

1. Neuroendocrine and immunological theory

The autonomic nervous system influences and is influenced by both,

other parts of the nervous system and the endocrine glands. Complex inter
relation of these various structures have been suggested to explain the
translation of problems of the everyday living into abnormal physiological
functions and tissue damage. The hypothalamus being the center for the
sympathetic and parasympathetic nervous activities, is of central
importance in these feedback circuits.

Hypothalamus pituitary axis (Boonstra R., et al., 1998)

It is suggested that emotional disturbances acting through the
hypothalamus affect the sympathetic and parasympathetic nervous system,
which results in alteration in the structure of the viscera to which these
systems innervate.
The imbalance of the sympathetic and the parasympathetic nervous
activities would alter the function of the viscera.

2. Organ-system weakness

Weakness of a specific organ system is largely as a result of genetic

influence or prior damage of a given system, e.g., a person may be
otherwise healthy may have a poor respiratory system. Such individuals
are more likely to develop bronchial asthma.

3. Psychoanalytical theory

According to this theory the basic underlying defect is the weakness of

the ego, which helps an individual to face the realities of life. The
development of both the ego and the personality of the person take shape
mainly during the first few years of life, future pattern of behavior is laid
down during the formative years. That individual who suffers from
psychosomatic disorders have certain infantile residues persists in later
years. Whenever such individual faced with stress of later life which they
cannot cope with it.

Adequately, these stress leads to psychological or physiological regression

to these infantile or immature patterns of functioning resulting in the
development of psychosomatic illness. This point is explained in the work
of Alexander and dunbar. According to this concept- psycho physiological
disorders are symbols of unsolved unconscious conflicts and frustration
.E.g.; unsolved dependency leads to the development of fear.

4. Behavioral theory

Lechman pointed out that psychosomatic disorder is a learned disorder.

5 methods of learning process which leads to specific symptomatology:

a) The role of stimulus substitution

 If a person responds to neutral stimuli associated with one action
producing stimuli, soon the patient learns to respond to neutral stimuli. e.g.,
while it is raining, a child is frightened not by raining but by lightning and
thunder outside. However on subsequent occasion even slight raining may
lead to fear reaction in the absence of thunder and lightning.

b) The role of emotional reintegration

A single component in the stimulus situation which is earlier associated

with a complex pattern of emotional reaction may itself be effective in
producing the total complex pattern of emotional reactions, e.g., a boy fell
into a river while fishing and was completely drowned. From this single
stimulus people fishing or sight of that bridge serves to revive emotional
reactions associated with earlier event.

c) The role of stimulus generalization

E.g., swimming in water may evolve emotional reaction that the boy felt
after falling in the icy water.

d) Role of symbolic stimuli

Stimuli in the personal history of the individual represent effective emotion

provoking stimuli. E.g.; the word ‘rape’ may provoke strong emotional
reactions in a woman who has been sexually assaulted.

e) The role of ideation

Organic affections of stimuli in terms of CNS manifestation, may persists

in the form of thoughts or ideas, e.g., an individual may think about an
emotional event may feel associated emotion (thinking about criticized by
an employer may lead to feel anxiety).

5. Diathesis stress theory

It means psychological or physiological predisposition. Diathesis when
associated with stress is likely to develop a psycho-physiological disorder
in an individual.

Classification of psychosomatic disorders according to ICD-10

According to criteria in the tenth revision of the ‘international classification

of disease and related health problems” (ICD-10) the classification can be
divided into:-

1. Somatization disorders
 Multiple somatic symptoms in the absence of any physical disorder.
 The symptoms are recurrent and chronic
 Symptoms are vague and narrated in dramatic manner and involve
multiple organs
 Frequent change of treating doctor
 Presence of conversion symptom is common- means person
experience many physical and sensory problems without underlying
neurogenic pathology. It should be differentiated from other
physical complaints like multiple sclerosis, hypothyroidism,
hyperthyroidism, SLE, pancreatic cancer and also from psychiatric
disorders like schizophrenia, hypochondriasis is, conversion
disorder, delusion disorder etc.
2. Hypochondriasis
 Persistent preoccupation with a fear or belief of having one or more
serious diseases, based on person’s own interpretation of a normal
body function or a minor physical abnormality. On examination no
physical abnormality found. Preoccupation with medical terms is
common. Change of physician is also is common. Course is usually
chronic with remissions and relapses. Age usually late third decade.
3. Somatoform autonomic dysfunction
 The symptoms are narrated as if they were due to physical disorder
of an organ system that pre-dominantly under autonomic control.
For example – heart and CVS palpitation, upper GIT (hiccough),
lower GIT (flatulence, IBS), respiratory system (hyperventilation),
genitourinary system (dysuria), other organ and systems.
4. Persistent somatoform pain disorder treatment involved for a
psychosomatic disorder.
 Persistent, severe and distressing pain is the main feature which is
either grossly in excess or inconsistent with anatomical distribution
of the nervous system. Pre occupation with pain is common. More
common with females and the onset is in the third and fourth
decades. The pain is not produced intentionally and is not under the
patients’ control.
 Pain is of two types:-

Pain disorder associated with psychological factors and non-

identifiable medical condition. Psychological factors play a major
role in the onset, severity, exacerbation or maintenance of the pain.
Pain disorder associated with psychological factors and also general
medical condition. Both these factors have important role in the
onset, severity, exacerbation or maintenance of pain.

Psychosomatic disorders according to DSM-IV-TR

The revised fourth edition of “Diagnostic and Statistical Manual of Mental

Disorders” (DSM- IV –TR) does not use the term psychosomatic, instead
it describes the psychological factors affecting the medical conditions as
“one or more psychological or behavioral problems that adversely and
significantly affect the course or outcome of a general medical condition,
or that significantly increase a person’s risk of an adverse outcome”.
DSM-IV-TR Diagnostic Criteria for Psychological Factors Affecting
General Medical Condition

A. A general medical condition (coded on Axis III) is present.

B. Psychological factors adversely affect the general medical condition
in one of the following ways:
 The factors have influenced the course of the general medical
condition as shown by a close temporal association between the
psychological factors and the development or exacerbation of, or
delayed recovery from, the general medical condition.
 The factors interfere with the treatment of the general medical
condition.
 The factors constitute additional health risks for the individual.
 Stress-related physiological responses precipitate or exacerbate
symptoms of the general medical condition.

Following are the examples of some disorders which could have

psychological cause:

 Cardiovascular disorders: Essential Hyper tension, Coronary artery

disease, post cardiac surgery delirium, Migraine, Cerebro vascular
diseases, etc.
 Endocrine disorders: Diabetes mellitus, Hyperthyroidism,
Cushing’s syndrome, Peri-menopausal syndrome, Amenorrhea
 Gastro-intestinal disorders: Osophageal reflux, Peptic ulcer,
Ulcerative colitis, Crohn’s disease
 Immune disorders: Autoimmune disorders like ulcerative colitis,
SLE, Allergic disorders like bronchial asthma, hay fever, Viral
infection
 Musculo-skeletal disorders: Rheumatic Arthritis,Systemic Lupus
 Erythematous.
 Respiratory disorders: Bronchial asthma, Hay fever, Vasomotor
rhinitis
 Skin disorders: Psoriasis, Pruritis, Urticaria, Alopecia areata, Acne
vulgaris, Psychogenic purpura, Trichotillomania, Dermatitis
Artifacta, Lichen planus, Warts,etc.

Psychosomatic relation of various disorders

1. Cardiovascular disorders:

With anxiety, there is a failure of the cardiac index to rise, accompanied

by an increase in pulmonary arterial pressure.

Diminution in functional cardiac reserve during tension may occur as a

result of interference with intrinsic cardiac mechanisms governing heart
rate and rhythm.

Behavioral risk factors for cardiac diseases, such as smoking, failure to

exercise, and failure to adhere to treatment and lifestyle recommendations,
are clearly exacerbated by psychological stress, depression, and anxiety.

There is a link between psychological stress and abnormal neuroendocrine

and autonomic function and platelet dysfunction.

Hypothalamic–pituitary–adrenal (HPA) axis dysregulation occur during

mental stress which is manifest by elevated levels of circulating cortisol
and loss of the usual diurnal variation in cortisol level. Elevated cortisol
has toxic effects on the coronary artery endothelium and plays a role in
plaque development.

Autonomic dysregulation with diminished cardiac vagal modulation and

increased sympathetic nervous system activation occurs in depression
(mental stress).This may provide a substrate for increased arrhythmic
activity and sudden death. Heart rate variability, an index of cardiac
autonomic control, is reduced in depression like mental events. In
depression, there is disordered platelet aggregation, leading to increased
thrombus formation, may also play a role in increasing risk of coronary
events.

Mental stress induces arterial endothelial dysfunction, with impaired flow-

mediated vasodilatation; paradoxical vasoconstriction during stress occurs
in atherosclerotic arterial segments.

States of fear, excitement, and, especially, acute anger reduce blood flow
through atherosclerotic coronary segments, provoke coronary spasm, and
are associated with abnormal left ventricular wall motion and myocardial
ischemia.

2. Gastrointestinal disorder:

There is an intimate relationship between the GI tract and the psyche. For
example, stress or anxiety may modulate GI function and result in
disturbances of function such as diarrhea, bloating, nausea, and discomfort.

There is marked influence of emotions on gastric acid secretion. The

hydrochloric acid secretion increases with anxiety regardless of its origin,
whether it is associated with sexual, hostile, or passive dependent wishes,
ideation, or motives. The unconscious responses, largely concerning
dependency problems, were accompanied by increased activity of the
peptic cells of the gastric mucosa as measured by pepsinogen excretion
levels.
There is a gut–brain axis; a bidirectional intercommunication between the
gut and the brain, which provides an explanation of the normal, acute, and
chronic alterations in digestive tract function.

It is now widely accepted that dysregulation at any level of the gut–brain

axis can lead to GI symptoms. Neurotransmitters such as serotonin (5-HT),
norepinephrine (NE), corticotropin-releasing factor (CRF), and opioids
modify both motility and sensation in the gut.

Schematic representation of the gut–brain axis (Sadock, B.J., 2007)

Psychological comorbidity such as depression, anxiety, and

hypochondriasis is common and it has been estimated that over half of
patients with IBS and IBD suffer from these disorders. Depression and
anxiety may affect symptoms and functioning through the development of
heightened pain sensitivity of the intra-abdominal organs, exacerbation of
bowel symptoms, and reduced self-motivation to overcome the difficulties
associated with GI disorders. The repressed wish for a dependent
relationship is reinforced by the struggle involved in this over
compensatory behavior, constituting the unconscious physiological
stimulus for those physiological processes which lead to ulcer formation.

3. Respiratory disorders:

A bronchoconstriction can be elicited by stress and various emotions.

Major physiological pathways for obstruction due to psychological stimuli
are parasympathetic excitation, hyperpnea (increased depth of breathing),
and hypocapnia. Observational studies have also expanded the current
knowledge, showing that psychosocial stressors, negative life events, and
adversity, such as low socioeconomic status, are linked to lung function
decline, airway inflammation, and changes in immune status favoring
exacerbations of respiratory disorders. Emotions and stress are now listed
among the well-established triggers of asthma symptoms.

Anxious or depressed mood can also affect disease management, for

example, by over- or underuse of rescue inhalers, lack of adherence to
prescribed maintenance medication, neglect of trigger control, problematic
health behaviors affecting the airways (e.g., smoking), or delayed
treatment seeking.

The contemplation of physical activity, particularly in the presence of real

or imagined danger, is known to be associated with increased respiratory
activity in anticipation of increased metabolic needs.
4. Skin disorders

Skin disease has long been regarded as the one strongly influenced by
emotional life. It is usually accompanied by itching, that often appears
disproportionate in severity to the visible lesions. Dr. Hamer, the originator
of German new medicine, who found that skin disorder is always linked to
“separation conflict” in which a person experiences as if his parent, his
spouse, his friend were separated from him. During the conflict, there is
active stress phase, the skin loses epidermal cells causing a loss of
sensitivity towards touch. As a result of loss of epidermal cells, the skin
becomes dry, rough and itching.

Guilt, anger, irritation, etc. predispose the individual to itching and

subsequent scratching. Emotions that leads to generalized itching are
commonly anger and repressed anxiety.

5. Connective tissue disorders

A number of investigations have theorized or demonstrated that changes

in the physiological and social environment are important as antecedents
of variety of illness. Meyerowitz for example suggested that connective
tissue disorder may tend to develop in person with particular identifiable
personality traits. The illness tends to develop in the contest of stress
associated with life events that are demanding and restricting. Rimson
further hypothesized that malignant progress of the illness develops in
patients with previous psychiatric disorders associated with and leading to
alteration immunological reactivity. In support to this hypothesis, reported
increased levels of certain types of immunoglobulin in psychiatric patients.

6. Circulatory disorders

Arterial dilatation with accompanying peri-arterial tissue reaction is

frequently seen in migraine and tension headache. One often find dilatation
of the major artery in the carotid trace. No single personality type is
predisposed to vascular headache, but person with obsessional
personalities are likely the candidate because they suppress or repress
anger by control mechanism. Excessive environmental demands may
produce vulnerability to ANS, stress and to situational and intra psychic
conflicts. As a group of patients with migraine are intelligent and
perfectionist, and they demonstrate an unusual capacity to deal with every
day crisis. However in adapting to major phases in the life cycle, such as
adolescence , menstruation , separation, changing jobs, marriage, they find
that their usual control do not work as well and bouts of vascular headaches
are precipitated. Moreover an underlying case of depression may be
demonstrated when their defense mechanism are no longer successful in
maintaining depression.

Table : Theorized psychological factors in classical psychosomatic

disorders

Symptom Psychological Presumed

(disease) factors psychosomatic
mechanism
Hyperacidity Inhibited dependence; Increased acid
(peptic ulcer) general stress secretion
Essential Conflict over hostility; Vasoconstriction
hypertension general stress
Bronchial asthma Conflict over wish for Bronchospasm
protection or separation;
anxiety; general stress
 Migraine Conflict over control; Vasoconstriction
general stress and vasodilatation
Thyrotoxicosis Conflict over Increased thyroid-
(Graves' premature self- stimulating
disease) sufficiency hormone secretion
Diarrhea Conflict over an Gastrointestinal
(ulcerative obligation cholinergic
colitis) activation

Modern management of psychosomatic disorders

Following points should be considered:

 Knowledge of emotional factors or stressors

It is basic thing to manage a psychosomatic disease, Reaction to life events

should be understood and also the physiological mechanisms by which the
emotional factors influence the disease process. Also general knowledge
of pathology along with above factors is primary requirement before the
treatment.

 Arrive at a psychosomatic diagnosis

There should be understanding of the stimuli affecting the physical

condition. These stimuli include stress, interpersonal or family problems,
change in work or home environment or losses.

 Regarding reference of the patient

Referring the patient to a psychiatrist or psychologist, at first instance will

do no good. It adds up to the anxiety of the patient instead of that. A proper
general management + medicinal management + supportive therapy can
do a lot for the patient.
A major role of physicians working with patients with psychosomatic
disorders is mobilizing the patient to change behavior in ways that
optimize the process of healing. This may require a general change in
lifestyle (e.g., taking vacations) or a more specific behavioral change (e.g.,
giving up smoking). Whether or not this occurs, depends in large measure
on the quality of the relationship between doctor and patient.

 Direct education: Explain the problem, goals, and methods to achieve

goals. Education must be geared to the patient's socioeconomic level and
cultural traditions. If the patient has questions, they should be answered
frankly. Explanations in keeping with the patient's capacity to understand
should be given. Such factors as intelligence, sophistication in regard to
personality reactions, and degree and type of illness should influence the
vocabulary and content of the physician's response. Every effort should be
made to convey to belligerent patients both understanding and tolerance
for their feelings.
 Third-party intervention: Family members, friends, and other clinicians
can provide support and encourage the patient to follow a course of action.
This may occur in a group setting, which is especially effective in
motivating patients who have substance abuse problems to obtain
treatment (called an intervention).
 Exploration of options: There may be alternative methods for achieving
a desired goal. For example, quitting smoking can be done with support
groups, nicotine patches or gum, psychotropic drugs, or cold turkey among
others.
 Provision of sample treatment: If a patient fears a particular course of
action or considers change impossible, a treatment trial can be
implemented. The patient always may opt out of the prescribed program.
 Control sharing: Some patients resent any approach that appears to be
authoritarian. They may wish to set the pace of a withdrawal program or
titrate their medication depending on adverse effects.
 Concession making: The clinician may grant the patient something that
he or she wants (e.g., medication) as a bargaining chip to get the patient to
comply with advice.
 Empathic confrontation: Patients who resist change may do so because
of fear or other uncomfortable emotions of which they are unaware. The
doctor can try to step into the patients' shoes in an effort to raise their level
of awareness.

Psychotherapy

Psychotherapy is the dialogue between patient and therapist in

diagnosis and treatment of mental disorders.

Psychotherapy based on analytical principles are usually effective in

treating psychosomatic disorders. Many a times people reject
psychotherapy for their illness, thinking that the disease is organic origin.
The constructive relationship can develop only when patient realize that
the emotional problems want psychotherapy.

The physicians must be supportive and reassuring especially during acute

phase of the illness. A strong patient- physician relationship is essential. A
physician must be aware of certain precautions to be taken with patient
with psychosomatic disorders.

Different systems of psychotherapy:

 Psychoanalytic - It encourages the verbalization of all the patient's

thoughts, including free associations, fantasies, and dreams, from
which the analyst formulates the nature of the unconscious conflicts
which are causing the patient's symptoms and character problems.
 Behavior Therapy- Behavior therapy focuses on modifying overt
 behavior and helping clients to achieve goals by changing
maladaptive patterns of behavior to improve emotional responses,
cognitions, and interactions with others.
 Cognitive behavioral - generally seeks to identify maladaptive
cognition, appraisal, beliefs and reactions with the aim of
influencing destructive negative emotions and problematic
dysfunctional behaviors.
 Psychodynamic - is a form of depth psychology, whose primary
focus is to reveal the unconscious content of a client's psyche in an
effort to alleviate psychic tension. Although its roots are in
psychoanalysis, psychodynamic therapy tends to be briefer and less
intensive than traditional psychoanalysis.
 Existential - is based on the existential belief that human beings are
alone in the world. This isolation leads to feelings of
meaninglessness, which can be overcome only by creating one's
own values and meanings. Existential therapy is philosophically
associated with phenomenology.
 Humanistic - It is explicitly concerned with the human context of
the development of the individual with an emphasis on subjective
meaning, a rejection of determinism, and a concern for positive
growth rather than pathology. It posits an inherent human capacity
to maximize potential, 'the self-actualizing tendency'. The task of
Humanistic therapy is to create a relational environment where this
tendency might flourish. Humanistic psychology is philosophically
rooted in existentialism.
 Brief - "Brief therapy" is an umbrella term for a variety of
approaches to psychotherapy. It differs from other schools of
therapy in that it emphasizes (1) a focus on a specific problem and
(2) direct intervention. It is solution-based rather than problem-
 oriented. It is less concerned with how a problem arose than with the
current factors sustaining it and preventing change.
 Systemic - seeks to address people not at an individual level, as is
often the focus of other forms of therapy, but as people in
relationship, dealing with the interactions of groups, their patterns
and dynamics (includes family therapy & marriage counseling).
Community psychology is a type of systemic psychology.
 Transpersonal - Addresses the client in the context of a spiritual
understanding of consciousness.
 Body-oriented Psychotherapy - It is also known as Somatic
Psychology. It generally focus on the link between the mind and the
body and try to access deeper levels of the psyche through greater
awareness of the physical body and the emotions. It addresses
problems of the mind as being closely correlated with bodily
phenomena, including a person's sexuality, musculature, breathing
habits, physiology etc. This therapy may involve massage and other
body exercises as well as talking.
 Gestalt therapy- Gestalt therapy is a humanistic, holistic, and
experiential approach that does not rely on talking alone, but
facilitates awareness in the various contexts of life by moving from
talking about situations relatively remote to action and direct,
current experience.
 Group psychotherapy- The term group therapy, however, was first
used around 1920 by Jacob L. Moreno, whose main contribution
was the development of psychodrama, in which groups were used as
both cast and audience for the exploration of individual problems by
reenactment under the direction of the leader.
 Expressive therapy- It is a form of therapy that utilizes artistic
 expression as its core means of treating clients. Expressive therapists
use the different disciplines of the creative arts as therapeutic
interventions. This includes the modalities dance therapy, drama
therapy, art therapy, music therapy, writing therapy, among others.
Expressive therapists believe that often the most effective way of
treating a client is through the expression of imagination in a
creative work and integrating and processing what issues are raised
in the act.

 Interpersonal psychotherapy (IPT) – It is a time-limited

psychotherapy that focuses on the interpersonal context and on
building interpersonal skills. IPT is based on the belief that
interpersonal factors may contribute heavily to psychological
problems. It is commonly distinguished from other forms of therapy
in its emphasis on interpersonal processes rather than intra psychic
processes. IPT aims to change a person's interpersonal behavior by
fostering adaptation to current interpersonal roles and situations.

 Narrative therapy- It gives attention to each person's "dominant

story" by means of therapeutic conversations, which also may
involve exploring unhelpful ideas and how they came to
prominence. Possible social and cultural influences may be explored
if the client deems it helpful.
 Integrative psychotherapy- It is an attempt to combine ideas and
strategies from more than one theoretical approach. These
approaches include mixing core beliefs and combining proven
techniques.
 Hypnotherapy – It is therapy that is undertaken with a subject in
hypnosis. Hypnotherapy is often applied in order to modify a
subject's behavior, emotional content, and attitudes, as well as a
 wide range of conditions including dysfunctional habits, anxiety,
stress-related illness, pain management, and personal development.
 Adaptations for children-counseling and psychotherapy must be
adapted to meet the developmental needs of children. Many
counseling preparation programs include courses in human
development. Since children often do not have the ability to
articulate thoughts and feelings, counselors will use a variety of
media such as crayons, paint, clay, puppets, toys, board games, etc.
The use of play therapy is often rooted in psychodynamic theory,
but other approaches such as Solution Focused Brief Counseling
may also employ the use of play in counseling. In many cases the
counselor may prefer to work with the care taker of the child,
especially if the child is younger than age four. Yet, by doing so, the
counselor risks the perpetuation of maladaptive interactive patterns
and the adverse effects on development that have already been
affected on the child's end of the relationship. Therefore,
contemporary thinking on working with this young age group has
leaned towards working with parent and child simultaneously within
the interaction, as well as individually as needed.

Homoeopathy and psychosomatic disorders

According to homoeopathy, disease consists of two parts: generalized

disturbance of the whole organism and localized problems. It can be seen
that generalized disturbance (which includes physical, general and
psychological changes) precedes localization of the problem.

Homeopathy has focused on the mental health of its patients for more than
200 years. It has holistic approach, the meticulous recording of mental
symptoms during drug proving and it gives importance on the mental and
emotional symptoms in every disease.
Hahnemann recognized psychosomatic approach long ago, and stressed
that bodily and mental symptoms are to be taken together to form the
portrait of disease.

In his Organon of Medicine in Aphorism 210 Hahnemann states regarding

mental diseases “They do not, however, constitute a class of disease
sharply separated from all others, since in all other so-called corporeal
diseases the condition of the disposition and mind is always altered;
and in all cases of disease we are called on to cure the state of the
patient's disposition is to be particularly noted, along with the totality
of the symptoms, if we would trace an accurate picture of the disease,
in order to be able there from to treat it homoeopathically with
success.”

Master Hahnemann states in Aphorism 211“This holds true to such an

extent, that the state of disposition often chiefly determines the choice
of the homoeopathic remedy”.

Hahnemann has said in aphorism 212- “There is no powerful medicinal

substance in the world which does not very notably alter the state of
the disposition and mind in the healthy individual who tests it, and
every medicine does so in a different manner” and these have been
verified on countless occasions.

Dr. Hahnemann as mentioned in Aphorism-213 of 6th edition of Organon:

We shall, therefore, never be able to cure conformably to nature- that
is to say, homeopathically-if we do not, in every case of disease, even
in such as are acute, observe, along with the other symptoms, those
relating to the changes in the state of the mind and disposition, and if
we do not select, for the patient’s relief, from among the medicines a
disease-force which in addition to the similarity of its other symptoms
to those of the disease, is also capable of producing a similar state of
the disposition and mind.

Here he told that the medicine which have power to produce the similar
state of mind and disposition that medicine only able to cure.

Homeopathy offers safe, gentle, non-toxic remedies, administered with

holistic principles. These drugs are capable of exerting a curative influence,
not only on the body but also on the patient’s personality as well. So they
can provide ideal alternatives to conventional medications without any
adverse effects. They can be used equally well in functional diseases as in
organic maladies. Moreover, the law of similars makes no such absurd
distinction between functional and organic disease because the former
untreated is invariably the precursor of the latter.

Hahnemann’s classification of mental disorders

Aphorism 216 221 224 225

Contents Mental Mental Mental Mental
diseases disease diseases of disease
appearing appearing doubtful arising
with the suddenly as origin ie- from
decline of an acute behavioral prolonged
corporeal disease in disorders. emotional
diseases the patients’ causes.
which calm state of
threatened mind due to
to be some
fatal. exciting
factors.
 Psora, Psora from Maintaining Psora in
Fundamen from sudden causes-
The
tal cause Secondar flaring of pseudo
developing
y stage ie- latent stage. chronic
stage.
from diseases.
developed
psora.

Treatment Proper Anti psorics Psychothera Psychother

Anti not py. apy And
psorics. immediately proper
but with Antipsoric
medicines manageme
like aconite, nt.
hyoscyamus,
mercurius,
stramonium
later. Anti
psoric
treatment
must

Views of Pioneers on Psychosomatic Disorders

The concepts of psychosomatic disorders entertained from the time of

Hahnemann and many masters of homoeopathy tried to highlight the
relationship between mind and the body.

Boenninghausen -Boenninghausen remarked, with regard to one of the

"Aphorisms of Hippocrates" that there are numerous cases of icterus which
manifest themselves on the day following an emotional upset and are cured
equally quickly by the remedy corresponding to the symptoms, such as
Aconite, Chamomilla, Nux vomica, etc.

Kent JT -Kent considered that the mind is the center of the whole
functioning of the organism and that it is also the focal point from which
the disease process starts. Kent states that “The mental symptoms must be
first worked out by the usual form until the remedies best suited to the
patient’s mental condition are determined...when the sum of these has been
settled, a group of five or ten remedies, or as many as appear, we are than
prepared to compare them and the remedies found related to the remaining
symptoms of the case. In his Lectures on Homoeopathic Materia Medica,
Kent say of Chamomilla: “It will never cure a sore throat except in these
irritable constitutions, The chamomilla mental state determines when you
are to give Chamomilla in sore throat.

C. M. Boger -The relative time for the appearance of each symptom

naturally varies with the speed of the disease. From, this we reason that the
earliest mental manifestations are decidedly the most important of all
symptoms.

William Boericke -Where mental states and emotions are evident primary
causes or contributing factors to the production or continuance of diseased
conditions, Homoeopathy offers much useful aid, thus: Remember the
adaptability of Coffea, Aconite and Opium to the ill effect of different
emotional disturbances, especially Gelsemium to the effect of fear. Ignatia
and Phosphoric acid to the effect of grief, etc.

JH Allen -It is though the mind that man sins, therefore it is frequently
through it that he becomes diseased. Frequently we hear the remark among
physicians "I have better success, or have greater success, when I base my
prescription upon the mental symptoms". Thus you see any expression of
life may be affected by the action of these miasms, and the nature of the
mental perversion, if carefully studied and compared, can be traced to the
prevailing active one.
Grimmer AH -All chronic diseases, if studied carefully, will show decided
and characteristic mental symptoms long before physical changes can be
discovered in the body by any laboratory test now known. The importance
and relationship of the mental and emotional states and symptoms to
disease, has in more recent times been verified and substantiated by the
observations and claims of the psycho-somatic branch of medical thought
that tells us, all constitutional disease, mental and physical, has its origin
in maladjusted and perverted modes of thinking. Clinical evidence in all
schools of medical and healing thought have verified these claims.

Paschero -Paschero writes, "It is the person and not the disease that
interests us in Homoeopathy. The symptoms expressing a human being's
functions reside only in the mind, as in the conception of classical
Psychology, but also through the body. Thus Homoeopathy bears out the
prevailing psychosomatic ideas of modern medical thought.

Edward C. Whitmont -Whitmont states that "Mentals are often of

overruling importance in determining the remedy which represents the
total symptom complex similar to the patient’s condition. Besides
justifying our method of remedy selection, this fact also suggests that the
mental attitudes, probably, are also of paramount importance in the
establishment of the very psychosomatic complex itself, which represents
the illness”.

Eugene Underhill -Emotional conflict is a major cause of disease.

Everyone suffers in some degree from such conflict. The more an
individual lives in his emotions, the more strife will he encounter both from
without and from within. Conflict produces tension, stress, strain of both
body and mind. If intense and long continued, physiologic equilibrium
cannot be maintained and dysfunction will begin in the weaker structures
of the organism. If uncorrected, organic disease will ultimately result. The
homoeopathic Materia Medica and the Repertories placed great emphasis
upon mental and emotional states and their correlation with bodily function
and disease. So Homoeopathic treatment of emotional conflicts and
complexes is far superior to any other therapeutic approach.

Julia Green -Julia green states in thinking back over the years of practice,
it is astonishing to realise how many children have been pulled out of their
emotional and mental handicaps to grow up into well-balanced citizens in
many instants to reach a most satisfactorily high development of usefulness
in the world. Suffering from many forms of inhibition, suppression,
misunderstanding or poor reaction to punishment. Unbalanced or of
physical and mental activity, also emotional and mental unbalance. Such
attributes these children have in common but the variation in manifestation
are most interesting.

Jan Scholtan -He states that the psychosomatic way of looking at

problems has become so much a part of our practice that we don't really
need to mention it separately anymore. It is always there, so the term has
become superfluous, obsolete.

Andre Saine -A very important point to understand in mental diseases is

that mental disease will have a tendency to become organic. With
psychosomatic diseases there are two elements of almost equal importance.
One is the stressing environment that will create the neurosis and the other
one is the susceptibility to become stressed. The remedy will affect the
susceptibility to become stressed, but if the environment doesn't change
and the environment is very stressful, then you will not expect results to be
as quick.

Farokh J Master -When psychological blockages occur, for whatever

reasons, emotional energy is not only repressed and pushed under, but it
also attacks itself to certain key organs, for example colon, heart, and these
are used as new pathways for the expression of feelings. When under
emotional pressure, certain patients react with an attack of asthma, colitis,
angina, depending upon which particular organ is sensitized and used as an
outlet.

Homoeopathy aims at a reintegration of the total self, with a reduction of

unhealthy psychological regression, blockages and isolation. The
homoeopathic prescription and general approach towards the person helps
to lessen the denial of painful hurts and memories, which can then be easily
brought to the surface, recalled, understood and discussed. This quite
naturally leads to a strong personality, confidence and to greater insights.
In the correct remedy there is a slow emergence of the bruised aspect of
the personality into the light of more adult maturity and understanding so
that a softening of earlier resentments and scar can occur.

Rajan Sankaran -It is being increasingly acknowledged these days that

the mind and body are interlinked. We now see the rapid rise of the holistic
concept of disease with an emphasis on the psychosomatic aspect.

Diagnosis of Psychosomatic Diseases

The diagnosis of psychosomatic disease requires the presence of clearly

defined signs and symptoms. Reliance upon the total clinical examination,
including an adequate history, review of systems, psychiatric assessment,
and clinical judgment, is more valid than reliance upon any single
laboratory or diagnostic test. Till date in conventional medical system there
is no clear test to differentiate organic and psychological diseases.

But Hahnemann in 1810 itself made a clear distinction between them. In

fact, he prescribed psychotherapeutic techniques.
In paragraph 224 he recommends “If the mental disease be still
somewhat doubtful whether it really arose from a corporeal affection
or result from faults of education, bad practices, corrupt morals,
neglect of the mind, superstition or ignorance. The mode of deciding
this point will be, that if it proceed from...the latter causes it will
diminish and be improved by sensible friendly exhortations,
consolatory arguments, serious representations and sensible advice,
whereas a real moral or mental malady, depending on bodily disease,
would be speedily aggravated by such a course, the melancholic would
become still more dejected, querulous, inconsolable and reserved, the
spiteful maniac would thereby become still more exasperated, and the
chattering fool would become manifestly more foolish.”

When it is difficult to find out whether the mental disease is arising from a
corporeal disease or from any psychological disturbance like faulty
education, bad practices, corrupt morals, neglect of mind, superstition or
ignorance. So it can be dealt in 2 headings:

i. If mental diseases of doubtful origin are based on the psychogenic

cause:-This disease can be controlled by sensible, friendly
exhortations, consolatory arguments, serious representations and
sensible advice.
ii. If mental diseases of doubtful origin are based on any corporeal
disease:-Hahnemann recommends one guideline to identify such
diseases. In these types of diseases the patient gets irritated when the
physician tries to give psychotherapy and consolatory arguments.
So, by psychotherapy alone such patients become more dejected,
inconsolable and reserved. Such mental diseases have to be
considered as one sided mental disease of corporeal causes (somato-
psychic).
Dr. Hahnemann has mentioned about psychosomatic disorder in his
organon of medicine 6th edition in aphorism 225-227.

In aphorism 225 Hahnemann states about psychosomatic diseases-

“There are, however, as has just been stated, certainly a few emotional
diseases which have not merely been developed into that form out of
corporeal diseases, but which, in an inverse manner, the body being
but slightly indisposed, originate and are kept up by emotional causes,
such as continued anxiety, worry, vexation, wrongs and the frequent
occurrence of great fear and fright. This kind of emotional diseases in
time destroys the corporeal health, often to a great degree.

Hahnemann mentioned in this aphorism that the mental diseases which

arise as a result of prolonged emotional disturbances, different
psychological depressions like continued anxiety, worry, vexation, wrongs
and frequent occurrence of greater fear and fright are psychosomatic type.
Such diseases may be of recent origin and may not have developed fully
into corporeal diseases. But, if left untreated they may damage the body.

Aphorism 226

It is only such emotional diseases as these, which were first engendered

and subsequently kept up by the mind itself, that, while they are yet
recent and before they have made very great inroads on the corporeal
state, may, by means of psychical remedies, such as a display of
confidence, friendly exhortations, sensible advice, and often by a well-
disguised deception, be rapidly changed into a healthy state of the
mind (and with appropriate diet and regimen, seemingly into a healthy
state of the body also).

In this aphorism master has mentioned regarding treatment of

psychosomatic disorders. He told - such mental diseases of psychic origin
can be treated by means of psychological remedies like confidence
building, friendly exhortations, sensible advice and a well-disguised
deception. This has to be always supported by good diet and regimen.

Aphorism 227

But the fundamental cause in these cases also is a psoric miasm, which
was only not yet quite near its full development, and for security’s sake
the seemingly cured patient should be subjected to a radical antipsoric
treatment, in order that he may not again as might easily occur, fall
into a similar state of mental disease.

In this aphorism master has mentioned that- The fundamental cause in

psychosomatic diseases is always psora. Hence, radical anti-psoric
treatment has to be given to avoid any type of recurrences.

Miasms-The Fundamental Cause of Chronic Disease

In aphorism 78 of 6th edition of Organon of Medicine Dr. Hahnemann

mentioned -“the true natural chronic diseases are those that arise from a
chronic miasm, when left to themselves, with improper treatment, go on to
increase, growing worse and torment the patient to the end of his life."

Hahnemann spent 12 years of his life investigating miasms, collecting

proof and then "the chronic diseases" was written. He describes regarding
miasms and importance of using anti-miasmatic medicines to cure
effectively. (footnote – 77)

The conditions that would modify a miasm in a person’s body would be

things like, climate and peculiar and physical character of the person,
mental delays, excesses, or abuses in life, in diet passions, habits and
various customs. (footnote – 78)
The medical profession (allopathic doctors) have put names on various
diseases such as, jaundice, dropsy, leucorrhoea, hemorrhoids, eczema,
asthma, hysteria, rheumatism, herpes, etc. and their treatment is based on
the name of disease, not on the individual person who is sick. All these
names have no use and no influence on the practice of the true physician.

Only the totality of the signs of the individual state of each particular
patient is used to cure the disease. So no real cure of miasms can take place
without a strict individualization of each case of disease. A difference
between acute and chronic disease (aphorism – 72): Acute meaning
starting suddenly, lasting for only a short amount of time. Chronic, a slow
gradual imperceptible beginning, a slow progression of imbalances and
vital force is unable to extinguish them by itself and ultimately disease
develops which destroys organism. Most of the time a reason behind the
chronic disease is imbalances being treated by allopathic suppressive
medicines turning into further and further complications as the disease lasts
and goes deeper into the human mind and physical body, even years go by
without let-up. Chronic miasms are hidden, the symptoms are much more
difficult to be ascertained. Lots of questions need to be asked to trace the
picture of disease. Questions about the history of one's family, mental
delusions, dreams, peculiar symptoms.

The miasms are: psora, sychosis, syphillis, and tuburcular.

Psora (aphorism 80) - the mother of all diseases goes back the farthest in
human history. Psora is nothing but the negative/evil thought of mind.
Psora or "itch" is the monstrous internal chronic miasm, the only real
fundamental cause and producer of all the other numerous forms of disease.
Hahnemann used the word with special connotations and denotations.
“Psora is the most fundamental cause of so many chronic maladies, is the
most ancient, most universal, most destructive and yet most
misapprehended chronic miasmatic disease”. Psora is the oldest miasmatic
disease known to us. It is the mother of all thousands of incredibly various
chronic diseases. Psora, or the itch disease is the oldest and the most hydra
headed of all the chronic miasmatic disease. The 7/8th of all the chronic
diseases are caused by psora, remaining 1/8th are by syphilis and sycosis.
Dr. Kent’s view on Psora:- It is the spiritual sickness which is the first
sickness of a man. If we imagine the state of human race before the other
two chronic miasms syphilis and sycosis, some sickness existed before
onset of these two miasms. Some state of disorder, which we can call psora.
As long as man continued to respect the wise rules and regulations of nature
(good behavior towards his neighbors etc), he remained free from
susceptibility to disease. “As are the will and understanding, so will be the
external man”. The internal man and the external man are interrelated and
interdependent. The departure of man from the virtue and justice into evils
and vice, reflected onto the body in form of susceptibility to the disease i.e.
Psora. Psora is the result of false thinking of the human race. “Psora is but
an outward manifestation of that which is prior in man”.
Psora will be all that which means inhibition, sense of inferiority, coldness,
functional deficiency, lack of productivity or of holding back. For example
we can think of symptoms such as shyness, anxiety, irritability [holding
back of anger], dryness, impotence, lassitude, weakness [whether it be
general or of an organ or a part of the body].
 Hypersensitive, emotional, anxious, fearsome, restless, concentration
poor, fatigue, anticipation aggravates, moods alternates, melancholic
and irritabe.
 Psoric patent is usually non-violent in nature.
 Mentally active and quick. Disturbances in sensation and functions.
 Easily prostrated from least mental activity.
 Restless, always in hurry.
 Heat of the body from slightest mental activity.
 Impurity of mind, fear of death and illness, lack of inclination of
being cured. Restless on full moon or during menses in females.
Pulsating sensation in different parts of the body.
 Dishonesty, privacy, feeling of constriction, timid, dizziness and
faintness in the crowd.
 Patient is never satisfied with living conditions, complaining,
faultfinding, unsatisfied mind. Time passes to a psoric patient either
too slowly or too fast. Absent minded patient, delirious mania, no
love or pity for body. Self-centeredness, builds castles in the air. Utter
theoretical man, cannot materialize his thoughts.
 Ragged both physically and mentally. A deceitful philosophical
 mind, psoric patient thinks that her thoughts are not under her control.
A feigning philosopher mentally alerts for some period and then
wants to take rest. Weakness of memory is psoric.
 Inhibitory quality is psoric. Perverted mind is psoric mind.

Sycosis (aphorism 79) - manifested by expansion, precipitancy,

hypersensitivity, hyperactivity, hypersecretion, pride, exaggerated fears,
irascibility [manifest anger], hyperthermia, neoplasms, hurried.

 Mean minded, suspicious and jealous with fixed ideas. Self-

condemnation, patient always broods on matters; anger always leads
to destructive violence. Cross, irritable person. Oppression and
anxiety. Sycotic have a tendency to keep everything secret.
Incoordination, quarrelsome. Repeats the same word or spelling
again and again. Criminal insanity. Most mischievous person.
 Difficulty in recalling the recent events but can easily calls the past
events.
 Sycosis + Psora = criminal insanity + suicide.
 Sycosis makes beast out of man. Suspicious about one’s own self.
Repeats the same thing again and again. Thinks the body is made up
of wood or as if something alive is moving inside his parts.
 Suspicious, thinks his food is full of insects.
 Inferior felling, jealousy- suicidal tendency.
 Aggravates by change of weather, hence called the human
barometer. Fear with outwardly manifestations. Sycotic mind is
absent minded.
 Expensive tendency is sycotic. Degenerative mind is sycotic mind.
 Hypertrophy of ego is noticed.
Syphilitic (aphorism 79) - manifestations include:
 Degradation
 Indifference
 Loathing life
 A perversion of biological functions
 Abnormal secretions
 Rage [blinding anger]
 Convulsions, spasms, deformities
 Haemorrhages, putrefactions and destructive tendencies in the
tissues as well as in the mind.
 Dull, stubborn, morose, guilty complexes, person with fixed ideas.
Slow in comprehension. Anger leads to violence.
 Destructive mentality is syphilitic. Tendency to suicide. Slow in
reaction.
 Always tries to escape from the responses.
 Perversion, imbecility.
 Idiotic and very slow in comprehension. Lack of responsibility.
Suicidal and homicidal tendencies are pre dominantly syphilitic.
Impulsive.
 Desire to kill is syphilitic.
 Cold blooded persons can kill anybody or himself without any
disturbance.
 “Closed mouthed fellows” are syphilitic.
 Inability to explain his symptoms to the physician is syphilitic.
 Cannot recall the past events. Fear with anguish and forgetfulness is
syphilitic. Destructive tendency, vitiated is syphilitic mind.
 Syphilitic patient is iconoclast, both idealistic and materialistic
 sense.

Tubercular

 Mentally keen, but physically weak.

 Intelligent, nut makes careless mistakes. Fear of dogs. Insanity, with
family history of tuberculosis.
 Changeability of symptoms is tubercular.
 Patient is fast in response to any stimuli, hence called the responsive
or reacting miasm. Mental symptoms are better by the outbreak of
ulcer. Dissatisfied mind, lack of tolerance, Anger, dissatisfaction of
job etc.
 Absolute lake of anxiety, even physical, mental, ack of
concentration, uncontrollable passion for life. Masturbation,
perverted cravings comes under this heading.
 The problematic child is tubercular. Child is slow in understanding,
dull un-social. Child desired for something, and when given throws
them at once.
 Dissatisfaction in anything comes under tubercular taint.\

Homoeopathic approach to treat Psychosomatic Disorders

The concept of psychosomatic disorder is not new to the homoeopathy.

They are chronic diseases in which the prolong conflict and stress from
which the patient is undergoing - leading to a somatic disorder. The
fundamental principle of homoeopathy is that it treats the patient as a
whole and as an individual. There is no medicine for any particular disease,
but there is a medicine for the patient suffering from the disease.

Master Hahnemann in every step of Organon of medicine, considers the

whole psychosomatic approach of a patient to reach at a perfect similimum.
Holistic concept of homoeopathic treatment is mentioned in many
aphorisms like aphorism -1,2,3,6,12,13,15. Following the guidelines of our
master, the suitable homoeopathic remedy should be selected with due
stress on it.

Hahnemann expects from the clinician to determine and evaluate the

various factors that have led the illness and are likely to act as obstacle to
cure (aphorism-3). He expects from the clinician to take adequate steps to
eliminate them whenever possible and to reduce their influence when
removal is not possible (aphorism-4, 6th edition). Only when the clinician
has done this, he is considered ready to administer the drugs as a remedial
agent to cure. Hahnemann insist the physician on accurate unprejudiced
observation of the development and course of illness. (aphorism- 6 , 6th
edition).

In Organon, the importance of the physical make up (constitution) and

mental character is introduced in the aphorism 5 of the 6th edition. It will
help the physician to bring about a cure if he can find out the data of the
most probable occasion of an acute disease, and the most significant factors
in the entire history of chronic disease, enabling him to find its
fundamental cause. The fundamental cause of chronic disease mostly rest
upon a chronic miasms. In these investigations, the physician should train
to account the patient's

1. Body constitution
2. Moral and intellectual character
3. Occupation
4. Life style and habits
5. Social and domestic relationships (relationship outside and inside
the home)
6. Age
 7. Sexual function.

With this other general factors should be taken into consideration while
taking the case are intelligence, duration of illness, insight, nature of
physical illness, environmental stress and personality structure of the
individual. Along with this, the homoeopath takes into consideration the
conceptual image of the patient which comprises:

 Constitution, Temperament, Diathesis of the patient

 Causative factors (Endogenous, Exogenous, Physical or Mental)
 Peculiar mental states
 Characteristic physical generalities including its general modalities
 Characteristic particular symptoms including its particular
modalities
 Relevant information from the Past/Personal/Family/Treatment
history of the patient
 Miasmatic profile of the patient
In treatment of chronic psychosomatic ailments, the aforesaid data should
be considered for totality of symptoms and a similimum is to be selected
accordingly. Whereas in acute cases, the presenting symptoms along with
causative emotional factors are considered, to reach the similimum.

As regards the miasmatic background of the Psychosomatic disorders

Psora plays an indubitable role according to Hahnemann, so in all cases
appropriate antipsoric treatment must be employed for complete cure.

In aphorism 228 Dr. Hahnemann has given general instructions to the

physician during case-taking in mental diseases as following:

 In cases of violent mania, the physician must resist the abnormal

behavior of the patient in a cool, calm yet firm resolution.
  In cases of “miserable, irritable sorrow”, the physician has to silently
display his feelings of sympathy in his looks and gestures.
 In case of “senseless chattering”, he must maintain silence, yet with
good attention towards the symptoms of the patient.
 When the patient is using abusive, bad, unpleasant language and
conduct, the physician has to exhibit his inattention in a controlled
manner.
 The physician must always try to prevent any type of damage,
destruction and injury to him and his surroundings. In this process,
he must always avoid talking bad or criticizing about the patient.
 Any form of corporeal punishments is not allowed in homeopathic
management of mental diseases.
 In the footnote to § 228, Hahnemann criticizes the medical men of
his times for the use of cruel methods and corporeal punishments.
 Mental diseases are psoric in origin. So anti-psoric treatment with
psychological counselling, diet and regimen is sufficient for their
cure.
 Contradiction, eager explanations, rude correction, use of insulting
language, violent behavior should not be employed by the physician
during case taking. Such procedures are even harmful to the patient.
 By such violent method, the patient become more irritated and their
complaints will aggravate. Hence, the physician must behave as if
he totally believes them to be possessed of reason.

Diet and regimen

Dr. Hahnemann has always given the importance to diet and regimen along
with medicinal therapy. In his 6th edition of Organon Of Medicine in
aphorism 259-262, he has mentioned regarding diet and regimen.
It is true that we depend on energy from our thoughts, feelings, and
consciousness to fuel the functions of our body, it is also clear that our
mental, spiritual, and emotional processes depend on a healthy physical
body. The body must be kept healthy if we hope for optimal expression of
our thoughts and emotions and one of the best ways to keep it healthy is by
fueling it with the right nutrition.

Balanced nutrition keeps the body functioning as it should, enabling the

various systems of the body to perform as they were designed. And good
nutrition supports the mind and the emotions, allowing to experience total
wellness.

Not all diseases are equally influenced by the things we eat. For example,
genetic diseases—such as Down syndrome or sickle cell anemia—are not
linked to diet at all. On the other hand, a condition like iron-deficiency
anemia is directly related to how much iron is in the diet.

There are conditions that have been established to have some sort of
connection to nutrition. We know, for example, that

 Too few essential nutrients (especially proteins) can cause some

forms of birth defects, low birth weight, some kinds of physical and
mental retardation, growth deficits, poor resistance to disease,
susceptibility to some kinds of cancer, and deficiency diseases (such
as scurvy and cretinism).
 Too many fats -especially saturated fats-can cause coronary artery
disease and certain kinds of cancers.
 Too much sugar can cause dental cavities (caries) and can lead to
obesity and its related diseases (such as diabetes, high blood
pressure, and certain kinds of cancers).
  Too much sodium (salt) may cause high blood pressure and related
diseases of the heart and kidneys.
 Too little calcium can cause loss of bone tissue in adults and may
lead to high blood pressure and colon cancer.
 Too little iron causes iron-deficiency anemia.
 Too little fiber in the diet can cause some digestive diseases
(including diverticulitis), can cause constipation, and can lead to the
development of colon cancer and some other cancers.
 Too much alcohol can cause liver disease and may cause sudden
death; because it has no nutrients, it can also cause the diseases
associated with inadequate nutrition.

Nutrients have also been shown to affect the functioning of the brain and
mental health. Some evidence indicates that mineral rich foods help protect
mental health, while eating too many sugary foods and carbonated
beverages causes the blood to leach minerals from the brain as well as from
body tissues, including the bones and teeth.

Dr. Hahnemann has always emphasized the importance of diet and regimen
along with medicinal therapy in management of various acute and chronic
diseases.

In aphorism 259-262, instruction regarding diet and regimen particularly

in treatment of acute and chronic disease are given.

Diet and regimen in chronic diseases

Knowledge about the diet and regimen of the patient in chronic diseases is
very important because in chronic miasmatic diseases the diet which has
the medicinal effect can alter the action of the minutest doses of
homeopathic remedy. By altering the diet and regimen, some chronic
disease because of maintaining causes, can be controlled very easily.
Things to be avoided:

1. Coffee, chinese and other herbal tea, beer prepared with medicinal,
vegetable substances
2. Liquors made of medicinal spices, all kinds of punch (punch = a drink
made from wine or spirits, mixed with water, fruit juice, sugar, spices, etc.
and drink hot or cold)
3. Spiced chocolates, odorous waters and perfumes of many kind, strong
smelling flowers, tooth powders, and essences and perfumed sachets,
compound drugs
4. Highly spiced dishes and sauces, spiced cakes and ices, crude medicinal
and vegetable soups, dishes of herbs, roots and stalks of plants possessing
medicinal qualities, asparagus with long green tips, hops, all vegetables
possessing medicinal properties, celery, onions, old cheese and
decomposing meats, etc.
5. The meat which has the medicinal properties like the flesh and fat of the
pork, ducks and geese
6. Excess of food, excess of salt, excess of sugar and spirituous drinks,
undiluted with water
7. Heated rooms, woolen clothing to the skins, a sedentary life in closed
apartments, frequent or over exercise like riding, driving, swimming, must
be as far as possible controlled.
8. Prolonged suckling, taking a long siesta (afternoon nap) in recumbent
position in the bed, sitting up long at night, etc. must be kept limited.
9. Uncleanliness, unnatural debauchery (immoral sexual acts), enervation
by reading obscene books, reading while lying down, onanism, imperfect
or suppressed intercourse to prevent conception etc.
10. Any control of diet regimen which very much disturbs regular life of
the patient should not be continued.
Things to be recommended:

1. Encouraging the patient to have good, moral life, and intellectual

recreation.
2. Active exercise in a well-ventilated place like walking, slight physical
work etc.
3. Depending upon nature of the disease and the condition of patient, a
suitable nutritious diet, unmedicinal food and drinks etc.

Yoga

Yogic therapies are based on self-regulation of patient. Yoga therapy

remains an essential part of the natural and spiritual healing.

Yoga philosophy explains that psychosomatic disease is due to a mental

conflict and emotional suppression, which causes imbalances on
neurovegetative system. Therefore, the yogic therapeutic approach should
consider the stages for mental healing with cultivation of concentration,
deep breathing techniques, observation and internal management of
emotional conflicts.

Yogic procedures increases the secretion of endorphins and activates the

parasympathetic nervous system leading to emotional regulations.

The practice of yoga-asanas having physical, mental and moral effects.

This system has such wide ranging impact on human body, mind, brain and
intellect.
The Eight Limbs of Austang Yoga are follows:
1. Yama (Code of Conduct) :- what to do
2. Niyama (Self-Regulation):- what not to do
3. Asanas (Physical Postures):- different forms of exercises for fitness
 4. Pranayama (Systematic Breathing Exercises):- various forms of
inhalation and exhalation techniques for control and cultivation of
thoughts
The following practices of Pranayamas (breathing exercises) are
recommended for the cure of psychosomatic disorders:-
 Kapalabhathi (skull cleaning)
 Anuloma-viloma (alternate nostril breathing)
 Yogendra Pranayam (abdominal breathing exercise)
5. Pratyahara (Withdrawal of Senses):- The withdrawal of the senses
from their respective outside objects and projecting them inwards
6. Dharana (Concentration):- is fixing up of mind on a particular object
7. hyana (Meditation):- It is paying constant attention on the object of
concentration to know about it.
8. Samadhi (Enlightenment):- The state of super-consciousness and
perfect calm.

OM Meditation

 OM is the most important part in the yoga practice. Chanting of OM

stimulate the whole body. Chanting of ‘OM’ improve the mental
condition and relaxing the whole body.

The homoeopathic materia medica and the repertories placed great

emphasis upon mental and emotional states and their correlation with
bodily function and diseases. The homoeopathic materia medica is full of
drugs which have been well proved on human beings.

Examples from Materia medica

 Aconite napellus: Amenorrhoea in plethoric young girls after fright
 Calcarea carbonicum: Least mental excitement causes profuse return
of menses.
  Chamomila matricaria: Convulsions of children from nursing after a
fit of anger in mother.
 Ignatia amara: Children when reprimanded, scolded, get sick or have
convulsions in sleep
 Opium: Involuntary stool, especially after fright.
At present we have many Repertories which can be utilized for the
selection of simillimum in psychosomatic cases. There are vast number of
rubrics especially all the “ailment from” in “Mind “ chapter and also
rubrics in generalities and in few particulars can be related to
psychosomatic condition.
Examples from Repertories
Mind - Ailments From – anger:
Acon, Aur. CHAM. Coloc. Ign. Ip. NUX-V.Op. Plat. STAPH
 Mind - Jealousy, feelings - ailments from: Apis HYOS. Ign. Lach.
NUX-V. Phos. PULS. staph.
 Stomach-Pain-Mortification, after: nux vom
 Rectum-Constipation-Vexation after: bry, nux vom, staph
 Chest-Oppression-Anger after: staph
When an individual becomes normalized by the homeopathic cure, the
deeper side of his being, the will and the understanding or the rational mind
are balanced. With the change in the mental and moral sphere, the physical
health improves with a high degree of resistance to maladies of all kinds.
The transition from constitutional weakness and suffering to health and
comfort is done by homeopathic treatment.

Though there are very less studies in general related with the
psychosomatic disorders in homoeopathy. Studies on specific somatic
disease conditions which can be related to psychic origins prove that
homoeopathy works better in psychosomatic diseases. But still we need to
conducted many methodologically rigorous clinical trials of
psychosomatic diseases in homoeopathy for the approval of the scientific
community.

Boonstra, R., Hik, D., Singleton, G.R. and Tinnikov, A., 1998. The impact of predator‐induced
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Sadock, B.J., 2007. Kaplan & Sadock's synopsis of psychiatry: behavioral sciences/clinical
psychiatry.