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Prepared by William J. Erdman, M.D.
while Medical Director of The Frederick Erdman Association; edited by Frank H. Erdman
Circulatory Problems and the Rate of Blood Flow
The "drill-field phenomenon" is one of many obvious evidences of poor circulation related to a reduced rate of blood flow. Other signs of problems with the rate of blood flow include cold hands or feet, numbness of the extremities, and faintness or light-headedness when suddenly changing position -- such as jumping from a sitting to standing position or leaning over and straightening up quickly.
In dealing with the circulatory system, much attention is paid by medical professionals to the constituent parts of the blood -- that is, the blood count, sugar, cholesterol, uric acid, sodium and potassium, etc. All of these are important factors, and none should be ignored. Yet it is critical we not overlook the rate of blood flow as a key factor in correcting health problems.
In addition the considering the pulse rate and regularity and the blood pressure, we should also consider the volume of blood flowing. After all, an individual with a 50-percent blood count, flowing at the normal rate, would obviously need iron supplements or a blood transfusion, since the amount of oxygen which could be carried from the lungs to the body's tissues would be only half the required amount. Yet that same individual would actually be no worse off than someone with a 100-percent blood count which was flowing at only half the normal rate. In the latter case, a medical professional might consider only the blood count and determine that nothing was wrong with the circulation. The first individual would be treated intensively; the other would be ignored.
There are occasions when the circulation is given immediate medical attention, but this usually occurs only in critical situations. A case of a gangrenous toe or foot, for instance, might prompt replacement of arteries so a better blood flow to the endangered extremity would result. Or an individual with transient blackouts may have actual constriction or narrowing of the arteries to the head, and an arteriography may be performed to determine whether that narrowing can be surgically corrected.
Yet the vast majority of people who suffer from reduced blood supply are not affected by narrowed arteries, but rather they generally suffer from an overall reduction in the supply related to the demand.
Examples of Insufficient Blood Flow
Though they may not faint as the person on the drill field, many people experience repeated incidents of light-headedness, and others go through periods of time when their brain cells do not function normally. When elderly people have trouble remembering names or information, we attribute it to the aging process. Yet this may not be caused by the aging process at all; it may actually represent a decrease in cerebral blood flow over a period of time.
In another case, an individual may have leg cramps after exercising (a condition known as Intermittent Claudication). This person can only exercise a short time before severe muscle pain sets in. When he stops exercising and uses less oxygen, the oxygen in the body increases, the lactic acid is carried away, and the pain disappears.
Some individuals like this have learned that by walking or exercising more slowly, they will use up oxygen less rapidly and can, therefore, walk or exercise longer. Others in this group might experience leg cramps at night, because as they lie down, their cardiac output decreases since there is less demand for blood flow. They, therefore, have painful muscle contractions when their circulation slows. If their circulation rate can be improved, then they can get through the night without leg cramps.
These examples represent only a few of the obvious manifestations of generalized or localized deficiencies in blood flow.
Understanding the Two Types of Vasomotor Tone
Most people who have difficulty with circulation have it because the muscle fibers in the blood vessel walls -- the arterioles in particular -- are more contracted than they should be. This narrows the cross-sectional diameter of the blood vessels and increases their resistance to blood flow. Therefore, most individuals -- we estimate 90 to 95 percent of the population -- are helped by treatments which relax the smooth muscle tone. 
Since 90 to 95 percent of the population have either a normal or excessive smooth muscle tone (described as vasomotor hypertonicity or high vasomotor tone), they are helped by treatments which relax that excess contraction of the smooth muscle fibers. A warm treatment, rest, hot sunshine, a hot shower or bath, heating pad, electric blanket -- any of these things can help relax smooth muscles and improve the rate of blood flow.
Similarly, almost any medication will relax the smooth muscles and, therefore, make a better rate of blood flow. Aspirin and related medications tend to relax smooth muscles. In fact, the mechanism by which these pain relievers work may well be an increase in local blood flow (the nerve axons). Almost any medicine will have the same relaxing effect -- even those which are known to act as vasoconstrictors, such as adrenaline. As its concentration in the body wears out, adrenaline also becomes a vasodilator. The net result is that, for most people, the primary or side effects of medication will improve the blood circulation.
When people with low vasomotor tone are exposed to heat, to most medications, or to increased amounts of histamine which is present in the body, they suffer a variety of complications. Many soon learn to avoid those things which trigger a negative response. They will avoid alcoholic beverages and overheated rooms. They do not enjoy exposure to the heat of the sun. Standing is very debilitating. They find that when exposed to allergens -- either in the skin, nervous system, nasal passages, or lachrymal glands of the eyes or bronchioles of the lungs -- they have severe problems. The histamine present in increasing amounts acts to further relax the smooth muscle fibers and make the rate of blood flow even poorer.
The same treatments which are beneficial to 90 to 95 percent of the population are detrimental to people with low vasomotor tone. Medicines are effective in the body in proportion to the concentration in the blood stream. So in those areas where the blood volume is maximal, or in blood vessels which have been enlarged because they have less tone than normal, medicines which further relax the blood vessels' tone will cause further hypotonicity of the vasomotor system. This causes more pooling of the blood, further reducing the amount available to the hands, feet, or head.
In developing a method of classifying individuals as either vasomotor hypersonic or vasomotor hypnotic, we have used the term "constricted" to mean the blood vessel tone is normal or excessive. The term "dilated" refers to blood vessel tone that is low or overly relaxed.
Evaluating an Individual's Vasomotor Tone
We put a great deal of emphasis on the size and shape of the pulse. We are naturally concerned with the pulse rate and regularity, but we particularly observe how well the pulse wave passes through a palpable artery, such as the radial artery at the wrist. The examiner places four fingers along the artery and presses just firmly enough so that he is certain that each finger can perceive the pulse. Then by putting pressure upstream -- that is, toward the elbow -- and increasing gradually the force applied to the artery until the fingers can no longer feel the pulse, the examiner can get an approximation of how well the pulse pushes through. This is not the same as blood pressure, because with extremes of pressure in either direction the pulse wave may be strong or may be weak.
As a further indication, we observe the pulse pressure -- the difference between the systolic and the diastolic pressure. If it is greater than normal (in the absence of any valvular problem at the aortic valve), is it usually because the blood is draining away from the arterial system into the capillary bed too rapidly. Thus, the pressure falls further from the pressure at the end of systolie to the beginning of diastolie. In testing, we always check the blood pressure to note its absolute amount as well as the ratio of pulse to systolic pressure.
After noting the blood pressure and the character of the pulses, we then apply a small amount of cold along the skin of the paravertebral area from C7, the prominent bone at the base of the neck distally, to the end of the coccyx. Over the years, we have tried a wide range of cooling agents and methods. We have found that witch hazel is the best. We apply it by using a cotton-tipped applicator.
After applying the cold, we again note the pulses to determine whether they are stronger or more easily compressed. We also observe any changes which may have occurred in the blood pressure itself.
Under normal circumstances the left pulse is stronger than the right pulse in people with low vasomotor tone or with enlarged or dilated blood vessels in the trunk of the body. Individuals in the normal tension class -- those who would be classified as having high vasomotor tone -- have a stronger right pulse. This is the most easily observed difference between the two types of patients, and it is extremely useful in testing or following the course of a patient.
If we determine, by evaluating the pulses, that a patient is in the normal tension class, we know that this person will not be helped by cooling treatment, but rather requires treatments which relax the muscles of the paravertebral area.
Probable Explanation of Why Warm and Cold Applications Work
There is a reciprocal balance between the blood supply to the sympathetic chain of nerves which runs adjacent to the spine, and the blood supply which goes to the paravertebral muscles of the back. At each vertebra level, the posterior intercostal artery splits -- one branch going to the sympathetic chain and the other going to the muscles and skin of the back on either side of the spine.
If the skin is warmed and the muscles of the back under the skin are warmed and relaxed, there is less resistance, and blood flows into the vascular bed. If that area is cooled, the resistance is increased and the blood is diverted into the other branch supplying the sympathetic chain of nerves which controls the tone of the blood vessels, the so-called vasomotor nerves of the sympathetic nervous system.
We use the reciprocal blood supply as a mechanism for testing and for treating patients.
Treatments Affecting the Intestinal Tract
The application of heat or cold to the paravertebral muscles areas of the back will also produce changes in the visceral motor system. (The visceral motor system includes the nerve fibers which control the tone of the smooth muscles in the walls of the intestinal tract.) Cold treatments, therefore, can be helpful in cases of post-operative ilius, a condition in which there is a cessation of normal peristalsis. The decrease in tone which is sometimes seen in these cases can be reversed by applying cold to the spine, thereby increasing the peristaltic action of the intestinal tract.
Even people whose abdomens may be slightly distended by intestinal gases can decrease the amount of distention by similar applications, which increase the peristaltic action of the intestines. The absorption of gas is also increased -- especially absorption of carbon dioxide in the descending colon where the rate of absorption may have been slowed.
Similarly, the rate of carbon dioxide production in the stomach may be increased if blood is forced into the wall of the stomach's mucosa lining. Though flatus is frequently thought to be due to swallowed air, this is not the case. If it were, then the gas analysis of air in the stomach should duplicate the air which the patient breathes. Instead, gas in the stomach is much higher in carbon dioxide than air that we breathe. The extra carbon dioxide must come from the carbonic anhydrase present in the stomach's mucosa lining. It is a necessary part of the digestive process, because, together with the churning action of the peristaltic waves, it assists in the digestive process by propelling foodstuff through the intestinal tract.
Examples of Medical Conditions Associated with Low Vasomotor Tone
Prolonged decrease in available blood flow leads to fatigue, irritability, and conditions easily characterized as neurotic. However, these patients are no more neurotic than the people who faint on the drill field.
There are a number of conditions which we find are associated with low vasomotor tone. Since our cold therapy is the only means we know of to increase tone, it is appropriate to discuss briefly some of these conditions.
We have found that almost all patients with migraine headaches require cold therapy. Migraine headaches are thought to be due to a dilation of the blood vessels in one half of the head (thus the name hemicranium, or migraine).
These patients do not do well with aspirin or with preparations which product vasodilation. They do not respond well to ingesting any amount of alcohol because this causes further dilation of the blood vessels, additional pain, and other symptoms characteristic of migraine headaches.
On the other hand, those with tension headaches are more likely to be in the 90 to 95 percent group of individuals with high vasomotor tone. Obviously, what is good for one group or one type of headache is not good for the other group.
Hyperactivity in Children:
We have found that hyperactive children are almost always in the low tone condition and they respond quickly and positively to our cold therapy.
It has been observed that, when treating children with medication, stimulants are often more successful than depressants. Originally it seemed that because the brain cells are hyperactive, a sedative would be more useful in calming the brain thus reducing the child's irritability. In time it was discovered that these children do better with stimulants which may, in fact, increase the cerebral blood flow and cut down on the child's hyper-irritability.
Epilepsy is another example of the relationship between restricted blood flow and specific health problems. During neurosurgical procedures it has been observed that just before an epileptic attack, the motor cortex in the brain blanches, and then the epileptic attack begins. We can assume this also occurs in other situations when epileptic attacks are underway. It may explain why the reduction in cerebral blood flow may be accompanied by an increased number of attacks. This relationship may also explain the periodicity of epileptic attacks related to the menstrual cycle in some women. And it may explain why patients with epileptic attacks frequently have problems with drugs which act as dilators. These same patients may instead be helped by first improving the general circulation and thus improving the rate of cerebral flood flow (in addition to any medication required for controlling the attacks and changes in the electroencephalographic pattern).
It is generally recognized that multiple sclerosis patients are made worse by heat and other treatments which act as vasodilators.
A neurologic test has been advocated in which a patient suspected of having M.S. is immersed in a tub or warm water. If there is an increase in a nystagmus of the eye, and the individual becomes weaker, it results in a presumptive diagnosis of the disease. We have never seen a patient with multiple sclerosis who did not fall into the class of low vasomotor tone, with less than normal tone of the smooth muscles and the walls of the blood vessels.
Multiple sclerosis patients themselves give evidence in accordance with these observations. They discover that their weakness is accelerated in hot weather or following exposure to warm sunshine. They learn to avoid getting overheated because they know it makes them feel worse. Similarly they avoid medications which tend to product vasodilation. Unfortunately, most of them are being given muscle relaxants because the increased spasticity of the striated skeletal muscles cause such inconvenience or pain that they take the best muscle relaxants, which also produce further relaxation of the blood vessels. Usually the time relationship is not close enough for them to realize the problem.
Insulin Dependent Diabetes:
Similarly, almost all, if not all, insulin dependent diabetic patients have fallen into the class of low vasomotor tone (vasomotor hypotonicity). This is not to suggest that this condition is in any way the cause either for M.S. or diabetes. But it is interesting that we have observed that one should not subject the limbs of a diabetic patient to localized heating. This is because if the blood supply is deficient, the heating may cause an increase in the metabolic rate and result in deterioration of the tissues of the extremities.
Raynaud's disease is a condition in which the fingers become cold or white and frequently cracked in the winter time. A certain number of patients with this condition will not respond to medicines which relax smooth muscles. Neither will the patients respond when the trunk of the body is warmed, because such warming further reduces the smooth muscles' tone and causes additional pooling of blood in that area. Instead, we need to relax the smooth muscle fibers in the arterioles at the patient's fingertips, where we are attempting to increase the blood flow. These individuals respond well to cold applied to the spinal muscles so that more blood goes to the extremities.
After identifying the existence of the two contrasting groups of people with either low tone or normal to high tone, Frederick Erdman then went on to devise a procedure to determine which category a patient is in. He then developed therapies to correct each type of imbalance. By carrying out the indicated therapy, a patient's circulatory condition can be restored to an optimum condition and symptoms can be reduced or alleviated, often dramatically.
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