The Abdominal Brain and Enteric Nervous System
David L. McMillin, M.A., Douglas G. Richards, Ph.D.,
Eric A. Mein, M.D., Carl D. Nelson, D.C.
Virginia Beach, VA 23454
[NOTE: This article was published in The Journal of Alternative and
Complementary Medicine, Vol. 5, No. 6, 1999; see
below for continuing
education credit for this article.]
Conventional medical treatment for neurological disorders such as epilepsy,
migraine, and autism focuses on the brain. Although standard medical
treatment is often helpful, the underlying causes of these disorders are
not well understood. Furthermore, some individuals respond poorly,
or not all to regular medicine. Evidence is accumulating in the medical
literature that the enteric nervous system (ENS) - that part of the nervous
system associated with the alimentary canal - also plays a role in these
disorders. Historically, the concept of an autonomous abdominal nervous
system was advocated by Byron Robinson, Johannis Langley, and Edgar Cayce.
The work of these three prominent historical figures is considered along
with modern viewpoints on the abdominal nervous system. Complementary
therapies that address the nervous system of the abdomen hold potential
as useful adjuncts to conventional treatment for certain neurological disorders.
It is evident both from the historical and modern literature that the
peripheral nervous system, and particularly that portion associated with
the alimentary canal, is a prominent element in certain neurological disorders
associated with the cerebral brain. For example, abdominal epilepsy
and abdominal migraine are well established diagnostic entities in modern
medicine in both children and adults (Babb and Eckman, 1972; Loar,
1979; Mitchell et al., 1983; Reimann, 1973; Santoro et al., 1990; Symon
and Russell, 1986). Some researchers regard the presence of abdominal
features in these illnesses as important and of possible etiological significance
(Amery and Forget, 1989; Mavromichalis et al., 1995; Peppercorn and Herzog,
1989). Recently, autism has been added to the list of neurological
conditions with abdominal features (Horvath et al., 1998; Murch et al.,
1998; Wakefield et al., 1998;).
A possible explanation of the relationship between abdominal symptoms
and neurological syndromes can be found in the influence that the enteric
nervous system (ENS) has on the CNS. The ENS is an extensive network of
neurons widely dispersed throughout the gut, that coordinate together to
regulate gastrointestinal events such as peristalsis, blood flow, secretion,
and absorption (Costa and Brookes, 1994; Goyal and Hirano, 1996;
Gershon et al., 1994). The ENS can influence the CNS both through
nerve reflexes and the production of neuropeptides. It is estimated that
80% of vagal fibers are visceral afferents (Davenport, 1978).
Recent work has also shown a vast overlap of neuropeptide activity in the
gut and the brain (Pert et al., 1985). The ENS is an active area
in physiological research with over 600 articles on Medline since 1985.
The revival of interest in the ENS has strong historical roots.
Nearly one hundred years ago, American physician Byron Robinson, a medical
doctor, did extensive research and writing culminating in his impressive
work, "The Abdominal and Pelvic Brain" (Robinson, 1907). The premise
of Robinson's book is that the abdominal viscera contain a vast and complex
nervous system, which influences, and to a great degree regulates, the
vegetative process of the abdominal viscera.
Robinson was not alone in his fascination with the nervous system of
the abdomen. At about the same time that Robinson was discovering
the "abdominal brain," British physiologist Johannis Langley of Cambridge
University recognized that "the nervous system of the gut was capable of
integrative functions independent of the central nervous system" (Gershon
et al., 1994, p. 424). It is now known that the human GI system,
deprived of CNS innervation, is capable of coordinated digestion, mobility,
secretion and absorption (Davenport, 1978). Langley labeled the brain
in the gut the enteric nervous system, the term now used for this system.
Edgar Cayce, who has been called the father of modern holistic medicine
(Callan, 1979; Mein, 1989) was another strong advocate for the abdominal
nervous system. Cayce believed that the idiopathic forms of certain
neurological syndromes (such as epilepsy and migraine) have an abdominal
etiology. A wide variety of non-intrusive therapies were recommended
by Cayce for the treatment of these syndromes.
The remainder of this article will focus on abdominal epilepsy, abdominal
migraine, and autism with colonic features with the aim of understanding
peripheral nervous system involvement in these disorders. Theoretical
and clinical implications of the re-discovery of the abdominal nervous
system will be explored.
The association of abdominal symptoms with epilepsy has been recognized
for many years. For example, "gastric and intestinal disturbances"
were viewed as primary etiological factors by medical doctors during the
late 19th and early twentieth century (Dercum, 1912, p. 917). Osteopaths
noted that, ".in cases where the exciting factor seems to be in the intestine
and there is reverse peristalsis of the intestines, causing a reversion
of the nerve current in the vagi, thorough rapid abdominal treatment will
normalize peristalsis and aid in preventing an impending attack" (Hazzard,
1905, p. 275). Edgar Cayce insisted that idiopathic epilepsy is produced
by lacteal duct adhesions along the right side of the abdomen that produce
nerve reflexes to the brain. "From every condition that is of true
[idiopathic] epileptic nature there will be found a cold spot or area between
the lacteal duct and the caecum" (Cayce, 1934). The invention and
clinical application of the electroencephalogram (EEG) during the 1920's
shifted the focus of medical attention from the abdomen to the brain where,
for the most part, it has remained to this day.
Another example of the abdominal connection in epilepsy is the aura
which is common in certain types of epilepsy. For example, temporal
lobe epileptic seizures frequently begin with an aura. In neurological
terms, an aura is actually a mild seizure which precedes the primary seizure.
It can be thought of as a warning that a seizure is about to happen.
Most often, auras manifest as an altered consciousness or peculiar sensation.
"The most common aura is of vague gastric distress, ascending up into the
chest" (Gordon, 1942, p. 610).
Modern medical science has rediscovered the abdominal connection in
epilepsy. A few papers published in the medical journals during the
1960s called attention to the abdominal features in epilepsy (Berdichevskii,
1965; Takei and Nakajima, 1967; Juillard, 1967). Over the past
twenty-five years, numerous researchers and clinicians have reported on
various aspects of abdominal epilepsy (Agrawal et al., 1989; Babb and Eckman,
1972; Bondarenko et al., 1986; Douglas and White, 1971; Hotta and Fujimoto,
1973; Loar, 1979; Matsuo, 1984; Mitchell et al., 1983; Moore, 1972; O'Donohoe,
1971; Peppercorn et al., 1978; Peppercorn and Herzog, 1989; Reimann, 1973;
Singhi and Kaur, 1988; Solana de Lope et al., 1994; Yingkun, 1980; Zarling,
Common clinical features of abdominal epilepsy include abdominal pain,
nausea, bloating, and diarrhea with nervous system manifestations
such as headache, confusion, and syncope (Peppercorn and Herzog, 1989).
"Although its abdominal symptoms may be similar to those of the irritable
bowel syndrome, it may be distinguished from the latter condition by
the presence of altered consciousness during some
of the attacks, a tendency toward tiredness after
an attack, and by an abnormal EEG." (Zarling, 1984,
p.687). Mitchell et al., (1983) regard cyclic vomiting as a primary
symptom of abdominal epilepsy manifesting as simple partial seizures.
Although abdominal epilepsy is diagnosed most often in children, the research
of Peppercorn and Herzog (1989) suggests that abdominal epilepsy may be
much more common in adults than is generally recognized.
One of the primary problems in understanding abdominal epilepsy is clearly
defining the relationship of the abdominal symptoms to the seizure activity
in the brain. In other words, what is the pathophysiology of abdominal
epilepsy? Is the essential pathology in certain areas of the brain
which happen to be connected to the abdominal organs? Or, is the
primary pathology in the abdomen, which is conveyed through connecting
nerve fibers to the brain, resulting in epileptic seizures? Peppercorn
and Herzog noted both possibilities in their attempt to understand the
cause of abdominal epilepsy:
The vagal link in epilepsy has also received attention with regard to a
surgical procedure in which a pacemaker is implanted on the vagus nerve
in the upper chest. Regular stimulation of the vagus has reduced
or eliminated seizure activity in some treatment-resistent patients (Amar
et al., 1998; Handforth et al., 1998; Lundgren et al., 1998). The
therapeutic effect is thought to be produced by calming "hyperexcited"
nerve cells and reverting brain activity to its normal patterns (Snively
et al., 1998).
"The pathophysiology of abdominal epilepsy remains unclear. Temporal
lobe seizure activity usually arises in or involves the amygdala.
It is not surprising, therefore, that patients who have seizures involving
the temporal lobe have GI symptoms, since discharges arising in the amygdala
can be transmitted to the gut via dense direct projections to the dorsal
motor nucleus of the vagus. In addition, sympathetic pathways from
the amygdala to the GI tract can be activated via the hypothalamus.
On the other hand, it is not clear that the initial disturbance in abdominal
epilepsy arises in the brain. There are direct sensory pathways from
the bowel via the vagus nerve to the solitary nucleus of the medulla which
is heavily connected to the amygdala. These can be activated during
intestinal contractions" (Peppercorn & Herzog, 1989, p. 1296).
If stimulation of the peripheral nervous system, in this case the vagus,
can reduce seizure activity in the brain, perhaps pathological irritation
of this or other peripheral nerves may also play a role in the etiology
of certain forms of epilepsy. At this time, there is no definitive
model of abdominal epilepsy which explains the association of brain seizures
and abdominal symptoms. The clinical (therapeutic) implications of
abdominal etiology in epilepsy will be discussed below.
From a medical perspective, migraine presents as a complex systemic
illness with various combinations of neurologic, gastrointestional and
autonomic symptoms. Although the neurological components are a primary
focus in medical diagnosis and treatment, historical and contemporary viewpoints
also attribute great significance to gastrointestinal features. "In
the majority of migraine patients there is some fault in the gastro-duodenal-hepatic
chain." (Hare, 1912, p. 382). "Gastrointestinal disturbances including
nausea, vomiting, abdominal cramps, or diarrhea are almost universal" (Silberstein,
1995, p. 387).
Historical perspectives on syndromes such as migraine tend to take all
of the symptoms into consideration in a more systemic interpretation of
the illness. Thus, the significant gastrointestinal aspects of migraine
received much greater attention, both with regard to causation and treatment.
The medical treatments prescribed for migraine in previous eras addressed
the gastrointestinal features of the illness directly with a spectrum of
relatively natural therapies intended to improve digestion, assimilation
and elimination through the bowel.
Diet was frequently emphasized. For example, Spear (1916) cautioned
that, "Heavy pastries, rich foods, and alcoholic drinks are best avoided"
(p. 626). Therapies for intestinal cleansing were also commonly prescribed.
"The bowels should be regulated, and under no condition should constipation
be allowed to occur.if the lower bowel contains much fecal matter, a hot
soapsuds enema should be given" (Spear, 1916, p. 626). Dercum relied
on a mild saline laxative (such as Carlsbad salts) for intestinal cleansing,
claiming that "It is a not uncommon experience to find that a beginning
migraine attack is frequently aborted by a saline, taken as soon as prodromal
symptoms are noted" (Dercum, 1912, p. 906).
Modern medical science has acknowledged the rediscovery of the abdominal
connection in migraine in various ways. The most obvious is the recognition
of a diagnostic entity called "abdominal migraine" (Bentley et al. 1984;
Mortimer and Good, 1990; Santoro et al., 1990; Symon and Russell, 1986).
Abdominal migraine is diagnosed most often in children. For example
Mavromichalis et al. studied a consecutive series of 31 children (median
age 12 years) suffering from migraine. Endoscopic oesophageal,
gastric and duodenal biopsy were used to determine whether the complaints
were of gastrointestinal origin. Of these 31 children,
13 (41.9%) showed esophagitis, 16 (51.6%) gastritis
of corpus, 12 (38.7%) antral gastritis and 27 (87.1%)
duodenitis. Thus, 29 of the 31 children studied had an underlying inflammatory
lesion explaining their complaints. The researchers concluded, "Our
findings provide further evidence that recurrent abdominal
pain is an early expression of migraine and strongly support a causal link
between recurrent abdominal pain and migraine" (Mavromichalis et
al., p. 406).
The gastrointestinal connection in migraine has also been rediscovered
with regard to food allergies (Bentley et al., 1984; Dalton, 1975;
Grant, 1979; Hanington, 1980; Hughes et al., 1985; Mansfield, 1987; Mansfield,
1988; Mansfield et al.,1985; Monro et al., 1984; Peatfield, 1995; Peatfield
et al., 1984; Trotsky, 1994; Vaughan, 1994; Wilson, et al., 1980).
The designation of dietary migraine is sometimes used in such cases (Dalessio,
1972). The conceptualization of migraine as a gastrointestinal allergic
response has historical precedent:
One of the major problems in understanding the etiology and pathophysiology
of migraine is how to conceptualize both the nervous and vascular aspects
of the syndrome. Traditionally, migraine has been regarded as a "vascular"
headache due the obvious abnormalities in circulation to the head (Agnoli
and DeMarinis, 1985; Thomsen and Olesen, 1995). More recently, nervous
system involvement has been emphasized, with particular emphasis on the
trigeminal or fifth cranial nerve (Buzzi et al., 1995). An integration
of these two models has culminated in a trigemino-vascular theory which
integrates nerve and circulatory processes (Buzzi and Moskowitz, 1992).
"The allergists have much to say which warrants careful evaluation as to
the nature of the migraine episode as well as its etiology. They
believe that fatigue, nervous and emotional factors produce changes in
the motor activities of the gastrointestinal system which result in duodenal
stasis. This promotes the absorption of the allergens to which the
patient reacts in his inherent pattern of migraine. They report that
accurate allergy diets result in complete relief in 30 per cent of migraine
patients and partial relief in 45 per cent" (Gordon, 1942, p. 556).
Interestingly, Edgar Cayce, an intuitive diagnostician practicing during
the first half of the twentieth century, also recognized the abdominal
connection in migraine. Cayce claimed that the pathophysiology of
idiopathic migraine involves allergic processes in the intestinal tract
which trigger nerve reflexes to the trigeminal (fifth cranial nerve) resulting
in migraine headaches. Consistent with abdominal etiology, Cayce's
therapeutic recommendations focused on the intestinal tract and peripheral
nervous system (i.e., diet, colonic irrigation, manipulative therapy).
As an example of Cayce's unique views on the association between the abdominal
brain and neurological disease, the following excerpt describes the pathophysiology
of migraine in a child:
Thus, according to Cayce, the general pattern of pathology in idiopathic
migraine involves an allergic irritation in the intestines which is transmitted
to the trigeminal (fifth cranial nerve) and also triggers an imbalance
of circulation to the head. Cayce's model of idiopathic migraine
takes into consideration both the nerve and vascular aspects of migraine.
"As we find, while the body is in the developing stages, the sources of
the conditions to which the body becomes allergic in the digestive system
should be looked for - that deal with all migraine headaches. So,
this information might be used universally as to the sources of such, if
it would be accepted. For, here we find such in its beginnings, and
it is in the digestive system, causing - through a state of circulation
- an inflammation in the connections of the intestinal tract through [the]
blood and nerve supply ." (Cayce, 1943).
Although Robinson did not directly address the topic of abdominal migraine,
he did devote a significant portion of a chapter of his book (Ch. 7) to
the abdominal and pelvic influence on the trigeminal nerve. (Robinson,
1907) Thus, in addition to the well-known visceral connections of
the vagus (tenth cranial nerve), the abdominal connections of the trigeminal
provide another possible route for nerve reflexes to the head in migraine.
The possibility that the abdominal features of migraine may have etiological
and therapeutic implications suggests that further research is needed.
The degree to which abdominal migraine exists as a subgroup within the
broader classification of migraine must be determined. Abdominal
migraine in children is well established. The prevalence of abdominal
migraine in adults is less well known. The efficacy of traditional
clinical interventions for migraine that focus directly on the gastrointestinal
system (i.e., diet and colonic irrigation) deserves further study.
Autism with Intestinal Features
People with classical autism show three types of symptoms: impaired
social interaction, problems with verbal and nonverbal communication and
imagination, and unusual or severely limited activities and interests.
Symptoms of autism usually appear during the first three years of childhood
and continue throughout life. Although there is no cure, appropriate
management may foster relatively normal development and reduce undesirable
Recent medical research may add autism to the growing list of neurological
illnesses with abdominal features. Wakefield et al. (1998) investigated
a consecutive series of children with chronic enterocolitis and regressive
developmental disorder. The twelve children (mean age 6 years) had a history
of normal development followed by loss of acquired skills, including language,
together with diarrhea and abdominal pain. Murch et al. (1998) report
that 47 out of 50 autistic children they studied showed significant bowel
pathology. When subjected to colon cleansing, these children showed
notable improvement in their autism symptoms. The researchers
conclude, "We re-emphasize the fact that there is a consistent pattern
of gut inflammation in a high proportion of children within the broad autistic
spectrum. Understanding the link between the bowel and the brain in autism
may allow new insights into this devastating illness." (Murch et al., p.
Further evidence of intestinal involvement in autism has surfaced when
a substance called secretin has been surprisingly effective in the treatment
of autism for some children. After Victoria and Gary Beck successfully
treated their autistic child with secretin and triggered interest in this
substance, Horvath et al. (1998) studied the therapeutic effects of secretin
on three autistic children and noted significant clinical improvement,
both gastrointestinal and behavioral. Secretin is now being tested
with more autistic children to determine its potential.
Secretin is a natural substance, produced in the intestinal tract by
all mammals. While it is not a drug, and not harmful, the FDA nevertheless
requires that it be sold only by prescription.
Secretin is usually given by slow injection (infusion), but other methods
of administration are being considered. The only FDA-approved use for secretin
is in the diagnosis of gastrointestinal problems, not as a treatment for
The Abdominal Nervous System
Although many of the researchers cited above allow for the possibility
that abdominal factors have etiological significance in neurological conditions,
the anatomical and physiological basis for such a connection is uncertain.
What is there about the abdomen that could possibly be linked to neurological
conditions such as epilepsy, migraine, and autism? To answer this
important question, it is helpful to review the medical literature of the
early decades of the twentieth century. For example, the work of
Robinson exemplifies the position that the abdomen contains a secondary
For Robinson, the abdominal brain is centered in the solar plexus (Figure
1). The abdominal brain is the primary control center of an extensive
peripheral nervous system containing a number of "little brains."
Anatomically, this peripheral system is roughly equivalent to the autonomic
nervous system. Physiologically, the comparison breaks down because
Robinson's perspective of the abdominal nervous system is much more autonomous
than modern opinions about this system.
"In mammals there exist two brains of almost equal importance to the individual
and race. One is the cranial brain, the instrument of volitions,
of mental progress and physical protection. The other is the abdominal
brain, the instrument of vascular and visceral function. It is the
automatic, vegetative, the subconscious brain of physical existence.
In the cranial brain resides the consciousness of right and wrong.
Here is the seat of all progress, mental and moral ... However, in the
abdomen there exists a brain of wonderful power maintaining eternal, restless
vigilance over its viscera. It presides over organic life.
It dominates the rhythmical function of viscera....The abdominal brain
is a receiver, a reorganizer, an emitter of nerve forces. It has
the power of a brain. It is a reflex center in health and disease....
The abdominal brain is not a mere agent of the [cerebral] brain and cord;
it receives and generates nerve forces itself; it presides over nutrition.
It is the center of life itself. In it are repeated all the physiologic
and pathologic manifestations of visceral function (rhythm, absorption,
secretion, and nutrition)" (Robinson, 1907, pp. 123 - 126).
Working separately from Robinson, British physiologist Johannis Langley
also recognized the relative independence of the abdominal nervous system.
Focusing on the ganglia of the gut, he believed that they do more than
simply relay and distribute information from the cerebral brain.
He was unable to reconcile conceptually the great disparity between the
enormous numbers of neurons [2 X 10 (8)] in the gut and the few hundred
vagus fibers from the cerebral brain, other than to suggest that the nervous
system of the gut was capable of integrative functions independent of the
central nervous system (Wood, 1994). Langley labeled the brain
in the gut the enteric nervous system (ENS).
Although for several decades Robinson and Langley's work was ignored,
modern medical research has finally rediscovered the abdominal brain with
its enteric nervous system. In fact, research on the nerve connections
in the abdomen represents one of the exciting areas of physiological research:
"To a considerable extent, the new interest in exploring the ENS has come
from the realization that both the ENS and the remainder of the autonomic
nervous system are richly endowed with neurotransmitters and neuromodulators.
Many substances are found in both the bowel and the brain, a coincidence
that strikes most observers as intrinsically interesting, if not immediately
explicable" (Gershon et al., 1994, p. 386).
In addition to the biochemical and structural similarities between the
cerebral brain and the abdominal brain, contemporary researchers are drawing
computer analogies and using information processing models to describe
the relationship between the cephalic and enteric brains.
"The similarity between the structure of the ENS and that of the brain,
combined with the ability of the ENS to mediate relatively simple behaviors,
suggests that general principles can be derived from studies of the ENS
that will eventually be applicable to the CNS. Given the unique position
of the ENS as the only peripheral system capable of autonomous function,
it seems more likely that such principles will emerge from investigations
of the ENS than from studies of other aggregates of peripheral ganglia.
The parallel between the bowel and the brain also suggests that newly discovered
principles of central neural function may find applicability in studies
of the ENS, in a sort of reverse form of reductionism whereby the brain
serves as a model for the gut" (Gershon et al., 1994, p. 414).
Langley regarded the ENS as a third division of the autonomic nervous system
(ANS) (Gershon et al., 1994). Considering the modern view of the
ANS, this classification does not adequately convey the scope and independence
of the ENS. In fact, if Langley and Robinson are to be taken seriously,
the modern concept of the ANS must be reconsidered. Currently, the
entire ANS is taken to be little more than a handmaiden to the CNS.
Langely and Robinson held the role of the ANS in much higher esteem than
their modern counterparts.
"The cephalic brain communicates with the smaller brain in the gut in a
manner analogous to that of interactive communication between networked
computers. Primary sensory afferents and extensions of intramural
neurons in the gut carry information to the central nervous system.
Information is transmitted from the brain to the enteric nervous system
over sympathetic and parasympathetic pathways.. The current concept of
the enteric nervous system is that of a minibrain placed in close proximity
to the effector systems it controls. Rather than crowding the hundred
million neurons required for control of the gut into the cranial cavity
as part of the cephalic brain, and transmitting signals over long, unreliable
pathways, natural selection placed the integrative microcircuits at the
site of the effectors" (Wood, 1994, p. 424).
It should also be noted that Langley focused on the nerves lining the
gut in defining the ENS, whereas Robinson was interested in the entire
abdominal nervous system. Robinson's perspective includes the solar
plexus (abdominal brain) and its extensive network of plexuses and connecting
fibers. In Robinson's book consisting of 40 chapters, the ENS is
covered in one chapter. If Robinson is correct in his view of the
peripheral nervous system, the re-discovery of the ENS is only the beginning
of a new appreciation of the nervous system of the abdomen.
Although this paper has focused on neurological conditions with intestinal
features, the reverse relationship has also been observed. For example,
irritable bowel syndrome (IBS), a common intestinal disorder involving
abdominal pain, disturbed defecation, and bloating, often presents with
significant neurological and psychiatric features. Watson et al. (1978)
and Jones and Lydeard (1992) documented a significant co-morbidity of IBS
and migraine. Fent et al. (1999) described associations between colonic
sensitivity in IBS and hemispheric preference and cognitive style. Whorwell
et al. (1986) and Maxton et al. (1991) have noted the numerous non-colonic
features of IBS, such as headache, which may be indicative of a much more
diffuse disorder than has previously been appreciated.
Numerous authors have described a link between IBS and psychiatric illness,
particularly anxiety and depression. The review by Walker et al. (1990)
is noteworthy, as it provides a pathophysiological model linking ENS dysfunction
in IBS to the locus ceruleus (LC), a portion of the brain that regulates
vigilance and attention to fear provoking stimuli. Commenting on the ENS/LC
model, Lydiard (1997) observed:
Thus the gut brain/cerebral brain interaction can manifest in a variety
of signs, symptoms and diagnostic categories. The abdominal nervous
system provides a plausible link between gastrointestinal and central nervous
system functioning regardless of the classification of the dysfunction.
"This model suggests that a potentially vicious positive feedback loop
may be initiated and maintained by pathologic anxiety and arousal.
Like IBS patients, individuals suffering from anxiety or depression experience
excessive autonomic symptoms, suggesting some common pathophysiology, perhaps
in part at the level of the LC..GI distress could theoretically cause or
worsen psychiatric symptoms such as anxiety" (p. 55).
The possibility that neurological syndromes such as epilepsy, migraine
and autism may be caused by pathology in the gastrointestinal system raises
some intriguing questions with regard to clinical practice and basic research.
What is the nature of the pathology? Can it be measured? If
pathology is shown (or assumed) to exist, what type of treatment
regimen is most effective? Is there any evidence to support therapies
which focus on abdominal pathology? Can these illnesses be cured?
As noted above, from an historical perspective, the medical treatment
of epilepsy and migraine often included therapy for the abdominal aspects
of these diseases. Robinson's work in particular was very influential
with some of the developing "alternative medicine" practitioners of the
late 19th and early 20th centuries. For example, the early osteopaths
held Robinson's discoveries in high esteem, citing his findings as supportive
of the premise of manual therapy for the treatment of a wide range of somatic
and visceral disease. Spinal and visceral manipulation techniques
were used to treat almost every illness including neurological disorders
such as migraine and epilepsy (American College of Mechano-Therapy, 1910;
Barber, 1898; Downing, 1935; Hazzard, 1905; Murray, 1925).
Figure 2 illustrates a traditional osteopathic
technique for regulating the pneumogastric nerve (vagus), a primary neurological
connection between the cerebral and abdominal brains. To provide
easy access to these historic works, McMillin (1998) has created a website
containing the text of Robinson's book and several of the early osteopathic
texts. A comparison of Robinson's and Cayce's views of the peripheral
nervous system is also available (McMillin, 1997).
Although osteopathy has become well integrated into mainstream medical
practice, the principles and techniques utilized by traditional osteopaths
(e.g., manipulative therapy, diet and nutrition, hydrotherapy) have also
been employed by various alternative practitioners such as chiropractors
and naturopaths. These forms of therapy have received increasing interest
as complementary to conventional medicine. Manipulative therapy has
been used in the treatment of migraine (Parker et al., 1978) and epilepsy
(McGarey, 1968; Swink et al., 1997). Dietary therapy is used for
migraine (Diamond et al., 1986; Mansfield et al., 1985; Vaughan, 1994).
The ketogenic diet has seen increasing use for epilepsy (Kinsman et al.,
1992; Swink et al., 1997). Hydrotherapy and abdominal castor oil
packs have been used for epilepsy and migraine (McGarey, 1968; Mein et
As noted, Edgar Cayce emphasized the role of the abdominal nervous system
with regard to causation and treatment of epilepsy and migraine.
Consistent with the growing body of medical information on the "abdominal
brain" and enteric nervous system, Cayce referred to the abdominal brain
as the "solar plexus brain" (1926, 1944), the "secondary brain" (1944),
and the "central brain in the solar plexus" (1927). Of particular
interest are Cayce's therapeutic recommendations for epilepsy and migraine
which included special diets, abdominal castor oil packs, colonic irrigations,
spinal manipulation and massage, and herbal teas to heal the intestinal
tract. All these therapies were directed to improving digestive system
functioning, and thereby decreasing nervous system incoordination between
the abdominal and cerebral brains. Detailed analysis of Cayce's approach
to epilepsy (Pahnke, 1968) and migraine (Bjork, 1983) have been published.
Reilly and Brod (1975), McGarey (1983), and Mein (1989) have described
Cayce's approach to the digestive system as it relates to systemic functioning.
Interestingly, one reading given for a child with mild autistic features
recommended a digestive supplement similar to secretin (1937). A
pilot study of 16 children with minimal brain dysfunction (including autism)
based on Cayce's concepts of intestinal etiology, showed promising results
(Pecci, 1977). The Meridian Institute has investigated Cayce's therapeutic
recommendations for migraine in a small pilot study (n=5). Participants
who followed Cayce's suggestions showed notable improvement (Meridian Institute,
Neurological diseases with systemic features (particularly with significant
gastrointestinal symptoms) may be approached from a complementary medicine
model that recognizes the role of the abdominal nervous system with regard
to etiology and treatment. By linking the historical, systems-oriented
clinical approaches to the modern research literature on the enteric nervous
system, a complementary approach may be created which integrates the best
of standard medical practice with traditional and alternative modalities
and systems that are consistent with established anatomy and physiology.
Although epilepsy and migraine are common illnesses, the abdominal form
of each is generally regarded as rare. Based on the sources described
in this paper, we are suggesting that idiopathic epilepsy and migraine
may be better understood if the abdominal features were more thoroughly
investigated. Abdominal epilepsy and migraine may not actually be rare.
Modern medicine considers them rare because little attention has been given
to the meaning of abdominal symptoms associated with these conditions.
Perhaps the idiopathic forms of both illnesses involve intestinal etiology.
Similarly, the intestinal aspects of autism may be clues to an important
subgroup of this disorder.
Further research into the etiology and treatment of these conditions
should consider possible abdominal nervous system involvement. Clinically,
the presence of significant abdominal features may indicate that the treatment
plan include traditional features (i.e., diet, colon hydrotherapy, and
manipulative therapy) which may favorably influence the abdominal brain
and enteric nervous system.
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Address reprint requests to: David L. McMillin, M.A., Meridian Institute,
1853 Old Donation Parkway, Suite 1, Virginia Beach, VA 23454.
|Figure 1. Figure 33 from The Abdominal
and Pelvic Brain by Byron Robinson, M.D. (1907). Robinson's massive
work on the peripheral nervous system consists of 670 pages and 207 detailed
drawings such as the one shown above.
|Figure 2. Cut 18 from Osteopathy Complete
by E.D. Barber, D.O., published in 1898. This illustration titled "Freeing
and Stimulating the Pneumogastric Nerve" shows a typical osteopathic treatment
intended to influence the 10th cranial nerve (pneumogastric/vagus).
Regulation of physiological processes (and particularly visceral physiology)
was a major emphasis of early osteopathic treatment for a wide range of
disorders. The vagus nerve is an important route for information
between the cerebral brain and the abdominal nervous system. Osteopaths
believed that they could influence both the peripheral and central nervous
system by techniques aimed at nerve centers throughout the body.
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