Terrain Theory or Germ Theory?

What Approach was Used by Ancient Persian, Ayurvedic (Indian) and Greek Physicians in Treating Disease?

A Bit of History

The Cannon was among the earliest books produced by the print press due to its importance. The copy shown is from 1593 (Avicenna, CC0, via Wikimedia Commons)

The current controversy over the effectiveness of COVID-19 vaccines is predated by a relentless and hot debate between advocates of the "Terrain Theory” and the “Germ Theory.” That debate started in late 19th Century with a bitter disagreement between two prominent scientists about the origin of disease-causing (pathogenic) microorganisms. Antoine Béchamp, the father of the microzymian theory, attributed pathogenic organisms to imbalances and dysfunctions in host and environmental conditions (The Terrain), whereas Louis Pasteur, the father of germ theory, blamed “exogenous” bacteria and microorganisms for disease.

Although Pasteur, towards the end of his life, attached more significance to the ecosystem’s impact on the health of organism, his Germ theory became mainstream and promoted in recent years by pharmaceutical and chemical companies selling antibiotics, drugs and vaccines. Although some medical experts are now starting to question the effectiveness of broad-spectrum antibiotics, questioning vaccines, on the other hand, is not tolerated in most Western countries and can often result in the loss of a medical license.

Yet, the controversy over the efficacy and risks of the “artificial active immunization” (vaccines) in contrast to natural active immunity (by our own immune system without the help of injections) has continued between the proponents of the Germ and Terrain theories. Even prominent microbiologists like Rene’ Dubos firmly believed that many bacteria and viruses are not inherently pathogenic: “No metabolic analysis of infectious disease is possible until an ecological concept is introduced to formulate the problem.” (See my full article: Informal Tennis Shoes: How a Top Microbiologist Chose America Over Homeland France?).

Some observers summarize the debate in the simplified image shown above. But the debate is more complex than just vaccinating the sick or the vulnerable. It deals with the choice of the system to study while treating diseases.

While the Terrain vs. Germ theory debate continues (as seen for example in the video below), I believe both theories have merits but …..

Which Theory is Valid?

Basically, Germ theory focuses on "exogenous" and the Terrain theory on "endogenous" factors that cause imbalances in the system, which humas call "Disease." My problem with both theories is their shared "reductionist" approach to disease by “separating” an "organism" into "organs" and from "nature" (Other organisms/organs). I use a “house buying and inspection” example in my book to discuss in simple terms the strengths and weaknesses of the modern reductionist approach to science.

Way before Béchamp and Pasteur, and before microscopes were invented, diseases were studied as imbalances in systems (ecosystems), a holistic (whole system) approach used today by engineers to solve many practical problems today, and what I was taught in my 20th century education as a Chemical Engineer and Materials Scientist. The goal of a “systems” approach is to identify the “root causes” of instability and imbalance in the system (organism) before prescribing a solution to revert to balance.

In fact, physicians like Avicenna (10th century, from Persia, named Ibn Sina in local language) and Galen (2nd century, from Greece) defined and treated diseases effectively using a system’s (non-reductionist) holistic approach. They stated that unlike objects without a soul (non-living), the human body, like all living systems, can only be in “quasi”-equilibrium (homeostatic) states or in a state of dynamic equilibrium which is constantly prone to temporal instabilities (malaise and disorders) which can lead to chronic diseases. The goal of a physician was to return the body close to its dynamic homeostasis, not to patch the symptoms for temporary relief of pain or symptoms.

The first page of The Cannon. Book and Documented Heritage Museum of Iran, Public domain, via Wikimedia Commons

To understand that approach, I have been studying parts of Avicenna's "The Canon of Medicine" (Ghanoon fi Teb in Persian/Arabic, first page or original manuscript shown above) which built upon Galen’s body of knowledge. Their approach to manage disease, which parallels some Ayurvedic principles, included steps to study the following:

1. Organism: They focused on defining and characterizing the overall energetic temperament and energy flow in the organism. This is related to what we call metabolism today. They gauged someone’s “cold” or “warm” metabolic temperament by observing “whole body” indicators such as their skin firmness, color or pallor, stool or urination habits and shape, temperature and feel of their skin in places like their finger tips, etc. People’s temperaments were also categorized by their propensity in fluid retention (such as high blood pressure) and extracellular fluid build up (such as edema and inflammation) as “dry-natured” or “moist-natured.” For example, a constipated person may be judged to be of cold and dry temperament. In today’s medicine, few doctors evaluate ask sick people about the climate in which they were born or raised or moved from.

2. Organ: They focused on defining and characterizing the “inherent” purpose (what they called “existential divine essence” or Gohar in Persian, Johar in Arabic) and “natural” function of each organ for the whole body as as assistant of another organ. Emphasis was placed on ensuring lifestyles and diets did not alter this inherent function of the organ. For example, in today’s world, the traditional holistic physician would discourage focusing on our mobile phones from close distances because the inherent “natural” functionality of eyes do not include staring upfront at small electronic screens for hours at a time.

3. Food and Diet: They focused on defining and characterizing the state of energy exchange with “food” and its metabolism. Each food was categorized as “warm-natured” or “cold-natured,” depending on its contribution to the person’s metabolic state. For example, as articulated in my article about garlic, in traditional Persian medicine garlic belonged to the “warm and dry” food category and would be best suited to balance people with a “cold and moist” constitution. In modern medicine, a cold constitution may correspond to low metabolic rates (hypothyroidism or low thyroid activity, as symptomized by weight gain, low metabolism, hair loss or dry hair, dry skin, etc.) and moist may refer to conditions like edema or inflammation with extracellular fluid build up (and high blood pressure). So garlic may be contraindicated for the minority of people who already have high metabolism or low inflammation. In today’s medicine, few doctors ask sick people about their detailed dietary choices apart from sodium (salt) and sugar intake.

4. Ecosystem and Environment: They focused on defining and characterizing environmental impacts on the organism. For example, a person with a “cold and dry” temperament would not benefit from living in an ecosystem which is also cold and dry! Holistic physician philosophers (real PhD) enquired about the person’s living place, birthplace, workplace and professional ambiance, before they diagnosed the disease and prescribed a cure. In today’s medicine, few doctors ask sick people about the climate in which they were born or raised or moved from.

   So holistic physician philosophers neither focused on the micro/nano scale nor know/care whether viruses or microbes were real (as Germ theory proponents advocate) or not (as Terrain theory proponents advocate). Their focus was helping the “visible” system “macroscopically” balance energy and matter. Although I am in awe of theoretical discoveries of reductionist science and medicine (and was trained in reductionist science), I still find much of the ancient holistic approach to treating disease wise, sound and cost-effective.