The Constitutional Systems Model
This category documents a single, ongoing case of mechanistic research: my own.
I live with a multi-system condition that spans rheumatoid arthritis, gut dysbiosis, pernicious anemia, cerebrovascular disease, and autonomic dysfunction. For years these were managed as separate diagnoses, each with its own specialist and its own treatment logic. They are not separate. The Constitutional Systems Model, or CSM, is my working framework for understanding them as one interconnected system.
Two tracks of damage
The central nervous system carries two distinct lines of damage, and the framework keeps them separate rather than treating one as an explanation for the other.
The first is regulatory. A vagus nerve running below capacity, degraded across decades by early antibiotic exposure, childhood stress, vitamin B12 deficiency, and two strokes, cannot suppress the inflammatory response driven by a compromised gut barrier. That failure of suppression is the upstream mechanism behind the joint disease, the colitis, and much of the broader inflammatory picture. Individual diagnoses across this history read as downstream expressions of that single regulatory failure.
The second is structural. Two cryptogenic strokes, progressive small vessel disease that predates both of them, and aneurysm growth are their own line of damage, with their own open question: a possible underlying vasculopathy that has never been confirmed. This track carries real, independent consequences: cognitive symptoms, balance impairment, word retrieval failure that persisted after an inflammatory episode had already resolved. That persistence is the clearest evidence this track produces effects the regulatory story doesn’t reach.
The two tracks meet at one point. Damage to the right insula, the primary site of autonomic integration, sits on both lines at once. It is itself structural damage, and it is also the mechanism that removed a major brake on the inflammatory system. Where they diverge is everywhere else: the ongoing small vessel disease, the aneurysm history, and the residual cognitive deficits belong to the structural track and stay there.
Treating the downstream expression without addressing the upstream regulatory driver has a track record in this case: five failed biologic drugs, each targeting a single inflammatory pathway while the upstream signal continued unchecked. That history is real and load-bearing. It is not, on its own, the whole picture.
What the documents cover
The series builds out both tracks piece by piece. A constitutional document lays out the full central nervous system picture, structural and regulatory together, including the unified vasculopathy hypothesis. A vagal tone reference details the five separate factors that have degraded that nerve across a lifetime. A neurological pattern reference tracks the imaging and clinical findings chronologically. Separate documents cover the gut foundational picture, helminthic therapy, an iron-triggered dysbiosis event, and the pharmacological response pattern that has shaped every treatment decision since 2008.
Each document is cross-referenced to the others. None of them stand alone.
Constitutional Systems Model — Full Series
I — Constitutional CNS: Cumulative Neurological Damage and Autonomic Regulatory Failure
https://dittany.com/case-study-csm-constitutional-cns/
IIa — Vagal Tone Deficit: Five-Factor Cumulative Model and Cholinergic Anti-Inflammatory Pathway
https://dittany.com/case-study-csm-vagal-tone-deficit/
IIb — Neurological Patterns: Chronological CNS History, Imaging Series, Diagnostic Questions
https://dittany.com/case-study-csm-neurological-patterns/
IIc — SetPoint VNS Responder Analysis: Mechanistic Case, Pharmacological Response Pattern, Genuine Uncertainties
https://dittany.com/case-study-csm-setpoint-vns-responder-analysis/
IIIa — Gut Foundational Reference: Intestinal Barrier Dysfunction, Microbiome Locked Attractor State, LPS Translocation
https://dittany.com/csm-gut/
IIIb — Helminthic Therapy: Mechanism, Clinical Response History, Current Status, Relationship to VNS
https://dittany.com/case-study-csm-helminthic-therapy/
IIIc — Iron-Triggered Dysbiosis: Iron Trigger Analysis, Locked Attractor State, Post-Collapse Deterioration
https://dittany.com/iron-biome-relationship/
IVa — Pharmacological Phenotype: Amplified Response Pattern, Sensitization Threshold, PRN Constraint, Reset Dynamic
https://dittany.com/case-study-csm-pharmacological-phenotype/