Could
This presentation is the property of its rightful owner.
Sponsored Links
1 / 28

Could TCM be described in terms of affective neuroscience ? PowerPoint PPT Presentation


  • 58 Views
  • Uploaded on
  • Presentation posted in: General

Could TCM be described in terms of affective neuroscience ? integration into a TCM clinical synopsis ( ppt-presentation ) 1st Revision MMXIV 05/05/2014 J.P.Fossion , MD Scientific commission Brussels BVGA Bibliography

Download Presentation

Could TCM be described in terms of affective neuroscience ?

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Could tcm be described in terms of affective neuroscience

  • Could TCM bedescribed in terms of affectiveneuroscience?

  • integrationinto a TCM clinical synopsis

  • ( ppt-presentation)

  • 1st Revision MMXIV

  • 05/05/2014

  • J.P.Fossion, MD

  • Scientificcommission Brussels

  • BVGA

  • Bibliography

  • The humancentralnervous system; Nieuwenhuys, Voogd, van Huiyzen

  • Springer Verlag, 3d revisededition, ’88

  • Chinese syndromes in terms of a coherent unifying model in neuroscience-

  • preliminary report 2005; J.P.Fossion (RG full text)

  • The psyche in Chinese Medicine; Giovanni Maciocia;

  • ChurchillLivingstone 2009

  • - Manual of Acupuncture; P.Deadman;


Could tcm be described in terms of affective neuroscience

Could TCM bedescribed in terms of affectiveneuroscience?

integrationinto a clinical synopsis

Af

f

e

c

t i v e

d i sorde r s

Clinical Synopsis

TCM

1st revision

MMXIV

Jean Pierre Fossion MD

Scientific commission Brussels


Could tcm be described in terms of affective neuroscience

Affective Disorders

integration

TCM

&

affectiveneuroscience

DeficiencySyndromes

Full Syndromes

StagnationLiver Qi

SHEN

Spirit

or the

awareness to Anticipate

HUN

ethereal soul

or coping styles

to Participate

Hot

Pole

Cold

Pole

Full Fire

Kidney-Yang

Zhi

Will-power

or the drive to survive individually & as species

Wind


Could tcm be described in terms of affective neuroscience

Affective Disorders

DeficiencySyndromes

Full Syndromes

frustration

StagnationLiver Qi

Thermogenesis

Glu

Full Fire

Cold

Pole

Hot

Pole

Kidney-Yang

DA

(over)compensation

l.&dl.PAG

decompensation

vl.PAG

depression <- -> mania

Wind


Could tcm be described in terms of affective neuroscience

Deficiencies

Premature responding

hyperreflexia, easy startle, easily distracted

def.Blood

Dorsalstriatum

Hyperaesthetic Emotional Syndrome Restless Organs/ Zang Zao

restlessness (motor)

unrest (mental)

Organ: Lu, He

Dizziness, ear-tingling

Fear (Spl) <-> Anxiety (Ki)

t°R

restlessness (motor)

unrest (mental)

Iped

striatum

Three

ttiers

ventral striatum

def.Yin

Nucleus accumbens(core & shell)

Impulsive choice

impatience, immediate satisfaction


Could tcm be described in terms of affective neuroscience

Deficiencies

Heart palpitations

β-blockers

nebivolol

He + Spl:

Fear

(XinJi)

cardioexcitation

BDZ tranquilizer

anxiolytic, aversiveconditioning, sleep-induction

def.Blood

HES/ Restless Organs/ Zang Zao

Medication side effects:

asthenia

-> concealed asthenia

-> revealed asthenia

BDZ tranquilizer

anxiolytic, aversiveconditioning, sleep-induction

propranolol

He + Ki:

Anxiety

(ZhengChong)

PanicThrobbing

def.Yin

Alprazolam

Panicattack

He + Lu

Sorrow

(Bai He Bing)


Could tcm be described in terms of affective neuroscience

All deficiencies

Heart palpitations

β-blockers

He + Spl:

Fear

(XinJi)

cardioexcitation

def.Blood

HES/ Restless Organs/ Zang Zao

Medication side effects:

asthenia

-> concealed asthenia

-> revealed asthenia

Asthenia

Anorexia

Anhedonia

Antidepressant

Activating (non-sedative!)

YU (decompensation)

Kidney-Y.

Spl.(Y-Qi)

Spleen-Qi

3 Yang-Qi deficiencies

Decompensation

Learned helplessness Porsolt-test

Major depression

cf. Cloninger:

Harm Avoidance

5HT↑ & 5HTT↓

BDZ tranquilizer

anxiolytic, aversiveconditioning, sleep-induction

He + Ki:

Anxiety

(ZhengChong)

PanicThrobbing

def.Yin

He + Lu

Sorrow

(Bai He Bing)


Could tcm be described in terms of affective neuroscience

Limbic circuits of

“deficiencies” in TCM

Limbic computation

medial forebrain: risk assessment

He + Spl:

Fear

(XinJi)

cardioexcitation

def.Blood

Fearconditioning

Cue-related

amygdala (Am.ce)

HES/ Restless Organs/ Zang Zao

He + Ki:

Anxiety

(ZhengChong)

PanicThrobbing

def.Yin

Anxietyconditioning

Context-related

extendedamygdala (BNST)


Could tcm be described in terms of affective neuroscience

limbic circuits of

“deficiencies” in TCM

subGenual subregion

Rodent:

PL Cx

IL Cx

Mammal:

preGenual Cx

subGenual Cx

YU (decompensation)

Side effects:

Asthenia

-> revealed -

-> concealed -

Major depression

def.KidneyYang

Spl.(Y-Qi)

Spleen-Qi

SNr↓: inhibition

rewardpredictionerror

aB 25↑

aB 32↓

Acc ↓

Apathy - anhedonia

behaviouralinhibition, delayingreward

LearnedHelplessness

visceral motor cortex

aB25

subGenual subregion

ventral striatum:

Nu. Accumbens

SNc

HES Zang Zao

(restlessness)

SNr

def.Kidney

Yin

cf.A.Damasio

somatic marker(s)

InterPeduncular nucleus

SNc↑: DAexpectation of reward

aB 32↑

aB 25↓

Acc ↑

Impulsive choice

impatience, immediate satisfaction

exploratory behaviour

actionreversal


Could tcm be described in terms of affective neuroscience

Addiction

DA↑

l.Hab

degeneration

pos.symptoms psychosis

(phlegm-heat)

Smoking

Nicotin

m.Hab

degeneration

relaxing

(settling

E ffect)

  • Med.forebrain:

  • risk assesment

  • approach

  • breaking point

  • avoidance

  • + memory

  • m.S->Hc

epi- thalamus

  • Affective neuroscience

  • stress coping styles

  • hardwired

  • reinforcement learning

  • plasticity

Passiveavoidancel.Hab: Glu

Inescapableorunavoidable stress coping style

YU (decompensation)

Major depression

Kidney-Ya

Spl.(Y-Qi)

Spleen-Qi

SNr↓inhibition of DA

rewardpredictionerror

prox.Raphe: cf. Cloninger

l. DRN:

passiveavoidance

Apathy - anhedonia

learnedhelplessness, behaviouralinhibition

Contextualanxiety: Kidney

extendedamygdala

sub-

lenticular . amygdala

HES Zang Zao

(restlessness)

activeavoidance

Kidney Yin

SNc↑: DA↑expectation of reward

Approachbehavior: Yang

ApproachinhibitedifnegativerewardpredictionerrorYin

-> devaluation

-> omission

Impulsive choice

impatience, immediate satisfaction

Active avoidancem.Hab.→IPed

Escapableoravoidable stress coping “flightpattern”


Could tcm be described in terms of affective neuroscience

med.fB -  rVLM: visceral alert

86% SLEA shifts in pos.& neg.salience

77% Am.ce fear encoding

59% BNST anxiety encoding

56% IPAC (non-fundus striati/putamini)

fear

TAN

cholinergic interneurons

Procedural memory

-> stroma

sensorimotor reflexes

salinecy

-> striosome patches

limbic functions

relevancy

Concept of “Blood” = stroma

-> sensorimotorreflexes

-> + sensorimotorgating(OCD)

Concept of Yin = TAN pauze

& Yang = TAN:

-> limbicfunctions = patches

-> oppositeoutcome

-> neg.&pos.psychosis = Phl


Could tcm be described in terms of affective neuroscience

CART mapping rodent


Could tcm be described in terms of affective neuroscience

Neurosis

pattern configurations150 BC: stress coping styles

Full syndromes

Deficiencies

Frustration Dysphoria

BDZ tranquilizer

anxiolytic, aversiveconditioning, sleep-induction

St.Liver Qi

St.Blood

def.Blood

Gb

irritability

HES/ Restless Zang

YU (stagnation)

Defensive aggression

Antidepressant

activating

YU (decompensation)

Ascending Yang

Full Fire

def. KiYang

Spl.(Y-Qi)

Spleen-Qi

anger

3 Y -Qi DEFICIENCIES

Liv.Fire

indignation

St Fire

Gb39

reproduction

Deficient Fire

P.Deadman

def.Yin

BDZ Alprazolam

Panicattack

Ki.Fire

Liv.Fire

Wind

St Fire

Gb39

BDZ Clonazepam

(anticonvulsive)

e.g. neck pain

Ki.Fire


Could tcm be described in terms of affective neuroscience

Dian-Kuang

soft-hard

madness

Frustration Dysphoria

St.Liver Qi

St.Blood

def.Blood

postpartum psychosis

HES/ Restless Zang

Defensive aggression

3 Y-Qi DEFICIENCIES

Full Fire

Kidney-Y.

Spl.(Y-Qi)

Spleen-Qi

TAN occludes (mental) “Heartopenings”

Phlegm-Cold

Phlegm - Heat

PSYCHOSIS

exception

def.Yin

Wind


Could tcm be described in terms of affective neuroscience

St.Liver Qi

def.Blood

YU

reactional depression

atypical depression boulimic

Monopolar depression YU

Learned helplessness

Full Fire

Kidney-Y.

Spl.(Y-Qi)

Spleen-Qi

BipolardepressionDian

Congenitalpredisposition

TAN: Ming dynasty

15th century

ManiaKuang

5HT2-R +

blocker

D2-R

Phlegm-Cold

Dian

Phlegm -Heat

Kuang

DA↓

5HT1A-R–

naturalligand

  • mental retardation

  • physicalhyporeflexia

  • weightgain

PSYCHOSIS

negative signs

positive signs

def.Yin

def.Yin

5HT↑

typical =D1-R&D2-R

neuroleptic

atypical

SSRI

OCD

D1-R

5HT = subtypical

effect dependsonreceptor subtype

Wind

tardivedyskinesia

(extrapyramidal)


Could tcm be described in terms of affective neuroscience

OS - -> PS

visceral alert

m.fB->rVLM

postprandialdistension

m.fB->DVC

fear

(a.o.) guilt

St.Liver Qi

St.Blood

def.Blood

YU

reactional depression

anorexia

(adHD) hyperkinetic disorder

atypical depression boulimic

YU Major depression anhedonia

seasonalaffective disorder

Full Fire

Kidney-Y.

Spl.(Y-Qi)

Spleen-Qi

DA↓

5HT2A/C-R

block

HES/ Restless Organs: Zang Zao

Phlegm - Heat

anxiety

def.Yin

5HT↑

MEL

(a)typical

neuroleptic

sleep phase shift

extrapyramidal

(ADhd) attention deficit disorder

Wind

SSRI

OCD

acroparesthesia

pruritus

urticaria

tremor

Agomelatine

Lighttherapy


Could tcm be described in terms of affective neuroscience

St.Liver Qi

def.Blood

reactional depression

atypical depression boulimic

Monopolar depression

Learned helplessness

Full Fire

Kidney-Y.

Spl.(Y-Qi)

Spleen-Qi

Bipolardepression

Congenitalcondition

Mania

Phlegm-Cold

Phlegm - Heat

DA↓

PSYCHOSIS

negative signs

positive signs

def.Yin

5HT↑

(a)typical

neuroleptic

St40 Liv5 Ki6

Plumpit Qi

SSRI

OCD

He7

Gb37

Spl1, St45, Gb44

Parasomnia

He7 Ki4

Dementia


Could tcm be described in terms of affective neuroscience

Transormations between pattern configurations

Wind: Xian

(fever) convulsions

epilepsy

Consumes

Blood & Yin:

PS hypo-activity

Full Fire

defensiveaggression

deficiency of Yin:

HyperaestheticEmotionalSyndrome

Irritation-> anger

PAG: NK1 -> CCK

def. Fire: Zang Zao

OS-hyper-activity

Stagnation of LiverQi:

Frustrationdysphoria


Chinese transformations between pattern configurations

Liv3

Gb41

Bl18

Liv13

Liv14

Chinese transformationsbetweenpatternconfigurations

(5HT- & NA-) RUI SNRI

(venlafaxine)

(5HT- & NA-) RUI

- Fear (cue-related)

  • frustration dysphoria

  • irritation

  • impatience

He5

St.Liver Qi

def.Blood

Liv.Blood: Liv3,Ki5

NA

  • frequent sighing

  • postprandial distension

  • photophobia

  • phonophobia

  • postmenopauzal dysph.

  • premenstrual tension

  • Late luteal phase/ PMDD: 02g-R, COMT-gene, 5HT↓

Liv 1, 2, 3, 4 Liv4, St41

  • hyperreflexia, easy startle

  • cold fingertips (& -toes)

Gb41

Spl2, Liv2, St44

Liv3, Gb41, Gb37

  • mental unrest

  • motor unrest

  • asthenia (concealed form)

HyperaestheticEmotionalSyndrome

RestlessOrgans

St37, St44

He7, He6, He5, He4 SI7, Pc8

Spl6, Pc6, RM6

Gb37, Gb41

  • impatience

  • hot fingertips & toes

Gb44

Ki6, Spl2,4,6

BDZ tranquilizer

anxiolytic, aversive conditioning, sleep-induction

First choice needling suggested by P.Deadman

def.Yin

Liv.Yin: Liv3, Bl18

5HT

- Anxiety (context-related)

Gb39

(5HT- & NA-) RUI

LC: NA -> sensorimotor “attention”: easilydistracted

Raphe: 5HT -> risk assesment (cf. Cloninger: avoidance)

Anxiolytic SSRI (paroxetin/ sertralin)


Could tcm be described in terms of affective neuroscience

VTA: DA +->Acc.: mesolimbic DA

(5HT- & NA-) RUI

Curcumine

Passifloraincarnata

Panax Ginseng

  • frustrationdysphoria

  • generalizedindifference

St.Liver Qi

frustration dysphoria

The 3 Yang-Qi deficiencies

OS - -> PS

Major Depression (monopolar)

Burn out syndrome

Learned Helplessness

Liver dominating Spleen

reactional depression

reversible

IMAO-A (5HT-NA-DA)

TCA: Amitryptilin (75mg?)

Sedative/ insomnia

  • anorexia

  • postprandial distension

  • sighing

  • constipation (dry stools)

  • cold fingertips & toes

Kidn.Yang

Spl.(Y-Qi)

Spleen-Qi

5HT-RUI/ SSRI

S-NA RI/ SNRI

  • - daytime somnolence

  • genital anhedonia

  • abdominal distension

  • undigested food

  • internal cold

  • oedema

  • Asthenia (revealed form)

  • Anorexia/nausea

  • Anhedonia

Liv2

Liv3

TCA ?

Imipramin/ activating

alternating

  • postprandial distension

  • loose stools

  • dyspnea

  • cold fingers & toes

  • memory loss

Spl9

- fluid stagnation (sweating)


Could tcm be described in terms of affective neuroscience

St.Liver Qi

- frustration dysphoria

He5

The 3 Yang-Qi deficiencies

Major Depression (neurotic)

Reward Deficiency Syndrome

Learned Helplessness

  • reactional depression

  • Liver dominating Spleen

Liv4

  • anorexia (eating delayed)

  • sighing

  • postprandial distension

  • constipation

  • cold fingertips & toes

Kidney-Y.

Spl.(Y-Qi)

Spleen-Qi

  • Asthenia (revealed )

  • Anorexia (vitalistic)

  • Anhedonia

  • daytime somnolence

  • genital anhedonia

  • abdominal distension

  • undigested food

  • internal cold

  • oedema

St36

Spl3

Spl6

TB6, Ki6

Liv2

Liv3

Spl6

  • nausea

  • loose stools

  • dyspnea

  • cold fingers & toes

Pc6

Spl9

Lu7, Ki4

Spl2, Ki3

Bl23, DM4, Ki2

-stagnation of fluids

Lu5


Could tcm be described in terms of affective neuroscience

Affective Disorders

DeficiencySyndromes

Full Syndromes

Dian

“soft madness”

Kuang

“hard meadness”

StagnationLiver Qi

Glu-ergict°-geneticaxis

POHA/ AV3V: Glu -> DM/ hT: Glu -> RPa

(cold-induced) Heat production

Glu

Full Fire

Cold

Pole

Hot

Pole

Kidney-Yang

DA

DA-ergic (meso)limbicaxis

VTA: DA -> Acc.: Rewardexpectancy

VTA: DA -> striatum :Exploratorybeh.

Wind


Could tcm be described in terms of affective neuroscience

Dynorphine

Carlezon/ CREB

“runners’ high”

(5HT- & NA-) RUI

κ-OR

- frustration dysphoria

St.Liver Qi

  • postprandial distension

  • anorexia

  • constipation

  • cold fingertips (& toes)

  • postprandialdistension

  • anorexia

  • constipation

  • coldfingertips & toes

irritation

μ-OR

  • hypersthenia

  • mania (overdrive)

anger

LiverFire

CCK

  • acid regurgitation

  • boulimia

  • constipation

  • hot fingers & toes

Insomnia

Sedative TCA/ amitryptiline

tryptizol


Could tcm be described in terms of affective neuroscience

(5HT- & NA-) RUI

- frustration dysphoria

St.Liver Qi

  • postprandialdistension

  • anorexia

  • constipation

  • coldfingertips (& toes)

  • hypersthenia

  • mania

St36

Full Fire

animal models of experimental agression

Liv2, St41

- defensive agression

Liver

Gb39, St37

- predatory agression

Stomach

Ki9, Ki1

- reproductive agression

Kidney


Could tcm be described in terms of affective neuroscience

Herman van Praag (Netherlands):

anxiety/aggressiondrivendepression

5HT-deficiency depression

R/ SSRI + -> 5HT1A-R

What is fuelling the angriness?

ASCENDING YANG

Full Fire

Liver

- defensive agression

Stomach

DEF.FIRE

- predatory agression

Liver

- defensive agression

KidneyYin deficiency

Kidney

  • reproductive agression

  • (PO/dimorphic)

Stomach

- predatory agression

anxiety

Kidney

  • reproductive agression


Could tcm be described in terms of affective neuroscience

5HT = subtypical

1R--

Fire

2R ++

Trigeminovascular

headache

Cave: central hyperthermia

anger

βB

5HT1A-R --

ASCENDING YANG

LiverFire

5HT1B/D-R --

DA2-R ++

blocker

5HT2A/C-R ++

Cave: serotonine syndrome

Anxiolytic SSRI paroxetin/ sertralin

migraine

Propranolol

Inderal/ non-selectiveBetaBlocker

DEF.FIRE

5HT

atypicalAntipsychotic

(olanzapine > risperidone)

multiple

GABA-agonist

KidneyYin

Wind

anxiety

trigeminal neuralgia

Triptans

tryptaminefamily: vasoconstriciton

Carbamazepine

anticonvulsant =

“moodstabilizer”

Surrenal Adrenalin: He Fire


Could tcm be described in terms of affective neuroscience

Bl67

Bl64

Gb44

Gb37, Gb38, Gb40

  • identicalanatomicalsubstratepostulation

  • pharmacology

  • needling

varia

wind

fire

alcohol

Lu7

Pc7

DM22

SI3

TW3

eye pain

Bl60

He9

DV1

Pc9

visual aura

Ki6

Gb20

anger

βB

5HT1A-R

ASCENDING YANG

LiverFire

5HT1B/D-R

DA2-R

blocker

5HT2A/C-R

Serotonine syndrome

Anxiolytic SSRI paroxetin/ sertralin

migraine

Propranolol

Inderal/ non-selectiveBetaBlocker

DEF.FIRE

atypicalAntipsychotic

(olanzapine > risperidone)

multiple

GABA-agonist

5HT

KidneyYin

Wind

anxiety

trigeminal neuralgia

Triptans

tryptaminefamily: vasoconstriciton

Carbamazepine

anticonvulsant =

“moodstabilizer”

SurrenalAdrenalin

Heart Fire


Could tcm be described in terms of affective neuroscience

Af

f

e

c

t i v e

d i sorde r s

Thankyou !

TCM

Clinical Synopsis

1st review MMXIV

Jean Pierre Fossion MD

Scientific commission Brussels


  • Login