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Transcript of To the Heart of the Matter - examining the conceptual context of the understanding of cardiac...
To the Heart of the Matter - examining the conceptual context of the understanding of cardiac illnesss
To the Heart of the MatterThe framework ofthe dissertation
To the Heart of the Matter - examining the conceptual context of the understanding of cardiac illness
Part 1.
The Human Context of Disease
Throughout history, mankind has been continually striving to develop and refine an understanding of the mechanisms of the life processes ultimately defined by disease and death.
Disease symbolises the portal between these two apparently irreconcilable aspects of human existence and its enigma has been the challenge of physicians since the dawn of time.
To the Heart of the Matter - examining the conceptual context of the understanding of cardiac illness
The Veil of Context - Conceptual models for defining disease
Conceptual models of disease have their foundations in the context of the contemporary understanding, and are derived from observation of the life processes.
Disparities that arise between differing theories can be understood as being products of incompatibilities in the context within which they are described, and are not necessarily reflective of theoretical misinterpretation or misunderstanding.
To the Heart of the Matter - examining the conceptual context of the understanding of cardiac illness
The Context of Medicine in an Historical Perspective
To the Heart of the Matter - examining the conceptual context of the understanding of cardiac illness
Ancient Medical context (monistic)
Classical Biomedical approach (reductionist)
Disease processes understood in relation to environmental, social and spiritual
relationships
Rooted in the Cartesian dualistic concept of division between psyche and soma
Western Herbal Medicine
Optimally, biomedical principles are used as an
adjunct to understanding health and disease processes
To the Heart of the Matter - examining the conceptual context of the understanding of cardiac illness
The Context of Medicine in a Contemporary Perspective
PNI/PNE combination of specialist research developing a model for understanding the relationships between all aspects of the human condition.
Psychonueroendocrinology (PNE)
Combination of an empiricism and biomedicine
To the Heart of the Matter - examining the conceptual context of the understanding of cardiac illness
Hypothesis
The comprehensive nature of PNE research into CV illness facilitates a comparison of understanding based upon broad therapeutic principles.
The choice of cardiovascular illness has been made in the light of recent advancements in the biomedical theories relating to these conditions within psychoneuroendocrinology (PNE).
Cardiovascular illness as a Debate Forum
The context of the empirical therapeutic philosophy of Western Herbal Medicinedemonstrates a conceptual understanding that isconcurrent with modern biomedical research.
To the Heart of the MatterThe contemporary
biomedical understanding
To the Heart of the Matter - examining the conceptual context of the understanding of cardiac illness
Part 2.
The Cardiovascular System~ the modern biomedical context (Psychoneuroendocrinology)
To the Heart of the Matter - examining the conceptual context of the understanding of cardiac illness
Hypothalamic-Pituitary-Adrenocortical (HPA) Axis Corticotropin Releasing Factor (CRF)
Glucocorticoids Autonomic Nervous System (ANS)
Intrinsic Neurological Activity of CRF Locus Coeruleus ANS
Interaction Amygdaloid Nucleus
Glucocorticoids
The Cardiovascular System~ the modern biomedical context (Psychoneuroendocrinology)
To the Heart of the Matter - examining the conceptual context of the understanding of cardiac illness
Hypothalamic-Pituitary-Adrenocortical (HPA) Axis Corticotropin Releasing Factor (CRF)
Autonomic Nervous System (ANS)
Intrinsic Neurological Activity of CRF Locus Coeruleus ANS
Interaction Amygdaloid Nucleus
To the Heart of the Matter - examining the conceptual context of the understanding of cardiac illness
Cardiovascular Pathogenesis~ a psychoneuroendocrinological understanding
CV pathogenesis is intimately associated with the passive stress response and the related influence of HPA hormonal activity.
CRF activity HPA activity CV Pathogenesis
?
Amagdaloid nucleus: produces CRF in response to anxiety & stress (mediated by norepinephrine)
CRF
Hypothalamic/Pituitary Axis andCorticotropin Releasing Factor influence
Glucocorticoid activity
Influences myocardial performance
Influences the vasoconstrictive activitiesof the catecholamines and angiotensin II
Influences the production of the vasodilatorprostaglandins and reduces vascularendothelium permeability.
Influences circulatory cholesterol
Influences circulatory triglycerideInfluences of the cardio-renal axis
Influences angiotenisnInfluences aldosterone
Locus Coeruleus
Production of norepinephrine
Influences the Autonomic Nervous System
Influences sympathetic vasomotor activity
Influences vagal activityInfluences SA node firing
Influences AV conduction
Influences the Tractus Solitarius
Influences circulatory baro- and chemorecepotor feedback
Proposed ’ feed-forward’ mechanism
To the Heart of the Matter - examining the conceptual context of the understanding of cardiac illness
Cardiovascular Pathogenesis ~ The Role of CRF
Control by Cardiac autonomic innervation
To the Heart of the Matter - examining the conceptual context of the understanding of cardiac illness
Cardiovascular Pathogenesis~ The Role of Heart Rate Variability
Heart rate variability describes low frequency modulation of the heart rate Dynamic physiological accommodation for
cardiovascular peripheral challenge
Reduction in heart rate variability results in an increase in blood pressure variability
BP = TPR(HR x SV) BP = TPR(HR x SV)
Cardiac regulation: Heart Rate Variability
Blood Pressure Variability Ventricular instability
ANS influence:
To the Heart of the Matter - examining the conceptual context of the understanding of cardiac illness
Psychoneuroendocrinology ~ A Model for Cardiovascular Pathogenesis Implicated pathological processes:
HPA influence: Glucocorticoid induced pathology: Platelet reactivity Circulatory triglycerides & circulatory
cholesterol Disturbances in ANS activity
Psychoneuroendocrinology ~ A Model for Cardiovascular Pathogenesis
To the Heart of the Matter - examining the conceptual context of the understanding of cardiac illness
A Relationship between psychological disturbance and CV disease.
Stress, anxiety & depression are linked to CV disease aetiology.
Negative emotional and cognitive responses dysregulate the finely tuned control mechanisms, which influence HPA/ANS interaction, resulting in disturbance of the CV system dynamics.
HPA and ANS activity are intimately related to CV
system regulation.
To the Heart of the Matter - examining the conceptual context of the understanding of cardiac illness
Part 3.
To the Heart of the Matter ~ the western herbal medicine
context
An examination the vitalistic therapeutic understanding of CV illness evident in traditional WHM
The Heart~ holistic perspectives in Western Herbal Medicine
To the Heart of the Matter - examining the conceptual context of the understanding of cardiac illness
Humoral Medicine Physiomedicalist & Eclectic based Herbal
Medicine
Areas of examination: Treatment philosophy Herbal materia medica
To the Heart of the Matter - examining the conceptual context of the understanding of cardiac illness
Cardiovascular illness ~ The humoral context
In Humoral Medicine aetiological understanding is directly related to the application of herbal remedies.
The concept of temperament, used to describe health, illness, the activity of herbal remedies and subsequently treatment, was central in defining the basis of the therapeutic strategy.
The heart is susceptible to affliction by negative emotion, due to the antithesis of the temperament of negative emotion in relation to the eucrasia of the heart.
Expression of the vital energy within the constitutional limitations of the individual
Autonomic nervous system balance
Physiological understanding
Cardiovascular illness ~ The Physiomedicalist context
Physiomedicalism described disturbances of the heart and vascular system in an eclectic vitalistic context:
To the Heart of the Matter - examining the conceptual context of the understanding of cardiac illness
Anemone pulsatilla L. Avena sativa L. Borago officinalis L. Convallaria majalis L. Crataegus oxyacanthoides Thuill. Leonurus cardiaca L. Melissa officinalis L. Selenicerus grandiflorus (L.) Britt. & Tilia spp. Veratrum viride Viscum album L.
To the Heart of the Matter - examining the conceptual context of the understanding of cardiac illness
Cardiovascular remedies in empirical Western Herbal Medicine
In both Physiomedicalism and Humoral Medicine, CV remedies are often described in terms that relate them to nervous system activity, e.g.
To the Heart of the matter~ Aspects of conceptual commonality
To the Heart of the Matter - examining the conceptual context of the understanding of cardiac illness
Nervousness, exhaustion, depression & gloom
These conditions correspond with the statesimplied in the development of CV illnessproposed within the context of PNE
MSc Dissertation presentationKen Lunn
February 2003
Thank you
To the Heart of the Matter - examining the conceptual context of the understanding of cardiac illness
H y p o th a la m u sC o r t ic o tr o p in R e le a s in g
F a c to r ( C R F )
P i t u i t a r yA d r e n o c o r t i c o tr o p ic
H o r m o n e ( A C T H )
C a t a c h o la m in e s
V a s o c o n s t r ic t iv ea c t iv i t y
S u s t a in m y o c a r d ia lp e r f o r m a n c e
F a c il i t a te
v a s o d ila t o rp r o s t a g la n d in s
A d r e n a l C o r t e x G lu c o c o r t ic o id p r o d u c t io n
F a c il i t a te
Psychoneuroimmunology~ Glucocorticoid activity upon the Cardiovascular system
Back
Sustains myocardial performance Facilitates the vasoconstrictive activities of the
catecholamines and angiotensin II Decreases the production of the vasodilator prostaglandins and reduces vascular
endothelium permeability Increases circulatory cholesterol Increases circulatory triglyceride
To the Heart of the Matter - examining the conceptual context of the understanding of cardiac illness
Locus Coeruleus (LC)Potentiation ofNorepinephrine
Vasomotor Regions inthe Brain
(Sympathetic)Activity
Iintermediolateralcolumns of the spinal
cordInhibitory effect
VasomotorInnervation Efferent
Activity
Dorsal Motor VagusNucleus
(Parasympathetic)Activity
Iintermediolateralcolumns of the spinal
cordInhibitory effect
Vagus MotorInnervation Efferent
Activity
Tractus Solitarius (TS)
Inhibitory effect
Baro- andChemoreceptors
Afferent CardiovascularFeedback Activity
Afferent CVFeedback
Activity
Amygdalioid Nucleus
Endogenous CRFproduction
Thalamus,Hypothalamus & Cortex
Stress/Anxiety Activity
CRF Activity Norepinephrine Activity
NeurologicalActivation
NeurologicalActivation
Psychoneuroimmunology~ CRF/ANS interaction
Back
Sympathetic vasomotor innervation Parasympathetic vasomotor innervation Afferent CV feedback activity