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

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Sympathetic vasomotor innervation Parasympathetic vasomotor innervation Afferent CV feedback activity