There is an interesting book called Blink, by Malcolm Gladwell. I would have actually bypassed even talking about it if I didnt have the means to acquire the process he eludes to all throughout the book. I have a way to gain that rapid cognition process… Now back to the book, it grants us a glimpse into the micro-timing functions of the brain and its effect on peak performance. Malcom is calling it thin-slicing. Thin-slicing is the ability to (correctly)make rapid decisions with limited information. And typically, the greater the pressure the better the performance for those that know the secret. Time and ability seem to shift when we find ourselves under pressure – our ability to manipulate the neurological reaction and interaction is the one of the key elements in decision-making. The inability to do so, leads to error production. The neurological perception of this time separates great athletes, executives, and even soldiers from mediocre or even good ones. Their decisions separate them from their peers and everyone else on the planet. Fighter pilot testing has shown this also – optimal cognitive control is mediated by enhanced processing of both relevant and irrelevant stimuli, and that such control is accompanied by structural alterations in the brain. Structural changes that are attainable through neurofeedback training if they are not already there. Mileage will vary depending on what you start out with… This has implications beyond simple distinctions between fighter pilots and the executive under fire in the boardroom, because it suggests expertise in certain aspects of cognition are associated with changes in the connections between brain areas. So, it’s not just that the relevant areas of the brain are larger — but that the connections between key areas are better defined, more efficient and timed properly… Forgive me for thoughts of a finely tuned engine that come to mind – tuned to the Tesla degree. Neurofeedback trains the ability of the brain to process micro moment neurological processes efficiently and effectively and gives a person the ability to keep the central nervous system regulated and the heart rate and heart rate variability within a very specific optimal zones – zones that are typically unattainable under severe stress. Once your central nervous system and brain take a hit, it translates directly into your physiological system reacting to the stress and kicking into overdrive. And its at that critical moment the ability to thin-slice is lost and so is your ability to win. If you can keep calm when the pressure mounts, things will appear to “move in slow motion” as many of these elite describe the most important moments in their careers. Very few people can keep their mind flowing and their heart-rates down in these situations, but neurofeedback therapy gives you that ability to stay within the zone of optimal performance.

Q&A with Malcom Gladwell – Excerpts from the book.

What is Blink about?
1. What is “Blink” about?

It’s a book about rapid cognition, about the kind of thinking that happens in a blink of an eye. When you meet someone for the first time, or walk into a house you are thinking of buying, or read the first few sentences of a book, your mind takes about two seconds to jump to a series of conclusions. Well, “Blink” is a book about those two seconds, because I think those instant conclusions that we reach are really powerful and really important and, occasionally, really good.

You could also say that it’s a book about intuition, except that I don’t like that word. In fact it never appears in “Blink.” Intuition strikes me as a concept we use to describe emotional reactions, gut feelings–thoughts and impressions that don’t seem entirely rational. But I think that what goes on in that first two seconds is perfectly rational. It’s thinking–its just thinking that moves a little faster and operates a little more mysteriously than the kind of deliberate, conscious decision-making that we usually associate with “thinking.” In “Blink” I’m trying to understand those two seconds. What is going on inside our heads when we engage in rapid cognition? When are snap judgments good and when are they not? What kinds of things can we do to make our powers of rapid cognition better?

2. How can thinking that takes place so quickly be at all useful? Don’t we make the best decisions when we take the time to carefully evaluate all available and relevant information?

Certainly that’s what we’ve always been told. We live in a society dedicated to the idea that we’re always better off gathering as much information and spending as much time as possible in deliberation. As children, this lesson is drummed into us again and again: haste makes waste, look before you leap, stop and think. But I don’t think this is true. There are lots of situations–particularly at times of high pressure and stress–when haste does not make waste, when our snap judgments and first impressions offer a much better means of making sense of the world.

One of the stories I tell in “Blink” is about the Emergency Room doctors at Cook County Hospital in Chicago. That’s the big public hospital in Chicago, and a few years ago they changed the way they diagnosed heart attacks. They instructed their doctors to gather less information on their patients: they encouraged them to zero in on just a few critical pieces of information about patients suffering from chest pain–like blood pressure and the ECG–while ignoring everything else, like the patient’s age and weight and medical history. And what happened? Cook County is now one of the best places in the United States at diagnosing chest pain.

Not surprisingly, it was really hard to convince the physicians at Cook County to go along with the plan, because, like all of us, they were committed to the idea that more information is always better. But I describe lots of cases in “Blink” where that simply isn’t true. There’s a wonderful phrase in psychology–”the power of thin slicing”–which says that as human beings we are capable of making sense of situations based on the thinnest slice of experience. I have an entire chapter in “Blink” on how unbelievably powerful our thin-slicing skills are. I have to say that I still find some of the examples in that chapter hard to believe.

3. Where did you get the idea for “Blink”?

Believe it or not, it’s because I decided, a few years ago, to grow my hair long. If you look at the author photo on my last book, “The Tipping Point,” you’ll see that it used to be cut very short and conservatively. But, on a whim, I let it grow wild, as it had been when I was teenager. Immediately, in very small but significant ways, my life changed. I started getting speeding tickets all the time–and I had never gotten any before. I started getting pulled out of airport security lines for special attention. And one day, while walking along 14th Street in downtown Manhattan, a police van pulled up on the sidewalk, and three officers jumped out. They were looking, it turned out, for a rapist, and the rapist, they said, looked a lot like me. They pulled out the sketch and the description. I looked at it, and pointed out to them as nicely as I could that in fact the rapist looked nothing at all like me. He was much taller, and much heavier, and about fifteen years younger (and, I added, in a largely futile attempt at humor, not nearly as good-looking.) All we had in common was a large head of curly hair. After twenty minutes or so, the officers finally agreed with me, and let me go. On a scale of things, I realize this was a trivial misunderstanding. African-Americans in the United State suffer indignities far worse than this all the time. But what struck me was how even more subtle and absurd the stereotyping was in my case: this wasn’t about something really obvious like skin color, or age, or height, or weight. It was just about hair. Something about the first impression created by my hair derailed every other consideration in the hunt for the rapist, and the impression formed in those first two seconds exerted a powerful hold over the officers’ thinking over the next twenty minutes. That episode on the street got me thinking about the weird power of first impressions.

4. But that’s an example of a bad case of thin-slicing. The police officers jumped to a conclusion about you that was wrong. Does “Blink” talk about when rapid cognition goes awry?

Yes. That’s a big part of the book as well. I’m very interested in figuring out those kinds of situations where we need to be careful with our powers of rapid cognition. For instance, I have a chapter where I talk a lot about what it means for a man to be tall. I called up several hundred of the Fortune 500 companies in the U.S. and asked them how tall their CEOs were. And the answer is that they are almost all tall. Now that’s weird. There is no correlation between height and intelligence, or height and judgment, or height and the ability to motivate and lead people. But for some reason corporations overwhelmingly choose tall people for leadership roles. I think that’s an example of bad rapid cognition: there is something going on in the first few seconds of meeting a tall person which makes us predisposed toward thinking of that person as an effective leader, the same way that the police looked at my hair and decided I resembled a criminal. I call this the “Warren Harding Error” (you’ll have to read “Blink” to figure out why), and I think we make Warren Harding Errors in all kind of situations– particularly when it comes to hiring. With “Blink,” I’m trying to help people distinguish their good rapid cognition from their bad rapid cognition.

5. What kind of a book is “Blink”?

I used to get that question all the time with “The Tipping Point,” and I never really had a good answer. The best I could come up with was to say that it was an intellectual adventure story. I would describe “Blink” the same way. There is a lot of psychology in this book. In fact, the core of the book is research from a very new and quite extraordinary field in psychology that hasn’t really been written about yet for a general audience. But those ideas are illustrated using stories from literally every corner of society. In just the first four chapters, I discuss, among other things: marriage, World War Two code-breaking, ancient Greek sculpture, New Jersey’s best car dealer, Tom Hanks, speed-dating, medical malpractice, how to hit a topspin forehand, and what you can learn from someone by looking around their bedroom. So what does that make “Blink?” Fun, I hope.

6. What do you want people to take away from “Blink”?

I guess I just want to get people to take rapid cognition seriously. When it comes to something like dating, we all readily admit to the importance of what happens in the first instant when two people meet. But we won’t admit to the importance of what happens in the first two seconds when we talk about what happens when someone encounters a new idea, or when we interview someone for a job, or when a military general has to make a decision in the heat of battle.

“The Tipping Point” was concerned with grand themes, with figuring out the rules by which social change happens. “Blink” is quite different. It is concerned with the smallest components of our everyday lives–with the content and origin of those instantaneous impressions and conclusions that bubble up whenever we meet a new person, or confront a complex situation, or have to make a decision under conditions of stress. I think its time we paid more attention to those fleeting moments. I think that if we did, it would change the way wars are fought, the kind of products we see on the shelves, the kinds of movies that get made, the way police officers are trained, the way couples are counseled, the way job interviews are conducted and on and on–and if you combine all those little changes together you end up with a different and happier world.

The Merck Manual describes Vascular Dementia as “a slow, progressive decline in mental function including memory, thinking, judgment, and the ability to learn.  The ability to remember, think, understand, communicate, and control behavior declines…”

Dementia, one of the basic diagnostic categories in brain disorders, is classified by type as Vascular Dementia, Lewy Body Dementia, Frontotemporal Dementia or mixed dementia.  Symptoms and severity often depend on location and the physical pathophysiology of the specific brain structures.  Vascular Dementia is now the second most common form of dementia.  Recently, Bowler and Hachinski introduced a new term called vascular cognitive impairment.  Currently, the evolving criteria of cerebrovascular disease is mixed and becoming more of a global definition for a decrease in performance as well as psycho-physiological and rheological function. New studies have increasingly shown that sub-cortical small-vessel arterial wall changes as a major underlying factor for cognitive impairment and dementia.

The main causes of Vascular Dementia are due to brain injury, tumors, supranuclear palsy, neuritic plaques and neurofibrillary tangles.  Plaques consist of neuritis, astrocytes, and microglial cells around an amyloid core; tangles consist of paired helical filaments that contain a form of tau protein.  Other factors that can damage blood vessels in the brain are high blood pressure, medication, diabetes, and atherosclerosis.  Modern poly-pharmacology also is shown to have a large impact on cognitive performance as toxins build up and the ability to excrete these drugs is lessened with age and function.  The pathogenesis of Alzheimers is still unclear and information is now pointing toward a vascular nature.[3] Brain physiological alterations in both AD and VAD show a global cortical atrophy with the main focus being in the hippocampal regions[4] and thickening in the basement region.[5]

Greitz was the first to give attention to vascular predominance of cerebral diseases by showing an imbalance between the CSF flow and vascular flow in intracranial coupling.[6]

Currently, studies show that vascular dementia and Alzheimer dementia often coexist and are indistinguishable, especially in older patients with dementia.

Autopsy studies show the coexistence of Alzheimer ’s disease and vascular lesions[7]

Diagnostic criteria for dementia include memory loss or memory impairment, language difficulties, difficulties with everyday activities such as social or occupational, disorientation, and disruptive or inappropriate behavior.  Vascular Dementia also contains identifiable neuropsychological markers.  Improvements in neuroimaging have shown that microvascular disease increases with age.  But as the imaging evolves, the ability to detect impairment is still modeled after the criteria for Alzheimer’s Disease that emphasizes deficits of new learning and memory.  It leaves out many of the prefrontal executive functions and motor slowing.  Better testing measures are needed to understand the etiology of vascular disease in the brain.  Mapping out the pathophysiology of dementia and cerebrovascular disease may help show which risk factors are treatable and what alternatives can be utilized to reduce this age related disorder.

The Merck manual states that “Unlike other types of dementia, Vascular Dementia can sometimes be prevented by correcting or eliminating the risk factors for strokes.”

There are non reversible risk factors such as increasing age, geographic origin and genetics.  But risk factors such as smoking, hypertension, and hyperlipidemia considered reversible risk factors that have a large impact on vascular disease and vascular dementia itself.

With the development and utilization of modern imaging such as the fMRI, microvascular obstruction can now be recognized in the onset of atherosclerotic and atherothrombotic vascular disease.  VAD and AD both typically show thrombus formation by atherosclerotic plaque.  This plaque is engendered when platelets aggregate and disaggregate which leads to inflammation or obstruction.  These atherosclerotic lesions may also shed particulate matter and lead to infarctions and obstruction in the veins, peripheral tissues, brain or heart.   This can result in cardiac insufficiency or eventually vascular dementia.

Recently western medicine has been looking at mental decline in age related populations as having a common origin in their vascular nature.

“The co-morbidity of many vascular related risk factors makes a compelling case for Alzheimer’s Disease and Vascular Dementia sharing a common origin.” [8]de la Torre JC.

Hemodynamics studies have given us a better view on the decline of functioning in dementia.  In hemodynamics, the rheology of blood flow is an in-depth study in blood flow and has the ability to generate intricate models of computational fluid flow and fluid dynamics.  Currently, hemorheological models can predict the results of hemodynamic variables that are known to impact the formation of thrombosis and the start of atherosclerosis.   Microcirculation and flow recirculation that are altered have been found to transfer atherosclerotic plasma to the arterial wall, changing the permeability and altering the pathways for cell signals and gene expressions. This results in arterial wall alteration, enlargement of perivascular spaces, and perivascular parenchymal rarefaction.  One of the major findings is that aging alters the vascular homeostasis and shows a reduction in vasorelaxation.  The precapillary segments are affected and increase the wall to lumen ratio in smaller arteries thereby reducing the ability of vasorelaxation.[9] There is also endothelium thinning and capillary diameter reduction.[10]

In patients with dementia who have had a stroke, the increase in mortality is significant. The 5-year survival rate is 39% for patients with vascular dementia compared with 75% for age-matched controls .[11]

The Merck Manual states that there is no western treatment that can repair the vascular degradation and that the approaches are focused on preventing future vascular insults by controlling major risk factors such as High Blood Pressure and elevated cholesterol.

High blood pressure, diabetes and elevated cholesterol are generally treated with a regimen of exercise, medication and dietary change.  Evidence substantiates the reduction of risks that lead to dementia with the treatment of high blood pressure, diabetes and arteriole plaque formation due to micro-tears.

The mainstay of management of vascular dementia is the prevention of new strokes. This includes administering antiplatelet drugs and controlling major vascular risk factors. Aspirin has also been found to slow the progression of vascular dementia. Huperzine, an anticholinesterase alkaloid is currently being evaluated at the Mayo Clinic in Jacksonville, Florida.  Head of research shows initial findings that Huperzine A is more effective and more specific than tacrine.

The American Psychiatric Association provides both practice guidelines and possible specific therapies:

“Drug treatment is primarily used to prevent further worsening of vascular dementia by treating the underlying disease such as hypertension, hyperlipidemia, and diabetes mellitus. Antiplatelet agents are indicated.

Pentoxifylline and, to a more limited extent, ergoloid mesylates (Hydergine), may be useful for increasing cerebral blood flow. In the European Pentoxifylline Multi-Infarct Dementia Study, which is a double-blinded, placebo-controlled, multicenter study, treatment with pentoxifylline was found to be beneficial for patients with multi-infarct dementia. Significant improvement was observed in the scales used for assessing intellectual and cognitive function.

Neuroprotective drugs such as nimodipine, propentofylline, and posatirelin are currently under study and may be useful for vascular dementia.

Increasing evidence supports the involvement of the cholinergic system in vascular dementia, similar to that seen in Alzheimer dementia. However, no cholinesterase inhibitors have been approved to date for the treatment of vascular dementia, despite positive results in clinical trials with this medication.

The general management of dementia includes appropriate referral to community services, judgment and decision-making regarding legal and ethical issues (eg, driving, competency, advance directives), and consideration of caregiver stress.”

http://www.psychiatryonline.com/pracGuide/pracGuideTopic_3.aspx [12]

In Chinese medicine, dementia is thought to be a combination of impure qi or phlegm and the collapse of the original qi brought on by the blockage of the orifices.

“Whoever’s heart has static blood will also be affected by poor memory” Xue Zheng Lun (treatise on bleeding patterns).

In Chinese Medicine, senility or feeblemindedness are closely related to the flow of qi and blood through the orifices.  As a person ages, pathological changes can occur in the vessels leading to stasis and obstruction and the eventual progression of senility within the organism.

“This occurs in people over 60 years of age due to organic changes in their cerebrum or due to sustained metabolic damage.  Further, this condition is related to disorders in the cerebral circulation and lack of blood flowing in the whole brain.  In addition, decrease in the volume of blood flowing in the whole brain is directly proportional to the severity of this dementia.”  Aging & Blood Stasis, Yan De-xin, Guo-shun, Flaws pg 60.

Yan De-Yin goes on to state that there is extensive frontal lobe atrophy and that the weight of the brain is at least 100g lighter than that of a ‘normal’ elderly person.

There is a certain amount of global atrophy, but in dementia, mass loss targets certain structures also. Studies find asymmetrical temporal lobe atrophy, with greater left-sided damage and atrophy in the entorhinal cortex, amygdala, middle and inferior temporal gyri.  Additionally the fusiform gyrus was found to be the most severely damaged. Asymmetrical, predominantly anterior hippocampal atrophy was also present.[13] In order to maintain mental acuity, regulation, flow and the integration of qi and blood must be a primary factor in mental longevity.

“In order for blood to supply the construction and nourishment of the tissues of the five viscera and six bowels, the five senses, nine portals, four limbs and hundreds of bones of the entire body normally, it must flow uninterruptedly like an endless circle.” Aging and Blood Stasis, Yan De-Xin, page 31.

In order to maintain health, qi and blood should be able to flow freely and move around uninhibited by obstruction or stagnation.   If the movement of qi and blood is interrupted, obstructed or stagnant, it will lead to blood stasis.  Chinese medical theory states that once the blood separates and becomes static, then it will lead to pathological states such as phlegm, phlegm turbidity and eventually lead to senility through the depletion of qi and blood.  Western medicine also recognizes this.  At five percent of total body mass, the brain consumes approximately 20 percent of the oxygen in the blood.  Since there is no ability to store energy in the brain, it counts on a continuous flow of blood for energy maintenance.

Yan De-xin states that blood stasis is a major cause or at least complicates most, if not all, cases of senile dementia. In Aging & Blood Stasis, Dr. Yan says: “...through years of exploration, I have come to believe that the root of this disease is static blood obstructing the mansion of the clear spirit. Therefore, using the methods of quickening the blood and transforming stasis, I have gotten satisfactory therapeutic results, changing the stale point of view that this disease is irreversible.” Aging and Blood Stasis, Yan De-Xin,p. 243

Master Wang Qing Ren wrote “…if the original qi is already vacuous, certainly it cannot reach the blood vessels.  Because the vessels are devoid of qi the blood must stop, be retained and become static.”  He is also the doctor that introduced nine formulas for boosting the qi and blood including Bu Yang Huan Wu Tang, Ji Jiu Hui Yang Tang and Zhi Xie Tiao Zong Tang.  He theorized that dementia was caused by a combination deficiency of the substance making up the marrow and brain, and by stagnant blood clogging the orifices.

Ling Shu (Spiritual Pivot says, “When the blood vessels are harmonious and uninhibited, the essence spirit can then abide there.”  This points out that the uninhibited flow of blood is essential for a harmonious balance of qi and blood and for the nourishment of the brain.  The decrease in blood and oxygen volume is directly proportional to the severity of dementia.

In the Yi Deng Xu Yan, Pan Ji wrote: “All yang moves upward to the head.  Clear yang moves upward to the eyes.  If blood dies, the vessels congeal and weep.  If the vessels congeal and week, the force of flowing upward will become thin.  If it becomes thin, there will be vacuity above and dizziness and vertigo will be engendered.”  The therapeutic focus should be on vasodilatation, increasing the volume of blood and oxygen to the micro-vessels of the brain.  Western medicine makes the error of providing training by utilizing function-based exercises.  It is intended to activate hypo-profused brain areas, but this also activates unrelated brain areas. The brain tends to direct activation away from damaged areas and activates alternative areas for problem solving. An interesting study showed that patients with brain damage did not use neural pathways generated by learned limb control. They reverted to the unaffected area of the brain to use that limb wherever possible.[14]

Traditional TCM therapeutic approaches partially made the same mistake by generally focusing on tonification, clearing the orifices and calming agitation.  Combining these therapies was often done based on the symptoms.   Modern journal extracts point more toward the principle of treating blood stasis as a means to treating vascular dementia.  They state that the improvement in circulation may restore certain mental functions.

A more focused look at the pathogenesis shows that its deficiency is in the root and excess in the branch.  Vacuity gives way to a blockage and gives rise to sub-pattern of excess within the vessels.  Traditional formulations emphasize supplementing and enriching.  Yan De-Xin suggests that when the enrichment cannot reach the areas without flow, then the engendering will not take place and imbalance will occur.

Xu Ling-tai in the Sheng Ji Chu Yan “Since the qi and blood of the elderly do not flow very uninhibitedly, how can they bear supplementation which keeps the evils, thus making difficulties with the qi and blood.”

Yan De-Xin in a foundation of pathomechanisms states: “The substances of senility consists of blood stasis.  Blood stasis is the foundation of the pathophysiology of geriatric diseases.  Thus we have consistently based our approach on improving the capillary circulation of the organism, clearing and eliminating the phenomenon of blood stasis from the organism, restoring the internal environment to balance and in the effectively preventing and treating disease.” Aging and Blood Stasis, Yan De-Xin, p. 106

The Sun Wen also supports this and says: “Blockage and obstruction of the pathways and lack of free flow greatly damage the form.”

Yan De-Xin’s conclusion: “I believe that in treating geriatric diseases characterized by marked symptoms of static blood, one should primarily use the methods of quickening the blood and transforming stasis.  Whereas, in geriatric diseases which do not present obvious symptoms of static blood or in which symptoms of static blood are not pronounced, one should mainly rely on treatment given on the basis of pattern discrimination combined with medicinal which quicken the blood and transform stasis.” Aging and Blood Stasis, Yan De-Xin, p. 107

Yan De-Xin uses three different pattern discriminations for dementia.

Studies:

A randomized controlled study on scalp electroacupuncture for treatment of vascular dementia was just published in November of 2008.

The acupuncture-medicine group were treated by scalp electroacupuncture on HN 1, GV 20, GV 24, GB 20 and oral administration of Nimodipine; the electroacupuncture group were treated with scalp electroacupuncture; the medication group were treated with simple oral administration of Nimodipine. Duration was 6 weeks.  Cognition improvement was 86.59% in the acupuncture-medicine group, 82.05% in the electroacupuncture group and 43.21% in the medication group, the electroacupuncture group and the acupuncture-medicine group being better than the medication group; and their total effective rates for improvement of ability of daily life were 59.76%, 65.38% and 32.10%, respectively, the electroacupuncture group and the acupuncture-medicine group being better than the medication group.  Scalp electroacupuncture or scalp electroacupuncture combined with oral administration of Nimodipine has a better therapeutic effect in improvement of recognition function and the ability of life activity than simple oral administration of Nimodipine with a higher safety.[15]

Two doctors from Shuguang hospital’s acupuncture department reported on the following protocol:
Dr. Shen Weidong  treated 40 cases of Dementia by acupuncture at LI 4, HT 7, PC 5, ST 36, SP 6,  LR 3, and GV 24. For cases with irritability and stirring up of fire, GB 20 and KI 3 were added; for cases of slobbering, ST 4 and ST 6 were added; for dysphasia, CV 23 was added; for chest distress and palpitation, PC 6 was added; and for dysuria, CV 4 and CV 3 were added. Of the 40 cases treated with the above prescription, 10 had marked effect, 24 medium effect, and 6 no effect.
Dr.Wang Zhuxing selected GV 20, GV 24, GB 20, PC 5, GV 26, and HN1 for the treatment. For dizziness and headache, HN5, LI 4 and LR 3 were added; for mania, HN13, LR 3 and GB 34 were added; for depression, PC 6, ST 40, and HN13 were added; for insomnia, HT 7 and PC 6 were added. The above points were needled by the reducing method.  160 cases were treated with complete recovery shown in 51, marked effect in 76, improvement in 18, and no effect in 15. The total effective rate reported was 90.6%.

Zhang Yang Guan. Treating 16 cases of apoplectic dementia with modified Bu Yang Huan Wu Tang. [16]

Sixteen cases of apoplectic dementia treated with Bu Yang Huan Wu Tang. This formula consisted of Huang Qi, Dang Gui, Chi Shao, Tao Ren, Hong Hua, Shi Chang Pu, Yu Jin, Dan Xing, Di Long, Chuan Xiong Cnidium, and Tian Zhu Huang. The results showed that three cases were resolved, eleven had noticeable improvement, and two cases had no improvement. The total effectiveness rate was 87.5%.

After intragastric administration of Bu Yang Huan Wu Tang or Bu Yang Huan Wu Tang plus Che Qian Cao and Bai Mao Gen, the auricular arteries dilate and the net number of capillaries increased in ICR mice of the two groups.[17]

Zhi Ling Tang, a TCM prescription designed for replenishing essence, supplementing marrow, invigorating qi, warming yang, removing blood stasis and phlegm, tonifying the brain, and invigorating mental activity was used in 32 cases of senile dementia SD. After treatment, the levels of serum cholesterol Tch, triglyceride TG, and plasma lipid peroxides LPO were lowered; the content of high density lipoprotein HDL and the activity of superoxide dismutase SOD in RBC significantly elevated, the cerebral blood flow was increased; latent period of P300 and P3 waves was shortened while the amplitude of P3 elevated; and topographic electroencephalogram, revised Hasegawa dementia scales HDS scores P < 0.05-0.01 and clinical symptoms were improved. The total effective rate was 81.3%.[18]

Bibliography

Beers, M.H. & Berkow, R. (ed). Dementia. The Merck Manual of Diagnosis and Therapy, 17th Edition. Merck Research Laboratories, NJ, 1999

Tang Gus-shun & Bob Flaws Aging and Blood Stasis, Blue Poppy Press, Boulder, CO, 1995.

Bob Flaws and James Lake Chinese Medical Psychiatry, Blue Poppy Press, Boulder, CO, 2000.

Jane Lyttleton & Will Maclean Clinical Handbook of Internal Medicine Vol 1.. Univ. Western Sydney, Australia. 1998.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition.. Washington DC: American Psychiatric Association; 1994

Endnotes

[2] Lobo A, Launer LJ, Fratiglioni L, Andersen K, Di Carlo A, Breteler MM, Copeland JR, Dartigues JF, Jagger C, Martinez-Lage J, Soininen H, Hofman A (2000) Prevalence of dementia and major subtypes in Europe: a collaborative study of population-based cohorts. Neurologic Diseases in the Elderly Research Group. Neurology 54:S4–S9

[3] Bornebroek MBM (2004) Epidemiology of non-AD dementia. Clin Neurosci Res 3:349–361

[4] Resnick SM, Pham DL, Kraut MA, Zonderman AB, Davatzikos C (2003) Longitudinal magnetic resonance imaging studies of older adults: a shrinking brain. J Neurosci 23:3295–3301

[5] Serot JM, Bene MC, Foliguet B, Faure GC (2000) Morphological alterations of the choroid plexus in late-onset Alzheimer’s disease. Acta Neuropathol (Berl) 99:105–108

[6] Lancet. 1969 Apr 26;1(7600):863-5.Effect of brain distension on cerebral circulation.Greitz T.

[7] Jellinger KA. The pathology of “vascular dementia”: a critical update J Alzheimers Dis. 2008 May;14(1):107-23.

[8] de la Torre JC. Critically-attained threshold of cerebral hypoperfusion: the CATCH hypothesis of Alzheimer’s pathogenesis. Neurobiological Aging.  2000;21:331–342

[9] Wootton, DM; Ku, NK. Fluid Mechanics of Vascular Systems, Diseases, and Thrombosis. Annual Review of Biomedical Engineering. 1999;1:299–329

[10] Schaller B (2004) Physiology of cerebral venous blood flow: from experimental data in animals to normal function in humans. Brain Res Brain Res Rev 46:243–260

[11] Brodaty H, McGilchrist C, Harris L, Peters KE. Time until institutionalization and death in patients with dementia: role of caregiver training and risk factors. Arch Neurol. 1993;50:643–650.

[12] http://www.psychiatryonline.com/pracGuide/pracGuideTopic_3.aspx

[13] Ann Neurol. 2001 Apr;49(4:433-42).

[14] Taub E, Miller NE.  Techniques to improve chronic motor deficit after stroke (1993).  Arch Phys Med Rehabil

[15] Zhongguo Zhen Jiu. 2008 Nov;2811:783-7

[16] Jiangsu Journal of TCM. 1998;193:21.

[17] Lu Sheng Kang, et al. Experimental research in modified Bu Yang Huan Wu Tang’s effect on auricular microcirculation in rats. Zhejiang Journal of Integrated Medicine. 1998;82:87-88.

[18] J. Tradit Chin Med. 2000 Jun;202:83-6.

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• Dopamine – Bacillus, Serratia
• Acetylcholine – Lactobacillus

This research may lead to selecting probiotic strains to influence  neurological applications and immune-modulatory effects. This could mean that adjunct treatment for people suffering from certain types of mental health problems is as easy as ingesting specific strains of  probiotics.

Ref.: M. Lyte, Probiotics function mechanistically as delivery vehicles for neuroactive compounds: Microbial Endocrinology in the design and use of probiotics, BioEssays, 2011; [DOI: 10.1002/bies.201100024]

Often ADHD is accompanied by more severe behavioral symptoms, such as opposition and poor conduct, as well as by specific learning disabilities.

ADD/ ADHD is best addressed by a variety of approaches, including parent education and training, dietary changes and nutritional support and Neurofeedback training.  Simple changes in diet like eliminating gluten, adding probiotics and taking omega 3 fatty acids can make a significant difference in the symptomology.    Depending on what is needed, specific recommendations can be addressed.  Medication is sometimes still warranted even after all the other avenues have been utilized, though it should only be used when the other approaches have been exhausted.  Medical factors can also contribute to the disorder, such as allergies or heavy metals toxicity. Other conditions such as primary depression, anxiety, and seizure activity can also impact functional and behavioral patterns.

Depending on underlying conditions, western medical management of ADHD may consist of stimulants, anti-depressants, or anticonvulsant medication. In my opinion medication is too readily prescribed based on insufficient testing and intervention.  The easy administration and popularity of stimulants has led to an over-simplification of this complex condition. This in turn has led to the incorrect/over-diagnosis and over-medication of many children and adults.

Neurofeedback has been shown to reduce and even eliminate the characteristic symptoms of ADHD and the related conditions, which are the immediate cause of medical referrals. The training has also been shown to have lasting effects, in contrast to medication. The effectiveness of medication in even temporarily normalizing a child’s behavior is proof that the child’s brain is capable of functioning normally. Neurofeedback simply allows us to accomplish that task with objective and measurable data.   The following link contains an excellent meta-analysis:  http://www.windgatehealth.com/EfficacyNeurofeedbackADHD.pdf

What then is the role of stimulant medication? It is to induce a forced temporary functional change in the brain.  Ritalin or Concerta for example, does not supply a missing neurotransmitter. Ritalin, like Concerta, Adderal, and Cylert is not ‘Vitamin R’. Ritalin, which is a controlled stimulant, simply speeds the brainwaves up by impinging on the state of regulation of several neurotransmitter systems (dopamine and norepinephrine). Once the medication is metabolized however, the brainwaves revert back to the same slower dominating pattern that existed before, regardless of how long you have been taking the medication. This is why medication will only mask the symptoms and never will they “fix” the problem.

Neurofeedback training rewards the child or adult for changing brainwave activity toward what is more characteristic of a functional brain.  We set multiple parameters on the EEG Program for the brain to regulate. When each parameter is met then they are rewarded by either a movie playing or a video game producing a reward. The learning process is largely an unconscious act. Neurofeedback challenges the individuals brain to self-adapt to a more functional state.

It is best considered as mental fitness training that over time teaches the individuals brain improved skills of managing attention, arousal (level of excitability), and affective or emotional state. The individual’s brain already manages attention, arousal, and affective state to a certain degree, and the relevant mechanisms are in place to do so. Simply exercising those mechanisms strengthens them, and allows the individual to have better control over his or her own behavior automatically, just as these things are automatic for those of us who don’t have ADHD.

Neurofeedback simply employs learning strategies that have been proven effective. For example, we incorporate visual feedback, audio feedback, and tactile feedback, which are the three ways in which we learn new tasks. Although we all learn better with one form or the other, if you use all three at once, you are very likely to learn the information quickly. If a child exhibits more severe disruptive behaviors, Neurofeedback will help to diminish and eventually for many, eliminate those troublesome behaviors. The child or adult will likely also notice an improvement in their quality of sleep, if this is a problem to begin with, which it usually is with the use of stimulant medications. Associated depression and anxiety will be found to be alleviated as well with the training.

With a more functional brain, the child or adult will exhibit his or her natural intellectual abilities, and measured IQ scores will likely increase significantly with the training as well. This is not because Neurofeedback will make someone smarter, but rather because it will allow the person to be more available to reach the potential they already possessed.

Neurofeedback training can also be helpful with specific learning disabilities such as dyslexia, dysgraphia, and dyscalculia, as well as with poor visual and auditory memory. Neurofeedback should therefore be considered as part of a comprehensive program for addressing the needs of the ADHD child/adult, learning disabled, or behaviorally disregulated.

Moreover, a child does not have to meet specific diagnostic criteria in order to benefit from the training. Neurofeedback training is a challenge to any brain to get it to function better.

In summary, Neurofeedback is a safe, proven, and non-invasive alternative that should be given a great deal of “attention” due to the overwhelming success qualified practitioners and researchers are having and have had for more than thirty years. Individuals may say many things about this modality, but the fact of the matter is that it simply works for about 8 out of 10 people. With the family support network in place and minimal compliance, success is very likely to be high.

I have been using Neurofeedback since 1996 in my practice and currently find it to be the best intervention for attention, hyperactivity and neurophysiological regulation.

One method, the six meridian method was developed early in the Eastern Han Dynasty by Zhang Zhongjing (150-219AD) in the book of Shanghan Zabzabinglun (Discourse on Fevers and Miscellaneous Illnesses).  It is based on the distribution of the three yang meridians (Tai Yang, Yang Ming, Shao Yang) and the three yin meridians (Tai Yin, Shao Yin, Jue Yin).

 Signs and symptoms are classified into six stages that correspond to those particular meridians. The three yang meridians are located on the exterior parts of the body and as a disease or ‘evil’ progresses the disease’s symptoms will progress along the more interior yin meridians.  The Shang Han Lun also contained detailed herbal formulations that addressed individual stages of a disease.

If we follow the Shang Han Lun’s elucidation on disease stages and determine the presenting signs and symptoms to determine a pattern, then we can determine the stage and proper treatment.  Swine Flu’s pattern typically starts out as Tai Yang disease as per the CDC list of signs and symptoms and then progresses to a Shao Yang disease.

A Tai Yang disease is an invasion of Wind Cold or Wind Heat.  These signs and symptoms match the typical ones found in the flu. The signs and symptoms for Wind Cold are:

• Floating Pulse
• Head and nape are stiff and painful
• Runny nose (clear)
• White or clear sputum
• Occipital Headache
• Body Aches
• Fever
• Chills (The chills are greater than the fever) and aversion to cold
• Thin white tongue coating

Wind Heat Pattern includes additional signs and symptoms minus the aversion to cold:

• Sore Throat
• Fever with light sweating
• A  floating, rapid pulse

If there is a shao yang pattern, there will be:

• Alternating fever and chills
• A bowstring or wiry pulse
• Lack of appetite
• Half of the tongue fur may be yellow with or yellow fur may encircle white
• Cough

Heat toxins are evidenced by:

• More pronounced sore throat
• Possible purulence of the tonsillar membranes
• Higher fever
• Yellow or Green Sputum

 There may also be other symptoms present such as shortness of breath in the case of asthma.

The Shang Han Lun states the formula for Wind Strike is Gui Zhi Tang as a first step in combating the disease.  The objective is to induce sweating and release exterior.  If this can be cleared before the Wind Strike settles into the body then the secondary bacterial infection in the lungs can be averted.

As the disease progresses or has progressed to either a wind heat pattern, the sputum will change to a yellow or green color, the headache will be more generalized, there will be more fever than chills and there may also be sore throat.  Yin Qiao San is typically prescribed for this stage of the illness.

In my clinical practice, I treated three siblings that had been diagnosed with swine flu.  The day of the consult they were just starting to cough and the sputum had changed from clear to a yellow/green.  Pulses were wiry and none were floating.  The tongue coating was still white with a tinge of yellow and thick.  One child had a red tip.  The sore throats were severe as were their headaches.  Chills had progressed from minor to major with flashes of heat and then finally fevers of 102 over the last two days.  They were told by the western doctor to take in plenty of fluids, oral decongestants, cough suppressants and Tylenol and if the signs and symptoms get worse then return to the hospital.   I prescribed a combination of a classic formula with a modification of a modern formula that has had success in China with the Swine Flu.   

They were to take 3 doses a day and keep track of the fever, sputum color and amount, pain and sore throat.  After 2 doses the fevers subsided by evening.  Cough remained and their sore throats had diminished by half by the evening.  By the afternoon of the second day and 5 doses, sore throats had subsided, no aches or pains, sputum had cleared in color and diminished considerably.  No signs of fever.  Day three, only minor signs and symptoms of sputum and general malaise with an occasional cough.  Day 4 we switched to Cold Quell Jr by Blue Poppy.  ColdQuell is based on a combination of three herbal formulas. These are Xiao Chai Hu Tang (Minor Bupleurum Decoction), Yin Qiao San (Lonicera & Forsythia Powder), and Si Wu Tang (Four Materials Decoction).  I changed to this because the severity of the symptoms had reduced to a point that a lesser strength formula with support herbs could be used. By day 4 the signs and symptoms were clear and only 2 more doses were taken.  

Though the genetics of each different Flu virus strain may be different, the Traditional Chinese Medicine approach is still valid as it is not based on attacking the virus but rather on assisting the body’s own healing processes.

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Acupuncture involves the insertion of extremely thin needles through your skin, to various depths at strategic points on your body. Acupuncture originated in China thousands of years ago, but over the past two decades its popularity has grown significantly within the United States. NIH, WHO and recent clinical studies indicate that it provides a number of medical benefits — from reducing pain to helping with chemotherapy-induced nausea. A full list is included under the conditions tab.

Acupuncture therapy usually involves a series of weekly or biweekly treatments in an outpatient setting. It’s common to have 4 to up to 20 treatments in total. Each visit typically includes an exam and an assessment of your current condition, the insertion of needles, and a discussion about self-care tips. An acupuncture visit generally lasts about 60 minutes.

Before the needles are placed, you’ll lie down on a comfortable surface. Depending on where the needles are to go, you will lie facedown, faceup or on your side. Make sure that your acupuncturist uses single-use sterile packaged needles. You may feel a brief, sharp sensation when the needle is inserted, but generally the procedure isn’t painful.

It’s common, however, to feel a deep aching sensation when the needle reaches the correct depth. After placement, the needles are sometimes moved gently or stimulated with electricity or heat. As many as a dozen needles may need to be placed for each treatment. Once the needles are inserted, they’re usually left in place for five to 20 minutes.