Transcript To the Heart of the Matter - examining the conceptual context of the

To the Heart of the Matter
- examining the conceptual context of
the understanding of cardiac illnesss
To the Heart of the Matter - examining the conceptual context of the understanding of cardiac illness
Part 1.
To the Heart of the Matter
The framework of
the dissertation
To the Heart of the Matter - examining the conceptual context of the understanding of cardiac illness
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


Ancient Medical context (monistic)
Disease processes understood in relation to
environmental, social and spiritual relationships
Classical Biomedical approach (reductionist)
Rooted in the Cartesian dualistic concept of
division between psyche and soma
To the Heart of the Matter - examining the conceptual context of the understanding of cardiac illness
The Context of Medicine in a Contemporary
Perspective


Psychonueroendocrinology (PNE)
PNI/PNE combination of specialist research
developing a model for understanding the
relationships between all aspects of the
human condition.
Western Herbal Medicine
Combination of an empiricism and biomedicine
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
Hypothesis
The context of the empirical therapeutic
philosophy
of
Western
Herbal
Medicine
demonstrates a conceptual understanding that is
concurrent with modern biomedical research.
Cardiovascular illness as a Debate Forum
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).
The comprehensive nature of PNE research into CV
illness facilitates a comparison of understanding
based upon broad therapeutic principles.
To the Heart of the Matter - examining the conceptual context of the understanding of cardiac illness
Part 2.
To the Heart of the Matter
The contemporary
biomedical understanding
To the Heart of the Matter - examining the conceptual context of the understanding of cardiac illness
The Cardiovascular System
~ the modern biomedical context
(Psychoneuroendocrinology)

Hypothalamic-Pituitary-Adrenocortical (HPA) Axis

Corticotropin Releasing Factor (CRF)

Intrinsic Neurological Activity of CRF

Locus Coeruleus
ANS

Amygdaloid Nucleus
Interaction
Glucocorticoids
Autonomic Nervous System (ANS)


To the Heart of the Matter - examining the conceptual context of the understanding of cardiac illness
The Cardiovascular System
~ the modern biomedical context
(Psychoneuroendocrinology)

Hypothalamic-Pituitary-Adrenocortical (HPA) Axis

Corticotropin Releasing Factor (CRF)

Intrinsic Neurological Activity of CRF

Locus Coeruleus
ANS


Amygdaloid Nucleus
Interaction


Glucocorticoids 
Autonomic Nervous System (ANS)
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.
 HPA activity

?
 CRF activity

CV Pathogenesis
To the Heart of the Matter - examining the conceptual context of the understanding of cardiac illness
Cardiovascular Pathogenesis ~ The Role of CRF
Amagdaloid nucleus: produces CRF in response to anxiety & stress (mediated by norepinephrine)
CRF
Hypothalamic/Pituitary Axis and
Corticotropin Releasing Factor influence
Glucocorticoid activity
Influences myocardial performance
Influences the vasoconstrictive activities
of the catecholamines and angiotensin II
Influences the production of the vasodilator
prostaglandins and reduces vascular
endothelium permeability.
Influences circulatory cholesterol
Proposed ’ feedforward’ mechanism
Influences circulatory triglyceride
Influences of the cardio-renal axis
Influences angiotenisn
Influences aldosterone
Locus Coeruleus
Production of norepinephrine
Influences the Autonomic Nervous System
Influences sympathetic vasomotor activity
Influences vagal activity
Influences SA node firing
Influences AV conduction
Influences the Tractus Solitarius
Influences circulatory
baro- and chemorecepotor feedback
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

Control by Cardiac autonomic innervation

BP = TPR(HR x SV)

BP = TPR(HR x SV)
Reduction in heart rate variability results in an
increase in blood pressure variability
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
ANS influence:

Cardiac regulation:

 Heart Rate Variability 
 Blood Pressure Variability

Ventricular instability
To the Heart of the Matter - examining the conceptual context of the understanding of cardiac illness
Psychoneuroendocrinology
~ A Model for Cardiovascular Pathogenesis




A
Relationship
between
psychological
disturbance and CV disease.
Stress, anxiety & depression are linked to CV
disease aetiology.
HPA and ANS activity are intimately related to CV
system regulation.
Negative emotional and cognitive responses
dysregulate the finely tuned control mechanisms,
which influence HPA/ANS interaction, resulting in
disturbance of the CV system dynamics.
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
To the Heart of the Matter - examining the conceptual context of the understanding of cardiac illness
The Heart
~ holistic perspectives in Western Herbal
Medicine
An examination the vitalistic therapeutic
understanding of CV illness evident in
traditional WHM
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.
To the Heart of the Matter - examining the conceptual context of the understanding of cardiac illness
Cardiovascular illness
~ The Physiomedicalist context
Physiomedicalism described disturbances of
the heart and vascular system in an eclectic
vitalistic context:

Physiological understanding


Autonomic nervous system balance
Expression of the vital energy within the
constitutional limitations of the individual
To the Heart of the Matter - examining the conceptual context of the understanding of cardiac illness
Cardiovascular remedies in empirical Western
Herbal Medicine

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
To the Heart of the matter
~ Aspects of conceptual commonality
In both Physiomedicalism and Humoral
Medicine, CV remedies are often described in
terms that relate them to nervous system activity,
e.g.

Nervousness, exhaustion, depression & gloom
These conditions correspond with the states
implied in the development of CV illness
proposed within the context of PNE
MSc Dissertation presentation
Ken Lunn
February 2003
Thank you
To the Heart of the Matter - examining the conceptual context of the understanding of cardiac illness
Psychoneuroimmunology
~ Glucocorticoid activity upon the Cardiovascular system

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
Hypothalamus
Corticotropin Releasing
Factor (CRF)
Pituitary
Adrenocorticotropic
Hormone (ACTH)
Catacholamines
Adrenal Cortex
Glucocorticoid production
Facilitate
Facilitate
Vasoconstrictive
activity
Sustain myocardial
performance
 vasodilator
prostaglandins
Back
To the Heart of the Matter - examining the conceptual context of the understanding of cardiac illness
Thalamus,
Hypothalamus & Cortex
Stress/Anxiety Activity
Neurological
Activation
Psychoneuroimmunology
~ CRF/ANS interaction
Neurological
Activation
Amygdalioid Nucleus
Endogenous CRF
production
CRF Activity
Afferent CV
Feedback
 Sympathetic vasomotor innervation

 Parasympathetic vasomotor innervation

 Afferent CV feedback activity
Norepinephrine
Activity
Locus Coeruleus (LC)
Potentiation of
Norepinephrine
 Activity
Vasomotor Regions in
the Brain
(Sympathetic)
Activity
Iintermediolateral
columns of the spinal
cord
Inhibitory effect
Tractus Solitarius (TS)
Inhibitory effect
Baro- and
Chemoreceptors
Afferent Cardiovascular
Feedback Activity

Dorsal Motor Vagus
Nucleus
(Parasympathetic)
Activity
Vasomotor
Innervation
 Efferent
Activity
Iintermediolateral
columns of the spinal
cord
Inhibitory effect
Vagus Motor
Innervation
 Efferent
Activity
Back