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To the Heart of the Matter

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.

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To the Heart of the Matter

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  1. To the Heart of the Matter - examining the conceptual context of the understanding of cardiac illnesss

  2. To the Heart of the Matter- examining the conceptual context of the understanding of cardiac illness Part 1. To the Heart of the MatterThe framework ofthe dissertation

  3. 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.

  4. 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.

  5. 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 • ClassicalBiomedical approach(reductionist) Rooted in the Cartesian dualistic concept of division between psyche and soma

  6. 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

  7. 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 Medicinedemonstrates a conceptual understanding that isconcurrent with modern biomedical research. Cardiovascular illnessas 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.

  8. To the Heart of the Matter- examining the conceptual context of the understanding of cardiac illness Part 2. To the Heart of the MatterThe contemporarybiomedical understanding

  9. 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 ANSInteraction • Amygdaloid Nucleus • Glucocorticoids • Autonomic Nervous System (ANS)

  10. 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 ANSInteraction  • Amygdaloid Nucleus • Glucocorticoids  • Autonomic Nervous System (ANS)

  11. 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

  12. To the Heart of the Matter- examining the conceptual context of the understanding of cardiac illness Cardiovascular Pathogenesis ~ The Role of CRF

  13. 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

  14. 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 • Cardiac regulation: • Heart Rate Variability   Blood Pressure Variability • Ventricular instability • ANS influence:

  15. 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.

  16. 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 medicinecontext

  17. 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

  18. 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.

  19. 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 vitalenergy within the constitutional limitations of the individual

  20. 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.

  21. 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

  22. MSc Dissertation presentation Ken Lunn February 2003 Thank you

  23. 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 Back

  24. To the Heart of the Matter- examining the conceptual context of the understanding of cardiac illness • Psychoneuroimmunology~ CRF/ANS interaction •  Sympathetic vasomotor innervation •  Parasympathetic vasomotor innervation •  Afferent CV feedback activity Back

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