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Perimenopausal Brain Fog Acupuncture and Herbs to Stimulate Brain Activity
by Subhuti Dharmananda
During perimenopause and menopause, mental functions are usually affected by the hormonal changes, and conditions arise involving both mood lability and poor memory, the latter sometimes referred to as "brain fog" because of the obscuration of memory and clear ideation. This condition can persist into the postmenopausal years. It has been suggested that early intervention with hormone therapy might protect memory (1), but the publicized risks of hormone therapy have deterred many women and their physicians from pursuing this route. The precise nature of brain fog is somewhat unclear, as tests for simple memory tasks often show little change; there may be some subtle shifts in memory function that especially affect complex tasks or reduce memory retrieval when the mind is not focused on the objective. Estradiol stimulation of the brain's acetylcholine may be important to rapid recall (2) and the estrogens may influence the health of the nerve endings (3, see illustration below). The common herb remedy recommended for memory deterioration with aging, Gingko biloba leaf extract, which is believed to act primarily by enhancing circulation (and, to a lesser extent by affecting acetylcholine levels), showed only minor effects in a six week treatment period (4).
Estrogen's role in memory may be due in part to its affect on the tiny knobs called spines that protrude from a neuron's message receiving ends, known as dendrites. Spines are where important connections between neurons are made. The above images demonstrate that doses of estrogen resulted in a two-fold increase of the number of spines in rat embryo brain cells (left) compared to those without the supplements of estrogen (right). The cells were taken from brain areas responsible for memory processes. Images by Diane Murphy, Ph.D., National Institutes of Health.
ACUPUNCTURE THERAPY
In a recent report in the Journal of Traditional Chinese Medicine (5), an acupuncture protocol was described for treatment of menopausal syndrome that focused on attempting to improve mental activities. The treatment was claimed to have a notable beneficial effect and also to alter the levels of key menopause-related hormones: E2 (estradiol), FSH (follicle stimulating hormone), and LH (luteinizing hormone).
The basis of the therapy was described by the authors, who utilized a modern TCM description and associated the hypothalamus and hypophysis (pituitary) glands with the brain and the ovaries with the kidney system:
TCM holds that climacteric syndrome is a condition in which the hypofunction of the ovary and the decreased secretion of estrogen may cause imbalance of the hypothalamus-hypophysis-ovary axis.
So, the occurrence of the syndrome is the result of the disturbance of the brain-kidney activities. In normal conditions, the brain vitality goes down to stimulate and control the kidney, while the kidney essence goes up at the same time to nourish the brain vitality. Based on this theory, we developed a strategy of regulating the mental activities and reinforcing the kidney to treat the disease. In the prescription, fengfu (GV-16) and baihui (GV-20), pertaining to the Du (governing) channel that connects the brain and kidney, are essential points. Needling them has the actions of refreshment and regulating the mental activities, freeing the Du channel to bring about communication between the brain and the kidney. Needling the pointshenshu (BL-23), where the kidney essence and kidney-qi converge and transport from, has the actions of supplementing the kidney and replenishing the essence, engendering the marrow, and nourishing the brain. Qihai (CV-6), a point pertaining to the Ren (conception) channel, has the actions of reinforcing the primordial qi, supplementing the kidney, and balancing the Du channel with the Ren channel.
FOLLOW-UP TREATMENT AND HERBS
Although the authors of the first study did not comment on what would be done following this initial one month of treatment, standard practice in China is to maintain the results through additional, but less frequent, acupuncture (e.g., once or twice per week depending on the patient needs) and with herb therapies.
One of the suitable herb therapies for brain fog is Bu Nao Wan (Brain Tonifying Pills), which are made with several different recipes, but an example is this one (8), produced by ITM (Pine Mountain), and similar to a popular patent remedy which was known as Cerebral Tonic Pills:
Wu Wei Zi Schizandra 20%
Suan Zao Ren Zizyphus 16%
Dang Gui Tang-kuei 10%
Rou Cong Rong Cistanche 8%
Gou Qi Zi Lycium 8%
Bai Zi Ren Biota 6%
Ren Shen Ginseng 4%
Yi Zhi Ren Alpinia 4%
Yuan Zhi Polygala 4%
Shi Chang Pu Acorus 4%
Tian Nan Xing Arisaema 4%
Hu Po Succinum 4%
Long Chi Dragon tooth 4%
Tian Zhu Huang Bamboo sap 4%
As can be seen, the formula is dominated by schizandra and zizyphus, two herbs that stabilize the mental functions. In Pharmacology and Applications of Chinese Materia Medica (9) it is noted that: "Human intellectual activity can be enhanced by schizandra so that work efficiency is increased. Schizandrin [a major active component of the herb, illustration below] at 5-10 mg could improve certain activities requiring concentration, fine coordination, sensitivity and endurance...." Zizyphus is the primary sedative herb used in Chinese medicine, but it produces a mild calming effect rather than a heavy sedating activity, and thus is often taken during the day, not just as night. Both schizandra and zizyphus help alleviate excessive sweating that may occur with menopausal flushing.
Bu Nao Wan includes several herbs that treat the condition called "phlegm-mist" or "phlegm-turbidity" which affects mental functions. As an example, the physician Jiao Shude (10) mentions that "acorus is frequently used to open and free the orifices of the heart, diffuse qi, and eliminate phlegm, thereby arousing the brain and clearing the spirit...phlegm turbidity and qi depression affect the heart spirit and result in palpitations, forgetfulness, fright and fear, and disquieted essence-spirit…." He further notes that polygala "promotes heart-kidney interaction, supplements the heart and boosts the kidney, and tends to be used for fright palpitations, forgetfulness, insomnia, and spiritlessness. In the Clinical Handbook of Chinese Prepared Medicines (11), Bu Nao Wan is described as being useful for symptoms of "poor memory, uneasiness, palpitations, and insomnia."
REFERENCES
1. Sherwin BB, Estrogen and memory in women: how can we reconcile the findings?, Hormones and Behavior 2005; 47(3): 371-375.
2. Daniel JM, Hulst JL, and Lee CD, Role of hippocampal M2 muscarinic receptors in the estrogen-induced enhancement of working memory, Neuroscience 2005; 132(1): 57-64.
3. Ariniello L, Estrogen's influence on the brain, Brain Briefings, Society for Neuroscience, http://web.sfn.org/content/Publications ... rogen.html
4. Elsabagh S, Hartley DE, and File SE, Limited cognitive benefits in Stage +2 postmenopausal women after 6 weeks of treatment with Ginkgo biloba, Journal of Psychopharmacology 2005; 19(2): 173-181.
5. Shen Xiaoming, et al., Acupuncture for treatment of climacteric syndrome, Journal of Traditional Chinese Medicine 2005; 25(1): 3-6.
6. Ouyang Gang, et al., The effect of acupuncture on bone mineral density in postmenopausal women, Journal of Traditional Chinese Medicine 2002; 22(1): 9-11.
7. Deadman P and Al-Khafaji M, A Manual of Acupuncture, 1998 Journal of Chinese Medicine Publications, Hove, England.
8. Dharmananda S, A Bag of Pearls, 2004 Institute for Traditional Medicine, Portland, OR.
9. Chang HM and But PPH (editors), Pharmacology and Applications of Chinese Materia Medica, 1986 World Scientific, Singapore.
10. Mitchell C, et al. (translators), Ten Lectures on the Use of Medicinals from the Personal Experience of Jiao Shude, 2003 Paradigm Publications, Brookline, MA.
11. Zhu CH, Clinical Handbook of Chinese Prepared Medicines, 1989 Paradigm Publications, Brookline, MA.