TCM: Dementia Etiology and Pathogenesis

• Dementia is a spectrum of diseases impacting cognition, memory, and mental and physical capabilities.
• In TCM, dementia is viewed as a spiritual and emotional abnormality arising from diminishing marrow, withering of the head, and a dysfunctional spirit mechanism.
• In Western medicine, Alzheimer’s disease is the most common type of dementia

Etiology and Pathogenesis in TCM

• The main pathogenesis of dementia involves dysfunction of the spirit mechanism, prolonged disease, and old age.
• Spirit Mechanism refers to the dynamic movement and regulation of Qi, Blood, and body fluids, governed by the Shen (Spirit), crucial for physiological balance.
• Seven Emotions are primary emotional states that can cause disease when excessive or prolonged, affecting Qi, Blood, and organ functions.
• Marrow Sea is the reservoir of marrow that nourishes the brain and spinal cord, related to the Kidneys and Essence.

TCM Perspective on Dementia Development

• Dementia originates in the brain but develops from heart, spleen, liver, or kidney disease.
• Age-related deficiencies of Qi and Blood weaken kidney qi, leading to deficiencies in the marrow sea and spirit mechanism.
• Kidney essence nourishes the brain and maintains its functions; deficiency leads to brain dystrophy, amnesia, headache, dizziness, and retarded response.
• In TCM, dementia is mainly caused by deficiencies of yin-essence, blood, and qi, secondarily by excesses of qi, phlegm, and stasis.

Prolonged Disease

• Prolonged stroke or vertigo damages qi and blood in the heart, liver, spleen, and kidney, reducing brain nutrients and marrow.
• Spleen Qi deficiency or Liver Qi stagnation induces Phlegm accumulation and Blood stasis, obstructing the brain orifices, leading to cognitive decline.

Phlegm in TCM

• Phlegm refers not only to respiratory phlegm but also to pathological metabolites accumulated in the body after being condensed.

Injury to Seven Emotions

• Emotional issues cause liver qi depression and blood stasis.
• Liver qi depression weakens spleen function, causing phlegm accumulation, which combines with blood stasis to block brain orifices, leading to spirit dysfunction.
• Negative emotions damage the spleen and stomach, reducing Qi and causing cognitive decline.

Dysfunction of Spirit Mechanism

• Dysfunction of the spirit mechanism involves disturbance of blood and qi regulation, leading to blood stasis and qi depletion.
• Blood stasis manifests as low cerebral blood flow or stroke.
• Memory impairment arises from blood stasis and insufficient qi.

Insufficiency of Marrow Sea

• Age-related deficiencies of Qi and Blood weaken kidney qi, impairing the spirit mechanism.
• Kidney essence nourishes the brain; deficiency leads to brain dystrophy, amnesia, headache, and dizziness.
• Western medicine identifies Alzheimer’s disease as the most common type of dementia, a progressive neurodegenerative disease.

Dementia Manifestations

• Dull expression and low IQ is associated with dementia
• Sudden crying or laughing is associated with dementia
• Murmuring or silence throughout the day is associated with dementia
• No appetite is associated with dementia
• Feeling of fullness and stomach discomfort is associated with dementia
• pale tongue with white greasy fur is associated with dementia
• Rolling pulse is associated with dementia
• Blood stasis is associated with dementia
• Poor memory, calculation skills, and direction determination is associated with dementia
• Poor judgement, laziness, rotten teeth, and sore waist and knees is associated with dementia
• pale enlarged tongue with white tongue fur is associated with dementia
• Short breath, cold limb, abdominal pain releived with pressing is associated with dementia

TCM Diagnosis Methods

• Inspection involves observing facial complexion, tongue (color, shape, coating), body shape, posture and observing eyes, nails, hair, and skin
• Inquiry involves assesing mental, cognitive, appetite, thirst and emotional state and energy
• Pulse diagnosis is also important
• A deep fine weak pulse indicates insufficiency of the marrow sea.
• A rolling pulse indicates orifice blinding by phlegm turbidity.
• A fine uneven pulse indicates blood stasis.

TCM Treatment Principles

• Treatment goals include expelling phlegm, treating depression, opening orifices, promoting blood circulation, cleansing the liver, supplementing marrow, nourishing the head, and invigorating kidney essence.

Herbal Treatments

• Qi Fu Yin nourishes yin and blood, strengthens the spleen to expel phlegm and open orifices.
• Huan Shao Dan tonifies Kidney Essence and Liver Blood and supports cognitive function.
• Di Tan Tang clears phlegm-heat, opens sensory orifices, and supports the spleen.
• Tong Qiao Huo Xue Tang promotes blood circulation, clears blood stasis, and unblocks meridians
• Acorus tatarinowii and Salvia miltiorrhiza are used in dementia therapies.

Acupuncture Points

• Shen Men calms the spirit and benefits memory.
• Shao Shang revives consciousness and helps with mental fog.
• Xin-Shu tonifies the Heart.
• Yong Quan restores energy and strengthens vitality.

Additional Treatment

• Balancing Qi promotes smooth blood circulation.
• Calming the Mind reduces stress and emotional imbalances
• Tai chi exercises can prevent dementia or slow its progression.