health begins with the brain

HEALTH BEGINS WITH THE BRAIN

Professor SW TangEmeritus Professor of Psychiatry,

UC Irvine , USADirector, Institute of Brain Medicine

THE MEANING OF LIFE MANY MILLION YEARS AGO:THE PRIMITIVE LIFE FORMS

Survival was the meaning of Life To Survive:

Food Then to preserve species :

Reproduction

Food & SexKnown for thousands of years:a. “The desire for food and sex is basic to

animals, & is human nature” (Mencius) 孟子 ( 告子 ) “ 告子曰 : 食色性也” b. “Eating and Sex are human wants”

(Confucius)孔子 : 礼记“饮食男女，人之大欲存焉”

CNS CORE WAS A SURVIVAL

CO-ORDINATION CENTER ONLY & STILL IS

THE BRAIN OF LOWER ANIMALS MAY NOT EVEN BE ESSENTIAL FOR SHORT TERM

SURVIVAL

Insects can live for a short term without the brain and to fulfill the

purpose of reproduction e.g. praying mantis

Mantis Mating

“Thinking” is NOT necessaryfor the continuation of Life

Insects Mammals

Limbic brain added :(hippocampus, amygdala, nucleus

accumben and other limbic circuit components)

To: Sense danger , eat or runSpatial orientation and memory for food

and escape (Hippocampal function, Serotonin (5HT) function)

Pleasure (Dopamine (DA) function) : to repeat behavior which are rewarding

Higher Mammals

Addition of Cortex to integrate the Limbic and the core brain :

Cortex needed for the Analysis of a complex world :

To find the best way to carry on with the species:

a. strong mate for strong genetics strong off-springs for best survival

b. Analysis of the othersc. Build a stable environment for bring up the

off-springs (society/civilization)

MAJOR DIFFERENCE BETWEEN THE HUMAN

BRAIN & BRAINS OF LOWER

ANIMALS

Addition of the 1. (Cortex) to

2. (Limbic brain) & 3. (Brain core)

SOME DO NOT USE THEIR CORTEX (THOSE WHO’S LIFE PURPOSE WAS ONLY

“EAT AND REPRODUCE” )

“The Wisest and the Most Stupid are NOT Changeable ” (Confucius )

子曰： “唯上智與下愚不移” (論語 ‧ 陽貨第

十七)

Evolution of The Tri- Brain

1. Brain Core : co-ordination center , …. All animals (e.g. insects have only brain core)

2. Limbic Brain : emotion, pleasure, fear, …..All

animals (e.g. reptiles have largely limbic brain)

3. The Cortex : a. Lower animals (small cortex, e.g.

rats) b. Primates (large cortex, e.g. human)

The Rise of the Cortex : Analysis of Complex environment (dangers abound)

Cortex

Pallium

subpallium

A

ACortex

A

Rat

PrimateAvian

The functions of the Tri-brain are same but forms differ in Human

1. Feeding ( job earning enough eat well) [DA, 5HT]

2. Love & Defense (love, attachment, fear, anger, aggression) [5HT, DA, sex hormones]

3. Reproduction ( sensation seeking, attracted to the right mate ) [DA, oxytocin, vasopressin]

4. Continuation of life ( commitment, family function, maternal behavior) [oxytocin, vasopressin]

5. Social Interaction (civilization) [cortisol]

Hippocampus

OB

MidbrainThalam

us

Sensory Inputs e.g. eye

Reproductive,Sexual attraction

Fear,Anxiety

Vocalization.e.g. Song

Motor OutputAppetitive Reward

Amygdala remains an important Structure in evolution and is the basis for psychosomatics

Avian Brain

Inputs

Sensory cortex

FrontalPre frontal cortex

Hippocampus(contextual input)

Olfactory(pheromones)ThalamusInsular Cortex

Hormonal

Outputs

Thalamus

Cortex

Striatum

Hippocampus

Hypothalamus

Brain Stem

Vagal

Role of Amygdala in psychosomatics

+ +

+

-

Vertebrate Cerebrum organization Using More Chemicals

Cortex

Striatum,Limbic

ThalamusHypothalamusTegmentumBrain Stem

DA

GABAPeptides

Ach

Glu

Amygdala/Hippocam

pus

Executive function

Cognitive function

DA reward Pathways

Core

Q: To what extent the frontal cortex can modulate amygdala activities ?

• Aristotle: "The person who is angry at the right things and toward the right people, and also in the right way, at the right time and for the right length of time is morally praiseworthy.”

• Menzi : Mother moving thrice to ensure the best environment

• Shunzi : Human’s evil nature modifiable by learning

Amygdala & Batman

Amygdala

alias of a character in Batman comicsa sometime opponent of Batmanhas reduced cortical capacity, is prone to

outbursts of violence due to the removal of his amygdala in an attempt to rid him of his homicidal rage

AUTISM, ASPERGER’S AND SENSELESS CRUELTY &

VIOLENCE Amygdala, Insula and Mirror

Neuron Implicated

Early Life Resilience Formation

Quality and Quantity of early-life maternal care : a predominant signal triggering gene expression in glucocorticoids and corticotropin releasing factor (CRH)

development of resilience or vulnerable phenotypes

Amygdala

Cortex

Hypothalamus Pons

Amygdala

Weak CortexInsula

Strong CortexInsula(Aristotle,Shunzi)

Insensitive Amygdala Amygdala

Un-buffered emotionSolution direct

Highly Buffered EmotionSolution after filtering

HUMAN The strength of Cortex over Limbic and

Brain Core center:: basis for civilization and social behavior but

also the basis for many important human health problems

HEALTH BEGINS WITH THE BRAIN

MANY BODY FUNCTIONS ARE UNDER SUBTLE BRAIN

CONTROL

Some commonly known (e.g. cannot use your fingers, walk after stroke),

some not so much known (e.g. immunological system)

But many related to human social interaction and psychosomatics

Psychosomatic

Common Brain based health presentations: a. Aches & Pains [Sciatica (special case of psychosomatic: Floating anxiety sleep disturbances muscle tension, back pain

b. GI disturbances (very high % of patients in GI clinics)

c. Chest discomfort (very high % of patients in cardiac clinics)

d. Dermatological (ezcema …) e. Medically unexplained symptoms

ANNUAL PHYSICAL CHECK UPS:

Begins with the Brain

Thank You !