Senile+Dementia

=**Senile Dementia**= Refers to mental disease which occurs before or after 65 years of age. It’s pathological change is cerebral atrophy which is marked in the frontal lobe. The weight of the brain is at least 100g. lighter than that of a normal elderly person The neurons are atrophic, and the nu ber and quality of nerve cells are reduced. Because the average length of human life has been prolonged, the incidence of senile dementia is gradually rising…

Relevant TCM Diseases: Feeble-mindedness (Chi Dai), impaired memory (Jian Wang), Deranged speech (Yan Yu Cuo Luan), Withdraw and Mania (Dian Kuang)

Differential Diagnosis: Medical Disorders: Metabolic disorders A. Vitamin Deficiencies including B12 and folic acid B. Hypercalcemia assoc. with hyperparathyroidism C. Hypoglycemia D. Hypothyroidism E. Organ System Failure, e.g hepatic, respiratory or renal encephalopathy F. Pellagra Structural disorders A. Alzheimer’s Disease B. Amyothrophic Lateral Sclerosis (ALS) C. Brain Trauma D. Communicating hydrocephalus E. Huntington’s Disease F. Multiple Sclerosis (MS) G. Parkinson’s Disease H. Pick’s Disease I. Vascular Disease J. Wilson’s DIsease Infectious disorders A. Bacterial endocarditis B. Creutzfeld-Jakob Disease C. HIV Dementia D. Neurosyphilis E. Tubercolar & functional meningitis F. Viral encephalitis Effects of Substances: A. Chronic alcohol abuse B. Drug intoxication Psychiatric disorders: A. Pseudodementia

TCM Etiology and Pathogenesis: “Due to decline in visceral function and especially that of the kidneys and spleen, during old age, qi and blood become progressively vacuous and debilitated, and hence to constructive and defensive are not well regulated. Therefore clear yang is not unborne, and tubid yin is not downborne, and the spirit brilliance suffers progressive damage and detriment day by day. In addition, due to a variety of disease causes and mechanism, there appear qi stagnation, blood stasis and phlegm congelation which mist and confound the orifices of the heart. Other disease causes resulting in the disease mechanisms associated with this condition include the side effects of many medications many elderly take on a regular basis and their interactions. Thus qi and blood are not able to fill and nourish the mansion of the original spirit, i.e. the brain. Rather there is bewilderment and chaos in the mechanism responsible for the spirit brilliance.”1

TCM Pattern Differentiation: Kidney Essence Insufficiency Pattern 1 Feeble-mindedness in the elderly, difficulty thinking, mental confusion, impaired memory, essence spirit abstraction, deafness, tinnitus, susceptibility to fear, easy fright, low back and knee soreness/weakness, lower limb atrophy, weakness **Tongue:** pale tongue, thin white coat **Pulse:** deep, weak esp. in chi positions **Treatment Principles:** Supplement the kidneys and fill the essence, boost the marrow and fortify the brain **Acupuncture Treatment:** Tonify: BL-23, BL-52, CV-4, KI-4, SP-6 **Herbal Treatment:** //Da Zao Wan Jia Jian//1 [Zi He Che (3g.), Du Zhong (9g.), Niu Xi (12g.), Mai Men Dong (12g.), Tian Men Dong (12g.), Shu Di Huang (12g.), Ren Shen (6g.), Yi Zhi Ren (15g.), Gui Ban Jiao (12g.), Lu Jiao Jiao (12g.)]

Yin Vacuity-Internal Heat Pattern 1 Dizziness, vertigo, impaired memory, scanty sleep, deafness, tinnitus, low back and leg soreness and weakness, parched throat and dry tongue, thin emaciated body, 5-palm heat, red cheeks, tidal heat, night sweats, symptoms worse in evening **Tongue:** red tongue, dry scanty coat **Pulse:** fine, rapid **Treatment Principles:** Nourish Yin and clear heat assisted by supplementing the kidneys **Acupuncture Treatment:** Tonify: KI-3, SP-6, BL-23, CV-4; Drain: HT-6, PC-7, HT-7 **Herbal Treatment:** //Zhi Bai Di Huang Wan Jia Wei// 1 [Zhi Mu (9g.), Huang Bai (9g.), Shu Di Huang (12-15g.), Shan Zhu Yu (9g.), Shan Yao (9g.), Fu Ling (9g.), Mu Dan Pi (6-9g.), Ze Xie (6-9g.), Yuan Zhi (6-9g.)] **Modifications:** Severe heat: + Huan Lian Marked insomnia: + Suan Zao Ren, Bai Zi Ren Pronounced agitation and restlessness: + Long Gu, Mu Li, Ci Shi Night sweats & palpitations: + Fu Xiao Mai, Wu Wei Zi Blood stasis: + Dan Shen, Yi Mu Cao

Spleen-Kidney Yang Vacuity Pattern 1 Feeble-mindedness, slow movement, scanty speech or no speech, difficulty thinking, confused thoughts, decreased memory power, loss of intelligence, fatigue, lack of strength, dizziness, deafness, tinnitus, low back/knee weakness, cold hands and feet, poor appetite, loose stools, possible cock-crow diarrhea, nocturia, clear long urination **Tongue:** pale, enlarged tongue, slimy white coat **Pulse:** deep, weak, moderate or slow **Treatment Principles:** Warm and supplement the spleen and kidneys, upbear the clear, boost intelligence **Acupuncture Treatment:** Tonify: SP-6, KI-7; Moxa: BL-23, GV-4, BL-20, BL-21, CV-8, CV-4 **Herbal Treatment:** //Jia Wei Shen Qi Wan//1 [Yi Zhi Ren (15g.), Huang Qi (12-18g.), Dang Shen (8-15g.), Bai Zhu (9g.), Fu Ling (9-12g.), Shu Di Huang (12-15g.), Shan Yao (9g.), Shan Zhu Yu (9-18g.), Mu Dan Pi (6-9g.), Ze Xie (9g.), Fu Zi (6-9g.), Rou Gui (6-9g.), Shi Chang Pu (6-9g.), Yuan Zhi (6-9g.)]

Heart-Spleen Dual Vacuity Pattern 1 Palpitations, impaired memory, insomnia, profuse dreams, sallow yellow complexion, bland effect, scanty speech, spontaneous perspiratio w/ slight exertion, decreased eating an drinking, abdominal distention, loose stools, fatigue, desire to lie down **Tongue:** pale tongue **Pulse:** fine, forceless **Treatment Principles:** Supplement the qi and nourish the blood, calm the heart & quiet the spirit **Acupuncture Treatment:** Tonify: BL-15, BL-17, BL-20, HT-7, ST-36, SP-6 **Herbal Treatment:** //Gui Pi Tang//1

Phlegm Misting the Clear Orifices Pattern 1 Feeble-mindedness, scanty/deranged speech, depressed affect, difficulty thinking, confused thoughts, slow movement, profuse phlegm, chest and abdominal oppression& fullness, somnolence, inability to control one's own activities, possible nausea and vomiting of phlegm drool, plum-pit qi **Tongue:** puffy, enlarged tongue that is both pale and dark; slimy white coat **Pulse:** slippery or bowstring-slippery **Treatment Principles:** Transform phlegm, open the orifices, settle the heart, quiet the spirit **Acupuncture Treatment:** Drain: ST-40, CV-12, CV-17, LR-3, PC-6 **Herbal Treatment:** //Wen Dan Tang Jia Wei//1 [Ban Xia (9-12g.), Fu Ling (9-12g.), Chen Pi (6-9g.), Zhu Ru (6-9g.), Zhi Shi (6-9g.), Gan Cao (3-9g.), Shi Chang Pu (9g.), Sheng Jiang (2-3 slices)] **Modifications:** Phlegm-heat: + Huang Lian, Dan Nan Xing, Hai Ge Ke, Meng Shi Marked Spleen vacuity: + Dang Shen, Bai Zhu

Stasis Stagnating In The Brain Network Vessels Pattern 1 History of external injury to the head, bland effect, difficulty thinking, confused thoughts, slow reactions, impaired memory, abstraction, scanty speech, dizziness and vertigo, vertex pain, fixed localized pain, possibly lancinating pain, an enduring condition that does not heal, age spots, varicosities, cherry hemangiomas, greenish blue lips, sooty facial complexion, dry scaly skin **Tongue:** dark purplish tongue, possible static macules or spots; thin white coat **Pulse:** fine, bowstring and/or choppy **Treatment Principles:** Quicken the blood and transform stasis, nourish blood, fortify the brain **Acupuncture Treatment:** Drain: LR-3, LI-4, SP-10, SP-6, GB-20, Yintang **Herbal Treatment:** //Tong Qiao Huo Xue Tang Jia Jian//1 [Chi Shao (9g.), Tao Ren (9g.), Hong Hua (9g.), Chuan Xiong (9-15g.), Cong Bai (9g.), Shi Chang Pu (9g.), Yuan Zhi (9g.), Dan Shen (9g.), Da Zao (2-3pcs.), Sheng Jiang (2 slices)]

Toxins Damaging the Brain Network Vessels Pattern 1 Symptoms associated with either a heat disease or poisoning, difficulty thinking, confused thoughts, unclear speech, emotional lability, heart vexation, insomnia, lassitude of the spirit, decreased intake, if extreme: lower limb paralysis, non-freely-flowing urination and/or defecation, loss of memory power **Tongue:** red tongue; scanty coat **Pulse:** fine, rapid **Treatment Principles:** Clear heat & resolve toxins, open the orifices, quiet the spirit **Acupuncture Treatment:** Bleed: Shi Xuan, GV-26 **Herbal Treatment:** //Huang Lian Jie Du Tang//1 [Huang Lian (3-9g.), Huang Qin (9g.), Huang Bai (9g.), Zhi Zi (6-12g.)]

Liver Depression Qi Stagnation Pattern 1 Emotional depression, vexation and agitation, easy anger, chest & abdominal oppression and discomfort relieved by belching and/or flatulence, no gusto in eating, lassitude of the spirit, lack of strength, insomnia, profuse dreams **Tongue:** thin white coat **Pulse:** bowstring **Treatment Principles:** Course the liver and rectify the qi, boost the intelligence, quiet the spirit **Acupuncture Treatment:** Drain: LR-3, LI-4, CV-17, PC-6, ST-36 **Herbal Treatment:** //Xiao Yao San Jia Wei//1 [Chai Hu (3-9g.), Yu Jin (9g.), Dang Gui (9g.), Bai Shao (9-18g.), Yuan Zhi (9g.), Bai Zhu (9-12g.), Fu Lin (9-12g.), Gan Cao (6-9g.), Bo He (3-6g.), Sheng Jiang (2 slices)]

Clinical Tips: Although Chinese medicine has traditionally emphasized the role of kidney essence vacuity in geriatric diseases, Yan De-xin suggests that kidney vacuity in the lederly is typically complicated by blood stasis. In addition, if there is feeblemindedness and clouded spirit, one must also factor in phlegm misting the clear orifices.