miércoles, 19 de septiembre de 2012
miércoles, 14 de marzo de 2012
martes, 7 de febrero de 2012
domingo, 11 de septiembre de 2011
Toxic Brain-Mind, the possible true cause
of seropositivity and AIDS
by Dr. Andrew MacLean Pagon MD
"Turn him to any cause of policy,
The Gordian Knot of it he will unloose,
Familiar as his garter"
The Gordian Knot of it he will unloose,
Familiar as his garter"
Henry V, Act 1 Scene 1. 45–47, (William Shakespeare (26 April 1564 CE-23 April 1616 CE)
1. The Objective of this little book
Contracting a HIV+ diagnosis is like having a huge punch in the face.
Psychological distress symptoms such as stigmatization, confusion, forgetfulness, anxiety, depression, interpersonal sensitivity, obsessive-compulsive behaviour, various personality traits and types, somatization and paranoid ideation and increased cortisol i.e. hydrocortisone levels etc. are mostly seen in the clinical situation.
Furthermore, in diagnosed AIDS dementia complex (ADC) specific neurological impairments are manifested by cognitive, behavioural, and motor abnormalities that occur after years of diagnosed HIV infection and are associated with low CD4+ T cell levels and high plasma viral loads.
AIDS related mania is sometimes seen in patients with advanced HIV illness; it presents with more irritability and cognitive impairment and less euphoria than could be associated with manic episode or true bipolar disorder.
Unlike the latter condition, it may have a more chronic course. This syndrome is less often seen with the advent and use of modern (Western) multi-drug therapy. All these symptoms are the result of the subsequent diagnosis and the further development of this complex syndrome.
Even though much is known about the pathogenesis of diagnosed HIV infection, important details still remain to be elucidated.
A thorough, complete, meticulous understanding of the pathogenesis of a disease ought to be prerequisite to knowing its cause and subsequently, the most optimal correct treatment.
In this little book the hypothesis is been presented which gives insight according to integrated and transcultural medical and psychiatric model that diagnosed HIV infection and AIDS might be related to an early psychological trauma(s).
True science is very well organised ethical knowledge.
The normal (relatively) steady state of the body’s organ systems and tissue function is termed (relative) homeostasis. One significant factor that may cause an upset to homeostasis is stress. Stress is the absence of (relative) homeostasis (Wisneski & Anderson, 2005).
Stress is a biological term which refers to the consequences of the failure of a human or animal to respond appropriately to mental- emotional or physical threats to the organism, whether actual or imagined. (The Stress of Life, Dr Hans Hugo Bruno Selye, New York: McGraw-Hill, 1956 CE)
There are four main physiological reactions to stress:
Blood is shunted to the brain and large muscle groups, and away from extremities, skin, and organs that are not currently serving the body.
An area near the brain stem, known as the reticular activating system, goes to work, causing a state of keen alertness as well as sharpening of hearing and vision.
Energy-providing compounds of glucose and fatty acids are released into the bloodstream. The immune and digestive systems are temporarily shut down. Signs of stress may be cognitive, emotional, physical, or/and behavioural.
§ Signs may include:
§ Poor attitude/judgment/decision making,
§ A general negative outlook: restriction of daily activities
§ Excessive worrying, nervousness
§ Moodiness, irritability, and agitation,
§ Inability to relax, loss of patience with spouse or children
§ Feeling lonely, isolated or depressed, social withdrawal
§ Inability to concentrate
§ Muscle tension and aches and pains which might migrate (wrist, head, neck, shoulder(s), elbow, chest, lower back, hip, knee, ankle etc.)
§ Numbness or tingling in the arms or hand, legs or feet
§ Digestive disturbances such as diarrhoea or constipation, and nausea etc.
§ Rapid heartbeat
§ Eating too much or not enough, trouble with weight gain or/and weight loss
§ Sleeping too much or not enough, sleep with interruptions
§ Procrastination or neglect of responsibilities
§ Increased alcohol, nicotine, various drug consumption
§ Nervous habits such as pacing about, nail-biting etc.
§ Unable to work long hours, decreased productivity restricted household duties and hinders participation in sports or ability to exercise
§ Exhaustion at the end of the day
§ Decreased sexual desire or/and performance etc.
In Dr Selye's terminology, "stress" refers to a condition, and "stressor" to the internal reaction causing stress. Both negative and positive stressors can lead to stress. The intensity and duration of stress changes depend on the circumstances and mental- emotional condition of the person suffering from it (Arnold. E and Boggs. K. 2007 CE).
Some common categories and examples of stressors include:
ü Sensory input such as pain, bright light, noise, temperatures, or environmental issues such as a lack of control over environmental circumstances, such as food, air and/or water quality, housing, health, freedom, or mobility etc.
ü Social issues such as struggles with conspecific or difficult individuals and social defeat, or relationship conflict, deception, or break ups, and major events such as medical diagnosis, birth and deaths, marriage, and divorce etc.
ü Life experiences such as poverty, unemployment, performance pressure stress from exams and project deadlines, stress at work etc.
ü Adverse experiences during development (e.g. prenatal exposure to maternal stress,), poor attachment histories, and sexual abuse etc. are thought to contribute to deficits in the maturity of an individual's stress response systems.
A. General Adaptation Syndrome (GAS)
Physiologists define stress as how the body reacts to a stressor, real or imagined a stimulus that causes stress. Acute stressors affect an organism in the short term; chronic stressors over the longer term.
Dr. Selye researched the effects of stress. Alarm is the first stage. When the threat or stressor is identified or realized, the body's stress response is a state of alarm. During this stage, adrenaline i.e. epinephrine will be produced in order to bring about the fight-or-flight response. There is also some activation of the HPA axis, producing cortisol i.e. hydrocortisone.
Resistance is the second stage. If the stressor persists, it becomes necessary to attempt some means of coping with the stress. Although the body begins to try to adapt to the strains or demands of the environment, the body cannot keep this up indefinitely, so its resources are gradually depleted.
Exhaustion is the third and final stage in the GAS model. At this point, all of the body's resources are eventually depleted and the body is unable to maintain normal function. The initial autonomic nervous system symptoms may reappear (sweating, raised heart rate, etc.). If stage three is extended, long-term damage may result, as the body's immune system becomes exhausted, and bodily functions become impaired, resulting in decompensation.
The result can manifest itself in obvious illnesses such as ulcers, depression, diabetes, trouble with the digestive system, or even cardiovascular problems, along with other mental-emotional distress and/or illnesses/syndromes.
B. Cognitive appraisal model
Dr Richard S. Lazarus argued that, in order for a psychosocial situation to be stressful, it must be appraised as such. He argued that cognitive processes of appraisal are central in determining whether a situation is potentially threatening, constitutes a harm/loss or a challenge, or is benign.
Both personal and environmental factors influence this primary appraisal, which then triggers the selection of coping processes. Problem-focused coping is directed at managing the problem, whereas mental-emotion-focused coping processes are directed at managing the negative thoughts and emotions. Secondary appraisal refers to the evaluation of the resources available to cope with the problem, and may alter the primary appraisal.
In other words, primary appraisal includes the perception of how stressful the problem is and the secondary appraisal of estimating whether one has more than or less than adequate resources to deal with the problem that affects the overall appraisal of stressfulness. Further, coping is flexible in that, in general, the individual examines the effectiveness of the coping on the situation; if it is not having the desired effect, s/he will, in general, try different strategies. (Lazarus, R.S. (1966). Psychological Stress and the Coping Process. New York: McGraw-Hill.)
C. Eustress and distress
Dr Selye published in 1975 CE a model dividing stress into eustress and distress. (Selye (1975) "Confusion and controversy in the stress field". Journal of Human Stress 1: 37–44.)
Where stress enhances function (physical or mental, such as through strength training or challenging work), it may be considered eustress. Persistent stress that is not resolved through coping or adaptation, deemed distress, may lead to anxiety or withdrawal (depression) behaviour.
The difference between experiences that result in eustress and those that result in distress is determined by the disparity between an experience (real or imagined) and personal expectations, and resources to cope with the stress. Alarming experiences, either real or imagined, can trigger a stress response. (Ron de Kloet, E; Joels, M. & Holsboer, F. (2005). "Stress and the brain: from adaptation to disease". Nature Reviews Neuroscience 6 (6): 463–475.)
Distress is the most commonly-referred to type of stress, having negative implications, whereas eustress is a positive form of stress, usually related to desirable events in a person's life. Both can be equally taxing on the body, and are cumulative in nature, depending on a person's way of adapting to a change that has caused it. The body itself cannot physically discern between distress and eustress. (J. Kabat-Zinn. Full catastrophe living - how to cope with stress, pain and illness using mindfulness meditation. (1996)
D. The neurochemistry of the stress response
Contrary to the popular belief, the neurochemistry of the stress response is neither well understood, nor how the components of this system interact with one another, in the brain, mind and throughout in the body.
However, the following is known:
Stress refers to any external or internal demands placed on the body and mind. This can be a cognitive sensory stimulus that comes from outside the body, such as the death of a spouse or a child. Cognitive stress is processed through the peripheral nervous system (cranial and spinal nerves) and central nervous system (brain and spinal cord).
Stress can also be an internal sensory input, or a non-cognitive stress, such as a bacterial or viral or fungal infection etc. Cognitive stress is received by the immune system, which relays this information to the neuroendocrine system (Blauer-Wu, 2002).
Psychoneuroimmunology focuses primarily on the mind-body connection concerning cognitive stress. When an individual can no longer adapt to a stressor, (relative) homeostasis is not maintained. The body cannot continue its normal functions. Stress causes chronic suppression of the immune system, increasing the risk for contracting certain diseases (Melmed, 2001).
In response to a stressor, neurons with cell bodies in the paraventricular nuclei (PVN) of the hypothalamus secrete corticotropin-releasing hormone (CRH) and arginine-vasopressin (AVP) into the hypophyseal portal system. The locus ceruleus and other noradrenergic cell groups of the adrenal medulla and pons, collectively known as the LC/NE system, also become active and use brain epinephrine to execute autonomic and neuroendocrine responses, serving as a global alarm system. The autonomic nervous system provides the rapid response to stress commonly known as the fight-or-flight response, engaging the sympathetic nervous system and withdrawing the parasympathetic nervous system, thereby enacting cardiovascular, respiratory, gastrointestinal, renal, and endocrine changes. (Tsigos, C. & Chrousos, G.P. (2002). Hypothalamic-pituitary-adrenal axis, neuroendocrine factors, and stress. Journal of Psychosomatic Research, 53, 865–871.)
The HPA axis, a major part of the neuroendocrine system involving the interactions of the hypothalamus, the pituitary gland, and the adrenal glands, is also activated by release of CRH and AVP. This results in release of adrenocorticotropic hormone (ACTH) from the pituitary into the general bloodstream, which results in secretion of cortisol and other glucocorticoids from the adrenal cortex. The related compound cortisone is frequently used as a key anti-inflammatory component in drugs that treat skin rashes and in nasal sprays that treat asthma and sinusitis. Recently, scientists realized the brain also uses cortisol to suppress the immune system and reduce inflammation within the body. (National Institute of Health, Harrison Wein, PhD, "Stress and Disease: New Perspectives")
These corticoids involve the whole body in the organism's response to stress and ultimately contribute to the termination of the response via inhibitory feedback. (Tsigos, C. & Chrousos, G.P. (2002). Hypothalamic-pituitary-adrenal axis, neuroendocrine factors, and stress. Journal of Psychosomatic Research, 53, 865–871.)
Some findings that point out the relationship between stress and disease are (very) noteworthy. There is an increased risk for heart disease for individuals experiencing either acute or chronic stress (Krantz, Sheps, Carney, & Natelson, 2000; O.Connor, C.M., Gurbel, P.A., & Serebruany, V.L., 2000).
These researchers have shown that stress increases platelet activation, which is a cause of heart attacks. Other correlations are pointed out between stress and gastrointestinal disorders, chronic pain and diabetes (Jacobs, 2001).
It has also been confirmed that stress is responsible for making one more vulnerable for catching the common cold (Cohen & Miller, 2001). Chronic stress has also been found to have devastating effects on the brain (McEwen, 2000). It decreases the size of the hippocampus, which impairs memory. Certain life experiences may be very stressful. Loss of a child, loss of a spouse, and divorce can be devastating to an individual. However, any stressor will stimulate and elevate enzymes in the adrenal glands to produce the major stress hormones, which are epinephrine, norepinephrine, and adrenal corticoids. These hormones are responsible for activating biochemical changes in the nervous, endocrine, and immune systems, which affect all organ systems (Blauer-Wu, 2002).
Psychological stressors are known to trigger the immune system and the responses made to these stressors may result in different diseases. The exact mechanisms involved in triggering the immune system are not clear. However, it is believed to be a multilayered response (Blauer-Wu, 2002).
Contrary to previous thinking, neurotransmitters that were once thought to be only in the brain are located in the immune system as well. Therefore, any immune function can occur in the brain. When the central nervous system (CNS) receives cognitive stimuli, it conveys that information by hormonal pathways to receptors on immune cells.
This causes immunological changes. For example, certain receptors that are the primary inhibitory neurotransmitters and benzodiazepine receptors that are anti-anxiety molecules have been found to exist in the immune cells in addition to the brain. These receptors can actually modulate the actions of the immune system (Song & Leonard, 2000).
This is the physical basis for the mind’s influence on the development of disease, which is a primary example of the mind-body connection. The immune system helps to maintain (relative) homeostasis within the body. Stress induced alterations in the immune system occur primarily in the spleen, lymph nodes, and lymphoid tissues. However, there are numerous components of the immune system that may be modified by stress hormones. It has been shown that individuals who are under stress are at an increased risk for developing autoimmune diseases. The most common autoimmune diseases related to stress are psoriasis, rheumatoid arthritis, and multiple sclerosis (Jacobs, 2001).
It must be pointed out that stress alone does not necessarily determine how well or poorly the immune system will function. The important factor is the individual’s ability to cope with stress (Blauer-Wu, 2002).
How an individual perceives a stressful event may be more important than the existence of the stress itself. Individuals with high stress levels and excellent coping skills may have minimal effects on the functioning of their immune systems. A low level of stress in individuals who have poor coping skills may have significant alterations in their immune functioning, increasing their susceptibility to disease. The actual amount of stress is not important for determining its effect on the immune system. An individual’s overall coping skills are the important factor for determining the immune system’s response to stress.
One other important finding is that behavioural characteristics in individuals may influence their immune response to stress. It is suggested that personality characteristics may have a role in how the immune system responds to stress.
Peaceful individuals may have lower cortisol levels, and consequently, have fewer alterations in their immune systems in response to stressors. Both the mind and body respond to stressors, and the physiological pathways of the neuroendocrine and immune systems communicate between them.
E. About lymphocyte apoptosis
Apoptosis (caspase-mediated cell death/programmed cell death0, is type of cell death in which the cell uses specialized cellular machinery to kill itself.
Various studies have clearly demonstrated that the immune system is very sensitive to either physiological or psychological stress. Stress has been demonstrated in both humans and animals to be immunomodulatory and alter the pathogenesis of tumour development, autoimmunity, and infectious diseases by influencing the onset, course, and outcome of the pathological processes (Rabin, Cohen, Ganguli, Lysle, & Cunnick, 1989).
Although acute stress is generally believed to exert positive effects on the immune system, chronic stress frequently leads to immunosuppression, which is at least in part due to the reduction of lymphocytes (Berthiaume, Aparicio, Eungdamrong, & Yarmush, 1999; Pariante etal., 1997; Zorrilla et al., 2001).
Stress-induced lymphopenia/ lymphocytopenia has been observed in surgical patients (Galinowski, 1993; Iwagaki, Morimoto, Kodera, & Tanaka, 2000; Kunes & Krejsek, 2000), over exercised athletes (Pedersen, Bruunsgaard, Jensen, Krzywkowski, & Ostrowski, 1999, 1997), persons under various psychological stress (Capitanio & Lerche, 1991; Zakowski, McAllister, Deal, & Baum, 1992), and animals subjected to physical restraint (Padgett, Marucha, & Sheridan, 1998; Sheridan et al., 1998; Yin et al., 1999).
Due to the rapid advancement of apoptosis research, a variety of methods have been devised to detect apoptotic cells. By using these technologies, research in several laboratories has concluded that lymphopenia/ lymphocytopenia observed after exposure to stress is in fact due to the induction of apoptosis (Yin et al., 1999).
The physical restraint mouse model was employed and examined the effect of chronic stress on lymphocyte apoptosis (Yin et al., 1999). Subjected BALB/c mice aged 7–9 weeks to a 12-h physical restraint regimen daily for 2 days (Bonneau, Sheridan, Feng, & Glaser, 1993) and found that this treatment dramatically affected splenic cellularity.
These mice showed approximately a 35–40% reduction in the number of lymphocytes in the spleen as compared to unstressed controls. To investigate whether the cell death is due to apoptosis, terminal deoxyribonucleotidyl transferase- mediated dUTP-digoxigenin nick-end labelling (TUNEL) assay was performed on spleen histological section from control and mice that underwent stress treatment. It has been found that there is a significant increase in TUNEL positive cells, indicating that the reduction of splenic cellularity is due, at least in part, to the induction of apoptosis (Yin et al., 2000).
It is generally believed that stress-induced apoptosis in peripheral lymphoid organs becomes apparent after 12 h or longer upon exposure. Stress also causes a marked increase in apoptosis in the thymus, and a reduction in the total number of thymocytes. Interestingly, the thymus appears to be more sensitive to stress. Apoptosis in the thymus occurs within 6 h. Among all thymic cell populations, the proportion of CD4 and CD8 double positive thymocytes are more sensitive, suggesting that the increased apoptosis mainly affected cells of the immature phenotype (Ayala, Herdon, Lehman, Ayala, & Chaudry, 1996; Dominguez-Gerpe & Rey-Mendez, 2001).
In a recent study, Dominguez-Gerpe and Rey-Mendez (2001) studied chronic stress on various populations of T cells.
Although the overall trend is that the majority of lymphocytes are reduced, there is some variation among different populations. Mature T cells are more sensitive than B cells. Interestingly, circulating immature T cells (CD3+PNA+) increase. The most significant increase in T cell numbers occurs in the bone marrow, suggesting a possible effect of chronic stress on cell migration.
Increases in T cell apoptosis have also been observed in patients undergoing surgical procedures (Delogu et al., 2000; Delogu et al., 2001; Oka et al., 1996; Schroeder et al., 2001).
It seems that monocytes play an important role in the induction of T cell apoptosis. Co-culture of T cells with monocytes from stressed patients induced apoptosis of T cells, whereas co-culture with monocytes from unstressed patients did not (Kono et al., 2001).
This observation may lead to the identification of cells responsible for providing a death signal to lymphocytes.
F. Endogenous opioids and lymphocyte apoptosis
Though it is known that several tissues and organs possess specific receptors for both endogenous and exogenous opioids, most information concerning the biological functions of opioid receptors is derived from studies of neuronal cells (Hyman, 1996; O’Brien, 1997).
However, the immune system is also profoundly affected by opioids as demonstrated by various in vitro and in vivo experimental systems (McCarthy, Wetzel, Sliker, Eisenstein, & Rogers, 2001).
It is now known that endogenous opioids play an important role in the interaction between the nervous and immune systems (Cabot, 2001; Salzet, Vieau, & Day, 2000; Vaccarino & Kastin, 2000).
The role of opioid receptors in the regulation of lymphocyte apoptosis was investigated mainly with exogenous opioids. The effect of exogenous opioids on apoptosis was first observed in the thymus in 1993 (Freier & Fuchs, 1993).
It was found that the in vivo administration of morphine could induce apoptosis in immature thymocytes. It is interesting to note that the effect of exogenous opioids on the immune system seems to be exerted through the opioid receptor (Wang et al., 2001).
Naloxone and naltrexone were employed as specific antagonists of opioid receptors and determined the role of endogenous opioids in stress-induced lymphocyte reduction in the spleen (Yin et al., 2000).
Although treatment of mice with opioid antagonists did not alter the number of splenocytes in unstressed mice, administration of naltrexone or naloxone prior to physical restraint completely blocked stress-induced reduction in splenocytes numbers. When apoptosis in spleen was analyzed by the TUNEL assay, it was found that both antagonists inhibited the appearance of TUNEL positive cells. Therefore, physical restraint-induced lymphocyte reduction appears to require endogenous opioids.
G. Glucocorticoids and lymphocyte apoptosis
High doses of steroid hormones have been shown to be immunosuppressive. In fact, the apoptosis associated characteristic 200-base pair genomic DNA fragmentation ladder was first identified from dexamethasone treated rat thymocytes (Wyllie, 1980).
This finding led many investigators to characterize apoptosis phenotypes with steroid hormones. Interestingly, steroid hormones have been suggested to play an important role in stress induced modulation of the immune system; however, some studies in the literature have challenged the general role of steroids in stress situations (Jefferies, 1991; Minton, 1994).
To examine the role of steroids in restraint induced lymphocyte reduction, adrenectomy on mice was performed. Both adrenectomized and sham treated mice were subjected to restraint stress. It was found that there is no significant difference in the restraint stress induced lymphocyte reduction in the two groups of mice (Yin et al., 2000). Therefore, the HPA axis is unlikely to be involved in mediating the reduction of splenocytes in this chronic restraint stress model. Our finding of the absence of an effect of adrenalectomy on chronic stress induced splenocytes reduction is in contrast with the role of the adrenal gland in acute stress induced enhancement of delayed-type hypersensitivity response reported (Dhabhar & McEwen, 1996).
This discrepancy is likely to be due to the stress duration and the evaluation parameters.
Indeed, McEwen et al. (1997) have suggested that the spleen is a relatively privileged site and is relatively inaccessible to endogenously produced corticosteroids.
Therefore, observation of the dispensability of adrenal glands in chronic stress-induced splenocytes reduction strongly suggests that the effects of endogenous opioids are likely exerted directly on splenocytes.
Recent studies indicate that stress-induced apoptosis in thymocytes is largely mediated by corticosteroids.
The experiments performed by Freier and Fuchs (1993) showed that in vitro exposure of thymocytes to morphine could not induce apoptosis, indicating the effect of morphine in vivo could be indirect.
Nevertheless, the effect could be completely blocked by the antagonist naltrexone. Furthermore, the effect of in vivo administered morphine could also be blocked by the Glucocorticoids receptor antagonist RU-486 (Fuchs & Pruett, 1993), indicating a critical role of the HPA axis in this process.
Therefore, a synthesis of the overall literature suggests that stress-induced apoptosis in immature T cells is through the HPA axis, while in mature T cells is mediated directly by endogenous opioids.
H. Free radicals and lymphocyte apoptosis
A redox imbalance caused by an over-production of prooxidants or a decrease in antioxidants plays an important role in the regulation of apoptosis, especially in the cells of the immune system.
Various studies have shown that antioxidant could block stress induced lymphocyte reduction (Brohee & Neve, 1994; Meerson, Sukhikh, & Pletsityi, 1985; Singh, Failla, & Deuster, 1994; Venkatraman & Pendergast, 2002).
It has been suggested that lymphocytes under oxidative stress are more prone to undergo apoptosis.
However, the mechanisms underlining redox sensitized cell death are not known. In light of investigation of the role of Fas and FasL interaction in stress induced lymphocyte apoptosis, it was hypothesized that redox produced under stress conditions promotes Fas-induced apoptosis. To test this hypothesis splenocytes were subjected from unstressed mice to either H2O2, JO2 (agonist antibody to Fas), or the combination and analyzed for apoptosis by DNA content analysis. It was found that when either H2O2 or JO2 was applied alone, there was minimal induction of apoptosis. However, when both reagents added to the culture at the same time, there is a significant increase in the number of cells underwent apoptosis.
Therefore, it is believed that the expression of Fas and the production of redox could act synergistically in the induction of apoptosis. This study provided an important link between redox and Fas in the stress-induced lymphocyte apoptosis. Further investigation of the molecular mechanisms by which redox promote Fas-mediated apoptosis will lead to a better understanding of how stress affect the immune system. It is suggested that oxidative stress is a physiological mediator of programmed cell death in lymphoid cells, and that HIV diagnosed disease represents an extreme case of what can happen when regulatory safeguards are compromised.
I. Neuroendocrine-Immune Interactions
Communication between the mind and the body is carried out by peptides called neurotransmitters. Three neurotransmitters, norepinephrine, serotonin, and dopamine, are essential for neurocommunication. In addition to these neurotransmitters, the hypothalamus, a key structure in the nervous system, plays a significant role in psychoneuroimmunology.
The hypothalamus is affected strongly by the emotional and cognitive states. It is surrounded by and interconnected with the limbic system, a part of the nervous system that controls the emotional state of an individual. It is also adjacent to the cerebral cortex, which provides cognitive and interpretive processes (Bloom & Lazerson, 2000).
Incoming stimuli is first recognized by the central nervous system (CNS) as a stressor. The brain becomes sensitized to these stressors and is more vigilant to incoming stimuli. The brain is stimulated by signals from inside the body (organs) or outside the body from cranial nerves (smell, hearing, sight, taste) and peripheral nerves (touch).
Stimuli produced by stressful thoughts and emotions are processed in the brain, specifically by the hypothalamus. These thoughts and emotions from the cerebral cortex and limbic structures lead to numerous other processes within the brain, as well as to the rest of the body. The entire body is now on the alert to these or other stressors. Reactions to these stressors are stored in the memory. As stressors are activated or reactivated, the previously conditioned responses are retrieved from the memory, primarily by the hippocampus, which is responsible for storing long-term memory. The hippocampus stores memories that are associated with trauma or stress. When a stressful thought reoccurs, the sympathetic nervous system secretes norepinephrine. This neurotransmitter strengthens the stressful memory and activates the stress response. In essence, each time there is a stressor similar to a previously stored one, the subsequent stressor reinforces the traumatic result from the first stressor. (Bloom & Lazerson, 2000).
This may explain why mind-body modalities, such as (yoga, and Pranayama (breathing exercises), (various) meditation (techniques) or psycho-spiritual techniques, guided imagery etc. that affect thoughts and emotions, can also lead to changes in the physiologic functioning.
It must be understood that the neurotransmission of the stress response is highly complex. One is only beginning to unravel the neural mechanisms involved in processing stressors and the impact of these stressors on neuroimmune mechanisms.
Psychoneuroimmunology helps to provide insight about the complex relationship between the immune system and stress, as well as the effects on this relationship on the health of individuals. The physiological pathways that connect the mind and body demonstrate the strong relationship between them and emphasize the mind’s effect on the body.
The mind and body continually send messages to each other and it is these messages that produce biological and physiological changes that help determine the (relative) health status of an individual. Responses made to these messages may result in either illness or (relative) wellness. The mind-body connection entails physiological pathways that involve the nervous system, the endocrine system, and the immune system (Freeman & Lawlis, 2001).
The mind and body are able to communicate with each other by the interactions of these three systems. These three systems are involved in two physiological pathways. The first is the sympathetic-adrenal-medullary (SAM) that activates the autonomic nervous system (ANS) whereby neurotransmitters and neuropeptides communicate directly with immune cells. Neurotransmitters attach to immune cells and affect their ability to multiple or kill invaders. Because neurotransmitters are released from the brain during times of stress, it is likely that the mental-emotional states resulting from stressors may increase susceptibility to disease (Freeman & Lawlis, 2001).
Neuropeptides, secreted by the brain and immune system, have a crucial role in mind / body interactions since immune cells carry receptors for all the neuropeptides. The limbic system of the brain that regulates emotions is particularly rich in receptor sites for neuropeptides.
It is reasoned that neuropeptides are a strong factor relating to the effects of the mind on immunity (Freeman & Lawlis, 2001).
The second pathway is the hypothalamic-pituitary-adrenal (HPA) that signals the endocrine system to release hormones. These hormones, particularly thyroid and adrenal, have a direct effect on the immune system. They can increase or decrease cellular processes. It is important to point out that cancer cells synthesize hormones identical to the endocrine glands, but in an excessive and uncontrollable amount (Freeman & Lawlis, 2001).
Neurotransmitters, neuropeptides, and hormones have been shown to have certain effects on immunity. For example, certain hormones, such as cortisol and epinephrine, are released in higher amounts when an individual is under great stress. These hormones are known to depress T-cell activity, and thus, depress one’s immune system (Freeman & Lawlis, 2001).
The mind may be referred to as both a healer and slayer because what one thinks, believes or feels can have a definite effect on one’s health. This can result in either a positive or negative outcome.
Pelletier (2002) points out those negative feelings, such as fear, despair, and depression, have a significant effect on the brain and can produce powerful changes in the body’s chemistry. This turns attention to the concept of mind-body healing, whereby the mind can have significant influence on one’s healing.
J. About enteric nervous system (ENS)
His mouth was dry, there were butterflies in his stomach, and his knees were shaking so much it was hard to walk on stage…
A fluttery feeling before an important situation or meeting such as having a first date?
A bout of gastrointestinal urgency the night before an examination?
A physical sensation that something wasn’t quite right?
An odd feeling that a situation was somehow dangerous?
A gut feeling that flies in the face of fact?
Where does it all come from?
From the enteric nervous system (ENS).
The enteric nervous system (ENS) is a subdivision of the autonomic nervous system (ANS) that directly controls the gastrointestinal system in vertebrates. It is derived from neural crest. (Burns AJ, Thapar N (October 2006). "Advances in ontogeny of the enteric nervous system". Neurogastroenterol. Motil. 18 (10): 876–87.)
The ENS is capable of autonomous functions such as the coordination of reflexes; although it receives considerable innervation from the autonomic nervous system it can and does operate independently of the brain and the spinal cord. (Dorland's Medical Dictionary; Template:Gershon MD. The Second Brain Harper 1998 p17)
The ENS consists of some one hundred million neurons, one thousandth of the number of neurons in the brain, and considerably more than the number of neurons in the spinal cord. The enteric nervous system is embedded in the lining of the gastrointestinal system. ("Gray's Anatomy: The Anatomical Basis of Medicine and Surgery, 40th edition (2008), 1576 pages, Churchill-Livingstone, Elsevier").
ENS has been described as a "second or gut brain".
It can operate autonomously, and normally communicates with the central nervous system (CNS) through the parasympathetic (e.g., via the vagus nerve) and sympathetic (e.g., via the prevertebral ganglia) nervous systems. However, vertebrate studies show that when the vagus nerve is severed, the enteric nervous system continues to function. (Gershon MD (July 1999). "The enteric nervous system: a second brain". Hosp Pract (Minneap) 34 (7): 31–2, 35–8, 41–2 passim. )
In vertebrates the enteric nervous system includes efferent neurons, afferent neurons, and interneurons, all of which make the enteric nervous system capable of carrying reflexes and acting as an integrating centre in the absence of CNS input. There are more nerve cells in the enteric nervous system than in the entire spinal cord. The sensory neurons report on mechanical and chemical conditions. Through intestinal muscles, the motor neurons control peristalsis and churning of intestinal contents. Other neurons control the secretion of enzymes. The enteric nervous system also makes use of more than 30 neurotransmitters, most of which are identical to the ones found in CNS, such as acetylcholine, dopamine, and serotonin. More than 90% of the body's serotonin lies in the gut, and about 50% of the body's dopamine lies in the gut as well, and is now being studied to understand the working of the dopamine in the brain. (Pasricha, Pankaj Jay. "Stanford Hospital: Brain in the Gut - Your Health")
The enteric nervous system has the capacity to alter its response depending on such factors as bulk and nutrient composition. In addition, ENS contains support cells which are similar to astroglia of the brain and a diffusion barrier around the capillaries surrounding ganglia which is similar to the blood-brain barrier of cerebral blood vessels. (Silverthorn, Dee U.(2007)."Human Physiology". Pearson Education, Inc., San Francisco, CA 94111.)
Enteric neurons secrete an intimidating array of neurotransmitters. One major neurotransmitter produced by enteric neurons is acetylcholine. In general, neurons that secrete acetylcholine are excitatory, stimulating smooth muscle contraction, increases in intestinal secretions, release of enteric hormones and dilation of blood vessels. Norepinephrine is also used extensively for neurotransmission in the gastrointestinal tract, but it derives from extrinsic sympathetic neurons; the effect of norepinephrine is almost always inhibitory and opposite that of acetylcholine.
The enteric nervous system can and does function autonomously, but normal digestive function requires communication links between this intrinsic system and the central nervous system. These links take the form of parasympathetic and sympathetic fibres that connect either the central and enteric nervous systems or connect the central nervous system directly with the digestive tract. Through these cross connections, the gut can provide sensory information to the CNS, and the CNS can affect gastrointestinal function. Connection to the central nervous system also means that signals from outside of the digestive system can be relayed to the digestive system: for instance, the sight of appealing food stimulates secretion in the stomach etc.
"The majority of patients with anxiety and depression will also have alterations of their gastrointestinal (GI) function," said Dr. Emeran Mayer, professor of medicine, physiology and psychiatry at the University of California, Los Angeles.
"Rather than Mother Nature's trying to pack 100 million neurons someplace in the brain or spinal cord and then sending long connections to the GI tract, the circuitry is right next to the systems that require control," said Jackie D. Wood, professor of physiology, cell biology and internal medicine at Ohio State.
Two brains may seem like the stuff of science fiction, but they make literal and evolutionary sense.
"What brains do is control behaviour," Dr. Wood said. "The brain in your gut has stored within its neural networks a variety of behavioural programs, like a library. The digestive state determines which program your gut calls up from its library and runs."
"What brains do is control behaviour," Dr. Wood said. "The brain in your gut has stored within its neural networks a variety of behavioural programs, like a library. The digestive state determines which program your gut calls up from its library and runs."
"The gut monitors pressure," Dr. Gershon said. "It monitors the progress of digestion. It detects nutrients, and it measures acid and salts. It's a little chemical lab."
"Clinicians are finally acknowledging that a lot of dysfunction in GI disorders involves changes in the central nervous system (CNS)," said Gary M. Mawe, a professor of anatomy and neurobiology at the University of Vermont.
"During stress, trauma or 'fight or flight' reactions, the barrier between the lumen, the interior of the gut where food is digested, and the rest of the bowel could be broken, and bad stuff could get across," Dr. Wood said. "So the big brain calls in more immune surveillance at the gut wall by activating mast cells."
In animals, Dr. Mawe said, inflammation makes the sensory neurons in the gut fire more often, causing a kind of sensory hyperactivity. "I have a theory that some chronic disorders may be caused by something like attention deficit disorder in the gut," he said.
Dr. Gershon, too, theorizes that physiology is the original culprit in brain-gut dysfunctions. "We have identified molecular defects in the gut of everyone who has irritable bowel syndrome," he said. "If you were chained by bloody diarrhoea to a toilet seat, you, too, might be depressed."
Still, psychology clearly plays a role. Recent studies suggest that stress, especially early in life, can cause chronic GI diseases, at least in animals. "If you put a rat on top of a little platform surrounded by water, which is very stressful for a rat, it develops the equivalent of diarrhoea," Dr. Mayer said.
Another experiment showed that when young rats were separated from their mothers, the layer of cells that line the gut, the same barrier that is strengthened by mast cells during stress, weakened and became more permeable, allowing bacteria from the intestine to pass through the bowel walls and stimulate immune cells.
"In rats, it's an adaptive response," Dr. Mayer said. "If they're born into a stressful, hostile environment, nature programs them to be more vigilant and stress responsive in their future life."
He said up to 70 percent of the patients he treats for chronic gut disorders had experienced early childhood traumas like parents' divorces, chronic illnesses or parents' deaths. "I think that what happens in early life, along with an individual's genetic background, programs how a person will respond to stress for the rest of his or her life," he said.
Either way, what is good for one brain is often good for the other, too. A team of researchers from Penn State University recently discovered a possible new direction in treating intestinal disorders, biofeedback for the brain in the gut.
In an experiment published in a recent issue of Neurogastroenterology and Motility, Robert M. Stern, a professor of psychology at Penn State, found that biofeedback helped people consciously increase and enhance their gastrointestinal activity. They used the brains in their heads, in other words, to help the brains in their guts, proving that at least some of the time two brains really are better than one.
o Gut affecting brain
Like the brain, gut or second brain has its own set of neurotransmitters for sending messages between nerve cells, and it has the ability to learn and remember. The brain and the enteric nervous system (ENS) are actually developed from the same foetal tissue, but they are considered separate entities. They are connected by a long nerve "cable" known as the vagus nerve, and via the prevertebral ganglia. The two systems are in constant communication through neurotransmitter feedback along this nerve pathway.
Referring to a certain presentiment as a "gut feeling" is not so far off the mark; and having "butterflies in your stomach" when one is feeling anxious is more than just a metaphor.
If what goes on in the brain can affect the enteric nervous system, then it is not surprising that what goes on in the gut can have a direct impact on the brain.
o Gut brain balance
A (relatively) healthy digestive system is full of beneficial bacteria.
These bacteria make vitamins that are essential to our health, such as vitamin K (needed for bone formation and blood clotting); and biotin, a B-complex vitamin necessary for activating enzymes that convert food to energy. The good bacteria also regulate the metabolism of cholesterol, detoxify poisons, and help to maintain a normal pH balance in the stomach.
As long as these beneficial organisms are in working (relatively) optimally, the gut functions efficiently and sends positive feedback to the brain.
o Gut brain imbalance
On the other hand, there are many things that can affect proper balance in the gut.
"Bad" bacteria, toxins in food, food allergens, yeast, and undigested food particles etc. can precipitate a series of neurological and immune system responses that interfere with healthy brain function and disrupt communication between the brain and the rest of the body. Bad bacteria produce toxins that trigger the immune system in the gut.
The brain is alerted to inflammation by the immune system via protein molecules known as cytokines; in response, the brain releases stress hormones, and neurotransmitter levels are altered.
Partially digested food proteins called peptides are toxic to the gut and can interfere with gut-brain communication. Fermentation of starches produces toxic levels of ammonia, which can result damage to brain cells. Digestive system balance can be upset by a number of elements, including diet, medications, stress, toxins and other environmental factors.
Here are some examples:
Allergens, infections in the gut, toxins, side effects of the modern and drugs of abuse, and malabsorption of nutrients etc. can severely alter the chemical balance of the brain.
As already mentioned, peptides (proteins) from improperly digested food can disrupt the communication between gut and brain to such an extent that digestive problems are directly linked to mood and behavioural disorders. Poor diet is a big contributor to brain-gut imbalances. A diet low in fibre and high in added sugars and preservatives can alter the environment in the gut, allowing the bad bacteria to take over.
Food allergies like Celiac disease (gluten intolerance) can cause inflammation and malabsorption of nutrients. Side effects of medications such as antibiotics, anti-inflammatories, steroids, and acid blockers etc. can all prevent the digestive system from doing its job optimally.
Environmental toxins like heavy metals etc. can damage normal function of the gut and prevent absorption of important nutrients. Alcohol can damage the lining of the gut, allowing toxins to leak into the blood stream. Excessive tension and stress can cause damage to the intestinal lining as well, disrupting proper digestive function. Overgrowth of yeast and bacteria can change the environment and prevent proper nutrient absorption.
When any of these occur, gut-brain balance is thrown into chaos. Neurotransmitters send faulty messages, causing a multitude of health problems; the body is also prevented from absorbing the nutrients it needs to maintain healthy function.
4. About AIDS
Conventional scientists/doctors are roused to fury by others departure from convention, largely because they regard such departure as a criticism of themselves.
According to modern conventional biomedicine the clinical manifestation of the symptoms of diagnosed HIV infection vary, depending on the phase of infection.
When patients are first diagnosed with HIV, they may have no signs or symptoms at all, although this person, supposedly, is still being able to transmit the virus to others.
Many people develop a brief flu-like illness two to four weeks after becoming in some instances infected.
The following signs and symptoms may occur:
§ Headache or/and body aches
§ Sore throat
§ Swollen lymph glands
§ Dry skin and lips
§ Inability to gain weight, no matter how much is eaten etc.
This condition is termed as acute retroviral syndrome, or primary diagnosed HIV infection. These early diagnosed HIV symptoms usually disappear within a week to a month and are often mistaken for those of another viral infection because they are extremely common and are somewhat similar in appearance.
However, a person may remain symptom-free for years. During this period, the person is in these cases supposedly very infectious. Furthermore, according to some authorities, more-persistent or more-severe symptoms of diagnosed HIV infection may not appear for several years after the initial infection. But as yet undetermined or/and nonexistent virus continues to multiply and destroy immune cells, a person may develop mild infections or/and chronic symptoms such as:
§ Swollen lymph nodes — often one of the first signs of diagnosed HIV infection
§ Loose stools or diarrhoea
§ Bleeding gums
§ Bloating, gas and flatulence, and/or dull abdominal pain
§ Weight loss
§ Cough and shortness of breath
§ Body pains
§ Frequent infections
§ More frequent fatigue- need to take naps after meals etc.
If one doesn’t receive treatment for diagnosed HIV infection, the syndrome typically progresses to AIDS in about 10 years, and eventually death occurs.
Furthermore, by the time AIDS develops, immune system has been severely damaged, making these patients susceptible to opportunistic infections i.e. diseases/syndromes that wouldn't trouble a person with a healthy (immunecompetent) system.
The signs and symptoms of some of these infections may include:
§ Soaking night sweats
§ Shaking chills or fever higher than 100 F (38 C) for several weeks
§ Cough and shortness of breath
§ Chronic diarrhoea
§ Persistent white spots or unusual lesions on ones tongue or in ones mouth
§ Persistent, unexplained fatigue
§ Blurred and distorted vision
§ Weight loss
§ Severe skin rashes or bumps such as molluscum contagiosum etc.
A. Integrated and transcultural medicine and psychiatry
Medicine and science that support just one programming, is without doubt very much paradigm constraining.
Having seen many patients in clinical situations across the globe, according to the integrated and transcultural medical and psychiatric model developed from the abovementioned, I have deduced that these initial symptoms and signs of diagnosed HIV infection are triggered by what is termed in Oriental medicine as Toxin(s) (毒 ).
B. Concept of Toxin (s) (毒 ) in Oriental medicine.
One should not coalesce any modern biomedical or naturopathic concepts of Toxin with the Oriental medical concept of the same name, as it typically leads to erroneous assumptions and, more importantly, erroneous treatments.
Toxin(s) (毒 ) has 11 basic characteristics:
1) Sudden onset. Toxic diseases start off very acutely, change and transmute very quickly, and can directly strike the Organ Systems.
2) Their nature is broad or extensive. In other words, their effect is not necessarily limited to s single, localized area of the body.
3) Have a virulent, fierce, strong nature. This means that they are especially infectious, producing very strong diseases with potentially many, serious symptoms.
4) These commonly reside deep and undetected within the Vital Force-matter and Blood (with appropriate presentation it corresponds to immune system), consuming and damaging Yin Fluids, vanquishing and ruining the Organ Systems.
5) Have a change-promoting nature. This specifically means that these promote changes in the physical substance of the body. These do not just cause functional disease.
6) Have a fiery, hot nature. Although there are many types of Toxins, most Toxins are overwhelmingly Hot. When pathogens transform into Toxins, mostly these transform into Heat/Fire.
7) Tend to produce unusual or extreme pathological changes. When Toxic pathogens result in disease, the pathological changes are not common or ordinary. Symptoms tend to be both extreme and abundant or profuse.
8) Tend to run or hasten internally. Toxic pathogens are especially explosive. These commonly quickly enter internally to harm the Organ Systems, leading to diseases that are rapidly malignant.
9) Accentuate the root nature of the original disease pathogen. This means that Toxins amplify the characteristics of the original disease pathogens which engendered and transformed the Toxins.
10) Have a simultaneously mixing nature. This means that Toxins tend to cause the production of Blood Stasis and Phlegm with which these then mutually bind.
11) Toxins' nature is recalcitrant. In other words, Toxic disease are very difficult to treat and do not heal easily, if at all. Toxins may also result in a variety of sequelae as well as relapsing-remittent conditions which may return like the "rising of [a swarm of] bees."
Furthermore this Toxin can be either primary or at a later stage namely a latent Toxic Heat.
Primary and/or later Latent Toxic Heat is one of special Pathogenic factors as understood in traditional Oriental medicine. Here pathogenic factor is either External or/and Internal.
External pathogenic factor includes pathogens such as Wind, Cold, Heat, Fire, Dampness, and Toxins which with appropriate presentation may correspond to various viruses, bacteria, protozoons, modern drug or recreational drug abuse, iatrogenic diseases, poor nutrition, as well as exposure to chemical pollution, ionizing radiation, electromagnetic fields etc.
Internal pathogenic factor is the very mental-emotional and spiritual milieu rooted in trauma (s), stress, tension, depression, shock, and many more psychological observed symptoms/diseases/syndromes.
When the Toxic Heat is primary it creates the initial flulike symptoms and signs that for many patients accompany the initial exposure to diagnosed HIV virus.
Under normalised circumstances Primary Toxic Heat manifestations are as following:
Ruptured abscesses; itching and burning sensation in the genital area; fever; headache; nausea; vomiting; increased vaginal discharge; turbid/cloudy urine; a burning sensation during urination; painful urination; frequent urination; urgent urination; a red tongue body with a yellow tongue coating; and a rapid pulse.
When the Toxic Heat is not cleared and is latent, patients move into more advanced stages of diagnosed HIV and finally AIDS. Also symptoms of diagnosed HIV infection and AIDS appearing without obvious acute infection are typical manifestation of the Latent Toxic Heat.
Under certain circumstances a Pathogenic Factor either of External or/and Internal origin can enter the body without causing immediate symptoms.
It then incubates inside of the body over time, turning into Toxic Heat which later emerges towards the Exterior causing a person to feel suddenly fatigue, weary limbs, slight thirst, hot and irritable, poor sleep patterns, discoloured urine, thready, a rapid pulse, and a red tongue.
This Latent Toxic Heat will also tend to injure Vital force-matter (Qi, Ki, Prana, rLung) and Yin and Blood (with appropriate presentation this corresponds to immune system), thus establishing a vicious circle or Toxic Heat and Deficiency.
This especially affects the Liver Organ System and causes Liver Organ System Heat/Fire, and it may pull latent Toxic Heat outwards.
The major factor that will draw this Latent Toxic Heat outwards towards the surface is Toxic Mind-Brain.
Toxic Mind-Brain is associated with specific triggers or events such as mental-emotional stress, tension, and above all developmental/childhood or adolescent/adulthood psychological traumas or shock etc., mostly connected with dissociative sexual development, sexual preference, sexual behaviour or sexual abuse.
Dissociative children who have been observed, many have little coping mechanism, often have secret places in their minds, where they go when over-whelmed, or in other instances rely on known factors to exhibit these. Many of these children, who exhibit zones of vivid, experiential fantasy without strong reality constraints, should not be confused with a normal healthy experience.
When a dissociative child enters into one of these fantasy states, meticulous observers note that the child has behaviourally ‘shut down’ and shows little contact with the real world experience. The child may curl up in a foetal position or rhythmically self-soothe by rocking, stroking, or bumping.
This is sometimes also a normal phase of child’s development:
Indeed, adults sometime regress in their minds to a secret place and a time when they had many good experiences, and some with not so good experiences.
This is not to say that all such behaviour is the norm, but should be viewed, if it continues over any length of time, as a phenomenon which requires differing assessment.
As adults, our Minds-Brains constantly process and analyse information at a conscious level, deciding what is useful and worthy of storage at an unconscious/subconscious level, and discarding what is not worth retaining.
A toddler, however, hasn't developed that logical, questioning capacity that an adult has, and therefore information can often be taken at face value, and stored directly in the subconscious/unconscious without any rational/reasoning intervention from their conscious mind.
Another possible cause of Latent Toxic Heat can be immunisations, when attenuated or inert forms of certain pathogenic organisms are injected in the body, bypassing the body’s first line of resistance.
From an integrated transcultural medical and psychiatric perspective it is as if an External Pathogenic Factor penetrated the body’s Interior directly, completely bypassing the Exterior Levels. This is exactly what happens with latent Toxic Heat. This primary and/or later latent Toxic Heat initially attacks Lung, Kidney and Spleen/Pancreas and Stomach Organ Systems.
These Organ Systems are central to this complex syndrome i.e. AIDS and must be supported throughout the entire course of the disease, even when related disharmonies expand to involve all the other Organ Systems as well.
C. The internal daemon of fright, fear, angst and anxiety
“It is more important to know what sort of person has a disease than to know what sort of disease a person has”.
“Natural forces within us are the true healers of disease”. Hippocrates (circa 460-377 BCE)
Let’s compare traditional Oriental medicine's internal daemon of fright, fear, angst and anxiety to the modern psychological and psychiatric concept of psychological trauma and how this all relates to what patients diagnosed as HIV+ commonly call "the void."
To begin, the traditional Oriental Eight Principle Theory is a pragmatic way to introduce traditional medicine philosophy to diagnosed HIV patients because it illustrates through absolute simplicity.
The three Yin/Yang pairings of Cold/Hot, Interior/Exterior and Deficiency (too little)/Excess (too much have been used for millennium to help understand the nature of health versus illness and can be just as easily applied to diagnosed HIV+. One should be encouraged to explain this simple set of pairings to a group of HIV + diagnosed patients.
Once they understand the basic notions of how this theory works, ask them their opinion upon whether diagnosed HIV+ is a Yin or Yang disease/Syndrome based upon the two prominent divisions of the Yin "too little on the inside" and the Yang "too much from the outside."
Leave out the Hot/Cold pairing to keep things simple, and it is guaranteed that one will be treated to a lively intense discussion.
The Yang segment of the group will put forth the argument that their HIV+ diagnosis is too much pressure from the outside and that everything would be just fine if only these hassles would stop being imposed/superimposed upon them.
Unfair scenarios like the ones presented in the form of the intense demands of a job, the guilt-laden expectations from parents, mother/father being cold and undemonstrative in her/his affection, the social pressure of peers and the ever expanding, role-fulfilling requirements as a life partner, spouse and a parent, etc. are a few of the commonly mentioned stressors that appear as "too much from the outside," which easily can trigger an diagnosed HIV+ into becoming self-obsessive-compulsive-destructive.
The Yin part of the group will agree that all of the above-mentioned factors are indeed real and will put added pressure; but the deeper motives of this unhealthy lifestyle still lie within.
D. Within, the very Self.
The concept of a Self is a psychological disposition/notion formed from birth through childhood experiences and adult life of an individual, autonomous, inward-looking self, centre of the inner, subjective mental-emotional states, the inner psyche in all its ramifications, whose mental-emotional life is influenced/affected deeply by complex of past, present and future experiences.
These people will recognize that it's the too little on the inside, which looks like mild to severe post-traumatic stress disorder following major childhood traumas, sexual or physical abuse, or political or ethnic conflicts or war etc. , unusual stress in their current situation, such as professional lives characterized by deadline pressures or pressure to overwork, abusive relationship, or poverty etc. devastated self-esteem, broken ability to forgive/forget oneself, a projection (a defence mechanism by which ones own traits and emotions are attributed to someone else) that has its roots in sibling relationship, thwarted (disappointingly unsuccessful) manifestation of guilt etc., a black hole of unworthiness and a complete lack of self confidence, to name a few, which are the instruments of attraction that act as a magnet to their self-obsession-compulsion-destruction.
So, which one is correct?
To use the traditional Oriental medicine point of view, it's generally agreed that the Deficiency on the inside is the cause for an individual to manifest disease on every level into one's being.
Giving the example of a common Wind/Cold Attack such as flu or influenza, traditional Oriental medicine states that if the Defensive Vital force-matter i.e. immune system is not Deficient and strong, there is no place for the invading Pathogen i.e. bacteria and virus or Toxin (s) to enter or it's expelled rapidly or immediately.
On the other hand, if a person's Defensive Vital force-matter i.e. immune system is weak, the Wind/Cold gets into the body and can even penetrate to deeper levels of the Vital force-matter, Nutritive and Blood Levels i.e. deeper diseases such as bronchitis, pneumonia and tuberculosis etc., if they are also Deficient.
It's the Internal Deficiency i.e. defiant/ noncompliant immune system that determines how deeply the invading Pathogen i.e. bacteria and virus and various Toxins of all sorts will affect the body.
At this point in the Yin/Yang explanation of HIV diagnosis, the Yin group usually feels "right," as it's plain for all to see that it's the too little on the inside that was there first, which then creates the vicious pull toward the too much on the outside.
To further solidify this viewpoint, HIV+ diagnosed patients are very familiar with the term "the void," which also is referred to as "the hole in the soul."
This concept is characterized by the reckless power that manifests as the ravenous, gluttonous need to fill it up with everything it can get its hands on, and especially one's particular lifestyle of supposed free choice.
This term, "the" is easily equated by the HIV + diagnosed patients with the Eight Principle Yin concept (of too little on the inside)
This insatiable heedless force also is given more description when compared with the Far East version of the "hungry ghost."
When told of this spirit's bottomless belly, which is forever trying to fill through the inadequate vehicle of a bottomless pinhole mouth, the HIV+ diagnosed patient can more fully relate their lifestyle with the language of Yin and Yang.
But then someone from the "losing" Yang i.e. "too much from the outside" group always inevitably asks, "But wait a minute, I wasn't born with this too little on the inside, this hole in the soul, this hungry wretched ghost, so where does the void come from?"
And the discussion is going once again. Indeed, where does this void come from? How does something like this happen and what can be done about it? The void, taking the form of all of the reasons why there is too little on the inside, is created through the infliction of conscious or/and subconscious/unconscious suffering and pain. To put it most succinctly, it's psychological trauma in myriad forms that causes the void.
Psychological trauma is defined as "an experience that is mentally-emotionally painful, distressful, or shocking and which may result in lasting mental-emotional and physical effects."
This experience can be singular or repetitive in nature and it's caused by an immediate and direct confrontation with the threat of "death, extreme suffering, severe bodily harm or injury, coercive exploitation or harassment, sexual violation/abuse, violence motivated by ethno-cultural prejudice, or politically based violence etc.
"To a lesser degree, it also can be attributed to verbal abuse, mental-emotional neglect and/or abuse, and being witness to any of the above-mentioned events etc. The experience of trauma causes what is known in psychology/psychiatry as dissociation. This is the term given to what happens when an individual's psyche "leaves the scene of the crime." When the trauma occurs, there is a part of an individual that will split off and become dissociated from the whole.
It's a natural or/and even subconscious/unconscious defence mechanism to preserve the ego that is employed in times of extreme pressure, stress, tension and shock. This paradigm does have traditional Oriental medicine equivalents and the best way it would be to say that trauma is translated as the internal devil of fright and fear, angst, anxiety and dissociation is seen as a fractured Mind-Brain. When the internal devil of fright and fear, angst and anxiety appears and breeches the defences of the Self which protects it, it makes its way into the imperial gardens of the Self and delivers its brand of pathological self obsession-compulsion-destruction. Specifically, the damage is imposed upon the Mind-Brain.
A fractured Mind-Brain is the term used to describe this type of injury and it's an applicable name for what occurs as a result of this type of trauma.
The fractured Mind/Brain is like a window; it's meant to be clear, transparent and able to let light shine in and out, but when it's hit by a small stone, all types of cracks will run out from the point of impact. The Mind-Brain does the same thing when hit by the "stone" of fright and fear. Like in psychology/psychiatry, when the natural phenomenon of dissociation occurs to protect the ego, aspects of the Mind-Brain escape the trauma/fright by travelling out along the cracks of shock.
This preserves the most important pieces of the Mind-Brain when the fright is inflicted upon the vulnerable Self. From this fracture, the ramifications of injury, as well as the answers to health's questions, lie hidden within these trails of wounds, and they must be followed if one wishes to find the dissociated aspects of the Mind-Brain. For the affected individual, life goes on, but the window is never the same; the Mind-Brain is never quite the same.
It's this aspect of the dissociated Mind-Brain, which leaves behind in its wake the vacuity/emptiness that we see in the HIV+ diagnosed patient’s eyes. This vacuum/emptiness becomes the force that is the voracious craving from inside of the hungry ghost's belly - this is the Vital force-matter of the Void.
This Vital force-matterof the Void is to be seen in the light of childhood mental-emotional upbringing, unconscious conflicts, defences, attachment, bonding and loss, projections, transferences, complexes, traumas, relationship with animus/anima and shadow projection etc.
At this point, the Yang side, representing the too much from the outside, has the feeling that they've finally trumped the Yin too little on the inside troop. For it has become obvious that the reason why there is all of those factors for the Void to form is because it has been inflicted from the trauma(s), which is by definition too much from the outside. But like the never-ceasing cycle of Yin and Yang, the answer to the original question, of whether a HIV+ diagnosed patient is either a Yin or Yang disease, is not stagnant in one definition. It's constantly evolving, ebbing and flowing, of the 10,000 things; it has provided us a starting point and given us something to talk about and ponder over, which hopefully leads to a deeper understanding of the mysteries.
Because in this scenario, there are only more questions, such as:
"But why didn't I have protection from that outside fright and fear that caused my void in the first place? Isn't it because I didn't have enough on the inside?"
Yes, the seeds of Yin are in the Yang, the wheel keeps on turning, and as one of my wise old teachers once told me,
"It's like an onion, son; there is only layer after layer and the deeper down you go, the more it stinks and the more it makes you cry."
So, how to eradicate it? I asked.
It is like Alexander the Great and the Gordian Knot, he said. When Alexander was in Anatolia (present-day part of Turkey), he was presented with the Gordian Knot and told that whoever was able to untie this knot would rule all of Asia. Many had tried, but all before Alexander had failed. Whenever one pulled on one side of this knot, it tightened up somewhere on the other side.
Alexander pondered this problem for a bit, then drew his sword, and cut the knot in two, all in one stroke.
Thus diagnosed HIV+ and later AIDS being the intractable but not impossible problem to resolve in the end is managed in integrated and transcultural medicine and psychiatry with much the same technique i.e. solved by a bold stroke ("cutting the Gordian knot") of awareness and pure clarity, correct information, iron will and determination, and above all utter calmness.
o Whenever a great physician treats diseases, he/she has to be mentally calm and his/her disposition firm.
o He/she should not give way to wishes and desires, but has to develop first a marked attitude of compassion.
o He/she should commit himself firmly to the willingness to take the effort to save every living creature.
o A great physician should not pay attention to status, wealth or age; neither should he/she question whether the particular person is attractive or unattractive, whether he/she is an enemy or friend, whether he/she is a local or from far away, or finally, whether he/she is uneducated or educated.
o He/she should meet everyone on equal grounds.
o He/she should always act as if he/she were thinking of his/her close relatives.
Dr Sūn Sī Miǎo 孫思邈 581 CE–682 CE)
Buddhist physician of the Sui and Tang Dynasty, China
Special note: This writing above has been piled up from various sources and databases as well as personal clinical experience over many years and then compiled with the purpose of presenting a rational and ethical grounds for ever-so-needed integration of various medical systems for the benefit of all concerned.
Let this writing become a tool in the ongoing renaissance of integrated and transcultural medicine and psychiatry, a point of dialogue and synthesis for the future.
Let it further encourage those working along similar lines to have faith and determination in what they are doing, as much more needs to be done to bring love and healing into this world, into our patients, into our mother, this beautiful blue planet earth.
Dr. Andrew MacLean Pagon MD
Lima, Peru, August 2011 CE
About the author
Dr. Andrew MacLean Pagon comes from a multiracial and multicultural background and heritage.
His great grandfather, grandfather and father were all medical doctors. He has been practicing integrated and transcultural medicine and psychiatry for over 20 years.
He is a consultant integrated and transcultural psychiatrist, educated in both modern and traditional medicine at Tianjin University of Traditional Medicine and Pharmacology and Tianjin Medical University (also International College of Integrated Medicine and WHO Centre for Traditional Medicine) of PRChina, where he obtained a MD (Medicinae Doctor) an advanced clinical and research degree in psychiatry - integrated and transcultural psychiatry.
Dr Andrew also taught hundreds of international students’ psychiatry at the same Medical University for many years.
He is specialised in entheogenic psychotherapy, culturally and sexually related mental-emotional disorders, and integrated and transcultural medical treatment of psychiatric, psychosomatic and immune deficiency disorders/syndromes.
He as well lived for many years among various native people in North, Central and South America, Africa, Asia and Australia doing field research into their traditional medicine and spiritual believes.
In Colombia, Ecuador, Brazil and Peru (since 2006 CE) he has lived among various Andean and Amazon tribes, where he conducted research into their traditional medicine. That research is still ongoing,
Dr Andrew believes that integrated and transcultural medicine and psychiatry blends the best of modern biomedicine and traditional medical approaches, addressing not only physical symptoms and signs, but also psychological, cultural, racial, social, environmental & spiritual aspects of health & illness. It is based in stimulating the innate human capacity for healing, empowering patients in their own care, while providing them with choices in integrated and transcultural healthcare that are proven to be safe and effective.