Perimenopausal Brain Fog

Acupuncture and Herbs to Stimulate Brain Activity

by Subhuti Dharmananda, Ph.D., Director, Institute for Traditional Medicine, Portland, Oregon

	During perimenopause and menopause, mental functions are usually affected by the hormonal changes, and conditions arise involving both mood lability and poor memory, the latter sometimes referred to as "brain fog" because of the obscuration of memory and clear ideation. This condition can persist into the postmenopausal years. It has been suggested that early intervention with hormone therapy might protect memory (1), but the publicized risks of hormone therapy have deterred many women and their physicians from pursuing this route. The precise nature of brain fog is somewhat unclear, as tests for simple memory tasks often show little change; there may be some subtle shifts in memory function that especially affect complex tasks or reduce memory retrieval when the mind is not focused on the objective. Estradiol stimulation of the brain's acetylcholine may be important to rapid recall (2) and the estrogens may influence the health of the nerve endings (3, see illustration below). The common herb remedy recommended for memory deterioration with aging, Gingko biloba leaf extract, which is believed to act primarily by enhancing circulation (and, to a lesser extent by affecting acetylcholine levels), showed only minor effects in a six week treatment period (4).
Estrogen's role in memory may be due in part to its affect on the tiny knobs called spines that protrude from a neuron's message receiving ends, known as dendrites. Spines are where important connections between neurons are made. The above images demonstrate that doses of estrogen resulted in a two-fold increase of the number of spines in rat embryo brain cells (left) compared to those without the supplements of estrogen (right). The cells were taken from brain areas responsible for memory processes. Images by Diane Murphy, Ph.D., National Institutes of Health.

ACUPUNCTURE THERAPY

In a recent report in the Journal of Traditional Chinese Medicine (5), an acupuncture protocol was described for treatment of menopausal syndrome that focused on attempting to improve mental activities. The treatment was claimed to have a notable beneficial effect and also to alter the levels of key menopause-related hormones: E2 (estradiol), FSH (follicle stimulating hormone), and LH (luteinizing hormone).

The primary therapy was based on a set of four acupuncture points, three of them along the center line of the body (governing and conception vessels) and one as a pair of points on either side of the spine (bladder meridian):

baihui (GV-20) needled posteriorly and horizontally 0.5 cun with reinforcing-reducing method

fengfu (GV-16) punctured slowly toward the mandible 1 cun with reinforcing-reducing method

qihai (CV-6) needled perpendicularly 1.5 cun with reinforcing-reducing method

shenshu (BL-23) needled by twirling obliquely toward the spine 1.5 cun with the reinforcing method

A number of adjunctive points were chosen and one or two were selected for treatment of individual symptoms or constitutional conditions (examples are sanyinjiao, taixi, zusanli, taichong, and sishencong). Needle retention was for 15-20 minutes with manipulation twice during the retention time. Treatment was administered daily for four weeks (6 days acupuncture, 1 day break for each week).

The basis of the therapy was described by the authors, who utilized a modern TCM description and associated the hypothalamus and hypophysis (pituitary) glands with the brain and the ovaries with the kidney system:

TCM holds that climacteric syndrome is a condition in which the hypofunction of the ovary and the decreased secretion of estrogen may cause imbalance of the hypothalamus-hypophysis-ovary axis. So, the occurrence of the syndrome is the result of the disturbance of the brain-kidney activities. In normal conditions, the brain vitality goes down to stimulate and control the kidney, while the kidney essence goes up at the same time to nourish the brain vitality. Based on this theory, we developed a strategy of regulating the mental activities and reinforcing the kidney to treat the disease. In the prescription, fengfu (GV-16) and baihui (GV-20), pertaining to the Du (governing) channel that connects the brain and kidney, are essential points. Needling them has the actions of refreshment and regulating the mental activities, freeing the Du channel to bring about communication between the brain and the kidney. Needling the point shenshu (BL-23), where the kidney essence and kidney-qi converge and transport from, has the actions of supplementing the kidney and replenishing the essence, engendering the marrow, and nourishing the brain. Qihai (CV-6), a point pertaining to the Ren (conception) channel, has the actions of reinforcing the primordial qi, supplementing the kidney, and balancing the Du channel with the Ren channel.

All but one patient showed significant improvement in symptoms with this treatment. According to the data presented, the following changes in hormone levels were noted (E2 in pg/ml; FSH and LH in IU/L):

In the developing menopausal condition, FSH and LH elevate and E2 declines, but the acupuncture treatment has reversed this trend. Unlike use of external sources of hormones, this therapy yields hormonal levels that stay within the normal physiological range and retain a balance of the different hormones, not just an increase in the estrogens.

One of the adjunctive acupuncture points suggested was taixi (KI-3), which is employed when there are signs of yin deficiency. A treatment for postmenopausal women with taixi, shenshu (BL-23), and guanyuan (CV-4), rather than qihai (CV-6; which has actions similar to CV-4) along with administration of calcium supplements was said to have a marked effect on bone mineral density (6). The treatment was given once every other day for three months, followed by a ten day break and then another three month course of therapy. The authors noted that laboratory animal studies had been conducted to reveal the mechanism of action, stating that:

Modern studies have proved that acupuncture at shenshu (BL-23) and guanyuan (CV-4) can increase the gonadal hormone level and the weight of adrenal cortex so as to exert a compensatory effect for the hyposecretion of gonadal hormone caused by hypo-ovarianism, thus inhibiting bone resportion and promoting bone formation to increase the bone mineral density.

In other words, the acupuncture treatment promotes the ovarian production of estrogens, thus helping to reverse osteoporosis. The two studies taken together suggest that acupuncture at shenshu plus a point of the lower conception vessel may aid endocrine function and normalize hormone levels, while the governing vessel points on the neck (at GV-16) and head (at GV-20) may specifically augment the treatment effects for improving mental function. Following is a summary of the actions of the acupuncture points mentioned (7):

FOLLOW-UP TREATMENT AND HERBS

Although the authors of the first study did not comment on what would be done following this initial one month of treatment, standard practice in China is to maintain the results through additional, but less frequent, acupuncture (e.g., once or twice per week depending on the patient needs) and with herb therapies.

One of the suitable herb therapies for brain fog is Bu Nao Wan (Brain Tonifying Pills), which are made with several different recipes, but an example is this one (8), produced by ITM (Pine Mountain), and similar to a popular patent remedy which was known as Cerebral Tonic Pills:

As can be seen, the formula is dominated by schizandra and zizyphus, two herbs that stabilize the mental functions. In Pharmacology and Applications of Chinese Materia Medica (9) it is noted that: "Human intellectual activity can be enhanced by schizandra so that work efficiency is increased. Schizandrin [a major active component of the herb, illustration below] at 5-10 mg could improve certain activities requiring concentration, fine coordination, sensitivity and endurance...." Zizyphus is the primary sedative herb used in Chinese medicine, but it produces a mild calming effect rather than a heavy sedating activity, and thus is often taken during the day, not just as night. Both schizandra and zizyphus help alleviate excessive sweating that may occur with menopausal flushing.

Bu Nao Wan includes several herbs that treat the condition called "phlegm-mist" or "phlegm-turbidity" which affects mental functions. As an example, the physician Jiao Shude (10) mentions that "acorus is frequently used to open and free the orifices of the heart, diffuse qi, and eliminate phlegm, thereby arousing the brain and clearing the spirit...phlegm turbidity and qi depression affect the heart spirit and result in palpitations, forgetfulness, fright and fear, and disquieted essence-spirit…." He further notes that polygala "promotes heart-kidney interaction, supplements the heart and boosts the kidney, and tends to be used for fright palpitations, forgetfulness, insomnia, and spiritlessness. In the Clinical Handbook of Chinese Prepared Medicines (11), Bu Nao Wan is described as being useful for symptoms of "poor memory, uneasiness, palpitations, and insomnia."

REFERENCES

1. Sherwin BB, Estrogen and memory in women: how can we reconcile the findings?, Hormones and Behavior 2005; 47(3): 371-375.
2. Daniel JM, Hulst JL, and Lee CD, Role of hippocampal M2 muscarinic receptors in the estrogen-induced enhancement of working memory, Neuroscience 2005; 132(1): 57-64.
3. Ariniello L, Estrogen's influence on the brain, Brain Briefings, Society for Neuroscience, http://web.sfn.org/content/Publications/BrainBriefings/estrogen.html
4. Elsabagh S, Hartley DE, and File SE, Limited cognitive benefits in Stage +2 postmenopausal women after 6 weeks of treatment with Ginkgo biloba, Journal of Psychopharmacology 2005; 19(2): 173-181.
5. Shen Xiaoming, et al., Acupuncture for treatment of climacteric syndrome, Journal of Traditional Chinese Medicine 2005; 25(1): 3-6.
6. Ouyang Gang, et al., The effect of acupuncture on bone mineral density in postmenopausal women, Journal of Traditional Chinese Medicine 2002; 22(1): 9-11.
7. Deadman P and Al-Khafaji M, A Manual of Acupuncture, 1998 Journal of Chinese Medicine Publications, Hove, England.
8. Dharmananda S, A Bag of Pearls, 2004 Institute for Traditional Medicine, Portland, OR.
9. Chang HM and But PPH (editors), Pharmacology and Applications of Chinese Materia Medica, 1986 World Scientific, Singapore.
10. Mitchell C, et al. (translators), Ten Lectures on the Use of Medicinals from the Personal Experience of Jiao Shude, 2003 Paradigm Publications, Brookline, MA.
11. Zhu CH, Clinical Handbook of Chinese Prepared Medicines, 1989 Paradigm Publications, Brookline, MA.

May 2005