Friday, May 13, 2016

MEMORY IN CHINESE MEDICINE

THE SHEN () OF THE HEART

The Shen of the Heart plays a prominent role in memory partly by itself and partly because it coordinates the Yi of the Spleen and the Zhi of the Kidneys which also play a role in memory.

The Shen of the Heart plays a role in memory in the sense of memorizing but especially also in intrinsic memory (see below).

Information that we have to consciously work to remember is known as explicit memory, while information that we remember unconsciously is known as implicit memory.  Implicit memory is  not always unconscious as it includes what we call “muscle memory” which in psychology is called “procedural memory” (see below).

Explicit Memory
When we are trying to intentionally remember something (like the names of acupuncture points or a list of dates for a history class), this information is stored in our explicit memory. We use these memories every day, from remembering information for a test to recalling the date and time of a doctor's appointment. This type of memory is also known as declarative memory, since we can consciously recall and explain the information.

Some tasks that require the use of explicit memory include remembering what we learned in a class, recalling a phone number, writing a research paper, and remembering what time we are meeting a friend, etc.

There are two major types of explicit memory:

1.     Episodic memory: These are our long-term memories of specific events, such as what we did the day before or our high school graduation.
2.     Semantic memory: These are memories of facts, concepts, names, and other general knowledge information.


Implicit Memory
Things that we do not purposely try to remember are stored in implicit memory. This kind of memory is both unconscious and unintentional. Implicit memory is also sometimes referred to as non-declarative memory, since we are not able to consciously bring it into awareness.

Procedural memories, such as how to perform a specific task like swinging a baseball bat or sewing, are one type of implicit memory since we do not have to consciously recall how to perform these tasks. While implicit memories are not consciously recalled, they still have an influence on how we behave as well as our knowledge of different tasks.

Some examples of implicit memory include singing a familiar song, typing on our computer keyboard, daily habits, driving a car, riding a bicycle, sewing.

Riding a bicycle is another great example. Even after going years without riding one, most people are able to hop on a bike and ride it effortlessly.

The Shen of the Heart plays a role in both extrinsic and intrinsic memory but it is especially the one that is responsible for intrinsic memory, which the Yi of the Spleen and the Zhi of the Kidneys are not.







Heart-Blood deficiency and Heart-Yin deficiency are a common cause of poor memory.

HEART-BLOOD DEFICIENCY 
Palpitations, dizziness, insomnia, dream-disturbed sleep, poor memory, anxiety, propensity to be startled, dull-pale complexion, pale lips.
Tongue: Pale, Thin, slightly dry.
Pulse: Choppy or Fine.
Key symptoms: palpitations, insomnia, poor memory, Pale tongue.
Acupuncture
Points: HE-7 Shenmen, Ren-14 Juque, Ren-15 Jiuwei, Ren-4 Guanyuan, BL-17 Geshu (with moxa), BL-20 Pishu.
Method: all with reinforcing method. Moxa can be used.

Herbal formula
Shen Qi Si Wu Tang Ginseng-Astragalus-Four Substances Decoction.

Three Treasures
Calm the Shen (variation of Gui Pi Tang).


HEART-YIN DEFICIENCY 
Palpitations, insomnia, dream-disturbed sleep, propensity to be startled, poor memory, anxiety, mental restlessness, dry mouth and throat, night sweating.
Tongue: no coating, deep midline crack reaching the tip.
Pulse: Floating-Empty. 
Key symptoms: palpitations, mental restlessness, night-sweating, tongue without coating.
Acupuncture
Points: HE-7 Shenmen, Ren-14 Juque, Ren-15 Jiuwei, Ren-4 Guanyuan, HE-6 Yinxi, SP-6 Sanyinjiao.
Method: all with reinforcing method, no moxa.

Herbal formula
Tian Wang Bu Xin Dan Heavenly Emperor Tonifying the Heart Pill.

Women’s Treasure
Heavenly Empress (variation of Tian Wang Bu Xin Dan).

THE YI () OF THE SPLEEN

The Chinese character for the mental aspect of the Spleen is Yi  which can mean “idea” or “intention”.

The Yi resides in the Spleen and is responsible for applied thinking, studying, memorizing, focusing, concentrating and generating ideas.

The Post-Natal Qi and Blood are the physiological basis for the Yi. Thus if the Spleen is strong, thinking will be clear, memory good and the capacity for concentrating, studying and generating ideas will also be good.

If the Spleen is weak, the Yi will be dull, thinking will be slow, memory poor and the capacity for studying, concentrating and focusing will all be weak.

The Spleen is responsible for memory in the sense of studying, concentrating, focusing and memorizing data in the course of one’s study or work.

Note that the Chinese character for “Yi” is based on the “heart” radical.  This indicates two things.  Firstly, it indicates that the memory of the Spleen depends also on the Heart.  Secondly, it refers to the Shen’s coordinating and integrating function in respect of the Hun, Po, Yi and Zhi.


SPLEEN-BLOOD DEFICIENCY
Poor appetite, slight abdominal distension after eating, tiredness, lassitude, dull-pale complexion, weakness of the limbs, loose stools, poor memory, thin body, scanty periods or amenorrhoea.
Tongue: Pale, Thin and slightly dry.
Pulse: Choppy or Fine.
Key symptoms: tiredness, slight abdominal distension, scanty periods, Pale tongue.
Acupuncture
Points: Ren-12 Zhongwan, ST-36 Zusanli, SP-6 Sanyinjiao, BL-20 Pishu, BL-21 Weishu, Ren-4 Guanyuan, BL-17 Geshu (with direct moxa).
Method: reinforcing method.  Moxa is applicable.

Herbal formula
Gui Pi Tang Tonifying the Spleen Decoction.

Three Treasures
Calm the Shen (variation of Gui Pi Tang).


THE ZHI () OF THE KIDNEYS

The word Zhi  has at least three meanings:
1. it indicates “memory”
2. it means “will power “
3. it is sometimes used to indicate the “five Zhi”, i.e. the five mental aspects Shen, Hun, Po, Yi and Zhi itself.

In the first sense, the Kidneys influence our capacity for memorizing and storing data. Some of the ancient doctors even said that the Yi of the Spleen and the memory of the Kidneys are almost the same thing, except that the Yi is responsible for memorizing in the course of studying and the Zhi of the Kidneys is responsible for the storing of data over the long term.

Tang Zong Hai says: “Zhi indicates Yi with a capacity for storing [data]”.

The character for Zhi is indicated below.  It is composed of Shi on the upper part and the “Heart” in the lower part.



KIDNEY-YIN DEFICIENCY
Dizziness, tinnitus, vertigo, poor memory, hardness of hearing, night-sweating, dry mouth and throat at night, lower backache, ache in bones, dark-scanty urine, infertility, premature ejaculation, tiredness, lassitude, slight anxiety.
Tongue: normal-coloured without coating.
Pulse: Floating-Empty. 
Key symptoms: backache, night sweating.
Acupuncture
Points: Ren-4 Guanyuan, KI-3 Taixi, KI-6 Zhaohai, KI-10 Yingu, KI-9 Zhubin, SP-6 Sanyinjiao, Ren-7 Yinjiao, LU-7 Lieque and KI-6 Zhaohai in combination (opening points of the Ren Mai).
Method: reinforcing method, no moxa.

Herbal fomula
Zuo Gui Wan Restoring the Left [Kidney] Pill.
Liu Wei Di Huang Wan Six-Ingredient Rehmannia Pill.

Three Treasures
Nourish the Root (variation of Zuo Gui Wan).

In the sphere of thinking, remembering and memorizing there is considerable overlap between the Yi of Spleen, the Shen of Heart and the Zhi of Kidneys. The main differentiating factor is that the Spleen is  responsible for memorizing data in the course of one's work or study. 

For example, it is not uncommon for someone to have a brilliant memory in his or her field of study or research (a function of the Spleen), and yet be quite forgetful in daily life (a function of the Heart).

The Heart and Kidneys also contribute to this function, but they are also responsible for the memory of past events and implicit memory. In particular, the overlap between the Yi and the Shen in thinking activity is very close, so much so that the “Ling Shu” says in chapter 8: “The Heart function of recollecting is called Yi”.

In turn, the memorizing function of the Yi is so closely related to the Zhi of the Kidneys that the same chapter continues: “The storing [of data] of the Yi is called  Zhi”.

These passages confirm that Shen, Yi and Zhi are a continuum.

Memory and sense of Self
In modern psychology, “memory” is more that just the ability to store facts and information in our brain.  It is actually an essential part in which our consciousness exists, works and manifests itself and working memory plays an important role in our consciousness.

Even the thought “I live in the present” requires short-term memory. Even the immediate present requires involves memory – what we know about the one present moment is basically what is in our working memory.  

Working memory allows us to know that the “here and now” is “here” and is happening “now”. This insight underlies the notion, adopted by a number of cognitive scientists, that consciousness is the awareness of what is in working memory.

LeDoux says: “The self is in part made and maintained by memory and both implicit and explicit forms are involved.[1]



Thus, in a broader sense, Zhi is much more than “memory” in the sense of being able to remember past events.  The Zhi (together with the Shen) contributes to our working memory and also to the long-term memory.  Together with the Shen of the Heart, this contributes to creating our consciousness and sense of self. 



Treatment of poor memory
Memory can be stimulated by treating:

Heart (Shen): HE-7, HE-3, BL-15, BL-44 Shentang

Kidneys (Zhi): KI-3, BL-23, BL-52 Zhishi

Spleen (Yi): SP-3, BL-20, BL-49 Yishe

Du Mai (Brain/Sea of Marrow): SI-3/BL-62, Du-16, Du-20.

The Du Mai and memory
Another factor in memory is the Du Mai for three reasons. 
1)     It flows through the Heart and therefore affects Shen.
2)     It originates from the Kidneys and therefore affects Zhi.
3)     It is the vessel through which the Kidneys’ Sea of Marrow reaches the Brain.

The three main points are Du-11 Shendao, Du-20 Baihui and Du-24 Shenting.

The Lungs and memory
However, remember that there are other factors at work in memory, e.g. the Lungs affect memory by regulating the amount of Qi reaching the head.  Thus LU-7 and LU-3 are important for poor memory due to Qi not reaching the head.

The “Explanation of the Acupuncture Points” says that LU-3 can make Qi rise to treat forgetfulness, sadness and weeping due to Qi not rising to head.[2]

Forgetfulness is an important indication for this point: this is forgetfulness due to clear Qi not rising to the head.  According to the “Explanation of the Acupuncture Points”, this point treats forgetfulness by stimulating the ascending of Qi of both Lungs and Heart.[3]

Phlegm and Blood stasis in memory
Finally, it is important to remember that memory is affected by Full conditions, especially Phlegm and Blood stasis obstructing the Brain. This happens especially in the elderly.

In particular, Phlegm is a common cause of poor memory: when it is, poor memory is accompanied by dizziness and a feeling of heaviness and muzziness (fuzziness) of the head.  The tongue is swollen, illustrated below.

Points for Phlegm obstructing the Brain and affecting memory are: Du-20 Baihui, Du-24 Shenting, ST-40 Fenglong, LU-7 Lieque, Ren-9 Shuifen, Ren-5 Shimen, BL-22 Sanjiaoshu, P-5 Jianshi. 

These two tongues are both swollen, indicating Phlegm. 











[1]  Joseph Ledoux, The Emotional Brain, Simon and Shuster, NY, 1996, p. 278.

[2]  An Explanation of the Acupuncture Points (Jing Xue Jie), pp.  26-7.

[3]  Ibid., p.  27.