Perimenopausal Brain Fog: Acupuncture and Herbs to Stimulate Brain Activity

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).

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.

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