This is the presentation on "Health Begins with our Brain" by Professor TANG SW at CUHKSPHPCAA Inauguration Ceremony and 1st Scientific Meeting at School of Public Health, CUHK on 22 Feb 2011.

1. Health begins with the Brain Professor SW Tang Emeritus Professor of Psychiatry, UC Irvine , USA Director, Institute of Brain Medicine

2. The Meaning of Life many Million years ago:The primitive Life forms Survival was the meaning of Life To Survive: Food Then to preserve species : Reproduction

3. Food & Sex Known for thousands of years: a. “The desire for food and sex is basic to animals, & is human nature” (Mencius) 孟子 (告子)“告子曰: 食色性也” b. “Eating and Sex are human wants” (Confucius) 孔子: 礼记“饮食男女，人之大欲存焉”

4. CNS Core was a survival co-ordination center only & still is

5. The brain of lower animals may not even be essential for short term survival Insects can live for a short term without the brain and to fulfill the purpose of reproduction e.g. praying mantis

8. “Thinking” is NOT necessaryfor the continuation of Life

9. Insects  Mammals Limbic brain added : (hippocampus, amygdala, nucleus accumben and other limbic circuit components) To: Sense danger , eat or run Spatial orientation and memory for food and escape (Hippocampal function, Serotonin (5HT) function) Pleasure (Dopamine (DA)function) : to repeat behavior which are rewarding

10. Higher Mammals Addition of Cortex to integrate the Limbic and the core brain : Cortex needed for the Analysis of a complex world : To find the best way to carry on with the species: a. strong mate for strong genetics  strong off-springs for best survival b. Analysis of the others c. Build a stable environment for bring up the off-springs (society/civilization)

11. Major Difference between the Human brain & Brains of lower animals Addition of the 1. (Cortex) to 2. (Limbic brain) & 3. (Brain core)

12. Some do not use their cortex (Those who’s life purpose was only “eat and reproduce” ) “The Wisest and the Most Stupid are NOT Changeable ” (Confucius ) 子曰：“唯上智與下愚不移” (論語 ‧ 陽貨第十七)

13. Evolution of The Tri- Brain Brain Core : co-ordination center , …. All animals (e.g. insects have only brain core) Limbic Brain : emotion, pleasure, fear, …..All animals (e.g. reptiles have largely limbic brain) The Cortex : a. Lower animals (small cortex, e.g. rats) b. Primates (large cortex, e.g. human)

14. Cortex A Rat Pallium A Cortex subpallium A Avian Primate The Rise of the Cortex : Analysis of Complex environment (dangers abound)

15. The functions of the Tri-brain are same but forms differ in Human Feeding ( job  earning enough  eat well) [DA, 5HT] Love & Defense (love, attachment, fear, anger, aggression) [5HT, DA, sex hormones] Reproduction ( sensation seeking, attracted to the right mate ) [DA, oxytocin, vasopressin] Continuation of life ( commitment, family function, maternal behavior) [oxytocin, vasopressin] Social Interaction (civilization) [cortisol]

16. Amygdalaremains an important Structure in evolution and is the basis for psychosomatics Hippocampus Reproductive,Sexual attraction Fear,Anxiety Motor Output Appetitive Reward Thalamus Midbrain Vocalization .e.g. Song OB Sensory Inputs e.g. eye Avian Brain

17. Role of Amygdala in psychosomatics Inputs Sensory cortex Frontal Pre frontal cortex Hippocampus (contextual input) Olfactory (pheromones) Thalamus Insular Cortex Hormonal Outputs Thalamus Cortex Striatum Hippocampus Hypothalamus Brain Stem Vagal

18. Vertebrate Cerebrum organization Using More Chemicals + Glu + Cortex + Ach Striatum, Limbic - GABA Peptides Thalamus Hypothalamus Tegmentum Brain Stem DA

19. Cognitive function Executive function DA reward Pathways Amygdala/ Hippocampus Core

21. Menzi : Mother moving thrice to ensure the best environment

23. Amygdala alias of a character in Batman comics a sometime opponent of Batman has reduced cortical capacity, is prone to outbursts of violence due to the removal of his amygdala in an attempt to rid him of his homicidal rage

24. Autism, Asperger’s and Senseless Cruelty & Violence Amygdala, Insula and Mirror Neuron Implicated

25. Early Life Resilience Formation Quality and Quantity of early-life maternal care : a predominant signal triggering gene expression in glucocorticoids and corticotropin releasing factor (CRH)  development of resilience or vulnerable phenotypes

26. Cortex Amygdala Weak Cortex Insula Strong Cortex Insula (Aristotle, Shunzi) Amygdala Hypothalamus Pons Insensitive Amygdala Amygdala Highly Buffered Emotion Solution after filtering Un-buffered emotion Solution direct

27. Human The strength of Cortex over Limbicand Brain Core center: : basis for civilization and social behavior but also the basis for many important human health problems

28. Health begins with the Brain

29. Many body functions are under subtle brain control Some commonly known (e.g. cannot use your fingers, walk after stroke), some not so much known (e.g. immunological system) But many related to human social interaction and psychosomatics

30. Psychosomatic Common Brain based health presentations: a. Aches & Pains [Sciatica (special case of psychosomatic: Floating anxiety sleep disturbances  muscle tension, back pain b. GI disturbances (very high % of patients in GI clinics) c. Chest discomfort (very high % of patients in cardiac clinics) d. Dermatological (ezcema…) e. Medically unexplained symptoms

31. Annual Physical check ups: Begins with the Brain Thank You !