I. Types of Hydrocephalus
1. Congenital hydrocephalus
Congenital hydrocephalus is a condition presented at birth as a result of genetic defect or abnormal fetal development. In the study to illustrate the value of knockout mice in identifying genetic factors involved in the development of congenital hydrocephalus, showed that dysfunctional motile cilia represent the underlying pathogenetic mechanism in 8 of the 12 lines (Ulk4, Nme5, Nme7, Kif27, Stk36, Dpcd, Ak7, and Ak8)... characterization of mouse models can enhance understanding of important cell signaling and developmental pathways involved in the pathogenesis of hydrocephalus(1). At least 43 mutants/loci linked to hereditary hydrocephalus have been identified in animal models and humans. Up to date, 9 genes associated with hydrocephalus have been identified in animal models. In contrast, only one such gene has been identified in humans. Most of known hydrocephalus gene products are the important cytokines, growth factors or related molecules in the cellular signal pathways during early brain development(2).
2. Acquired hydrocephalus
Acquired hydrocephalus is a condition developed after birth as a result of injure or diseases.
3. Communicating hydrocephalus or non-obstructive hydrocephalus,
Communicating hydrocephalus is defined as condition as the cerebrospinal fluid (CSF) can still flow between the ventricles.
4. Non communicating hydrocephalus or obstructive hydrocephalus
Non communicating hydrocephalus is defined as a condition as the cerebrospinal fluid (CSF) is blocked and can not flow between the ventricles.
II. Causes and risk factors
Although the actual causes of Hydrocephalus is unknown, some researchers suggested that
1. Genetic defect
Congenital hydrocephalus id associated with dysfunctional motile cilia represent the underlying pathogenetic mechanism in 8 of the 12 lines (Ulk4, Nme5, Nme7, Kif27, Stk36, Dpcd, Ak7, and Ak8).(3). Other researchers suggested that Although hydrocephalus is usually a sporadic disorder, there exist some rare but well delineated syndroms, in which recurrence is to be expected. The here presented Bickers-Adams-Syndrome of sex-linked hydrocephalus is caused by congenital aqueductal stenosis(4).
Hydrocephalus is associated with the complications of tuberculous meningitis (TBM) occurred in up to 85% of children with the disease. It is more severe in children than in adults. It could be either of the communicating type or the obstructive type with the former being more frequently seen(5).
3. Neural tube defect
Congenital hydrocephalus is a relatively uncommon abnormality in population malformation surveys accounting for between four and ten out of every 10,000 births. In the review of Sixty cases of 28 with NTD (group 1) and 32 without NTD (group 2). The groups were similar in terms of maternal and child variables at birth and hospitalization days during the 1st year of life. The mortality (including intrauterine deaths and deaths of babies with malformations incompatible with life that characterize a very poor prognosis) until 1 year of age was 36% in group 1 and 59% in group 2 (p = 0.077). The rate of cardiac malformations was higher in the group without NTD (p = 0.015). The length of hospital stay after birth (1st admission) was significantly higher in the group with NTD (p = 0.007)(6).
5. Intraventricular hemorrhage
Intraventricular hemorrhage and posthemorrhagic hydrocephalus are common causes of neonatal morbidity and mortality among preterm and low-birth weight infants (PT-LBWIs), but Intraventricular hemorrhage in PT-LBWIs remains a significant problem, particularly when it is associated with PHH leading to long-term neurological impairment and decreased survival rate(7).
6. PTB Deficiency
Polypyrimidine tract-binding protein (PTB) is a well-characterized RNA-binding protein and known to be preferentially expressed in neural stem cells (NSCs) in the central nervous system. Dr. Shibasaki T and the research team at the Center for Experimental Medicine and Systems Biology. showed that PTB depletion in the dorsal telencephalon is causally involved in the development of HC and that PTB is important for the maintenance of AJs in the NSCs of the dorsal telencephalon(8).
Tumor-associated hydrocephalus is common in primary pediatric brain tumors. In the study of a total of 56.7% of cases presented hydrocephalus, including hydrocephalus that occurred at tumor diagnosis (51.5%), and hydrocephalus developed after tumor diagnosis (5.1%). At tumor diagnosis, the hydrocephalus was mainly obstructive type (98%) and rarely communicating type (1.9%). Definite shunting procedures in this series comprised of ventriculoperitoneal (VP) shunt in 54.4%, endoscopic third ventriculostomy (ETV) in 10.9%, subduroperitoneal (SP) shunt in 4.8%, septostomy in 0.7%, lumboperitoneal shunt in 0.6%, and ventriculoatrial shunt in 0.1% of patients with hydrocephalus(9).
7. Traumatic head injury
Post-traumatic hydrocephalus (PTH) is considered a frequent complication after severe head injury (HI). External hydrocephalus is a well-established entity in infants which is benign and usually resolves without shunting [1, 2]. The term “External Hydrocephalus” has also been used to describe the presence of extra ventricular cerebrospinal fluid (CSF) collections accompanied by hydrocephalus, particularly in cases of adults suffering from aneurysmal subarachnoid hemorrhage and severe head injuries [3–6]. Several other terms have been used to describe this entity  which has lead to confusion about this disease(10).
8. Subarachnoid hemorrhage
Acute hydrocephalus as a consequence of subarachnoid hemorrhage is a relatively frequent problem. Dr. Suarez-Rivera O. at the National Institute of Neurology and Neurosurgery, Mexico City, indicated that that acute hydrocephalus is present in 20% of patients with subarachnoid hemorrhage. One third of them may be asymptomatic on admission; 50% of those who have clinical hydrocephalus recover spontaneously within the first 24 h(11)
B. Risk factors
1. Family history
Family studies suggested that the risk to siblings of a child with uncomplicated congenital hydrocephalus, where the anatomical site is not specified, is about 1 in 50 (1 in 40 for males, 1 in 80 for females). With aqueduct stenosis, the risk to brothers of affected boys is 1 in 22, to sisters only 1 in 50. The risks to siblings of sisters is less. Probably less than 2% of uncomplicated hydrocephalus has an X-linked basis and such an aetiology should be suspected if the special clinical features are present, there is more than one male sibling affected, or there are affected male relatives on the mother's side(12).
2. Nontumoral aqueductal stenosis, nontectal tumor and tectal glioma
Hydrocephalus was most commonly due to nontumoral aqueductal stenosis (43%), nontectal tumor (25%), or tectal glioma (13%). Five patients (16%) had multicystic/loculated hydrocephalus(13).
3. Preterm and low-birth weight infants
Preterm and low-birth weight infants are associated with increased risk of intraventricular and/or periventricular hemorrhage (IVH and PVH, respectively) of that can lead to Hydrocephalus(14).
4. Other factors
Although the precise nature of the neuropsychological deficits in hydrocephalus are not completely known, several factors such as etiology, raised intracranial pressure, ventricular size, and changes in gray and white matter tissue composition as well as shunt treatment complications have been shown to influence cognition. In fact, the presence of complications and other brain abnormalities in addition to hydrocephalus such as infections, trauma, intraventricular hemorrhage, low birthweight, and asphyxia are important determinants of the ultimate cognitive status, placing the child at a high risk of cognitive impairment(15).
A. In infancy
1. Increase in head circumference or an unusually large head size
Fluid accumulated will result in Increase in head circumference or an unusually large head size in infant regardless to the types of hydrocephalus due to bulge of the fontanelle (soft spot), Dr. Bhasker B and the research team in the reports a new finding in two siblings with primary hypomagnesaemia as a result of renal magnesium wasting, namely, rapidly increasing head size. External hydrocephalus and brain shrinkage in primary hypomagnesaemia seen on computed tomography of the brain with reversibility after magnesium treatment has not been reported previously(16).
2. Rapid eye movement sleep
In the monitor of Intracranial pressure (ICP) for 24 h in 30 hydrocephalic patients (21 infants, 9 children) showed that during sleep related to a period of rapid eye movement (REM) fairly regular steep-rising waves of raised ICP recurred every 50-75 min, decreasing slowly to previous levels in 25-40 min(17).
3. Sleepiness, Irritability, Sunsetting of the eyes, Seizures are most common symptoms in infant(18)
4. Other symptoms
Dr. Kirkpatrick M and scientists at the Royal Hospital for Sick Children, in the study of Symptoms and signs of progressive hydrocephalus, showed that in the clinical features of 107 cases of children with hydrocephalus and measured raised intraventricular pressure were analysed retrospectively. Fifty one children had recently been diagnosed as having hydrocephalus, and the remainder had had shunts injected to direct the cerebrospinal fluid. The most common symptoms in the group were vomiting, behavioural changes, drowsiness, and headaches. The most common clinical signs were inappropriately increasing occipitofrontal head circumferences, tense anterior fontanelles, splayed sutures, and distension of the scalp veins. Half the infantile cases of hydrocephalus were without symptoms, and a quarter of the cases with cerebrospinal fluid shunts and measured raised intraventricular pressure were without signs. There were no fewer than 33 different clinical signs including several unusual ones, such as macular rash and sweating. We believe that the presentation of hydrocephalus with raised intraventricular pressure is sufficiently variable, unusual, or even absent to justify the direct measurement of intracranial pressure(19).
B. Children and adults
Beside some symptoms mentioned in the infant section, Children and adults with the disease may also be experience other symptoms because of the head can no longer expand to accommodated to the accumulation of the fluid
1. The most common symptoms in the group were vomiting, behavioural changes, drowsiness, and headaches. The most common clinical signs were inappropriately increasing occipitofrontal head circumferences, tense anterior fontanelles, splayed sutures, and distension of the scalp veins(19).
2. Diplopia, headaches, and papilledema
Hydrocephalus can also cause symptoms of diplopia, headaches, and papilledema, There is a report of a 48-year-old woman was admitted to the hospital because of diplopia, headaches, and papilledema. Imaging revealed cysts in the fourth ventricle and spinal canal(20)
3. Headache, hearing difficulty and blurred vision
Headache and blurred vision are also associated with symptoms of hydrocephalus. There is a report of a
patient of 25-year-old female, admitted to the department of otorhinolaryngology with complaints of hearing difficulty, headache and blurred vision(21).
4. Other symptoms
Dr. Kubo Y and research team at the Osaka University Graduate School of Medicine, in the study of Validation of grading scale for evaluating symptoms of idiopathic normal-pressure hydrocephalus, showed that the interrater reliability of this scale was high. The iNPHGS cognitive domain score significantly correlated with the cognitive test scores, including the Mini-Mental State Examination (MMSE), the gait domain score with the Up and Go Test and Gait Status Scale scores, and the urinary domain score with the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) score. The MMSE, Gait Status Scale and ICIQ-SF scores significantly improved in patients whose iNPHGS scores improved after CSF tapping but not in those whose iNPHGS scores did not improve after CSF tapping. Fourteen of the 38 patients received shunt operations. In these 14 patients, changes in the iNPHGS cognitive and urinary domains after CSF tapping were significantly associated with the changes after the shunt operation(22). Other found that the most frequently observed neuropsychiatric symptom in the iNPH patients was apathy followed by anxiety and aggression. No symptom was more prevalent or more severe in iNPH than in AD. The severity of cognitive impairment was correlated with both aberrant motor activity and apathy(23).
Because some of these symptoms may also be experienced in other disorders, sometimes normal pressure hydrocephalus is incorrectly diagnosed and never properly treated, including
Neurosarcoidosis, a complication of sarcoidosis in which inflammation occurs in the brain, spinal cord, and other areas of the nervous system is observed in approximately 5% of sarcoidosis. Its common manifestations are facial palsy (50% of patients with neurosarcoidosis) and optic neuritis. Hydrocephalus is a very uncommon reported finding. Although the typical presentation of sarcoidosis such as facial palsy is not a diagnostic dilemma, more atypical presentations such as hydrocephalus with altered mentality in a tuberculosis patient can lead to a misdiagnosis(24).
2. Alzheimer's disease
Dr. Silverberg GD and scientists at the Stanford University School of Medicine in the study of Alzheimer's disease and normal-pressure hydrocephalus, suggested that if all else being equal, the initially dominant physiological change determines whether CSF circulatory failure manifests as Alzheimer's disease (AD) or as normal-pressure hydrocephalus (NPH). If CSF production failure predominates, AD develops. However, if resistance to CSF outflow predominates, NPH results. Once either disease process takes hold, the risk of the other disorder may rise. In AD, increased deposition of Abeta in the meninges leads to greater resistance to CSF outflow. In NPH, raised CSF pressure causes lower CSF production and less clearance of Abeta(25).
3. Parkinson's disease
There are several reports of cases with the characteristic clinical manifestations of normal pressure hydrocephalus--progressive dementia, gait difficulty and urinary incontinence--have been published earlier, it was Adams and Hakim who emphasized the clinical triad and the effect of shunting the cerebrospinal fluid as a means of treatment. Messert and Baker stressed that the gait disturbance had a close resemblance to the freezing gait of parkinsonism but Dr. Lobo Antunes J, and the the research team suggested that recognition of the existence of both disorders in the same patients is important since appropriate treatment of each of them led to marked improvement of their symptoms(26).
4. Creutzfeldt-Jakob disease
There is a report of two different dementing diseases, Creutzfeldt-Jakob disease and normal-pressure hydrocephalus in a single patient. The inefficacy of a shunt procedure in this particular case, and the need of a brain biopsy in patients with normal-pressure hydrocephalus before undergoing cerebrospinal fluid shunting are stressed. A purely coincidental occurrence, or a possible aetiopathogenic relationship between both diseases are postulated(27).
According to Dr. Michael Kiefer and the research team, in the study of the Differential Diagnosis and Treatment of Normal-Pressure Hydrocephalus suggested that
B.1. Diagnosis according to patient impairement
1. For patient of Gait impairment, differential diagnosis include the Characteristics of Externally rotated posture of the feet, Particular difficulty turning on the body’s long axis and Absence of apraxia.
2. For patients with Cognitive deficits/dementia, aside from reactive depression (without depressive thought content), patients with NPH generally do not have any psychiatric abnormalities. Thus, changes of mood, personality, and behavior steer the differential diagnosis toward a neurodegenerative disorder of another type. An objective examination should be performed with the aid of specific psychometric tests for the assessment of subcortical frontal lobe deficits.
Some suitable tests of this type are :
2.1 The grooved pegboard test
2.2. The Stroop test
2.3. The digit span test
2.4. The trail-making A/B test
2.5. The Rey auditory-verbal learning test
3. For patients with Incontinence
Disturbances of bladder function in NPH result from detrusor hyperactivity owing to the partial or total absence of central inhibitory control. Patients initially suffer from increased urinary frequency (e42– e44); later developments are urge incontinence and, finally, permanent urinary incontinence. Fecal incontinence is rare in NPH (2) and should arouse suspicion of another type of neurodegenerative disease. If present in a patient with NPH, it implies severe frontal subcortical dysfunction.
CSF shunting can improve bladder dysfunction in as many as 80% of iNPH patients if performed early, but in no more than 50% to 60% if performed in an advanced stage of the disease (e15, e20, e45).
4. NPH and other neurodegenerative disorders
Findings that make NPH less likely
4.1. Asymmetrical findings
4.2. Cortical deficits, e.g., aphasia, apraxia, paresis
4.3. Progressive dementia without gait disturbance
4.5. Lack of progression of symptoms
B.2. General Diagnosis and tests
1. Computerized tomography (CT) or magnetic resonance imaging (MRI)
Either computerized tomography (CT) or magnetic resonance imaging (MRI) of the brain is necessary—yet, alone, never sufficient to establish the diagnosis of NPH.
2. Invasive diagnostic testing
The aim of the tests is needed to raise the prognostic accuracy above 80%
2.1. Spinal tap test: lumbar puncture with the removal of 30 to 70 mL of CSF. This can be repeated on two or three consecutive days
2.2. Continuous spinal drainage of 150 to 200 mL of CSF per day for 2 to 7 days (1– 2)
If the number of steps taken in a 10 m gait test, and the time needed to walk 10 m, are reduced by at least 20%, and/or psychometric tests show an improvement of at least 10%.
3. Other invasive tests
Long-term ICP measurement for 24 to 72 hours is performed in no more than a few centers. Special pressure waves and brain pulse amplitudes are measured Such techniques are not recommended for routine use, both because their predictive value has not yet been sufficiently documented and because they require specialized equipment and expertise
Other than structures abnormalities caused by genetic defects, accidence, etc., most acquired hydrocephalus can be prevented by enhancing the immune system in fighting against forming of free radicals causes of irregular cells growth and foreign invasion such virus and bacteria and reduce the risk of diseases cause of Hydrocephalus, such as dementia.
A. Do's and Do Not's list
1. Mediterranean diet
If you are typical American dieter, you are at increased to develop dementia when you get older as the diet is classified as one of the most unhealthy diet in the existence, as the study of ,researchers wrote in an older population of Southern Italy with a typical Mediterranean diet, high monounsaturated fatty acids energy intake appeared to be associated with a high protection against cognitive decline. In addition, dietary fat and energy in older people seem to be risk factors, while fish consumption and cereals are found to reduce the prevalence of AD in the European and North American countries(1). Also recent research supports the hypothesis that calorie intake, among other non-genetic factors, can influence the risk of clinical dementia.(29).
Yoga is believed to have beneficial effects on cognition, attenuation of emotional intensity and stress reduction. In the study to evaluate the effects of yoga on memory and psychophysiological parameters related to stress, comparing yoga practice and conventional physical exercises in healthy men (previously yoga-naïve). Memory tests, salivary cortisol levels and stress, anxiety, and depression inventories were assessed before and after 6months of practice. Yoga practitioners showed improvement of the memory performance, as well as improvements in psychophysiological parameters(30). Other researchers at the G.J. Patel Ayurved College, showed that Mind and body are inseparable entities and influences each other until death. Many factors such as stress, anxiety, depression, negative thoughts, unhealthy life style, unwholesome diet etc., disturb mental and physical wellbeing. Senile dementia is the mental deterioration, i.e, loss of intellectual ability associated with old age. It causes progressive deterioration of mental faculties, e.g., memory, intellect, attention, thinking, comprehension and personality, with preservation of normal level of consciousness.(31). Other suggested that the effect of stress on the immune system and examine how relaxation techniques such as Yoga and meditation could regulate the cytokine levels and hence, the immune responses during stress(31a).
3. Aging of theory of mind
In the study to predict that educational level and cognitive processing are two factors influencing the pattern of the aging of ToM at Anhui Medical University, showed that the younger group and the older group with equally high education outperformed the older group with less education in false-belief and faux-pas tasks. However, there was no significant difference between the two former groups. The three groups of participants performed equivalently in the eyes test as well as in control tasks (false-belief control question, faux-pas control question, faux-pas control story, and Eyes Test control task). The younger group outperformed the other two groups in the cognitive processing tasks(32)
3. Moderate alcohol drinking
Moderate alcohol drinking of less than 2 cups for men and 1 cups for women are said to offers possible health benefits(3), but Binge drinking in midlife is associated with an increased risk of dementia, according to the follow-up, 103 participants had developed dementia. Binge drinking (ie, alcohol exceeding the amount of 5 bottles of beer or a bottle of wine on 1 occasion at least monthly), as reported in 1975, was associated with a relative risk of 3.2 (95% confidence interval=1.2-8.6) for dementia. Passing out at least twice as a result of excessive alcohol use during the previous year, as reported in 1981, was associated with a relative risk of 10.5 (2.4-46) for dementia in drinkers.(33). Other in the study to evaluated how (1) the number of alcoholic drinks the subjects consumed per month and (2) the drinking cessation of certain subjects were associated with their relative and absolute T, B, CD4, and CD8 lymphocyte counts and immunoglobulin A (IgA), IgM, and IgG levels, indicated that indicated that measures of immune status differed among the drinking categories and that, generally, the differences changed after adjustment for covariates. These differences consisted, as alcohol consumption increased, of higher IgA and IgM levels, relative T and CD4 lymphocytes, and the ratio of CD4 to CD8 cells, and of lower IgG levels, relative B and CD8 lymphocytes, absolute lymphocyte, and lymphocyte subset counts after adjusting for other covariates(33a).
4. Stop Smoking or never smoke before
Smoking is a risk factor for several life-threatening diseases, but its long-term association with dementia is controversial and somewhat understudied.In a studyof a total of 5367 people (25.4%) were diagnosed as having dementia (including 1136 cases of AD and 416 cases of VaD) during a mean follow-up period of 23 years. Results were adjusted for age, sex, education, race, marital status, hypertension, hyperlipidemia, body mass index, diabetes, heart disease, stroke, and alcohol use, Dr. Rusanen M, and the team at the University of Eastern Finland, said " heavy smoking in midlife was associated with a greater than 100% increase in risk of dementia, AD, and VaD more than 2 decades later. These results suggest that the brain is not immune to long-term consequences of heavy smoking"(34).
5. Drink you tea and coffee
Caffeine in tea and coffee may enhance cognitive function acutely. In Aging and Dementia (CAIDE) study, the findings of the previous studies are somewhat inconsistent, but most studies (3 out of 5) support coffee's favorable effects against cognitive decline, dementia or AD. In addition, two studies had combined coffee and tea drinking and indicated some positive effects on cognitive functioning. For tea drinking, protective effects against cognitive decline/dementia are still less evident. In the CAIDE study, coffee drinking of 3-5 cups per day at midlife was associated with a decreased risk of dementia/AD by about 65% at late-life. coffee(35). Others in the study of Immunomodulatory effects of decaffeinated green tea (Camellia sinensis) on the immune system of rainbow trout (Oncorhynchus mykiss), showed that decaffeinated green tea in lower doses of administration could be optimum to enhance the immunity of rainbow trout(36a).
6. Eat you fruits and veggies
Fruits and veggies contains high amounts of antioxidant which enhance the immune system in fighting against forming of free radicals in which can cause damage to the brain cells of that lead to dementia. Researchers at The Johns Hopkins University indicated that use of vitamin E and vitamin C supplements in combination is associated with reduced prevalence and incidence of AD. Antioxidant supplements merit further study as agents for the primary prevention of AD(36).
7. Regular exercise and moderate exercise for elder
In the study to evaluate to the effects of regular exercise versus a single bout of exercise on cognition, anxiety, and mood were systematically examined in healthy, sedentary young adults who were genotyped to determine brain-derived neurotrophic factor (BDNF) allelic status, indicaed that altered activity-dependent release of BDNF in Met allele carriers may attenuate the cognitive benefits of exercise. Importantly, exercise-induced changes in cognition were not correlated with changes in mood/anxiety, suggesting that separate neural systems mediate these effects(37). Other indicated that Overall, in healthy older adults, regular, particularly aerobic, exercise appears to be a friend of the immune system, helping to offset diminished adaptive responses and chronic inflammation. The possibility exists that particularly strenuous exercise may cause acute immunologic changes, such as diminished NK cell activity, which could predispose to infection in certain individuals(37a)
8. Avoid nutritional deficiency with balance diet
Beyond our believe, in the study to highlight how an excess of dietary carbohydrates, particularly fructose, alongside a relative deficiency in dietary fats and cholesterol, may lead to the development of Alzheimer's disease and a first step in the pathophysiology of the disease is represented by advanced glycation end-products in crucial plasma proteins concerned with fat, cholesterol, and oxygen transport.(38). Dr Pae M, and the research team at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, suggested that the need for a more in-depth, wholestic approach to determining the optimal nutritional strategies that would maintain a healthy immune system in the elderly and promote their resistance to infection and other immune-related diseases(38a).
9. Avoid environment risk of dementia(39)
Certain environment toxins produced as a result of industrialization or naturally have been linked to cognitive degenerative diseases. Researchers at the University of British Columbia in the investugation of Novel environmental toxins: steryl glycosides as a potential etiological factor for age-related neurodegenerative diseases, showed that Mice fed washed cycad flour show signs that mimic ALS-PDC, which include progressive deficits in motor, cognitive, and olfactory functions associated with neuron loss in the spinal cord, nigrostriatal system, cortex, hippocampus, and olfactory bulb. Through a series of chemical extractions of washed cycad flour, we identified steryl glycoside molecules as bioactive molecules that are neurotoxic in culture and in mice. A detailed review of this class of molecule revealed that the molecules are abundant in the environment, particularly in plants and bacteria. Lipid analysis showed that some bacteria that are associated with some forms of neurodegenerative disorders have the capacity to synthesize steryl glycosides. Furthermore, certain steryl glycosides have been found to be a cell stress mediator and may have some immunomodulary effects. Others researchers showed that Parkinson disease (PD) and Alzheimer disease (AD), are of purely genetic origin in a minority of cases and appear in most instances to arise through interactions among genetic and environmental factors and early environmental origins of neurodegenerative disease in later life. Also environment toxins can reduce the immune function in protecting against other diseases.
10. No illicit drug, please(40)
Illicit drug used may cause nervous system impairment as a result of direct and indirect effects on the integrity and function of nervous system tissue and, potentially, through immune effects. HIV-1 infection poses an additional risk of impairment, and this risk may be decreased as a result of antiretroviral drug treatment. Others researchers suggested that injection drug use represents the primary risk factor for up to 40% of patients with HIV infection. Illicit drug also can effect the CNS and weaken the immune system.
11. Prevent prolonged period of using certain drug(41)
As aging, accumulation of toxins of certain medication used to treat certain diseases, such as antidepressants, sedatives, cardiovascular drugs and anti-anxiety medications may cause increased risk of cognitive dysfunction leading to produced dementia-like symptoms. Certain medication can suppress the immune system.
B. Diet to prevent Hydrocephalus
The aims of the diet is to provide sufficient nutrients to body and enhance the immune function in fighting against inflammation and weakened immune system causes of Hydrocephalus
B.1. Black beans (Phaseolus)
1. Antioxidant effect
In the evaluation of the indigestible fraction (IF)of the cooked seeds of three pulses (black bean, chickpea and lentil) and their antioxidant effect found that Condensed tannins were retained to some extent in the IF that exhibited significant antioxidant capacity. The total IF of the three pulses produced short chain fatty acids (SCFA) after 24 h of in vitro fermentation by human colonic microflora. IF from black bean and lentil were best substrates for the fermentative production of butyric acid, according to "In vitro fermentability and antioxidant capacity of the indigestible fraction of cooked black beans (Phaseolus vulgaris L.), lentils (Lens culinaris L.) and chickpeas (Cicer arietinum L.)" by Hernández-Salazar M, Osorio-Diaz P, Loarca-Piña G, Reynoso-Camacho R, Tovar J, Bello-Pérez LA.(42)
Molybdenum cofactor is vital for human enzymes, including xanthine oxidase, sulfite oxidase, and aldehyde oxidase, Deficiency may cause
a. Prenatal brain disruption, according to the study of "Prenatal brain disruption in molybdenum cofactor deficiency" by Carmi-Nawi N, Malinger G, Mandel H, Ichida K, Lerman-Sagie T, Lev D.(43)
3. Nervous system
Protein is essential for the brain in transmitting information between themselves and cells in the other parts of the body, thus reducing the blood sugar levels from rising too rapidly after a meal, reducing the risk of nervous symptoms cause of anxiety, stress and depression, etc., according to the study of "The planar polarity protein Scribble1 is essential for neuronal plasticity and brain function" by Moreau MM, Piguel N, Papouin T, Koehl M, Durand CM, Rubio ME, Loll F, Richard EM, Mazzocco C, Racca C, Oliet SH, Abrous DN, Montcouquiol M, Sans N, posted in PubMed (44)
B.2. Brown rice
Oat contains trace minerals selenium which is essential for the healthy function of the thyroid and immune system as it increases the antioxidant defense system by fighting against the forming of free radicals and reduce the risk of irregular cells growth causes of tumor and cancer, according to the study of "Selenium in the immune system" by Arthur JR, McKenzie RC, Beckett GJ.(45)
Beside containing high levels of magnesium which is necessary for the synthesis of fatty acids to produce energy for our body needs, it also is one of the important component of antioxidant enzyme of which increases the body in fighting against the forming of free radical, according to the study of "Analysis of antioxidant enzyme activity and magnesium level in chronic obstructive pulmonary disease (COPD)" by Kurys E, Kurys P, Kuźniar A, Kieszko R., posted in PubMed(46)
1. Immunomodulatory activity
In the research of Roots of Asparagus racemosus Willd (Shatavari in vernacular) and its effect on immunostimulation found that asparagus racemosus root aqueous extract (ARE) also showed higher antibody titres and DTH responses. ARE, in combination with LPS, Con A or SRBC, produced a significant proliferation suggesting effect on activated lymphocytes and suggested that mixed Th1/Th2 activity of ARE supports its immunoadjuvant potential, according to "Immunomodulatory activity of Asparagus racemosus on systemic Th1/Th2 immunity: implications for immunoadjuvant potential" by Gautam M, Saha S, Bani S, Kaul A, Mishra S, Patil D, Satti NK, Suri KA, Gairola S, Suresh K, Jadhav S, Qazi GN, Patwardhan B.(47)
Asparagus contains some kinds of antioxidant that help to improve the immune system in fighting against the forming of radicals, thus promoting synthesis DNA and regulates cell division, according to "The role of antioxidant supplement in immune system, neoplastic, and neurodegenerative disorders: a point of view for an assessment of the risk/benefit profile" by Brambilla D, Mancuso C, Scuderi MR, Bosco P, Cantarella G, Lempereur L, Di Benedetto G, Pezzino S, Bernardini R.(48)
1. Vitamin K
Since leak contains a measure amount of vitamin K, it helps to protect against aging diseases and the under layers of the skin, thus reducing the risk of wrinkle due to aging and enhances the absorption of calcium, thus promoting the formation of healthy bones, according to the study of "Vitamin K, osteoporosis and degenerative diseases of ageing" by Vermeer C, Theuwissen E., researchers found that According to the triage theory, long-term vitamin K inadequacy is an independent, but modifiable risk factor for the development of degenerative diseases of ageing including osteoporosis and atherosclerosis.(49)
2. Antioxidant activities
In the investigation of the methanol extract of dried skin of Allium cepa and its isolation of quercetin-3'-O-beta-D-glucoside  found that the antioxidant activity of 1 was evaluated in the oxygen radical absorbance capacity assay; it showed 3.04 micromol Trolox equivalents/mmol. 1 was shown to be a promising ingredient that could be useful for treating hyperpigmentation and for protecting against oxidative stress, according to "Melanin biosynthesis inhibitory and antioxidant activities of quercetin-3'-O-beta-D-glucoside isolated from Allium cepa" by Arung ET, Furuta S, Ishikawa H, Tanaka H, Shimizu K, Kondo R.(50)
C. Photochemical to prevent Hydrocephalus
C.1. Rosemarinol, is a phytochemical monophenols, found in essential oil of labiate herbs like Rosemary and also in variety of other plants.
1. Chemical stabilization of fish oil
In the study of fish oil undergoes multiple changes in its physical properties and its autoxidation occurred found that rosemary extract rich in carnosic acid to ternary blends of tocopherols, ascorbyl palmitate and lecithin or Citrem significantly retarded autoxidation, according to "Chemical stabilization of oils rich in long-chain polyunsaturated fatty acids during storage" by Pop F.
2. Anti-inflammatory effects
In the research of the extract of rosemary leaves from supercritical fluid extraction and its anti inflammatory effects found that the yield of 3.92% and total phenolics of 213.5 mg/g extract obtained from the most effective extraction conditions showed a high inhibitory effect on lipid peroxidation (IC(50) 33.4 μg/mL). Both the SC-CO(2) extract and CA markedly suppressed the LPS-induced production of nitric oxide (NO) and tumor necrosis factor-α (TNF-α), as well as the expression of inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2), phosphorylated inhibitor-kappaB (P-IκB), and nuclear factor-kappaB (NF-κB)/p65 in a dose-dependent manner, according to the study of "Anti-inflammatory effects of supercritical carbon dioxide extract and its isolated carnosic acid from Rosmarinus officinalis leaves" by Kuo CF, Su JD, Chiu CH, Peng CC, Chang CH, Sung TY, Huang SH, Lee WC, Chyau CC.(51)
3. Supercritical fluid
In the investigation of rosemary extract could enhance antioxidant defenses and improve antioxidant status in aged rats found that rosemary extract produced a decrease in antioxidant enzyme activity, lipid peroxidation and ROS levels that was significant for catalase activity in heart and brain, NOS in heart, and LPO and ROS levels in different brain tissues. These observations suggest that the rosemary supplement improved the oxidative stress status in old rats, according to "Protective effect of supercritical fluid rosemary extract, Rosmarinus officinalis, on antioxidants of major organs of aged rats" by Posadas SJ, Caz V, Largo C, De la Gándara B, Matallanas B, Reglero G, De Miguel E.(52)
Gingerole, is also known as gingerol, a phytochemical of Flavonoids (polyphenols) found in fresh ginger. and in variety of other plants. The herb has been used to treat nausea and vomiting of pregnancy, motion sickness, rheumatoid arthritis, relieve migraine, etc.
1. Antioxidant and anti-inflammatory effects
In the investigation of the effectiveness of chemical constituents of Zingiber officinale Rosc. (Zingiberaceae)in treating oxidative stress found that compounds -gingerol, -gingerol, -gingerol and -shogaol of the herb scavenges of 1,1-diphenyl-2-picyrlhydrazyl (DPPH), superoxide and hydroxyl radicals, inhibitsof N-formyl-methionyl-leucyl-phenylalanine (f-MLP) induced reactive oxygen species (ROS) production in human polymorphonuclear neutrophils (PMN), lipopolysaccharide induced nitrite and prostaglandin E(2) production in RAW 264.7 cells, according to the study of "Comparative antioxidant and anti-inflammatory effects of -gingerol, -gingerol, -gingerol and -shogaol" by Dugasani S, Pichika MR, Nadarajah VD, Balijepalli MK, Tandra S, Korlakunta JN(53)
In the study of Ginger effectiveness in treating dementia in South Asia with A 70% aqueous/methanolic extract of dried ginger (Zo.Cr) was used. Zo.Cr tested positive for the presence of terpenoids, flavonoids, secondary amines, phenols, alkaloids and saponins found that
specific inhibition of butyrylcholinesterase (BuChE) rather than acetylcholinesterase enzyme. Different pure compounds of ginger also showed spasmolytic activity in stomach fundus, with 6-gingerol being the most potent. 6-Gingerol also showed a specific anti-BuChE effect, according to "Muscarinic, Ca(++) antagonist and specific butyrylcholinesterase inhibitory activity of dried ginger extract might explain its use in dementia" by Ghayur MN, Gilani AH, Ahmed T, Khalid A, Nawaz SA, Agbedahunsi JM, Choudhary MI, Houghton PJ.(54)
Naringenin, a flavanone, belonging to the red, blue, purple pigments of Flavonoids (polyphenols) found predominantly in citrus fruits is considered as one of powerful antioxiant with many health benefits.
1. Antioxidant, radical scavenging and biomolecule activity
In the affirmation of the capacity of flavonoid naringenin and its glycoside naringin in the comparison of theirs antioxidant capacities, radical scavenging and biomolecule activities found that naringenin exhibited higher antioxidant capacity and hydroxyl and superoxide radical scavenger efficiency than naringin and both flavanones were equally effective in reducing DNA damage. However, they show no protective effect on oxidation of GSH, according to the study of "Antioxidant properties, radical scavenging activity and biomolecule protection capacity of flavonoid naringenin and its glycoside naringin: a comparative study" by Cavia-Saiz M, Busto MD, Pilar-Izquierdo MC, Ortega N, Perez-Mateos M, Muñiz P.(55)
2. Anti-inflammatory effects
In the evaluation of the mechanisms of action of the effective compounds. Flavone, the isoflavones daidzein and genistein, the flavonols isorhamnetin, kaempferol and quercetin, the flavanone naringenin, and the anthocyanin pelargonidin amd theirs anti-inflammatory effects found that they inhibited iNOS protein and mRNA expression and also NO production in a dose-dependent manner, according to "Anti-inflammatory effects of flavonoids: genistein, kaempferol, quercetin, and daidzein inhibit STAT-1 and NF-kappaB activations, whereas flavone, isorhamnetin, naringenin, and pelargonidin inhibit only NF-kappaB activation along with their inhibitory effect on iNOS expression and NO production in activated macrophages" by Hämäläinen M, Nieminen R, Vuorela P, Heinonen M, Moilanen E.(56)
In the unvestigation of Naringenin, a flavonoid in grapefruits and citrus fruits and its effec in immune system found that naringenin potently suppressed picryl chloride (PCl)-induced contact hypersensitivity by inhibiting the proliferation and activation of T lymphocytes. In vitro, both of the activated hapten-specific T cells and the T cells stimulated with anti-CD3/anti-CD28 showed growth arrest after naringenin treatment, according to "A novel regulatory mechanism of naringenin through inhibition of T lymphocyte function in contact hypersensitivity suppression" by Fang F, Tang Y, Gao Z, Xu Q.(57)
Tangeritin, one of the flavones, is found in tangerine and many citrus peels
1. Neuroprotective effects
In the evaluation of neuroprotective effects of a natural antioxidant tangeretin, a citrus flavonoid and its effect on Parkinson's disease found that tangeretin crosses the blood-brain barrier. The significant protection of striato-nigral integrity and functionality by tangeretin suggests its potential use as a neuroprotective agent, according to "Tissue distribution and neuroprotective effects of citrus flavonoid tangeretin in a rat model of Parkinson's disease" by Datla KP, Christidou M, Widmer WW, Rooprai HK, Dexter DT.(58)
In the comparison of hand-pressed juice of polymethoxylated flavones (PMFs) and flavanone glycosides (FGs) and the peeled fruit of 'Sainampueng' tangerines ( Citrus reticulata Blanco cv. Sainampueng) antioxidant effects found that hand-pressed juice of C. reticulata Blanco cv. Sainampueng serves as a rich source of PMFs, FGs, carotenoids, and antioxidants: 4-5 tangerine fruits ( approximately 80 g of each fruit) giving one glass of 200 mL hand-pressed juice would provide more than 5 mg of nobiletin and tangeretin and 36 mg of hesperidin, narirutin, and didymin, as well as 30 mg of ascorbic acid, >1 mg of provitamin A active beta-cryptoxanthin, and 200 microg of alpha-tocopherol, according to "Polymethoxylated flavones, flavanone glycosides, carotenoids, and antioxidants in different cultivation types of tangerines ( Citrus reticulata Blanco cv. Sainampueng) from Northern Thailand" by Stuetz W, Prapamontol T, Hongsibsong S, Biesalski HK.(59)
D. Antioxidants to prevent Hydrocephalus(60)
D.1. Antioxidant enzymes
Antioxidant enzymes are chemical substances found in plants that can protect the body from damage of free radicals by terminating the chain reactions by removing free radical intermediates and inhibiting other oxidation reactions.
Catalase is an enzyme, found in most living organisms that are exposed to oxygen helped to converse hydrogen peroxide (free radicals) to water and oxygen as a rate of 40 million molecules of hydrogen peroxide to water and oxygen each second, using either an iron or manganese cofactor.
2. Glutathione peroxidase
The function of glutathione peroxidase is to protect the organism from oxidative damage by reducing lipid hydroperoxides, an oxidation of lipid cell membranes which can easily break and form free radicals of the form RO and converting free hydrogen peroxide to oxygen and water.
3. Glutathione reductase
Glutathione reductase, an enzyme reduces pair of sulfur atoms glutathione to the a organosulfur compound form of antioxidant (consisting of three amino acids joined by peptide bonds) which helps to prevent damage of important cellular components caused by free radicals and peroxides.
4. Super oxide dismutase (both Cu-Zn and Mn)
Super oxide dismutase is an important antioxidant defense in nearly all cells exposed to oxygen by converting superoxide into oxygen and hydrogen peroxide depending on the metal cofactor such as both Cu-Zn and Mn.
D.2. Metals binding proteins
Ceruloplasmin, the major copper-carrying protein in the blood plays a role in iron metabolism. It prevents the oxidation that leads to the forming of oxidation from Fe2+ (ferrous iron) into Fe3+ (ferric iron) by exhibiting a copper-dependent oxidase activity, causing mutations in the ceruloplasmin gene cause of iron overload in the brain, liver, pancreas, and retina.
Ferritin, the protein produced by almost all living organisms, acts as a component to fight against iron deficiency and iron overload, keep in a soluble and non-toxic form and transport it to the body needs, including organs. It enhances the immune system in the presence of an infection or cancer and prevent the infectious agent attempts to bind iron to become free radicals by migrating from the plasma to within cells.
Lactoferrin, a multifunctional protein of the transferrin family, is one of the components of the immune system of the body by fighting against foreign invasion of bacteria and virus and lipid oxidation by inhibiting oxidation in a concentration-dependent manner even at concentrations beyond its capacity.
Metallotheinein, a family of cysteine-rich, low molecular weight proteins helps to bind both physiological heavy metals through the organosulfur compound of its cysteine residues. It also captures harmful superoxide and hydroxyl radicals by liberating the metal ions which were bound to cysteine.
Transferrin is a glycoprotein that binds iron very tightly but reversibly. It enhance the immune system in fighting against infection, inflammation by creating an environment low in free iron that impedes bacteria survival and cell oxidation.
Hemoglobin is the protein molecule in red blood cells that enhances the carrying of oxygen from the lungs to the body's tissues and return CO2 from the tissues to the lungs.
During oxidate stress, the cell membrane is protected by intraerythrocytic hemoglobin from the forming of free radical.
Myoglobin is an iron- and oxygen-binding protein found in the muscle tissue of vertebrates. The binding of oxygen by myoglobin is unaffected by the oxidation or chain of oxidative reaction in the surrounding tissue, thus reducing the free radicals damage caused by oxidate stress.
A. In Conventional medicine perspective
A.1. Surgical treatment
In general, treatment of Hydrocephalus involves the placement of a tube made of silastic, into the cerebral ventricles to bypass the flow obstruction and drain the excess fluid into other body cavities, where the fluid can be reabsorbed. In the study of Lumboperitoneal shunts for the treatment of normal pressure hydrocephalus, Dr. Bloch O, and Dr.McDermott MW. indicated that Studies have reported shunt complication rates up to 38%, with subdural hemorrhage rates as high as 10%. Lumboperitoneal (LP) shunts with horizontal-vertical valves (HVV) are an alternative for cerebrospinal fluid (CSF) diversion that avoids direct cerebral injury and may reduce the risk of overdrainage. They also showed that
in 33 patients with LP-HVV shunts inserted for the treatment of iNPH from 1998 to 2009. Patients were evaluated for improvements in gait, urinary function, and dementia after shunt placement. All patients had evidence of ventriculomegaly and a positive response to pre-operative lumbar puncture or extended lumbar drainage. All 33 (100%) patients had pre-operative gait dysfunction, 28 (85%) had incontinence, and 20 (61%) had memory deficits. Mean follow-up time was 19 months. Following shunt placement, 33/33 (100%) patients demonstrated improved gait, 13/28 (46%) had improvement in incontinence, and 11/20 (55%) had improvement in memory. Shunt failures requiring revision occurred in nine patients (27%), with an average time to failure of 11 months. Infections occurred in two patients (6%). There were no neurologic complications, including no hemorrhages. Thus, LP-HVV shunt placement is a safe and effective alternative to ventriculoperitoneal shunting for iNPH, resulting in significant symptomatic improvement with a low risk of overdrainage. It should be considered as an option for the treatment of patients with iNPH who demonstrate clinical improvement following lumbar drainage(61).
Other cautioned of The incidence of infection and malfunction with an LP shunt is significantly lower than that with a VP shunt. An LP shunt is also indicated for pediatric patients, although a relatively higher incidence of malfunction is noted compared to adults(62)
A.2. Non Medical treatment
1. Occupational therapy and physical therapy
In the study to examine effectiveness of standardized occupational therapy and physical therapy assessments in detecting functional changes and predicting clinical improvement in patients with suspected normal pressure hydrocephalus undergoing cerebrospinal fluid drainage, indicated that specific occupational therapy and physical therapy assessments demonstrate sensitivity to change and predictive value with patients with suspected normal pressure hydrocephalus undergoing cerebrospinal fluid drainage(63).
2. Psycological and Speech therapy
In the review of the literature on psychic disturbance in normal pressure hydrocephalus, showed that in the 26 cases of CSF drainage, impairment of memory and concentration were always present in normal pressure hydrocephalus; behaviour disorders were very frequent and characterized by both types of frontal behaviour; the mental picture also comprised difficulties of calculation, writing, visuoconstructive praxis and, less frequently, impaired speech and reading ability. CSF drainage brought clinical improvement in 73% of the cases. Disorders of consciousness, mental function and behaviour regressed generally progressively as soon as the operation had been performed(64).
B. In herbal medicine perspective
There is no specific herbs formula or herbs
According to the article of Hydrocephalus by Dherbs, Hydrocephalus is a result of the building up of toxins cause of accumulations of fluid on the brain as he provide each step
1. Toxins removal
a. Blood and Lymphatic with ECHINACEA ANGUSTIFOLIA, BEET ROOT, DRAGONS BLOOD, SPIRULINA, DANDELION, BURDOCK, MANJISTHA, BITTER MELON, RED CLOVER, CHICKWEED, SASSAFRAS, AMLA FRUIT, CLEAVERS, VIDANGA, INDIGO, POKE ROOT, NETTLE, IRON WEED, CAPSICUM, RED ROOT, YELLOW DOCK, PAU D’ARCO, ANANTAMUL, SOLOMON SEAL, OLIVE LEAF, GOLDENSEAL.
b. Cardiovascular with GARLIC, CAPSICUM, HAWTHORN BERRIES, LILY OF THE VALLEY, ARJUNA, SIBERIAN GINSENG, REISHI MUSHROOM, MOTHERWORT, DANDELION LEAF, MYRRH, GINGER, BALA, PUNARNAVA, MISTLETOE, GINGKO BILOBA, PRICKLY ASH, MULBERRY.
c. Liver and Gallbladder with MANJISTHA ROOT, ANANTAMUL, SCHIZANDRA, BEET ROOT, DANDENLION, BHUMYAMALAKI, ARTICHOKE, ROSEMARY, TURMERIC, LICORICE, BUPLEURUM, AMALAKI FRUIT, PIPPALI FRUIT, MILK THISTLE SEEDS, PEONY ROOT, BHRINGARAJ, RHUBARB, FENUGREEK, GOLDENSEAL.
d. Lungs and Respiratory with GOKSHURA FRUIT, JUNIPER BERRY, GUDUCHI, CORN SILK, CORIANDER SEED, FENNEL SEED, PUNARNAVA, UVA URSI, ASPARAGUS, BUCHU, CRANBERRY, TRIBULUS, CLEAVERS, GOLDENROD, CELERY SEED, ANANTAMUL, PARSLEY LEAF, GRAVEL ROOT, PIPSISSEWA, HORSETAIL, NETTLE.
e. Colon and Digestive Tract with SENNA LEAVES AND PODS, OAT BRAN, BARLEY GRASS, SLIPPERLY ELM, BLACK PEPPER, CASCARA SAGRADA, CARBON (ACTIVATED CHARCOAL), BUCKTHORN, HARITAKI, TURMERIC, PSYLLIUM HUSK, IRISH MOSS, ALOE VERA, GINGER, CLAY BENTONITE, POKE ROOT, CAYENNE PEPPER, HINGVASTAK.
f. Carbon (also known as Activated Charcoal) is not a formula but the residue of burnt plant matter (Willow bark) that is carbon and copper-based and therefore ELECTRICAL
2. 10 DAYS ELECTRIC GREENS COMBO REGIMEN
10-day Cleanse that helps cleanse, build, and nourish the body at the same time. It is a unique cleanse consisting of a mix of super green foods such as alfalfa, nettle, kamut grass, blue green algae, spirulina, chlorella, and wheat grass to name a few.
3. Soften and dissolve hardened, stubborn mucus and phlegm of which can cause toxins accumulation with LICORICE, CALENDULA, MULLEIN LEAVES, RED CLOVER, QUASSIA, PLANTAIN, FENUGREEK.
4. Enhance circulation with HAWTHORNE BERRY, CAYENNE (40,000), CINNAMON, AND GINGER.
5. Release fluid with UVA URSI, LILY OF THE VALLEY, DANDELION LEAF & ROOT, CORN SILK, BILBERRY, ANISE, CELERY, FENNEL, BLACK COHOSH, MULLEIN LEAF, ROSEMARY, QUEEN OF THE MEADOW, PARSLEY, AND BURDOCK ROOT.
6. Nourish, strengthen, and tone the veins and venous system with HORSE CHESTNUT, BILBERRY, ORANGE PEEL, BUTCHER’S BROOM, GOTU KOLA, MANJISTHA, CINNAMON, GINGER, HORSETAIL, WHITE OAK BARK, LEMON PEEL, AND CALENDULA.
7. Colon and intestinal complaints and helps to maintain overall colon and intestinal health and wellbeing! with SENNA LEAVES, CHAMOMILE, GINGER, PEPPERMINT, LICORICE, and STEVIA .
For more information of DHerbssolution, please visit (65)
C. In Traditional Chinese medicine perspective
According to the article of Hydrocephalus posted on Dicovery TCM, Hydrocephalusis a result of
1. Deficiency of the kidney qi
a. Main symptoms and signs
Marked enlargement of skull, widened fontanel with separation of sutures,sluggish expression, dimness in the eyes, dropping eyeballs like "the setting sun", large anteverted head with thin neck, strabismus, vomiting and convulsion in severe cases, whitish complexion, poor appetite, loose stools, pale tongue with a little fur, weak pulse and bluish superficial venule of index finger.
b. Therapeutic method
Tonifying the kidney and marrow.
c. Prescription and drugs The prescription used is the modified Bushen Dihuang Pill (Rehmannia Pill for Tonifying the kidney) composed of 10 g of Shudihuang ( Radix Rehmanniae Praeparata ), 10 g of Shanyao (Rhizoma Dioscoreae ), 10 g of Shanzhuyu ( Fructus Corni), 10 g of Fuling (Poria), 10 g of Zexie (Rhizoma Alismatis), 10 g of Mudanpi ( Cortex Moutan Radicis), 6 g of Niuxi (RadixAchyranthis Bidentatae), 6 g of Lujiaojiao (colla Comus Cervi) (melted) and 6 g of Danggui ( Radix Angelicae Sinensis )
Modification For the patients with concurrent talantropia, strabismus or blurred vision, 10 g of Gouqizi (Fructus Lycii), 8 g of Tusizi (Semen Cuscutae), 10 g of Juemingzi ( Semen Cassiae ) and 10 g of Juhua ( Flos Chrysanthemi) are added.
2. Hyperactivity of the liver due to asthenia of the kidney
a. Main symptoms and signs
a. Main symptoms and signs
Separation of skull sutures, large and wide anterior fontanel, dropping eyeballs with more white than black, brightless eyes, dry mouth, dysphoria, feverish palms and soles, muscular twitching and cramp, occasional scream, red tongue,deep, thready and rapid pulse and purplish superficial venule of index finger
Nourishing the kidney yin, calming the liver yang to stop wind.
c. Prescription and drugs The prescription used is the modified Zhibai Dihuang Pill in combination with Sanjia Fumai Decoction composed of 6 g of Shudihuang (Radix Rehmanniae Praeparata), 10 g of Shanyao (Rhizoma Dioscoreae), 8 g of Shanzhuyu (Fructus Corni), 10 g of Fuling ( Poria ), 6 g of Zexie ( Rhizoma Alismatis ), 10 g of Guiban ( Plastrum Testudinis) ( to be decocted first), 6 g of Zhimu (Rhizoma Anemarrhenae), 3 g of Huangbai ( Cortex Phellodendri), 6 g of Ejiao ( Colla COrii Asini) and 12 g of Baishaoyao (Radix Paeoniae Alba ).
Modification For the patients with fever due to yin deficiency, 6 g of Yuzhu (Rhizoma Polygonati Odorati) and 6 g of Baiwei (Radix Cynanchi Atrati ) are added; for the patients with dysphoria, 3 g of Hupofen (powder of Succinum) (taken separately) and 15 g of Zhenzhumu (Concha Margaritifera Usta) (to be decocted first) are included; for patients with muscular twitching and cramp, or occasional scream, 6 g of Tianma ( Rhizoma Gastrodiae ), 10 g of Gouteng ( Bamulus Uncariae cum Uncis) (to be decocted later) and 10 g of Baijiangcan (Bombyx Batryticatus) are added.
3. Water retention due to asthenia of the spleen
a. Main symptoms and signs Wide and large fontanel, separation of fontanel sutures, whitish complexion,lassitude, poor appetite, loose stools, epigastric and abdominal distension, pale tongue with whitish and thin or whitish and greasy fur, thready and weak pulse and light red superficial venule of index finger.
b. Therapeutic method
Warming the spleen to promote water metabolism.
c. Prescription and drugs The prescription used is the modifided Fuzi Lizhong Decoction (Aconite Decoction for Regulating the Middle Energizer) in combination with Wuling Powder (Five-ingredient Powder with Poria) composed of 3 g of Renshen (Radix Ginseng), 10 g of Baizhu (Rhizoma Atractylodis Macrocephalae), 6 g of Ganjiang (Rhizoma Zingiberis), 3 g of Zhifuzi ( Radix Aconiti Praeparata) (to be decocted first), 10 g of Zhuling (Polygorus Umbellatus), 10 g of Fuling (Poria), 6 g of Zexie (Rhizoma Alismatis ) and 6 g of Guizhi ( Ramulus Cinnamomi )
Modification For the patients with poor appetite, 10 g of Jiaoshanzha (carbonized Fructus Crataegi), 10 g of Jiaomaiya (carbonized Fructus Hordei Germinatus ) and 10 g of Jiaoshenqu (carbonized Massa Fermentata Medicinalis) are added; for the patients with loose stools,6 g of Cheqianzi ( Semen Plantaginis) (to be wrapped) and 10 g of Shanyao (Rhizoma Dioscoreae) are included; for the patients with vomiting, 6 g of Banxia (Rhizoma Pinelliae ) and 6 g of Zhuru ( Caulis Bambusae in Taeniam) are added; for the patients with yang deficiency of the spleen and kidney, poor appetite and loose stools,Kidney-regulating Powder may be applied. The powder is composed of 10 g of Shanyao (Rhizoma Dioscoreae), 3 g of Renshen (Radix Ginseng), 10 g of Baifuling (Poria), 10 g of Fushen (Poria cum Ligno Hospite ), 10 g of Baizhu (Rhizoma Atractylodis Macrocephalae), 12 g of Baishaoyao (Radix Paeoniae Alba ), 6 g of Shudihuang (Radix Rehmanniae Praeparata), 8 g of Danggui (Radix Angelicae Sinensis ), 10 g of Huangqi (Radix Astragall seu Hedysari), 6 g of Chuanxiong (Rhizoma Ligustici Chuanxiong) , 3 g of Zhigancao (Radix Glycyrrhizae Praeparata) and 10 g of Shichangpu ( Rhizoma Acori Graminei). The ingredients are ground into fine powder, 10 g of which is decocted with ginger and Chinese dates to be taken each time.
4. Stagnation of preponderant heat and toxin
a. Main symptoms and signs Gradual enlargement of skull, prominent and distending fontanel, closure of fontanel sutures with recurrent separation, dropping eyes, fever, short breath, dysphoria with cry and tantrum, flushed complexion with red lips or strabismus, spasm of limbs, dark and scanty and deep yellow urine, constipation, red tongue with yellowish fur, taut and rapid pulse, purple and sluggish superficial venule of index finger.
b. Therapeutic methods
Clearing away heat and removing toxin, removing blood stasis and dredging collaterals.
c. Prescription and drugs The prescription used is the modified Xidi Qingluo Decoction (Decoction of Rhinoceros Horn and Rehmannia Root for Clearing away Heat from Collaterals) composed of 15g of Shuiniujiaopian (slices ofcornu Bubali) (to be decocted first), 10 g of Shengdihuang ( Radix Rehmanniae ), 10 g of Lianqiao ( Fructus Forsythiae ), 3 g of Dengxincao ( Medulla Junci), 10 g of Mudanpi ( Cortex Moutan Radicis ),10 g of Chishaoyao ( Radix Paeoniae Rubra ), 6 g of Taoren (Semen Persicae ) and 10 g of Baimaogen (Rhizoma Imperatae ) .
Modification For the patients with stagnation of phlegm and heat, chest distress with nausea, red tongue with yellowish fur, 6 g of Danxing (Arisaema cum Bile), 10 g of Shichangpu ( Rhizoma Acori Graminei ) ,6 g of Dilong ( Lumbricus ) and 10 g of Tianzhuhuang (concretio silicea Bambusae ) are added; for the patients with clonic convulsion, 6 g of Quanxie (Scorpio), 10 g of Gouteng (Bamulus Uncariae cure Uncis) (to be decocted later) and 12 g of Baishaoyao (Radix Paeoniae Alba) are included. For enlargement of skull, separation of fontanel sutures without closure, visible local bluish superficial venules, tongue with ecchymosis, or deafness and dumbness, hypophrenia and paralysis of limbs resulted from the fact that blood stasis obstructs cerebral collaterals, constricts cerebral marrow and blocks cerebral orifices, the therapeutic method is removing blood stasis to eliminate obstructive orifices. The prescription used is the modified Tongqiao Huoxue Decoction (Decoction for Removing Obstruction from Orifices and Activating Blood Circulation) composed of 10 g of Danggui (Radix Angelicae Sinensis ), 8 g of Chuanxiong ( Rhizoma Ligustici Chuanxiong), 10 g of Chishaoyao (Radix Paeoniae Rubra), 6 g of Taoren ( Semen Persicae), 6 g of Honghua (Flos Carthami ), 10 g of Danshen ( Radix Salviae Miltiorrhizea), 8 g of Dilong (Lumbricus), O. 05 g of Shexiang (artificial Moschus) (to be infused separately),8 g of Niuxi (RadixAchyranthis Bidentatae) and 10 g of Fuling (Poria).
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