neuroendocrine basis of Adrenal Fatigue Syndrome.

由神經內分泌學的角度來看「腎上腺疲勞綜合症」

First we need to understand

首先我們需要了解

that stress enters our sphere through a small area of the brain called the locus coeruleus or the LC.

當人感受到壓力後，訊息會經由腦中的一個小區域稱為藍斑核(或LC)進入大腦

Discovered in the eighteenth century,

藍斑核於十八世紀時被發現

this area of the brain stem deals with the physiological responses to stress and panic.

這個位於腦幹中的小區域專門負責遭受壓力或恐慌時的生理狀態

An important homeostatic control center of the body, the LC receives input from a variety of sources

作為人體的內部生理平衡的調節中心，LC接收來自身體各處的感官訊息

from our senses it is then routed through the hypothalamus, the amygdala,

這些訊息接著被傳遞到下視丘、杏仁核、

the cerebellum as well as the prefrontal cortex.

小腦以及前額葉

Emotional pain and stressors from the outside world enters our inner world through these pathways.

來自外界的情感創傷以及壓力經由上述路徑進入我們的內在

Once arrived, excitatory signals trigger production and release of norepinephrine from the LC.

傳達到腦中後，這些訊息刺激使得LC開始製造並釋放正腎上腺素

Now, norepinephrine has two functions. In the brain, it acts as a central neuro-transmitter

目前已知正腎上腺素具有兩種功能。在腦中，它作為中樞神經傳遞物質

and keeps us aroused: we become alert.

使我們保持警醒

Norepinephrine released from the LC also increases the sympathetic

LC釋放的正腎上腺素也會增加交感神經放電

discharge and inhibits parasympathetic tone in the peripheral nervous system,

並在周邊神經系統中抑制副交感神經的作用

which we will go into later. At that point it exerts its excitatory effect directly on

詳細細節我們接著會提到。當正腎上腺素開始作用時

the target organs such as the heart.

會使一些器官像是心臟等更為活躍

So as a result, the heart rate as well as the heartbeat force goes up.

因此心跳的速率以及心搏的強度都會增加

Aside from being the principal production site of the brain norepinephrine,

除了作為腦內正腎上腺素的主要生產場所

the LC is also connected on the output side to many parts of the central nervous system;

LC還投射到中樞神經系統中許多部位

including the spinal cord, brain stem, cerebellum, hypothalamus, amygdala as well as the cerebral cortex.

包括脊椎、腦幹、小腦、下視丘、杏仁核以及大腦皮質

So as you can see, it is a two-way street with many many directions and a

如你所見，好幾個雙向的路徑

collaborative network of information flow, to the LC and out of the LC.

共同組成了訊息網路進出LC

Collectively, the LC and areas of the CNS (or the central nervous system),

LC與CNS(中樞神經系統)

affected by the norepinephrine it produces, are described as the LC-NA system,

中受正腎上腺素調控的部位，可視為一個整體，統稱為LC-NA 系統

which stands for locus coeruleus-noradrenergic system.

也就是「藍斑核-正腎上腺素」系統

Noradrenergic is the same as norepinephrine and that is what it connotates here.

「Noradrenergic」與「norepinephrine 」在這裡都是指正腎上腺素

Now the distribution as we talked about of the LC-NA system is ubiquitous

「藍斑核-正腎上腺素」系統的影響是無處不在的

and is consistent with the prominent role that norepinephrine plays

並且，在中樞神經系統的許多功能中

in a variety of central nervous system functions,

正腎上腺素都是不可或缺的

as well as behavior that includes locomotor functions, cognitive functions, motivation and attention

在一些涉及運動、認知、動機以及專注等功能的行為中，也同樣不可或缺

Now what is important is that once the LC-NA system is activated

當「藍斑核-正腎上腺素」系統被活化時

it is responsible for much of the psychological effects we see in Adrenal Fatigue Syndrome.

會造成好幾種我們在「腎上腺疲勞綜合症」中觀察到的生理症狀

They can include fear, anxiety, alertness, memory changes and REM sleep dysregulation.

包括了恐懼、焦慮、警覺、記憶異常以及快速動眼睡眠週期失調

Psychiatric research has documented that the role the LC plays in cognitive function

精神病學中的研究紀錄顯示LC會影響受壓力狀態下的認知功能

in relation to stress is complex and is multi-modal: there is no one direct link,

其中的關係十分複雜並涉及多項機制，而非單向直接的因果關係

multiple factors are involved.

許多不同的因素都涉及其中

From a neuroendocrinological perspective it is clear

從神經內分泌學的角度來看，很明顯地

that the body's multiple stress response pathways are all for it

許多案例中，人體內各種受壓力引起的反應都是為了達到同樣的目的

in a redundancy pattern to handle stress in many many cases,

藉由繁複的反應路徑來調節壓力

it has ensured the survival of our species for quite some time.

在某些時刻，這些機制確保我們人類得以存活至今

What is confusing clinically is that in Adrenal Fatigue Syndrome,

但是讓人困惑的是，在「腎上腺疲勞綜合症」的例子當中

these pathways can be activated few at a time

這些反應路徑隨著個體的不同，有時一點一點地啟動

all at once, or quickly or slowly as the body sees fit.

有時一次全部啟動、有時快、有時慢

The body's truly in control but the symptoms are so convoluted because

我們確定是身體在調控這些反應，但這症狀是如此讓人費解

it depends on what stage and how the body perceives stress.

因為它受到「身體是處於壓力下的何種階段」以及「身體是如何察覺壓力」的影響

Different parts of different systems are being activated all at the same time as necessary.

當有需要時，不同系統中的不同路徑可能同時啟動

To fully appreciate the body's heroic effort to rescue us from stress,

為了充分了解身體是經過多少努力才讓我們得以倖免於過度的壓力

it is important to first understand that our brain is in control,

我們首先要知道的是大腦調控著

the pathway is through the neuroendocrine system.

神經內分泌系統中的各種路徑

What one person perceives as stress may not be for another person.

一個人視為壓力的事情，另一個人可能完全無感

Based on what is perceived as stress by the mind, the body automatically activates

端看用怎樣的心態面對壓力。人體會自動的啟動

any or all of the anti-stress mechanisms in place.

任何有必要的抗壓力機制

In order for us to fully grasp the big picture,

為了能掌握整體情形

clinicians need to take a step back,

臨床醫師必須要退一步才能見得全貌

because it is easy to be confused when you look too close.

太拘泥於細節反而適得其反

The picture from afar is quite clear.

抽離一點來看，事情就很清楚了

We see a body in trouble, unable to maintain homeostasis

當身體遇上危機，無法維持生理平衡時

and trying to use all its ways and means to recover on its own, using the methods that it knows.

身體會竭盡所能地用它所知道的方法來努力恢復

By activating any or all of the built-in stress response systems

藉由啟動體內所有內建的系統來抵抗壓力

modulated by the neurological and endocrine systems working in tandem.

這些系統是由一連串的神經以及內分泌系統調控

The more severe the stress,the more other systems

壓力越是沉重

such as musculoskeletal, psychiatric, cardiac and immune systems are also affected adversely.

越是對運動、心理、心臟以及免疫等功能不利

Remember, that the body is a closed system.

記住，人體是一個封閉的系統

Severe dysregulation of one system invariably impacts other systems.

單一系統嚴重失調時，多少會影響其他系統

This is inescapable.

這是無可避免的

Despite this clinical chaos,

儘管臨床症狀看似雜亂無序

we can see a controlled collapse that is logical and systematic from the body's perspective.

從身體的角度來看，我們仍能看出這是合理的、有系統的機制

Symptoms are simply the messages

這些症狀都只是

or signs the body sends us warning of such impending danger and

身體面對眼前的危機所發出的警訊

thereby alerting us to take appropriate action.

使我們知道要採取適當的行動

If stress is never really resolved or let go,

如果壓力一直沒有被解決或者消失

then even despite a loosing battle,

就算是在絕望的境地下

The mind continues to be ultimately in charge throughout this ordeal

身體仍會有意識地直面困境

through its various endocrinological stress response pathways

持續地透過內分泌路徑來調控身體

The neuroendocrine basis of Adrenal Fatigue is quite clear and solid.

神經內分泌學對「腎上腺疲勞綜合症」的研究是十分清晰且堅實的

Evidence-based scientific research has proven

研究上已有充分的證據顯示

beyond a doubt that stress can kill.

「過度的壓力足以致命」是毫無疑問的