前幾天，我和母親討論了她做完眼部手術後出現的現象：她似乎只能看到她想看的東西。我想了很多可能的解釋，還問了她一些更細節的問題，排除了一些可能性。不過，我並不打算在這裡展開病例討論。
A few days ago, my mother and I discussed a phenomenon that occurred after she had eye surgery: she seemed to only be able to see what she wanted (or intended) to see.
I thought about many possible explanations and ruled out some of them by asking her detailed questions. But I’m not going to begin a case discussion here.
我們之前吵過架，起因是我覺得她故意裝作聽不懂我說的話，或是裝沒看到眼前的東西，只是想測試我的耐性。常常要我牢牢指著那個她眼前的東西，請她順著我手指的方向看，經過好幾秒，她才反應過來。似乎只有到了這一刻，她才能看見它。
We had a fight before because I thought she was pretending not to understand what I said or not seeing the stuff right before her, just to test my patience. It always ended up that I had to point firmly at the thing in front of her and ask her to look in the direction I was pointing. And then it took several seconds before she realised what it was. It seemed that not until that moment could she start to see it.
差不多這時候，我剛讀完小說《剪刀 石頭 布》，故事的主角有臉盲症（相貌失認症），我其實正在查臉盲症的機轉。然後就從梭狀迴（就是耳朵那附近到後腦勺那邊的腦葉和溝溝），再延伸看到角迴，再延伸看到DMN（大腦的預設模式網路 Default Mode Network）。（每次查資料都會這樣延伸再延伸超展開）之後我花了一個上午複習大腦的視覺感知和視覺認知路徑，以及腦區之間的連結。
Meanwhile, I just finished reading a novel Rock, Paper, Scissors, and the main character in the story has face blindness. So I was searching for the mechanism of prosopagnosia. Then it extends from the fusiform gyrus (the lobes and sulci from near the ears to the back of the head), then to the angular gyrus, and then to the DMN (the brain's default mode network). (Every time I research something, it expands and expands like this.)
And then I spent a morning reviewing the brain's visual sensory and visual cognitive pathways and the connections between brain areas.
大腦視覺處理區包括負責初始輸入的V1（紋狀皮質），其次是V2、V4和下顳葉皮質（IT）。梭狀迴臉孔區（FFA）（處理臉孔）和外側枕葉複合體（LOC）（處理物體）等區域也參與其中。
Brain areas of visual processing include V1 (striate cortex) for initial input, followed by V2, V4, and the inferotemporal (IT) cortex. Specialised areas like the fusiform face area (FFA) (faces) and lateral occipital complex (LOC) (objects) are also involved.
V1、V2 和 V4 是枕葉中特化的、層級排列的視覺區域，負責處理視覺訊息（訊號從 V1 ⮕ V2 ⮕ V4 傳遞），從基本的邊緣偵測（V1）到複雜的形狀、顏色和物體辨識（V4）。
V1, V2, and V4 are specialised, hierarchical visual areas in the occipital lobe that process visual information (signals move from V1 ⮕ V2 ⮕ V4), moving from basic edge detection (V1) to complex shape, colour, and object recognition (V4).
V1（紋狀皮質/布羅德曼17區）是第一個視覺皮質區，透過視丘（外側膝狀核）接收來自視網膜的輸入。它會偵測基本特徵（方向、運動、影像清晰度和顏色）並將影像分解為邊界和方向。紋狀皮質的損傷會導致相對應視野的失明，通常表現為暗點（視野盲點）或同側偏盲（視野一半喪失）。然而，部分的患者仍保留了「盲視」，使他們能夠無意識地偵測到物體所在的正確位置。
V1 (Striate Cortex / Brodmann Area 17) is the first cortical staging area, receiving inputs from the retina via the thalamus (LGN). It breaks down images into edges and orientation by detecting basic features: orientation, motion, spatial frequency, and colour. Damage to the striate cortex causes blindness in the corresponding visual field, often resulting in scotomas (blind spots) or homonymous hemianopia (loss of half the visual field). However, some patients retain "blindsight," allowing them to unconsciously detect or locate objects.
V2（次級視覺皮層/布羅德曼18區）處理複雜的視覺訊息，例如錯覺輪廓、深度和精細度，並有助於區分前景和背景。與導致完全失明的V1損傷不同，V2損傷通常會導致更具選擇性的障礙，例如視覺失認症、色覺喪失或空間關係處理能力下降，並且會影響對視覺線索的記憶。嚴重的慢性壓力與視覺皮質（包括V2區域）的萎縮有關。
V2 (Secondary visual cortex/Broadmann Area 18) processes complex visual information, such as illusory contours, depth, and spatial frequency, and aids in distinguishing foreground/background. Unlike V1 damage, which causes absolute blindness, V2 damage typically results in more selective impairments, such as visual agnosia, loss of color perception, or inability to process spatial relationships, and can affect memory for visual cues. Severe chronic stress has been linked to atrophy in the visual cortex, including the V2 region.
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視覺訊息從初級視覺皮質往其他皮質區傳遞的走向取決於訊息的類型。用於定位物體和偵測其運動的訊息是經過背側流傳送；而用於偵測和利用顏色和形狀做辨識的資訊則是經過腹側流傳送。
The flow of visual information from the primary visual cortex to other cortical areas depends on the type of information being processed. Information used to locate objects and detect their motion is sent through the dorsal stream. Information necessary to detect, identify and use colour and shape information is sent through the ventral stream.
背側流的視覺聯合皮質受損會導致空間定向、運動偵測和視覺追蹤眼動的引導有缺陷。腹側流的視覺聯合皮質受損會導致複雜視覺知覺處理、注意力和學習/記憶能力下降。
Damage the dorsal visual association cortex results in deficits in spatial orientation, motion detection and in guidance of visual tracking eye movements. Damage to the inferior visual association cortex produces deficits in complex visual perception tasks, attention and learning/memory.
V4是腹側流中負責顏色恆常性（在不同光照條件下準確感知顏色）和複雜物體辨識的重要節點。 V4損傷主要導致嚴重的顏色感知喪失，即皮質性色盲。V4損傷也會損害視覺搜尋能力，特別是區分目標物體與周圍干擾物的能力。由於V4位於其他視覺處理區域附近，損傷往往會擴及其他缺陷，例如相貌失認症、上象限視野缺損和失讀症（閱讀困難）。
V4 is a crucial node in the ventral stream for color constancy (perceiving colors accurately under different lighting) and complex object recognition. Damage to V4 primarily results in a profound loss of color perception, known as cerebral achromatopsia. Lesions here can also impair visual search, particularly the ability to distinguish an object from surrounding distractors. And as V4 is located near other visual processing areas, damage often extends, causing additional deficits like prosopagnosia, superior quadranopsia, and alexia.
總之，這讓我覺得，如果是視覺「感覺」，我們必須針後腦勺；如果是視覺「知覺」，就要用顳葉那邊，再加上大腦區域之間的連接，最好加上額葉和頂葉，因為和「認知」有關。
Anyways, I suppose if it is visual “sensory,” we must target the back of the head, and if it’s visual “perception,” must target the temporal lobe; plus the connections between brain regions, it will be better adding the frontal lobe and parietal lobe, because it involves the “cognition” function.
說到DMN（大腦的預設模式網路） ，它和TPN（任務正向網路Task Positive Network，當人專注於處理一項工作或任務，需要用到理性分析或決策時會活躍的腦神經網絡）之間的失衡，對於理解ADHD、自閉症、PTSD、反芻思維、強迫性思考和慢性疼痛等問題非常重要。一些研究將大腦的TPN和DMN和中醫的陰陽平衡作類比，我以前從未想過這一點。
And speaking of DMN, the imbalance between DMN and TPN (activates during attention-demanding, goal-directed tasks, such as problem-solving) plays a key role in conditions such as ADHD, autism, PTSD, rumination, obsessions in OCD and chronic pain. Some studies compare TPN and DMN of the brain to Yang and Yin balance, I never thought about that before.
不論是傳統針灸還是YNSA，似乎都能夠藉由降低DMN的過度活躍來調節DMN-TPN的平衡。DMN的過度活躍會導致持續的走神（沉浸於內心世界，與「當下」脫節）或認知障礙。針灸能夠降低DMN過度活躍的「噪音」，誘導大腦進入「休息」或「內在平靜狀態」，這樣才能釋放內耗一直佔據注意力的腦神經網絡容量，讓大腦更有效地「回到當下」去運作。因此，針灸才被說有降低精神疲勞、減輕腦霧、恢復精力和直接提高注意力的效果。
Both traditional acupuncture and YNSA seem to be able to regulate the DMN-TPN balance by reducing hyper-connectivity in the DMN that can lead to constant mind-wandering or cognitive impairment. These treatments work by reducing the “noise” in the hyperactive DMN, thereby freeing up capacity for the attentional networks to function more efficiently. In other words, acupuncture mediates a “restorative” effect by lowering mental fatigue and reducing brain fog, which directly improves focus.
DMN的過度連結——特別是疼痛處理區域（初級體感皮質、次級體感皮質、視丘、島葉）的連結增強——會將身體疼痛整合到「自我」中，導致持續存在的疼痛，並干擾大腦將注意力從疼痛轉移開的能力。也就是說，疼痛變成長期存續的狀態，從短暫的感覺轉變為「預設」的自我意識狀態。
Hyperconnectivity within the Default Mode Network (DMN)—and specifically its increased connectivity with pain-processing regions (primary somatosensory cortex (S1), secondary somatosensory cortex (S2), thalamus, insula)—causes or sustains chronic pain by incorporating physical pain into the self-concept, resulting in the feeling that “I am pain,” and disrupting the brain's ability to switch away from focusing on pain. It means that when pain becomes chronic, it shifts from a transient sensory input to a “default” state of self-awareness.
在一些研究中曾被用於DMN過度活躍的疾病的治療穴位包括百會、印堂、合谷、陰陵泉。在這些穴位針刺激能調節DMN腦區之間的連結，尤其是減弱mPFC與角迴之間過強的連結，效果立即且持久。
In some studies, acupoints such as GV20 (Baihui), GV29 (Yintang), LI4 (Hegu), GB34 (Yanglingquan) have been used to treat diseases with hyperactive DMN. Stimulation at these acupoints specifically reduce functional connectivity between the mPFC and angular gyrus, and increase functional connectivity between the PCC and Anterior Cingulate Cortex (ACC) with immediate and lasting effects.
𖡥 mPFC (內側前額葉皮質)，和自我認知、同理心、社交判斷以及調節情緒反應有關。
𖡥 角迴負責多感官資訊的整合，特別是將視覺訊息轉換為語言理解，與情境記憶提取、空間認知和社交認知有關。
𖡥 mPFC is a hub for self-referential thought, adaptive behavior, decision-making, emotional regulation, and enables individule to response based on context.
𖡥 Angular gyrus is where an individual integrates multisensory information, particularly converting visual information into language comprehension, and episodic memory retrieval, spatial cognition, and social cognition.
話說，大概在所有近代「中醫實證醫學」產出的學術論文中所用的穴位都差不多是那些，我猜原因是在實驗設計中最好操作，不論是在人身上或是動物模型。然後因為前面的人先這樣做了，後面的人寫論文就跟著這樣做，因為寫論文都要引用已發表的論文當背書。
It's worth noting that the acupoints used in almost all modern academic papers on "evidence-based traditional Chinese medicine" are roughly the same. I suspect the reason is that they are the easiest to manipulate in experimental design, whether on humans or animal models. And because earlier researchers did it this way, later researchers followed suit in their papers, since papers need to cite published papers as endorsements.
YNSA的依據是神經刺激點，不是中醫，不過每次要處理某症狀時如果發現中醫找的穴位和YNSA的刺激點很近，就還蠻有趣的。
YNSA is based on neuroscience not Chinese medicine, but sometimes it’s interesting when the two correlate.
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