The disorder that was to become known as Parkinson's disease was first described as shaking palsy in 1817 by a London physician named James Parkinson. Parkinson's disease is now known to be a progressive neurological disorder involving degeneration of neurons in a region of the brain that controls movement. This degeneration creates a shortage of dopamine, which is the immediate cause of the movement dysfunctions that characterize the disease: administration of l-dopa (a precursor to dopamine, which is converted in brain cells to dopamine) has considerable beneficial effects in many patients with Parkinson's disease.
In most cases, the first symptom of Parkinson's disease is tremor (trembling or shaking) of a limb, especially when the body is at rest. The tremor often begins on one side of the body, frequently in one hand. As the disease progresses, both sides of the body may be involved and shaking of the head may also occur. Other common symptoms include slow movement, difficulty in initiating movement, rigid limbs, a shuffling gait, a stooped posture, and reduced facial expressions. In about a third of the cases, the disease also causes or is associated with depression, personality changes, dementia, sleep disturbances, speech impairments, and/or sexual difficulties.
Parkinson's disease is relatively rare overall, but it becomes a common problem of the elderly, affecting about 6% of those over the age of 65. In the United States, about 500,000 to 1,000,000 people are believed to suffer from Parkinson's disease, with about 50,000 new cases are reported annually. The disorder is more common in men than women. The average age of onset is about 60; rarely occurring before age 40, but increasingly diagnosed with aging.
Causes of Parkinson's disease are not fully known, but there are genetic factors involved in susceptibility and there may be contributions from a variety of behaviors. For example, it has been suggested recently that people who drink coffee and tea are less likely to suffer from Parkinson's than those who drink none or little of these caffeinated beverages. Cigarette smoking actually appears to have had a protective effect as well. Both caffeine and nicotine affect the brain and nervous system.
There is no known cure for Parkinson's disease. Many patients are only mildly affected and need no treatment for several years after the initial diagnosis. When symptoms grow severe, doctors usually prescribe levodopa (l-dopa), which helps replenish the brain's dopamine. Sometimes doctors prescribe other drugs that affect dopamine levels in the brain (e.g., drugs that inhibit the breakdown of dopamine). In patients who are very severely affected, a kind of brain surgery known as pallidotomy has reportedly been effective in reducing symptoms. Another kind of brain surgery, in which healthy dopamine-producing tissue is transplanted into the brain, is also being tested. Finally, researchers are trying to identify substances that will prevent dopamine-producing brain cells from dying, such as antioxidants, with investigation of coenzyme Q10 as an example.
The characteristic symptoms of Parkinson's appeared in ancient Chinese medical texts that described trembling of the hands and shaking of the head. The disorder and its basis has been subjected to considerable analysis over the centuries. Syndromes in which elderly patients suffer from spontaneous shaking, or from other muscular manifestations such as paralysis or tonic spasm, are thought to be the result of yin deficiency of the kidney and liver leading to generation of "internal wind."
According to the theoretical understanding of aging, over time, the yin essence of the kidney and liver declines, and this leads to common signs of old age, such as drying of body fluids, fragility of body structures, graying of the hair, wrinkling of the skin, loosening of the teeth, and withering of the flesh. The basic text of Chinese medical theory, Neijing Suwen (ca. 100 A.D.), says that "One who is over 40 years of age will have his yin half-reduced." In ancient descriptions of trembling of hands and shaking of the head, and stiffening of the muscles, it is mentioned that these symptoms are a manifestation of wind and involve the liver organ system. The Neijing says: "All kinds of wind and dizziness are associated with the liver; all kinds of sudden stiffness are associated with wind." In order for the blood and yin of the liver to be full, the kidney essence must be adequate, as it is the source of the liver yin. The decline of kidney and liver functions have a common origin in the aging process in which kidney yin (or kidney essence) is reduced (1).
In order for the normal aging pattern to lead to Parkinson's-like symptoms, the liver yin has to become so weak that a syndrome of wind is elicited. This may occur because there are additional factors that adversely influence the kidney and liver. Genetic propensity to suffer from Parkinson's disease corresponds to inherited defects in the kidney essence. Susceptibility of the liver to deficiency and generation of wind may occur as the result of diseases that damage the liver, from excessive use of alcohol and drugs that can damage the liver, or from a long history of behaviors that are unhealthy. In addition, external wind may penetrate the channels and invade the liver to induce the internal wind syndrome. External wind is a mysterious concept invoking environmental factors of various types that adversely influence the body, starting at the body's surface and penetrating inward. The experience of external wind usually produces symptoms of aches and pains. The internal wind, whether generated from within or from the influence of external wind, produces symptoms of shaking, described in Compendium of Medicine this way: "The upgoing qi in the channels and collaterals does not keep its proper position, thus causing the head to shake and the limbs to tremble."
The mental disturbances that arise in some Parkinson's patients may be attributed, from the perspective of traditional Chinese anatomical connections, to a failure of the kidney to nourish the brain. In addition to genetic components contributing to this decline, there may also be weakening of the kidney by exposure to cold, by excessive fear, by excessive sexual activity, and by consuming foods, drugs, or other substances that harm the kidney and especially that deplete kidney yin. Also, physical injuries and surgeries can disrupt the normal interconnection of the internal organs and result in depletion of yin of the kidney and liver.
This interpretation of symptoms and signs associated with Parkinson's disease leads almost immediately to a therapeutic regimen: nourish the kidney and liver, with focus on nourishing yin, and sedate internal wind. While nourishing kidney and liver is often accomplished by herb therapy, calming wind syndromes is more frequently attempted through acupuncture therapy. In China, acupuncture and herbs have been used both independently and in combination.
One of the most commonly used formulations for treating yin deficiency with aging is Rehmannia Six Formula (Liuwei Dihuang Wan), with key tonic herbs rehmannia and cornus; it might be modified with additional tonics for kidney and liver (typically, lycium fruit and ho-shou-wu would be recommended). Yang deficiency may exist with this syndrome, and might be treated by herbs that gently strengthen yang while benefiting yin, such as cistanche and cuscuta. There are several wind-inhibiting substances recommended by Chinese herbalists. The main plant-based remedy is gastrodia tuber (others include uncaria and tribulus), while most of the substances are of animal origin, including scorpion, centipede, earthworm, antelope horn, and silkworm. The persistence and progression of the disease may be attributable to "phlegm obstruction of the channels." According to this concept, a residue from food essences accumulates in the channels (blood vessels, meridians) and "fixes" the wind so that the symptoms persist over a long period of time. Otherwise, wind syndromes tend to come and go. Herbs used to resolve this problem of phlegm obstruction include arisaema, pinellia, and acorus (these are botanically related); silkworm and gastrodia are considered helpful for both calming wind and clearing phlegm obstruction.
Few publications of clinical trials for Parkinson's disease treatments have appeared. While keeping in mind that the Chinese evaluations are conducted and reported in a manner that does not meet Western criteria, these reports help illustrate the treatment strategies, duration of treatment, and types of responses claimed. In this review, only recent publications (that is, during the past decade, since 1995) are considered.
A report (2) on treatment of 40 cases of Parkinson's syndrome involved 31 male and 9 female patients, aged 54-80 years (mean 69 years), with cases classified as being severe (3 patients), moderate (27 patients), or mild (10 patients). All patients were considered to have deficiency of kidney and liver yin with stirring up of internal wind. In addition, 3/4 of the patients were described as having phlegm in the channels. Of the remaining 10 patients, rather than this phlegm obstruction syndrome, 6 were said to have deficiency of qi and blood and 4 were said to have deficiency of yang.
A basic prescription was developed for treatment:
|Ho-shou-wu ||20 g|
This collection of herbs, cooked to yield a decoction for drinking, would be modified according to symptoms, for example:
After decocting the herbs, the resulting tea was divided into three portions (each about 100 ml), to be taken one portion each time, three times per day. Treatment time was three months taking the decoction daily while discontinuing Western medications (such as l-dopa or cholinesterase inhibitors).
According to the authors of the report, 5 of the patients were "markedly improved" by the treatment and 15 additional cases were improved, while the remaining 10 only had slight changes. Improvement was evaluated on the basis of scores for symptoms characteristic of Parkinson's disease, including tremor, rigidity, hypokinesis, gait disturbance, and mask-like face. They suggested that acupuncture, moxibustion, and scalp-needling might be helpful additions to the treatment.
One can presume from the information provided that most patients took decoctions made from about 120 grams per day of crude herb materials, and that they took the herbs daily and experienced some improvements during this period, but none were completely cured of the disease. Therefore, continued use of herbs would likely be necessary to maintain the apparent beneficial effects.
Many patients with Parkinson's also suffer from atherosclerosis, and there is some thought that this problem contributes to degeneration of the neurons, perhaps as a result of insufficient blood flow or related to inflammatory processes that contribute to atherosclerosis and to neuron degeneration. In a study of patients with atherosclerosis and Parkinsonism, 60 cases were treated with the same herb formula described above, by the same research group (3). In this case, there were 42 male and 18 female patients, aged 61-78 years (mean 67 years). In this group, it was reported that 7 of the patients were markedly improved, and 24 were improved, 15 were slightly improved, while the remaining 14 failed to respond to treatment.
In another study of Chinese herbal medicine (1), 700 cases of treatments of Parkinson's patients at a hospital were reviewed; 50 of them, involving prolonged therapy, were analyzed. The case reports were concerning 32 men and 18 women, with age ranging from 35 to 75 years. The patients were divided into three categories by the traditional method of differentiation and were treated with herbs accordingly. Because these were case studies, rather than a specific prescription, commonly used herbs were mentioned.
The formulas would be modified according to specific symptoms, for example, to address continuous trembling, use antelope horn, uncaria, and gastrodia; additional wind-sedating substances might also be used.
The herbs were prepared in the form of decoction, which was given in two doses per day. Most of the patients took the decoctions daily for three months. Many of the patients were taking standard Western medicines at the start of the treatment and, according to the authors, several were able to reduce their dosage or discontinue these medicines during or after treatment with the decoctions. The authors reported that of the 50 patients analyzed, the treatment was markedly effective in 15 cases, and somewhat effective in 24 cases, the remainder (11 cases) did not respond to therapy significantly.
In a study (4) of acupuncture therapy administered to 29 patients with Parkinson's, the patients were treated every other day for three months. Western drugs (mainly l-dopa, dopaminiergic receptor stimulants, and anticholinergics) were used as per usual practice; a control group taking Western drugs alone (24 patients) was also monitored.
Two sets of acupuncture points served as the basis of therapy, and they were administered alternately:
Group 1: sishencong (EX-HN-1), quchi (LI-11), waiguan (TB-5), yanglingquan (GB-34), zusanli (ST-36), and fenglong (ST-40).
Group 2: benshen (GB-13), fengchi (GB-20), baihui (GV-20), hegu (LI-4), sanyinjiao (SP-6), and taichong (LV-3).
Electro-stimulation was administered to sishencong, benshen, and fengchi for 15 minutes, using a frequency of 180 cycles/minute, with the intensity adjusted to the tolerance limit for the patient. To avoid reduction of sensitivity to the stimulus over the course of the treatment, a continuous wave was used initially, but then followed by a "disperse-dense" wave. The other points were needled with the conventional manual method of stimulation. Needle retention was 40 minutes. Additional acupuncture points would be used for treating specific symptoms, so that, with most points being bilateral, about 12-16 needles were used in each treatment.
The authors reported that there was a significant improvement in symptoms (10 symptoms were monitored to obtain a composite figure for change) for those treated with acupuncture, while for patients treated with drugs alone, there was a worsening of symptoms. Further, the patients treated by acupuncture ended up using a lower total dosage of drugs after the three months of treatment, while those using the drugs only retained their original drug dosage.
A follow-up study (5) was conducted by the same group, focusing on the sishencong points (a group of four points at the top of the head, surrounding the point baihui, GV-20), with a comparison group treated with four points on the limbs (arms and legs). According to the report, acupuncture increased the cerebral blood flow velocity, which was taken as a sign of improved circulation to the affected parts of the brain, and the sishencong points had a more notable effect on the brain circulation.
Another report on acupuncture (6) also focused on acupuncture near the scalp point baihui (GV-20). In this case, acupuncture was performed along the scalp from qianding (GV-21) to baihui (GV-20), using the standard techniques of scalp acupuncture. Needles were inserted at a small distance to either side of the governing vessel (central line), in parallel groups with a total of 12 needles used. After manual manipulation using a rapid twirling maneuver, the inner needles (closest to the center line) were attached to electrodes of an electro-stimulation device (with disperse-compact alternating wave form) and stimulated for 40 minutes at the highest intensity the patient would accept. Treatment was administered every other day for ten consecutive treatments over a three week period; this was repeated each month for three months. In addition to the scalp points, yamen (GV-15), fengchi (GB-20), and other points at the neck would be treated by standard acupuncture.
It was noted that there were some responses immediately after treatment, with calming of tremor in 2/3 of the patients. Among 24 patients that completed three months of therapy, 6 were said to show marked improvement, and the other 18 moderately effective (there were 43 patients starting the therapy, and some discontinued due to lack of efficacy).
The progressive damage to nerve cells in Parkinson's might be prevented to a certain extent by antioxidant therapies. This approach has been suggested for many diseases, but laboratory studies indicating this potential value have not been followed up by adequate clinical trials. Coenzyme Q10, a well-known antioxidant, has been used in recent early stage trials. Patients with Parkinson's disease may have an increased risk of falling. Since osteoporosis is a common problem of aging (especially in those who can't exercise frequently) and falls may result in bone fractures (which have slower healing in those with neurological disorders), nutritional supplements that help counter osteoporosis may be helpful. Several nutrients, such as calcium, magnesium, vitamin D3, and other minerals and vitamins appear important in maintaining bone mass.
Both acupuncture and herb therapies have been reported to show benefits for some patients suffering from Parkinson's disease. The herb therapies are mainly high dosage preparations of herbs that nourish yin and blood, sedate wind, vitalize blood circulation, and resolve phlegm-obstruction of the channels. Acupuncture is administered every other day, usually with prolonged stimulus (30-40 minutes). Prompt effects of acupuncture (right after treatment) may be observed, but standard therapeutic regimens are three months.