Editor's Note: Part 1 of this article ran in the May issue and discussed dietary / nutrient recommendations.
Acupuncture has been used for more than 3,000 years to help reduce pain, anxiety, insomnia, stiffness and more. Regular treatments may help slow cell death and attenuate oxidative stress that causes damage to dopaminergic neurons in the substantia nigra.7 (For more details and recommended acupuncture points, go to www.itmonline.org/arts/parkinsons.htm.) According to TCM theory, there are a number of possible TCM patterns identified as strategies for treating PD:
TCM / Herbal Strategies
Deficiency in the ben (root) and excess in the biao (branch). The ben (root) is insufficiency of liver and kidney, and deficiency of qi and blood; and the biao (branch) is wind, fire, phlegm and stasis. Good therapeutic effects have been obtained by treatment based on syndrome differentiation, treatment with specific herbal formulations and acupuncture.8
Depletion of energy, especially in the spleen and stomach. PD patients who present with fatigue, constipation and/or mood disorder are classified in the subgroup of "spleen qi deficiency." Treatment typically involves different herbal formulas to replenish spleen qi.
Jia Wei Liu Jun Zi Tang (JLT) "strengthens the spleen and regulates the stomach," and has been used in China to treat the symptoms of PD.9 This patent herbal formula was evaluated in a double-blind 2011 pilot study with 55 PD patients, resulting in marked improvements in the Parkinson's Disease Questionnaire (PDQ-39) and improved scores in the Unified Parkinson's Disease Rating Scale (UPDRS).
The study showed significantly reduced non-motor complications10 in patients with PD under traditional Chinese medicine, with the major improvement reflected by the reduction in score of the UPDRS, which assesses gastrointestinal disorders, including anorexia, nausea and vomiting, sleep disturbances (such as insomnia and hypersomnolence), and symptomatic orthostasis.11
One of the principal herbs in this formula, Uncaria rhynchophylla (Gouteng in Chinese), efficiently promotes the clearance of α-synuclein aggresomes (misfolded proteins) in vitro and in vivo by inducing autophagy, which protects neurons in PD.12
Liu Jun Zi Tang (LJZT) is also effective in treating PD patients with clinical fluctuation. Assessment includes observation of tremor, rigidity and bradykinesias, absorption of acetaminophen, plasma level of L-dopa, and the patient's subjective scoring scale. In one study, after two weeks, LJZT significantly improved mobility and percentage of daily "on" time. Frequency of gastric discomfort, anorexia, and nausea were lowered.13 Also noted was gastric emptying and stability of plasma L-dopa level.14
Deficiency of kidney and liver yin with stirring up of internal wind or phlegm obstruction syndrome. For yin deficiency, a common herbal formula is Rehmannia Six Formula (Liuwei Dihuang Wan), with key tonic herbs rehmannia and cornus. This formula might be modified with additional tonics for kidney and liver (typically, lycium fruit and ho-shou-wu would be recommended). 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.
The generation of "internal wind" often associated with liver imbalances can result in symptoms such as dizziness and stiffness. Generation of wind may occur as the result of diseases that damage the liver, such as the excessive use of alcohol and drugs, or from a long history of unhealthy lifestyle habits. Internal wind, either by itself or in conjunction with "external wind," can result in symptoms of shaking.
Kidney imbalances resulting in failure to "nourish the brain" can result in mental disturbances that arise in some Parkinson's patients.
Genetic propensity to suffer from Parkinson's disease corresponds to inherited defects in the kidney essence. One study involved the treatment of 40 cases of PD with herbs focused on either being diagnosed with "phlegm obstruction syndrome", deficiency of qi and blood, or deficiency of yang (all patients were considered to have deficiency of kidney and liver yin with stirring up of internal wind) showed Results were as follows: five patients were "markedly improved" by the treatment, 15 cases were improved, while the remaining 10 only experienced slight changes.15
In another study of Chinese herbal medicine, 700 cases of treatments of Parkinson's patients at a hospital were reviewed; 50 of them, involving prolonged therapy, were analyzed. Herbs were prepared in the form of a decoction, which was given in two doses per day. Most of the patients took the decoctions daily for three months.
The authors reported that of the 50 patients analyzed, treatment was markedly effective in 15 cases and somewhat effective in 24 cases; the remainder (11 cases) did not respond to therapy significantly.16
The traditional Chinese compound Zishenpingchan also can be used as an add-on treatment to the Parkinson's drug levodopa for improvements in motor symptoms and quality of life in patients, according to researchers.17
Acupuncture Strategies
Another report focused on acupuncture18 near the scalp points GV 20 and GV 21. 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, and electrostimulation was applied. Treatment was administered every other day for 10 consecutive treatments over a three-week period, repeated each month for three months. In addition to the scalp points, GV 15, GB 20, other points at the neck were treated by standard acupuncture.
Two-thirds of the 24 patients noted immediate responses with calming of tremors. The patients completed three months of therapy, with six showing marked improvement, and the other 18 showing moderate improvement (43 patients started the therapy, and some discontinued due to lack of efficacy).19
References
7. Zeng BY, Salvage S, Jenner P. Current development of acupuncture research in Parkinson's disease. Int Rev Neurobiol, 2013;111:141-58.
8. Zhang QJ, Zhang YY, Huang WY. [Traditional Chinese medicine in treatment of Parkinson's disease]. Zhong Xi Yi Jie He Xue Bao, Jan 2014;2(1):75-77.
9. Huang TK, Zhang DB. Extrapyramidal Disease. In: Neuropathy and Psychosis of Traditional Chinese Medicine. Beijing: Chinese Medical Science Publishers, 2017: p.p. 426-27.
10. Huang TK, et al., Ibid.
11. Kum EF, Durairajan SS, Bian ZX, et al. Treatment of idiopathic Parkinson's disease with traditional Chinese herbal medicine: a randomized placebo-controlled pilot clinical study. Evid Based Complement Alternat Med, 2011:724353 (open access).
12. Lu JH, Tan JQ, Durairajan SS, et al. Isorhynchophylline, a natural alkaloid, promotes the degradation of alpha-synuclein in neuronal cells via inducing autophagy. Autophagy, Jan 2012;8(1):98-108.
13. Chua KK, Wong A, Chan KW, et al. A randomized controlled trial of Chinese medicine on nonmotor symptoms in Parkinson's disease. Parkinson's Dis, 2017 May 23:1902708 (open access).
14. Chua KK, et al., Ibid.
15. Jianzong C, et al. Traditional Chinese medicine treatment of Parkinson's syndrome-a report of 40 cases. J Trad Chin Med, 2003;23(3):168-169.
16. Li G. Clinical observation on Parkinson's disease treated by integration of traditional Chinese and Western medicine. J Trad Chin Med, 1995;15(3):163-169.
17. Ye Q, Yuan XL, Yuan CX, et al. Zishenpingchan granules for the treatment of Parkinson's disease: a randomized, double-blind, placebocontrolled clinical trial. Neural Regan Res, 2018 Jul;13(7):1269-1275.
18. Guifang X, et al. Impact of electrostimulation at scalp points on tremormyeloectropotential in Parkinson's disease patients. Shanghai J Acu Moxi, 1996;15(3):5-6.
19. Guifang X, et al., Ibid.
Chronic pain afflicts over 20% of the adult population. Sadly, most MDs have essentially no education in treating pain, beyond offering a few toxic medications. Then they tend to steer people with pain away from those health practitioners who are trained. This puts the acupuncture community on the front lines for addressing this epidemic.
When the body is going through a stressful event, the sympathetic system is activated. This activation will help the body with a life-threatening situation. If this state is activated for prolonged periods of time, it starts to consume energy. These traumatic events that generate stressors in the autonomic nervous system (ANS) will eventually become internalized.
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One of the things that makes acupuncture so difficult to measure is that the medicine actually does contain some esoteric aspects. There have been numerous studies that demonstrate the neurochemical reasoning behind why acupuncture points stimulate the autonomic nervous system to enact change However, not all the benefits of TCM can easily be measured by randomized, controlled trials. But does that make them fundamentally and definitively untrue?
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