A Summary of Parkinsons disease in Asian Medicine

Introduction Many chronic diseases are thought to be more prevalent in modern society, but none are thought to be more severe than the neurodegenerative diseases. These diseases, mainly Alzheimers and Parkinsons disease, are thought to affect a vast number of elderly patients. These two conditions represent two very human qualities: conscious thought and conscious movement. This paper will discuss some of the issues relating to Parkinsons disease (PD), mention some historical and modern issues, and specifically focus on the treatment of PD with Oriental medicine. Historical Perspective PD was first formally described in modern times in An Essay on the Shaking Palsy, published in 1817 by a London physician named James Parkinson. It was also known as paralysis agitans. In Parkinsons essay, he states the condition was known to Galen, who lived in the 1st century CE, who had also described and treated similar symptoms, which he described as:1 Involuntary tremulous motion, with lessened muscular power, in parts not in action and even when supported; with a propensity to bend the trunk forwards, and to pass from a walking to a running pace: the senses and intellect being uninjured. But long before Parkinson, the syndrome had been described in both Chinese and Indian medical text. In India the ancient Ayurvedic text, Charaka Samhita, described a condition called Kampavata,2 which means tremors due to vata (a combination of elements air and ether, responsible for all movements, and easily disturbed by Wind). Syndromes similar to Parkinson's were described nearly 2500 years ago in foundational Chinese Medicine texts such as the Huangdi Neijing. According to the "Principles of Medicine", written in 1565, "Wind tremors are (caused by) Wind entering the Liver and the Qi of the channels rebelling upward, (causing) tics of the face and tremors of the limb." A Shared Beginning As the oldest systems of medicine in the world believed that Wind is primary etiology of Parkinson disease, it would be good to review concepts. While Vata isnt strictly Wind in Ayurvedic medicine, it is more of constitutional type, but Kampavata is a derangement of movement where there is an inclination to move combine with tremor, a fixed stare, drooling, a love of solitude, among other symptoms.3 In Oriental medicine Wind takes on a role as both an external pernicious factor and an internal influence on the body. When Wind is external, is can cause syndromes that present suddenly and may have quick changes, migrating pain, spasms, convulsions, and deviations in movement. When Wind is internal, the chief clinical manifestations are tremors, tics, dizziness, vertigo and in severe cases unconsciousness or convulsions. In

most causes internal Wind is due to a Liver disharmony.4 Historically, wind was looked upon as evil and, according to Paul Unschuld, the evilness of Wind has lead to demonology5, as the evil spirits can move quickly, much like the way external Wind presents clinically. Contemporary Disease or Long Standing Human Condition? Since the first Western description of the shaking disease by Parkinson, Western medicine has been looking for a cause. Although this condition has been known for some time, many speculate that there is an environmental cause. Indeed, some forms of agrochemicals have shown to play in role in the pathology of Parkinsonism, which is a manifestation of the symptoms of PD, but perhaps not the full diagnosis. Examples include paraquat and rotenone, which have both been associated with increased risk of PD. Paraquat is one of the most widely used pesticides in the world, especially since the 1960 and 1970s (interesting to note, in the 70s paraguat was sprayed on Cannabis fields in Mexico, and it is thought that many Americans, and possibly people from other countries, eventually smoked this the herb, even though treated). Does the recent scientific evidence of chemical exposure invalidate the historical basis for Wind conditions causing PD? In this authors opinion, no. The fundamental Western cause of PD is a disturbance of dopamine, which is responsible for movement, as well as motivation and desire. It is the authors opinion that dopamine is a chemical that has a distinct yang aspect, which perhaps is easily disturbed by chemicals. Current statistics As many as one million Americans live with Parkinson's disease and approximately 60,000 Americans are diagnosed with Parkinson's disease each year, although this number does not reflect the thousands of cases that go undetected. The incidence of Parkinsons increases with age, but an estimated four percent of people with PD are diagnosed before the age of 50. Worldwide, approximately four million people are estimated to be living with Parkinson's disease.6 Incidence of PD is highest among the U.S.A. (the highest location in the US is Nebraska) with the prevalence differing according to race, with Hispanics, then Whites, then Asians, then Blacks being more prone. The next highest incidence is Japan. European countries vary but have a similar incidence, as with Australia. The incidence in China and India is considered very low (except for a small area in India of most Parsi in Mumbai and on the western part of the country). The lowest incidence is in the Ethiopia.7

Clinical presentation Main signs and symptoms are a grouping of symptoms commonly called TRAP. 8 T: 50- 80% of patients have a resting tremor. The tremor is worse with stress, fatigue, and usually affects, in order, the hands, arms legs, feet. The head is usually not affected by the tremor. R: Spastic rigidity, cogwheel rigidity, clasp knife rigidity. Patients can have rigidity with associated muscle pain or fatigue. A: Akinesia and Bradykinesia are the most disabling component, resulting in a shuffling gait w/ stooped posture, head and neck are forward, hips and knees lightly flexed (festinating gait). The arms do not swing with walking. Patient is slow getting started. Patient turns entire stiffly (en bloc turning). P: Postural instability which may present with a characteristic bending or flexion of the body, associated with difficulty in balance and disturbances in gait Other signs include a short, mask-like face, open mouth, decreased blinking, loss of postural reflexes are common. 50% of patients have dementia, which tends to occur later in the disease progression, and indicates a poorer prognosis. Possible etiologies of PD in Oriental medicine In addition to Wind, one needs to look towards the Liver and Kidney disharmonies. As the quote above states: Wind tremors are (caused by) Wind entering the Liver and the Qi of the channels rebelling upward, (causing) tics of the face and tremors of the limb." The climacteric factor for the Wood element and Liver is Wind, therefore it will always have some involvement, even though the disease process may have progressed. Factors that can be an etiology in factor PD (as well as many diseases)9: Overwork and excessive sexual activity can weaken Kidney, especially Kidney Yin. When Kidney yin becomes depleted, it is more likely that Liver Wind will be stirred up. Poor diet, which in our contemporary American culture includes many fried foods and alcohol, can lead to increased formation of Phlegm. Phlegm can then obstruct the channels, and thereby stopping blood from nourishing the channels and tissues. Phlegm can also create heat and possibly fire, which can also cause Liver Wind to stir up. Emotional stress is something very difficult to avoid, but in particular, anger, frustration are worse for the Liver, and can therefore cause the Liver Yang to rise, which may lead to Liver Wind. Another factor that is not commonly recognized as an etiology in PD is Rebellious Qi of the Stomach channel with an associated Gall Bladder channel excess. 10 Janice WaltonHadlock, DAOM (a teacher at Five Branches University of Traditional Chinese Medicine in Santa Cruz, California) is the main creator of this theory. The original insult to the

Stomach channel could have happened in childhood as an injury or when a person has received a severe skin-lacerating injury or has lost a significant amount of blood. This injury causes a modified dissociative mode of the psyche, which is then stored in the tissues and creates the Stomach and Gallbladder meridian pathology. Pathologies and Treatment of PD in Oriental medicine The beginning stages of PD are characterized by Qi and blood deficiency. The main symptoms of this syndrome will be a longstanding, pronounced tremor of a limb, staring look to the expression of the face, festination movements and uncoordinated walking with cramps in the limbs. There may also be restlessness, insomnia, night sweats, blurred visions. The tongue is pale and swollen and it may be quivering with teeth marks, and the pulse is weak and tready. The treatment principle for this condition is to tonify Qi, nourish blood, invigorate the connecting channels and extinguish Wind. Points used can include Stomach 36, Spleen 6, Ren 6, Liver 8 and Gallbladder 34. Classical herbal treatment is with Tian Ma Gou Teng Yin (Gastrodia and Uncaria Decoction). The focus of this formula is to sedate the Yang, calm the Liver, and extinguishes internal wind. It also tonifies the Liver and Kidneys, invigorates the Blood, and clears heat. This herbal formula can be supplemented with a tonifing formula such as Ba Zhen tang or Di Huang Yin Zi. 11 The next syndrome is Phlegm Heat agitating Wind. The main manifestations are a tremor of a limb (which can be stopped), staring look; a dislike of exercise; a feeling of chest oppression; dry mouth; sweating; dizziness; spitting of yellow phlegm; a stiff neck and back. The tongue is red with a sticky, yellow coat; the pulse if wiry, fine and rapid. The treatment principle is to resolve the phlegm, clear heat, extinguish wind and invigorate the connecting channels. The points used are Stomach 40, Ren 12 and Bladder 20, Spleen 6 and 9, Liver 3 and Gallbladder 34.. An Herbal formula for this condition would be Dao Tan Tang, which works specially for Phlegm. It can be added to Tian Ma Gou Teng Yin.12 According to Giovanni Maciocia, an empirical herbal formula is used containing gua lou, nan xing and zhu li to resolve phlegm; gou teng, tian ma, ling yang jiao and zhen zhu mu to extinguish wind; and dan shen and chi shao to move the blood.13 The last syndrome is Liver and Kidney yin deficiency. The manifestations are a thin body; dizziness; tinnitus; insomnia; dream-disturbed sleep; headache; night sweats; mental restlessness; sore back and knees; numbness of the limbs; stiff neck and back;

tremor of the head; clenched teeth and tremor of the jaw; longstanding tremor of a limb; difficulty and clumsiness of walking; a staring look; and poor memory. The tongue is moving, thin and red, without a coat. The pulse is either thready and rapid or floating and empty, especially in the Kidney position. The treatment principle is to nourish the yin, extinguish wind, and invigorate the connecting channels. The points used are Ren 4, Bladder 23, Kidney 3 and Spleen 6. Bladder 18, Liver 8, Kidney 3, Gallbladder 34 can be added for support. A classical herbal treatment for this syndrome includes using Liu Wi D Huang Wan (Six Ingredient Pill with Rehmannia). While the syndrome of Qi rebelling in the Stomach meridian is not a classic syndrome, the treatment includes Yin Tui Na, a gentle holding technique that is done frequently, at the Stomach meridians of the lower body, especially around Stomach 42.14 Needling of the points Stomach 42 (where the original injury occurred) and SP 3 can be helpful, and in one case resulted in full restoration of facial expression in 24 test subjects with Parkinson's disease. 15 Scalp acupuncture is a popular treatment for neurological conditions effecting sensory or motor system. Two areas to use would include the Motor area, located 0.5 posterior to the midline, and the Chorea area, 1.5 anterior to the midline (or 1 cum according to Maciocia). One could also add the bilateral leg motor and sensory area, and for organ support the thoracic cavity and stomach area could be needled. 16 Conclusion PD is a debilitating, chronic disease that, while many people may present with different syndromes and symptoms, Wind and the original deficiency is always going to be a factor, no matter what kind of chemical exposure has happened. Treatment should be focused on herbal support, the addition of various needling techniques including regular scalp acupuncture, and possibly even Yin Tui Na. The prognosis for PD is usually poor, and if there a concurrent Western diagnosis, such as dementia, the prognosis is generally worse. Has it always been this way, even in days past when paraquat wasnt around? One can only speculate. Since the treatments described in the paper are from reliable sources, we can say that Oriental Medicine can possibly delay the progression of the tremors and movement issue. While this author has not had the opportunity to explore the treatment approach outlined here, it is looked forward to in the future. References:

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1

Dr. Zide Mooni, Association of Ayurvedic Professionals of North America. Acupuncture & Ayurveda Wellness Center presents KAMPA VATA PARKINSONS DISEASE. http://www.aapna.org/Kampa%20Vata.pdf Accessed July 20th, 2010
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Manyam BV. Paralysis agitans and levodopa in "Ayurveda": ancient Indian medical treatise. Mov Disord. 1990;5(1):47-8.
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Student manual p91-92

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Parkinsons Disease Foundation (PDF): http://www.pdf.org/en/parkinson_statistics. Acessed July 29th, 2010

6

Johan Lkk, Mats Nilsson.Frequency, type and factors associated with the use of complementary and alternative medicine in patients with Parkinsons disease at a neurological outpatient clinic. Parkinsonism & Related Disorders, In Press, Corrected Proof, Available online 23 July 2010
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University of Maryland patient library. http://www.umm.edu/parkinsons/signs.htm. Acsessed August 10, 2010

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Maciocia, G. The Practice of Chinese Medicine. Churchill-Livingston. 1994

Walton-Hadlock J. the Use of Yin Tui Na and Stomach channel Acupuncture Points in the Treatment of Facial Immobility in Parkinsons Disease. Journal of Chinese Medicine Number 69 June 2002
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Xue, Yufang. Parkinsons Disease. Journal of Chinese Medicine Number 73 October 2003 Kim, H. Oriental Medicine Differential Diagnosis 2 class notes, summer term 2010 Maciocia, G. The Practice of Chinese Medicine. Churchill-Livingston. 1994 Walton-Hadlock J. Personal communication with the author, 2003

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Walton-Hadlock J. The use of yin tuina and stomach channel acupuncture points in the treatment of facial immobility in Parkinson's disease. Journal of Chinese Medicine June 2002;69:43-48.
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Xue, Y Journal of Chinese Medicine Number 73 October 2003