Interpretation and Treatment with Chinese Medicine
The term "degenerative diseases" has been loosely applied to numerous severe health problems, but the primary medical use of this designation is for describing progressive diseases of the central nervous system-the brain and spinal cord. In the central nervous system (CNS), under ordinary circumstances, the nerve cells do not regenerate. These CNS neurons differ from most of the other cells of the body that break down and are then replaced. The central nerves also differ from peripheral nerves which, under usual circumstances, are able to regenerate when injured. Among the better known neurodegenerative diseases are Alzheimer's disease, Parkinson's disease, amyotrophic lateral sclerosis (ALS), and multiple sclerosis (MS).
The spinal cord is the soft nerve material in the core of the hard spinal vertebrae, and this cord is seen by the traditional Chinese system as a type of "marrow." The kidneys, as the only organ near the base of the spinal column and located on either side of it, are understood to be the spine's origin, since all body components are depicted as derivatives of the viscera. Hence the spinal cord, and its blossoming into the complex brain at the top, is considered an outgrowth of the kidney likened to the marrow of the bones. The kidney system is the storehouse of the prenatal and postnatal essence (jing), the basis of the life gate, and the controller of the underlying fire and water (yang and yin) of the body, working as a regulator in harmony with the heart.
The description we get from the traditional Chinese medical (TCM) system doesn't correlate readily with what is known about the body from modern medical investigations, which clearly distinguish the nature of bone marrow, nerves, and kidneys, but the Chinese description can be viewed a functional one that helps describe the nature of the body as a whole. The utility of the TCM depiction of the central nervous system depends on whether or not the remedies devised on the basis of that description actually help the patients. For us to know whether these remedies are helpful, we would ideally have viable clinical evidence. The type of evidence available to us is somewhat limited, mostly as a result of the poor quality of evaluations and reporting by the Chinese physicians rather than a lack of clinical experience treating such conditions. As a result, we are able to observe what the Chinese doctors do, while recognizing that the recommended therapies still need to be proven effective.
It is recognized in the Chinese medical system that degeneration occurs spontaneously to a certain extent with aging, and these age-related changes then serve as a model for interpreting degeneration from other causes. Specifically, the prenatal essence has been "used up" through the aging process, while the ability to supply postnatal essence declines, partly because of weakening of the zangfu functions, most notably that of the stomach/spleen which is responsible for deriving the essential elements from foods to produce qi, blood, and essence. With aging, it is common to have a lower appetite, thus to eat less, and therefore to have less essence to store in the kidneys. Also, with aging, the mobility of the body slows, and that includes both the overall physical activity (e.g., ability to walk and get exercise) as well as the internal processes (ability to circulate qi, blood, and moisture). With this sluggish circulation, there can be accumulation of materials in the body, particularly static blood and phlegm (dried fluids), which further obstruct the circulation, damage the organ functions, and inhibit replenishment of the essence. All or some of these processes may be triggered earlier in life that they would appear otherwise by certain mechanisms, such as injuries, pathogenic organisms (e.g., viruses), and genetic disorders (in TCM: a derangement or short supply of the prenatal essence). Within the comprehensive Chinese system of interpreting disease causation are the climatic influences (e.g., cold, damp, wind, etc.), but these are mainly seen in modern Chinese work as triggers for initiating a disease or exacerbating a mild condition, while the other factors just described are considered the fundamental causes (i.e., deficiency and stagnation; the latter is considered a type of excess syndrome).
According to the traditional Chinese understanding of aging, over time the yin essence of the kidney and liver declines, and this leads to the most 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, shaking of the head, and stiffening of the muscles (characteristics of Parkinson's disease), it is mentioned that these symptoms are a manifestation of wind that arise from deficiency of yin and blood of 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 (thus preventing internal wind from arising), the kidney essence must be adequate, since it serves as the primary source of the liver yin. The decline of both kidney and liver function has a common origin in the decline of yin during the aging process.
Modern medical investigations of the central nervous system can often reveal the specific site of degeneration, and yield some details about the biochemical processes involved. In some instances, one or more contributing causative factors have been determined, but for most of the neurodegenerative diseases, it appears that there are multiple causative factors merging together to initiate or accelerate the disease process. The Chinese descriptions of the disease provide some suggestions for help through means available now, used for either preventing the disease or bringing it under control (especially if treated early enough). The modern medical descriptions may also provide some limited preventive strategies and a few drugs for alleviating the symptoms at the early stage, but they generally provide little satisfactory results at present, partly because any modern preventive or treatment strategy now under development must undergo extensive evaluation before a claim for efficacy is made. By contrast, with the traditional Chinese system, the strategy to be employed is based on the underlying theories rather than conclusive evidence.
Chinese medical treatments using herbal formulations for neurodegenerative disorders generally rely on four components:
Acupuncture therapies may be utilized to accomplish the same objectives as described here for the herb formulations; in addition, acupuncture may be applied locally (over the head or along the spine) in an effort to invigorate the affected part of the nervous system. Thus, points along the governing vessel and in close proximity on either side of it (e.g., Hua Tuo points and Bladder Meridian points), are often part of the treatment. Another aspect of acupuncture therapy is to treat the deficiencies and stagnation through body points that are particularly suited to those purposes (e.g., zusanli for deficiency and hegu for stagnation).
Although numerous ingredients have been used by Chinese doctors to make the formulas given to patients with neurodegenerative diseases, in fact there are only about 50 ingredients that are routinely relied upon; these are outlined below as tonics, blood-vitalizing herbs, herbs for resolving phlegm and phlegm-mist, and herbs for calming internal wind. Some ingredients which are no longer available for use, because of concerns about toxicity or endangered species status of the sources, have not been included here.
|Common Name, Pinyin, Sources||Relevant Primary and Secondary Properties||Comments|
|tonifies qi, increases and raises yang, benefits stomach/spleen||Frequently used for persons debilitated by disease with weakened immune functions, poor digestion, and spontaneous sweating.|
|tonifies qi, harmonizes stomach and spleen, dries damp||Especially used in cases of weakened digestion and diarrhea, but also for general debility.|
|tonifies yang, nourishes blood and essence, moistens intestines||Considered a balanced yang tonic because of its moistening properties. Often used for impotence and infertility; useful in cases of constipation due to blood deficiency.|
|tonifies qi, benefits spleen, increases fluids||Frequently used as a substitute for ginseng; it lacks the yang invigorating action but is less costly.|
|tonifies yang, replenishes essence, controls cough and dyspnea||Mainly used for kidney deficiency or kidney/lung weakness; recently adopted as an immune enhancing agent.|
|nourishes liver and kidney, astringes essence||This is the most commonly used astringent for kidney tonic formulas; it also nourishes yin and blood and benefits the liver.|
|tonifies yang, benefits yin, astringes essence, clears vision||Widely used in kidney-tonic formulas due to its mild nature. Used in vision formulas based on treating kidney/liver deficiency.|
|tonifies yang, nourishes blood, benefits marrow||Frequently used in cases of weakness with a combination of yin, yang, and blood deficiencies; the gelatin nourishes blood and yin.|
|tonifies qi, nourishes kidney, nourishes spleen yin||Commonly used for spleen deficiency with diarrhea and for kidney deficiency syndromes, especially those involving yin deficiency.|
|tonifies yang, vitalizes blood||Used for yang deficiency with blood stasis due to aging; also a common remedy for bone weakness and injured bones.|
|tonifies yang, dispels wind-damp||Especially used for hormonal disorders, including impotence and menopause; also for arthralgia affecting the lower body.|
|tonifies yang and benefits yin, strengthens muscles, tendons, and bones||Frequently used due to its mild nature, it is mainly employed for weakness and pain in the lower body; also lowers blood pressure.|
|tonifies qi, invigorates kidney and lung, pacifies spirit, invigorates yang||Useful in virtually all deficiency syndromes; especially used with spirit agitation. High doses are used to invigorate yang.|
|nourishes blood and yin; used for essence deficiency and aging disorders||Ho-shou-wu is commonly used when there is combined kidney and liver deficiency; it is almost always used in formulas for the hair.|
|Hoelen (or Poria)|
|strengthens spleen, dispels damp, calms spirit||Commonly combined with atractylodes and other qi tonics to improve stomach/spleen function and dissipate stagnant moisture.|
|harmonizes actions of herbs, invigorates stomach/spleen functions||Processing (honey-fried; baked) is used to enhance its tonic effects; small amounts of licorice are said to harmonize ingredients.|
|nourishes yin and blood; replenishes essence||Used for kidney/liver deficiency with dizziness, palpitation, and insomnia. Modern usage: immune enhancing effects.|
|nourishes blood and yin, aids vision||Especially used for the combination of kidney- and liver-deficiency syndrome, for general essence deficiency, and for eye disorders.|
|Peony (or white peony)|
|nourishes, cools, and vitalizes blood, astringes liver yin, alleviates spasms||Peony is extensively used for nourishing the liver; red peony (chishao) is used when blood vitalizing is the main concern.|
|tonifies qi, nourishes essence, moistens dryness||Used in some kidney-deficiency syndromes; considered to be like cooked rehmannia but with qi tonic rather than blood tonic effects.|
|nourishes blood and yin||Used for most cases of kidney deficiency. The related herb scrophularia is sometimes combined with rehmannia to reinforce the effects.|
|nourishes blood, vitalizes blood, moistens intestines||This is the most widely used blood nourishing herb; it also invigorates circulation and helps prevent wind from invading the meridians.|
|nourishes yin and blood, lowers yang, cools blood, stops bleeding||Frequently used for deficiency of yin and blood with yang agitation or bleeding; the gelatin portion is sometimes isolated for this purpose. Used along with deer antler (or antler gelatin) to nourish essence.|
|Common Name, Pinyin, Sources||Relevant Primary and Secondary Properties||Comments|
|nourishes blood, vitalizes blood, dispels wind-damp||Used to harmonize with yang tonic herbs, such as eucommia to nourish kidney essence; a directing herb to move blood from upper to lower body. For blood stasis, cyathula (chuanniuxi) is sometimes used instead.|
|vitalize blood, alleviates pain||Most often it is combined with persica in treatments of blood stasis, especially when the stasis is causing pain.|
|vitalizes and nourishes blood, dispels wind, regulates qi, controls pain||It is used in most formulas for blood stasis and in many formulas for nourishing blood; it is especially used for headache and dizziness.|
|vitalizes blood, regulates qi, controls pain||Mainly used for abdominal pain, especially with peony and licorice to alleviate spastic pain, including pain in the limbs.|
|regulates qi, vitalizes blood disperses accumulations (especially phlegm)||Mainly used in cases of stagnation with accumulation, including treatment of phlegm obstructing meridians or forming masses.|
|vitalizes and nourishes blood, alleviates numbness, relaxes tendons||Modern applications are mainly for patients with anemia; traditionally used for numbness and spasm of the legs in the elderly.|
|vitalizes blood, cools blood||Especially used for blood stasis syndrome with blood heat, often combined with salvia and/or moutan.|
|vitalizes blood, moistens the intestines||Often used for abdominal blood stasis accompanied by constipation; combined with carthamus for many blood stasis disorders.|
|vitalizes, cools, and nourishes blood, sedative||Primarily used for cardiovascular disorders and for liver fibrosis, but increasingly used for all blood stasis syndromes, especially those associated with aging, autoimmunity, and progressive diseases.|
|Sparganium (or Scirpus)|
|vitalizes blood, regulates qi, disperses mass||Mainly used for hard masses (blood stasis type), especially those in the abdomen; usually combined with zedoaria.|
|vitalizes blood, regulates qi, disperses mass, benefits stomach functions||Mainly used for hard masses, in combination with sparganium; also for digestive disturbance with distention.|
|Relevant Primary and Secondary Properties||Comments|
|opens orifices blocked by phlegm-mist, sedative, warms meridians||A primary herb for resolving blockages of meridians and heart vessels; it is included in many sedative and brain tonic formulas.|
|resolves phlegm, disperses accumulations||This herb is most often used in cases of CNS disorders (e.g., mental disturbance, stroke, epilepsy) due to phlegm obstruction.|
|resolves phlegm, calms irritability||This herb is commonly used in treating mental disorders, particularly when there is a heat syndrome; also lowers uprising stomach qi.|
|resolves dampness and phlegm accumulation, disperses qi||Used in cases of abdominal distention, fullness in the chest, anxiety, neurosis, and depression; helps to rapidly dissipate damp|
|resolves phlegm, lowers stomach qi, promotes digestion||The most commonly used phlegm dispelling herb, its mild nature allows it to be used freely in both warming and cooling formulas.|
|Common Name, Pinyin, Sources||Relevant Primary and Secondary Properties||Comments|
|calms wind, calms fright, cleans toxin||It is often used as a substitute for the rare rhino horn; sometimes used as an antipyretic for viral infections; turtle shell may be used as substitute.|
|calms wind, removes toxin||Mainly used for convulsions and spasms, usually along with scorpion. It functions as an inhibitor of excess neurological activity.|
|calms wind, clears meridians, clears heat||Earthworm is said to open blockages in the meridians; it is used in cases of phlegm-mist obstruction.|
|calms wind, analgesic||Used for headaches, hypertension, brain disorders, and spasms; gastrodia mushroom, having the same properties, is a substitute.|
|calms wind, controls pain, disperses accumulations||Mainly used for convulsions and spasms, usually combined with centipede; it is especially used when there is pain.|
|calms wind, resolves phlegm, disperses accumulations||It is used for wind-phlegm disorder, with tonic paralysis or convulsion. A fungus infecting the silkworm is the active component.|
|clams wind, clears heat||This herb is used in remedies for epilepsy, convulsions, and hypertension; may also be used for calming nervousness.|
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. It is now known to involve progressive 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 (the Ayurvedic herb, Mucuna pruriens, is a natural source of l-dopa and has also been used to treat the 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 (reminiscent of restless legs syndrome). 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 associated with aging: it affects about 6% of those over the age of 65 (average age of onset is about 60), affecting more men than women. 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 habitual activities. Coffee consumption, for example, appears to help protect against getting this disease.
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, surgery and various experimental procedures may be attempted. None of the current therapies have long-term success.
The characteristic symptoms of Parkinson's have appeared in ancient Chinese medical texts, which described a syndrome of 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 of disease, 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."
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 (having the effect of damaging yin and essence). The result is disordered flow of qi. As described in the Compendium of Medicine: "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 also arise in some Parkinson's patients may be attributed, from the perspective of traditional Chinese medicine, to a failure of the kidney to nourish the brain as well as from stagnation of phlegm that may obstruct the pathways for flow of qi and blood. In addition to genetic factors related to this decline in kidney essence, 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 those 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. In a recent review article about Parkinson's treatment with TCM (1), the authors noted the following commentaries by Chinese physicians on causation:
The disease has various causes and complicated pathogenesis. Zhu holds that insufficiency of the liver and kidney and failing of the brain, spinal cord, and tendons to be nourished are the basic pathogeneses of the disease, and stagnation of phlegm in the collaterals is an important pathological link in the development and changes in the condition. Wang considers that the disease is caused mostly by gradual loss of the kidney essence due to old age and infirmity, or various poisoning factors caused by trauma….The pathogenesis is deficiency in origin and excess in superficiality; deficiency in origin manifests in deficiency of qi and blood, and insufficiency of liver and kidney; and excess in superficiality manifests as endogenous wind, stasis of blood, and phlegm-heat….Zhou, et al., consider the important pathological factors of this disease mainly deficiency of liver and kidney, wind stirring inside, accumulation of phlegm and blood stasis, a disease with coexistence of deficiency and excess….
This interpretation of causation, as well as the symptoms and signs associated with Parkinson's disease, leads directly to a therapeutic regimen: nourish the kidney and liver, with focus on nourishing yin, disperse accumulated phlegm and blood stasis, and sedate internal wind.
For the tonification component, one of the most commonly used formulations-especially for treating yin deficiency with aging-is Rehmannia Six Formula (Liuwei Dihuang Wan), with its key tonic herbs rehmannia and cornus for liver and kidney, and dioscorea and hoelen for spleen and kidney. It might be modified with additional tonics for kidney and liver (typically, lycium fruit and ho-shou-wu would be recommended). Yang deficiency often exists with the syndrome; it especially appears as the disease progresses, and the person's ability to move declines, and their metabolism weakens. That problem might be addressed by herbs that gently strengthen yang while still benefiting yin, such as cistanche and cuscuta. Zuogui Wan, a well-known formula for nourishing kidney essence, primarily nourishes yin, but also gently assists yang (it is comprised of rehmannia, cornus, dioscorea, cuscuta, lycium, tortoise shell, deer antler, and achyranthes).
There are several wind-inhibiting substances recommended by Chinese herbalists. The main plant-based remedy is gastrodia tuber (uncaria is sometimes combined with it), while most of the substances given for this purpose 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." This substance in the meridians and blood vessels "fixes" the wind so that the symptoms worsen and also 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. Curcuma (yujin), an herb often used for vitalizing blood circulation, is used in modern Chinese practice for dispersing stagnant obstructive phlegm.
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 (20g), lycium (12g), cistanche (12g), gastrodia (15g), uncaria (18g), cnidium (15g), and acorus (10g). This collection of herbs would be modified according to symptoms, adding 2-6 herbs (yielding a total of about 120 grams of herbs per daily dose). After decocting the herbs, the resulting tea was divided into three portions, to be taken one portion each time, three times per day. Treatment time was three months, with the patients taking the decoction daily while discontinuing Western medications. 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.
Many patients with Parkinson's also suffer from atherosclerosis, and there is some thought that this problem contributes to more rapid degeneration of the neurons, perhaps as a direct result of insufficient blood flow, or as a development from inflammatory processes that contribute to both 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 the effects of Chinese herbal medicine (4), 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. 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 administration of 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 for this purpose. 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 using 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.
Information from other Chinese clinical work was reported at the International Congress on Traditional Medicine held in Beijing (April 22-24, 2000). Limited details were provided in the abstracts, indicating that most of the patients given these herb therapies showed improvement. Treatment time, when reported, was 6-12 weeks, and the herbs might be given in capsules or decoctions. No side effects of the herb therapies were noted. As with the studies reported above, the methodology employed does not meet current standards for reliably demonstrating effectiveness. Following are summarized from three reports.
Clinical study on treatment of Parkinson's disease with Wengan Zhichan Jiaonang, by Gai Guozhong, et al.
32 cases of Parkinson's disease were randomly divided into a treatment group and a control group (16 patients each). The treatment group received Wengan Zhichan Jiaonang (Warming the Liver to Control Vibration Capsule), which included the following herbs: astragalus, ginseng, ho-shou-wu, dipsacus, magnolia bark, ligustrum, and cnidium (incomplete list). The herb extracts were encapsulated (500 mg per capsule), with administration of 4 capsules, three times daily. The control group received l-dopa and carbidopa. According to the authors, the results for the two groups, in terms of Parkinson's symptoms, were the same, but the herb-taking group had improvement of other symptoms associated with deficiency syndrome.
Clinical observation on treatment of Parkinson's disease with Xiaochan Tang, by Ding Hongzhan
A new formula for alleviating wind-paralysis, Xiaochan Tang, was evaluated; it is a decoction made with silkworm, scorpion, centipede, uncaria, and aconite; patients were also given powder of antelope horn. This basic formula was then modified with addition of numerous herbs for the patients according to their diagnostic category as follows:
All the herbs were used in heavy dosage, typically 9-15 grams in decoction (except the scorpion and centipede, about 6 grams each). The herbs were given once daily for 25-60 days (average 42 days). Some degree of improvement was noted in 86% of patients, though only 13% showed marked improvement with the 6 week average treatment.
Clinical effect of Zhenchanshu capsule on 21 cases of Parkinson's syndrome by Feng Guangkui
Zhenchanshu was made as a capsule containing herb extracts, taken 4-6 capsules each time, three times daily, for three months to patients who had limited response to levodopa. The ingredients were not listed. It was stated that 86% of patients showed some degree of improvement, with 10% showing complete resolution of symptoms. The authors said that this herb therapy was better for early and intermediate cases and that it performed better for tremor and rigidity but not very effectively for difficult limb movement.
In a review of Parkinson's disease treatment (1), it was noted that "The use of acupoints on the head is extremely important…moxibustion should be used as the main method with acupuncture as assistance." The main points recommended for moxibustion were baihui (GV-20) and dazhui (GV-14) in the head region; plus tender points at the shoulder and upper back, plus certain body points: tanzhong (CV-17), zhongwan (CV-12), tianshu (ST-25), along with zusanli (ST-36) or sanyinjiao (SP-6). These suggestions, sometimes using acupuncture rather than moxibustion, have been followed in some clinical work reported recently, mentioned in the review article (1) and the following reports.
For example, in a study (5) of acupuncture therapy administered to 29 patients with Parkinson's, the patients were treated every other day for three months while the standard drugs 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:
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 session. The authors reported that there was a significant improvement in symptoms 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 only the drugs retained their original drug dosage.
A follow-up study (6) was conducted by the same group, focusing on the sishencong points, 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 (7) also focused on acupuncture near the 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, 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 improved (some other patients discontinued the treatments).
Cord Tablets (Seven Forests brand tablets, 700 mg) serves as a tonic for the Chinese diagnostic category of kidney essence deficiency syndrome:
This formulation focuses on the pairing of deer antler and tortoise shell to nourish the essence. These ingredients are described as have these actions: "deer antler supplements kidney yang, opens the governing vessel, strengthens sinew and bone, boosts marrow, and nourishes blood; tortoise shell enriches yin and blood and supplements the liver and kidney to invigorate the root." Dragon bone secures and astringes the kidney essence, and directs the action of the formula to the spine. Eucommia, dipsacus, and cuscuta assist antler in nourishing the kidney and strengthening the root. Rehmannia, along with tortoise shell, harmonizes the yang tonics, aiding in nourishing yin, blood, and essence. Tortoise shell and dragon bone prevent yang from rising to cause agitation. Astragalus and atractylodes promote the spleen's function of absorbing essences from food to nourish the kidney essence. Disorders to be addressed include:
Cord Tablets shares herbs and characteristics with the traditional formula You Gui Wan (Restore the Right Kidney Pill), which has deer antler, rehmannia, cuscuta, and eucommia in common. It was described, by Bensky and Gamble in Formulations and Strategies, as "one of the best formulas for treating kidney yang deficiency with insufficiency of essence and blood." This revised version maintains these benefits. A formulation for ALS reported in the Chinese literature was comprised of antler and tortoise shell gelatins, rehmannia, tiger bone, dipsacus, cuscuta, eucommia, atractylodes, licorice, (with astragalus added for a later prescription), eucommia, achyranthes, tang-kuei, peony, phellodendron, anemarrhena, and citrus. In Cord Tablets, tiger bone is replaced by dragon bone and the herbs for deficiency fire (phellodendron and anemarrhena) have been left out (Zhi Bai Di Huang Wan could be administered along with this formula).
Stabilizing Tablets (Seven Forests brand tablets, 750 mg) was designed for the treatment of destabilizing conditions (with loss of motor and/or sensory controls) that most often arise with aging and involve more rapid than normal decline in liver and kidney yin and essence.
This formulation focuses on the pairing of gastrodia and batryticated silkworm to inhibit wind, particularly the syndrome of wind-phlegm; these ingredients are described as have these actions: "gastrodia extinguishes wind, dispels phlegm, and checks spasm; silkworm dispels wind and resolves spasm, disperses phlegm, and dissipates binding." Lycium fruit, ho-shou-wu, cornus, cordyceps, and cistanche nourish the liver and kidney, supplementing the yin, blood, and essence, while gently tonifying yang. Salvia, acorus, and cnidium enliven the circulation of blood to overcome some of the damaging effects of chronic disease, aging, and lack of healthy exercise. Disorders that may be addressed by a formula such as this include:
The tonic portion of Stabilizing Tablets shares herbs and characteristics with the traditional formula Huan Shao Dan (Youth Restoring Pellet), which has lycium fruit, cistanche, cornus, and acorus in common. Although the other herbs in Stabilizing Tablets differ, they contribute to several actions intended for the Huan Shao Dan formula, which is described by Ellis in Notes from South Mountain this way: "greatly supplements root qi, [it treats] abstraction, confusion, and clouding of the essence-spirit, congealed or stagnant qi and blood, inability to taste food and drink, thin body, fatigue, diminished sight and hearing loss." The added wind-calming herbs in Stabilizing Tablets contribute to the treatment of shaking, spasm, convulsion, and unsteadiness. In a review of Parkinson's disease treatment, one of the formulas suggested was the "Powder for Checking Tremor and Stopping Spasm," comprised of ho-shou-wu, salvia, earthworm, gastrodia, cistanche, and other ingredients; another formula mentioned contains lycium fruit, cnidium, uncaria, ho-shou-wu, astragalus, atractylodes, gastrodia, and other ingredients. These approaches are similar to the ones expressed in Stabilizing Tablets.