Parkinson’s disease (PD) is an age-related progressive neurodegenerative disorder. Its clinical manifestation of motor symptoms includes bradykinesia, resting tremor, rigidity of muscles and joints, gait and posture imbalance. The non-motor symptoms of PD are found in the vast majority of patients with PD, consisting of autonomic dysfunction, neuropsychiatric disturbance, sleep disorders, gastrointestinal symptoms and many others.
Tremors of the hands, rhythmic contraction and relaxation of antagonistic muscles, difficulty in movement and rigidity, stiff limbs, a staring look and mask-like face etc. are all common manifestations of Parkinson’s disease. At the later stage of the disease, all movement is reduced in speed and frequency. Many of these are typical signs and symptoms of internal wind associated with liver disharmony in TCM. PD usually occurs in patients over 50 years old. Chinese medicine believes that overwork, excessive sexual activity, improper diet and emotional stress are all common and important pathogens for many diseases. If these pathogens last a long period of time they will eventually give rise to kidney deficiency. Furthermore, senility, the late stage of life, is characterised by decline of kidney essence. This is why geriatric diseases always present with an underlying kidney deficiency pattern. As the liver and kidney share the same origin, kidney deficiency leads to both liver and kidney deficiency. Malnourishment of the tendons due to this deficiency results in stirring of liver wind internally.
From a TCM perspective, the main manifestations and age of onset of PD indicate that the disease relates primarily to liver and kidney disharmony and liver wind. PD is characterised by signs and symptoms of liver wind. In clinical practice, this degenerative condition often overlaps with other chronic geriatric diseases such as hypertension, high cholesterol, coronary artery disease, arteriosclerosis and diabetes. These are commonly associated with phlegm and blood stasis. In Chinese medicine, the pathogenesis of PD includes both root deficiency and excessive manifestations such as wind, phlegm, qi stagnation and blood stasis. Patterns of PD are represented by a progressive continuum from mild to severe. Qi and blood deficiency begins the disease progression. Left untreated or aggravated, the condition often degenerates into deficiency of liver and kidney. Wind-phlegm is then prone to obstruct the channels leading to blood stasis with endogenous wind. Finally, at the severe end of the spectrum, yin and yang both become deficient.
As a result, the general treatment principle is “nourishing yin and extinguishing wind”. Nourishing liver and kidney yin treats the root and extinguishing wind focuses on eliminating its manifestation. “Invigorating blood and transforming phlegm” is an additional principle applied because blood stasis and/or phlegm are patterns that appear often in this disease. The specific treatment plan will be different in different stages of the disease and with different patients. Generally speaking, PD is a chronic and difficult disease requiring a long period of treatment with acupuncture and herbs. In the acupuncture treatment of Parkinson’s disease, although the selection of acupoints is primarily based on patterns, some special empirical points are also important. Secondly, keep in mind that due to the long treatment period and the need for frequent treatments, it is important to avoid overuse of commonly used points. To do this, organise acupuncture points into groups and alternate them each time, and supplement acupressure of the points at regular intervals. For the herbal treatment of PD, the following two aspects should be taken into account. First of all, the functional state of the spleen and stomach is not strong in the elderly. Herbs that move qi to promote the spleen and stomach’s functions are commonly used, therefore, to prevent the nourishing herbs from cloying. Secondly, herbs that invigorate blood and transform phlegm are warm, pungent and scattering and have a tendency to injure body fluids, blood and yin. It is important, therefore, to select relatively mild herbs for eliminating blood stasis and phlegm. Ultimately, maintaining mood, changing lifestyle and practising some oriental exercises such as qigong and taiji are equally as important as herbs and acupuncture in preventing and treating PD.
- This article is contributed by: Dr Baiyun Zeng, ATCM Research Committee Chair
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