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in parts not in action and even when supported. There is a tendency to bend the trunk
forward and to pass from a walking to a running pace. The senses and the intellect
are uninjured”
Intro
This literature review intends to explore the aetiology, pathogenesis and management
of Parkinson’s disease (PD) from an eclectic perspective. I intend to balance the main
focus on the Chinese Medical approach with a general overview of the Western
Scientific Medical (WSM) perspective as well as with elements of the other herbal
medical traditions that share common Materia Medica with Chinese Herbal Medicine
The review will discuss how the concept of PD its diagnosis and treatment with
Chinese Herbal Medicine, has been classified, questioned, and approached since
This literature review is limited to English language titles from my private library and
research on search engines like Google Scholar and the InfoLinx database.
Western Medicine:
Definition:
attributable to the death of nerve cells in the Substantia Nigra. This specific area of
the Brain contains the cells responsible for the production of Dopamine - a
neurotransmitter that carries messages from one nerve cell to another (Underwood,
2004).
The Substantia Nigra is connected to the Corpus striatum by the nerve fibers in which
imbalance of the ratio between these two that characterizes the consequent Signs and
Symptoms: tremor, rigidity, postural instability and bradykinesia. The first two being
due to an increase in acethylcholine and the last two being due to a decrease in
Although there is no established definite cause for the loss of the dopamine centers
The most common theory points to the possibility of environmental toxins such as
herbicides and pesticides leaching into ground water (Bartrams, 1995; Alexander,
2004) or carbon monoxide poisoning (Flaws & Sionneau, 2001). Closely related to
these, Balch (2000) mentions the inability of the Liver to detoxify, filter and
These theories needs to be critically questioned in the face of mounting evidence that
strikingly comparable pathology with similar features has been described all over the
ancient world.
texts (Jin Gui Yao Lue ) as “Lily Disease” – Bai He Zheng (Flaws and Lake, 2001), in
(Bendick, 2002) and in the Tibetan Medical Tantras – the rGyud-bZhi as “Tsakar”,
(Brant-Zawadzki, 2005).
Ancient renown physicians like, Galen in 175 AD (Halpern, 2010), Zhang Zhong Jing
in his Jing Gui Yao Lue (Flaws and Lake, 2001), Dioscorides in the Classic “De
Materia Medica” (Viartis, 2010), Ibn Rush in his “Al-Kulliat fi al Tibb” (Tbakhi and
Amr, 2008), and Ibn Sina in his “Al-Qanun fi al-tibb” (Has, 1991), all seem to have
been acquainted with this pathology and described and proposed treatment strategies.
-viral infections of the brain as in the case of encephalitis lethargica might be the
trigger for this degenerative progression Long (1997) and Flaws & Sionneau (2001),
and were until the 70’s considered as the main cause for PD (Brown & Knox,1972),
often connected with influenza as we can observe in the words of Moore (1977):
“Most investigators agree that many if not most cases of Parkinson's disease are a
result of viral infection and that the 1918-19 influenza epidemic is of signifi-
cance. It is not clear, however, whether other neurological viruses also can cause
parkinsonism”.
By the 80’s authors started questioning the validity of the above statements: “…the
elucidate the relations between Parkinsonism and the viruses…” (Irkec, 1982, p.293).
-Bartram’s (1995) points to the increase in the disease in patients born during
influenza pandemics.
Oxidative Stress
apoptosis in the Substantia Nigra of the brain, dramatically reducing the levels
Closely related to the above, some authors point to the impairment of the
proteins leading to its accumulation and binding within the neurons. These
abnormal aggregates of protein are called the Lewy bodies, which are
interfering with the normal functioning of the neurons (McNaught & Olanow,
2003).
Local Inflammmation
the brain areas of neuron loss. These cells – Microglia, are the brain resident
elimination of dying and dead neurons (Barzilai & Melamed, 2003), while
Based on the review of extensive articles and case-studies some authors (Lees
& Todes, 1985) suggested that certain personality traits like emotional and
among PD patients.
From the case-studies arena there is increasing evidence that emotional and
neurons. Within this hypothesis some authors mention that the search for the
initial traumatic trigger should focus between 10 to 20 years before the main
Prognosis:
There is no known cure in WSM for PD. The management of this pathology is aimed
at relieving Signs and Symptoms through the intake of drugs designed to correct the
chemical imbalances in the brain (Gascoigne, 2001), delaying the advance of the
disease and supporting the Patient’s independence for as long as it is possible (Balch,
2000).
The disease seems to initially manifest almost imperceptibly with a mild tremor of the
hands while at rest, a general slowness of movement and progresses over the course
of some years to muscular rigidity, changes in muscle tone, drooling, loss of appetite,
tremors, mask like face, impaired speech, disturbance of voluntary movements and
and death.
Gasgoine (2003) includes Parkinson’s drugs in level 2 (taken regularly and there is
where Ama (pathological fluids, toxins) and Vata (wind) are in excess. It is
Interesting to note that in Chinese pathological terms Ama is Phlegm and Damp, and
Vata is Wind (uncontrolled movement), exactly some of the main pathogenic factors
behind the Chinese medical diagnosis of this Pathology. The main herb used is Kapi
Kachu (Mucuna Pruriens) - velvet bean, a bitter-sweet seed of the fabaceae family
that appears in more than 200 Ayurvedic formulas and is supposed to diminuishes
Kapha and Vata and stabilize Pitta (fire), affecting the nervous and reproductive
Ayurveda as a “messenger” to the brain). The seeds contain the L-dopa active
principlein the PD drug of choice (Khalsa & Tierra, 2008). These effects have been
The foundational text of the Tibetan medical tradition, the rGyud-bZhi or ‘the four
tantras’, identifies a disease known as Tsakar, literally “disease of the white nerves,”
but referred to as “the shaking limb disease” by Tibetan doctors. Tsakar is generally
2005).
A formula composed mostly by heavily aromatic substances is used. Some of these
are:
From a Chinese Medical perspective we can understand this formula as a recipe for
pathologies specifically related to Cold (as most of those herbs are warm) and Damp
and Phlegm obstruction in the channels which as we will see is a possible pattern in
In the western herbal medicine field, Central nervous system stimulators like Gotu
Kola (Centella Asiatica) and Gingko (Gingko Biloba) are used in formulas alongside
(Viburnum Opulus) to reduce cramping and tremors and sporadically we can see
nervine, and spasmolytic herbs like Black Cohosh (Cimifuga Racemosa), Motherwort
Uniflorus and Rosa Damascena), other mineral elements (mercury and sulphur) and
two animal products (whey and cow’s urine) called Kushta Tila Kalan is attributed
(Said, 1969). The complex process of purification during the ash preparation is
believed to render it therapeutically effective and safe (Bajaj and Vohora, 2000).
Parkinsionism - The name given to a group of disorders with similar features -- four
primary symptoms (tremor, rigidity, postural instability, and bradykinesia) that are the
www.alsa.org/resources/glossary.cfm
Chinese Medicine
(zhèn zhàn xìng má bì) [convulsions and paralysis] which most authors - past and
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"
(Dharmananda, 2004).
The Neijing clearly states that all kinds of wind and dizziness are associated with the
liver and that all kinds of sudden stiffness are associated with wind (Ni, 1995)
Ming Dynasty physician Lou Ying mentioned this connection in 1565 in his Yi Xue
wind entering the Liver and the Qi of the Channels rebelling upward causing tics of
the face and tremors of the Limbs” ( cited in Maciocia, 1994, p.657).
In the Han Dynasty the genius Zhang Zhong Jing in the Classic Jin Gui Yao Lue
(Essentials from the Golden Cabinet) describes a disease pattern named Bai He Zheng
(百合症) – Lily disease, where the patient is “…laconic and downcast, they want to
lie down but are unable to lie down; they want to walk but are unable to walk…the
physical appearance is normal, but the pulse is faint and rapid…” (cited in Scheid et
al., 2009). The name is after the herb Bulbus Lilii (Bai He-百合) the main ingredient
in the set of formulas Zhang Zhong Jing prescribes for this pathology (Flaws and
Lake, 2001).
Modern authors:
Aetiology:
Most authors (Maciocia, 1994; Flaws & Sionneau, 2001; Xue, 2003) seem to agree
that a combination of overwork, emotional stress, and the wrong diet are at the root
These authors describe similar pathways in the pathogenesis of PD. Through long-
term overwork, the weakening of the Post Heaven Qi drains from the Pre-Heaven Qi
resources creating deficiency at the root, which often tends to manifest as Kidney-Yin
and Kidney Qi deficiency (Maciocia, 1994; Flaws & Sionneau, 2001; Xue, 2003).
Unable to receive support from the “Mother”, the Liver - the core organ in this
pathology, in its turn, will exhibit the signs of Liver Yin and in cases of Liver Blood
arise: Yin is no longer able to keep Yang in check and Liver Yang will often rise.
Both the emptiness of Liver Blood and Yin as the Rising of its Yang aspect will stir
up Wind.
From the Dietetic perspective, the regular intake of sweet oily and fried foods along
with amounts of Alcohol will tend to accumulate as Damp. Once the impairment of
the transformative power of the Spleen and Kidney Qi, these untransformed fluids
WSM side (Smith et al., 2002; Lees, 2004; Lees & Todes, 1985) seem to add to this
stagnated picture through the impairment of the natural coursing attributable to the
Liver Qi.
This combination of Wind and Phlegm/Damp is in Flaws & Sionneau (2001) opinion
a recipe for congestion and obstruction of the channels leading to tremors and
As the sinews are a manifestation of the Liver, a dryness of fluids and blood in the
second will consequently imply a dryness and malnourishment on the first (Maciocia,
1994). In face of these facts becomes clear Xue (2003) statement that PD includes
deficiency at the root overlapped by pathological factors like Phlegm and Wind on
top.
Common Patterns:
Liver Yin deficiency with wind internally stirring (Flaws & Sionneau, 2001);
Liver Qi stagnation, Qi stagnation and Blood Stasis (Flaws & Sionneau, 2001);
Individual Herbs:
According to Chang and But (1987), Wu Wei Zi has shown interesting benefits in
-Chai Hu Jia Long Gu Mu Li Tang (Bupleurum plus Dragon Bone and Oyster Shell
Decoction);
The Shanghai TCM University mainly uses Xi Feng Tang (Wind Allaying Decoction)
for cases of Liver Wind and Rou Gan Huo Xue Tang for cases of Liver and Kidney
deficiency with Blood-stasis in the collaterals. According to Neeb (2007), this latter
Case Studies:
In the collection of western case histories Birch refers a case of Parkinsionism where
a mix of Liver vacuity, Blood stasis, middle and lower burner weaknesses, Qi and
Blood deficiency and a shock were successfully treated with Japanese acupuncture
(MacPherson & Kaptchuk, 1997). Shizue et al., (2006) report a case where the
Research
Reviewing the available literature in terms of Chinese Herbs and PD, it is possible to
define 4 main approaches mirroring what happens in other fields where botany,
animals with extracts taken from the Chinese Materia Medica with the idea
chemical changes in the affected areas of the brain (Van Kampen et al.,
Medicine;
can be tested and evaluated on the impact they produced in specific Signs
and not single herbs neither isolated single active principles are tested
case of the studies conducted by Dai & Kunio (2001), Ishikawa et al.
(1995).
formula was chosen. From this formula its individual herbs were singled
out and again tested and analysed to seek the one with the strongest effect.
The next step was the isolation of active principles from this main herb.
formulas with Western medical drugs (Cui et al., 2003), (Li, 1995),
(Oikawa, 2004).
Even when whole formulas are used instead of single active principles, rarely there is
Chinese Medicine can be extremely challenging for the study’s design, therefore
certain studies try to compromise and try to assume a certain level of differentiation in
their patient’s universe as is the case of Oikawa et al.,(2004) who grouped patients
References:
Scheid, V., Bensky, D., Ellis, A., Barolet, R., (2009). Chinese Herbal Medicine:
Formulas & Strategies (2ed.). Seattle: EastLand Press.
Shizue, O., Yukari, G., Toshihiko, H., (2006). A case of Parkinson’s Disease on
which Sho-Joki-To-ka-Shakuyaku-Kanzo gave remarkable effects. Journal of Kampo
Medicine 53 (12), 2060-2064.
Syeda, A., Rughooputh, S., Greenwell, P., (2004). The Unani system of medicine:
does it have a scientific basis? The Biomedical Scientist 48 (9), 971-972.
Tbakhi, A., Amr, S., (2008). Ibn Rush (Averroes): Prince of Science. Arab and
Muslim Physicians and Scholars 28 (2), 145-147.
Tierra, M., (1988). Planetary Herbology. Twin Lakes: Lotus Press.
Ueda, Y., Komatsu, M., Hiramatsu, M., (1995). Free Radical Scavenging activity of
the Japanese Herbal Medicine Toki-Shakuyaku-San (TJ-23). Neurosciences 21, 75-
79.
Underwood, J., (2004). General and Systematic Pathology(4th ed.). Edinburgh:
Churchill-Livingstone.
Van Kampen, J., Robertson, H., Hagg, T and Drobitch, R., (2003). Neuroprotective
actions of the ginseng extract G115 in two rodent models of Parkinson’s Disease.
Experimental Neurology 184, (1), 521-529.
Viartis (2008). History of Parkinson’s Disease [online] London. Avaiable from:
http://viartis.net/parkinsons.disease/history.htm [acessed 24th June 2010].
Xue, Y., (2003). Parkinson’s Disease. Journal of Chinese Medicine 73, 9-12.
Yang, M., Li, M., Dou, Y., Liu, Y. et al., (2010). Effects of Bu Shen Huo Xue
granules on motor function in patients with Parkinson’s disease: a multicenter,
randomized, double-blind and placebo-controlled trial. Journal of Chinese Integrative
Medicine 8, (3), 231-237.
Zhang, J., Perry, G., Smith, M., et al., (1999). Parkinson's disease is associated with
oxidative damage to cytoplasmic DNA and RNA in substantia nigra neurons.
American Journal of Pathology 154, 1423-1429.