“It is characterized by involuntary tremulous motion, with lessened muscular power 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” James Parkinson in “Essay in Shaking Palsy” (1817)

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 (Ayurveda, Kampo, European, Unani-Tibb, Tibetan, etc.). The review will discuss how the concept of PD its diagnosis and treatment with Chinese Herbal Medicine, has been classified, questioned, and approached since Classic Han Dynasty times to the post-cultural revolution ‘Traditional Chinese Medicine’ (TCM) interpretations and classifications. This literature review is limited to English language titles from my private library and the University of Westminster’s library, as well as scientific papers available through research on search engines like Google Scholar and the InfoLinx database.

Western Medicine: Definition: Parkinson’s disease (PD) is a chronic, idiopathic and progressive neurodegenerative disease of the central nervous system characterized by impaired control of movement 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 both Dopamine and Acetilcholine act as neurotransmitters. It is the resulting 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 dopamine (Long, 1997).

Aetiology and Pathodevelopment: Although there is no established definite cause for the loss of the dopamine centers within the brain, a number of theories have been advanced: 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

2002) and in the Tibetan Medical Tantras – the rGyud-bZhi as “Tsakar”. Galen in 175 AD (Halpern. 2010) (Manyam. often connected with influenza as we can observe in the words of Moore (1977): . 2001). and were until the 70’s considered as the main cause for PD (Brown & Knox. 2010). 1991). 2010). These theories needs to be critically questioned in the face of mounting evidence that millennia prior to the appearance of the first environmental industrial toxins. Other theoretical causes are: -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). 2001). Ancient renown physicians like. 2008). and Ibn Sina in his “Al-Qanun fi al-tibb” (Has.these. all seem to have been acquainted with this pathology and described and proposed treatment strategies. Zhang Zhong Jing in his Jing Gui Yao Lue (Flaws and Lake.1972). 2005). Ibn Rush in his “Al-Kulliat fi al Tibb” (Tbakhi and Amr. Balch (2000) mentions the inability of the Liver to detoxify. in the Graeco-Islamic Unani Medical literature as “Shaking Palsy” (Halpern. Dioscorides in the Classic “De Materia Medica” (Viartis. filter and metabolize these toxins leading to its accumulation in the body. a strikingly comparable pathology with similar features has been described all over the ancient world. 1990). in the Classical Chinese Medical texts (Jin Gui Yao Lue ) as “Lily Disease” – Bai He Zheng (Flaws and Lake. 2010) (Bendick. It appears in the ancient Indian Four Vedas (Rik-Sama-Yajur-Atharva) as “Kampavata” (Halpern. (Brant-Zawadzki.

2004). Oxidative Stress The significant increase of oxidized products of proteins. Genetics might as well interact with environmental toxins as in a predisposition turned effective in the presence of certain chemicals (Alexander. p.. It is not clear. By the 80’s authors started questioning the validity of the above statements: “…the evidence obtained is conflicting.. -Bartram’s (1995) points to the increase in the disease in patients born during influenza pandemics.1994). This imbalance between free-radicals and anti-oxidants apparently triggers apoptosis in the Substantia Nigra of the brain. however. whether other neurological viruses also can cause parkinsonism”. 2004). 1982. More elaborate and detailed research is needed to elucidate the relations between Parkinsonism and the viruses…” (Irkec.“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 significance. Nowadays the research is directed into these areas: -genetic mutations in the α -synuclein gene in certain families with an autosomal dominant form of PD (Underwood.293). dramatically reducing the levels of the neurotransmitter Dopamine (Alexander. 2004). et al. . lipids and DNA (Zhang.1999) together with the decrease of intrinsic antioxidants like glutathione seem to be abundant in PD patients (Sian et al.

some authors point to the impairment of the normal pathways for the degradation of unwanted or damaged intracellular proteins leading to its accumulation and binding within the neurons. anhedonic. which are responsible for the displacement of other cell components damaging and interfering with the normal functioning of the neurons (McNaught & Olanow. 2003). 2003). These cells – Microglia. (2002) . are the brain resident macrophages. 1985) suggested that certain personality traits like emotional and attitudinal inflexibility. while others understand not their presence as a secondary response but as agents of a causal relationship.. These abnormal aggregates of protein are called the Lewy bodies. as can be proven by the improvement obtained by the use of anti-inflammatory substances (Orr et al. which some authors point as having a logical role in the elimination of dying and dead neurons (Barzilai & Melamed. As Smith et al. Local Inflammmation Other studies underline the apparent over-presence of inflammatory cells in the brain areas of neuron loss.. Based on the review of extensive articles and case-studies some authors (Lees & Todes. suppressed aggression. absence of affect and a predisposition for depression were frequently found among PD patients.Proteolytic Stress Closely related to the above. over-control. From the case-studies arena there is increasing evidence that emotional and physical traumas are often present in PD patients. 2002).

) . mask like face. Drugs. drooling. 2000). stress induced by emotional traumas can be a cause for neuronal loss and therefore a valid hypothesis as a key factor in the loss of Dopamine neurons. 2001). Prognosis: There is no known cure in WSM for PD. a general slowness of movement and progresses over the course of some years to muscular rigidity. side-effects and other considerations: Gasgoine (2003) includes Parkinson’s drugs in level 2 (taken regularly and there is little or no threat to life if discontinued. impaired speech. delaying the advance of the disease and supporting the Patient’s independence for as long as it is possible (Balch. eventually leading to dementia and death. disturbance of voluntary movements and appearance of involuntary movements. loss of appetite. Within this hypothesis some authors mention that the search for the initial traumatic trigger should focus between 10 to 20 years before the main signs were recognized with certainty (Lees. The disease seems to initially manifest almost imperceptibly with a mild tremor of the hands while at rest. insomnia. 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. 2004). changes in muscle tone. tremors.refer. etc.

velvet bean. 1990) considered a condition where Ama (pathological fluids. 2008).In Ayurveda : In this tradition. 2005). . It is Interesting to note that in Chinese pathological terms Ama is Phlegm and Damp. These effects have been confirmed by Morais et al. and Vata is Wind (uncontrolled movement). PD is called Kampavata (Manyam. The main herb used is Kapi Kachu (Mucuna Pruriens) . literally “disease of the white nerves. (2003). In Tibetan Herbal Medicine: The foundational text of the Tibetan medical tradition. 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). the rGyud-bZhi or ‘the four tantras’. toxins) and Vata (wind) are in excess. Tsakar is generally considered a 'cold disease' arising from a rlung (wind) imbalance (Brant-Zawadzki.” but referred to as “the shaking limb disease” by Tibetan doctors. identifies a disease known as Tsakar. The seeds contain the L-dopa active principlein the PD drug of choice (Khalsa & Tierra. exactly some of the main pathogenic factors behind the Chinese medical diagnosis of this Pathology. It is used in milk decoctions of 250mg to 1gr (milk is considered in Ayurveda as a “messenger” to the brain). affecting the nervous and reproductive systems.

Central nervous system stimulators like Gotu Kola (Centella Asiatica) and Gingko (Gingko Biloba) are used in formulas alongside Tonics like Ginseng (Panax Ginseng/Panax Quinquefolium) and tranquilizers like Valerian (Valeriana Officinalis). Motherwort (Leonurus Cardiaca). 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 Chinese medical bianzheng for PD. Passionflower (Passiflora incarnata) and Ginger (Zingiber .A formula composed mostly by heavily aromatic substances is used. Often added to it we find herbs like Crampbark (Viburnum Opulus) to reduce cramping and tremors and sporadically we can see nervine. Cloves (Ding Xiang) [Caryophylli Flos]. Safflower (Hong Hua) [Carthamus tinctorius]. Western Herbal Medicine: In the western herbal medicine field. Cinnamon (Gui Zhi) [Cinnamoni ramulus]. And different types of cardamons. Nutmeg (Rou Dou Kou) [Myristicae Semen]. Some of these are: Sandalwood (Tan Xiang) [Santali albi lignum]. Myrobalan fruit (He Zi ) [Chebulae frucus]. and spasmolytic herbs like Black Cohosh (Cimifuga Racemosa).

cfm Bradykinesia . Dolichus Uniflorus and Rosa Damascena).The name given to a group of disorders with similar features -. other mineral elements (mercury and sulphur) and two animal products (whey and cow’s urine) called Kushta Tila Kalan is attributed neuropsychiatric disorders like PD medicinal properties and nervine tonic effects (Said. Parkinsionism .Neurologic condition characterized by a generalized slowness of .2004). rigidity.. 1 in every 200 over sixty is affected in US more men than women. www. In Unani-Tibb Islamic Medicine A traditional calcination technique of Gold.four primary symptoms (tremor. postural instability. herbal compounds (Aloe Vera. 2000). 1995) (Tierra.alsa. 1988) (Flaws and Sionneau. 1969). Seems to have therapeutic properties in ischaemic brain damage (Syeda et al. and bradykinesia) that are the result of the loss of dopamine-producing brain cells. 2001).Officinalis) (Bartram.org/resources/glossary. The complex process of purification during the ash preparation is believed to render it therapeutically effective and safe (Bajaj and Vohora.

2004). The Compendium of Medicine: "The upgoing qi in the channels and collaterals does not keep its proper position. PD comes under the pattern differentiation (Bian Zheng) of 震顫性麻痹 (zhèn zhàn xìng má bì) [convulsions and paralysis] which most authors . 1994.657). In the Han Dynasty the genius Zhang Zhong Jing in the Classic Jin Gui Yao Lue .motor activity.past and present relate to Liver-Wind (Maciocia. thus causing the head to shake and the limbs to tremble" (Dharmananda. 1994. 1995) Ming Dynasty physician Lou Ying mentioned this connection in 1565 in his Yi Xue Gang Mu (医學綱目) [Principles of Materia Medica]: “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 Limbs” ( cited in Maciocia. Chinese Medicine 震顫性麻痹 (zhèn zhàn xìng má bì) [convulsions and paralysis] 帕金森病 (pà jīn sēn bìng) [parkinson’s disease] Historically. p. Flaws. 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. 1994).

2009). 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. Flaws & Sionneau. Flaws & Sionneau. These authors describe similar pathways in the pathogenesis of PD.. they want to walk but are unable to walk…the physical appearance is normal. 1994. will exhibit the signs of Liver Yin and in cases of Liver Blood deficiency (Maciocia.the core organ in this pathology. Xue.(Essentials from the Golden Cabinet) describes a disease pattern named Bai He Zheng (百合症) – Lily disease. Through longterm overwork. 2001. 2003) seem to agree that a combination of overwork. Unable to receive support from the “Mother”. 1994). 2001. 1994. . From this Zang Fu pattern a myriad of complications arise: Yin is no longer able to keep Yang in check and Liver Yang will often rise. but the pulse is faint and rapid…” (cited in Scheid et al. they want to lie down but are unable to lie down. 2003). in its turn. 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. Both the emptiness of Liver Blood and Yin as the Rising of its Yang aspect will stir up Wind. (nao esquecer por wooden face essentials of chronic illness) Modern authors: Aetiology: Most authors (Maciocia. emotional stress. and the wrong diet are at the root cause of this Pathology. where the patient is “…laconic and downcast. the Liver . Xue. 2001).

2001). Lees. these untransformed fluids will accumulate and substantiate as Phlegm. especially in a picture of underlying Yin deficiency. 1994). 1985) seem to add to this stagnated picture through the impairment of the natural coursing attributable to the Liver Qi. Qi and Blood deficiency (Flaws & Sionneau. 2001) (Maciocia. As the sinews are a manifestation of the Liver. Liver and Kidney Yin deficiency (Maciocia. Once the impairment of the transformative power of the Spleen and Kidney Qi. a dryness of fluids and blood in the second will consequently imply a dryness and malnourishment on the first (Maciocia. Common Patterns: Liver Yin deficiency with wind internally stirring (Flaws & Sionneau. 2001). as it is the case. 2004. Emotional problems and stress. Lees & Todes. acknowledged as an aetiological hypothesis on the WSM side (Smith et al. Phlegm-Fire stirring internally (Flaws & . Qi stagnation and Blood Stasis (Flaws & Sionneau. 2002. the regular intake of sweet oily and fried foods along with amounts of Alcohol will tend to accumulate as Damp. 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. 1994) Liver Qi stagnation. Spleen Qi deficiency with dampness.From the Dietetic perspective. 1994).. 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 shaking.

Wu Wei Zi has shown interesting benefits in small open clinical studies (cited in Bone. Blood stasis. (2006) report a case where the Kampo medicine Sho-Joki-To-Ka-Shakuyaku provided remarkable effects on 65 year . middle and lower burner weaknesses. Qi and Blood deficiency and a shock were successfully treated with Japanese acupuncture (MacPherson & Kaptchuk. this latter formulaas used in 48 cases of PD with over 60% of efficacy rate. 1994) Individual Herbs: Wu Wei Zi (Schizandra Sinensis) According to Chang and But (1987). Common Formulas used: Huang (2009) mentions two formulas: -Chai Hu Jia Long Gu Mu Li Tang (Bupleurum plus Dragon Bone and Oyster Shell Decoction). 2001). p. According to Neeb (2007).Sionneau. 1997). Phlegm-heat agitating wind (Maciocia. 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. Shizue et al.. 2001.72). Case Studies: In the collection of western case histories Birch refers a case of Parkinsionism where a mix of Liver vacuity. -Zhen Wu Tang (True Warrior Decoction).

1992). Often research assumes the aspect of laboratory experimentation on animals with extracts taken from the Chinese Materia Medica with the idea of isolating active principles that manifest positive and interesting chemical changes in the affected areas of the brain (Van Kampen et al..the most common approach in Pharmacology. 2010)... Other times research is designed so that specific Chinese Herbal formulas can be tested and evaluated on the impact they produced in specific Signs and Symptoms of PD (Yang et al. (Li. et al. (Iwasaki. pharmacology and western scientific medicine interact with traditional medical systems. it is possible to define 4 main approaches mirroring what happens in other fields where botany. (Hiyama et al... et al. .old patient with PD. These could be presented as: A) The testing of isolated active principles from the Chinese Materia Medica . 2009).2010). 2000). 2007) B) The testing of whole Chinese Herbal Formulas on a constellation of Signs and Symptoms of PD patients – closer to the spirit of Chinese Medicine. (Kum et al. Research Reviewing the available literature in terms of Chinese Herbs and PD.. 2003) (Chen.

C) A deductive approach . In certain Kampo studies there is a gradual process of deduction from the formula to the active principle..A synthesis of the above two approaches.(2010) and Ueda et al. Kawanabe et al. 1995). Such is the case of the studies conducted by Dai & Kunio (2001).(2004).. (1995). a group of Kampo formulas are tested in relation to a single enzymatic change. D) A combination of western drugs and Chinese Herbal medicine. Mostly. Kaneko et al. rarely there is an attempt to include a degree of pattern differentiation.(2005). From this formula its individual herbs were singled out and again tested and analysed to seek the one with the strongest effect. Even when whole formulas are used instead of single active principles. (Li. (2000). The next step was the isolation of active principles from this main herb. Ishikawa et al. Another trend or approach is the combination of Chinese herbal medicine formulas with Western medical drugs (Cui et al. (Oikawa. In Kato et al.This has been the main option in Kampo research where whole formulas and not single herbs neither isolated single active principles are tested against a plethora of signs and symptoms characteristic of PD. 2004). The strongest formula was chosen. 2003). formulas are .

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