Traditional Chinese Medicine for Parkinson's Disease in China and Beyond

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Head acupuncture for Parkinson's disease by row acupuncture method along Bladder meridian/channel of foot greater Yang and Governor vessel.

P arkinson's disease (PD) is a common progressive neurodegenerative condition resulting from the death of the dopamine-containing cells of the substantia nigra. ¹ The incidence of PD increases with aging, with a lifetime risk of 1.5% to develop the disease in developed countries. ² In mainland China, a cross-sectional prevalence study reported that the prevalence of PD was 1.7% in people older than 65 years, and there were about 1.7 million patients with PD in those aged 55 and over. ³ The results suggest a similar prevalence rate of PD to the developed countries. However, China is facing the largest number of PD cases in the world because it has a population of 1.3 billion. Thus, the burden of PD in China is much higher than that in the developed countries, and is expected to increase in the coming decade due to the expansion of the aging population.

The most appreciable distinction between China and the West in treating PD is the use of Traditional Chinese Medicine (TCM) therapy, which includes Chinese herbal medicine (CHM), acupuncture and other nonmedication therapies. For example, cupping therapy refers to a method of applying acupressure by creating a vacuum on the patient's skin. This therapy is able to dispel stagnation and influence the flow of energy and blood in the body. Cupping is one of the oldest medical practices and has a history of more than 2000 years in China, ⁴ but varieties of it have also been used in other countries such as India, Arabia, Central Europe, and parts of Africa. ⁵ The earliest extant Chinese prescription book, Wushierbingfang (Prescriptions for Fifty-two Diseases; 476–221 bc), has recorded the cupping (horn method) therapy for hemorrhoids. Currently, cupping is mainly recommended for the treatment of nervous system diseases and disorders such as pain and paralysis, respiratory diseases, gastrointestinal disorders, and also other disorders. According to a recent systematic literature review, ⁶ the majority of included studies showed that cupping therapy was potentially beneficial for pain conditions, herpes zoster, and other diseases. Interestingly, Ding ⁷ reported that the total effective rate with combined use of cupping and acupuncture for PD achieved 89.66% according to the Webster scale. There are several major types of cupping practice such as fire cupping, bleeding cupping (wet cupping), moving cupping, needle cupping, and water cupping in China. ⁶ Each kind of cupping therapy may be used for different diseases or different treatment purposes. Row cupping method refers to using several cups sucking up along the surface of a meridian or a muscle bundle. ⁸ The Governor vessel (GV) governs Yang Qi of the whole body. The Bladder meridian/channel of the foot greater Yang (BL) governs the exterior of the entire body. Furthermore, to perform cupping on the back points is simple and practicable. Thus, back Shu points (BL) and GV points are important and convenient points that are often used in cupping therapy. For PD, cupping at BL and/or GV can harmonize Yin-Yang and Qi-Blood, and improve the flow of energy and blood in the body. We usually use fire cupping with row cupping method along BL and/or GV on patients' back for the treatment of PD (see previous page for photograph of cupping therapy). In fact, TCM has played an important role in the medical care of patients with PD for thousands of years in China. The precise records for the clinical symptoms of PD and its preliminary treatment prescriptions could date back to the Eastern Han Dynasty (206 bc–220 ad). ⁹ Zhang Zihe (1156–1228 ad) for the first time described a typical case of PD in his book Confucian's Duties to Their Parents. This case was recorded 600 years earlier than those reported by James Parkinson. ¹⁰ For a long time, TCM was the main available method of health care in the China before Western modern medicine was introduced to this region. In modern times, TCM is widely used to treat PD and covers three fourths of the areas in China.

In recent years, public awareness of TCM for PD is increasing. The important characteristic of China's national medical system is that TCM and Western medicine complement and cooperate with each other, being responsible together for the health care of Chinese people. The Chinese Government is reforming the national health care system and has published the first 3-year action plan (2009–2011). ¹¹ Chen Zhu, the Minister of Health in China, emphasized the policy of paying equal attention to Western medicine and TCM. ¹¹ In 2009, the State Council issued a document called Several Opinions of the State Council on Supporting and Promoting the Development of TCM Industry. It proposes to continue to stick to the guideline of equality between TCM and Western medicine and giving TCM full play. The opinions point out that supporting and promoting the development of TCM plays an important role in deepening the health system reform and in improving the heath condition of the people. We believe that this health care system and health insurance plans will benefit most of the patients with PD in China.

After 30 years of reform and opening up in the academic field, PD recently has drawn increasing attention to Chinese scholars. ¹² In Zhang's study, ³ a strikingly large number of PD sufferers were unaware of having the disease, with a rate as high as 48% and even higher in rural areas, and 63% of the patients had not received treatment with levodopa. However, the incidence and survival rate of PD in China are similar to those in developed countries where most patients are diagnosed and received levodopa treatment. The possible reason is that TCM works as a compensation for the lack of standard Western-style medical care for patients with PD because of economic reasons and easy access to TCM therapy in China. Managing scarce resources and health care effectively and efficiently is an important part of the health system reform. We believe that TCM for PD remains a high priority, especially in rural areas. In the future, it will be necessary to do more epidemiological investigations on the usage rate of TCM for PD and to what extent local TCM treatments can influence the natural history of PD.

Supportive scientific evidence is gradually beginning to emerge from recent clinical studies, suggesting that TCM has potential benefits for patients with PD. Dopamine replacement therapy is still the most effective treatment for PD, but this mainstay of pharmacologic treatment is usually complicated by highly disabling fluctuations and dyskinesias. ¹³ Supported by government grants, three high-quality studies on CHM for PD were performed and published recently. ^{14 –16} A multicenter, randomized, double-blinded, controlled clinical study showed better efficacy of CHM plus levodopa than the placebo plus levodopa in improving motor dysfunction and relieving muscle tension. ¹⁴ A multicenter, double-blinded, layered, randomized and grouped, placebo-controlled clinical trial indicated that combined use of CHM and levodopa for treating PD patients with Hoehn & Yahr grade 1.5–3 can significantly improve patients' motor syndrome and the quality of life, and reduce the dosage of levodopa required. ¹⁵ A multicenter, randomized, nonplacebo-controlled trial showed that the combined use of CHM and levodopa can obviously relieve the patients' motor symptoms, and increase on-time duration and reduce off-time duration. ¹⁶ Furthermore, application of acupuncture therapy has become more frequent in treating PD. A systematic review showed that there is evidence indicating the potential effectiveness of acupuncture for treating PD, and the 13 most commonly used acupoints were GB20 (80%), DU16 and EX-HN1 (40%), BL9, BL10, DU17, DU21, GB5, GB6, GB19, GB34, LI4, and MS6 (30%). ¹⁷ Another systematic review and meta-analysis of acupuncture treatment for PD indicated that acupuncture is safe and effective in the treatment of PD and acupuncture plus Western drugs may be superior to Western drugs alone, in spite of the defects in the methodological quality of the included trials. ¹⁸ The row acupuncture method was created by modern practitioners based on the combination of ancient acupuncture manipulation with modern clinical practice. The row acupuncture method is a multi-acupuncture method, with the puncture being more intensive on certain local parts of the human body and arranged in a line. ¹⁹ The row acupuncture method can enhance channel Qi and accelerate the recovery of neuromuscular function. We often give head acupuncture for PD treatment using row acupuncture method along BL and GV (Fig. 1). Good-quality policymaking depends on high-quality information. Hopefully there will be increased numbers of high-quality trials to assess TCM monotherapy and/or TCM combined therapy for patients with PD.

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FIG. 1.

Cupping therapy for Parkinson's disease by row cupping method along Bladder meridian/channel of foot greater Yang (BL). The skin will become reddened due to local congestion of blood flow. Generally, the cups will be left for about 10 minutes. The cupping therapy will be done once a day or once every 2 days and 10 times as a course of treatment.

Until now, no modern therapy for PD has been shown to be neuroprotective, and patients continue to experience progressive deterioration of body functions, daily activities, and participation. There is an enticing but unconfirmed prospect that a number of agents besides levodopa might protect against worsening neurological disability. ¹ Growing data have suggested that Chinese herbs and herbal extracts have potential clinical benefit in retarding the progression of PD by attenuating degeneration of dopamine neurons and symptoms, promoting neuronal survival and neurite growth, and facilitating functional recovery of brain injures. ²⁰ We look forward to seeing neuroprotective drugs from CHMs and achieving the critical goal of slowing the progression of disability. However, CHM may interact or interfere with Western pharmaceutical drugs. At present, little is known about CHM–levodopa interactions. Thus, appropriate methods should be developed to determine the safety of combined medication.

Parkinson's day has been held annually on April 11 since 1997 on the birthday of Dr. Parkinson. The day is partly intended to boost awareness of this disorder and to spur new research and treatment innovations. PD has existed in different areas of the world since ancient times, and people have to deal with it with different cultures and methods. Traditional therapies in the form of herbal preparations containing anticholinergics, levodopa, and monoamine oxidase inhibitors were used in the treatment of PD in India, China, and the Amazon basin. ²¹ Currently, near two thirds of patients with PD worldwide resort to various kinds of complementary or alternative medicine, which may influence the motor and/or nonmotor symptoms of PD, and/or the effectiveness of dopaminergic therapy, to alleviate the progressive functional disabilities caused by the disease. ²² China has the largest number of PD cases in the world, but in a country with a medical system in which TCM and Western medicine complement and cooperate with each other, but with a lack of access to Western-style medical care in some areas, a great number of PD patients have been using, are using, or will potentially use TCM for disease treatment. Therefore, we hope that the increase of public awareness of TCM therapy for PD can promote prevention and treatment of PD in China and also in the world.