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neurodegenerative
disorders
ACUPUNCTURE
AND HERBS IN THE TREATMENT OF NEURODEGENERATIVE DISORDERS: ALZHEIMER'S
DISEASE, STROKE, AND PARKINSON'S DISEASE
John K. Chen, MD
ABSTRACT
Neurodegenerative disorders (such
as Alzheimer's disease, sequelae of stroke, and Parkinson's disease)
plague a sizable portion of the geriatric population. They are
poorly recognized due to low public visibility and social isolation
of those affected. Although neurodegenerative disorders include
a vast number of illnesses, this article focuses on Alzheimer's
disease, stroke sequelae, and Parkinson's disease. Approached
from perspectives of both Western and Traditional Chinese medicine,
treatment using acupuncture and herbal therapies is discussed.
KEY WORDS
Neurodegenerative Disorders, Stroke,
Parkinson's Disease, Alzheimer's Disease, Chinese Herbs, Herbs,
Acupuncture, Traditional Chinese Medicine Neurodegenerative Disorders
and Traditional Chinese Medicine
INTRODUCTION
Neurodegenerative disorders are complex
and pernicious diseases; their onset is insidious, followed by
progressive deterioration. Clinical manifestations are determined
by the location and seriousness of the disorder. Although the
causes may differ, patients with neurodegenerative disorders are
likely to show localized to generalized atrophy of brain cells,
leading to compromises in both mental and physical function. Mentally,
patients will exhibit forgetfulness, poor memory, decreases in
mental capacity, emotional disturbances, and/or poor speech. Physically,
patients will exhibit partial to complete incontinence, aspiration
of food particles, tremor, poor balance, muscle rigidity, and/or
muscle paralysis. These decreases in mental and physical function
dramatically reduce the quality of life for the patients, and
increase the burden on the family and caregivers.
Neurodegenerative Disorders and Western Medicine
Practitioners of Western medicine traditionally
believe that nerve cells cannot regenerate once they die. Alzheimer's
disease, stroke, and Parkinson's disease each involve atrophy
and death of neurons in the brain. Thus, currently there is no
cure for neurodegenerative disorders, and most available therapies
focus on symptomatic treatment only.
Neurodegenerative Disorders and Traditional Chinese Medicine
Represented by the deficiency of
Kidney Essence (Jing) and/or the blocking of the brain channel
by blood stasis, the pathogenesis of these disorders is a mixture
of deficiency and excess conditions. Causes of neurodegenerative
disorders lie not so much in the brain, although it is the brain
where symptoms manifest, as in the kidney. According to the theories
of Traditional Chinese Medicine, the kidney controls the bone
and generates the marrow. Therefore, the viewpoint of disease
differentiation through viscera and their interrelations states
that the disease is due to deficiency of the kidney and the bone
marrow. The blood stasis and phlegm accumula tion are considered
symptoms and not the cause. According to this theory, the keys
to treating neurodegenerative disorders are to tonify the kidney,
eliminate the phlegm, remove blood stasis, and induce resuscitation.
TREATMENT
OF NEURODEGENERATIVE DISORDERS WITH ACUPUNCTURE
According to the theories of Traditional
Chinese Medicine, the spirit (Shen) resides in the heart and brain.
The spirit is affected by the overall mental and physical health
of a person. If the spirit is damaged, both the mental and physical
function of a person are compromised. Deterioration in mental
functions may result in delirium and dementia; the decline in
physical functions may resemble complications of stroke. Therefore,
the treatment for neurodegenerative disorders focuses on awakening
the spirit (Shen), opening the sensory orifices, and stimulating
the brain. Acupuncture focuses on selecting acupuncture points
from the Yin channels.
Selection of Main Points Neiguan (PC 6), Renzhong (GV 26),
and Sanyinjiao (SP 6)
Neiguan (PC 6) functions to nourish the
heart, calm the spirit (Shen), and promote smooth circulation
of Qi and blood. Renzhong (GV 26) opens up sensory orifices, stimulates
the brain, and awakens the spirit (Shen). The combination of Neiguan
(PC 6) and Renzhong (GV 26) has been found to increase the contractile
strength of the heart and the cardiac output of blood circulation
to the brain. S anyinjiao (SP 6) is the meeting point of the 3
Yin channels of the foot. It nourishes the kidney and tonifies
the Essence and the bone marrow to improve the function of the
brain.
Selection of Local Points
Jiquan (HT 1), Chize (LU 5), Weizhong
(BL40), and Hegu (LI 4) are local points that open up the channels
and collaterals, and improve the circulation of Qi and blood.
Jiquan (HT 1), Chize (LU 5)l and Hegu (LI 4) are used to treat
paralysis and tremor of the Medical Acupuncture - SprinRISummer
1999 - Volume 11 /Number I arms and the hands; Weizhong (BL 40)
is used to treat paralysis of the legs. Fengchi (GB 20), Yifeng
(TH 17), Wangu (GB 12), and Tianzhu (BL 10) are 4 points that
may help patients who have speech impairment or frequent aspiration
of food particles leading to respiratory tract infections.
Shanshangdien (upper Thunder Point) and
Xiashangdien (lower Thunder Point) were discovered through clinical
trial and experience. These 2 acupuncture points are potent and
should be reserved for those patients who have partial to complete
paralysis. Shanshangdien is located on the lateral side of the
neck, on the same level with the Adam's apple, and between the
sternal and clavicular heads of the stemocleidomastoid muscle.
It is 3 cun posterior to the Adam's apple and 1 cun posterior-inferior,
located slightly inferior to Neck-Futu (LI 18). Its indications
include frozen shoulder, shoulder pain, paralysis of the arm,
stiff and rigid muscles of the arm, and tremor of the hand. Xiashangdien
is located in the buttock region; it is the posterior tip of an
equilateral triangle with the greater trochanter and the iliac
crest as the anterior 2 points. Located slightly superior to Huantiao
(GB 30), its indications include pain in the lower back and hip
region, muscular atrophy, sciatica, pain, herniplegia, weakness,
and muscular atrophy of the lower extremities.
Needling Technique
Stroke is an excess condition; sedation
is warranted. Stroke is characterized by the spirit trapped inside
the head, with the complete or partial closure of the sensory
orifices. Therefore, the overall treatment focus is to open up
the sensory orifices, release the spirit, and awaken the brain.
To achieve the maximum benefit from acupuncture,
the location for some of the acupuncture points and their corresponding
needling techniques are slightly different. Both Neiguan (PC 6)
should be needled first. Insert the needle 1 to 1.5 cun; stimulate
the point for at least 1 minute by slightly turning the needle
and moving it up and down. The healthy side should be tonified
while the diseased side should be sedated. Renzhong (GV 26) should
then be needled. Aim slightly upward toward the top of the head;
stimulate strongly until the patients' eyes tear. Stimulation
should be done with rapid movements, a motion similar to a woodpecker
drilling on trees. The point of insertion for Sanyinjiao (SP 6),
the third point, should be moved 0.5 cun toward the dorsal side
of the body (or toward KI channel) for greater stimulation. Tonify
Sanyinjiao (SP 6) by moving the needle up and down until the patient
shows a "Jerking motion" of the lower leg 3 times.
Jiquan (HT 1) should be needled with
the patient raising 1 arm in the air. The point of insertion is
moved 0.5 cun toward the fingers and away from the body. Jiquan
should be sedated by moving the needle up and down until the patient
shows a jerking motion of the arm 3 times. Weizhong (BL 40) may
be needled with the patient lying on the back or on the stomach.
The point of insertion should be moved 0.5 cun higher toward the
buttocks along the BL channel. The needle should be inserted for
1 to 1.5 cun, and the point should be sedated until the leg shows
a jerking motion 3 times. Hegu (LI 4) should be needled obliquely
with the tip of the needle pointing toward Sangjian (LI 3). This
point should be sedated until the index finger jerks 3 times.
Shanshangdien should be needled perpendicularly 1 cun deep and
stimulated until an "electric sensation" runs through the entire
length of the arm. The needle is then withdrawn. Shanshangdien
should never be needled downward toward the lung because it may
puncture the lung and cause pneumothorax. Finally, Xiashangdien
should be needled perpendicularly 1.5 to 3.0 cun deep, and stimulated
until an electric sensation runs through the entire length of
the leg. The needle is then withdrawn.
For maximum effect, acupuncture treatment
should be conducted daily for 7 days during the first course of
treatment, every other day for 3 weeks for the second course,
and 2 to 3 times per week for the next 2 months. A 3-day break
is advised between each course of treatment. Evaluations are made
at 1 and 3 months after the initiation of treatment.
TREATMENT OF NEURODEGENERATIVE DISORDERS WITH HERBS
While it is the brain that manifests
the symptoms of neurodegenerative disorders, some believe the
cause lies in the kidneys. The viewpoint of disease differentiation
through viscera and their interrelations states that the disease
is due to the deficiency of the kidneys and the bone marrow; blood
stasis and phlegm accumulation are considered symptoms and not
the cause. Consequently, some believe that the keys to treating
neurodegenerative disorders are to tonify the kidney, eliminate
phlegm, remove blood stasis, restore cognition, and promote perception.
Listed below are herbs that have shown promising effects in treating
neurodegenerative disorders.
List of Ingredients and Their Traditional Applications
Cordyceps (dong chong xia cao), morinda
(baji tian), eucommia (du zhong), lycium fruit (gou qi zi), polygonum
(he shou wu), alpinia fruit (yi zhi ren), cuscuta (tu si zi),
and cornus (shan zhu yu) are used to nourish the Yin and Yang
of the kidney. Hence, the production of the Essence (Jing) and
the marrow may be increased. Ginseng (ren shen), dioscorea (shan
yao), astragalus (huang qi), American ginseng (xi yang shen),
white atractylodes (bai zhu), and poria (fu ling) are used to
reinforce the Source (Yuan) Qi, calm the spirit, and increase
mental function. Pseudoginseng (san qi), crataegus (shan zha),
hirudo (shui zhi), salvia root (dan shen), carthamus (hong hua),
pangolin scales (chuan shan jia), gastrodia (tian ma), tokoro
(bei xie), fresh rehmannia (sheng di huang), and scolopendra (wu
gong) are used to open the channels and collaterals, invigorate
blood circulation, and remove blood stasis. Polygala (yuan zhi),
acoru s (shi chang pu), and angelica (bai zhi) are used to open
up the sensory orifices, eliminate phlegm, and calm the spirit.
Testudinis (gui ban) and cornus cervi fragments (lu fiao shuang)
may tonify the true Yin and Yang of the kidney and generate Qi
and blood flow. Ginkgo leaf (yin xing ye) and lycopodiurn serrati
(qian cheng ta) are used to improve memory function in patients
with dementia or Alzheimer's disease.
Modern Clinical and Laboratory Results
Ginkgo (yin xing ye) has been used in
China and Europe for the treatment of dementia. In a placebo-controlled,
double-blind, randomized clinical trial with 309 patients for
a 52-week period, ginkgo was found to be "safe" and capable of
"improving the cognitive performance and the social functioning
of demented patients for 6 months to I year."1
Ingredients isolated from the herb lycopodium (qian cheng ta)
exhibited promising effects in treating Alzheimer's disease. The
mechanism of action of lycopodiurn is similar to that of tacrine
(Cognex), the first drug approved in the United States to treat
symptoms of Alzheimer's disease. According to researchers, the
herb may be more effective and causes fewer adverse effects than
the pharmaceutical. The herb has been used to treat approximately
100,000 patients with dementia in China; clinical trials are in
the planning stages in the United States.2
Acorus (shi chang pu) has demonstrated
effectiveness in treating seizures and convulsions, especially
those caused by primary or cerebral trauma.3
One of the main causes of neurodegenerative
disorders is the lack of blood perfusion to the brain, depriving
it of essential nutrients and leading to deterioration in mental
and physical function. Salvia (dan shen) may improve microcirculation
and is commonly used to increase blood perfusion to the brain.3,
4 Two studies showed salvia to have
a protective effect against cerebral ischernia by increasing cerebral
perfusion and reducing ultrastructural abnormalities.5,
6 Other studies demonstrated that
with an increase in cerebral perfusion, salvia reduces neurological
deficits and repairs cellular damage.7,
8
Pseudoginseng (san qi) has cardiotonic
functions: blood flow is increased to the heart, oxygen consumption
by the cardiac muscle is decreased, blood pressure and heart rate
are lowered. Clinically, pseudoginseng and salvia are commonly
combined to treat circulatory problems, including, but not limited
to, angina pectoris and atherosclerosis.3,
9
Salvia, hirudo (shui zhi), and carthamus
(hong hua) inhibit coagulation, activate fibrinolysis, and are
especially effective in treating and/or preventing stroke caused
by blood clots blocking the blood vessels in the brain.3,
9
Centipede (wu gong) has an excellent
effect in stopping muscle spasms and cramps. It is commonly used
clinically to treat seizures, convulsions, diphtheria, and other
conditions that cause muscle stiffness and spasm. Although mechanisms
of actions differ, gastrodia (tian ma) also has anticonvulsive
and muscle relaxant effects. These 2 herbs are used together to
treat muscle spasms, tremors, muscle rigidity, and general musculoskeletal
problems.3, 9
LIFESTYLE
INSTRUCTIONS FOR PATIENTS
Additionally, the patient should be instructed to:
- Decrease
the amount of food ingested at any meal (ie, stop eating when
approximately 80% full). Lose weight if obese.
- Reduce
cholesterol level (use vegetable oil instead of animal oil for
cooking).
- Eat more
white meat, less red meat.
- Consume
adequate amounts of vegetables for vitamins A, B,, B2, Q and E.
- Avoid
fried, smoked, and barbecued foods.
- Eat frequent,
small meals instead of 1 or 2 large meals.
- Stop smoking.
- Avoid
foods containing heavy metals, ie, aluminum.
- Exercise
daily.
- Maintain
a positive, hopeful outlook toward the future.
CONCLUSION
Acupuncture and herbal medicine
are 2 modalities that can be used in an attempt to treat neurodegenerative
disorders. Traditional Chinese Medicine maintains that deficiencies
in the kidneys and bone marrow probably lead to these disorders;
thus, tonifying the kidneys, eliminating phlegm, and removing
blood stasis are the keys to treat ment. In addition, patients
should make certain lifestyle modifica tions to supplement therapy
for the best outcome.
REFERENCES
1.
LeBars PL, Katz MM, Berman N, Itil TM, Freedman AM, Schatzberg
AF. A placebo-controlled, double-blind randomized trial of an
extract of Ginkgo biloba for dementia. JAMA. 1997;278:1327-1332.
2.
Skolnick AA. Old Chinese herbal medicine used for fever yields
possible new Parkinson's disease therapy. JAMA. 1997;277:776.
3.
Yeung HC. Handbook of Chinese Herbs. Rev ed. Brookline, Mass:
Redwing Book Co; 1983.
4.
Nagai M, Noguchi M, lizuka T, Otani K, Kamata K. Vasodilator effects
of des(alpha-carboxy-3,4-dihydrophenethyl) lithospermic acid (8-epiblechnic
acid), a derivative of lithospermic acids in salviae miltiorrhizae
radix. Biol Pharm Bull. 1996; 19:228-232.
5.
Wu W, Kuang P, Zhu K. The effect of radix Salviae miltiorrhizae
on the changes of ultrastructure in rat brain after cerebral ischemia.
J Tradit Chin Med. 1992; 12:183-186.
6.
Kuang PG, Wu WP, Zhang FY, Liu JX, Pu CQ. The effect of radix
Salviae miltiorrhizae on vasoactive intestinal peptide in cerebral
ischemia: an animal experiment. J Tradit Chin Med. 1989;9:203-206.
7.
Kuang P, Tao Y, Tian Y. Effect of radix Salviae miltiorrhizae
on nitric oxide in cerebral ischemic-reperfusion injury. J Tradit
Chin Med. 1996; 16:224-227.
8.
Kuang P, Li Z, Zhang F, Tao Y, Liu J, Wu W. Protective effect
of radix Salviae miltiorrhizae composita on cerebral ischernia.
J Tradit Chin Med. 1995;15:135-140.
9.
Bensky D, Gamble A. Chinese Herbal Medicine: Materia Medica. Brookline,
Mass: Redwing Book Co; 1986.
AUTHOR
INFORMATION
Dr John Chen is the President and Founder of Lotus Herbs, Inc
(La Puente, California). He graduated from the University of Southern
California School of Pharmacy and South Baylo University of Oriental
Medicine. Dr Chen teaches Herbal Medicine at the University of
Southern California, Chinese Herbology at South Baylo University,
and Western Pharmacology at Yo San University.
John K.
Chen, PhD, PharmD, OMD, LAc
1124 No. Hacienda Blvd
La Puente, CA 91744
Phone: 626-916-1070 - Fax: 626-917-7763 - E-mail: LotusHerbs@aol.coml
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