Research has found that Parkinson's disease occurs in the midbrain, where a group of nerve cells called substantia nigra neurons, which synthesize a neurotransmitter called dopamine, regulate the brain's motor functions. When more than 80 percent of these nigrostriatal neurons degenerate and die, the symptoms of Parkinson's disease appear.
To date, the cause of primary Parkinson's disease is still not completely clear, and is generally believed to be primarily related to a combination of factors such as ageing, genetics and the environment. There is no cure for Parkinson's disease, which is a chronic progressive disease. If not treated in time, the survival period of patients is significantly shortened, and in the late stage of the disease, because of prolonged bed rest is prone to complications such as pneumonia and urinary tract infections. About a quarter of Parkinson's patients suffer from depression due to excessive worry about the disease.
Currently, the prevalence of Parkinson's disease among people over 50 years old in Europe and the United States is 1%. In China, there are more than 1.7 million Parkinson's disease patients among the elderly over 55 years old, and the prevalence rate is close to that in Europe and the United States.
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Abstract Parkinson's disease is a primary chronic degenerative neurological disease, as early as the ancient Chinese medicine on a series of similar symptoms of a wide range of diseases, this paper in the following areas of Traditional Chinese Medicine (TCM), the combination of traditional Chinese medicine and Western medicine in the treatment of Parkinson's disease, research status is summarized. The current status of research is summarized in the following aspects: (1) Chinese medicine's understanding of the mechanism of Parkinson's disease; (2) Chinese medicine treatment of movement disorders in Parkinson's disease; (3) Chinese medicine treatment of non-movement disorder symptoms in Parkinson's disease. (4) Modern pharmacological research on Chinese medicine treatment of Parkinson's disease.Chinese Classification Number R742.5 Literature Identification Number A
Article Number 1007-5496(2000)03-0338-02
Parkinson's disease (Parkinsonsdisease) is a Parkinson's disease (Parkinsonsdisease) is a primary chronic degenerative neurological disease, also known as tremor paralysis, for which there is no strictly corresponding diagnostic name in Chinese medicine. In many Chinese medical literature, when discussing the disease of "tremor paralysis", it was first traced back to Article 19 of the "Nei Jing", which reads, "All winds and spins belong to the liver". Some authors [1] note that the discussion on "Miscellaneous Disease Diagnosis and Treatment Guidelines" is even more detailed, "Trembling, shaking also; vibration, moving also. The tendons and veins cannot be restrained and cannot be held at their disposal, and the wind is also the sign of the wind". Contemporary authors based on different literature and their own experience, respectively, the disease will be attributed to the Chinese medicine "shock off", "vibration chestnut", "vibration", or even "spasmodic". "spasm" and "liver wind" category, understanding gradually enriched, but also produced confusion. 1991, held in chongqing city of chinese medicine association of geriatric encephalopathy seminar on the unification of the name of the disease "geriatric fibrillation" and the development of a series of diagnosis and treatment of the disease. "and the development of a series of diagnostic and treatment standards [2], for Chinese medicine diagnosis and treatment of Parkinson's disease objectivity, standardization of the initial work. However, the concept of "geriatric tremor evidence" still seems to be too broad, blurring the distinction between primary Parkinson's disease and Parkinson's syndrome, which has not been fully emphasized by later authors.
1. Chinese medicine's understanding of the mechanism of Parkinson's disease
The typical symptoms of Parkinson's disease, such as tremor, rigidity, and slowness of movement, are scattered in different Chinese medical literature, and it is needless to say that the unification of the above mentioned symptoms into a single disease is rarely seen in Chinese medical texts. Contemporary Chinese medicine scholars usually adopt the traditional method of "identifying the cause" to deduce the mechanism of Parkinson's disease in Chinese medicine. Most scholars believe that the pathogenesis of Parkinson's disease is characterized by a deficiency at the base and a solid at the center. There are many reasons for this deficiency, and the most important ones are: (1) age factor: Parkinson's disease occurs more often in the elderly, Zhou's [3] believes that after middle age, the yin qi from half, there will be a physiological weakness of the liver and kidney from the weakness of the liver and kidney, coupled with the consumption of labor and lust, which led to the yin and essence of the deficiency of the body decay. (2) Emotional factors: some authors [4] pointed out that, the five wills can be over-excited fire, the five wills into the fire, burned yin Jin, can make a person appear essence and blood dark depletion. (3) Long-term disease and kidney, high years of disease overlap, resulting in liver and kidney deficiency [3]. The above factors lead to the deficiency of liver and kidney yin, qi and blood as the most fundamental pathological basis of this disease, and also the basic root cause of the formation of internal wind, phlegm, fire and stasis. Zhou's pointed out that the beginning of liver wind is caused by deficiency of liver and kidney, on the basis of which phlegm and blood stasis arise internally, blocking the cerebral collaterals and aggravating the dark movement of internal wind [3]. According to Wang, Yin deficiency of the liver and kidney can lead to the internal growth of deficiency fire combined with heat-evil factors such as phlegm-dampness internalization and five-vessel fire, thus forming wind-fire, phlegm-fire, stasis-fire, etc., which further aggravate the condition [1]. Wang Yongyan et al. emphasized the importance of loss of nourishment of tendons and veins and obstruction of collaterals by blood stasis based on their own clinical observations [5]. Based on his experience in recognizing and treating three cases of elderly patients accompanied by slowness of consciousness [6], Pan put forward the proposition that Parkinson's disease and senile dementia have some intrinsic connection, and believed that Parkinson's disease ailment exists in the form of pathological manifestations of cardiac ying deficiency and incitement of internal wind. Wang Kunshan et al. believe that the spleen Yang weakness, qi and blood biochemistry lack of source and add spleen deficiency wet poly phlegm birth, can also lead to tremor [4]. In conclusion, Chinese medicine believes that the essence of the pathology of Parkinson's disease lies in the Yin deficiency of the liver and kidney, which also involves the heart and spleen organs. Symptoms such as tremor, rigidity and slow movement are due to the formation of pathological changes such as internal wind, phlegm, fire and stasis on the basis of this deficiency. Internal wind, phlegm, fire and stasis are pathologic factors that interact with each other, and the *** same pathway of their interaction is the meridians, and their ultimate pathological outcome is the loss of nourishment of the tendons and veins.
2, Parkinson's disease movement disorders of traditional Chinese medicine
The identification of evidence-based treatment is still the most basic idea of the current Chinese medicine treatment of Parkinson's disease. Throughout the years, most Chinese medicine scholars have dealt with the symptoms of movement disorders in Parkinson's disease as the main evidence-based criteria, and the efficacy criteria have also taken the improvement of movement disorder symptoms as the main observational index, so it can be assumed that the main link targeted by these literatures is the symptoms of movement disorders in Parkinson's disease. In the relevant literature, as many as 17 evidence types were reported, among which the repetition rate of 4 evidence types, namely, deficiency of qi and blood, hyperactivity of liver and yang, deficiency of yin in liver and kidney, and wind-phlegm obstruction, was slightly higher. Even for the above four types, the commentators also have their own emphasis. Wang's believes that the deficiency of qi and blood is accompanied by blood stasis and wind movement, and the treatment should benefit qi and nourish blood, activate the collaterals and extinguish the wind, and treats 12 cases, with 8 effective cases, with the addition of Astragalus, Radix Codonopsis, Radix Angelicae Sinensis, Radix Paeoniae Alba, Tentacles, Mother-of-Pearl, Salvia Miltiorrhiza, Corydalis, and Antelope Horn Powder [5]. Cai repeated Wang's above experience in treating Parkinson's disease also obtained satisfactory results [7]. Some authors also emphasized the weakness of qi and blood and the loss of nourishment of the tendons and veins, and the treatment should be to replenish qi and blood, nourish the glory and set up the vibration, and treat with ginseng, astragalus, angelica sinensis, white peony, ripened earth, atractylodes macrocephala, cinnamon heart, poria, moxa licorice, tianmu, scorpion, antelope horn, dan shen, and chick's blood vine, but unfortunately, no therapeutic effect has been reported [4]. For the liver and kidney yin deficiency type, Wang also emphasized the accompaniment of blood stasis and wind movement, and the treatment should be yu yin plus wind quenching and clearing the channels [5]. Zhou's believes that Parkinson's disease is characterized by Yin deficiency of the liver and kidney, and other variations of the disease are all based on it, among which phlegm and stasis are particularly prominent, blocking the brain and collaterals, and the treatment focuses on nourishing the liver and kidney, resolving phlegm and clearing the collaterals [3]. The evidence of hyperactivity of liver and yang is mostly formed on the basis of yin deficiency of liver and kidney, some authors list it as a type, some authors list it as a variant of yin deficiency of liver and kidney, so this article will not be described in detail. Most authors recognize the importance of internal wind, phlegm and dampness in Parkinson's disease as a single disease, but the number of single stand-alone certificates is significantly reduced compared to the previous three certificates. Pan's treatment of wind-phlegm obstruction, limb tremor paralysis, pointed out that it should be differentiated from rheumatoid arthritis, the treatment should be to activate the blood to promote paralysis, extinguish wind and phlegm [6]. Ren's treatment of phlegm prolongation and congestion, using Er Chen Tang with simmered soap horn, borax, gall star, etc. [8]. The discriminative use of acupuncture treatment has also been adopted by many authors, Xie Yaofang et al. treated 56 cases with acupuncture methods in combination with traditional Chinese medicine according to the TCM discriminative type, and the efficacy of the treatment was significantly better than that of the control group that used drugs such as levodopa and antan [9]. Jiang et al. used defibrillation pills (tianma, hookworm, mother-of-pearl, stiletto, etc.) together with head acupuncture dance tremor control area (in parallel lines 1.5 cm in front of the motor area), body acupuncture fengchi, quchi, defibrillation points, waiguan, yanglingquan, taichong, and straight stabbing with No. 32 1-1.5 inch millimeters needle, with flat tonic and flat cathartic and adding and subtracting acupuncture points according to the evidence, and achieved a satisfactory efficacy [10].
Looking at the medical practice of Chinese medicine in the treatment of Parkinson's disease over the years, we feel that the efficacy of the motherland medicine in the treatment of Parkinson's disease is true. However, we should also see that there are still many major problems that have not yet been solved. First of all, the classification is very confusing. Authors are benevolent and wise, to a very arbitrary degree. The fact that there are such huge differences in the identification and treatment of Parkinson's disease indicates that the authors of TCM and TCM-Western medicine are still at a shallow level of understanding of Parkinson's disease and have not yet achieved any significant results that are recognized by everyone. Second, there are more than 120 types of Chinese medicines reported in the literature for the treatment of Parkinson's disease, with a high repetition rate of only 10 types of medicines, such as tianmu, hooker's teng, mother-of-pearl, angelica sinensis, bai shao, and dihuang. Thirdly, the identification and typing over-emphasized the difference between the evidence and the evidence cut the connection between the evidence and the evidence. Although the reports of Zhou and Wang [1,3] paid attention to the overall unity of Parkinson's disease in terms of the etiology, pathogenesis and identification of the evidence and treatment of Parkinson's disease, most of the authors' reports are still divided into blocks and lack of intrinsic connection. Fourth, the efficacy criteria are arbitrary, and a considerable number of reports lack statistical significance. Of the 165 cases with statistical data we collected, only 78 cases used the Webster score, of which only 22 cases followed the efficacy standards set by the Ministry of Health's guidelines for drug research [11], and the other 56 cases used their own efficacy standards that were lower than the Ministry of Health's standards [9]. This makes the literature on TCM and combined TCM and Western medicine for Parkinson's disease lack comparability with other similar literature.
3. Traditional Chinese medicine treatment of non-motor disorder symptoms in Parkinson's disease
Parkinson's disease is a chronic disease that is accompanied by a lifelong condition, which makes it important to improve the quality of the patient's survival. Non-motor disorder symptoms in Parkinson's disease are also an important factor affecting the quality of survival of patients. There is no evidence that non-motor disorder symptoms improve when motor disorder symptoms improve in Parkinson's disease, and it is usually after motor disorder symptoms improve that non-motor disorder symptoms become an important cause affecting the quality of survival of patients. Currently, there is a large body of international literature exploring the issue of non-motor disorder symptoms in Parkinson's disease. There have been few reports in TCM literature about TCM treatment of non-motor disorder symptoms in Parkinson's disease. The reasons leading to the failure of TCM to study non-motor disorder symptoms as an important topic may be as follows:(1) Many TCM practitioners have insufficient knowledge of non-motor disorder symptoms in Parkinson's disease. (2) The traditional Chinese medicine diagnosis and treatment takes these non-motor disorder symptoms as one of the identification bases in the diagnosis and treatment of Parkinson's disease, thus concealing the control effect of Chinese medicine on non-motor disorder symptoms. In clinical practice, the treatment of certain non-motor disorder symptoms with Chinese herbal medicine often achieves very good efficacy. For example, senna is used to treat constipation in Parkinson's disease patients, blood nourishing and tranquilizing herbs are used to treat the mental symptoms of Parkinson's disease, and water-inducing and swelling-reducing herbs are used to treat swollen ankles. In this paper, the influence of traditional Chinese medicine on Parkinson's disease is not a symptom of dyskinesia, and we hope that it can play the role of a brick to attract jade, and cause widespread attention.
4, Chinese medicine treatment of Parkinson's disease of modern pharmacological research
4.1 Chinese medicine's anticholinergic effect of the study of the late 70's and early 80's, some authors noted that Chinese medicine anti-Parkinson's disease, may be related to the Chinese medicine contains anticholinergic components. Recently there are also authors who still hold this view when analyzing the pharmacological effects of Chinese medicines. In fact, as early as more than 100 years ago in the West, a plant was applied to treat Parkinson's disease, which was later analyzed for its anticholinergic effects as the main active ingredient [12]. It is now known that even chemically purified or chemically synthesized anticholinergic drugs have only a weak antitremor effect, and this effect is significantly weakened with the prolongation of the medication. The future of the use of anticholinergic components that are present in raw Chinese medicines against Parkinson's disease, then, is highly questionable.
4.2 Research on dopaminergic receptor agonists in traditional Chinese medicineThe alkaloid levodendronine, extracted from the Yunnan river valley in China, has been shown in animal tests to have a blocking effect on normally sensitive dopamine receptors, and when the application of 6-OHDA damages the dopamine neurons of the substantia nigra densa and then hypersensitizes the receptor, levodendronine exhibits a agonistic action at D1 receptors. Some authors have applied this drug to the treatment of dyskinesia caused by levodopa overdose; more recently, some authors have used it as a dopamine agonist in the clinic, but no definitive conclusions have yet been reached.
4.3Research on antioxidant of traditional Chinese medicineNowadays, people tend to think that oxidative stress is an important cause of neuronal degeneration and further damage to the residual neurons, and the clinical trials of antioxidant treatment of Parkinson's disease have received wide attention. Since it has been studied that many Chinese medicines have antioxidant effects, the idea of screening antioxidant Chinese medicines to delay the process of Parkinson's disease has been emphasized by some Chinese medicine scholars. To the author's knowledge, experimental studies in this area are underway, only that no relevant conclusions have been reported yet.
4.4 The effect of traditional Chinese medicine on the striatal dopamine system in the midbrain The main pathological change in Parkinson's disease is the degeneration and necrosis of dopaminergic neurons in the dense part of the substantia nigra, which in turn leads to the neurobiochemical changes within the nigra-striatal system mainly characterized by the decrease in dopamine (dopamine, DA) synthesis, and the beginning of the application of levodopa to clinical use in the 1960s is precisely aimed at this link. Until now, levodopa-based preparations are still the most effective anti-Parkinson's disease drugs. Existing experimental studies have shown that Chinese herbs can also exert a certain effect on the striatal dopamine system in the midbrain, and there are reports that this effect of Chinese herbs is significantly different from that of levodopa-based preparations. Our preliminary study suggests that the Nourishing Liver and Quenching Wind formula medicine can modulate tyrosine hydroxylase, the rate-limiting enzyme of dopamine synthesis, and further studies are still in progress.
5, the status of traditional Chinese medicine in the anti-Parkinson's disease
The efficacy of traditional Chinese medicine in the treatment of Parkinson's disease in the end, there have been many opinions, according to the author of the information available to the author shows that there is still a certain gap between the efficacy of the drug therapy with modern medicine. First, most of the Chinese medicine treatment of Parkinson's disease clinical observation of the reported cases is very small, coupled with a large number of subtypes, the efficacy of observation is difficult to accurately. Secondly, in clinical practice, it is difficult for patients to completely stop using anti-Parkinson's disease western medicines and apply Chinese medicine therapy alone, which makes the factors affecting the clinical therapeutic effect uncertain, thus interfering with the objectivity of the observation of the clinical effect. Third, the objective scales for evaluating the degree of Parkinson's disease have not been mastered by most TCM scholars, and a series of efficacy standards developed according to these scales have not been adopted by most TCM authors, which has led to a large number of TCM literature on efficacy standards that are highly arbitrary.
Throughout the clinical reports in recent years, there is no evidence that traditional Chinese medicine produces levodopa-like anti-Parkinson's disease strength, therefore, we believe that traditional Chinese medicine is not yet able to take a dominant role in the treatment of Parkinson's disease, but this is not the same as to say that clinical and experimental studies of traditional Chinese medicine in the treatment of Parkinson's disease have become meaningless. Firstly, since most of the anti-Parkinson's disease western drugs have side effects and their efficacy will decrease with the prolongation of medication, finding new effective drugs is still an important issue in Parkinson's disease research; secondly, the current treatment of Parkinson's disease is still aimed at symptom control, and there is no effective means of slowing down the course of the disease. Chinese medicine may be able to play an important role in slowing down the disease process, which is also an important task in the research of Chinese medicine for Parkinson's disease. Thirdly, there are studies suggesting that Chinese medicines have the effect of improving the therapeutic effect of Parkinson's disease, and this research prospect is now beginning to be emphasized. Fourth, traditional Chinese medicine can control some non-motor disorder symptoms of Parkinson's disease, which is important for improving the quality of patients' survival.
In any case, today's understanding of Parkinson's disease is growing. Past research in Chinese medicine and the combination of Chinese and Western medicine has already laid the original foundation for future research. We believe that through unremitting efforts, in the next few years or even more than a decade, the research on Parkinson's disease by combining Chinese and Western medicines will surely move from disorder to order, and from the beginning to development, so that it can make its due contribution to the health of human beings in the field of anti-Parkinson's disease.