Parkinson's+Disease

//Western Diagnosis:// slowly progressive degenerative CNS disorder Idiopathic Slowness and dec movement, muscular rigidity, resting tremor, postural instability Onset usually after age 40

Etiology primary a. idiopathic b. loss of substantia nigra cells from basal ganglia c. dopamine depletion - dopamine is inhibitory secondary a. drug ingestion - haldol b. CO or Mn poisoning c. other neuro lesions

Signs & Symptoms 1. insidious onset 2. resting “pill-rolling” tremor: maximum at rest, dec during movement, absent during sleep 3. progressive rigidity 4. bradykinesia - slowness and poverty of movement 5. akinesia - difficulty initiating movement 6. masklike facies, open mouth, dec blinking 7. stooped posture 8. shuffling gait 9. arms do not swing with stride 10. festination 11. lead-pipe rigidity interspersed with cogwheel rigidity 12. depression common 13. dementia in 50% 14. seborrhea, constipation, urinary hesitancy, ortho hypo

Diagnosis 1. clinical

Treatment 1. levodopa usually with carbidopa ---levodopa metabolized peripherally so must be given in large doses and causes side effects (N, palps, flushing); carbidopa prevents catabolism 2. amantadine 2. remain active 3. PT 4. stool softeners

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=================================== TCM Pattern Differentiation tendencies: Early stage primarilyLR & KI Yin deficiency, w/ abdundant phlegm, heat & blood stasis; in the middle stage mainly KI & SP deficiency w/ phlegm & damp retention; in late stage mainly Qi deficiency & Yang deficiency, later developing into deficiency of both Yin & Yang (Zhonggyi Zazhi August 2009, Vol.50 No.8)

Basic formula (ITM): This collection of herbs, cooked to yield a decoction for drinking, would be modified according to symptoms, for example:
 * Ho-shou-wu || 20 g ||
 * Gou Qi Zi || 12 g ||
 * Rou Cong Rong || 12 g ||
 * Tian Ma || 15 g ||
 * Gou Teng || 18 g ||
 * Chuan Xiong || 15 g ||
 * Shi Chang Pu || 10 g ||
 * Tremor: add oyster shell, mother of pearl, and scorpion
 * Rigidity: add Mu Gua, Bai Shao, and Hou Po
 * Heat syndrome (constipation, aversion to heat, perspiring): add anemarrhena, phellodendron, gardenia, and moutan
 * Cold syndrome (lassitude, aversion to cold, frequent urination): add eucommia, dipsacus, epimedium, ginseng, rose fruit, and alpinia
 * Depression, anxiety, insomnia: add schizandra, albizzia bark, cyperus, and shou wu stem.
 * For slow mental responses and amnesia: add polygala and curcuma
 * For poor blood circulation: add salvia and red peony

Orthomolecular Treatment -Methionine -Phenylalanine (LDPA, DPA) -Tyrosine

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IBIS: Definition: A chronic progressive CNS disorder characterized by slowness of purposeful movement, resting tremor, and muscle rigidity. Also called "Parkinsonism" and "Paralysis Agitans".

Etiology: The patient is typically middle-aged or elderly when symptoms begin. The disease is extremely gradual in progression. In the majority of patients it is not a familial disorder, but occurs randomly. Although the syndrome is well presented in a worldwide distribution and the manifestations often are clearly distinguishable and easily diagnosed, the disease is idiopathic and the pathophysiology poorly understood.

There is usually a loss of cells in the substantia nigra, locus ceruleus, and in other pigmented cells, as well as a decrease in the dopamine levels in the axon terminals of cells connecting the substantia nigra to the caudate nucleus and putamen.

The disease initially presents as a unilateral disorder, but in later stages becomes symmetrical. It has an insidious onset, and may not become incapacitating for many years. After World War I, there was an encephalitis outbreak that led to numerous patients developing symptoms almost exactly like Parkinson's, as the same cells that become disordered in Parkinson's were the same ones to be affected by the encephalitis, which is one of the known causes of the disease. Generally, however, only the idiopathic version of the disease is termed Parkinsonism.

Nutrition: therapeutic foods: • foods that rid Wind, soothe the Liver • increase foods rich in Calcium, Phosphorus, Manganese, Sulfur, Iodine, tryptophan (Jensen, p. 63) • egg yolk, kale, celery, fish, raw goat's milk, veal joint broth, cod roe, rice polishings, brewer's yeast, nutritional yeast (Jensen, p. 63)

fresh juices: • celery, carrot, prune (Jensen, p. 63) • prune and rice polishings (Jensen, p. 63) • raw goat's milk and 1 tsp. sesame, sunflower or almond butter, 1 tsp. honey and sliver of avocado (Jensen, p. 63) • black cherry and egg yolk (Jensen, p. 63) • carrot, celery, spinach, and parsley (Walker, p. 149) • carrot and spinach (Walker, p. 149) • carrot, celery, and parsley (Walker, p. 149) • carrot, beet, and cucumber (Walker, p. 149)

avoid: • cooking in aluminum pots, meat, alcohol, hot sauces, spicy foods, fried foods, fatty foods, rich foods, salty foods, coffee, caffeine, sweet foods and sugar, cow's milk and other dairy products, white bread, refined foods, processed foods

Botanicals • Atropa belladonna (toxic): in special cases, i.e. post-influenza Parkinsonism (Weiss, p. 305) • Avena sativa: nerve tremors of Parkinson's disease, neurotonic (Ellingwood, p. 204) • Conium maculatum (toxic): soothing for spasmodic affections and irregular muscular movements (Ellingwood, p. 104) • Corydalis cava: tremors (Weiss, p. 306) • Datura stramonium (toxic): symptomatic treatment of tremor, sialarrhea (Weiss, p. 306; British Herbal Pharmacopoeia, p. 77) • Equisetum spp.: baths (Husemann, p. 444) • Gelsemium sempervirens (toxic ): trembling without rigidity (Mittman) • Ginkgo biloba (standardized extract): increases cerebral circulation (NCNM) • Hyoscyamus niger (toxic): tremor of, senile tremors, tincture of fresh herb used in higher dosage range (Weiss, p. 306) • Scutellaria lateriflora: nervousness, insomnia; nervous disorders with irregular muscle action, twitching, tremors, restlessness with or without incoordination (Ellingwood, p. 124) • Viburnum opulus: relaxes cramps and spasms (listed in Ellingwood's index; Felter and Lloyd, p. 2059)

Chinese Formulae • Du Huo Ji Sheng Wan (patent): Xue Xu (Blood Deficiency) with Qi Xu (Deficiency) (Zhu, p. 111) • Gastrodia 9 (patent): Liver Wind Stirring (Dharmananda, 1990, p. 83)

Acupuncture after assessing the person and palpating, consider these patterns: Kidney Yin Xu (Deficiency) and/or Jing Xu (Essence Deficiency); Xue Xu (Blood Deficiency) with Qi Xu (Deficiency); Liver Wind Stirring

» therapeutic notes: • With a condition of less than six months' duration, acupuncture has been reported very successful facilitating a cure. After six months, treatment resulting in a cure is more difficult to obtain. When the condition has been affecting the patient for more than a year, cure is very difficult to realize with acupuncture alone and may be impossible. (So, 1987, p. 294; McWilliams, et al., Lesson 31, p. 179) • In treating unilateral tremors, it "may helpful to use first tonification on the noninvolved side before sedating the same points on the involved side". (McWilliams, et al., Lesson 31, p. 180)

» illustrative combinations: • Ht-3 and St-33 (d. D), five cones each, red bean size, and GV-14 (d. D), seven cones, for Parkinson's disease (So, 1987, p. 294; McWilliams, et al., Lesson 31, p. 179) • LI-15, LI-11, Lu-5, PC-3 and LI-4 for Parkinson's disease affecting the arms (So, 1987, p. 294; McWilliams, et al., Lesson 31, p. 179) • GB-30, GB-31, GB-34, GB-39, Sp-6, UB-60, Kd-3 and UB-54/40 for Parkinson's disease affecting the legs (So, 1987, p. 294); same except substitute Kd-6 for Kd-3 (McWilliams, et al., Lesson 31, p. 179) • GB-20, GV-12, GV-4, CV-12, CV-4, Lu-5 and SI-3 for Parkinson's disease (McWilliams, et al., Lesson 31, p. 180) • UB-10, UB-11, GV-9, CV-13, CV-6, Lu-6 and UB-62 for Parkinson's disease (McWilliams, et al., Lesson 31, p. 180) • Ht-3, PC-3 and St-33 for Parkinson's disease • GB-41, GB-44, TW-6, UB-58, UB-34, Ht-3, SI-3 and Lu-10 for tremors associated with Parkinson's disease; add GB-39 and GB-34 (-) for generalized tremors, or with unilateral tremors, tonify noninvolved side first and then sedate involved side (McWilliams, et al., Lesson 31, p. 180) • GB-20, Lv-3, UB-17, UB-20 and UB-18 for tremors due to Internal Wind with Xue Xu (Blood Deficiency) (Jirui and Wang, p. 137) • Ht-3 and St-33 for chest pain with tremors of the hand (Shanghai, p. 252)

Homeopathy • Agaricus muscarius: diagonal course of symptoms and crawling sensations; vertigo with impulse to fall backward; < cold weather • Antimonium crudum: Parkinsonism associated with gastric symptoms; desires sour foods which disagree; thickly white coated tongue; stubborn; anxious; disgust of life; < heat, wine; mentals < in moonlight • Argentum nitricum: tremulousness especially of nervous origin; desires sweets; < night, warm room; > cool open air; apprehension and fear gives rise to diarrhea • Aurum sulphuratum: constant nodding of the head; staggering gait; rush of blood to head • Camphora bromata: nervous excitability guiding condition; directions appear reversed (north appear south); hysterical; laughing and weeping alternately; restlessness • Hyoscyamus: tremulous, weakness and twitching of tendons; suspicious, jealous, talkative, quarrelsome; great hilarity; < night, menses, after eating and lying down; > stooping • Loleum temulentum: symptoms particularly < wet weather; confusion of mind; great depression; tremors and convulsions; tightness in calves • Lycopodium: mentals and generals important to select it » causation: fear, fright, chagrin, vexation, anxiety, fevers, overlifting, masturbation, tobacco chewing » generals: loss of confidence; aversion to company but wants company in the adjoining room, desires sweets; flatulence; < 4 p.m. to 8 p.m. • Mercurius solubilis: marked weakness and tremors of the hand; weak memory; slow in answering questions; increased salivation with thirst for cold drinks; profuse perspiration without relief; vibration in forehead; tremors of tongue and hand • Plumbum metallicum: (all types of paralysis); convulsive movements of arms and hands with pain in joints; it could be due to cerebral sclerosis; spasm of facial muscles, painful spasms > hard pressure, < touch, motion; constipation with sheep dung-like stool • Rhus toxicodendron: left-sided predominantly affected with tremors and characteristic festinating and propulsive gait of Parkinsonism; initial movement easier; numbness and tingling after extension; physical restlessness. • Zincum metallicum: lameness and weakness; weak memory; repeats everything; automatic motion of head and hand; soles sensitive; fidgety feet; often involvement of CNS coming as a result of suppressed eruptions. • Zincum picricum: symptoms similar to zinc.; weakness is more marked

Mind/Body • Certain types of Parkinson's disease and schizophrenia might be the consequence of autoimmune blockade of striatal dopamine receptors (Parkinson's) or limbic dopamine receptors (schizophrenia). This hypothesis correlates with the discovery that several autoimmune diseases, such as myasthenia gravis, are the result of an immunopharmacological block as receptor sites. (Locke, 1983, p. 160) • Fear and an intense desire to control everything and everyone. (Hay, 1984, p. 178)

Chinese psychophysiology: • Kidney ~ Shen stores Jing (Essence) and governs birth, growth, reproduction, development, and aging; houses the Zhi (Will); expresses ambition and focus; provides the "Fire of Life" through its Yang functions; provides the nourishing and stabilizing qualities of Yin and Water that balance the Yang and the Fiery qualities; produces the Marrow which generates the spinal cord and "fills up" the brain; nourishes the brain to sustain concentration, clear thinking, and memory; carries the constitutional endowment from the parents; and displays the effects of sexual dissipation, overwork, aging, chronic debilitation or degenerative processes, and extreme stress. » Healthy expressions are gentleness, groundedness, and endurance. » Kidney Xu (Deficiency) signs include indecisiveness; confused speech; dreams of trees submerged under water; cold feet and legs; abundant sweating (Seem, p. 28); fearfulness; apathy; chronic fatigue; discouragement; scatteredness; lack of will; negativity; impatience; difficult inhalation; low sex drive; lumbago; sciatica; and musculoskeletal irritation and inflammation, especially when worse from touch. » Intense or prolonged fear depletes the Kidney. Often chronic anxiety may induce Xu (Deficiency) and then Fire within the Kidney. (Maciocia, p. 250) Overwork, parenting, simple aging, and a sedentary or excessively indulgent lifestyle all contribute significantly to Kidney Xu (Deficiency).

• Liver ~ Gan is the home of the Hun (Ethereal Soul); it relates to decisiveness, control, and the principle of emergence; stores and cleanses the Xue (Blood); maintains smooth flow of Qi and Xue (Blood); opens into the eyes; and expresses itself in the nervous system; and reflects emotional harmony and movement. » Healthy expressions are kindness, spontaneity, and ease of movement. » Liver Xu (Deficiency) signs include impotence; frigidity; pain in thighs, pelvic region, and throat; ready tendency to "the blahs" (Seem, p. 28); timidity; depression; irritability; vertigo; pruritus; dry eyes, skin, and/or tendons; asthma; aching at the waist; hernia; and difficulty raising head up and down. Liver Yin Xu (Deficiency) predisposes to the Shi (Excess) conditions of Liver Wind. » Liver Qi Stagnation reflects and accentuates emotional constraint as the Liver's function of facilitating smooth flow in the body is constricted. Stagnation is associated with frustration, irritability, tension, and feeling stuck. With time this pattern tends to produce a gloomy emotional state of constant resentment, repressed anger or depression, along with tightness in the chest, frequent sighing, abdominal tension or distension, and/or a feeling of a lump in the throat with difficulty in swallowing. (Maciocia, p. 216) » Liver Wind derives from Liver Yin Xu (Deficiency) and/or Liver Xue Xu (Blood Deficiency) and their subsequent inability to embrace the Yang, and can manifest as joint stiffness, dizziness, tremor, paralysis, convulsions, rashes, itching, and neurological problems. Wind can also be internalized after exposure to inclement, especially windy, weather and any concomitant influences of Damp, Cold, and/or Heat.

• Heart ~ Xin houses the Shen (Spirit) and reveals itself through the brightness in the eyes; governs Fire and Heat; rules the Xue (Blood) and its vessels and directs the circulation; opens into the tongue and controls speech; and relates to the integration of the organs and the personality. » Healthy expressions are warmth, vitality, excitement, inner peace, love, and joy. » Heart Xu (Deficiency) signs include sadness; absence of laughter; depression; fear; anxiety; shortness of breath (Seem, p. 28); cold feeling in the chest and limbs; palpitations; cold sweat; inability to speak; memory failure; nocturnal emissions; and restless sleep. » The Heart is the Emperor of the bodily realm so that when the Heart is disturbed all the other organs will be disrupted.

ITM: []

http://www.hindawi.com/journals/ecam/2014/342506/ - Effect of Zishenpingchan Granule on Neurobehavioral Manifestations and the Activity and Gene Expression of Striatal Dopamine D1 and D2 Receptors of Rats with Levodopa-Induced Dyskinesias