Medical History
Identification and Vital Statistics
Male 76, 178 lbs, 5’5’
Occupation Store owner
CC: Parkinsons
Present Illness (P. I. )
Left side sciatica, multilevel disc and degenerative changes; right lumbar scoliosis; hypertension; sinus allergies with occasional inhaler use for asthmatic response, The Parkinson’s diagnosis took place in 2000 after hands began to shake, three falls, walking slower and many episodes of imbalance.
Gate, is uneven shears to the left side when walking. In sitting posture, raising the left leg causes pain. There is sharp lancinating pain when shifting position in the lateral recumbent, prone and supine positions. Once just the right position is found, the patient is able to rest without pain. There is increasing pain and day be day more difficult to walk. He awakes two times at night to urinate. There is tension throughout the IT band. Acupuncture reduces the pain.
He often arrives at the treatment with aromatic plants plugged in his nose – it is an Unani traditional treatment. His mouth drools, and he has grae difficulty moving from one area to another.
There is a past history of low back pain, hypertension, and nocturia
Family history: Father died of heart failure, mother died of a stroke
Physical examination:
Leaning to the left 45 degrees when walking. Dermatomes pressure in the L3-S1 regions causes clonus. BP: 172/81 rt, 169/68 left before treatment, 113/48, 131/58, 168/92, 175/95
Tongue: pale with a greasy yellow coat, swollen towards the tip, thick sublingual engorgement
Pulse: right: yin qiao, slippery, suppressed wave; left: yin qiao, cotton, slippery. The pulse is often pounding with force and when using the lifting method, it gets much thicker at the blood depth.
Tenderness throughout the shao yang trajectory
Diagnosis
Traditional Chinese Medical Diagnosis
a. Eight Principles – internal, heat, deficiency, yin
b. Zang-Fu Differentiation – Liver Wind due to liver Yin and Kidney Essence Deficiency
c. Six Channel, Four Level, etc. slight heat in the blood,
Working Diagnosis: liver wind due to kidney essence deficiency with liver yin and blood xu plus and blood stasis with phlegm blocking the channels.
Western Medical Diagnosis – Parkinson’s
Treatment
Treatment principle – subdue liver wind, nourish kidney essence as well as liver yin and blood, resolve phlegm and move blood
Acupuncture: lower motor area of scalp, ear substantia nigra, hua tuo jia ji L1-L5, distal ah shi, san jiao 17 and ah shi in scalp xiao yang area, SJ5, bleeding around luo in the feet. The substantia nigra area of the ear was used in order to stimulate that area associate with Parkinson’s’ this was the same reason for using the San Jian channel because the shao yang follows the same pattern as the area of the brain that is affected by the Parkinon’s condition. Bleeding was used to drain some of the heat in the blood and thin the blood slightly.
Herb formula
10 bai shao she
15 long gu
30 tian ma
10 gou teng
10 dang gui
10 chian xiong
20 bai shao
20 shu di
½ stick wu gong
3 gan cao
10 tao ren
10 dan shen
15 yin yang huo
10 dan nan xing
10 zhi bei mu
Recommendations
a. Diet & Nutrition with explanation -
b. Exercise – McKenzie postures, cardiovascular, qi gong
c. Lifestyle changes, etc. -
Progress
The patient’s condition has progressively gotten worse over the last two years. He discontinued herbs due to concerns over drug-herb interactions, they seems to help the most. The use of the channels and points related to the substantia nigra such as the ear point and the shao yang points seemed to help the most.
Discussion - TCM
TCM Pathomechanism described in the Compendium of Medicine: "The upgoing qi in the channels and collaterals does not keep its proper position, thus causing the head to shake and the limbs to tremble." The Neijing states, "All kinds of wind and dizziness are associated with the liver; all kinds of sudden stiffness are associated with wind." In order for the blood and yin of the liver to be full, the kidney essence must be adequate, as it is the source of the liver yin. The decline of kidney and liver functions have a common origin in the aging process in which kidney yin (or kidney essence) is reduced.TCM Pathomechanism described in the Compendium of Medicine: "The upgoing qi in the channels and collaterals does not keep its proper position, thus causing the head to shake and the limbs to tremble.1"
History and etiology
Parkinson's disease is a slowly progressive degenerative disorder of the nervous system characterized by tremor when muscles are at rest (resting tremor), slowness of voluntary movements, and increased muscle tone (rigidity). The tremor often begins on one side of the body, frequently in one hand. As the disease progresses, both sides of the body may be involved and shaking of the head may also occur. Other common symptoms include slow movement, difficulty in initiating movement, rigid limbs, a shuffling gait, a stooped posture, and reduced facial expressions. In about a third of the cases, the disease also causes or is associated with depression, personality changes, dementia, sleep disturbances, speech impairments, and/or sexual difficulties.
When the brain initiates an impulse to move a muscle (for example, to lift an arm), the impulse passes through the basal ganglia. The basal ganglia help smooth out muscle movements and coordinate changes in posture. Like all nerve cells, those in the basal ganglia release neurotransmitters that trigger the next nerve cell in the pathway to send an impulse. The main neurotransmitter in the basal ganglia is dopamine.
Its overall effect is to increase nerve signals to muscles. In Parkinson's disease, nerve cells in part of the basal ganglia called the substantia nigra degenerate, reducing the production of dopamine and the number of connections between nerve cells in the basal ganglia. As a result, the basal ganglia cannot smooth out movements as they normally do, leading to tremor, incoordination, and bradykinesia. The cause of nerve cell degeneration in Parkinson's disease is unknown. Genetics does not appear to play a large role, although the disease tends to occur in some families. There is no known cure for Parkinson's disease. Many patients are only mildly affected and need no treatment for several years after the initial diagnosis. Parkinson's often occurs concomitantly with atherosclerosis, and there is some thought that this problem contributes to degeneration of the neurons due to insufficient blood flow or related inflammatory processes that contribute to atherosclerosis and to neuronal degeneration4.
1. Genghe L. Clinical observation on Parkinson's disease treated by integration of traditional Chinese and Western medicine. Journal of Traditional Chinese Medicine. 1995;15(3):163-169.
2. Katzenschlager R. Mucuna pruriens Seed May Be Helpful in Long-term Management of Parkinson's Disease. J Neurol Neurosurg Psychiatry. 2004;75:1672-1677.
3. (NCHS) NCfHS. NCHS Data on Parkinson’s Disease.
4. Chen Jianzong ea. 60 cases of atherosclerotic Parkinsonism syndrome treated by supplementing liver and kidney method. Shaanxi Journal of Traditional Chinese Medicine. 1999;20(1):19.