Synergistic effect of Chinese herbal medicine with l-dopa in treating Parkinson’s

Although conventional treatments such as l-dopa and many more markedly improved motor symptoms of Parkinson’s, long-term use is associated with severe adverse effects that could significantly impact on the quality of life of patients with Parkinson’s. Alternative therapies such as Chinese herbal medicine is proved to be as effective as conventional medicine but with markedly less side-effect.

Very recently Dr. Ahn S and colleagues investigated whether the modified Cheong-gan-tang (淸肝湯 CGT, KD5040) would have synergistic effects with l-dopa on motor function and reduce l-dopa-induced dyskinesia. Modified Cheong-gan-tang (淸肝湯, KD5040), consisting of Paeonia lactiflora Pall, Ligusticum chuanxiong Hort, Angelica gigas Nakai, Bupleurum falcatum Linne, Gardenia jasminoides Ellis, and Paeonia suffruticosa Andrews plus Eugenia caryophyllata Thunb and Pogostemon cablin Bentham was co-administered with l-dopa to the Parkinson’s mouse model.

It was shown that co-administration of CGT with low-dose l-dopa synergistically improved the motor function. In addition, it significantly reversed MPTP-induced lowering of substance P, improved enkephalin levels, both are neuropeptides involved in the motor regulation in the basal ganglia. Further, co-administration of both CGT and l-dopa ameliorated abnormal reduction in glutamate content in the motor cortex. Moreover, modified CGT significantly lowered abnormal involuntary movements and controlled l-dopa-induced abnormal levels of striatal FosB, pDARPP-32, pERK, and pCREB, which is the early gene expression pathway regulating occurrence of involuntary movement.

The findings of study suggested that modified CGT can be a possible candidate for adjunct therapy in treating motor dysfunction and dyskinesia in PD patients.

Reference

Ahn S et al., Effects of a combination treatment of KD5040 and L-dopa in a mouse model of Parkinson’s disease. BMC Complementary and Alternative Medicine (2017) 17:220.  https://www.ncbi.nlm.nih.gov/pubmed/28424060

Acupuncture significantly improved symptoms of narcolepsy – a case report

A patient (male, 45-year old) diagnosed with narcolepsy by the specialist about a year ago. Recently, he came to me for acupuncture treatment due to the worsen conditions. His narcolepsy was presented with poor interrupted night sleep and excessive daytime tiredness with at least 2 uncontrollable sleep attacks a day which lasted from a few seconds to a few minutes. His day time sleepiness has been for a couple of years. His cataplexy occurred when he was laughing or angry with someone and was presented as sudden head slump down or the jaw dropping for a few seconds and even fell down on the ground. The patient has had bad sleep for decades. He hasn’t taken any medication.

The patient was treated with manual acupuncture on many acupoints including BL62, KI6; GV20, EX-HN1, HT7, PC6, ST36, SP6, SP9 for 30 min twice a week for two weeks. After two sessions of acupuncture the patient had good sleep for a consecutive three-night and felt energetic. His daytime sleep attack reduced. After six-session treatment, the severity of cataplexy episode attack was markedly reduced. He could avoid fell down and held himself up when episode was occurring. When he was laughing, the anticipated episode didn’t happen. Then acupuncture was applied on above acupoints once a week. It was shown that the consecutive good sleep could last up to 4 or 5 nights after one session of acupuncture treatment. Daytime sleep attack was no longer an issue and cataplexy episode occurred in a minor level even with laughing or big mood swing during this time period. Now therapeutic effect of one session of acupuncture could last up to 6-7 days. The patient is very pleased.

Traditional Chinese medicine believes that ying-qi and wei-qi disharmony and imbalance of yin and yang may be the cause of narcolepsy. Ying-qi is running though Yin Qiao vessel and wei-qi is running though Yang Qiao vessel. Both Yin Qiao vessel and Yang Qiao vessel are believed to be part of body defence system, equalling to immune system in convention medicine. Modulation the activity of both vessels by stimulating corresponding acupoints on the vessels leads to rebalance body’s ying-qi and wei-qi and yin and yang. This may result in the improved immune system and rebalanced the levels of neurotransmitters or neuromodulators, in particular orexin (or hypocretin) in the brain leading to improvement of narcoleptic symptoms.

Acupuncture has been recommended as one of the favourable nonpharmacologic treatments for low back pain by American College of Physicians

Recently, acupuncture, an important part of traditional Chinese medicine, has been recommended as one of the favourable nonpharmacologic therapies for low back pain by American College of Physicians. Two reports published on journal of Ann Intern Med in February 2017 by Chou et al., 2017, and Qaseem et al., 2017 made the recommendation.

Lower back pain is one of the most common reasons for clinic visits in the United States. It is associated with increased healthcare costs as well as lost wages and decreased work productivity. Acute back pain generally lasts less than 4 weeks and usually resolves on its own. Subacute low back pain is defined as lasting 4 to 12 weeks, while chronic back pain lasts over 12 weeks. Up to 30% of patients report persistent low back pain up to 1 year after experiencing an acute episode. One in five report substantial limitations in activity, according to background information in the articles.

To develop the guideline, the ACP reviewed randomized controlled trials and systematic reviews of studies evaluating noninvasive, nondrug, and drug therapy for low back pain in adults. To be included, studies had to be published in English between January 2008 and November 2016. The authors identified earlier studies using the 2007 ACP/American Pain Society systematic reviews. The agency evaluated outcomes including reduction or elimination of back pain and number of back pain episodes, improvement in back-specific function, improvement in health-related quality of life, reduction in work disability, patient satisfaction, and adverse events. The guidelines and evidence reviews also underwent peer review and a public comment period.

Overall, the new guidelines emphasize conservative treatment. First-line therapy should incorporate nondrug therapies. New evidence supports acupuncture in acute low back pain alongside with massage, or spinal manipulation; and tai chi and acupuncture in chronic low back pain alongside exercise, multidisciplinary rehabilitation, yoga, motor control exercise, progressive relaxation. Nonsteroidal anti-inflammatories (NSAIDs) or muscle relaxants should be considered when nondrug therapy fails. The guidelines strongly discourage the use of opioids (which can be associated with addiction and accidental overdose).

Reference

Chou R, Deyo R, Friedly J, Skelly A, Hashimoto R, Weimer M, Fu R, Dana T, Kraegel P, Griffin J, Grusing S, Brodt ED. Nonpharmacologic Therapies for Low Back Pain: A Systematic Review for an American College of Physicians Clinical Practice Guideline. Ann Intern Med. 2017 Apr 4;166 (7):493-505.  https://www.ncbi.nlm.nih.gov/pubmed/28192793

Qaseem A, Wilt TJ, McLean RM, Forciea MA; Clinical Guidelines Committee of the American College of Physicians. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline from the American College of Physicians. Ann Intern Med. 2017 Apr 4;166 (7):514-530.   http://annals.org/aim/article/2603228/noninvasive-treatments-acute-subacute-chronic-low-back-pain-clinical-practice