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Hi John (thanks again) , and other friends, An article published in the Parkinson Magazine, two years ago but it is still up to date. Kees ---------------------------------------------------------------------------- ----------------------------------- Public interest in alternative methods of treatment has been growing over the years. Since Parkinson patients, according to the latest developments in orthodox medicine, are bound to take a variety of different medicines for the rest of their lives, their interest in non medical therapies is understandably high. It must be stated that it is rare that all symptoms can be improved in the course of the illness. Therefore the search for additional non-medical methods without side-effects is, especially useful for the chronically ill; and in the wake of this, the Aertzlicher Beiratoften receives inquiries about the status of specific alternative methods of treatment. To date it has hardly been possible to give any reliable answers, since in most cases weare about the findings of empirical medicine which have not passed any scientific test. In the following article some alternative treatment will be introduced and discussed regarding their possible use in the treatment of Parkinson's Disease. We shall start with traditional Chinese medicine Tradionanul Chinese Medicine. Most people in our part of the world associate acupuncture with Traditional Chinese Medicine [TCM). However acupuncture represents only 20-30 percent of the entirespectrum of TCM. At the centre of the Chinese art of healing is medicinal-therapy, whichtakes the form of teas, individually prepared for each patient (decoction).In addition to this, other supportive measures are being undertaken to strenghten the lifeenergy, such as massage tehniques (Tuina massage) and general exercises for breathing and movement (e.g.Qi-Gong). Historical Development Under the obvious influence of the two dominant philosophical schools of Taoism and Confucianism, TCM has developed over more than l000 years into a unified system. The system of thinking in analogies goes back to Taoism. Taoism demands a very precise observation of nature and applies some of the interrelating concepts that are found here to all levels of being, e.g. the human being or the entire cosmos. Confucianism, on the other hand, puts the emphasis more on the rational aspect and social contacts between people. The most important source of TCM is the book "The Inner Classic of the Yellow Pince" that was compiled in the third century B.C. and still has to be read by today's sudents of TCM. The book has been constantly change and extended, e.g. by the "Classic of Acupuncture and Moxibution-Treatment" in about 300 A.D. In the beginning, medical knowledge was treated almost as an esoteric lore which was directly passed on from master to disciple. However, when the art of printing was introduced about 500 years earlier than in Europe, the spread of knowledge increased, but at the same time an obvious weakening in the art of healing took place. Many physicians merely acquired a certain "theoretical knowledge from books" without actually having gained many years of the experience for themselves. Further more, magic practices were added, with the result that the decline of TCM started in about 1000 A.D. Also, Western medicine gained the upper hand in China owing to its clearly spectacular successes infighting infectious diseases. It was only in the middle of this century that a new discussion about Western as well as traditional Chinese medicine began. Even during Mao Tse Tung's rule only Western medicine was promoted. At the moment, Western medicine and TCM are considered equal. Students of medicine can choose between the two schools. Both courses take about six Years. The same choice is also given to the patients when seeking treatment.Occasionally, doctors of the two schools share a practice so that supplementary treatment becomes possible. The Chinese Concept of illness Western and Chinese attitudes towards illness are completely different. Within the framework of this article only a rough outline of the Chinese point of view can be attempted. In Chinese thinking the individual is part of the cosmos which itself is embedded between the sky and the earth. The generally applicable laws of being canbe applied to this individual. According to Chinese Philosophy this means that the human being is part of the life-energy "Qi" which is constantly flowing through him. Since all forms of being are polar, this energy is polar too; i.e. it is composed of two opposing parts. The polarity is symbolized at all levels by the symbols Yin and Yang.This pair of concepts describes all sorts of polarities and phenomenon at all spheres of lifeare related to it: for example, the sky and the day reflect the Yang-principle and the earthand the night the Yin principle. In the field of medicine, Yang represents the "non-material" whereas Yin stands for everything organic. Consequently, all active functions of the body such as movement, digestion, sweating, emotions etc. are allocated to the Yang aspect but the individual organs to the Yin aspect. A moral valuation of positive and negative, however, is not offered by this pair of opposites, because the polesare value-free. The life-energy "Qi" flows through the human body in five so called "functional areas" which represent the load-bearing columns of the entire medical system. The names of these functional areas are allocated to specific organs, e.g. "heart" or "liver". But they by no means denote their anatomical counterparts as we know them. The names of the organs express the sum of different symptoms. 2000 years ago these names were used because of pure observation of the phenomena rather than as a result of, anatomical fact. The Chinese doctor's skill consist of realising in which functional area the life energy is being disrupted and where the flow is beginning to flag. He hardly needs any technical equipment to make a diagnosis: in most cases, a very detailed case history, the thorough of examination of the tongue and a precise check of the pulse are sufficient. Drug therapy Over many thousands of years about 3000 plants were observed and documented with regard to their effect on the human being. The results take all parts of the plant into account, such as the root, blossom, leaf etc. In so doing, the effect shown is allocated to one of the five functional areas previously mentioned. Usually the remedies administrated as tea and are produced by means of slow boiling (decoction). This preparation takes several hours. Afterwards the tea is also drunk within a period of several hours. An average tea contains ten different components, occasionally including mineral or animal elements. As the preparation of each tea is very individual, a medicine in the form of a tablet is hardly possible. Only a few "standard mixtures" are obtainable as tablets. Otherwise, even today, a mixture of herbs is prepared for each patient individually. On the one hand, this is time consuming, but on the other hand, it is ensured that the symptoms of each individual patient are considered. Owing to a lack of detailed knowledge of our native flora, Chinese doctors who practise in Germany prescribe healing herbs from China which are shipped to Europe. Consequently, these teas tend to be expensive. Acupuncture Acupuncture means "prickling and burning" as both needle therapy and heat treatment are combined. The needles are either heated by red light or by moxibution. In the case of the latter ,Moxawool (mugwort) is put on the needle and lit. Afterwards the needle has to smoulder some milli-metres above the flame. For traditional Chinese acupuncture needles are used. In Germany, however, it is becoming increasingly common for laser beams to be applied. No consensus has yet been reached on the extent to which both methods are identical. Chinese colleagues, on the one hand, seem reserved when expressing their views on the laser therapy, since they do not have much experience with this technique. German colleagues, on the other hand, tend to regard the laser therapy as having an identical or equal result. The advantage of the use of laser beams is that the risk of infection can be ruled out. The theoretical basis for the effects of acupuncture has always been unclear although more and more doctors can become convinced of the effects. The "channels of energy" which have been recorded in China for thousands of years and along which the"Qi-stream" flows gas not yet found ananatomic equivalent. There are, however, hints that an increased distribution of certain body substances -like serotonin and peptide-exists at these acupuncture points. This assumption might lead to an explanation of the effects on different forms of pain. On the whole, the question of finding the points of acupuncture comes about a result of experience. By means of the injections,the "Qi-energy" which has come to a stand still, is supposed to flow again. Also, energy from well-supplied functional areas can be usefully diverted to other areas. To do so, an experienced acupuncturist only needs a few needles. Otherwise, in most cases the treatment has to be carried out for several weeks. The main reasons for the use of acupuncture are different forms of pain such as migraine, phantom-pains, shingles, HWS- and LWS-syndrome. Also, asthma, allergies, sleeping disorders and other disorders are said to respond, whereas pathological changes of organs can not be reversed. Tuina-massage This special type of massage is to a large degree unknown in Germany. But since an increasing number of Chinese doctors come to Germany, this method of treatment will also be disseminated here. Tuina-massage is very suitable for all forms of rheumatic complaints. The therapist works his way forward layer by layer: from the skin to the muscular system to the bones and the joints. Every layer is massaged and loosened up intensively. A treatment takes 40-50 minutes. Qi -Gong Qi-Gong is the name given to working with "Qi", that is the energy of life. It is a breathing therapy in combination with therapeutic exercises and has a meditative character. Qi-Gong can be used in many different ways. Probably the most common variation is a programme consisting of 18 exercises which is supposed to keep "Qi" in cyclical motion. These exercises are natural and relaxing and can easily be practised by elderly people. In addition, there are specific exercises which maybe used under medical supervision. Here, the transfer of energy or the building up ofenergy in special functional areas can be achieved. These exercises are far more complicated and need the guidance of a trained teacher. Besides, a mainly meditative Qi-Gong is used which is similar to modified relaxation through self-hypnosis. TCM and Parkinson-therapy. The main emphasis of Chinese medicine is put on the prevention of illnesses and the remedying of functional disorder. Obvious oganic changes cannot be influenced. As regards the Parkinson syndrome it must be understood right from the start that the previously mentioned methods can only be employed as a supplement to the therapy. There may be cases of sleeping disorders in various forms, increased sweating and probably also some disor-der of the bladder and the bowel. Furthermore, pains of arheumatic nature, which might be increased the Parkinson symptoms, may experience some improvement. At the moment, tests are being carried out in the Paracelsus-Elena-Clinic as to whether itis possible to improve the already the quality of speech with acupuncture treatment. Sofar, definite results are not available. In China, too, the Parkinson therapy concentrates on the Western medicinal complemtreatment, especially the therapy with L-Dopa. Regarding the concept of TCM, acupuncture and some therapeutical exercises might be transferable to the West. It seems unlikely, however, that drug therapy would be transferable. On the one-hand for an im the one hand, it is elaborate and not practicable to get hold of the plants and to prepare them for use. On the other hand, there is a lot to be said in favour of the fact that this therapy achieves the best results in the cultural area where it was developed. Just the taste of the Chinese "decoction" is barely palatable for Western patients; and according to Chinese thinking, the patient should enjoy the tea in order for it to work. Already this minor aspect points out the enormous differences between the cultural areas and their respective approaches to medicine. Nonetheless, it makes sense to try a complementary view, especially when there are very different approaches to diseases. In the course of this, the creative reworking of some techniquesical might arise, e.g. laser acupuncture instead of the traditional use of needles.Both the use of laser acupuncture for an improvement of speech, as well as the influence of different autonomic functions by means of acupuncture are being researched at the Paracelsus-Elena-Clinic. As soon as results become available, they will be made public to the patients. Resource : Parkinson Magazine, Summer 1993, issue number 1 written by Dr. Gudrun Ulm, Kassel, Germany