Experience treating Parkinson’s disease with acupuncture

Introduction to Parkinson’s disease (PD)

PD is a neurodegenerative disease, most commonly seen among middle-aged and elderly people. There is neither any known treatment capable of halting the progression of PD, nor is there any known cure, treatment focuses primarily on decelerating disease progression and improving quality of life. Western medical treatment chiefly consists of oral medication and deep brain stimulation (DBS) surgery, while TCM treatment consists mainly of herbal decoctions and acupuncture (1).

Clinically, the cardinal motor symptoms of PD are: (I) resting tremor, (II) bradykinesia, and (III) rigidity. Common non-motor symptoms include abnormal sense of smell, constipation, rapid eye movement sleep behavior disorder (RBD), pain, fatigue, salivation, and so on (2).

Demonstration of essential acupoints

Cranial base acupoints

First, we will introduce the standard acupoints used to treat PD—the cranial base acupoints, which include DU-17, DU-16, DU-15, BL-9, GB-20, and BL-10. The cranial base acupoints have a widespread use in the acupuncture treatment of PD (3,4).

DU-17 Naohu

Meeting point of the Governing vessel and Foot Taiyang (Bladder channel). Located in the depression directly superior to the external occipital protuberance.

DU-15 Yamen

Intersection point of the Governing vessel and Yang Wei. Located at the neck, 0.5 anatomical inch (cun) above the midline of the posterior hairline, below the spinous process of the first cervical vertebra.

DU-16 Fengfu

Intersection point of the Governing vessel and Yang Wei. Located at the neck, 1 inch above the midline of the posterior hairline, directly below the occipital protuberance, in the depression between the bilateral trapezius muscles.

BL-9 Yuzhen

Belongs to the Bladder channel of Foot Taiyang. Located 2.5 inch above the posterior hairline and 1.3 inch laterally from the midline, roughly in the depression of the upper margin of the external occipital trochanter.

GB-20 Fengchi

Meeting point of Foot Shaoyang (Gall bladder channel) and Yang Wei. Located in the posterior neck, below the occiput, in the hollow between the origins of the sternocleidomastoid and trapezius muscles.

BL-10 Tianzhu

Belongs to the Bladder channel of Foot Taiyang, located at 1.3 inch laterally from the midline of the posterior hairline.

Scalp acupuncture: chorea-tremor area

The chorea-tremor area is one of the most commonly used scalp acupuncture areas for treating PD. When locating the chorea-tremor area, it is necessary to first define two positioning lines: the anterior-posterior midline and the eyebrow-occipital line. The starting point of the anterior midline is the middle point of the brow, that is, GV-29 Yintang, and the terminus of the posterior midline is the depression at the lower border of the occipital protuberance, that is, near DU-17. The eyebrow-occipital line is a horizontal line from the upper border of the eyebrow midpoint to the inferior border of the occipital protuberance. After that, two points need to be defined. The first point is 0.5 cm posterior to the midpoint of the anterior-posterior midline, and the second point is the intersection of the eyebrow-occipital line and anterior border of the corner of the temporal hairline.

The line between these two points is the Motor Area, 1.5 cm anterior and parallel to the Motor Area is the Chorea-Tremor Area.

Acupuncture manipulation

Key points: fire needle manipulation of the cranial base acupoints

• Heating the fire needle: Ignite a cotton ball soaked in 75% ethanol, and use the outer flame to heat the tip and body of the needle until red hot, repeat 2–3 times;
• Disinfect the cranial base acupoints with 75% ethanol;
• Key point—“Red”: Use the outer flame to heat the needle until red hot;
• Key point—“Quick”: Needle insertion must be quick;
• Key point—“Accurate”: The acupoint location must be accurate;
• Wipe the acupuncture points with a dry cotton ball after completion of the fire needle manipulation.

Key points: filiform needle manipulation of cranial base acupoints

• The needles are inserted into DU-17 and BL-9 horizontally along the skin in the direction of the feet, to a depth of 3–5 mm;
• The needles are inserted perpendicularly at DU-16, DU-15, GB-20, and BL-10, to a depth of about 5 mm (5).

Demonstration of auxiliary acupoints: governing vessel

Orthostatic hypotension (OH) occurs in a number of PD patients, and can be treated by filiform needle manipulation or fire needling of the Governing vessel acupoints. This patient did not display OH, thus only the acupoint selection is shown, with acupuncture treatment excluded.

Standard acupoints for treating OH include:

DU-14 Dazhui: Located in the depression below the spinous process of the seventh cervical vertebra.

DU-12 Shenzhu: Located in the depression below the spinous process of the third thoracic vertebra.

DU-11 Shendao: Located in the depression below the spinous process of the fifth thoracic vertebra.

DU-9 Zhiyang: Located in the depression below the spinous process of the seventh thoracic vertebra.

DU-8 Jinsuo: Located in the depression below the spinous process of the ninth thoracic vertebra.

DU-6 Jizhong: Located in the depression below the spinous process of the eleventh thoracic vertebra.

DU-4 Mingmen: Located in the depression below the spinous process of the second lumbar vertebra.

DU-3 Yaoyangguan: Located in the depression below the spinous process of the fourth lumbar vertebra.

Acupuncture manipulation: scalp acupuncture chorea-tremor area

Key point: Horizontal insertion along the skin, rapid rotation.

Summary

This video summarizes the clinical experience of the Deputy Director of the Acupuncture Department of Capital Medical University Affiliated Beijing Hospital of Traditional Chinese Medicine, Dr. Peng Chen, in treating PD with acupuncture. Due to time constraints, this video focuses mainly on the acupuncture methods particular to the treatment of PD, including fire needle and filiform needle manipulation of the cranial base acupoints, the scalp acupuncture chorea-tremor area, and Governing vessel acupoints, without mentioning the commonly used Liver and Kidney channel acupoints. This video was made to provoke thought among our TCM colleagues regarding the use of acupuncture in the treatment of PD, in order to improve the quality of life of PD patients.

Acknowledgments

Funding: None.

Footnote

Provenance and Peer Review: This article was commissioned by the editorial office, Longhua Chinese Medicine for the series “Visualized Chinese Medicine”. The article did not undergo external peer review.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://dx.doi.org/10.21037/lcm-21-27). The series “Visualized Chinese Medicine” was commissioned by the editorial office without any funding sponsorship. PC serves as an unpaid editorial board member of Longhua Chinese Medicine from Jun 2021 to May 2023. The authors have no other conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee(s) and with the Helsinki Declaration (as revised in 2013). Written informed consent was obtained from the patient.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

References

1. Huang M, Kan B. Clinical research progress of acupuncture and moxibustion in the treatment of Parkinson’s disease. Chinese Journal of Acupuncture and Moxibustion 2021;10:59-62. (Electronic Edition).
2. Zhao X, Chen P, Niu Y, et al. Advances in the etiology and pathogenesis of Parkinson’s disease. Journal of Xinxiang Medical University 2021;38:378-81.
3. Chen F, Yuan Y, Cai X, et al. Clinical observation of 114 cases of Parkinson’s disease treated with “Seven Cranial Base Acupoints” acupuncture. Chinese Journal of Basic Medicine in Traditional Chinese Medicine 2013;19:547-8.
4. Yuan Y, Cai X, Chen F. Clinical observation on the effect of “Seven Cranial Base Acupoints” in improving Parkinson’s disease with depression. Chinese Journal of Geriatric Care 2020;18:27-30.
5. Chen P, Liu H, Wang S, et al. 27 cases of primary Parkinson’s disease treated with fire needle and cranial base integrated acupuncture. Chinese Acupuncture and Moxibustion 2021;41:71-2.

(English Language Editor: J. Jones)