ARTICLE
International Journal of Integrative Medicine
The Current Status of Integrative Therapies in Treating Parkinson's Disease in Six General Hospitals in Shanghai Original Research Article
Hua Lu1, Weidong Pan2,*, Jun Wang2, Chunlan Wu2, Fan Gong2, Yan Sun2, Yun Liu2, Jun Liu3, Yi Liu4 and Yu Bai5 1 Center for Clinical Effectiveness Evaluation, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China 2 Department of Neurology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China 3 Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China 4 Department of Neurology, Shanghai Traditional Chinese Medicine Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China 5 Department of Neurology, Putuo District Center Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China * Corresponding author E-mail:
[email protected]
Received 16 Jan 2013; Accepted 29 Jan 2013 © 2013 Lu et al.; licensee InTech. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract Objective: To investigate the current use of Western medicine and integrative therapies in the treatment of patients with Parkinson’s disease (PD). Methods: A cross‐ sectional, multicentre clinical epidemiological survey was conducted in six hospitals in Shanghai. We investigated the varieties and frequencies of use of prescriptions of Chinese herb decoctions and compounds as well as the frequencies of other selected therapies. Results: All of the patients with PD were treated by Western medicine, in which 30.16% of them were treated by Western medicine only while 68.24% were treated by one or two forms of traditional Chinese medicine (TCM) and a few were treated by Tai Chi quan or rehabilitation therapy combined with Western medicine. Chinese herb decoctions such as Tian‐ma Gou‐teng Decoction, Liu‐wei Di‐huang Decoction, Si‐jun‐zi Decoction, Da‐ding‐feng Zhu, etc., and Chinese herb compounds such as Liu‐wei Di‐ huang pill, Huang‐xing Run‐chang tablet, Cong‐rong Tong‐bian liquid, Qi‐ju Di‐huang pill and Dan‐lou tablet, all have a higher frequency of utilization. The purposes behind taking TCM mainly focus on the common symptoms of PD patients, such www.intechopen.com
as constipation, sweating, tremors, fatigue, insomnia, forgetfulness, bradykinesia and palpitation. Conclusion: Traditional Chinese treatments combined with Western medicine are still popular in integrative administrations in Shanghai. TCM is mostly used in combined therapy and the main purpose behind it is to deal with non‐ movement disorders for patients with PD. It would be possible for more doctors ‐ especially Western medicine doctors ‐ to make a reasonable selection of integrative treatments in clinical practice in treating PD. Keywords Integrative Therapy, Traditional Chinese Medicine, Parkinsonʹs Disease, Clinical Epidemiology, Chinese Herb Decoction, Chinese Herb Compound
1. Introduction Parkinsonʹs disease (PD) is degenerative disease of the central nervous system (CNS), affecting movement,
j. integr. med., 1, 17:2013 Hua Lu, Weidong Pan, Jun Wang, Chunlan Wu, Fan Gong, YanInt. Sun, Yun Liu, Jun 2013, Liu, YiVol. Liu and Yu Bai: The Current Status of Integrative Therapies in Treating Parkinson’s Disease in Six General Hospitals in Shanghai
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muscular tension and balance. The disease is progressive, with patients’ symptoms becoming more severe over time and leading to a loss of postural stability, gait dysfunction, difficulty in managing the activities of daily living and frequent falls. The prevalence of PD is approximately 1.02 percent among Chinese people aged over 55 years. The total number of patients with PD is more than 1.7 million, and it is predicted to increase by more than 100,000 a year [1‐2]. This will give rise to a very serious burden, both for the families of patients and society in general. Western medical therapies still predominate in the management of PD. L‐dopa agents have been the mainstay of therapy; however, efficacy is decreased and the phenomena of ʺon‐offʺ, ʺwearing‐offʺ and ʺdyskinesiaʺ develop approximately 3 to 5 years after commencement [3]. These limitations have encouraged clinicians to revisit the potential role of traditional Chinese therapies in treating PD. Studies have found that combining standard Western therapies with traditional Chinese medicine (TCM) can delay the progression of PD and ameliorate some of the symptoms related to non‐movement disorders (NMDs) [4‐6]. Other studies indicate that complementary and alternative therapies ‐ such as Tai Chi quan ‐ when performed for more than six months, can improve gait and balance and decrease the number of falls [7]. Some clinical studies also suggest that, when combined with TCM, the dose of L‐dopa can be reduced and the side‐ effects can be effectively eliminated [8]. The current study investigates the use of integrative therapies (including TCM, Tai Chi quan and rehabilitation combined with Western medicine) in patients with PD. 2. Materials and methods 2.1 Patients Data was collected from 296 patients with PD treated in six hospitals in Shanghai over a 3 month period. Eighteen specially‐trained investigators performed all of the assessments. The UK Parkinson’s Disease Society Brain Bank clinical diagnostic criteria were used[9].
2.2 Survey tool The questionnaire included demographic information, previous and current use of Western medicine, use of TCM (including Chinese herb decoctions, Chinese herb compounds, acupuncture and moxibustion, massage and Qi Gong exercise) or other additional therapies, PD‐ related symptoms that have been treated, and the rationale for using complementary therapies. The Unified Parkinsonʹs Disease Rating Scale (UPDRS) and the Parkinsonʹs disease sleep scale (PDSS) were also used to evaluate the clinical severity and sleep quality of patients [10‐11]. 2.3 Statistical method The EpiData software package (version 3.2) was used for data entry and data documentation. The original data was converted to the SAS system (version 9.2) for statistical analysis [12]. The mean and standard deviation was calculated for numerical variables. If the numerical variable is non‐normal distribution, the median and quartile will be calculated for statistical detection. For categorical variables, the rate or constituent ratio was calculated. The independent samples t‐test was used for the comparison of means between males and females and the chi‐square test was used for the comparison of a constituent ratio between the two groups. A significant difference was defined as P
