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A variety of herbs may be useful to treat the motor symptoms of PD as well as some of the associated symptoms or possible side effects from PD medications (14).

Ayurvedic Herbs

Mucuna pruriens is a natural plant, indigenous to India, which contains levodopa. It is also called kawach, cowage, cowhage, or velvet bean. It has been studied extensively and shown to reduce the motor symptoms of PD similar to carbidopa/lev-odopa (15). In fact, mucuna seeds have been prescribed by Ayurvedic physicians in India for over 4500 years to successfully treat PD. In 1936, levodopa was first isolated from the plant mucuna, but it was not until the discovery in the 1960s that dopamine deficiency in the brain was linked to PD that this herb was given international attention for its potential treatment of PD. However, the development of synthetic lev-odopa resulted in little use of mucuna outside of India (16). The herb has been developed and manufactured into a drug called HP200, which is a powder that is mixed with water just before ingestion. It has been studied in animals for safety, and when compared with the same amounts of synthetic levodopa, it has been found to be two to three times more potent or effective, meaning that lower doses of mucuna achieve the same results as with synthetic levodopa. No major adverse effects have occurred at high doses in animal studies (17,18). A subsequent study of 60 PD patients who took HP200 for three months showed significant improvement in the motor symptoms of PD with minimal side effects (19). HP200 under the name of Zandopar is approved for the treatment of PD in India.

Additional ayurvedic herbs that may be added to mucuna pruriens to support vata at its origin in the colon include moist laxatives such as psyllium (plantago psyllium), flaxeed (linum usitatissimum), and triphala. Rigidity may benefit from herbs that relax muscles such as jatamansi (nardostachys jatamansi) and shank pushpi (canscora dicussata). Depression may be treated with gotu kola (hydrocotyle asiatica) and St. Johns Wort (hypericum perforatum). If the pitta dosha is affected in addition to the vata, the herbs gotu kola and gaducci (tinospora cordifolia) may help cool and tonify the mind and reduce anger and stress.

Chinese Herbs

A number of herbs based upon the Chinese concept of PD would likely be prescribed and be tailored for the specific symptoms of the individual (14). Herbs that support liver and kidney function to replenish the deficient yin state thought to occur in PD are lycium fruit and ho-shou-wu. Supplemental herbs that might be added to these to boost yin are rehmannia, dioscorea, cornus, peony, tortoise shell, ligustrum, and achyranthes. Yang deficiency may also occur and would be treated with cistanche and cuscuta that would gently support yang while also benefiting yin. More advanced PD is thought to result from stagnation of the body fluids or phlegm obstruction of the channels (meridians and blood vessels) and would benefit from the herbs acorus, arisaema, and pinellia. Herbs to support blood circulation include ginseng, hoelen, atactylodes, licorice, rehmannia, tagkuei, peony, and cnidium all found in the Bazhen Tang formula. Specific symptoms such as tremor might be treated with the addition of gastrodia, uncaria, oyster shell, mother of pearl, or scorpion, whereas chaenomeles, peony, and magnolia bark would be prescribed to lessen rigidity.

Though there are no controlled, double blind studies on herbal therapies for the treatment of PD, several open label studies have reported a reduction in the motor symptoms of PD. One study reported 40 persons with PD treated with a standard herbal prescription (20 g of Ho-shou-we, 12 g of lycium, 12 g of cistanche, 15 g of gastrodia, 18 g of uncaria, 18 g cnidium, 10 g of acorus) (20). The standard herbal remedy was then altered with the addition of specific herbs according to the particular symptoms of the individual patient (i.e., magnolia bark, peony, and chaenome-les for rigidity). A tea with the herbs was made and ingested three times daily for three months and all prior Western dopaminergic medications were discontinued during the study. Only five patients (8%) were reported to be markedly improved and 15 (27%) reported some improvement in the motor symptoms of PD, whereas the remainder (65%) had little improvement, no improvement, or a worsening of PD symptoms. Guoshong (21) reported 32 persons with PD randomly assigned to receive the herbal remedy, Wengan Zhichan Jianonang at 2000 mg three times daily or carbidopa/levodopa for up to 12 weeks. There were no differences in motor symptoms between the two groups suggesting that the herbal therapy was as effective as the most potent conventional PD medication.

Specific herbs for some of the associated symptoms of PD include some of the following (5). Datura stramonium seeds provide anticholinergic effects and can reduce tremor and rigidity. Evening primrose oil (oenothera biennis) may lessen tremor by increasing bioavailability of levodopa. Ginger (zingiber officinalis) minimizes nausea and vomiting which may occur as a side effect from dopaminergic medications. Banisterine and Nicotiana tabacum both have monoamine oxidase inhibitor activity similar to that of selegiline and rasagiline, and thereby may enhance the activity by reducing the metabolism of naturally occurring endogenous dopamine as well as synthetic dopamine. Passion flower (passiflora incarnata) may lessen anxiety and insomnia as well as enhance sexual libido. St. John's Wart (hyper-icum perforatum) has been studied and shown to reduce symptoms of mild depression. Memory may improve with use of ginko biloba and constipation can be treated with triphala.

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