Before reading this chapter please start with the chapters:
First Concepts.
WOB is Optimal

Medicine tells us that  Parkinson's disease (PD) is a neurological syndrome resulting from a damage (necrosis) of the basal ganglia (substantia nigra) in the brain, initiating a deficiency of the neurotransmitter dopamine. PD is  initiated by a shortage of dopamine, and ought therefore be treated by dopamine replacement, with an analog called levodopa.

Medicine has only one therapeutic objective, dopamine replacement. Otherwise she has little to offer . A  simplistic approach to an intricate disease. Medicine ignores the main therapeutic objective, which  is to slow down disease progression! It will be illustrated  here with the aid of a simple model.

WOB controls dopamine production which is driven by a demand by  environment and mind (culture).

Environment drives dopamine demand in a variety of ways. During daytime, for instance, demand rises, and at  night it  declines. When demand is high, cell birth rate rises, death rate declines, and  dopamine pool increases. When demand declines birth rate diminishes, death rate rises, and the pool diminishes. Dopamine demand is the only stimulus for dopamine production.

Mind is the site of our will.  One day  it decides to become an athlete and instructs WOB to build more muscle  (hypertrophy)  which requires more dopamine. Each neuron raises its production rate and when attaining maximal  capacity new neurons are formed, and cell birth rate rises. Since death rate does not change, neuron population rises (hyperplasia).

During prolonged diminished activity WOB reduces muscle mass (hypotrophy), and dopamine demand declines. Superfluous neurons die,  death rate rises, birth rate declines, and  cell pool shrinks (hypoplasia),  When production meets the new demand, birth rate equals death rate


WOB controls all processes and adjusts them to meet the demand of the organism, constrained by environment and mind. When it gets cold WOB turns the heat  on , and vice versa.  WOB responds  also to the mind, which receives signals and directives from society (culture). The adjustment of  processes at any instant is called WOB solution.  It is always the most optimal solution in the given circumstances.

Acute Injury

Injury destroys cells (necrosis), death rate rises, and production declines. WOB lets the remaining cells live longer, so that their death rate declines. As long as demand for dopamine is not met, new cells are formed, birth rate rises,  cell pool increases, and production rises. Once production meets the requirements of the body,  birth rate equals death rate and cell pool does not change.

Chronic injury

The main causes  of chronic injury are infection and reduced blood flow (ischemia due to arteriosclerosis), like in  elderly individuals and diabetics. Initially WOB responds like in acute injury, yet the outcome depends on the relationship between cell birth and death. Ischemia kills cells and so raises death rate. WOB may raise birth rate to a certain extent, however it cannot replenish an extensive cell loss and  dopamine production  declines. It has to be stressed that even in chronic damage new cells are formed, however birth rate  does not cope with  death rate.

Chronic injury proceeds through three phases:

1. Full compensation, when cell birth and death rates are high and equal.
Decompensation, when cell birth and death rates are high and death rate exceeds birth rate.
3. Total dopamine loss (aplasia) when no cells are formed.

Decompensation is manifested clinically as Parkinson’s disease. Total dopamine loss (aplasia) results in dyskinesia.

Compensated chronic deficiency

When less dopamine is produced than the body needs, WOB initiates a slight tremor.  Tremor is neither a pathology nor a disease. It is the most optimal solution which  WOB arrived at.  At this stage, when patient sleeps and mind stops bogging  WOB down, tremor disappears.  A sleeping motor system needs less  dopamine.


Tremor is also a WOB message to the mind as if saying: "My dopamine reserves are slightly  depleted, cut down your motor activity  otherwise  I shall have to respond with tremor".  Yet mind does not want to yield.  Social responsibilities demand that  business  be as usual,  and mind  takes  levodopa   Since demand for dopamine is met  tremor disappears.  The external supplement   reduces the demand for internal dopamine production. Cell death rises, cell birth declines, and cell pool also declines. The price for tremor removal is a decline of  internal dopamine production.

All processes respond  to an external supply of resources in the same way. Like when a patient is confined to  bed for a long time. Her daily effort is smaller and WOB removes some of her muscle fibers. Muscle cell death rises and muscle cell birth declines. Finally patient remains with less muscles. A similar response of a patient with ischemic angina is described elsewhere. WOB boosting. Angina pectoris

As chronic injury proceeds dopamine cell pool declines. Since getting levodopa, cell birth is smaller than  in an untreated patient.  Internal  dopamine reserve is smaller than that of a healthy patient. Since PD is an ongoing decline of dopamine reserves, levodopa speeds PD progression to the state of dyskinesia.

Quality of life

What WOB regards as an  optimal solution, may not meet the patient’s expectation. He (mind) demands a good life, and  gets from his doctor  the desired pill. However levodopa has a disadvantage which cannot be ignored. Since suppressing internal dopamine production internal dopamine reserve declines.  On the other hand levodopa effectiveness depends on internal dopamine reserves. As they dwindle so does levodopa effect. In other words, levodopa speeds PD progression and should be taken with  a great care. Physician’s task is to work out a compromise between WOB solution and mind demand for a better life.

WOB-PD and Mind-PD

We have to distinguish between two aspects of  PD. A declining  production which is handled by WOB, and  called WOB-PD, and a demand for a better life, called Mind-PD. Physician can do little to assist WOB which knows best how to handle  declining resource. His main task is to assist the mind. Social and cultural pressure on the patient increases her misery, which has nothing to do with the  chronic  injury from which she suffers. Her misery is product of the mind ,  or Mind-PD, which ought to be the main concern of the physician.


First he ought to turn his attention to patients whose PD progresses slowly. They know how to live with PD in good health, and are called here PD-yogis. What is their secret and how to apply it to other patients?  It is striking that during sleep tremor vanishes, which indicates that  WOB manages well without assistance. One wonders what other conditions may enable the patient (WOB) to reduce tremor?


A meditating  patient may attain a sleep like condition while maintaining his full consciousness.  His muscles relax, heart beats slower, and  so is breathing.  Dopamine demand declines, and tremor vanishes. Meditation has yet another advantage. Patient learns how to ignore his mind with all this noise generated by society and culture. Meditation reduces the demand for dopamine.  It introduces the patient to a new life. From now on his  mission is to be a PD-Yogi.


Is risky, however  has many advantages. Body building  is not desired since it increases dopamine demand. Aerobic exercises may be very helpful, since  organism learns how to conserve oxygen and utilize less dopamine. Aerobics improve blood circulation, and may  alleviate  local ischemia which kills neurons and depletes dopamine.


Is effective for treating Mind-PD.  When patient demands levodopa treatment at all cost, he may benefit from  interleaving placebo pills between the real stuff (v. Placebo)

Cerebral blood flow

PD is first of all a pathology of the brain. Dopamine is required by neurons which control muscle activity. As it become less and less available, it might be therapeutically redistributed so that some neurons receive more and other less.  For instance, by supplying more dopamine to neurons which control facial muscles, tremor and rigidity of the face might be reduced.

When a muscle is activated, brain neurons controlling it get more blood. When I laugh neurons controlling my laughter get more blood . One wonders whether it might be possible to divert blood to neurons controlling facial muscles by activating other muscles?  This might be achieved with Tai  Chi and Chi Gong.

Chinese Mind-Body Exercises.

Ancient Chinese martial arts, Tai Chi, and Chi Gong help improve balance, strength and body awareness. Tai Chi is described as meditation in movement using controlled breathing combined with a slow and precise flow of body postures.  Chi Gong, is described as meditation in stillness during which participants learn to better control their movements through directed visualization (imagery), meditation and controlled breathing.

Like sport these exercises are risky and the patient has to be closely monitored. They may be applied to bolster a 'Slow is chic' attitude.  Thai Chi is like in a slow dance. It gradually activates different muscles. One wonders what might be the choreography  which enhances blood flow in  neurons controlling facial muscles, enabling the patient to laugh again.

Terra incognita

These examples illustrate the vast treatment potential of the so called alternative medicine, which ought to be examined scientifically.  How to evaluate  effectiveness of these treatments? Two indicators might suffice: Whether they reduce tremor or rigidity, and whether patient feels better.

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