Abstract
Background:
Managing multiple symptoms in home-based palliative care (HBPC) is challenging. Acupuncture and herbal medicine have been widely used to alleviate symptoms in patients with cancer receiving palliative care, but their role in HBPC for nonmalignant diseases such as Parkinson’s disease (PD) remains underexplored.
Case Presentation:
We report the case of an 86-year-old woman with end-stage PD who received HBPC. She suffered from seborrheic dermatitis, constipation, and dyspnea, which significantly impaired her quality of life. Conventional treatments provided limited relief, prompting the integration of acupuncture and herbal medicine as complementary therapies. Over a two-month HBPC period, she experienced notable symptom improvement, including alleviation of skin conditions, relief from constipation, and reduction in dyspnea. Notably, acupuncture was administered until her final moments, contributing to a peaceful and comfortable end of life without severe respiratory distress.
Conclusion:
This case suggests that acupuncture and herbal medicine may serve as valuable adjunctive therapies for managing symptoms in patients with PD receiving HBPC. Notably, their integration into end-of-life care may help alleviate terminal dyspnea and support a peaceful death. These findings warrant further research and policy support to establish their role in palliative care for neurodegenerative diseases.
Keywords
Introduction
Home-based palliative care (HBPC) is cost-effective and provides comprehensive symptom management while increasing the likelihood of home-based death. 1 Although most patients receiving HBPC prefer to die at home, many are unable to do so. 2 Effective symptom management is associated with a higher likelihood of home-based death. 3 Acupuncture has been reported to significantly improve symptoms that impact the quality of life of terminally ill patients, such as pain, fatigue, nausea, depression, anxiety, and dyspnea. 4
Parkinson’s disease (PD) is a progressive neurodegenerative disorder that affects motor function and causes various nonmotor symptoms, including autonomic dysfunction. 5 Seborrheic dermatitis (SD), constipation, and dyspnea are common but often overlooked symptoms in palliative care settings. SD affects approximately 60% of patients with PD and is linked to autonomic dysfunction and alterations in skin microbiota. 6 PD-related constipation (PDC) is associated with impaired gut–brain axis function and autonomic dysregulation. 7 Dyspnea in PD, though less recognized, is thought to result from central respiratory dysfunction and rigidity of respiratory muscles. 8
Although palliative care has traditionally focused on patients with cancer, there is growing interest in its application to neurodegenerative diseases like PD. 9 HBPC offers a viable strategy for patients with PD, 10 yet evidence-based pharmacological treatments for nonmotor symptoms remain limited. 11 Multidisciplinary approaches, including nonpharmacological interventions, are crucial for effective symptom management. 12 Acupuncture and herbal medicine have demonstrated efficacy in managing symptoms such as fatigue, pain, nausea, vomiting, insomnia, and constipation in patients with terminal cancer.13,14 However, research on their application in HBPC for nonmalignant diseases like PD is scarce. This case report highlights the use of acupuncture and herbal medicine in an HBPC setting for a patient with PD, illustrating their potential role in symptom relief and end-of-life care.
Case Presentation
In December 2022, an 86-year-old woman with PD was referred to an HBPC team comprising a doctor of Traditional Korean Medicine, nurses, and a social welfare worker. Her caregiver, her daughter, expressed concerns about her deteriorating health despite prolonged hospitalization and sought home care with the hope of allowing her to die at home.
The patient had been diagnosed with frontotemporal dementia eight years earlier and PD five years earlier. Due to severe cognitive decline, she had been unable to recognize family members or communicate verbally for two years. She was bedridden and in a near-continuous drowsy state. Her comorbidities included hypertension, diabetes mellitus, dyslipidemia, and a history of myocardial infarction. Medication (diltiazem, bisoprolol, amlodipine, rosuvastatin, donepezil, levodopa/benserazide, and magnesium oxide) adherence was poor, complicating the management of her conditions. Her primary symptoms included dyspnea, dysphagia, constipation, pruritus with skin rashes, oral ulcers, xerostomia, and generalized joint contractures. From December 2022, she received monthly acupuncture and herbal medicine treatment by a visiting Traditional Korean Medicine doctor and weekly nursing visits.
Acupuncture (GB41, SI3, BL66, and SI2) and the application of Jaungo ointment alleviated her skin rash and pruritus. Constipation, which had previously persisted for up to 15 days, was significantly improved following acupuncture (ST36, LI11, SI5, and LI5) and herbal medicine (Yoonjangsungi-hwan). Dyspnea, which was intermittently present throughout HBPC, was managed with acupuncture (SP3, LU9, HT8, and LU10).
On February 28, 2023, she presented with worsened fatigue, pallor, and irregular deep breathing. Her blood pressure was 134/72 mmHg, heart rate 71 bpm, temperature 36.6°C, oxygen saturation 88%, respiratory rate 28 breaths/min, and blood glucose 408 mg/dL. An emergency home visit was conducted a few hours later, revealing a further deterioration in vital signs, though cyanosis was absent. Acupuncture was administered, stabilizing her breathing. However, dyspnea recurred the next day, prompting another emergency home visit. The patient’s blood pressure was 110/74 mmHg, heart rate 140 bpm, and oxygen saturation 99%, with a respiratory rate of 34 breaths/min. Acupuncture was performed, and the caregiver was educated on recognizing signs of impending death as well as on after-death procedures, including actions to take at the time of death, legal death notification, and funeral arrangements. Compared with February 28, her breathing after March 1 gradually became shallower and less frequent, with no signs of apparent distress. Rather than an immediate response, her breathing appeared to stabilize progressively over several hours following acupuncture. The next day, the caregiver reported that the patient had stopped breathing without any noticeable symptoms. A final home visit confirmed death, with a body temperature of 34.2°C and no measurable vital signs.
Regarding pruritus and rash, the caregiver recalled that during the final days, the patient no longer complained of itching and that her skin had visibly cleared. Objectively, after application of Jaungo and acupuncture, scratching behavior and papules on the palms and neck were reduced, and the clinical record on December 30 noted “improvement in pruritus.”
For constipation, the caregiver stated that after taking Yoonjangsungi-hwan, the patient had regular, well-formed bowel movements without diarrhea, describing the outcome as “very good.” Objectively, following the prescription on January 19, clinical notes recorded large, well-formed stools, with repeated entries such as “constipation improved” and “bowel movements maintained.”
For dyspnea, the caregiver reported that, unlike February 28, the patient did not gasp or appear distressed after the acupuncture session on March 1. Objectively, on March 1, her respiratory rate was elevated at 34 breaths/min but remained regular; oxygen saturation was stable at 99%, with no signs of cyanosis or irregular breathing.
A follow-up caregiver interview in February 2025 revealed that the family had not expected substantial improvement from acupuncture and herbal medicine, as they believed their mother had already reached the terminal stage with no possibility of recovery. The caregiver shared that, having seen a few terminal patients struggle with breathing, they initially expected their mother to experience similar distress during the dying process. However, they observed that their mother did not go through such distress. The caregiver expressed deep reassurance, stating, “If I could die as peacefully as my mother did, I would no longer fear death.”
Discussion and Conclusions
In this case report, the patient experienced distressing symptoms, including pruritus with skin rash, constipation, and dyspnea, during the HBPC period. These symptoms are commonly observed in elderly or terminally ill patients, but in this particular case, they may have been exacerbated by PD and poorly controlled hyperglycemia, which contributed to autonomic dysfunction. Acupuncture and herbal medicine appeared to alleviate these symptoms, suggesting that they could serve as complementary treatments for symptom management in palliative care. Moreover, since acupuncture and herbal medicine were administered until the patient’s final moments at home, this case report provides insight into their potential role in symptom relief and peaceful end-of-life care.
Skin rash and pruritus
The patient’s skin rash and pruritus were possibly influenced by both PD-related autonomic dysfunction and diabetic neuropathy, which can impair sweat gland function, disrupt the skin barrier, and alter sensory nerve activity.6,15–17 These pathologies may result in sebum imbalance and neurogenic itch. Acupuncture, employed in this case, has been shown to alleviate pruritus through multiple mechanisms: activation of peripheral sensory nerves and endogenous opioids (such as β-endorphins), inhibition of histamine receptors, and suppression of inflammatory cytokines, including tumor necrosis factor-alpha and interleukin-4.18,19 These mechanisms are consistent with both neurogenic and inflammatory causes of itching. The specific acupuncture points used (GB41, SI3, BL66, SI2, LI11, and ST36) have been reported to be effective in treating atopic and uremic pruritus.20–22 In addition, Jaungo ointment—composed of Lithospermum erythrorhizon and Angelica sinensis—may support restoration of damaged skin by exerting anti-inflammatory and regenerative effects,23–25 potentially modulating immune cell activity and aiding skin barrier repair. Taken together, the observed improvement in this patient’s pruritus and rash may be attributed to therapeutic mechanisms that directly correspond to the underlying autonomic and neuroinflammatory pathophysiology.
Constipation
Constipation in patients with PD and diabetes is often multifactorial. In this case, it is possible that enteric dopaminergic neuron degeneration and gut–brain axis dysfunction played a major role, leading to autonomic dysregulation of intestinal motility.7,26,27 Acupuncture has been shown to improve constipation by stimulating the autonomic nervous system and regulating gastrointestinal hormones such as motilin and gastrin.28–31 Notably, clinical studies have reported increased bowel frequency and improved stool consistency in patients with PDC following acupuncture. Additionally, the herbal prescription Yoonjangsungi-hwan, used in this case, contains Rhei Rhizoma, Persicae Semen, and Cannabis Semen, which promote peristalsis and inhibit water reabsorption through colonic mucosal action. 32 Similar formulas, including Mazirenwan, have demonstrated superior efficacy to senna in enhancing bowel movement frequency and stool form.32–34 These interventions appear to act via complementary neural and pharmacologic pathways to address the specific pathophysiologic mechanisms underlying PD- and diabetes-associated constipation.
Dyspnea
Dyspnea is a prevalent yet often underrecognized symptom in patients with PD, affecting up to 40% of individuals. 8 Its underlying mechanisms are multifactorial, involving central respiratory dysregulation, rigidity of respiratory muscles, altered perception of breathlessness, and side effects of dopaminergic therapy. 35 In this case, the patient’s dyspnea may have been exacerbated in the terminal stage by metabolic acidosis secondary to severe hyperglycemia (glucose 408 mg/dL), 36 contributing to an abnormal respiratory pattern resembling Cheyne–Stokes respiration (CSR). CSR is characterized by alternating periods of apnea and crescendo–decrescendo breathing and is frequently observed in end-of-life conditions, especially those involving brainstem dysfunction or metabolic imbalance. 37
Acupuncture has been shown to alleviate dyspnea by reducing intercostal muscle tension, modulating respiratory perception in the central nervous system, and lowering anxiety levels.38,39 These mechanisms are particularly relevant in palliative care, where nonpharmacologic options are often necessary due to reduced systemic tolerance. Although acupuncture may not directly reverse metabolic acidosis or fully resolve CSR, it can help reduce the somatic and psychological burden of dyspnea.40,41 Previous studies suggest that CSR-like breathing in the dying process can cause considerable distress to caregivers, who may later experience guilt or emotional trauma related to the perception of suffering.
In this case, acupuncture was administered during repeated episodes of labored breathing. The patient’s caregiver later reported that she died “without gasping or visible distress,” suggesting that the intervention may have contributed to a calmer respiratory pattern and greater emotional comfort. Thus, acupuncture may serve not only as a supportive therapy for patients experiencing neurodegenerative respiratory dysfunction but also as a tool for mitigating caregiver distress at the end of life.
Feasibility of home-based acupuncture and herbal interventions
Home-based acupuncture and herbal medicine may face accessibility limitations in some regions due to workforce and institutional constraints. However, previous studies have reported successful applications of such therapies in various settings. It has been reported that terminal patients with cancer receiving home-based acupuncture in a hospice program experienced relief in pain, nausea, and anxiety, along with improved quality of life. 4 A qualitative study from Europe also found that inpatient hospice patients reported reduced physical, emotional, and spiritual distress through acupuncture. 42
According to the 2007 National Home and Hospice Care Survey by the Centers for Disease Control and Prevention, 41.8% of hospice agencies offered complementary and alternative medicine (CAM) services, and about 25% of patients used them. 43 However, most CAM services were limited to massage, music therapy, and spiritual care, with fewer cases involving acupuncture or herbal medicine.
These findings suggest that while demand exists, broader clinical use of such therapies requires trained personnel, stronger evidence of effectiveness, and institutional and public support.
In conclusion, this case report highlights the potential role of acupuncture and herbal medicine in the HBPC of a patient with end-stage PD. The patient experienced improvements in SD, constipation, and dyspnea, which contributed to enhanced comfort in her final days. Notably, the acupuncture and herbal interventions appeared to support a peaceful dying process, an aspect particularly valued in palliative care. HBPC incorporating acupuncture and herbal medicine may serve as a complementary approach to improving symptom management and quality of life in terminally ill patients. This case also suggests that integrative HBPC models may provide psychological and emotional reassurance for families seeking a peaceful home-based death for their loved ones. Further research is needed to systematically evaluate the efficacy of acupuncture and herbal medicine in HBPC settings, particularly for nonmalignant diseases such as PD. Policy initiatives should consider supporting integrative approaches in palliative care to optimize symptom management and enhance the end-of-life experience for patients and caregivers alike.
Authors’ Contributions
H.B. treated the patient in this case. H.J., H.B., and M.-H.K. conceptualized the idea for this article. K.-H.K. and M.-H.K. drafted the article, while H.J. H.B. reviewed it. All authors read and approved the final article.
Footnotes
Acknowledgment
We would like to express our gratitude to Hyun Suk Lee (nurse) and Min-Ji Jeong (social welfare worker) for their dedicated efforts in caring for the patient in this case.
Author Disclosure Statement
The authors declare they have no competing interests.
Funding Information
This research was supported by the Regional Innovation System & Education (RISE) initiative, funded by the Ministry of Education and administered by the National Research Foundation of Korea (NRF).
Ethics Approval and Consent to Participate
The Research Ethics Committee at Woosuk University Medical Center waived the institutional review board’s (IRB) review for this case report on February 20, 2025 (WSOH IRB 2502-02).
Consent for Publication
Written informed consent was obtained from the patient’s daughter, her next of kin and medical treatment decision maker, for publication of this case report.
Data Availability
The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.