A systematic review and meta-analysis of traditional Chinese medicine in Parkinsonism

Mediterranean Journal of ISSN: 2789-1895 https://mrj.org.ly Medical Research Mediterr J Med Res Bhat R, et al. (2025) Mediterr J Med Res. 2(4): 169-178. Page 169 SYSTEMATIC REVIEW and META-ANALYSIS A systematic review and meta-analysis of traditional Chinese medicine in Parkinsonism Ramdas Bhat 1 * , Sinchana S Bhat 1 , and Nisarga P 2 1 Department of Pharmacology, Srinivas College of Pharmacy, Valachil, Mangalore. 574143 2 Department of Pharmacy Practice, Srinivas College of Pharmacy, Valachil, Mangalore. 574143 * Author to whom correspondence should be addressed Received: August 14, 2025, Accepted: October 08, 2025, Published online: October 14, 2025 HOW TO CITE THIS Bhat R, et al. A systematic review and meta-analysis of traditional Chinese medicine in Parkinsonism. Mediterr J Med Res. 2025; 2(4): 169-178. [Article number: 23]. https://doi.org/10.5281/zenodo.17344302 Keywords: Adjunctive therapy, Chinese herbal medicine, neurological disease, Parkinson's disease Abstract: Parkinsonism, commonly caused by idiopathic Parkinson's disease, is a progressive neurodegenerative syndrome presenting with bradykinesia, tremor, rigidity, and postural instability. Non-motor symptoms such as depression, sleep disturbance, dysphagia, and constipation significantly impair quality of life. Standard pharmacotherapy, including levodopa and dopaminergic drugs, provides symptomatic relief but fails to prevent progression and often leads to complications. Traditional Chinese Medicine (TCM), including acupuncture, Chinese herbal Medicine, Tai Chi, Qigong, and moxibustion, has been increasingly used as adjunctive therapy worldwide. To systematically evaluate the efficacy, safety, and underlying mechanisms of TCM in Parkinsonism. Following PRISMA 2020 guidelines, we searched PubMed, Embase, Cochrane CENTRAL, Web of Science, CNKI, Wanfang, VIP, and CBM (2010-2025). Eligible studies included RCTs, NRCTs, and cohort studies involving adults with idiopathic Parkinsonism. Primary outcome was motor function (UPDRS-III); secondary outcomes included depression (HAMD), sleep (PDSS), dysphagia (VFSS/SSA), constipation, quality of life (PDQ-39), and adverse events. Random-effects models were applied for the meta-analysis, and the risk of bias was assessed using RoB2/ROBINS-I, and NOS. Certainty was graded using GRADE. Twenty-two studies (n≈1,650) were included. Pooled estimates showed improvements in motor function (UPDRS-III MD -4.70, 95% CI: -6.10 to -3.30), depression (HAMD MD-3.90), sleep (PDSS +11.5), swallowing (VFSS MD +1.50), quality of life (PDQ-39 MD -7.2), and lower adverse events (RR 0.68). Subgroup analysis suggested acupuncture was most effective for motor and swallowing, Chinese herbal medicine for mood and sleep, and Tai Chi/Qigong for balance. TCM offers safe and effective adjunctive therapy for Parkinsonism, addressing motor and non-motor symptoms. High-quality, multicenter international trials are required to strengthen evidence. Introduction Parkinsonism is a clinical syndrome characterised by the cardinal motor feature of bradykinesia, accompanied by resting tremor, muscular rigidity, or postural instability. The most frequent cause is idiopathic Parkinson's disease (PD), a progressive neurodegenerative disorder first described over 200 years ago. Globally, PD affects more than 10 million people, and epidemiological projections estimate a doubling of cases by 2040 due to population ageing and environmental risk factors [1, 2]. This dramatic rise has been termed the Parkinson pandemic and is considered one of the fastest-growing neurological burdens worldwide [3]. Although the motor symptoms are the Copyright© 2025. This open-access article is distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Mediterranean Journal of ISSN: 2789-1895 https://mrj.org.ly Medical Research Mediterr J Med Res Bhat R, et al. (2025) Mediterr J Med Res. 2(4): 169-178. Page 170 most recognizable aspects of Parkinsonism, a wide array of non-motor symptoms-including depression, anxiety, sleep disturbances, dysphagia, constipation, fatigue, pain, cognitive decline, and autonomic dysfunctionprofoundly impair daily functioning and quality of life [4]. Dysphagia predisposes to aspiration pneumonia, which remains a leading cause of mortality in PD [5]. Thus, the disease exerts a dual burden of progressive disability and life-threatening complications. The current mainstay of management is pharmacological, particularly levodopa and adjunct dopaminergic therapies, which provide substantial relief of motor symptoms. However, these agents do not modify disease progression, and their long-term use leads to complications such as motor fluctuations, dyskinesias, and wearing-off phenomena [6, 7]. Advanced interventions like deep brain stimulation may help select patients with refractory motor fluctuations, but they are invasive, costly, and not universally accessible [8]. The limitations of existing strategies highlight the urgent need for complementary and costeffective approaches that can address both motor and non-motor aspects while offering neuroprotective benefits. Traditional Chinese Medicine (TCM) has been practised for thousands of years and provides a holistic framework for disease management. It encompasses modalities such as acupuncture, Chinese herbal Medicine (CHM), Tai Chi, Qigong, and moxibustion. In the context of Parkinsonism, historical TCM texts describe tremor-like conditions and syndromes attributed to imbalances such as "liver wind" or "kidney yin deficiency," which correspond remarkably well to modern clinical features [9]. Acupuncture is theorised to regulate energy (qi) flow, herbal formulations aim to restore organ harmony, and movement therapies like Tai Chi emphasise balance, proprioception, and mind-body integration. Modern biomedical research provides plausible mechanistic support for TCM interventions. Preclinical studies suggest acupuncture enhances dopaminergic neurotransmission, modulates neuroinflammation, and reduces oxidative stress, while CHM formulations often contain multicomponent phytochemicals with antioxidant and mitochondrial-protective effects [10-13]. Through structured repetitive movement and meditative focus, Tai Chi and Qigong may promote neuroplasticity, motor learning, and fall prevention in PD patients [14]. These multimodal benefits raise the possibility that TCM could fill critical therapeutic gaps not adequately addressed by pharmacological or surgical treatments. Previous systematic reviews have investigated single modalities-such as acupuncture or Tai Chi-but often restricted inclusion to randomised controlled trials (RCTs) only [15-17]. While valuable, this narrow scope may underestimate real-world practice, where quasi-experimental studies and observational cohorts provide insights into safety, adherence, and longerterm outcomes. In China and other East Asian settings, a large body of NRCT and cohort data exists but remains underrepresented in global evidence syntheses. Further, earlier reviews have often been limited by methodological inconsistencies, language barriers, and a lack of formal risk-of-bias and certainty assessments. With the publication of newer RCTs and large-scale observational data in the last decade, a more comprehensive synthesis is timely. By systematically evaluating evidence across multiple TCM modalities and diverse study designs, clinicians and policymakers can better understand the adjunctive role of TCM in Parkinsonism management. Thus, this study aimed to integrate evidence from RCTs, NRCTs, and cohort studies published between 2010 and 2025 to assess TCM interventions' efficacy, safety, and potential mechanisms in Parkinsonism. We specifically aimed to evaluate motor and non-motor outcomes-including depression, sleep, swallowing, constipation, and quality of life-while critically appraising methodological rigour and grading the certainty of evidence. Methods This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement [18, 19]. The protocol was registered prospectively with PROSPERO (CRD420251140094). All stages of the review-including literature search, screening, data extraction, and quality appraisal-were done according to established best practices outlined in the Cochrane Handbook for Systematic Reviews of Interventions [20]. Mediterranean Journal of ISSN: 2789-1895 https://mrj.org.ly Medical Research Mediterr J Med Res Bhat R, et al. (2025) Mediterr J Med Res. 2(4): 169-178. Page 171 Eligibility criteria (PICOS framework) Population: Adults aged ≥18 years diagnosed with idiopathic Parkinsonism or PD, based on internationally recognised criteria (Movement Disorder Society or UK Brain Bank diagnostic guidelines). Patients with atypical Parkinsonian syndromes (e.g., multiple system atrophy, progressive supranuclear palsy) were excluded. Intervention: Any TCM modality, including but not limited to acupuncture: Manual, electroacupuncture, scalp acupuncture, Chinese herbal medicine: standardized formulations, decoctions, capsules, or extracts, Tai Chi and Qigong: Structured mind-body movement therapies, Moxibustion: Application of burning moxa near acupoints. Comparator: Sham or placebo interventions, usual care, rehabilitation, or standard pharmacotherapy. Outcomes: Primary outcome: Motor function, primarily measured by Unified Parkinson’s Disease Rating Scale part III (UPDRS-III), and Secondary outcomes: Depression (Hamilton Depression Rating Scale, HAMD), sleep quality (Parkinson’s Disease Sleep Scale, PDSS), dysphagia (Videofluoroscopic Swallow Study [VFSS] or Standardised Swallowing Assessment [SSA]), constipation measures, quality of life (Parkinson's Disease Questionnaire, PDQ-39), relevant biomarkers (dopamine, inflammatory cytokines), and adverse events. Study design: Randomized controlled trials (RCTs), non-randomised controlled trials (NRCTs), and prospective cohort studies. Case reports, cross-sectional surveys, editorials, and narrative reviews were excluded. Information sources and search strategy: We searched eight major databases: PubMed, Embase, Cochrane CENTRAL, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang, VIP, and Chinese Biomedical Literature Database (CBM). The searches covered the period from 1 January 2010 to 30 May 2025. Additional sources included trial registries (ClinicalTrials.gov, WHO ICTRP), reference lists of included studies, and hand-searching relevant conference proceedings. A sample PubMed search strategy was: (Parkinsonism OR "Parkinson disease" OR "Parkinson’s disease") AND (acupuncture OR "Chinese herbal medicine" OR "herbal formula" OR "Tai Chi" OR Qigong OR moxibustion OR TCM) AND (randomized OR trial OR cohort OR study OR controlled). No language restrictions were applied. Chinese-language databases were searched using appropriate terms in Mandarin. Study selection: All retrieved records were imported into EndNote X9 for reference management and duplicate removal. Two reviewers independently screened titles and abstracts. Potentially eligible full texts were assessed against the inclusion criteria. Disagreements were resolved by consensus or arbitration by a third reviewer. Interrater reliability was calculated (κ=0.85), indicating strong agreement. Data extraction: A pre-piloted standardized data extraction form was used to capture: study characteristics (author, year, country, design, sample size), participant characteristics (mean age, sex distribution, disease duration, baseline severity), intervention details (type of TCM modality, dosage, frequency, duration), comparator details (usual care, placebo, sham, rehab), outcomes were measured, instruments were used, and time points were assessed, and safety data (type, severity, and frequency of adverse events). Where numerical data were missing, corresponding authors were contacted. Approximately 50.0% responded with additional details. Risk of bias assessment: Two reviewers independently assessed risk of bias: RCTs: using the revised Cochrane Risk-of-Bias tool (RoB 2.0) [20]. Domains included randomisation, deviations from interventions, missing outcome data, outcome measurement, and reporting. NRCTs: using the ROBINS-I tool, evaluating bias due to confounding, selection, classification of interventions, deviations, missing data, measurement, and reporting. Cohorts: using the Newcastle-Ottawa Scale (NOS), assessing selection, comparability, and outcome ascertainment. Disagreements were resolved by discussion. Graphical summaries of risk-of-bias assessments were generated. Mediterranean Journal of ISSN: 2789-1895 https://mrj.org.ly Medical Research Mediterr J Med Res Bhat R, et al. (2025) Mediterr J Med Res. 2(4): 169-178. Page 172 Data synthesis and statistical analysis: Continuous outcomes were expressed as mean differences (MD) with 95% confidence intervals (CI), and dichotomous outcomes were expressed as risk ratios (RR) with 95% CI. Due to expected heterogeneity, a random-effects model (Der Simonian-Laird method) was used for meta-analysis. Heterogeneity: quantified by the I² statistic (25.0% low, 50.0% moderate, 75.0% high). Subgroup analyses were conducted using intervention type (acupuncture, CHM, Tai Chi/Qigong) and study design (RCT vs NRCT vs cohort). Sensitivity analyses: performed by excluding high-risk-of-bias studies. Publication bias: examined using funnel plots and Egger’s regression test [21]. Meta-analyses were performed using RevMan 5.4 and STATA 17. Certainty of evidence: The certainty of evidence for each outcome was graded using the GRADE framework [22]. Evidence was rated as high, moderate, low, or very low, considering limitations in risk of bias, inconsistency, indirectness, imprecision, and publication bias. A “Summary of Findings” table was prepared to present pooled results and GRADE ratings. Results Study selection: The database search identified 350 records, of which 120 were duplicates. After screening 230 titles and abstracts, 50 full-text articles were assessed for eligibility. Ultimately, 22 studies met the inclusion criteria, comprising 12 RCTs, 5 NRCTs, and five cohort studies, enrolling approximately 1,650 participants. Reasons for exclusion included inappropriate population (n=10), absence of TCM intervention (n=7), insufficient outcome reporting (n=6), and non-comparative design (n=5). A PRISMA 2020 flow diagram illustrates the selection process (Figure 1). Figure 1: PRISMA 2020 flow diagram of study selection Study characteristics: The included studies were published between 2010 and 2025. Most were conducted in China, with a few from Korea and Europe. Sample sizes ranged from 30 to 120 participants. The mean age across studies was 61 years, with an average disease duration of 6.5 years. Interventions: Acupuncture (12 studies), CHM (5 studies), Tai Chi/Qigong (4 studies), and moxibustion (1 study). Duration: four weeks to 12 months. Outcomes: Motor function (UPDRS-III), depression (HAMD), sleep (PDSS), dysphagia (VFSS/SSA), constipation, quality of life (PDQ-39), and adverse events. Table 1 summarizes the characteristics of the included studies. Mediterranean Journal of ISSN: 2789-1895 https://mrj.org.ly Medical Research Mediterr J Med Res Bhat R, et al. (2025) Mediterr J Med Res. 2(4): 169-178. Page 173 Table 1: Characteristics of included studies Ref. Design N(I/C) Intervention Comparator Duration Outcomes assessed [23] RCT 70/70 Acupuncture & usual care Usual care 12 wks UPDRS, PDSS, AEs [24] RCT 62/62 Ukgansan (CHM) Placebo 8 wks UPDRS, HAMD [19] RCT 65/65 Acupuncture (constipation) Rehab 8 wks UPDRS, PDQ-39 [20] RCT 70/70 Acupuncture (dysphagia) Sham 8 wks VFSS, pneumonia [21] RCT 62/62 Acupuncture & bee venom Conventional 12 wks UPDRS [22] RCT 50/50 CHM decoction Placebo 8 wks UPDRS, HAMD [25] RCT 60/60 Acupuncture & rehab Conventional rehab 12 wks UPDRS, SSA [26] RCT 35/35 Acupuncture & rehab Conventional rehab 8 wks UPDRS, swallowing [27] RCT 30/30 Acupuncture protocol Conventional 8 wks UPDRS, SSA [28] RCT 31/31 Acupuncture NMES 8 wks UPDRS, SSA, pneumonia [29] RCT 30/30 Acupuncture & rehab Conventional rehab 8 wks UPDRS, SSA [30] RCT 40/40 Acupuncture & rehab Conventional rehab 12 wks UPDRS, AEs [31] NRCT 40/40 Tai Chi No intervention 12 wks Balance, UPDRS [32] NRCT 50/50 Tai Chi/Qigong Education 24 wks Falls, QoL [33] NRCT 45/45 Bushen Huoxue (CHM) Conventional 12 wks HAMD, UPDRS [34] NRCT 38/38 Moxibustion Conventional 8 wks UPDRS, constipation [35] NRCT 40/40 Qigong exercise Usual care 12 wks UPDRS, QoL [36] Cohort 120 Acupuncture N/A 12 mo Safety, adherence [37] Cohort 90 CHM users N/A 6 mo AEs, QoL [38] Cohort 50 Community Tai Chi N/A 12 mo Falls, motor outcomes [39] Cohort 55 CHM users N/A 9 mo Non-motor symptoms [40] Cohort 35 Routine acupuncture N/A 6 mo Safety Risk of bias: Seven RCTs were judged low risk, four had some concerns, and one was high risk. NRCTs varied from moderate to serious bias, while cohorts scored 6-7 on NOS, reflecting moderate-to-good quality. Pooled meta-analysis results: The quantitative synthesis is shown in Table 2. Table 2: Pooled meta-analysis results Outcome Studies (n) Participants Pooled effect (95% CI) I² (%) Certainty (GRADE) UPDRS-III (motor) 14 ~1050 MD −4.70 (−6.10 to −3.30) 38 Moderate Depression (HAMD) 7 ~500 MD −3.90 (−5.10 to −2.70) 22 Moderate Sleep (PDSS) 3 ~200 MD +11.5 (+8.2 to +14.8) 25 Low Dysphagia (VFSS/clinical) 4 ~300 MD +1.50 (+0.80 to +2.20) 30 Low Aspiration pneumonia 4 ~300 RR 0.29 (0.12 to 0.71) 0 Low Quality of life (PDQ-39) 5 ~320 MD −7.2 (- −10.1 to −4.3) 28 Moderate Adverse events (any) 10 ~700 RR 0.68 (0.52 to 0.89) 15 Moderate Primary outcome - motor function: UPDRS-III scores improved significantly with TCM compared to controls (MD -4.70, 95% CI: -6.10 to -3.30), exceeding the minimal clinically significant difference (MCID 3.0-3.5) [21]. This effect is illustrated in Figure 2a. Secondary outcomes: Depression (HAMD): TCM interventions produced a significant reduction in depressive symptoms (MD-3.90, 95% CI: -5.10 to -2.70; p<0.001). The forest plot is shown in Figure 2b., Sleep (PDSS): Pooled analysis demonstrated an average improvement of +11.5 points (95% CI: +8.2 to +14.8), indicating clinically meaningful sleep benefits (Figure 2c), Dysphagia (VFSS): TCM improved swallowing scores (VFSS MD +1.50, 95% CI: +0.80 to +2.20) and significantly reduced pneumonia risk (RR 0.29, 95% CI: 0.12-0.71). These findings are summarised in Figure 2d. Quality of life (PDQ-39): Pooled results indicated a mean improvement of -7.2 points (95% CI: -10.1 to -4.3), surpassing the established MCID [25]. This is presented in Figure 2e. Adverse events: The incidence of adverse events was lower in TCM groups than in controls (RR 0.68, 95% CI: 0.52-0.89), with most events being mild and transient. The pooled analysis is displayed in Figure 2f. Mediterranean Journal of ISSN: 2789-1895 https://mrj.org.ly Medical Research Mediterr J Med Res Bhat R, et al. (2025) Mediterr J Med Res. 2(4): 169-178. Page 174 Figure 2: Forest plots for primary outcomes of Traditional Chinese Medicine (TCM) in Parkinsonism (a) UPDRS-III (motor function); (b) Depression (HAMD); (c) Sleep quality (PDSS); (d) Dysphagia (VFSS/pneumonia); (e) Quality of life (PDQ-39); and (f) Adverse events. The red dashed line indicates the pooled effect size. Footnote: CI = Confidence Interval; MD = Mean Difference; RR = Risk Ratio; UPDRS-III = Unified Parkinson’s Disease Rating Scale, Part III; HAMD = Hamilton Depression Rating Scale; PDSS = Parkinson’s Disease Sleep Scale; VFSS = Video fluoroscopic Swallow Study; PDQ-39 = Parkinson’s Disease Questionnaire-39; AE = Adverse Event. Subgroup and sensitivity analyses: Acupuncture had the most substantial motor/dysphagia effects, CHM for mood/sleep, and Tai Chi/Qigong for balance. Excluding high-risk studies did not change outcomes. Publication bias and certainty: Funnel plots for UPDRS-III outcomes were broadly symmetrical (Figure 3), suggesting no significant small-study publication bias. Egger's test was non-significant (p=0.27), further supporting the absence of bias. The certainty of evidence was assessed using the GRADE framework. Motor function, depression, quality of life, and adverse events were rated moderately likely. In contrast, sleep and dysphagia outcomes were rated as low due to small sample sizes and outcome heterogeneity. The overall grading is summarized in Table 3. Table 3: GRADE Summary of findings: TCM vs control in Parkinsonism Outcome Participants (studies) Relative effect (95% CI) Absolute effect* Certainty of evidence (GRADE) Motor function (UPDRS-III) ~1050, (14 studies) MD -4.70 (-6.10 to -3.30) Clinically relevant (>MCID 3.0) Moderate Depression (HAMD) ~500, (7 studies) MD -3.90 (-5.10 to -2.70) Moderate improvement Moderate Sleep (PDSS) ~200, (3 studies) MD +11.5 (+8.2 to +14.8) Improved sleep quality Low Dysphagia (VFSS) ~300, (4 studies) MD +1.50 (+0.80 to +2.20) Reduced swallowing difficulty Low Aspiration pneumonia ~300, (4 studies) RR 0.29 (0.12-0.71) Fewer pneumonia events Low Quality of life (PDQ-39) ~320, (5 studies) MD −7.2 (-10.1 to -4.3) Exceeds MCID threshold Moderate Adverse events (any) ~700, (10 studies) RR 0.68 (0.52–0.89) Fewer mild AEs in the TCM arms Moderate Mediterranean Journal of ISSN: 2789-1895 https://mrj.org.ly Medical Research Mediterr J Med Res Bhat R, et al. (2025) Mediterr J Med Res. 2(4): 169-178. Page 175 Figure 3: Funnel plot of studies reporting UPDRS-III motor outcomes Each circle represents an individual study. The vertical red dashed line indicates the pooled mean difference. The plot's symmetry suggests minimal publication bias. Footnote: SE=Standard Error; MD=Mean Difference; UPDRS-III=Unified Parkinson’s Disease Rating Scale, Part III. Discussion This systematic review and meta-analysis synthesising evidence from 22 studies (12 RCTs, 5 NRCTs, 5 cohorts; ~1,650 participants) provides comprehensive insights into the role of TCM in Parkinsonism. We found clinically meaningful motor improvements (UPDRS-III mean difference -4.70) and significant benefits for non-motor symptoms, including depression, sleep disturbance, and dysphagia. Also, quality of life improved, and there were fewer adverse events than in the controls. Subgroup analysis highlighted acupuncture as particularly effective for motor and swallowing, CHM for mood and sleep, and Tai Chi/Qigong for balance and fall prevention. These suggest that TCM modalities complement pharmacotherapy and fill therapeutic gaps in domains poorly addressed by dopaminergic drugs. TCM's safety profile was favourable, with most mild and transient adverse events. Motor symptom relief remains the cornerstone of Parkinsonism management. Our pooled estimate of -4.7 points on UPDRS-III exceeds the minimal clinically significant difference (≈3.0-3.5 points) [21], suggesting genuine clinical benefit. While levodopa provides robust motor improvements, TCM may enhance outcomes when added to standard therapy, particularly in patients experiencing residual disability or fluctuating responses. Non-motor benefits are noteworthy. Depression is highly prevalent in PD and often inadequately managed with conventional antidepressants due to polypharmacy and tolerability issues [29]. CHM demonstrated improvements of nearly -4 points on HAMD, comparable to or exceeding the effect size of pharmacological antidepressants in PD cohorts. Similarly, PDSS improvement (+11.5 points) indicates better sleep, a domain strongly linked with disease burden and caregiver stress. Swallowing outcomes are especially relevant, as aspiration pneumonia is a leading cause of death in PD [5]. The observed VFSS improvements and 71.0% reduction in pneumonia incidence suggest that TCM-particularly acupuncture combined with rehabilitation-may directly influence survival outcomes. Quality of life (PDQ-39) improved by -7.2 points, surpassing the MCID threshold [27]. Together, these results highlight TCM's holistic impact, which is consistent with its traditional philosophy of addressing body and mind. Mediterranean Journal of ISSN: 2789-1895 https://mrj.org.ly Medical Research Mediterr J Med Res Bhat R, et al. (2025) Mediterr J Med Res. 2(4): 169-178. Page 176 Earlier systematic reviews typically focused on a single modality, such as acupuncture [12,13], Tai Chi [31], or herbal Medicine [33]. While they reported encouraging results, their scope was limited, often excluding quasiexperimental and cohort studies. By contrast, our review integrates diverse study designs, capturing both efficacy (via RCTs) and real-world safety/adherence data (via cohorts). For instance, a 2008 review of acupuncture for PD [12] concluded that the evidence was insufficient due to small sample sizes and methodological flaws. Our findings, informed by larger and more recent RCTs [17-20, 25-30], suggest that acupuncture consistently yields motor and swallowing benefits. Similarly, Tai Chi reviews [31, 33] demonstrated balance and fall reductions; our analysis supports these findings and extends them by including quality-of-life outcomes. Thus, compared with prior evidence, our review provides the most comprehensive and updated synthesis of TCM in Parkinsonism up to 2025. Potential mechanisms: The observed benefits of TCM are biologically plausible. Acupuncture: Functional MRI studies show cortical-subcortical networks modulation, including the motor cortex and basal ganglia [10]. Animal models demonstrate increased striatal dopamine release, reduced neuroinflammation, and attenuation of oxidative stress [11]. These neuromodulatory effects may explain improvements in motor and dysphagia outcomes. CHM: Herbal formulations often contain multi-component phytochemicals with synergistic actions. Ukgansan and Bushen Huoxue decoction compounds exhibit antioxidant and mitochondrial protective properties, modulate monoaminergic neurotransmission, and reduce neuroinflammatory cytokines [18, 33]. These mechanisms align with improvements in mood and sleep. Tai Chi/Qigong: These mind-body practices emphasize posture, proprioception, and rhythmic breathing. Neuroplasticity induced by repetitive motor learning may enhance gait stability and reduce falls [21, 32]. Additionally, the meditative component may reduce stress and autonomic dysfunction. Moxibustion: Although evidence is limited, its thermal stimulation may improve peripheral circulation and bowel motility, explaining observed benefits in constipation [33]. Together, these multimodal mechanisms provide a coherent explanation for the wide-ranging clinical benefits observed. Clinicians may consider TCM as an adjunctive therapy for patients seeking complementary approaches, especially in domains poorly addressed by pharmacotherapy (e.g., mood, sleep, dysphagia, balance). Importantly, integration into multidisciplinary care should priorities: Use of evidence-based acupuncture protocols and validated herbal formulations. Delivery by qualified practitioners to ensure safety. In addition, Patient-centered discussions about realistic expectations and cultural preferences. To strengthen the evidence base, future research should: Conduct large, multicenter RCTs in diverse populations outside East Asia, Develop CONSORT-style reporting extensions for TCM to improve methodological quality, Standardize acupuncture protocols (point selection, frequency) and CHM formulations (composition, dosage), extend follow-up beyond 12 months to assess durability and diseasemodifying potential, Incorporate mechanistic endpoints such as neuroimaging, cerebrospinal fluid biomarkers, and gut microbiome analysis, and evaluate cost-effectiveness and health policy implications for integrating TCM into mainstream care. Conclusion: Traditional Chinese medicine shows promise for clinically meaningful improvements in motor and non-motor symptoms of parkinsonism, with an overall favourable safety profile. While encouraging, these findings should be interpreted cautiously due to small sample sizes, methodological heterogeneity, and the predominance of East Asian studies, which may limit generalizability. Traditional Chinese medicine appears to be a promising complementary strategy that may enhance conventional pharmacological and rehabilitative care by addressing domains such as depression, sleep, dysphagia, and balance-areas often inadequately managed by standard treatment alone, and with further high-quality evidence, it could be more formally integrated into multidisciplinary management frameworks and future clinical guidelines. Mediterranean Journal of ISSN: 2789-1895 https://mrj.org.ly Medical Research Mediterr J Med Res Bhat R, et al. (2025) Mediterr J Med Res. 2(4): 169-178. Page 177 References 1. Postuma RB, Berg D, Stern M, Poewe W, Olanow CW, Oertel W, et al. MDS clinical diagnostic criteria for Parkinson’s disease. 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