Clinical Observation on Acupuncture Treatment for Cerebral Infarction Sequela

Zhang Zhen-shan, Dai En-hai, Guan Li-mei, Li Ying-hua

Laoting Hospital of Traditional Chinese Medicine, Hebei 063699, China

Clinical Observation on Acupuncture Treatment for Cerebral Infarction Sequela

Zhang Zhen-shan, Dai En-hai, Guan Li-mei, Li Ying-hua

Laoting Hospital of Traditional Chinese Medicine, Hebei 063699, China

Objective: To observe the clinical effects of the warm-dredging needling method for cerebral infarction sequela.

Methods: Sixty patients with cerebral infarction sequela in conformity with the inclusion criteria were randomly divided into a treatment group and a control group, 30 cases in each group. The control group was given the basic treatment of Western medicine. The treatment group was added with acupuncture treatment based upon the treatment of Western medicine. The neurological defects of the patients were assessed before and after the treatments by National Institute of Health Stroke Scale (NIHSS).

Results: The remarkable curative rate was 83.3% and the total effective rate was 93.3% in the treatment group, versus 56.7% and 70.0% in the control group, with statistical differences in the remarkable curative rate and the total effective rate between the two groups (P＜0.05). After the treatment, NIHSS scores decreased in both groups (P＜0.01 or P＜0.05), and the difference was statistical significant between the two groups (P＜0.01).

Conclusion: The warm-dredging needling method was better than single treatment of Western medicine in the treatment of cerebral infarction sequela.

Acupuncture Therapy; Cerebral Infarction; Stroke; Complications; Hemiplegia

Clinically, cerebral infarction is a commonly encountered disease, and its morbidity and mortality are both high. After the acute stage, the patients with cerebral infarction would often present the sequela of hemiplegia, dysphasia and wry mouth and tongue, severely endangering the health of the patients and bringing about heavy economic burden to the family. We treated this disease by using the warm-dredging needling method, in comparison with the treatment of Western medicine. Now, the report is given as follows.

1 Clinical Materials

1.1 Diagnostic criteria

1.1.1 Diagnostic criteria in Western medicine

The diagnostic criteria in Western medicine referred to the diagnostic points of cerebral infarction in the Diagnostic Points of Various Cerebrovascular Diseases approved at the Fourth National Conference on Cerebrovascular Diseases in 1995[1].

1.1.2 Diagnostic criteria in traditional Chinese medicine

The diagnostic criteria in traditional Chinese medicine referred to the Criteria for Diagnosis and Therapeutic Effects of Stoke Diseases stipulated by the cooperative team for acute diseases and patterns, State Administration of Traditional Chinese medicine, in 1996[2].

Main symptoms: Hemiplegia, dizziness, dysphonia or aphasia, abnormal sensations on one-side of the body, and wry mouth and tongue.

Secondary symptoms: Headache, vertigo, change in the pupil, choke when drinking water, wry eye, and ataxia.

Mode of onset: Acute onset, with inducing factors before the onset, often presented by premonitory symptoms.

Age of incidence: Mostly over 40.

Explanation: The diagnosis can be confirmed when two or more main symptoms, or one main symptom and two secondary symptoms are met, in combination of the onset mode, inducing factors, premonitory symptoms, and age. Without above conditions, the diagnosis can also be confirmed by image examinations.

1.2 Inclusion criteria

In conformity with the above-mentioned diagnostic criteria of both Western medicine and traditional Chinese medicine; within three months after onset; with stable life signs; with the age ranging from 40-85 years old; having signed informed consent.

1.3 Exclusion criteria

Those with cerebral hemorrhage or subarachnoid hemorrhage; those accompanied with severe cardiac, hepatic and renal dysfunctions; those unable to cooperate with the treatment due to complication of severe cognitive impairment and complete aphasia; those with mental disorders; pregnant or breast-feeding women.

1.4 Statistical management

Statistical analysis was processed by SPSS 11.0 version software. The measurement data were expressed by mean ± standard deviation (). The comparison of the same group between before and after the treatments was processed by paired t-test. The comparison between the groups was processed by t-test. The comparison of rates was processed by Chi-square test.

1.5 General data

Totally, 60 patients recruited were the inpatients of the hospital between June of 2009 and June of 2010, and were divided into a treatment group and a control group, 30 cases in each group. The materials of gender, age and duration of the two groups were not significantly different by statistical management (P＞0.05) and the two groups were comparable (table 1).

Table 1. Comparison of general data between the two groups ()

Table 1. Comparison of general data between the two groups ()

Treatment3020 10 66.4±1.5 0.62±0.35 Control 3019 11 65.7±1.7 0.65±0.41

2 Therapeutic Methods

2.1 Treatment group

2.1.1 Symptomatic treatment

In accordance with the pathological situation, the anti-hypertensive, glucose-reducing, lipid-reducing, and anti-inflammatory and anti-platelet aggregation treatments were given by Western medications (for instance, oral administration of Aspirin enteric-coated tablets, 100 mg, q.d.).

2.1.2 Acupuncture treatment

Acupoints: Qingling (HT 2), Ximen (PC 4), Neiguan (PC 6), Jianyu (LI 15), Binao (LI 14), Quchi (LI 11), Hegu (LI 4), Futu (ST 32), Huantiao (GB 30), Fengshi (GB 31), Xuehai (SP 10), Yinlingquan (SP 9), Weizhong (BL 40), Chengshan (BL 57), Sanyinjiao (SP 6), and Taichong (LR 3) on the affected side.

Operation: According to the process of the warmdredging needling method[3], press the acupoint with the thumb or index finger of the left hand, and insert the needle into the acupoint with the right hand. After the needling sensation arrived, the left hand increased the pressure and twisted and pressed the needle with the thumb of the right hand forward to produce a sinking and tense sensation under the needle, and then thrust heavily and lifted the needle lightly in a small amplitude continuously with the needle tip pulling the sensitive area for nine times, and again twisted and pressed the needle forcefully with the thumb of the right hand for nine times, with the needle tip holding the sensitive area for promoting and remaining the needling sensation, to continue the sinking and tense sensation under the needle. And at the same time, the “closing” method was used, namely, by pressing the meridian at the other part of the acupoint with the thumb of the left hand, in order to induce the needling sensation to the diseased area, for producing a heat sensation and remaining the needling sensation for 1- 3 min. After the needle was retained for 20 min, the needle was taken out slowly and the needle hole was pressed. The treatment was given once every day, continuously for three weeks.

2.2 Control group

Only the symptomatic treatment was given to the patients in the control group, with the same type and dose of the medications as for the treatment group.

3 Observation of Therapeutic Effects

3.1 Observed indexes

3.1.1 Assessment of neurological defects

National Institute of Health Stroke Scale (NIHSS) was adopted to assess the defects of the neurological functions of the patients. The lowest score is 0 point and the highest score is 45 points. The higher the score is, the worse the neurological defect is.

3.1.2 Total effective rate and remarkable curative rate

Total effective rate = (Basic cure cases + Remarkable improvement cases + Improvement cases)/Total cases of the group ×100%.

Remarkable curative rate = (Basic cure cases + Remarkable improvement cases)/Total cases of the group × 100%.

A doctor who did not know the design of this trial was invited to assess the neurological defects of each patient before and after the treatment and calculate the total effective rate and remarkable curative rate.

3.2 Criteria of therapeutic effects

They were stipulated in reference to the Guiding Principles for Clinical Study of New Chinese Medicines[4].

Basic cure: The score of functional defect decreases greater than or equal to 90%, and the disability was grade 0.

Remarkable improvement: The score of functional defect decreases greater than or equal to 45%, but lower than 90%, and the disability was grade 1-3.

Improvement: The score of functional defect decreases greater than or equal to 18%, but lower than 45%.

No change: The score of functional defect decreases lower than 18%.

Deterioration: The score of functional defect increases greater than or equal to 18%.

3.3 Therapeutic results

3.3.1 Comparison of total effective rates between the two groups

The total effective rate was 93.3% in the treatment group and was 70.0% in the control group, with a statistical difference between the two groups (P＜0.05), and the remarkable effective rate was 83.3% in the treatment group and was 56.7% in the control group, with a statistical difference between the two groups (P＜0.05). The results indicate that the general therapeutic effect is better in the treatment group than that in the control group (table 2).

3.3.2 Comparison of NIHSS scores before and after treatments between the two groups

Before the treatment, the difference of NIHSS scores between the two groups was not statistically significant, indicating that the two groups were comparable. After the treatment, NIHSS scores in the two groups decreased somewhat than those of the same group before the treatment. In comparison of those in the same group, the differences were statistically significant (P＜0.01); the score decreased more obviously in the treatment group than in the control group (P＜0.01), indicating that the neurological defects of the patients are improved better in the treatment group than in the control group (table 3).

Table 2. Comparison of therapeutic effects between the two groups (case)

Table 3. Comparison of neurological defects before and after treatment between the two groups (, point)

Table 3. Comparison of neurological defects before and after treatment between the two groups (, point)

Note: Compared with the results of the same group before the treatment, 1) P＜0.01, 2) P＜0.05; compared with the control group after the treatment, 3) P＜0.01

Groups n Before treatmentAfter treatment Treatment 30 24.40±8.44 15.70±6.251)3)Control 30 24.47±7.89 18.53±7.532)

4 Discussion

Cerebral infarction sequela seriously influences the health and the patients’ quality of life, and the rehabilitation is a major issue. Currently, the treatment is mostly applied by nourishing the cells, improving the cerebral circulation and resisting thrombosis and by traditional Chinese medicine and acupuncture. Stroke was mostly described theoretically as “invasion of pathogens due to internal deficiency” before the Tang and Song Dynasties, and the treatment was designed to reinforce qi, activate blood and dredge the collaterals. Warm-dredging needling method is put forward by Prof. Zheng Kui-shan based upon the propagation of the meridians, having the effects to warm and smoothen qi and blood by applying the needling techniques to theacupoints to dredge and regulate or excite the meridian qi[5-9]. Jianyu (LI 15), Binao (LI 14), Quchi (LI 11), Hegu (LI 4), Futu (ST 32) are acupoints from the Yangming Meridians and are able to circulate qi, activate blood, and nourish the meridians. The spleen is the post-natal resource for production of qi and blood. Acupuncture on Xuehai (SP 10), Yinlingquan (SP 9) and Sanyinjiao (SP 6) from Foot Taiyin meridian can reinforce and benefit qi and blood. Acupuncture on Huantiao (GB 30) and Fengshi (GB 31) from Meridian of Foot Shaoyang is able to excite qi dynamics of the Meridian of Shaoyang, benefit qi and activate blood. Qingling (HT 2) is from the Meridian of Hand Shaoyin, and Ximen (PC 4) and Neiguan (PC 6) are from the Pericardium Meridian of Hand Jueyin. The heart dominates the mind and spirit and governs blood and blood vessels. Acupuncture on Qingling (HT 2), Ximen (PC 4) and Neiguan (PC 6) can dredge the blood vessels, promote qi and blood circulation, and realize the regulatory effect on the original mind and spirit by the function of “the heart dominating blood and blood vessels”. Weizhong (BL 40) is a major acupoint to dredge the meridians of the lower limbs and has the effect to strengthen the myodynamia of the sick limb in combination with Chengshan (BL 57). Hegu (LI 4) and Taichong (LR 3) are nicknamed the acupoints of four gates. Hegu (LI 4), from Yangming Meridian with profuse qi and blood, is able to reinforce qi, promote qi movement and activate blood. Taichong (LR 3), from the Meridian of Jueyin with less qi and profuse blood, is mainly used to reinforce and regulate blood. The combination of the two acupoints can be used to regulate qi, blood, yin, yang and Zang-fu organs simultaneously and realize the effects to balance the liver, extinguish wind, calm the mind, tranquilize the spirit, resist spasm, stop twitching, activate blood, disperse blood stasis, and reinforce and benefit the liver and kidney[10]. In this study, the acupoints are selected from many meridians and punctured by the warmdredging needling method, in order to correct the status of yin-yang imbalance and to regulate and harmonize qi and blood, and eliminate blood stasis and dredge the collaterals. Once the meridians are smooth and Ying-Nutritive and Wei-Defensive qi are harmonious, it will be beneficial to the restoration of the paralyzed limbs. It has been proved in the clinical observation that this method has a higher remarkable effective rate than the symptomatic treatment of Western medicine in the treatment of stroke sequela and is worthy of clinical popularization.

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[9] Zhu YZ, Chen Y, Zhang YY. Changes of electroencephalogram in post-stroke hemiplegia patients treated with electroacupuncture at the nerve trunk. J Acupunct Tuina Sci, 2010, 8(6): 349-352.

[10] Ding MQ, Lei HM, He L, Cao SY, Tian HF. Observation on the efficacy of scalp electroacupuncture plus opening four orifices in treating post-stroke depression. Shanghai Zhenjiu Zazhi, 2011, 30(10): 661-662.

Translator: Huang Guo-qi

R246.1

A

Date: December 20, 2012

Author: Zhang Zhen-shan, bachelor, attending physician of traditional Chinese medicine. E-mail: 13582877124@163.com