Clinical Research on Opportunity of Scalp Penetration Acupuncture in Treatment of Acute Apoplexy

                           LIU Jianhao¹， DONG Hongsheng²，BAO Chunling²，DONG Guirong²

1. Traditional Chinese Medicine Hospital of Sanya City, Sanya Hainan China 572000

2. Yueyang Hospital of Integrated Chinese and Western Medicine Affiliated to Shanghai University of Chinese Medicine，Shanghai China 200437

ABSTRACT: Objective:To observe the opportunity of Scalp Penetration acupuncture in treatment of acute apoplexy as an effective method and try to illustrate the mechanism of the treatment. Methods: 60 cases were randomly divided into acupuncture group (30 cases) and western medicine group (30 cases).The acupuncture group was treated by the scalp penetration acupuncture needling from Baihui (GV20) to Taiyang (EX-HN5) on the affected side by 4 continuous needling. The western medicine group was treated conventional drug therapy. 28 days later，observing the nerve function defect degree score and the overall efficacy of all the patients in the two groups before and after the treatment. Results: The effective rate of acupuncture group was 89.58%, while that of the control group was 74.55%. The nerve function defect score of the acupuncture group was significantly higher than that of the control group (P<0.05). Conclusion: The effectiveness of scalp penetration acupuncture is correlated with penetration opportunity, being the earlier the better.

KEYWORDS: apoplexy; scalp penetration acupuncture; opportunity of acupuncture

Being a serious disease, stroke affects the quality of people’s life with high morbidity. Therefore, how to prevent and treat for stroke is a research focus, especially about the acute stroke. In recent years, a large number of research results suggest that point penetrating acupuncture is a special and effective method in treatment of stroke. At present, there are many studies of the therapy. However, there are few studies on the timing of the therapy. Therefore, in the clinical work, the authors carried out the scalp point acupuncture treatment of acute stroke and did the research of the acupuncture timing. Now we report it as follows.

1        Materials and methods

1.1  Information

Patients in acupuncture department of TCM Hospital of Sanya City and of Yueyang Hospital of Integrated Chinese and Western Medicine Affiliated to Shanghai TCM University, and outpatient department as well as 60 patients with acute stroke from June 2010 to July 2014 were chosen and were randomly divided into acupuncture group and western medicine group with 30 patients in each group. The specific information of the two groups of patients are shown in table 1

Table 1  General comparison of the two groups of patients

Note: by t-test, it was found that there was no significant difference between the two groups of patients with general data comparison (P > 0.05)

1.2  Diagnostic criteria 

1.2.1  Diagnostic criteria in western medicine

Referring to Criteria of All Kinds of the Cerebrovascular Disease Diagnosis established on the 4th national conference of cerebrovascular disease in 1996 ^[1] and by computed tomography (CT) or magnetic resonance imaging diagnosis, patients were diagnosed with cerebral infarction, cerebral hemorrhage.

1.2.2  TCM diagnosis

TCM diagnosis was carried out according to Stroke Diagnosis and Curative Effect Evaluation Standard (Trial) established by State Administration of Traditional Chinese Medicine Encephalopathy Emergency Research Consortium ^[2].

1.3  Therapeutic method 

1.3.1  Therapeutic schedule of acupuncture group

Scalp acupuncture treatment methods: 4 continuous needling along the line between Baihui point(GV20) and Taiyang point(EX-HN5) after 75% ethanol routine disinfection on local skin. By using Huatuo brand 0.30 mm × 40 mm acupuncture needle. Needling of vertical stab into the subcutaneous first, and then mild and rapid stab with 15°angle without turning the direction of needle was carried out into 30 mm deep of the skin. Then alternatively turning the needle fast with two hands alternatively for 2 min, with frequency above 200 revolutions per min. Patients were instructed to do physical exercises mildly at the same time. Turning needles for each 8 min, and repeat that for 3 times. After 30 min’s retaining time of the needles, the needles were pulled out quickly without turning. Acupuncture like this was done once a day. The specific clinical practices were as follows:

(1) In case of disturbance of consciousness, the acupuncture penetrating direction is from Shenting (GV24) to Shangxing (GV23), Yintang (EX-HN3) to Shangen and Renzhong (GV26) to nasal septum.

(2) In case of headache, the acupuncture penetrating direction is both from Taiyang (EX-HN5) to Shangguan (G3) and Fengchi (G20).

(3) In case of paraplegic uracratia and encopresis, the acupuncture penetrating direction is from Sishencong(EX-HN1) to Baihui (GV 20).

(4) In case of aphasia, the acupuncture penetrating direction is Fengfu (GV16) to Yamen(GV15).

(5) In case of facial paralysis, the acupuncture penetrating direction is from Dicang (ST4) to Jiache (ST6), Xiaguan (ST7).

(6) In case of dysphagia, acupuncture was done on Lianquan (RN23，CV23), Jinjin (EX-HN12), Yuye (EX-HN13), Haiquan (EX-HN11), Fengfu (GV16), Fengchi (G20), and Yifeng (SJ17, TE17).

(7) In case of paralysis, the acupuncture penetrating direction is from Baihui (GV 20) to Taiyang (EX-HN5).

(8) In case of eyeball dyskinesia, the acupuncture was done on Yintang (EX-HN3) and Taiyang (EX-HN5).

(9) In case of psychiatric symptoms, the acupuncture penetrating direction is from Shenting(GV24) to Shangxing (GV23) and from Qucha (BL4) to Wuchu (BL5) and Benshen(G13).

(10) In case of sensory disturbance, the acupuncture penetrating direction is from Luoque (BL8) to Chengling (G 18) to Xuanli (E 6).

At the same time, the acupuncture group also received dehydration treatment and other western medicine therapy, which was the same as that of the western medicine group. Treatment of 28 d was decided as a treating period.

1.3.2  Treatment of western medicine group

Dehydration, which functions in reducing intracranial pressure and giving nutrition to nerves, and other symptomatic treatment were carried out with drug application being made according to Conventional Medical Diagnosis and Treatment Norm ^[3]. During Week 1 the dehydration treatment was applied accordingly condition to reduce patients’ brain edema and/or to reduce patients’ intracranial pressure.

The following methods were used: (1) volume fraction of 20% mannitol 250 mL, intravenous drip, 8~12h, pay attention to renal function; (2) 20 to 40 mg furosemide(furosemidum), intravenous drip, 8~12 h, interval with mannitol. In week 2~4, citicoline 250 mg was used to give nutrition to cranial nerve, intravenous drip once a day. Control the blood pressure at 20.0/12.0 kPa (150/90 mm Hg). Prevent and control all kinds of complications and do symptomatic treatment if necessary. 28 d constitutes one therapeutic course and the curative effect of the two groups was observed.

1.4  Provisions on drug combination

The using of drug combination in the treatment was according to Guidelines for Cerebrovascular Disease Prevention and Treatment in China ^[4].

1.5  Observational index

Conform to the standard given on Fourth National Cerebrovascular Disease Conference (1995), the evaluation was done according to the basic neural function defect scale reduction and the degree of the sickness ^[5].

1.6  Efficiency criteria

Being generally cured: the sick degree level is 0. Have significant progress: the sick degree level is 1~3. Being improved: the function defect score decreased by 18%~45%; Being not improved: function defect scale change to around 17%; Getting worse: function defect score increased by more than 18%.

Effective rate = ( cases being cured + cases having significant progress + cases being improved) / n ×100%.

1.7  Statistical analysis

Statistical analysis with SPSS 19.0 statistical software package when measurement data conforms to normal distribution t-test was used, while with non-hierarchical count data χ2 test, in which P < 0.05 means the difference is statistically significant.

2  Results 

2.1  Changes of patients before and after treatment in nerve function defect degree score

Changes of the two groups of patients before and after treatment in nerve function defect degree score are shown in Table 2.

Table 2  Changes of two groups before and after treatment in nerve function defect degree score  (`x±s)

Note: Comparison within groups, *P<0.01; comparison among groups, △P<0.05

2.2  Clinical curative effect comparison between the two groups

The clinical curative efficacy comparison between the two groups can be seen in Table 3.

Table 3  Clinical efficacy comparison between the two groups of patients                 Cases

Note: by Ridit test, P<0.05

3  Discussion 

Being a treatment of TCM, the original discussion of the theoretical basis of acupuncture can be read in a TCM classic called Huangdi Neijing (Huangdi’s Canon of Medicine).This treatment with acupoint selection and combination is fine and accurate, which can improve the efficacy of other single-point therapies. It has apparent curative effect, treat for diseases of a wide range, be convenient in operation and be safer, with less adverse reaction, thus it have been widely used in clinical treatment.

The method of scalp penetrate acupuncture therapy for stroke comes from a classic named Ling Shu Jing (Spiritual Pivot Canon). It was pointed out in Ling Shu Hai Lun (Spiritual Pivot · On Sea) that human brain is like the sea of marrow with its important point being up to Baihui point and down to Fengfu point. That means marrow coming together and shaping brain, which makes human head the residence of human intelligence. As the central organ of the body, being chosen as acupuncture points in treatment is an important way to improve the curative effect of brain diseases. According to traditional Chinese medicine, the injury place of stroke is in the brain, with Marrow Sea being damaged and leading to limb movement dysfunction. Therefore, scalp penetrate acupuncture treatment of stroke can awaken human’s consciousness and open cardiac orifice, dredge meridian, set obstructed Qi and Blood free, and get marrow sea nourished.

Professor Dong Guirong, by motion evoked potential technology research, confirmed that scalp penetrate acupuncture treatment area is the best acupuncture area in treatment of stroke. Penetrating acupuncture includes needling from Baihui to Taiyang and needling several other points such as Baihui, Chengling, Qubin, Taiyang, etc. It has the characteristic of co-functioning. In this area the parietal lobe, temporal lobe, frontal area, Du meridian, gall bladder meridian, and bladder meridian are also located. These three Yang meridians, going from head to foot, cover the whole longitudinal area of human body. With head being the meeting area of all Yang-channels of human body and Du meridian being the sea of Yang meridian, needling along Du meridian and Yang Ming meridian, which is the No. 1 choice in treating for impotent muscles, should be the first choice to adjust and encourage the Yang Qi of human body and eventually to prompt muscle movement and nourish the hemiplegic limbs. The acupuncture point Baihui, which is on the top of the head, is not only the important acupuncture point along Du meridian but also is the meeting place of hand and foot three Yang meridians and Du meridian. Qubin point is the meeting place of bladder meridian and gall bladder meridian, while Cheng ling point is the crossroad of gall bladder meridian and Yangwei Meridian. In scalp penetrate acupuncture treatment, try to driving Qi and promote its movement at the same time can better the clinical effect. Patients were instructed to make initiative or passive movements of the hemiplegia limbs to cooperate. Actually, the area also conforms to the modern medical recognition about the functions of the cerebral cortex and scalp locating. The region covers the precentral gyrus and posterior central gyrus of the scalp projection area, which regulates the sensory and motor functions of human body.

Conventional studies suggest that acupuncture be used mainly during the sequela period since the acupuncture effect is not obvious enough in acute phase. Sometimes it would aggravate brain edema, even induce bleeding again. Although many scholars still held a denial attitude to acupuncture in treatment of hemorrhagic stroke during acute phase, more researches have proved that acupuncture treatment of acute stroke is feasible and necessary. Professor Dong Guirong ^[6] adopted acupuncture treatment on head acupuncture points in treating for acute hemorrhagic stroke, and it was found that the curative effect is superior to that of the conventional western medicine group, with imaging examination showing that the hematoma of the acupuncture group was absorbed faster, which proved that the recovery of patients’ limb function after treatment is closely related to the timing of acupuncture treatment. The sooner acupuncture intervention time is, better curative effect it would bring about. Early as long as stable vital signs exist, can patients with cerebral apoplexy be acupunctured and would the possible rehabilitation come soon. Based on large literature, Lu Shoukang ^[7] put forward that the improvement of stroke hemiplegia rehabilitation is significantly associated with acupuncture timing, and the application of modern science and technology method can help with scalp acupuncture curative effect observation with objective and persuasive data display.Liu Kongjiang^[8] considered that early intervention of acupuncture treatment in treating for ischemic and hemorrhagic stroke can effectively protect brain cells, regulate the blood flow in the brain, and timely deal with the complications to promote patients’ recovery.

Shi Xuemin^[9] adopted the “Consciousness Restore Resuscitate” acupuncture therapy method to deal with the super early and acute stage cerebral infarction. He also carried out researches on clinical nerve function defect, clinical curative effect and related mechanism. Results confirmed that acupuncture method is a safe and effective method and compared with treatment of early ischemic stroke the efficacy of super early treatment is better. By conducting scalp acupuncture treatment in vasomotor area, Cai Jingzhou^[10] found that the early scalp acupuncture treatment can get the time of cerebrovascular recanalization advanced, the infarction area reduce and the clinical symptoms improved. The risk of bleeding after infarction can also be reduced.

In recent years, with more researches on needling application, early intervention of acupuncture treatment has been used more frequently and become the main treatment strategy in treating for stroke with high safety, less adverse reaction.It is also accepted by more and more patients. In conclusion, the new concept is that to patients with stable vital signs after stroke, earlier acupuncture intervention would bring about better clinical efficacy.

REFERENCES

1  China Neuroscience Society. Criteria of all kinds of cerebrovascular disease diagnosis. The Journal Neurology.1996;29(6):379.

2  State Administration of Traditional Chinese Medicine Encephalopathy Emergency Research Consortium. Stroke diagnosis and curative effect evaluation standard (Trial). Journal of Beijing University of Chinese Medicine.1996;19(1):55-56.

3  Shanghai Municipal Health Bureau, Shanghai Branch of China Medical Association. Conventional Medical Diagnosis and Treatment Norm. Shanghai: Shanghai Science and Technology Press, 1999.

4  Neurology Branch of China Medical Association. Guidelines for Cerebrovascular Disease Prevention and Treatment in China. Beijing: People's Medical Publishing House, 2007.

5  Fourth National Cerebrovascular Disease Conference. Published in the Chinese Journal of Neurology.1996;2(6): 379-381.

6  Dong G., Wu B., Zhang X..Clinical research of Baihui, Taiyang compatibility for the treatment of acute cerebral hemorrhage. Journal of Traditional Chinese Medicine.1994;40(5): 276.

7  Lu S..Head needle therapy for stroke hemiplegia and curative effect evaluation. Traditional Chinese Medicine Magazine.1991;37(10): 49-51.

8  Liu K..Early acupuncture intervention in stroke treatment and strategy. Chinese Acupuncture and Moxibustion Magazine.2003;23(10): 615-617.

9  Shi X., Zhao X., Xiong J., et al. Clinical curative effect evaluation of consciousness restoring and resuscitating acupuncture method in treatment of acute cerebral infarction and the related proteomics research. Tianjin Chinese Medicine Magazine.2008;23(5):44.

10  Cai J., Pan J..Head needle treatment of early vascular recanalization after cerebral infarction. Shanghai Acupuncture Magazine.2001;21(4):9-11.

Received 25 January 2017;accepted 20 February 2017

Correspondence: Dong Guirong , Professor;E-mail:Dongguirong@tom.com

Editor:Wang Jihui